Sometimes You Just Have to Get Them Off the Bus

One of my mentors, Leif Beck, veteran practice-management consultant, attorney, and publisher, has never been afraid to tell the unvarnished truth. Medical groups who engaged his consultative services didn’t always like his straightforward advice, because he has told more than one dysfunctional organization to rid itself of a disruptive member.

I’ve heard Beck tell dozens of “war stories” about medical groups paralyzed by their pathological group cultures. Many of those groups were being held back by one or two disruptive doctors who refused to get with the program. Beck liked to say, “Sometimes a medical group has to shrink in order to grow.” In other words, sometimes you have to ask someone to leave the group if you want to make any real progress toward becoming a “best-run” practice.

Critics like to use terminology like “good-old-boy system” and “conspiracy of silence” when they condemn medical groups, hospital staffs, or medical societies for their failures to identify and discipline disruptive members. While there may be more than a modicum of truth in their accusations, there is another dynamic at work, too: most conscientious and decent leaders simply dread the idea of uttering the words, “You’re fired.”

Which Is Harder: Hiring or Firing?

Years ago I sat before the desk of a hospital system’s human resources (HR) manager, hoping he would offer me the job of running the hospital’s newly formed physician group. He was a skilled interviewer who helped applicants feel safe enough to engage in honest conversation. As we talked about managing human beings, he somewhat abruptly asked me, “Which would you rather do: hire someone or fire someone?”

I didn’t hesitate: “Well, hire someone, of course!”

“Not me!” He leaned back in his chair and locked his fingers behind his head.

I couldn’t think of anything to say. Up to that point, I had been thinking, I believe I’d like to work for this guy. Now I wasn’t so sure.

He paused long enough for his response to sink in, then he continued, “You see, whenever I finally dismiss an employee, I feel very confident of my decision. I’ve given the worker multiple chances to correct or improve performance. I’ve carefully documented our conversations and have given the situation much thought. If I fire you, you better believe you deserved it.”

“On the other hand,” he continued, “a hiring decision is always a gamble. You do your best to choose the right candidate. You do the due diligence and check references. You might even do some skills testing. But in the end you sort of hold your breath and pick someone, hoping for the best.”

It’s the Uncertainty

What he said made a lot of sense, and it has stayed with me for 30 years. Even though I didn’t get that job, I remembered that executive each time I had to fire an employee—which, thankfully, wasn’t often. He clearly was an HR professional who knew how to confidently give someone the boot. Not every manager has that kind of self-assurance. All kinds of questions haunt you when terminating an employee:

• Have I been fair?

• Am I vulnerable to discrimination accusations?

• Have I documented everything adequately?

• Did I violate any federal or state laws?

• Am I going to get sued? And if so, will I prevail in court?

If you can’t get the “wrong” people off the bus, don’t expect the “right” people to stay on board.

These are legitimate questions, but you must come to terms with each issue if you hope to become the effective leader your practice needs. Best-performing practices have leaders who not only know how to “hire smart,” but also know how to “fire smart.”

If you can’t rid your practice of deadwood and troublemakers—whether you’re dealing with a janitor or with a chief medical officer—you can’t earn the kind of respect that inspires the rest of the organization to follow you. If you can’t get the “wrong” people off the bus, don’t expect the “right” people to stay on board.

So how can you gain the self-assurance that allows you to terminate an employee and to know confidently that you have “done the right thing”? It boils down to developing a proper mindset, legally sound policies and procedures, and the strict self-discipline to follow those policies and procedures consistently.

The Proper Mindset

If you have attained ownership or a management position that entails hiring and firing authority, you are getting paid to make tough and timely calls as you develop the best team possible. Blogger and CEO advisor Mindy Mackenzie tells executives to face the truth about firing: the employee’s behavior has produced the outcome.(1) The employee is responsible for his or her actions (or lack of action).

This doesn’t automatically absolve you of all blame. When you have to fire an employee, you have failed to reform or salvage the worker. But you are only responsible for your own actions. Some employees and some situations are simply impossible.

Your decision to fire an employee usually falls in one of two categories: (1) egregious violations; or (2) chronic unsatisfactory performance.

