Bringing dysfunctional or underperforming personnel up to the level of peers

Approach to dysfunctional team members

In our healthcare organization doctors and nurses are highly protected and no formal performance standards are set. Although 95% of these providers  perform excellent in this very liberal system, 5% are less efficient and loyal coworkers and pose a threat to morale of the whole team.

Any thoughts on how to bring coworkers (who cannot be laid off) up to speed?


How to make sense of advanced analytics ?


How to encourage Physicians and patients to choose quality and safety.

Participant comments on Bringing dysfunctional or underperforming personnel up to the level of peers

  1. Involving human resources directly to implement a formal performance review policy across the organization would be critical (regardless of how well or poorly any provider is performing). Then a more formal and individualized performance improvement plan can be implemented for each provider. I think engaging the formality of the process may lessen some of the emotional impact.

  2. First is that you have to set clear expectations of what is expected. Second, obtain feedback from the providers of what is blocking them to be more efficient or motivated and then remove those barriers. Once you have improved processes and define your culture with clear expectations, then you can move into corrective actions. Some people with jump in and buy into the culture but you will lose some of them and that is OK.

  3. In most instances performance expectations can be set, and should be set. And in most, if not all, global environments if measurable and reasonable performance requirements are unmet they can and should be dealt with. Often perception is that they cannot, or the perceived volume of work associated with dealing with them prevents it from happening, but it can be done. It starts with clear expectations that can either quantitatively or qualitatively be measured. From there, if there is a gap you need to determine if the gap is culpable or non-culpable. Non-culpable would be (typically) and education/training/clarity gap that can be rectified with clear expectations or with a training plan of some sort; OR disability-related. any other reason for the gap is culpable and should be dealt with through clear performance management.
    If your HR department can’t help you work through how to deal with this, then your issue may be there. Ofcourse, it could also be that your performance expectations are too high and maybe they are performing to an acceptable level (in which case, you shouldn’t change – keep those standards high! BUT bear in mind that not everyone performs to the same high standard. Again, HR should be able to help you with this – its one of the things they are there for.

  4. Hold up the mirror to their performance (hopefully their lack of excellence has been documented). Then explore why they are underperforming in a way that demonstrates you care for them (“surely this isn’t the type of doctor you wanted to be when you where 25, what is motivating this behavior?”) In my experience most physicians who are disruptive or underperforming are struggling with personal issues. Find out what they are. If someone is just pathological, do everything in your power to get rid of them.

    1. In addition to this, I’d establish metrics are benchmarks and create a transparency initiative showing performance across providers. This may provide the motivation to strive for excellence

  5. This is always a difficult problem to tackle. There is no easy answer but I think it lies in multiple steps:
    1] set clear expectations, common goal, but also a boundery system that aligns with internal motivation of people
    2] measure outcome and share team (average) performance/success with everbody (I would not compare individual performance)
    3] have annual reviews on individual motivation (in particular barriers or causes of unhappiness), goals, and performance. Implement tools like 360 degree reviews, etc to establish feedback channels
    4] give immediate (documented) feedback if bounderies are crossed
    5] involve HRM actively..

    1. Agree- setting clear expectations for all on behavior, communications and productivity are critical. A 360 type evaluation that allows peers, supervisors and reports to comment on the individual can be a great impetus for discussion with the individual.

  6. First thing is to speak with person and make sure you both understand the situation in the same way. Secondly, after finding common understanding – ask employee what he/she thinks on what needs to be done to change the situation. And then meet each week to see on progress. In my experience – many of the underperforming people do not understand they underperform.

  7. This is a challenging problem that occurs in many organizations. In fact, I think 5% is very good! That said – the organizations that I have seen manage this best have a culture of excellence. This happens from the top, the middle and the bottom of the organization. And when someone who doesn’t fit this cultures is inadvertently hired they don’t last long because they stick out and nobody (their co-workers and bosses) want them as part of the organization.

  8. Transparency of definied performance metrics can often drive improvement of your low performers. Creating meaningful performance metrics and making them transparent to your group, organization, or the lay public is powerful tool for change. There are some obvious negatives, but the positives can outweigh the internal angst, especially if low enagement is a factor in the suboptimal performers.

  9. I agree with the comment about creating a culture of excellence from the top down. I also agree with the comment that 5% is very good. In our system we have seen some examples where sharing statistics and outcomes leads to competition and improves performance overall. We have also added financial penalties in some cases where targets are not met.

  10. I do echo the suggestions from my colleagues.
    Most often it is challenging to subjectively tell a person that they are underperforming therefore, I would recommended a well written plan using SMART objectives, a review process and a personalized professional development plan aimed at meeting the set objectives. Consequently, it is imperative that every employee understands their contributions toward a common vision and mission that defines the organization’s value, success and sustenance. Similarly, it is vital to have a well-planned regular meetings to track the status of the incomplete set goals, and encouraging brainstorming on existing or potential problems. This promotes accountability for the responsibilities they assume, the choices they make and the deadlines they have agreed to meet. The team derives satisfaction and ownership when they are engaged in the decision-making process, which in turn yields productivity and system approach.

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