Combative Employee Rubbing Patients the Wrong Way.

39 Comments

1. AnonymousOctober 25,2023 at 6:33PM UTC

   I’ve seen this before where a well intentioned leader fails to flex their coaching style for this type of employee.
   These types of employees are my “specialty” and I love them. Be direct. Don’t hint or speak in generalities. Give clear examples of what was done inappropriately and then clearly show how you expect it to be done and why. Provide clear and direct consequences. It can all be done in a dispassionate way. You aren’t angry, scared or etc. These are the facts. Then let them know you value their work and etc but these are the things needed in order to avoid negative consequences . I’m very passionate about this as I’ve seen good employees terminated or all parties made miserable, when all that was needed was a change in approach. And many of these types of employees were grateful to have someone give it to them straight.

2. AnonymousOctober 25,2023 at 7:29PM UTC

   Being direct is absolutely the goal. I am using direct quotes that are not acceptable and offering what is acceptable.

   What do you say to 'shut down' the combative response? This employee will explain away or always have a reason that she thinks she is right. Quick response to defensiveness. I really want to break through the defensive knee-jerk response to encourage her growth.

   I know it will not be easy but I believe that coaching her is worth the effort, to help her and also to learn how to be more skilled myself at reorienting behavior like this. Thank you.

3. AnonymousOctober 26,2023 at 12:22AM UTC

   Have you asked her if there was a way she could have handled it better to see how she self-evaluates after one of these incidents?

4. maria roseOctober 26,2023 at 6:03PM UTC

   Utilize this employee’s self evaluation skills for each encounter that you have an issue with. It sounds like this employee has no perception of how they are being viewed by others because they are not on the receiving end of their feedback to the patient ( could be their tone of voice or very clinical explanation that is making them seem cold) I was strongly reminded of the autistic doctor on the Good Doctor series who has an excellent sense of the problem but has to learn how to communicate emphatically with others with less clinical wording to give a more personable attitude to the patients about their situation. Perhaps if they write down what they are trying to communicate verbally would help you get them to understand how to communicate better verbally.

5. AnonymousOctober 26,2023 at 2:58AM UTC

   my suggestion is to pause when she offers pushback. Pause and leave quiet air for 5 to 10 seconds. Then calmly let her know that your goal is to let her know what is expected and the consequences of not doing what is expected. Understand there are feelings and opinions but these are non negotiable expectations and if not met there are consequences. Then let them know that you are making the effort to coach and redirect because you value their work and their efforts but, if they proceed to reject feedback, you will stop providing it and simply hold accountable. Then smile.

6. AnonymousOctober 25,2023 at 7:53PM UTC

   I would shadow her for a day. This may help her to be better. But also do it randomly for a few other employees so she doesn't think it is just her. When she argues then ask her why she felt that was important to argue over. Or why did she feel the patient was wrong. Does she realize she is doing this?

7. Maggie StoneOctober 26,2023 at 1:16PM UTC

   I might take the opposite approach. No one does their best under scrutiny. Have her listen to calls or shadow you or someone else who models the kind of behavior you want. Have her note what worked or got better client response. Do some role playing with her, or give her examples of language to use. Ask her if her approach gets the action or response she wants. Does she feel she is explaining why she is asking for or advising a certain thing? But I think it will be hard for her to get over the mindset about being right. If she doesn’t get it, and you don’t want to fire her, is it possible that you can switch her to a different position that doesn’t involve client interaction? BTW, is she aware of client complaints?

8. Sparks Hope Anxiety Relief - TammyOctober 25,2023 at 8:56PM UTC

   Hi. I work with folks like this; it may likely be some personal experiences that have led to defensive and reactive behaviors. I can do a discovery call with you both or just with her if she is willing to be coachable. I can help you and her see what's possible. I work with even the cynical and easily get them to show results on day one. It's all about helping her to see how she can become aware of what is blocking her and causing her to be reactive and commit to being open to learning new ways to release the old beliefs and stuck experiences. Then we practice taking new, calmer, and more connected responses. You both and the patients also get to see the results long-term, so this will be life-changing work for her. It's great how you are committed to keeping her and seeing all she has to offer.

