Winter 1999, Vol. 8, No. 2.

Workplace Psychiatric Interventions:

Proactively Managing Employees with Problems

By Stephen Heidel, MD, MBA
San Diego, CA

All organizations have an occasional employee whose performance or behavior is so unacceptable that it comes to management's attention. A crisis in the office from such an incident is potentially dangerous, costly, and disrupts the flow of work. Organizations have frequently ignored warning signs until an employee's behavior has become so unacceptable that there is no alternative but to take some action to manage the crisis. Given corporate America's constant demands for improved productivity, organizations should look for patterns of performance problems and manage them proactively rather than waiting and reacting to a crisis. This allows them to prevent crises and create a more productive workforce.

Recently several organizations have found ways to identify and manage employees with problems before a crisis occurs. They have begun to systematically look for employees who have patterns of problems such as unscheduled absences, repeat accidents, disciplinary problems, and customer complaints. Employers can easily calculate the average number of days of absence per employee, the accident rate, or the frequency of customer complaints. Once those with the highest rates are identified and compared to the company averages, the organization can decide whether any action is warranted.

One organization reviewed the customer complaints among 1,200 employees who had customer service jobs. They determined on average there were less than 0.1 complaints per employee per year, but there were 35 employees who averaged greater than 20 complaints per year. This information had been stored on a computer, but never accessed before. The Director of Human Resources said, 'We've had computers for over 20 years, but never thought to run this kind of data before.' Based on these findings, letters were mailed to these 35 employees notifying them that they were one of a very few employees with extremely high numbers of customer complaints and asked them to change their behavior reduce the complaints against them in the future. They were referred to a series of classes on customer service and reminded of their Employee Assistance Program (EAP) if they thought it would help. Letters were also sent to all those employees who had no customer complaints in the past year giving them recognition for a job well done. Every six months they plan to monitor the numbers of complaints received by these employees and to individually manage employees with continuing high rates of complaints.

Another organization checked all employees filing workers' compensation claims to see if they had a history of repeat accidents and injuries. The Risk Manager's office had a record of all of the accidents and injuries on a computerized report, so it was easy to determine whether people with current claims had problems in the past. Approximately 1,500 cases were screened and it was determined that 90 of these cases had at least five accidents or injuries in the past five years or three accidents and/or injuries in the past two years. These cases were reviewed by several staff to see if there were performance and/or conduct problems in addition accident and injury profile. An occupational psychiatrist reviewed some of the cases. One complaint was about an employee who had threatened a customer. This employee was subsequently seen for a fitness-for-duty exam because of threats he had made. He had a personality disorder. A 40 year-old male who had hit a parked vehicle after falling asleep while driving had a positive drug test. A 30 year-old female drove a forklift into the side of a parked truck. She had Attention Deficit Disorder since childhood, but had never been treated. A 60 year-old male fell out of a delivery truck which then proceeded unattended until it hit a tree. This individual had unusually severe side effects to medications used to treat his bipolar (manic-depressive) disorder which impaired his balance. Based on reviews of the available information, it appeared that a majority of the 90 had a
psychiatric disorder. A formal program was then initiated to identify and intervene with accident prone employees.

Assess Your Company

Problems, such as workers' compensation claims, accidents, absenteeism/tardiness, customer complaints and disciplinary actions, appear from time to time with your employee population. To determine if there is a pattern, follow the these steps:

• Target one or more of these problem areas for exploration.
  
• Identify existing ways to collect data regarding employees with that type of problem.
  
• Collect data in this problem area and analyze it to determine if there are repeat offenders or patterns not previously recognized.
  
• Determine what actions to take to manage the identified employees.
  
• Measure the target behavior after each intervention.
  
• Evaluate your results.

Getting Started

There are some common elements for a program to manage employees at risk.

Team Formation:

Form a multi-disciplinary team with the goal of identifying and managing employees with problem behavior. Team members might include occupational nursing, safety, risk management, employee relations, workers' compensation, and occupational psychiatry. The occupational psychiatrist may be the only consultant and brings a unique expertise to the team. He/she can serve as a trainer and consultant.

Training:

Train team members about common psychiatric illnesses and how they manifest in the workplace. Other training topics will emerge from this group.

Identify Employees at Risk:

Review employment related records for those employees who have been identified as being at risk for problem behavior or performance. Records may include accident/injury profile, absenteeism records, incident reports, performance evaluation, disciplinary reports, etc. Based on this information, the team may recommend a variety of interventions.

Employee Interventions:

Interventions may include, but are not limited to, talking to the employee to gather more information, safety training, disciplinary action, referral to the EAP, and refer for a medical or a psychiatric evaluation.

Supervisor Coaching:

The employee's supervisor may benefit from coaching about how to talk to an employee with a problem, how to resolve disputes, potential warning signs to look for, and how to respond if any of these signs occur.

Did it Work:

Any new program should be evaluated to see if it has been successful and how it might be improved. Methods of evaluation include polling team members. Ask them whether they think the time and money spent for the program was worth it and why. Poll the supervisors of the identified employees. Did they find the program helpful? If so, in what way? For other employees identified as having and unusual number of problems, look at the frequency and cost of that problematic behavior before and after the interventions. Track the trends of absenteeism, accidents, workers' compensation claims, etc. in the company overall. If performed, evaluate the effectiveness of medical and psychiatric fitness-for-duty exams. Did they resolve the issues they were intended to address?

There are a variety of behavioral and performance problems in every workplace. It is more important than ever before for employers to identify and proactively manage these problem employees. An occupational psychiatrist may help facilitate the process by acting as a consultant and trainer.

 
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