One of the most difficult subjects for any medical practice is dealing with under-performance. Viewed through its various lenses- including productivity, patient, staff and owner (hospital, etc.) satisfaction- under-performance is multifaceted and difficult to effectively engage from all perspectives. An additional distortion is added when normal aging is thrown into the mix.
"You are as old as you feel" is a great saying. However, if a healthcare provider does not have enough personal insight into his/her own actual competencies, normal workplace deterioration can, over time, lead to major interpersonal, financial, and professional problems.
Honesty with coworkers, employees, partners, and spouses is an idealized goal. But such honesty- fraught with misinterpretation and potential conflicts- is rate, and seldom materializes.
Many solutions have been proposed, but a good resolution always requires creating a plan in advance to address performance and performance failures. such a plan not only helps identify problems as they arise, but also gives concrete steps to support affected individuals, while anticipating potential snags that may appear over time. Optimally, taking such steps as a group will get buy-in from co-workers and associates because everyone faces the possibility of such circumstances, at some point.
When a plan is not in place, steps may need to be taken. Fortunately, some people have the insight to recognize increasing limitations. However, others have to be firmly counseled. Because discrimination on the basis of numerical age must be avoided, competency, rather than age, should be the basis for any action. Age discrimination is not an uncommon claim in workplace litigation, consequently, some jobs to have mandatory retirement ages built into employment agreements. Yet, all of us know of very senior individuals who show no signs of slowing down; and - on the flip side - we know of those whose abilities seemed to have tapered off far earlier than otherwise expected.
The best overall solution is to establish a retirement pathway, one that allows for more senior members to shoulder increased administrative responsibilities, and avoids the type of battle faced by many practices in which less experienced "Baby-boomers" wind up unintentionally in charge. Rarely do the more neophyte understand issues that face their maturing predecessors, and the situation can become tense and uncomfortable for all concerned. Honesty and communication are extremely difficult in hindsight; unless pathways have been created to prophylactically deal with such issues, the character, mood, and even the stability of the group can all be placed in jeopardy.
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