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I'm sick and can't come to work today.

Entries from our phlebotomy phone log:

* Friday, Dec. 22, 1989: "I won't be in today. My boyfriend's in jail."

* Monday, Jan. 22,1990: "I have sun poisoning and won't be in today."

* Friday, Feb. 2: "I have an earache and can't work today."

* Monday, Feb. 13: "I had a car wreck last night and I have a stiff neck. I won't be in today."

* Friday, March 3: "I was sick all night and my car wouldn't start this morning. I just can't make it in today."

All these excuses were given by the same phlebotomist. Each day was a Monday or Friday; two of the Fridays were the day after payday. This phlebotomist was not the only staff member making such calls. Abuse of sick time was costing our lab a lot of time and money--far too much.

* Identifying the problem. Our independent laboratory provides a wide variety of phlebotomy services. A staff of 46 phlebotomists (40 FTEs) in a laboratory staff of more than 200 employees draws about 5,000 patients a week. We provide phlebotomy services 24 hours a day, seven days a week for a 175-bed hospital. We staff seven outpatient locations at which patients' blood is drawn and from which specimens are transported to the laboratory by our couriers. We send phlebotomists to 17 convalescent homes, some of which are visited three times a week, some five, and some only one. The average number of draws per nursing home visit is 20.

We staff phlebotomists at health fairs, diabetes clinics, and other special events. We will send a phlebotomist to a private residence to collect specimens when a patient is homebound and being cared for by a home health organization. Our phlebotomists fill in at physicians' offices when their own staff phlebotomists are sick or on vacation. We compile charts, order and stock supplies, print computer lists, review orders, do special procedures, and perform all the other miscellaneous tasks that phlebotomists do.

Because we are staffed at the bare minimum, a sick call from an employee creates a problem. If we cannot get someone else to come in, our service suffers. Morning rounds may be late at the hospital, or an outpatient facility will be forced to open late, or draws at a convalescent home will take more time, causing fasting patients to go hungry longer than they should.

* Long weekends. It came to our attention that a number of phlebotomists always seemed to get sick on Mondays or Fridays. Our policy allows employees to be paid for sick days after 90 days' employment. It was amazing how many employees were in perfect health for three months and then became chronically ill.

One problem was that we were offering no incentive for employees to follow the rules. Morale was at an all-time low. Something had to be done, and it couldn't cost a lot of money. We decided to start keeping track of sick time. We would note the date, the day of the week, the excuse, and any other pertinent factors, such as day after payday, day before or after a holiday, or day off denied.

To avoid influencing employees' habits and thus skewing the study, we didn't tell them about it. After six months, the results surprised us. Abuse was more pervasive than we had thought--as the review sheets in Figure I demonstrate.

* Money matters. Ordinarily, employees had been receiving an annual merit increase of 0% to 6% based on individual performance. We decided that the way to get the message across was to make absences due to sickness directly affect the pay raise.

As a result, the following policy was formulated:

1) A sick time review sheet, on which we record all needed information, is kept for each employee.

2) After accumulating five sick days, the employee is shown the re view sheet and given an opportunity to explain any unusual circumstances relating to the illness. Any days for which the supervisor believes the explanation is reasonable do not count in the accumulation process. After each additional five days, the employee is shown the sheet again and given another chance to explain.

3) An employee who takes 10 days of sick time within one year will find 1% deducted from the annual merit increase. Each additional group of five days triggers another 1% reduction. Example: For an employee who calls in sick 10 times within one year with no surgeries, extended illnesses, or extenuating circumstances, 1% will be deducted from the merit increase. Anyone who calls in sick 15 days in one year will find 2% deducted. We define "extended illness" as one involving five or more consecutive working days with a physician's excuse required to return to work.

4) In employees' annual reviews, each circumstance is c on an individual basis. Examples include Monday/Friday abuse (the term we use for the days bracketing the employee's work week, whichever days it happens to include), habit-forming days (usually immediately before or after the person's scheduled work week, but occasionally associated with something else, such as a spouse's vacation day or the tennis tournaments that are common in our town), length of time of each illness, and nature of illness.

* New leaf turned. After tallying the results of our six-month study, we called a department meeting and shared our information with the staff. We introduced and explained the new policy and answered questions. Each employee received a clean review sheet. Everyone agreed that our implementation date would be Nov. 1, 1990.

Sick time abuse decreased dramatically. Morale rose because action was being taken. Figure II shows the marked improvement in the habits of the four employees, formerly chronic abusers, whose endless excuses are suggested in Figure I.

While our policy may not work in every laboratory, the time and effort involved in designing and implementing it was worth while for us. The policy is explained to every newly hired phlebotomist. It has worked so well for us that it was used as a model throughout the facility by our first human resources director, hired in late 1991. When she arrived, she found that inconsistency was the rule. Sick leave policies similar to our lab's are now used in client services, accounting, and other areas.

Chronic sick time abusers no longer find our laboratory a happy place in which to work. They tend not to stay with us longer than a year, after observing how small their merit increases are. On the other hand, employees who consistently refrain from abusing sick time realize they will be rewarded with heftier merit increases.

Now when a suspicious sick call comes in, coworkers don't resent it. They just grin and go about their business.

Edwards is laboratory manager and Edmunds is phlebotomy service supervisor at Associated Pathologists Laboratories, Las Vegas, Nev.
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Title Annotation:control of sick-leave abuse
Author:Edwards, Jo Anne; Edmunds, Richard
Publication:Medical Laboratory Observer
Date:May 1, 1992
Previous Article:Safety protocols no lab can ignore.
Next Article:Study aids for retraining and updating technologists.

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