EP 59: The Power of Documentation: Building Accountability and Leadership

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Dr. Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Dr. Renee Thompson.

Dr. Renee Thompson:
Hi everyone! Welcome back to another episode of the Coffee Break podcast. Wherever you are listening or watching, I hope you're having a really great week. I know I am. Not only did I get to spend some time with some amazing leaders and a couple of different cities across the country, but as I record this, my daughter is here visiting, and it's my daughter Courtney, who's actually our digital content specialist. So, a lot of you on social media, if you're in our community, the emails that you get on Tuesdays or Thursdays, a lot of that is Courtney's work, and so super excited. So, actually, after I record this, we're going to have a mom-daughter chill-out session, and looking forward to it.

Dr. Renee Thompson:
Okay, today, we're going to talk about documentation. They say in clinical practice, if you didn't document, you didn't do it. Although I heard someone else put a spin to it. It was basically it's not that you didn't do it. If you don't document, you can't prove that you did it. And I thought that was one of those ooh moments. It's very similar with trying to hold an employee accountable for their professional conduct. If you don't document that shows a pattern of repeated incidents of disruptive behaviors, it's going to be really hard for you to build a big enough case, if you decide that the outcome needs to be termination, that you're going to get the support to be able to do that. So that's what we're going to talk about today. Documentation.

Dr. Renee Thompson:
All right. First I do want to have another conversation about coffee. So, as everything in my life Coffee Break podcast, your coffee, and conversations about nurse bullying, I tell stories about me drinking coffee, some people have actually written in and asked me, I noticed that you use the same like two different coffee mugs, and I do. This is my favorite, number one. So, if you're watching this right now, if you're not, hop on over to YouTube so you can see this. This is my favorite coffee mug of all time. And it's one of those things like when you have that sweatshirt that every time it comes out of the dryer, you put it on, it's like your favorite or your woobie. This coffee mug was given to me by a very dear friend of mine, Joanne Terka. Joanne Terka taught me how to be an educator, and I worked with her when I worked as an educator for a large health system. And then when I started this company, Joanne did a lot of work with me because she's just she's amazing. And she was vacationing, I think, in Cape May somewhere up north. And she went into this little specialty gift shop, and she knows I love coffee. And she saw that mug, and she thought of me, so she bought it for me. I've had this now for probably about ten years, and it's still my favorite, and even more so now because I think a little more than a year ago, unfortunately, Joanne passed away, and that was really hard for me. It came it was a little unexpected, and I just couldn't imagine a life without Joanne in it. And so even more so, every time I see that cup and it's clean, it's out of the dishwasher, and I know I'm going to have a cup of coffee or a cup of tea. I grab that cup because it reminds me of Joanne. Okay, so the other one is, it says on there a cup of gratitude. It's actually getting chipped. Okay. But I don't care. I still use it. That's the other mug that you typically see when I'm doing this podcast.

Dr. Renee Thompson:
Okay, let's get back to documentation. There is in general, I would say, a disconnect between the leadership team leaders and their HR partners. And actually we explore this in episode 28, which I will link in the show notes. I will link to that episode because part of it is and I'll just give you a glimpse of it, you finally decide you're going to do something about this disruptive person in your department and HR basically says, where's the documentation? There's not a shred of evidence that shows that this person has behaved in this way in the past. So you give them very little room to be able to support your decision to either put on corrective action or terminate. So please go back and listen to episode 28, if you're having that struggle with your HR partner too.

Dr. Renee Thompson:
Something else that I've written about, it's the Five Common Mistakes Leaders Make When Trying to Address Disruptive Behaviors. One of those mistakes is waiting to document, waiting for that time when you have had enough, and then you start a documentation trail. Again, you're a little late if you're going to wait until you've had enough of somebody's behavior. I'll also link that resource for you in the show notes. It's a free resource, so make sure that you grab that because there are four other mistakes that leaders make.

Dr. Renee Thompson:
But in today's episode I'm going to really focus on two different strategies for good documentation. The first one is going to be to get into the habit of documenting, and the second one will be, what do you document? Okay. Because that's where a lot of confusion is. Like, what do I actually document? Because trust me, I've seen plenty of documentation about somebody's behavior, and I'm like, no wonder why HR won't support you in this. There's nothing here, or it actually makes it sound like you've targeted them. So those are the two things we're going to talk about today.

