In a study of 400 leaders, about 94% of individuals stated they have worked with a toxic person. In another study, 70 to 80% of the errors in healthcare were related to dysfunctional interpersonal behaviors. And yet another study found that 51% of respondents reported an increase in patient errors as a result of verbal abuse. In fact, the Institute for Safe Medication Practices has done a research study on this and found that 75% reported they would go to a colleague to interpret the order rather than an intimidating physician. 30.7% of nurses reported someone that they knew who quit because of disruptive physician behavior. The evidence is overwhelming that when healthcare leaders don’t do something about toxic employees, bad things happen to patients and the team.
How do you know if you’re working with a toxic employee?
What is a toxic person? A toxic person is not someone just having a bad day and lashes out. We’ve all had bad days but we’re not all toxic. A toxic person is someone who demonstrates a pattern of counterproductive and destructive behavior in the workplace. As a leader, toxic employees tend to be the ones you struggle with the most because they may be clinically excellent but leave a trail of “dead bodies” behind them. They may be overtly toxic (criticize, argue, make demands, openly blame others, etc.) or covert (sabotage, undermine, gas light, etc.). Once they target someone, that person either quits, transfers, or may attack back leaving you to deal with a constant battle between employees.
Make no mistake about it; leaders have an ethical responsibility to DO something about these toxic employees. However, in many cases, although the leader may know how destructive they are, they also justify, ignore, or do work-a-rounds themselves to avoid being their next target!
Why taking action against toxic behaviors matters in healthcare
Research shows that toxic individuals affect personal well-being, team performance, and organizational productivity. As previously shared, numerous studies show the negative impact toxic behaviors have on patient outcomes. When destructive behaviors are ignored, it causes others on the team to have less commitment to the organization. The less commitment, the more they are likely to reduce their work effort.
Often, the targets of these toxic behaviors will figure out a way around that toxic person. Nurses will call off if they see they are working with a toxic co-worker, or if they’re working, will go out of their way to avoid interacting with this person at the detriment of patient care. So, it not only impacts our personal well-being, but also the organizational effectiveness as well.
Strategies to Address Toxic Employees
Ultimately, addressing toxic employees requires a strategic plan, preparation, and a healthy dose of moral courage! The following strategies will help you.
Strategy 1: Meet With Your Toxic Employee
Many times, a toxic employee isn’t even aware of their destructive behavior because everyone else has normalized it. “Well, that’s just the way she is. Just stay out of her way and you’ll be fine.” You can’t expect someone to adapt their behavior if they’re not even aware their behavior needs to be adapted. Therefore, you start with heightening their awareness by confronting them.
Use this 3-point process to confront a toxic employee:
- The Intro-say something like:
- “Help me understand what just occurred…”
- “I’m not sure you’re aware of this…”
- “I was offended by a comment that you made at this meeting and would like to talk about it with you.”
- The Behavior-identify concrete behaviors, like:
- “I just saw you roll your eyes at John when he spoke.”
- “The last few times we had a team meeting, you raised your voice at me in front of others.”
- “When you saw your assignment this morning, you stomped down the hallway loudly complaining.”
- The Adapted Behavior– end your conversation by saying:
- “I never want to find out that you behaved this way again.”
- “When you receive an assignment that you don’t like, I want you to respectfully discuss the assignment with your charge nurse – not yell and stomp in patient care areas.”
- “It’s unprofessional to raise your voice, yell, or criticize a peer in front of others. Instead, I want to see you communicating with honesty and respect, calmly, and professionally.”
Strategy 2: Identify Consequences
Work with your HR department and executive leadership team to agree on the consequences of these behaviors. Unless there are consequences, there’s likely not going to be behavior change. It’s like a kid having a tantrum in a grocery store because she wants a lollipop and the parent gives the kid a lollipop to quiet them. The kid learns that if he just keeps acting out, he’ll get what he wants.
As a leader, it’s important that you’re holding employees accountable for professional conduct as well as performance. Follow these 3 “simple” tactics:
- Identify consequences – Based on policy, process, and HR’s input.
- Inform your employee of those consequences – “If you do ____ again, this is what will happen.”
- Follow through – “Because you continued _______ we have no choice but to ___________.”
Sounds simple…right? However, in our experience, leaders are not consistently doing this. And when they either “threaten” the employee with consequences but then ignore, rationalize, or justify why they don’t follow through on those consequences, they end up with a bunch of kids throwing tantrums.
Strategy 3: Make sure you don’t hire a toxic employee
The final strategy is to try and avoid hiring these individuals. When interviewing someone, include your team in the interviewing process – nurses, unit clerk, PCTs, etc. After they’ve had an opportunity to interview them, ask these questions:
- Did the person engage you in conversation?
- Did the person look like they lived out our values?
- Did the person seem like someone you would like to work with?
And after the interview, come back and collect the data. You will find some very surprising things because people are on their best behavior with interviewers, but not necessarily with individuals who they perceive don’t have power. We know many of these people actually do have power.
Finally, don’t try to do everything at once. After all, unless your toxic employee does something totally horrific, it may take some time before they either adapt their behavior in a positive way or you decide to “therapeutically extract” them! The key is to be consistent with setting behavioral expectations, identifying consequences, confronting, and holding your toxic employees accountable for their behavior.
Remember, as Perry Belcher said, “Nothing will kill a great employee faster than watching you tolerate a bad one.”
Co-written by Dr. Renee Thompson and Dr. Mitch Kusy. Dr. Kusy is a consultant with the Healthy Workforce Institute and author of many publications including, “Why I don’t work here anymore.”