Answering your questions on fire drills, cross-training, yo-yo employees and performance management.

Manager gets heat over fire drills

Q As part of our lab's safety program, we run fire drills about twice a year. At our last drill, several staff members refused to leave the building, claiming they were too busy to stand around outside for nothing. As their supervisor, what can I do to get them to cooperate?

A While full participation in fire drills would be the ideal situation, panelists admit it isn't practical or essential, for that matter, for every person to evacuate the building, particularly if patient care would be compromised. It's safe to assume a few staff members would need to stay back to answer telephones, continue processing Stat tests.

According to Linda Blacklidge, the important thing is that all employees go through the mental exercise of what they would do in a real fire. Consequently, she recommends fabricating a drill for people at convenient times and informally quizzing them (verbally) regarding proper protocol. Employees should be able to do the following:

* Recite the appropriate actions to take were a fire to occur at a given location. Responses should assure you your staff is aware the fire must be reported either by pulling the fire alarm or by using the phone.

* Indicate doors to be closed to prevent the spread of fire beyond the initial location.

* Demonstrate how to use a fire extinguisher if the fire is small enough.

* Identify appropriate escape routes (depending on fire location) and know the rendezvous location to meet up with other staff members.

Marti Bailey urges you to document in black and white what your policy is for fire drill attendance. She cautions that including in your policy exceptions such as excluding someone from the drill to answer the phones, paves the way for noncompliance. "After developing your policy (with liberal staff input), circulate it, review it with your staff, and clarify your expectations. Failure on anyone's part to follow the rules should be documented and result in disciplinary action." She suggests either you or an appointed safety officer should monitor compliance during each fire drill.

In Michele Best's lab, full evacuation drills are limited to one per year to minimize the impact on patient care. "We leave one person behind in each section to take care of critical work and the telephones. We also expedite the evacuation process and the return of lab staff to further minimize impact on our workload."

Best says assuming your evacuation drill protocols are reasonable and efficient, you must take the time to reeducate a reluctant staff why fire drills are so important to maintaining the lab's readiness when it really counts. "Laboratorians must understand the full impact of a fire drill on their safety and on the lab's liability in the event of a fire."

Bailey has a hunch if you're having trouble getting people to participate in fire drills, other safety issues are being violated as well. She says supervisors have to be continually vigilant the staff is following all safety rules and let it be known how serious noncompliance is. "Safety is the very last thing you want to be lax about."

Cross-training employees

Q What is the panel's opinion about whether employees should be trained up or down? Should a higher level person be trained to perform lower level duties, or should a nonprofessional employee be trained to perform a wider span of responsibilities that may include some higher level duties?

A Both Marti Bailey and Lynne Garcia agree that one type of cross-training shouldn't be chosen to the exclusion of the other. Once it has been determined that a lab's employee mix is optimal, they advise managers to consider all training options rather than to limit themselves to a one-time decision. Ideally, cross-training plans will evolve as the economies of healthcare change.

"We routinely cross-train our employees to cover several benches within the lab in addition to their main technical job function," Garcia explains. "Our goal is not to make any one person an expert in several areas, but rather, to increase flexibility so that staffers can take on some routine tasks, thus allowing more highly trained people to focus on more complex tasks."

She notes it is inappropriate to attempt to make everyone totally cross-trained (that is, able to work in all sections of the lab) since people tend to forget tasks performed only periodically. "Further, coverage should be geared to high levels of flexibility where job duties are shared among coworkers and where no one person is expected to totally take over another's job."

For lab operations to be cost effective, says Bailey, "all staff members must be more multi-skilled than before. It's also important, however, that skills be matched to compensation, so you need to focus on employee mix." She explains it is a poor decision, from an economic standpoint, to expect an MT to take time out of his/her work day to perform clerk-level tasks. Conversely, when clerks are asked to perform tasks above their educational level, chances are this work will need to be redone - again, a poor economic decision.

Bailey says the way around this situation is to define the tasks involved in all procedures conducted in your lab, determine what skill level is required to perform each task, and then proceed to train as many people as possible accordingly. "The greatest opportunities in the lab seem to lie in cross-training all levels of employees across departments," she notes, "creating more generalists. This implies laboratorians will lose their departmental identity and function at a system-wide level, working for the benefit of the entire lab rather than for an individual lab section. It follows logically, then, that employees should be rewarded according to the number of skills they practice."