Dr. Renee Thompson:
So the first one is to get into the habit of documenting any conversation you have with an employee about, and of course, I focus on behavior, but it can be performance, too. Okay. Why not do the same? Get into the habit of documenting any conversation you have with your employee about setting behavioral expectations. This is what I need to see from you. It's not okay that you yell and huff and puff down the hallway when you don't get the assignment that you like, okay? Whatever that is, make sure you're actually, like getting into the habit of documenting all of those situations. And there are a variety of ways that you can do this. First of all, you can create your own electronic document, and you can create it for each employee if you want. Now, if you have 150 employees, that might get a little tedious. So you might just want to create a document that basically, anytime there's an incident, you just put the person's name, the date, and what we're going to talk about documentation. But then you just keep a running journal of different incidents. And then, because what if it's just a one-off? You may never need that again. If it's not, then you can go and search for that person's name. And then, you can copy-paste into a separate document. Okay. So you could create your own electronic. It could be a Word document, it could be an Excel spreadsheet, but you've got to have a place to document. Now the second option is, your organization might also have a form, something that you can utilize. You might have a form for each employee that you can go ahead and document, and it stays in that employee sort of record. And the third way is, I alluded to it before, you could just keep a running list, or you can have files for certain employees, and you create them as you need them. So, you might not want to create a journal for every single employee. But when there is an incident, create a journal for that incident and that employee. And then, if you have continued issues and you can just add to it, okay, now I will give you some another consideration as we focus a lot on addressing disruptive behaviors, but something that I actually do within my company. We have a journal on every person who works for us, and we include good things that they've done. If they had a good catch, they caught something before it went out to everyone. If they were a rock star or superstar when it came to a project that they were working on. We also collect the good and you can do the same.

Dr. Renee Thompson:
Get into the habit of documenting any conversation you have with an employee about behavior. One of our clients, years ago, she said before she left for the day, she documented on her employees like she documented on her patients when she was at the bedside. Think about this. You would never think of leaving your shift without documenting on your patients. Okay, you, and sometimes you'd have to stay overtime to finish your documentation. I want you to adopt that same mindset because this is what ends up happening. There's an incident. You have a conversation with an employee. You set expectations, and you're like, okay, yeah, I'm going to document that tomorrow. I got to get home. I've got all these other things going on. Tomorrow comes, you forget. Oh, that's right, I need to document that. Then the next day comes, you forget. And then, before you know it, you end up saying. But you know what? All right. If it happens again, then I'll document. By then, it's too late. Okay. Start a documentation trail early as soon as there's an incident. As soon as you have a conversation about expectations. Okay. I think you get it by now.

Dr. Renee Thompson:
All right. I want to spend the rest of our time really talking about how to document. I had one of our clients. It was a leader. She had an incident with an employee. This was in an ambulatory care clinic. And I said, she said, okay, I documented it because we were talking about this as part of our process, you got to document. And she documented the incident. I said, can I see your documentation? Can you share it with me? It was eight pages long, and when I asked her how long the incident was, it was like a minute and a half. And what she put in there was all of this other stuff. She's been bullying people for years. I've had issues, time and attendance all over the place. So I worked with her and we actually reduced the amount of pages down to one. So, what I'm going to go over with you are the essentials, and that's what I want you to think about in your documentation. And when you understand the essentials, what must you document? You'll find that it's so much easier to start a document documentation trail on your employees because I'm making it easy for you, okay? It's not all this other stuff. It's just very clear this is what you document.

Dr. Renee Thompson:
The first thing that you need to include is the date and the time or aproximate time, and this even works if you didn't witness this behavior. So if there's an incident, the date and the time might be when somebody told you it happened, like in morning, in morning during shift report, this happened. Without a date, your documentation is almost invalid. And again, it's not, document that it happened, but can you prove that it happened? So you always want to include a date and a time. Believe it or not, sometimes that's missing. Sometimes, people do not include that. Then, the location. Where did it happen? Was it at the nurse's station? Was it in the break room? Was it in the patient care hallway? Where exactly did it happen? Then, were there any witnesses? Now, I talk about this. I think in that episode with HR and episode 28, when I was a frontline manager, people would run into my office complaining about their coworkers, and I would say, and they would give me examples of things that they did, and I'll be like, oh my gosh. I said, okay, can you write that down? I'm not writing anything down. Okay, here's the deal. It actually doesn't matter if the witness documents the incident. What matters is that if there was a witness that you include their name. Okay. Now, chances are HR is going to want to do an investigation depending on the severity of the behavior, and they're going to get pulled in anyway. Don't, like use, they're not going to document it anyway as an excuse not to identify where there are witnesses there. So, if you know there are certain people standing there when the incident happened, make sure you include their name because it just lends more credibility to your documentation. You want to then describe the incident; what happened? Now, you want to be as objective as possible. Just the facts. Do not include your opinion. Do not include, This is the 27th time that I've had a conversation with this person. Just include the facts about the incident, and then if you're going to document your conversation with that employee, just include those facts. This is what I said. This is what they said. Okay. It even works really well if you didn't witness the incident but somebody tells you about it. So remember what I said: my employees would come in. I'm not writing anything down. And then I would say, okay, I'm going to go and talk to them. You know, don't say anything. If they find out it was me, they're going to make my life miserable. So, a lot of leaders get frustrated. They don't think they can do anything while you're handcuffing me. There's nothing I can do. If you're not willing to help me, I can't help you. You got to document. And some people will actually will disagree on this. I say, don't force them to document, but what you can do is as soon as they walk out of your office, you document it. Okay, you document the incident. It's not going to be as strong, I know that. But if you have 40 of your employees complaining of the same person, similar situations, and you've got all that documentation, you're clearly showing a pattern. But let's say your employee is not willing to document, doesn't want you to say anything to the person.

