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Lesson Plan CHL 322
Progressive Discipline Programs for Central Sterile
Supply Departments
[Reprinted from Communiqué: November/December 2010]

LEARNING OBJECTIVES: As a result of satisfactory completion of this section, readers will be able to: Define the term “discipline” and explain that there are two types of discipline. Describe each of the four steps in a progressive disciplinary program.

For many, the concept of discipline involves reaction to an employee’s improper behavior. While this is necessary, a broader view considers discipline to be any effort to influence an employee’s behavior. Managers should reinforce desired behavior and discourage undesirable actions.

The term “discipline” is used in the military to describe the need for soldiers to follow orders and perform in a structured and predictable way that enhances their ability to achieve objectives. It is also an appropriate way to describe Central Sterile Supply departments (CSSDs) because disciplined staff members must follow established rules and regulations to best serve customers and enhance patient care.

The Discipline Process

Positive discipline is used to encourage desired behavior, while negative discipline is used to discourage improper behavior. CSSD managers and supervisors should be concerned about the proper use of discipline efforts. For example, they use personal instructions, written directions, employee manuals, role modeling and, often, organizational culture and tradition to relay their expectations about employee behavior. Most employees carefully follow behavioral standards when they know what is expected of them, and providing this information is the responsibility of their leadership team.

“Honest” mistakes and occasional errors do occur, and coaching activities can typically correct these actions. However, intentional and repetitive noncompliance with standards should result in pre-established consequences. These should be identified in a progressive discipline program: activities designed to modify employee behavior through a series of increasingly severe punishments for unacceptable behavior.

Douglas McGregor, the well-known management theorist, pointed out the consequences of non-compliance with appropriate behavior with his “hot stove principle.” When one touches a hot stove with his or her hand:

• the consequence is immediate (ouch!)
• there is a warning: the hand becomes warmer as it approaches the stove
• the punishment is consistent
• the burn is impersonal; anyone and everyone who touches the stove will be burned.

When the burn occurs, there is no doubt about what caused the pain. One’s typical reaction is not to be “upset” with the stove. Instead, it is to question why it was touched and to avoid the clearly foreseen consequences of touching it again.

Humans have emotions and cannot typically remain neutral and be consistent like a stove. However, a well-thought-out and consistently applied progressive discipline program lets employees know, in advance, the consequences of unacceptable behavior, which become more serious as the behavior is repeated. To be effective and change behavior, the consequences of repeated behavior must be undesirable.

In many healthcare facilities, human resources personnel provide significant assistance in the development of an effective progressive discipline process. Their coordinating efforts include gaining support and advice from top-level facility administrators, department heads, managers, and supervisors, and, hopefully, the employees themselves. They frequently develop, review and revise proposed procedures, and they gain input from legal counsel as a final step before the process is adopted. Then, policies, procedures, and necessary documents must be developed and used in communication efforts with affected personnel. Additional follow-up tasks often include the evaluation, revision, if necessary, and consideration of unanticipated issues, and Human Resources personnel may also manage progressive discipline information as it is entered and maintained in the healthcare facility’s personnel records.

 

Figure 1: Sample Format for Documented Written Warning Record

Four-Step Progressive Discipline Process

A commonly used four-step progressive discipline program includes an oral warning, a documented written warning, suspension and, finally, dismissal. Coaching to correct behavior may precede the oral warning, especially if a one-time occurrence does not create significant difficulties. Example: a CSSD technician uses a personal but unapproved shortcut when stocking a case cart.

Note: a progressive discipline process may not be used to address, and immediate termination may be the only response to, very serious problems including violence, theft and falsification of employment records.

In the remainder of this lesson, we’ll look at the four-step progressive discipline process more closely.

Oral Warning

An oral warning is the first step in a progressive discipline process. In some facilities, this can be done informally, or it can done more formally with a written record made of the oral reprimand given to an employee.

Some managers believe that a written record of an oral warning record should not become part of the employee’s permanent personnel file but should, instead, be maintained in a separate manager’s file. Others document the oral warning, but discard it after passage of a specified period of time without repeat of the incident. Human Resources or other staff with facility-wide responsibilities should determine and communicate whether a written record of the oral warning should be made and, if so, what should be done with it so all employees receive identical treatment.

Documented Written Warning

A documented written warning is a second common step in a progressive discipline process, and this record typically does become part of an employee’s permanent file. Its purpose is to alert an employee that further inappropriate behavior will lead to suspension.

This written record should include the employee action that preceded the warning, the date of the incident and the previous oral warning, and the name of the supervisor issuing it. It should also detail the plan to prevent further occurrences, and it typically permits the employee to provide his/her own version of the incident.

