Making 2019 The Year of Civility in Healthcare: The Performance Improvement Plan

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Developing a Performance Improvement Plan is the last thing a person in leadership wants to do. Typically it is the capstone on a fifteen to eighteen-month effort to appeal to someone to choose a better way of conducting themselves at work. Let’s go through the checklist of documentation and interventions that should be captured in the disruptive individual’s HR file before this last resort is taken:

  • Documentation of progressive discipline in accordance with your organization’s policy and procedure.
  • Documentation of a series of ongoing coaching and feedback sessions.
  • A spreadsheet outlining episodes of disruptive behavior and who was the target of such behavior.
  • Any written complaints about the individual’s disruptive behavior made by patients, family or colleagues.
  • Training in related topics such as anger management, stress management, Team STEPPS, conflict resolution.
  • Annual Performance Evaluations that speak to the disruptive behavior and the necessity for a change in such behavior.

If all these steps have been taken without significant, sustained improvement in the disruptive person’s behavior then a final Performance Improvement Plan is the next step.

When creating the PIP there are some key things to remember:

  • The timeframe for the plan can vary but should not be longer than 100 days. If someone isn’t going to respond to a PIP in 100 days, they are not going to respond in 101 days.
  • Be sure to create scheduled touch points within the plan. Meeting every ten days to two weeks is important to exhausting all efforts.
  • These meetings should have at least one human resource professional attending in addition to the principles.
  • This is going to be a difficult and challenging time for you as a leader. The narcissist/bully will raise the level of his or her game as they sense the end is near. You must prepare yourself (and the administrative team) for a new round of emotionally charged accusations aimed at ruining your reputation and portraying them as a victim of your bad leadership.
  • Cognitive rehearsal is vital. You need to practice your calm, professional verbal and non-verbal responses so that you can call on them when the bully tries to goat you into a public confrontation and catch you off guard. Keep in mind you do not want to respond in a manner that invites further discussion. Keep your remarks short and professional and your tone even. I find that “I’m sorry you see think that way” works for me. It is important to make the statement and then walk away.
  • It is also vital that you suspend your open-door policy for this person during the PIP. One of the tools a narcissist will use to regain the high ground is nagging and badgering. They will do all they can to wear you down in an effort to move the finish line yet again. They can be relentless so you must take steps to protect yourself from this onslaught of emotion. This is a good time to seek support from a trusted friend, colleague, coach, or mentor.
  • Do not let them crash your office unannounced or ambush you in the hall or cafeteria. Never respond to their emails during this time. Simply restate that their issue can be reviewed during the next scheduled touch point meeting with human resources and walk away.

The bottom line is that the termination of this staff member may be inevitable. It is not the failure of your team or the action plan. It is the choice of that individual. Disruptive behavior in any form presents a chronic distracts from the mission of the organization, the smooth operation of your department and undermines the foundation of a healthy work environment. It is unrealistic to expect the majority of your team to provide world-class care and service under circumstances that are innately challenging and power through these additional distractions day in and day out. We must put the wellbeing of our staff and that of our patients and their families’ front and center. Inaction or ineffective action undermines the credibility of your organization’s leadership at every level.

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