Dr. Renee Thompson:
Ask them questions. What exactly did they say? Who was there when this happened? You want to do some Intel. You want to try to get as much information as you can, objective information, so that you can include it in your documentation. Okay. And speaking of what did they say? If you can use any verbatim comments, include them in quotes in your documentation. So I've told this story many times where when I was his manager, I had a nurse and a nursing assistant who did not get along, and everybody knew it. And one night, they were both working, and the nursing assistant said to my nurse, my boyfriend knows which shuttle you take, and he's going to be waiting for you to beat the s h i t out of you. Okay. Not only does she say that word, she said it three times in a patient care hallway. How do you think I found out about it? Do you think any of my employees contacted me? Not one. The wife of one of my patients overheard this, was concerned for my nurse, called security. Okay. Security made sure she got to her car. Okay. I was actually able to terminate that employee because I had plenty of documentation. That patient's wife. We had another patient who heard this. There was a pharmacy tech delivering meds who heard it, and there was transport bringing a patient up from the emergency department. Not one of my employees documented, but thank God for other people. In all of their documentation, they all had almost verbatim exactly what she said. You can't deny. And I remember bringing her into HR. I didn't say that. I'm like, I've got the documentation. And then she says, oh, I was just kidding. Can't she take a joke? You weren't just kidding. And I was able to, as I like to say, and you've probably heard me say, therapeutically extract her because she was a problem from the beginning. I had another new nurse who said she had asked a group of nurses sitting at the nurses station if they could tell her what the number for pharmacy was, and one of them said to her, yeah, it's one 800, go f yourself. But said the word, what is wrong with people? And so you better believe. I told her in her documentation to use that verbatim language. This is what he said to me. Verbatim language in quotation marks lends credibility to your documentation. So, anytime you can include verbatim comments, do that.

Dr. Renee Thompson:
Now, there's another component that's an essential component to your documentation. If you can utilize any language from your existing code of conduct policies on disruptive behaviors. Think about your core values. Any language that you can insert. This is a violation of this part of our code of conduct. Link it back to an existing organizational document that, actually, this is how we treat each other here, okay? Every organization has it. Take a look at it and pull out some of that language because that strengthens your documentation. It's not like my opinion that this was disruptive behaviors. It's, oh, wait a minute. We have this clearly identified in our employee code of conduct that we don't behave in this way. Okay. And then here's the tying this up with a bow. You've got to link someone's behavior to a patient safety quality satisfaction or a team performance issue. Because when you think about it. So, someone rolled their eyes at someone. And let's say you're going to document that. I'm going to ask you what's the so what factor here. So what? Somebody rolled their eyes. Now, if you ever heard me talk, eye-rolling is a problem. But is it worthy of all of your documentation? And where's the link? Where's the harm? If it's an insulated incident? Now, I might jot that down in my little journal, but I don't know that I'm going to go down this path for eye-rolling. You've got to be able to link someone's behavior to something that's bad. Somebody refused to give report to someone else. Somebody didn't like their assignment, and they're stomping down the hallway saying, I'm not taking this f-ing assignment, and they're saying the word in front of patient care rooms. You've got to ask yourself, so what somebody acted in this way? Where's the harm? What's the impact? And if you can show that, I'm telling you, it's slam dunk.