9. AnonymousOctober 25,2023 at 9:27PM UTC

   Just me? The title of this concern? Really, is it just me? I think some wordsmithing would help.

10. AnonymousOctober 26,2023 at 12:42PM UTC

    Honestly, as kind and compassionate as you want to be, you are not going to rehabilitate this employee. This is especially aggregious given it is happening to patients. I had an employee who had a similar disposition and was gently warned on several occasions and warned that if her approach / behavior didn't improve; specifically that she could not speak to people that way, that she could be terminated. I eventually fired her and right up to the time she walked out the door (angrily and unprofessionally), she insisted that everything was someone else's fault. My only regret in that whole scenario is that I allowed her to remain employed with us far longer than I should have. Shame on me! Never again. It is not your job to retrain personalities. If

    an employee does not reflect the type of behavior, respect, restraint required in your business, than she or he must go sooner than not.

11. Michele Cresmen-BlockOctober 26,2023 at 1:16PM UTC

    There is opportunity for growth here for both you and the employee.

    First, you need to be clear: what do you expect of them and what you will do if they don't change. What do you expect in 30 days? 60 days? 90 days? Permanent change doesn't happen over night, and it sounds like you've already given them coaching and direct conversations. Are you ready to go to a more formal Growth Plan? "Here's what I expect, I'm here to help you, if you can't change this behavior, I'll have to let you go." Be frank with yourself - will you really let them go? If not, then why are you spending energy on trying to help someone improve who may not see the problem. If you are, then be explicit and try to make your expectations tangible. Like "take a course", read book "X" (maybe Emotional Intelligence 2.0 - which encourages making your own plan to improve), with review dates so you both follow up on how they're doing. Prepare yourself in whatever way you need to be ready to have the conversation. Check out some of the free materials from https://cruciallearning.com/ or read their book Crucial Conversations. Or visit https://www.radicalcandor.com/ for free info or read Kim Scott's book Radical Candor. Both have great views on these kinds of conversations.

    Second, once you're clear on your expectations and have ideas down for their continued growth, have the conversation with them. See if they think this is a problem - if they don't think it is, you have an uphill battle. If they're interested in growing, ask if they have actions that they can take to grow, if they do and you agree with them, see how you can adjust the growth plan. Make this collaborative, not an order from only your perspective.

    Third, this part is the most difficult: keep following-up and keeping a record of how they're growing. Expect that they're human and will fall back into old ways. Celebrate when they make milestones you both have set. Set new milestones as needed. Staying the course over time can be a grind and sticking with it will be hard for you and for them. Support each other and let them know you're in it for the long haul (if you are).

    Finally, be clear with them when they have exited the formal Growth Plan. It's not fair to have it hanging over their head for eternity. And consider continuing to work with them on growth - for your mutual benefit. See how you've grown as a leader and how they've grown and if it's something you want to continue - without the possibility of firing.

12. AnonymousOctober 26,2023 at 4:17PM UTC

    Have you tried shadowing with her on calls with patients? That might be a way to listen in and advise accordingly. if there are specific examples then share them with her. Does she know her behavior is such? If not first thing is she needs to acknowledge this behavior and show some ability to fix it. Perhaps she is concerned that people are not listening to her? or that she is not being heard. Maybe some anonymous surveys to patients where you can consume in one place the issues will help to fine tune the fix. As her manager this is fixable and the fact that she knows you want to retain her but have not been able to contain her may be fueling the behavior. Set strong guide posts and don't waiver from where they get set.

13. Terrie McWhorterOctober 26,2023 at 10:14PM UTC

    Expectations. Pull her in and ask her how she is doing with her responses. Re-iterate that it is very important to the facility that you have zero patient complaints and that you are needing to track them. Let her know and let ALL employees know that in this tracking process if they have 3 in a quarter or more than 3 in 6 months or whatever you choose, that there will be steps that need to be taken. First step is a verbal warning, second step is a write up third is HR counseling and 4 is termination. You have to make sure that you keep really good records of EVERYONE. But having your employees to know what to expect and them giving them examples helps. Hope this helps

14. LauraOctober 27,2023 at 12:46PM UTC

    good idea

15. AnonymousOctober 27,2023 at 1:53AM UTC

    Are there video cam recorders where you work? (They are everywhere where I work.) if there is a tape recording, show her how she’s acting.