Linda Blacklidge's experience in this area indicates the highest probability of cross-training success occurs when people are trained in duties that are comparable to their regular assignments, that is, at the same level of complexity. This experience resulted from her facility's establishment of a patient care tech program that sought to combine responsibilities from respirator care, cardiac graphics, and phlebotomy. "Our original premise was to combine these duties, which could be taught easily on the job and did not require any type of formal education or licensure. We used phlebotomists from the lab, EKG techs from cardiac graphics,' and respiratory techs and therapists. The director of respiratory care supervised the program."

Blacklidge continues: "We found many lower level staff members who were asked to perform higher level responsibilities lacked the appropriate judgment to assess patients' physical conditions, a skill that comes from formalized training. Conversely," she continues, "many higher level employees resented being asked to take on lower level duties, and as a result, they frequently placed these tasks at the bottom of their priority list.

"These adverse experiences are countered by successful cross-training efforts within our department to train techs between sections and to cross-train secretaries to cross-cover," she notes. "These employees, who weren't expected to perform at either a significantly higher or lower level, accepted their new duties as a challenge. Professional image and self-esteem were maintained."

Blacklidge explains the incentive for cross-coverage evolves from the need to use the most expensive resources judiciously. "Our experiments resulted from a perception that certain employee groups had downtime that could be used more effectively to improve productivity. We found enlisting employees' full cooperation by creating new jobs that are reasonably challenging and that offer a variety of duties leads to the greatest potential for success."

Curbing the ups and downs of the yo-yo employee

Q Is there a sure fix for the yo-yo employee? I'm speaking of the worker whose performance is consistently inconsistent - up one review period, down the next. Significant time is spent coaching her, and then her performance improves only temporarily. How does a manager break the cycle?

A The panel maintains most managers are forced to deal with this type of employee at least once during their careers. Handling this type of staff member takes time and effort, but it's a problem that must be addressed expeditiously.

They suggest that the best way to break this vicious cycle is to require sustained performance improvement from this individual. Marti Bailey advises that you also must focus on the long term, rather than on monthly or quarterly intervals. Whatever your employee's performance deficiencies are, they need to be spelled out. Judgments of performance must be made based on performance standards.

"Documenting a worker's failure to meet these standards is key to resolving your problem," Bailey continues. "When a worker fails to meet a standard, is counseled, then meets it, and then fails to meet it again, overall she is failing to meet that standard. Hence the reason why performance generally should be judged on the long term." Favoring the short term, she says, is unfair to employees who generally are good performers but who, from time to time, have performance problems that usually are of short duration and self-corrected.

As the work environment continues to evolve and become more challenging, employees need to know as much as they can about both current and future changes in health care, notes Lynne Garcia. "The more information people have, the more likely they are to adjust to the changes and to work consistently at or above expectation." She advises leaders in the lab to make sure workers understand what these changes mean to them in terms of work styles, levels of work complexity, need for flexibility, and consistent work performance.

Sometimes jobs become more complex than certain people can handle, explains Garcia - no matter how hard they try. "And then some people elect not to grow with their jobs, which leads to an overall decline in their job performance." Fortunately, she says, these people often decide to leave on their own.

Linda Blacklidge has frequently heard other managers in her facility complain about having to deal with yo-yo employees. Her department even served as a pilot for a new approach to motivating this type of problem staffer. She explains: "Over the past few years, we have downsized by more than 20% through attrition. While we were not required to lay off employees, we were encouraged to weed out the underachievers. The new approach was to force employees with recurring problems to take full responsibility for their actions; to write their own corrective action plan, subject to the approval of their supervisor;, and to acknowledge that failure to adhere to these guide lines would result in termination. All of this is put in writing and signed by both employee and supervisor."

Blacklidge is a firm believer in documenting that a problem exists and that the employee has been informed of the need to improve his/her performance. Recurrence of a performance issue within 18 months of a written warning serves as the impetus for an employee to write a corrective action plan. This process assumes a supervisor or manager has spent sufficient time coaching the employee on how to improve performance and has provided all the necessary training.

