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Addressing management issues.

Sick-time abuse

Q Does the panel know of any successful incentive plans that motivate staff members not to use sick time needlessly?

A Alton Sturtevant says: "I do not condone abuse of any policies, especially those adversely affecting productivity and quality. Being short staffed certainly does influence this area. This era of two working parents and single parents adds considerable pressure to families and the workforce, which impacts our staffing levels. If an employee's child is sick and no support person/group is available, the employee might call in sick rather than taking a vacation day. While this is not right, it does happen.

"Many organizations have eliminated sick time from their vocabularies by switching to 'earned time off (ETO) and holidays, by converting all vacation time-and-a-half of sick time to ETO. In other words, two weeks of vacation and two weeks of sick time would become 15 to 16 days of ETO. This approach rewards those who avoid taking sick time with extra days to take as vacation--without creating more time off for the institution as a whole. Study the ETO levels of other facilities in your area to ensure that your approach is competitive.

"Establish a method for penalizing individuals who create staffing problems through their last-minute calls for ETO. One approach is a policy that defines scheduled/unscheduled absences and excused/unexcused absences. These definitions can be fluid, based on your staffing levels, but must be uniformly applied. For example, a request for more than one day off may require two weeks" advance notice to be considered 'scheduled,' depending on whether or not you are at full staff at the time. You can excuse a last-minute physician's appointment if staffing levels meet the lab's needs. Either or both of these examples may be classified as scheduled, unscheduled, excused, or unexcused. Obviously, unscheduled and unexcused absences adversely affect the lab operation the most.

"With regard to unscheduled/unexcused absences, your policy could state that a total of four unscheduled and/or unexcused absences in a 12-month period signals a written reprimand, while four unexcused absences call for termination. Employees should be verbally cautioned at each occurrence and reminded of the consequences of repeating this unacceptable behavior. This puts as much pressure on employees to make arrangements to be at work as it puts on the lab to provide good service during absences--all while encouraging employees to be at work when scheduled."

Marti Bailey explains: "You should have a hospital-wide policy for sick time that applies to all employees. Developing a set of rules for the lab staff that differs from the rest of the staff creates enforcement problems. Ultimately, consult with your human relations (HR) department before implementing any new policy.

"Our hospital sick-time policy applies to everyone. Each pay period, employees have a small amount of time deposited in their extended-illness bank. They also accrue a more generous amount of time termed 'paid time off (PTO), which is used for scheduled (vacation) and unscheduled (sick, emergency) time off. Other than for extended illness, PTO must be used for both vacation and short-term illnesses. This adds incentive for minimizing sick days. It also provides some control over sick days because the policy stipulates a graduated series of consequences for unscheduled absences for any reason.

"The policy requires warning letters for excessive unscheduled absences, with eventual termination if absences continue beyond the stated cap. Having this policy supports managers as timekeepers by making disciplinary action for sick-time excesses non-arbitrary. HR policies that address time off for any reason can offer some measure of control. In lieu of a hospital-wide policy, my suggestions include the following:

* Publicly reward staff who take minimal sick time within a predesignated time period and, perhaps, include a token of appreciation; decide the recognition level in advance;

* Establish a required process for sick call-ins;

* Keep detailed records of each employee's sick call-ins and look for trends that suggest abuse (the day before or after a vacation, requested days off that were not approved, Fridays before a weekend off); and

* Use your records to counsel employees with higher-than-normal sick days; determine a point after which an employee can be terminated based on excessive unscheduled time off, but check with HR first. Make sure that you consider and follow Family Medical Leave Act guidelines.

According to Larry Crolla: "This is a tough question, since most folks believe that sick time is part of their benefits package; they use it or lose it. HR may have some plan in place that offers a monetary trade at the end of the year for some of the unused sick days. You might reward people who have had perfect attendance. In this case, the reward would have to be substantial. Finally, at year's end, HR could consider offering straight-time pay (with no shift differential) for employees with sick time remaining on the books."