To illustrate how the first two progressive discipline steps may work, let’s assume that Alberta, a CSSD technician, has been late twice in the last week and was informally coached about the problem by Ajay, her supervisor. When the problem next occurs, Ajay meets privately with Alberta to formally explain why punctuality is important. Ajay should then allow Alberta to respond. Ajay may then discover that (a) Alberta did not understand some aspect of the expected behavior or (b) he did not know about a specific situation that was occurring that accounted for the late arrivals.

Unfortunately, Alberta was late for her next shift as well, and now Ajay must meet with her so they can mutually develop and agree upon an appropriate solution. Ajay should also tell Alberta about the consequences of further late arrivals. Details of this conversation should be included in the employee written warning record, and both Ajay and Alberta should sign the record to complete the document and finalize this second step in the progressive discipline oral warning process. Hopefully, this will resolve the problem. If not, the next step in the progressive disciplinary process becomes necessary.

The documented written warning process must be done correctly to protect the healthcare facility if the employee later challenges the legality of its progressive disciplinary process. For example, the behavior leading to this second step should relate to that exhibited in the first step. Managers should remember that courts generally view the term “progressive” to mean “related to the same.”

Returning to our example of Ajay and Alberta, assume that Alberta improperly labeled an item before placing it in inventory. It would not be appropriate for Ajay to issue a documented written warning to Alberta for this behavior because it does not relate to her late arrivals. Since this is a first time for this improper behavior, perhaps only an oral warning may be needed. Is an incident one in a series or the beginning of a new series of incidents? This question must be answered to determine the appropriate management action in a progressive disciplinary process.

It is always a good supervision rule to “praise in public” and to “reprimand in private.” However, many progressive discipline processes require an observer to be present at the second and later steps in the process. Co-managers, supervisors or others can monitor the discussion and serve as an eyewitness.

Suspension

The third and increasingly severe step in a progressive discipline process is typically suspension, with or without compensation. This involves time off from work for the period of time that administrators deem appropriate. As with all steps in the progressive discipline process, suspension should be applied consistently. For example, if one employee is suspended for a specific time for a specific behavior, then all employees suspended for that same behavior should be suspended for the same time period.

Suspension documentation is important, and a copy should be placed in the employee’s personnel file. Some employees may refuse to sign the document and, if so, it should be signed by the supervisor along with a note that the employee refused to do so.

Employee suspension is a serious warning that the employee’s behavior is not acceptable, and that job loss is very possible. If the employee’s behavior is not corrected at this step, this will likely occur.

Dismissal

Dismissal is the fourth and final last-resort step in a typical progressive discipline program. It generally involves a termination interview conducted by a manager with another manager or human resources representative serving as a witness.

Several questions can help to assure that the discharge decision is appropriate. If any can be answered “no,” more investigation before the action is taken should probably be undertaken. These questions include:

• Did the employee know what was expected?
• Were rules clearly and fairly communicated?
• Did a manager explain why the rules were important?
• Were the broken rules reasonable and important”?
• Is discharge evidence substantial and reliable?
• Is termination equal to the seriousness of the offense?
• Were sincere efforts made to identify poor performance and to correct undesired behavior?
• Is the action taken for breaking this rule applied consistently to all employees?

It is very important to have the appropriate documentation and a progressive discipline program comprised of policies, rules and procedures that are consistently applied to all employees. If not, potentially costly and time-consuming wrongful discharge lawsuits can occur. Many attorneys acknowledge that the easiest wrongful discharge case for an employee to win is the one in which rules are enforced unfairly.

Employee dismissals involve more than just immediate employee replacement and training costs. In most states, employees who are dismissed qualify for unemployment compensation payments. While there are exceptions, (examples: employees dismissed for theft or other illegal activities), significant increases in payments to these employees will result in an increase in the amount the healthcare facility must pay into the state’s unemployment compensation funds.

Some Concluding Thoughts

This lesson has examined a progressive discipline process that ends with employee dismissal by the facility. In other words, the employee leaves involuntarily. However, what about an employee who leaves voluntarily, but does so involuntarily? In other words, the employee decides to leave the job, but the reason relates to the job. Then, the ultimate source of the problem creating the need for discipline may be the employee’s supervisor and/or policies, rules or other regulatory guides issued by the facility itself.

For example, an employee may like her job (what she does) but still want to work in a similar position in another facility at the same pay rate. She feels her manager does not appreciate her, and recognition for a job well done is important to her. Sometimes, the motivation of employees who want to leave remains unknown. However, CSSD supervisors must consider whether the root cause of some problems leading to progressive discipline may be created by the supervisor or allowed to continue by the facility.

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