PART I: CHANGE YOUR OUTLOOK TO CHANGE THE OUTCOME

This is a multi-part series on fostering an effective physician remediation and skill-building strategy. The strategy can be applied to all healthcare workers who struggle in certain aspects of their jobs. Leaders from all backgrounds can use it to their advantage.

Consider this statistic: 74% of healthcare employees in hospitals report they have seen doctors engage in disruptive, unprofessional behaviors.

There is no denying that healthcare work is tough. It is a blend of strong personalities and business, technical, ethical, and emotional pressures. Sometimes good employees take a bad turn. Sometimes they are ineffective from the start. Sometimes the job or people-environment changes, and employees are simply ill-prepared. And while it is easy to start the probation cycle and simply go through the steps, it much harder to transform the employee and improve the situation. In this part, we focus on changing the narrative surrounding remediation—moving it from process to relationship, from discipline to benefit.

The cost of remediation is substantially lower than the cost of turnover.

According to the AMA, the cost of turnover for a single physician ranges from $500,000 to $1,000,000. Others put the average cost of turnover between $400,000 and $600,000 or even higher. Lost revenue, recruitment costs, and signing bonuses add up to substantial dollars.

Keep those figures in mind: they are what follow when remediation efforts fail. It’s also worth noting that there is no guarantee the physician’s replacement will be tangibly better. (After all, you were confident in your initial hire, and it still didn’t work out the way you intended).

This is where remediation comes in. Given the success rate of remediation strategies and the uncertainty of new hires, allocating a modest sum to remediate struggling physicians is an extraordinarily-wise investment. Coalition research puts the successful turnaround of physicians undergoing remediation at 75%. Our statistics peg it similarly at 80%, although we focus primarily on professionalism and interpersonal issues, not medical or technical.  Surveys from resident physicians show variable remediation success rates, ranging from 49% for professionalism problems to 89% for medical knowledge deficiencies. All signs point to the fact that, when done well, remediation can and does have a good chance of working.

The typical spend on remediation ranges from $10,000 to $25,000—a far cry from the $500,000 to $1,000,000 for a single turnover. While outcomes are not guaranteed, if it works in three of four cases, you can cover a good many remediations for the price of a single turnover. The long-term financial return on an organization’s remediation investment is enormous.

Remediation is not a punishment but a benefit.

Compare the cost of turnover to that of a successful remediation effort. Now, think of remediation like a health club membership or a wellness benefit. It is designed to greatly reduce your long-term health spend by making positive lifestyle changes, especially for those currently making unhealthy choices.

Unfortunately, the word “remediation” has some baggage. Due to the negative connotations involved, some people believe a person on remediation is well on their way to leaving the organization.

Probation. Documentation. Progressive discipline. Termination. And let’s not forget the whispers in the hallways. Seldom is remediation viewed as a benefit—but we can change that narrative. We can illustrate that remediation is an effective strategy for helping people through a rough patch. We can remind people that there is no shame in struggling.

In our experience, we have found that remediation requires surprisingly small changes, implemented consistently. You might think of remediation as a targeted growth spurt. It is not uncommon for doctors to grow and mature asymmetrically in their skillset. Knowledge often exceeds application, and technical competence may override interpersonal prowess. There are times when empathy may outpace leadership. 

And again, this is where remediation comes in. It is designed to rebalance the physician’s efforts and promote a greater symmetry of skills, all while recognizing their exceptional talent in specific areas. Since we don’t want a shortcoming to supersede the physician’s talent, remediation can help the individual leverage their talent, readjust their skills, and make small behavioral changes that will transform their work efforts.

Some of those small behavioral changes might fall upon the physician, while others might be the responsibility of the leader or team. One thing is certain, however: success is built on small, positive behaviors that accumulate over time.

Remediation is a relationship rather than a process.

Before we continue exploring the benefits of remediation, let’s go over some contextual information.

95% of remediation cases are referrals from leadership. 5% are self-referrals.