Bottom line. Implement policies that clearly state how paid time off is handled in your institution, including definitions and disciplinary actions for abuse. Apply sick leave and vacation time equally across the board--and equally enforce the rules. Recognize that employees have a right to utilize their time off, so prepare staff to cover when others may not show for work.

High stress levels

Q A new employee cannot handle the stress of our core laboratory in a 600-bed hospital. More than once, she has left the lab in tears. The lab manager extended her probation; but, after five months, nothing has changed. We see a nervous breakdown coming on. How can we resolve this?

A According to Alton Sturtevant: "The lab manager and/or the direct supervisor should have a frank discussion with the employee regarding performance expectations and the stress that it can exact on an individual. Since her probation period has been extended, I assume that her performance has not met job requirements. The lack of performance should be detailed and, likely, has already been identified for her. Her continued lack of performance should be detailed, and a final deadline should be set for compliance or termination.

"Management should consider ways to eliminate as much stress from the core lab environment as possible through discussion with all employees, including the new one. Is it assumed that stress is necessary in this section? Could, in fact, some changes benefit all current and future employees? Careful examination of this situation can ensure that the current method of dealing is best for all concerned.

"Performing in a high-stress job is certainly not for all of us and does not mean that we are not good techs under different circumstances. The new employee should be counseled about the job stresses that she is not handling well. Her strong points should be discussed--along with her weaknesses. She should know that not all lab jobs are so stressful. In the final analysis, she should not be continued in her current position for the good of the facility and its patients if she cannot achieve proper performance."


Marti Bailey advises: "One or two of you should meet with the lab manager to discuss your observations and thoughts. Your right and responsibility is to report the issues with this employee to your supervisor. It is unfair to this employee to let her continue in an unsuitable job and also unfair to co-workers to have to deal with the emotional issues and lack of support this employee brings to the work group.

"Why the lab manager extended this employee's probation is puzzling, but it seems that she might have thought that, with a little more time and exposure, there was hope for a turnaround. Since this has not happened and the employee is obviously hurting, the staff might now step in and enlighten the lab manager who does not have the advantage of

Why the tab manager extended this employee's probation is puzzling, but it seems that she might have thought that, with a little more time and exposure, there was hope for a turnaround. observing this employee's work situation on a daily basis.

"The lab manager has several options including moving the employee to a less-stressful position within the lab (if that is possible); helping her find a more suitable position in the institution outside of the lab; or terminating her. Termination under these circumstances would not be entirely negative because letting the employee go may be the only means of salvage. If your lab manager disagrees or chooses to do nothing, contact HR and let that department know of the issue. This situation needs serious attention."


Larry Crolla says: "Sometimes, something at home must be straightened out before one can focus at work. This whole situation sounds as if appropriate personnel need to talk to this employee through a counselor to make sure the root cause of her problem is known. If the employee is still on probation and HR has already been consulted, redeploying the individual to another job within or outside of the institution may be doing other lab employees a favor. Stress increases the chance for error (i.e., a needle stick) that could cause harm to a patient and/ or the lab employee. If you are not the person in charge, express your feelings to your supervisor and explain your fear of possible harm since this young lady seems to be in a job for which she is not suited. All of this is predicated on your assumption that she is crying because of job stress."

Bottom line. No matter what you think an employee is crying over, it is essential to make your concerns known to the lab manager, the lab supervisor, and/or the HR department. Analyze the root cause of the "crying" to determine how to eliminate stress inducers. In order for everyone to be comfortable, appropriate actions need to be taken by appropriate lab personnel. Work with HR, management, and the employee to place her in the right position.

Anne Pontius is the president of Laboratory Compliance Consultants Inc. in Raleigh, NC, and president-elect of CLMA 2007-2009. Send questions to Ms. Pontius at manga@

There should be a policy that dictates how to respond to unscheduled/unexcused absences.

Edited by C. Anne Pontius. MBA. CMPE. MT(ASCP)
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Title Annotation:Management Q&A
Author:Pontius, Anne
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Nov 1, 2008
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