Whether they're always late for work or they don't carry their share of the load, problem employees can sap your surgery center's morale and sabotage its performance. What makes these situations worse are managers who don't deal with the situation head-on.

Nothing but trouble
We've all had to deal with problem employees. They come in all shapes and sizes, but share a few key traits. They're oblivious as to how their poor performance is affecting others, they don't respond to subtle hints and they're gifted at finding others to share their load. In my experience, we can lump poor performers into several broad categories.

• Competent. These people know how to do their jobs, but they just don't do it enough. These are smart people who pass competency training every year. Certain doctors really like them and they perform well in selected situations. But you'll find them inexplicably failing again and again.

For example, an RN does an excellent job circulating orthopedic cases. When you assess competencies, she passes with flying colors. Yet she doesn't like to do eye cases, and when you assign her to those rooms, nothing ever goes right. The doctors complain, the cases run over and the turnover times are long. Why? She doesn't want to be there. She is competent, but only when she chooses to be.

• Lazy. These people might be smart, too, but nothing is ready when it needs to be, supplies aren't pulled and areas aren't restocked. They're very disorganized and move slowly. Most infuriatingly, they frequently seem to be out of the area. (What exactly are they doing?)
• Incompetent. These are the people who perform the same type of case all morning and never seem to get it right. Equipment isn't in order from one case to the next. You find that special instruments needed on one case aren't there for the subsequent cases. They're also totally disorganized. They can't find anything in the room or back table. Everything in their work area is a mess.
• Clueless. These folks wander through the day with no worries. No matter what you do to help them, nothing changes. They don't seem to care that doctors won't work with them. Sarcasm doesn't faze them and constructive criticism goes right over their heads. Hello ... anybody home?

Don't ignore it
So what's a manager to do? The worst thing to do is to ignore a poor performer. The rest of the staff loses respect for a manager who does nothing. If you condone bad behavior, you're in effect rewarding bad behavior at the expense of good.

But often managers who do try to correct one employee's performance do it in indirect ways that are almost as bad. Some managers will speak generally to an entire group when it is a single employee who's causing the problem. This approach skirts the specifics in favor of general statements. It paints all employees with the same brush. Good employees resent it and the bad employee probably doesn't get it. No way can you be talking about her, she's thinking.

Some managers informally approach other employees and ask for help with the problem employee. This won't work. It avoids the specifics of the problem and causes a stir at the surgery center.

The right way
The best way to approach an employee performance problem is to begin to document problems (tardiness or missing supplies, for examples). Be specific and make sure there are times and dates for each situation. You should have disciplinary procedures in your employee handbook and you should use them to begin a disciplinary timeline.

Usually, this timeline includes a verbal discussion first, a written warning next and then termination. Give the employee a time frame within which to improve. Set up the re-evaluation as an appointment when you and the employee will sit down together to discuss the problems - and potential solutions. The length of time involved will depend on the seriousness of the situation.

Whatever your center's policy is, you must follow it to the letter. It's better to have a somewhat vague process that you can keep to than to have a very detailed process that you rarely follow. (Consult your facility's legal counsel for advice on developing or reviewing your process.) By following this firm-but-fair approach, other employees likely will notice that you're handling the problem. They shouldn't notice too much, though; disciplinary procedures should be confidential.

Turning things around
Once you've identified a problem with performance, you need to develop an action plan with an employee. For instance, let's say you have an employee who's late two days a week. Her fellow employees pick up the slack for a while, but it's becoming a morale breaker.

First, verify against the timecard that the employee is truly late. Compare this to her scheduled arrival time. Make notes and bring the employee in to discuss the problem. Develop an action plan that both of you can live with. That might mean asking the employee to get a second alarm clock or setting the one she has on the other side of the room. It may mean suggesting she get up 15 minutes earlier to get a head start.

Develop a plan that will help her succeed, and then set a time to reevaluate. If the problem is resolved, everyone wins. If there is still a problem, follow your center's process, which may be a formal written warning. Make it clear that this is the last warning. Tell her that if the problem isn't resolved, for the good of the center, you'll need to let her go.

When it comes time to see if your employee held up her end of the action plan, you should be objective. Ask for input from your staff and the physicians and consider it along with your personal observations.

In addition, when you have an employee who's not performing well, provide guidance and assistance. You might even assign another one of your staff as a temporary tutor.

Decision time
There will be times when your employee turns around so spectacularly that your decision to retain her will be easy. But often you'll be confronted with a harder dilemma. You'll have to decide if the employee is salvageable or if it's time to cut your losses.

If the employee is strong in a certain area - remember those smart, competent "problem children" - you might see if she'd work part-time or on a per-diem basis. When you have to let the occasional person go, be reassured that your attention to the problem will help the rest of your surgery center. For one thing, it sends a message to others: If your performance isn't adequate, you'll be dealt with because our surgery center must maintain its standards. That has benefits further down the line. You'll have more credibility with your physicians. And you'll have more room for your high-achievers to prosper.