16. AnonymousOctober 27,2023 at 12:21PM UTC

    Being “right” with patients and having arguments is never a great thing but it is two sided and a product of an employee that is overwhelmed in the health care system. Everybody she encounters probably fights her on every thing from copays to service and every patients wants everything right now immediately. It can be overwhelming. Maybe no one is listening to her and the arguments escalate. Again, having to be “right” and arguing isn’t the answer either but she’s probably burnt out. Are you understaffed? Is she taking on more work than other staff members? Ask her how she feels about her workload? Is there a way for her to do her job where she can focus on what’s the most important part of her job and she can do less and have the work spread out among the staff? This will hopefully make a difference.

17. AnonymousOctober 27,2023 at 12:22PM UTC

    A good employee is someone who does all of the tasks well AND has a great attitude toward patients. I managed in healthcare for years. You cannot fix a bad personal service culture but you can hire for a good one. I would manage her out of the organization. She's not a fit and patients deserve better always. There is a better candidate out there.

18. AnonymousOctober 27,2023 at 3:55PM UTC

    "manage(ing) her out of the organization" without even trying to determine a root cause or if there are other ways to communicate more clearly is just really bad management and exemplifies much of what is wrong with work culture these days.

19. AnonymousOctober 27,2023 at 4:17PM UTC

    Nope. It's years of experience. She has already been managing her without result. This isn't a "good" employee, doing this over and over. Patients aren't test cases. They aren't practice. There's ZERO excuse to be argumentative with people who are vulnerable and ill. It's unprofessional and makes them feel like less. Many people get into healthcare these days because the pay is great. Not because they have the calling and EQ to do it. My teams had the highest patient satisfaction awards in our system year after year because no one allowed themselves to treat people as anything other than an intelligent human being who needed caring and respectful treatment during a vulnerable time. They aren't working in retail.

20. AnonymousOctober 27,2023 at 12:24PM UTC

    The person flat out needs a vacation. Then in a calmer state a one-on-one conversation can occur about resolving this issue.

21. Darlene MirtoOctober 27,2023 at 12:30PM UTC

    You might look at this another way. Are there some policies in your practice that are causing patients to be frustrated and argumentative thereby triggering her? Perhaps this employee is caught in a position where she is always giving patients bad news or not able to help them due to policies of the practice. It’s worth a discussion with her about what she finds frustrating about her job. It may be eye opening.

22. LauraOctober 27,2023 at 12:45PM UTC

    I, too, have left practices due to people like this. Sad situation.

23. AnonymousOctober 27,2023 at 12:54PM UTC

    She might have OCD, and feel very strongly that if she doesn't speak up, something really bad will happen to the patient, and she MUST say her piece, even knowing that she shouldn't. An example, when I was a kid I worked in a hospital kitchen, and kept sending glasses back because they didn't look clean, and what if someone dies if I use them. What works for me is to be reassured: like, stuff that comes out of the dishwasher is sterile, you will not cause anyone to get sick. If someone had told me that, I could have relaxed. I simply didn't know enough about microbiology.

24. Lauren JohanesenOctober 27,2023 at 1:00PM UTC

    She sounds like she has some unresolved trauma. Do her benefits cover therapy. Coming from someone who struggled with needing to be "right" or heard a lot. The direct tip I'd give is to be very validating. Anytime she does it with you, say something like, I appreciate and value your opinion. That's not going to be the right thing for me to do, I am going to do it my way. And see how she responds. It's hard! I get it. You're doing great and being kind/empathetic.

25. AnonymousOctober 27,2023 at 1:11PM UTC

    I had a similar situation when I took on a new management role. A lot of people gave me similar negative feedback about a specific person. While my initial thought was to go in and be direct, I decided to take a different approach and simply asked a lot of questions about how they felt about the role, what was motivating, what was frustrating and guiding the discussion around the topics i had negative feedback. After the discussion this person thanked me for listening to their point of view. THEN, I could coach them. They made a lot of improvement in short time.

    I share this because often as managers we want to go in and address an issue but without a better understanding of root cause or contributing factors. Some things we can influence and some things we can't. It's important to break down the situation and change what you are able. Does she feel she has to set the record straight? Does she find people confused about certain policies or procedures? Does she realize people have a negative reaction to her corrections? Does she have home stress, mental health, etc issues?