Dr. Renee Thompson:
Okay. Now, especially if you have anyone on your care team, so you have a nursing assistant, you have a respiratory therapist, you have a nurse, you have a physician, any of those who are directly impacting patient, see if you can pull the mom card like somebody refuses to give report to someone else or withholds information. And that could affect someone's mother, okay, someone's mom. But what if it's ancillary? What if it's housekeeping? What if it's registration? They really don't have any direct alignment with patients. You're going to have to think back to see where this actually may end up impacting a patient. I think housekeeping it does affect patient satisfaction if the room is dirty, if the housekeeper is rude. Gosh, I've heard so many stories, wonderful stories about people who work in EBS, and I've also heard horrific stories about people who work in EBS. Clean it up yourself. They don't pay me enough around here, okay? I'm like, oh, did you just really say that to a patient? So no matter what role, no matter what the situation, before you sit down to document to the point where I'm going to document this, and this is going to become a part of their file, and I'm going to share this with HR. Make sure you can answer the so what factor.

Dr. Renee Thompson:
So I'll just do a recap of this, and then we'll wrap things up. First of all, get into the habit of documenting. Somebody tells you in passing okay that an employee behaved in a certain way. Just go ahead and document it. Just jot it down somewhere, okay? Remember, don't leave your work day until you've documented on your employees. Document on them like you've documented on your patients. So just keep a running list, okay, of different situations that have occurred that day. And honestly, I would do good and bad so that you can capture it and maybe recognize somebody for goodness later. Use it in a shout out during your huddles, but also those incidents of negative behaviors, you just want to document them. But then let's say there's a situation where, ooh, okay, this is an incident of disruptive behaviors that either I witnessed or somebody told me about that is more serious. Make sure you include date and time, location, any witnesses and objective account of the situation, any verbatim comments that you can that were used. Okay, if you can use verbatim comments, do that. Link their behavior to two different sources. Number one, your policies, your code of conduct, your values, whatever that is from your organization, show a direct alignment to that, like a violation. And then, if you can link it to patient safety quality, patient satisfaction, or in some way communication like with team communication, relationships, team performance. Once you have all of that, then share it with your boss and then share it with someone from HR, say, here's my documentation and I would do this early.

Dr. Renee Thompson:
I wouldn't wait until six months from now to say, this is there's an incident, I documented it. Can you take a look at my documentation? Is this good? Is there anything that I should have added? Is there anything that you would need? If I get to the point where I need to put this person on corrective action, because this might be their first step on corrective action if the incident was significant enough. But again, the goal is not to put people on corrective action. I hope you understand that's never my intent ever, with all of the work that we do. My goal is not to put everybody on corrective action. I truly believe that if you sit down and have an honest conversation with somebody about their behavior, and I call it a coffee conversation, and again, it depends on the severity of the behavior. Obviously, if somebody is threatening someone, that's an immediate I'm going to document what happened. That's not, let's sit and have a chit-chat about what made you so angry to threaten her with your boyfriend beating her up. But I truly believe if you sit down and you just tell people the truth, or I'm not sure you're aware, but you come across as very argumentative and abrasive at times, and then you give them an example. It's not okay. Can we talk about this? You have that conversation. Most people will actually step up and behave in a more professional way, but they're not going to be able to do that if you don't tell them the truth.

Dr. Renee Thompson:
There are people who are misbehaving in your department right now, probably for a decade or two. And nobody's actually sat down and had an honest and respectful conversation with them. So start there. Just start telling people the truth. Just start having honest conversations with people. But then every one of those conversations, you need to document it. And if there is an incident that you're like, oh no, this kicks it up a notch here, I need to do something. Follow this documentation process where you immediately fill this out. Make sure you can align their behavior to the organization's policies and conduct. And then with patience, get HR to review it to make sure the documentation is good, independent of whether or not you're going to put them on corrective action. Just get into this habit. It will save you so much time, and energy, and frustration later on if you decide that this person truly needs to be therapeutically extracted from your organization. Because I've said to so many leaders, when you have that honest conversation, one of two things are going to happen. That employee will step up like, oh my gosh, I had no idea I was coming across that way. Okay, I don't want people to, I don't want to be known as the bully in the department, or I don't want to be known as someone who's argumentative.

Dr. Renee Thompson:
They'll step up, or they'll step out. They'll step out on their own, or you'll step them out. Okay. And hopefully, you'll be more prepared if and when you need to do that. Okay. So I hope that was helpful. So many people ask me about documentation. So, I wanted to have an episode just to give you some pointers on how to do that. And I want to thank you for carving out time out of your day to be here with me today. And if you like this podcast, if you could please give us a review, if you could rate us, and if you can share this with someone who might need to hear this, and if you have any requests, if there's any topics that you would like me to include in this podcast, just go ahead and reach out to us at [email protected]. So, I want to thank you all for being here today. Take care everyone. Bye.

Dr. Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found this podcast helpful, we invite you to click the Subscribe button and tune in every week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit us at HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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