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How to keep toxic employees from harming your practice


Toxic employees can be a drag on your medical practice, sapping the morale of your staff and impacting how your patients view you. Here are some tips to help you identify and manage toxic employees, and provide these workers a chance to shape up before you have no choice but to ship them out.


Judy BeeToxic employees can be a drag on your medical practice, sapping the morale of your staff and impacting how your patients view you. Here are some tips to help you identify and manage toxic employees, and provide these workers a chance to shape up before you have no choice but to ship them out.

Physicians value technical skill in a worker over almost everything else. Of the three components of employee evaluation-attitude, availability and ability, physicians are inclined to forgive lapses of the first two where the employee has high procedural capabilities. “Yeah, she’s a tough nurse but she’s good.”

In the operating room, that may make sense. But in the office, tough is inherently bad. An employee who is cool or clipped with patients or co-workers is a public relations or management liability, no matter how skilled. And tolerating it often erodes morale in the rest of the staff and generates turnover. We call workers with reliability (on time, every day) and attitude problems toxic because they poison the atmosphere where teams need to grow.

On any performance review for office staff we stress three parts of the performance:  Availability, Attitude, and Ability, in that order of priority.  It is true of almost every job in the office: If a worker brings the first two qualities and an average IQ to work, you can teach him or her what to do to succeed. 


Some practices experience high absenteeism and late arrivals.  That might not be a problem for a hospital with large numbers of workers with flexible schedules and redundant systems for coverage. 

In a smaller practice with ten employees, having one out for any reason is a problem.  With three employees out it can be a disaster.  Even though there are good reasons to be off work-child care, illness and the like-you depend on the worker. If he or she is not reliable you are not being well served no matter how good she is when she shows up.  The remaining staff gets grumpy when pushed to their limits over and over, and they may also start taking “mental health days” in retribution.  That generates resentment and depresses physician production.


Most people say it’s too subjective to fairly evaluate employees’ attitudes.  But here are real examples of good attitude that, if not present, affects the practice:

  • A cheerful demeanor no matter how stressed.

  • Courteous and cooperative at all times.

  • A willingness to help the team all of the time, not just some of the time.

  • Clean and professional appearance every day, all day.

  • Considerate of other’s time and feelings.

  • A willingness to give co-workers the benefit of the doubt.

Remember, attitudes are contagious, both good and bad. 

If you don’t believe it, go visit a depressing office in your town.  Where do they get all those drones?  They don’t hire them. The office environment helps create them. 


Do the performance review

First, deal with the objective criteria. Get the facts about time off (all reasons) and late arrivals. Define ‘on time’ as ‘at work and ready to work.’ Point out that quality of work doesn’t count if the worker doesn’t show up. And arriving late prohibits a worker from helping other workers even if it doesn’t interfere with her primary duties.

Then tackle the more ‘soft’ (but equally destructive) behaviors:

  • Does the worker persevere and keep trying to improve and meet expectations?

  • Does he/she show initiative?  Offer to help others without being asked?  Act when she sees a need, such as emptying an overflowing trash bin in the patient bathroom?  A team-player, work-oriented attitude isn’t about whose job it is.

  • What about cooperation?  Is he/she willing to help others when asked? Some workers are not very intuitive but willing if you just tell them what you need or want. 

  • Courtesy is a big one.  Some workers will be sickeningly sweet to patients and snarky with staff members.  That just makes them look phony to patients.  A team player is as courteous to coworkers as they know they should be to patients. 

Finally, ask the worker what his appearance says about his respect for the job and the patients. Unkempt hair, chipped nail polish, wrinkled uniforms all say “I don’t care; it’s just a job. “

Don’t overlook corrosive behavior

Toxic employees fail the Attitude portion of the performance process.  When you allow that, the rest of the staff loses respect for the leader, whether manager or physician.  American psychologist Abraham Maslow observed that  belonging to a group, being part of a team, is a high order motivator and it’s hard to achieve self- and conferred esteem and self-actualization without this crucial step in the process.  Worse, toxic employees ruin the sense of a team and belonging for the rest of the staff.  Often we see morale tumble as the other employees observe a skilled but toxic worker get away with murder, especially if  it’s the highly skilled nurse, tech, or medical assistant.  Non-confrontational physicians or managers will overlook the corrosive behavior, making the rest of the team feel like saps.

Just do it

Take the toxic employee aside for a performance review and tell him he has to have acceptable scores in all three areas of his job. 

Describe where he’s failing, and give examples.  Tell him what you want instead.  “Be nicer” doesn’t help much, so be specific about what you expect and when it is required.  When he makes improvements, notice it and privately comment on that.  We all work better for rewards than avoidance of punishment. 

Know when to show toxic workers the door

Finally, if a toxic employee can’t or won’t make the changes you need them to, it’s time for physicians and managers to make the decision to part ways with that employee, and to give that toxic worker an opportunity to find a job where showing up with a positive attitude isn’t a requirement. 


When conducting an employee evaluation, Practice Performance Group recommends using

Judy Bee is a practice management consultant with Practice Performance Group in La Jolla, California, and an editorial consultant to Medical Economics. Send your practice management questions to medec@advanstar.com.


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