26. AnonymousOctober 27,2023 at 1:31PM UTC

    Does she always argue about the same topics or is it just everything or how does that look? I don't work in healthcare but was a victim of someone like this after delivering a baby. It's 13 years later and I still think about it and am still annoyed by the fact that I had to get cranky and ask for a new nurse (and yes, at one point I nicknamed her Nurse Ratchet). I had a c-section and she INSISTED and argued with me multiple times about taking a bunch of pain killers. This was my second one, I went through the first with nothing stronger than tylenol and I don't like what those drugs do to my body. I have a high pain threshold, etc. In other words, I was ok with my decision and willing to live with it if it was painful (it wasn't). She would not let it go. She went on some tangent about her daughter needing them etc. I don't know if that was what was driving her to be so argumentative and insistent, if it was her own experience, or what, but after I told her no in the neighborhood of 5-10 times, I finally said it in a not nice way and asked her to leave my room, and never come back. I have no idea how far this person is going in being argumentative but from the other side of the situation you have to get to the root cause and get her to stop it. If it still bothers me 13 years later, that's really kind of unacceptable. In my opinion it is a career derailer and you may have to be that blunt with her. Look you do a lot of things well (name them) but this issue is a career derailer. You cannot continue on this path so how do we get to the bottom of it, what tools can you use when you feel yourself wanting to argue, how do you read the room to know that it is time to walk away from this argument, etc. It will take time and a lot of your involvement in my opinion but it does need to stop.

27. K MadiOctober 27,2023 at 1:36PM UTC

    What do her co-workers say? Is she obnoxious to work with as well? From an employee standpoint, there is nothing worse than working with someone who feels entitled to be a “right-fighter” with customers or worse, patients? Come on! Trust me when I say that the other employees are wondering why she gets away with being a jerk. She has been there for 4-years—maybe she’s burnt out? It doesn’t really matter, bc for the sake of the patients and the practice she should not have customer/patient contact. Tell her you overheard some of her interactions with patients (you know about this behavior-either first hand, by complaining employees, or by unhappy patients so you can say what makes sense to you), then give her a warning that she is on notice, and although you’d like her to still work there if this doesn’t change immediately, then this position is no longer a good fit. A couple of things may happen: You might have a better position available or coming up soon that you can discuss with her (that doesn’t involve constant, if any, customer contact, she might agree with you and this could lead to a great conversation that may lead to her hitting the reset button, she might realize that it IS time to leave and she’s grateful for the feedback and for not being fired—staying to train her replacement, or she might tell you to F Off! In that case, well, now you know. Bottom line is that I’ve seen it time and time again where employers put too much effort into appeasing the wrong employee for far too long. Good luck!!!

28. Amy GrimshawOctober 27,2023 at 1:47PM UTC

    tell her straight up what you want her to say. This is a personal issue that goes back to childhood. She’s not catching on to the way you’re communicating it to her

29. AnonymousOctober 27,2023 at 4:32PM UTC

    Someone already mentioned this, but the first thing you need to know is if she sees the problem. If not, I recommend recording interactions to show her and talk through the scenarios where she was combative and see if she sees it. I would ask her if after seeing/hearing the recording how she thinks she could have done it differently. This should be a conversation that you guide her through, and you may need to help her refine her ideas or model the behavior you’re looking for trough role play.

30. AnonymousOctober 28,2023 at 2:43PM UTC

    I like this idea, and if recording isn't an option or not something she or the patient would readily agree to, setting up "mock interactions" where someone suggests something she would be opposed to and then critique it at the end. Recording in a healthcare setting with actual patients can get dicey due to HIPAA regulations.

31. Clydene HorriganOctober 28,2023 at 10:46PM UTC

    Good point in the patient privacy. If it’s happening with team mates, that would be a good place to start.

