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Reason #3: The employee doesn't understand there is a negative consequence for the behavior.

Have you ever wondered why employees continue to do inappropriate things? Have you wondered why your daily angst grows? It is your responsibility as the doctor to hold employees accountable to negative behavior. You must provide a negative consequence. Failure to do so leads to continued bad behavior and stress on you. To stop issues, first provide a time frame for the employee to correct the issue. Then discuss action steps that require immediate action and use a performance improvement plan to aid this effort. Then let the employee know of any negative consequence if the behavior does not change quickly.

Reason #4: The employee's ability to do the work is hindered by a process that is not working.

Try to eliminate as much bureaucracy as possible by empowering the worker to get the job done in the most efficient and effective manner. Bureaucracy exists for the good of the practice. It helps as a system of checks and balances. Yet many practices get into analysis paralysis, thereby creating too many rules whereby nothing is accomplished.

Reason #5: The employee has personal problems that are interfering with their work.

Present society has all of us dealing with a myriad of personal issues. The present economy and an aging population create countless issues this country has not seen. We have Generation X'ers living with parents and parents living with Gen X'ers and Baby Boomers. Not to mention the vast number of individuals seeking full-time employment, better pensions and a better life style. Personal issues take their toll on employees, as illustrated by tardiness, absenteeism, rudeness, arrogance and perhaps insubordination. Chiropractors can assuage some of this by offering some degree of flexibility when possible. There are many practices that offer flextime and time off. But no matter the path, the employee still needs to perform and the chiropractor needs to ensure that the personal issues do not hinder the practice.

The Last Straw

Obviously, after attempting one, if not all of these things, the chiropractor's angst continues to grow. Many of you reading this I'm sure have stated that you have spoken with the employee numerous times and nothing has changed, even if it is some of the information mentioned above. The first question to consider is what action have you taken to ensure that the employee will change? In other words, if you have had a conversation with the employee, have any action steps been taken to ensure an immediate reversal? A verbal warning or even two verbal warnings are often suggested in altering employee behavior, but if no action steps are stated, nothing will change.

If after two verbal warnings the person continually decreases in performance, the next step for any chiropractor or chiropractic assistant is a written warning. A written notification of job performance is a more formal transaction that is meant to illustrate to the employee that their performance is lacking and they need immediate improvement. Typically, many of these written warnings or letters from the chiropractor to the employee are templates typically called performance improvement plans. If you are seeking some of these templates, many are available online or there are several resources in bookstores.

However, if after several meetings and one written performance improvement plan nothing changes, then the employee must be terminated. The best way to do this is at the beginning or at the end of the day and with one other person in the room. It is often suggested to never terminate anyone without cause or without a witness. In today's litigious society, a chiropractor must do all that is necessary to follow the rules and avoid any ridiculous lawsuits. Therefore, having another party present will ensure there is a lack of hearsay and the termination is handled professionally. At this point, the employee is to return all equipment, provide all patient information and update the chiropractor on any open issues. Moreover, while this is a very sensitive issue, maintaining professionalism will be a key to success. The employee should sign any non-disclosures, non-compete and required termination paperwork so that they leave without open issues.

It is unfortunate when anyone leaves a practice. After working together closely for a while, people become family but all are required to productively add to the practice. Each day is to begin and end with results and when patients are not cared for and when paperwork is dismissed, the practice could become dysfunctional. The only way of ensuring a profitable practice is having good, productive employees. What you begin the practice with is not what you will end with, but if you constantly seek out the best, you will get the best from the people you hire.

Drew Stevens, PhD, is known as "The Revenue Doctor." He helps chiropractors develop strategies that exponentially grow revenue and returns personal time. He is the author of eight books including the widely acclaimed "Practice Acceleration" by Greenbranch publishing. He can be reached through his website at

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