Employees required to write their own corrective action plan are given a day off with pay to complete this task. They are warned that failure to devise an appropriate plan may result in termination. Problems are explained clearly to employees before their "day off" so they understand what needs correction. They also are offered help if they need it (i.e., they can call their supervisor as often as necessary). The final sentence of the document must state that failure on their part to follow the plan will result in the resignation of their position or involuntary termination.

Thanks to this process, Blacklidge says employees now realize poor performance is their problem, not their supervisors', and that the issue of staying versus leaving their job is entirely up to individual workers and their ability to control their actions. "In this current healthcare environment, supervisors and managers no longer have the time to coach nonreceptive, uncooperative employees."

In Michele Best's facility, coaching is regarded as a key activity used for performance management/improvement and as a way to prevent the need for disciplinary action. She says coaching should occur on an ongoing basis during the review year so managers don't wait until the review date to identify inconsistent performance. "If we don't see improved, consistent performance once several coaching sessions have been held with an employee over specific performance issues (we use three strikes and you're out), we move to progressive discipline."

The panel closes by leaving managers and supervisors with this food for thought:

As downsizing continues in the industry, the lab's ability to support and maintain suboptimal employees diminishes. Think in terms of your entire organization and whether your yo-yo employees contribute adequately to your operation.

The longer you keep substandard employees, the more difficult it will be to let them go once you finally decide to bite the bullet. It is unfair to employees performing below acceptable standards to let them believe they are doing fine work when, in fact, they aren't. If yo-yo staffers are allowed to continue their off-again, on-again performance, chances are staff morale will plummet and your department will see you as someone who is unable to solve problems.

It is crucial for employees to understand that inconsistent performance makes them vulnerable in the event of a lay-off or reorganization effort. Consistently meeting all performance standards is a requirement of the job and critical for the laboratory to compete in today's environment.

A lesson in performance management

Q Is there anything a lab supervisor can do about a lab manager who tolerates, and even defends, an employee who has a distinct performance deficiency but who is excellent in many other respects? In other words, he meets most performance standards effortlessly but clearly fails one or two on a consistent basis.

A The panel reminds readers that performance management and competency assessment are key responsibilities of lab managers. When not managed appropriately, these two areas can have great impact on test quality, patient outcome, staff morale, and productivity.

Everyone has strengths and weaknesses. "Who doesn't employ at least one staff member who is exceptional in every aspect of job performance but has tremendous difficulty getting out of bed in the morning and making it to work on time?" Linda Blacklidge asks. "The difficult issue is whether this one fault should cancel out all that he contributes once he gets to work."

"Most managers have personally experienced the frustration and disruption created when an employee remains deficient in a particular area of performance," says Marti Bailey. "It simply must not be allowed to continue, particularly since too many employees are willing to meet all performance standards."

Ideally, employees have the fight to expect they will be held to the same standard as anyone else who performs the same job. This means establishing expectations for every duty and implementing some type of reward for positive behavior and penalties for negative performance. Application of this program must be consistent so all workers get the same message.

Meeting performance standards mustn't be treated like a smorgasbord, says Bailey. Anyone should be able to see the flaw in allowing willingness or ability to meet individual performance standards to be "averaged." Performance standards should be set so they are achievable by the average employee who has the desire to do so. In addition, each standard should indicate the minimum acceptable level of performance, and should be important in achieving and/or sustaining the lab's mission.

Performance management systems based on merit work well to encourage and reward behavior that meets or exceeds expectations. Exceeding expectations leads to above-average increases, while failure to meet expectations leads to a lower increase or no increase. Financially based programs send a clear message to employees that it is advantageous to do one's best.

In the absence of a merit-based program, a progressive disciplinary approach can be applied. Here the employee is made aware of any shortcomings in a performance area and coached to improve performance or suffer the consequences, which could include further disciplinary action, or termination.

The need to apply discipline in a consistent manner is essential to the motivation and morale of the entire laboratory. Failure to do so destroys incentive to follow the rules. The panel suggests you explain to your manager that by her letting an employee off the hook in one or two areas of responsibility, she is inviting all employees to allow their performance to slide as well. Multiplying the effect by many employees will definitely affect patient care.