Certain offenses call for swift, decisive action. An employee might egregiously violate company policy or even commit a criminal act. Take care of such matters quickly, with no sign of equivocation. But seek out qualified legal counsel—emotions can run high, and you don’t want to incur legal liability.

As dramatic and challenging as an egregious violation might be, your decision to fire the offender is generally straightforward.

The more common termination scenario involves a longer series of events loaded with subtle nuance. You may find it necessary to terminate an employee for any of the following causes:

• Chronic behavior that doesn’t meet your standards: Employees who consistently arrive late or miss work fall into this category. You can include troublemakers and gossips who interfere with productivity and erode morale. You may have to get rid of employees with bad attitudes or those with a demeanor that regularly seems to say, “That’s not my job!” Problems in this category include offenses like an abundance of personal phone calls at work, inappropriate or forbidden Internet use, or taking too many (or too lengthy) breaks.

• Sub-par job performance: You might have workers who make too many errors or refuse to follow policies and procedures. An employee who can’t keep up with his or her teammates’ productivity might need to be replaced. You may have to deal with a staffer who just can’t “get” the new electronic health record system or appointment module.

• Workforce reorganization, consolidation, or upgrades: You might find it necessary to downsize your staff after a merger, or if you have to close a satellite office. Maybe you’ve discovered a way to automate or streamline operations. Perhaps you need to “upgrade” a position: What happens to that paper-pushing file clerk when you no longer have paper charts?

It seems only the most heartless physician or administrator wouldn’t be troubled by scenarios like these. But every job includes responsibilities and tasks we’d rather not have to do. (That’s why they pay us to show up.) That’s okay—just remember that if you’ve done your job well, about-to-be-fired workers have generally brought this on themselves.

Some Practical Considerations

With legal or HR-professional guidance, develop thorough evaluation, discipline, and termination policies and procedures. And stick to those policies and procedures religiously! Managers get in trouble faster by making exceptions to the rules. Even if you’re motivated by mercy or pity, you do no favors for yourself, your organization, or your other staffers by “letting it go this time.” You open yourself up to discrimination accusations the next time you choose not to make the same exception.

Make sure you document everything. You don’t have to file a verbose report—a few dated notes in the employee’s personnel file will do. Make sure you capture the main issue, what you said to the employee, and his or her response, and include the date and location of the discussion. More than a few managers have found themselves wishing they had started documenting sooner in the disciplinary process.

After you given an employee every opportunity to improve (as specified in your policies and procedures), and you have gone through your internal “warning-and-consequences” steps, you may finally be faced with the dreaded conversation.

Three Important Principles

• Before you meet with the employee, admit to yourself that firing someone simply stinks! You’re a real human if it bothers you to look another person in the eye and deliver the ultimate rejection. Just don’t let these uncomfortable human feelings prevent you from taking action. Don’t let your guilty feelings stymie you. Sometimes getting fired can bring a certain amount of relief to the terminated employee: Most people know when they’re failing at a job.

• Make sure you are kind and clear. Even if he or she feels a little relieved, the news is going to hit hard. State your decision clearly and explain any support you will provide, and how you plan to communicate the employee’s departure to other team members. Avoid being heavy-handed or insensitive, but don’t get too “chummy,” either. Do what you can to protect their dignity. Don’t make a show of collecting keys and ID badges; there is no need to march the employee to the exit (unless security or dishonesty is the big issue).

• Be courageous. Your top-performing staffers probably notice a poor performer long before you do. They know when someone needs to get the boot, and they may very well be watching you to see if and when you will step up and do what is necessary and right. Your marginal performers will likely improve (at least for a while), and those who disagree with your decision should at least respect you for taking action.

In the end, your life will be easier. Leading a top-notch team in a better-performing medical practice is one of the best experiences you can have in this industry. It’s what we often refer to when we use the term “success.”

Reference

1. Mackenzie M. Why “You’re fired” is something every boss should be saying. Upstart Business Journal. May 15, 2016; http://upstart.bizjournals.com/resources/author/2016/05/05/why-you-re-fired-is-something-every-boss-should-be.html?page=all.