32. KatOctober 27,2023 at 4:56PM UTC

    If she's always been like this with patients, I doubt there's any coaching you can do to make her stop that behavior. Are you sure she has "better aspects" to her personality or do you just think she does? Maybe she's burnt out and doesn't want to do direct patient care/interaction anymore. If there is a position available (or could be created/restructured) to take her out of patient interaction, shift her into that. If not, you need to start taking concrete steps to fire her. She has to know what the expectations are for patient care and how to meet them. Be direct and explicit, don't hint or suggest. [Example: If patient says no, ask why. Discuss other options besides the one you want them to do. Consult with others if needed.] If she can't meet them, she has to go. I know it's hard to find good workers (burn out in health care is huge) but letting this behavior continue doesn't help anyone, especially the patients. If she can't be flexible, collaborative and compassionate with patients and co-workers, she needs to find a workplace that will let her be combative, pedantic and dictate what's "right" to patients.

33. Rosa GoesOctober 27,2023 at 5:27PM UTC

    I think your approach is good. But just remind her of the legal document 'patient rights'. She will see you have to treat patients with respect & dignity.

34. KatOctober 27,2023 at 8:47PM UTC

    I didn't. She should be asking patients for their thoughts on treatment, making sure they understand the pros and cons of each option, not just the one she prefers. But she has to be willing to listen and adapt to their needs. If she doesn't like their answer, insisting that her way is the only "right" way isn't collaborative. Dictating/forcing a patient to do what she wants because she's "right" is not a positive, patient centered approach.

35. AnonymousOctober 27,2023 at 10:46PM UTC

    You may have to start taking applications.

36. Liz MilneOctober 28,2023 at 12:17AM UTC

    In a medical field - as this seems to be - this employee sounds actively dangerous to me. I can see a patient using a medical word incorrectly, thinking it maybe applies to symptoms they're having, and this employee becoming focused on the actual definition instead of listening to the patient's intentions in what they're saying...

    Perhaps tell her that, and tell her the challenge is to understand what the patient is telling her BEFORE she gets into 'winning' the conversation or getting into semantic arguments?

37. AnonymousOctober 28,2023 at 2:25PM UTC

    Most neurodivergent people do not disclose at work because the fear of discrimination is very valid; it seems like that could be a factor here.
    Communication challenges are real!
    Does she seem to mean well/care about doing well and just execute in a manner that is a little "off?"
    As someone who is ND myself, it's BEYOND frustrating to have someone say they don't like how I said something, and then when i ask for examples or ask how it would sound better . . . crickets.
    Does she have counterparts in the role who could help with "scripts" or could you?
    If patient says "x" you should say something like "y."
    Try some role-playing.
    This approach isn't ND specific either, but please, if she is ND (which I'm not suggesting you ask directly, as that puts someone on the spot), she's been criticized her whole life without understanding why. Start by telling her what you appreciate and that you want to help her be the best staffer she can be and get the best performance review possible, and you want to lay out a plan to work on these particular areas of communication.
    If asked, make it clear what you are suggesting is NOT a PIP; that really ends it for most people because they are so stigmatized.

38. AnonymousOctober 28,2023 at 11:24PM UTC

    While I typically don't like people trying to diagnose others on a board like this, I would agree that this is a possibility, and ND or not, what you suggest is valid. I suggested something roughly similar in my reply. As a case in point, when I onboarded new employees and interns at a non-profit drop-in center who were starting (or interning) as case managers, we had a process where they shadowed two veteran case managers for two weeks (one week with each). Then they took over, and for the next two weeks, the same two case managers shadowed them as they interacted during intakes and service encounters. Once they felt comfortable working with clients, we started to back away and let them go, but always being there if they had questions. During these second two weeks, we critiqued every encounter after it was finished with how they did and gave suggestions if we thought it could be done better. One of my case managers I inherited, and he was ND from Cerebral Palsy, and it was difficult to manage him because he could only "work from a script" and a strict set of "rules." That doesn't work in case management, as every case is different. I had to keep reminding him that is why it's called "CASE management." You find the solution that fits the case, and every case is different.

    You presented an excellent way to do that in a healthcare setting. Thank you.

    Also, the OP is prohibited from asking if they are ND, as that would violate ADA guidelines, depending on the formal diagnosis.

39. AnonymousOctober 29,2023 at 4:30PM UTC

    In the medical industry it's even harder because you can loose your medical license if you have, say, depression and a whole host of other mental health issues. I think this needs to change stat, what's the best way to have people avoid getting treated? Put their very career on the block if they do.