When coaching and interventions haven't worked and you've had it up to here with a problem employee, it might be time for a Decision-Making Day. You send problem employees home for the day with pay to think about their behavior and commitment to your facility. Afterward, they'll either change their ways or you'll ask them to resign. It's as simple as that. We've used it at our facility with great results.

Paying for an unworked shift sends the message that the Decision-Making Day is serious business. You're paying the employees to go home and think about their behaviors, to work at making constructive change. You demand significant effort from them before they are allowed back to work. It's a cooling-off period, yes, but it's more about developing goals and robust action steps to obtain the expected level of performance.

What makes a good action plan?
It's up to you to clearly state the behavior you desire and why what you're seeing isn't measuring up to your facility's standards. Be transparent with employees about the specific behaviors you'd like corrected. During a sit-down meeting, detail what people are saying and what you're seeing, and let them know that your physicians agree with those observations. Remind them that you addressed their problem behaviors and provided the education and tools for change, which didn't work. Tell them they need to go home, think about her workplace performance and come back the next day with an action plan that contains detailed steps for change. They must present the action plan before you'll allow them back on the unit, or they can present their resignation. The choice is theirs.

The action plan must be realistic and include specific, corrective steps for change. For example, one of my employees who realized her actions were detrimental to the team promised to apologize to her teammates and asked them to provide feedback if they saw her repeating old habits.

All isn't forgotten once you approve the action plan. Tell employees sent home for a Decision-Making Day that they can't resort to their old ways when they return. Put them on notice: Tell them that as soon as they slip up, you will take immediate and aggressive disciplinary action toward their termination.

Make sure physicians support the program and buy in when you target someone for improvement. Ask a physician leader to sit in during the first few times you confront an employee, because the meetings might be difficult, especially since word of your new hardline stance hasn't yet filtered back to the masses. Having a medical staff leader present also shows employees that they can't run to physicians for support.

Attitude adjustment
Unless egregious behavior demands immediate termination, problem employees stick around for years, infecting your facility's culture with manipulation, sabotage, bullying or constant negativity that drives valuable staff members from the organization.

Perhaps like us, you have behavioral standards tied to your facility's core values — compassion, excellence, and stewardship and service, for example — which every employee agrees to follow upon hire. But that doesn't mean they live up to the agreement. You can and should attempt to correct troublesome conduct through education, coaching, role-playing and one-on-one counseling to develop a culture of respect throughout the surgical department.

When those interventions repeatedly fail, you can go down the road of progressive discipline and eventual termination, but that may lead to uneven improvement, if employees improve at all, and could spark negative reactions among the physicians, who may think, They're excellent in the OR, why would you get rid of them? I'm sure you're also well aware that troublesome behaviors often occur out of sight and earshot of surgeons, with nurses and techs the only ones feeling the wrath.

Instituting a Decision-Making Day cuts to the chase: Do you want to be a productive teammate or do you want to look for employment elsewhere? You'll likely see a lot of shocked faces the first time you send an employee home. Thoughts of they're serious about this might reverberate throughout your department. That's good. You want everyone to realize that being skilled in the OR isn't enough, that well-rounded employees ultimately impact the clinical, financial and patient satisfaction goals you set.

I've used Decision-Making Days 3 times with good results. The outcomes were different for each employee, but in all 3 cases, the issues were resolved one way or another.