Prevent Toxic Employees from Poisoning Your Practice

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Take action before patients go elsewhere for care and valued workers look for new jobs

No matter how long you have been in practice, chances are you have encountered a toxic employee who poisoned the atmosphere of your workplace. If you don't take action fast, such an employee can threaten your relationships with your patients and your staff, affecting your income in many ways:

Staff defections. When one employee treats another one poorly, says Keith Borglum, a consultant with Professional Management and Marketing in Santa Rosa, California, "often, the other staff members are reticent to say anything, so they quit."

And it happens more than you might think. Twelve percent of workers have left jobs because of poor treatment (See "How one uncivil act can affect employees.") When that happens, an employer will spend an amount equivalent to one to five times an employee's annual salary to recruit and train the departed employee, depending on his or her position.

Those statistics come courtesy of research conducted by Christine Pearson, PhD, professor of global leadership at the Thunderbird School of Global Management and Christine Porath, PhD, associate professor at the Georgetown University McDonough School of Business, authors of The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What You Can Do About It.

Decreased productivity. More than 95% of Americans say they've experienced rudeness at work, according to Pearson and Porath. Among workers who decide to remain in their positions despite their bad experiences, a toxic employee frequently becomes the focus of the workplace, causing a time-wasting distraction. And teamwork among staff members may become a thing of the past.

"The productivity of the toxic individual can slow, because nobody wants to be around [him or her]," says Borglum, a Medical Economics editorial consultant. "One bad player on a football team can cause the whole team to lose."

Also, office morale will take a hit if your dependable, hardworking employees think you condone poor behavior. They may see you as an ineffective manager who does not know the difference between workers you should value and those you should fire.

Lost patients. If a patient has a run-in with a problem employee- or even witnesses one staff member treating another one poorly- he or she may be compelled to seek medical care elsewhere and to spread the word about the negative experience in your practice. (See 'Tatient retention: Attitude is everything")

Given these threats to your livelihood, only one solution works when it comes to a confirmed problem worker, experts advise, and although it may seem extreme, you can't afford to put it off: Fire the employee. But first you must properly identify toxic activity, and you'll also want to handle the situation fairly for all involved.


A toxic employee is not necessarily an ineptly skilled one. He or she may even be making positive contributions to the practice, but the person's net effect on the practice is negative.

"Sometimes your toxic employee is doing a really good job; she is just a jerk," Borglum says.

What are the warning signs?

Watch for unethical, inappropriate, or unprofessional conduct. Toxic employees often exhibit passive-aggressive behavior, spread gossip about their co-workers, and are rude to patients and colleagues.

'They stimulate a sense of discord in the workplace," Borglum says.

They also may be uncooperative, exhibit a flagrant disregard for office rules, and seldom take responsibility for their actions. "It's everybody and everything else that's wrong, not themselves," Borglum says.

Many have negative attitudes. "Almost never do you have a toxic employee who is a happy-go-lucky, positive person in the rest of [his or her] life," he adds.

Because you are a busy physician, your staff members may recognize the telltale indicators before you do, so take their complaints about a co-worker seriously, and try to be aware of staff dynamics. …