These are the first statistics that need to change.

When we chat with an employee after a leadership referral, 90% know they need to make some sort of change. Only 10% are unaware.

These statistics speak volumes about our culture and our failure to proactively help those who struggle in their jobs.

Any mediocre leader can take good employees and make them better. Real leadership inspires and transforms employees who are not rising up to expectations.

It’s easy to get frustrated. It’s easy to think the struggling physician is taking up valuable space—space that would be better filled by a different recruit. We have all heard clichés like: “cut your losses,” “you can’t save everyone,” and ”he’s a lost cause.”

It’s easy to start the disciplinary cycle, offer some coaching, and follow the approved process. Most of us know the drill. We know all about listing out the grievances in specific terms, noting the required changes, and then spelling out the potential consequences. From there, it’s document, document, document. The stronger the documentation, the better the organization’s position when it comes time to terminate. This represents a technical, almost legalistic approach to remediation that is far more threatening than encouraging.

Yet, documentation is not the center of remediation—it is an adjunct. The center of remediation is your relationship with the employee, your journey and joint efforts in fashioning a future of productive behaviors. Focus on building that alongside the physician. It goes beyond being a mentor or coach, and into being a true advocate. Great partnerships are crucial to great leadership.

Leaders can change their outlook to change the outcome.

The moment we label an employee, we adjust our behavior towards that person. We start to focus on the behaviors that support what we already think, and we overlook what doesn’t fit. Psychologists call this “selective attention.” The phrase indicates that our beliefs determine what we see.

Inherently, this is an unfair approach. It keeps us from being objective. What else might be going on to enable the employee’s unacceptable behaviors? Moreover, how do we know that the employee’s failures are not—at least partly—linked to the manager or even the system at large?

Put simply, the surest way to have a problem employee is to label them as such. Reputations spread. When we have a problem with someone, we let others know, infecting them and perpetuating the issue.

To counteract this, we must assume positive intent. Now, this does not mean we should excuse bad behavior—quite the opposite. Rather, it means we must uphold an underlying belief in the worth of that person. Most people want to do good work and be an accepted member of the team. Positive changes to the relationship will transform all parties’ behavior for the better.

And ultimately, remediation can pivot on how you define the relationship. You can view yourself as a boss trying to manage a broken employee, or you can see yourself as one-half of a productive partnership meant to benefit everyone involved. At the end of the day, your culture is directly proportional to the quality of your relationships.

Leaders are defined by the challenges they overcome.

Some of the most amazing employees in my career have gone through rough patches, passed through immaturity, and made poor choices. I have watched a number of so-called “problem employees” become role models and champions of important initiatives. Some of them have even risen to the highest ranks of the organization. They often look back on their mistakes and the remediation that followed, and they view the experience as a positive career turning point.

Why? An intolerance of employee mistakes is a surefire way to spread mediocrity. “Worst to first” is a probable, not possible outcome. “Turnarounds” will likely become your most loyal, dedicated employees—and many will go on to share their stories of triumph as coaches, mentors, and advocates.

Who doesn’t love a rags-to-riches story? Inspiration is all about overcoming the odds. In this way, remediation is an ideal setup for another inspirational story that will, over time, create a virtuous cycle of success and foster a culture that cherishes its employees.

As a leader, you are defined by the challenges you confront. Remediation of a struggling employee is one of those difficult challenges every leader will face again and again. Your real worth as a leader is rooted in what you do, not in what you achieve. Consistently do the right thing and the outcomes will take care of themselves.

In the next part, we will begin moving through the remediation process, starting with the initial conversation. Far too often, this conversation is delayed and fails to get the process off to a positive start—but this doesn’t have to be the case.

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Fred Fishback

President and CEO of Javelin Learning Solutions. Demonstrated history of working across industries including healthcare, pharmaceuticals, manufacturing, aerospace, law enforcement, and more. Educational background in industrial psychology, learning science, and IT. Graduated from Virginia Tech Graduate School.