Addressing management issues

Nov. 1, 2008

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

“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.

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

“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

“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

“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.”

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.

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

“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 observing this employee’s work situation on a daily

“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

[email protected] .

“Management Q & A” provides practical, up-to-date solutions to readers’
management issues from a panel of laboratory management experts. Readers
may send questions to the Anne Pontius at
[email protected] . Unless
otherwise noted as “confidential” by readers, all queries will be
considered for publication without further notice to them. Names,
institution, city, and state will be removed before publication. The
following panel of laboratory directors, managers, and supervisory
technologists have provided their input in the answers given in this
column: Marti K. Bailey, MT(ASCP), work unit leader, Pathology, Penn
State Milton S. Hershey Medical Center, Hershey, PA; Lawrence J. Crolla,
PhD, consulting clinical chemist, Departments of Pathology and
Respiratory Care, Alexian Brothers Hospital, Elk Grove Village, IL, West
Suburban Medical Center, Oak Park, IL, and Northwest Community Hospital,
Arlington Heights, IL; and Alton Sturtevant, PhD, laboratory director,
LabCorp, Birmingham, AL.