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Some of the most difficult moments experienced by a department manager can occur in the necessary application of one particular personnel policy that affects all employees. We refer to a policy we will find in most if not all health care organizations' policy manuals: the policy addressing attendance.


Case in point: A manager faced a situation in which an employee used up all of her sick and vacation time for medical reasons, following which she asked to work through lunch times and apply other overtime options to earn more time. The manager believed the employee to be chronically ill and that her time off all went for legitimate medical reasons. Eventually, however, the employee reached a point beyond which her next time off would have to be leave without pay. Although the employee had experienced brief absences far in excess of those allowed under the attendance policy, the manager felt considerably ill at ease over the prospect of having to apply disciplinary action. The manager had but one simple but all-encompassing question: What should I do?


All dimensions of time off, for whatever purposes, are ordinarily addressed in the organization's personnel policies. Concerning such policies the manager has 2 basic responsibilities: be thoroughly knowledgeable of the policies and how they are applied and ensure these policies are implemented in a way that supports consistent application throughout the organization.


Consistency is critical where such policies are concerned. A manager might, if convinced of legitimate medical reasons for an employee's absence, be tempted to act out of sympathy and bend or ignore an applicable policy. It is often tough for the manager to have to face the need to treat the good employee who is genuinely ill with the same rules applied to the employee who is simply playing the system for time off.


But policies concerning excessive absenteeism are in place for good reason; when a person is repeatedly absent from the job, whether the reasons for being so are sound or frivolous, the fact remains that important work is not getting done. Certainly, an employee with chronic health concerns should be treated with every human consideration, but concerning time away from the job, the person must necessarily be treated the same as all other employees.


The work-through-lunch request is, of course, out. Labor laws require a meal period during a shift, and there is the matter of consistency as well: Can the same special circumstances be granted to everyone else who might ask?


If the employee has indeed reached a position in which her next time off must be without pay, so be it. The organization may well have a policy concerning informal leave, a practice in place specifically to help protect the employment of an employee who has no sick time or vacation remaining.


Could the manager possibly be "taken for a ride" by an employee who spins a good tale concerning illness? Certainly this is possible. But if the manager has received a physician's statement concerning the employee, this has to be taken at face value. But if the manager has only the employee's word for the medical reasons for absence, the manager should be asking the employee to produce documentation from her physician or other health care providers.


In addition to the possibility of informal leave, there are other potential options. With physician concurrence, perhaps a formal leave of absence could be granted for medical reasons or perhaps a change in employment status is in order, with the individual becoming part-time or reverting to per diem status under which she works either on a limited schedule or only when called. All these means have the effect of protecting her affiliation with the organization.


The fact remains, however, that regardless of the reasons for an employee's absences, when the person is not there, either the work does not get done or someone else must be paid to do it. Which brings this discussion back to its beginnings: Often, one of the toughest tasks facing a department manager is applying an attendance policy uniformly to all employees regardless of whether an individual's absences seem valid or false and regardless of the manager's personal feelings. In the long run, it is consistency of application that gives any particular policy its strength.


This issue of The Health Care Manager (23:3, July-September 2004) offers the following articles for consideration:


* "The Paradox of the Not-for-profit Hospital" reports on a research study having policy implications concerning access to clinical services, the availability of charity care, and the long-term viability of the not-for-profit health care industry in the face of potential bankruptcy and closure.


* "Health Care Professionals as Online Faculty" recognizes the growing popularity of online degree programs and suggests what experienced health professionals can expect to encounter when functioning as online faculty.


* "Job Satisfaction Among Hospice Workers: What Managers Need to Know" reports on a study conducted to investigate the perceptions of job satisfaction among hospice interdisciplinary team members including social workers, nurses, spiritual care providers, and home health aides.


* "The Practicality of Employee Empowerment: Lessons From the Admitting Department" suggests that for true employee empowerment to succeed, health care organizations must promote a culture of psychologic safety to ensure that a genuine commitment exists to its stated mission.


* "Enhancing Emotional Intelligence in the Health Care Environment: An Exploratory Study" reports on an investigation conducted to examine the effects on an adventure-based intervention on the emotional intelligence of employees of a multisite dental practice.


* Case in Health Care Management: "The Informant" asks the reader to consider what to do concerning a department volunteer who continually brings tales and problems to the manager in gossip fashion-and who is almost always correct.


* "Hospitalists: Evolution, Evidence, and Eventualities" presents an in-depth literature review concerning the growth, development, and likely future directions of hospitalists, those physician who spend at least 25% of their time serving as physicians-of-record for hospital inpatients.


* "Strategic Implications of Culturally Competent Care" defines culturally competent care and enumerates the important strategic implications of delivering such care, including basic steps recommended for doing so.


* "Creating a Culture of Service Excellence: Empowering Nurses Within a Shared Governance Councilor Model" reports on the formation of a shared governance model under which staff nurses in one specific institution were successfully empowered in an organization that encouraged professional autonomy over practice, effective communication, and development of leadership skills.


* "Professional Ethics at the Bottom Line" focuses on the ethical behavior of health care professionals and how they teat each other in the workplace and presents a pair of case studies involving serious ethical breaches.


* "Managing Employee Performance" addresses the art and science of dealing with employees in a manner intended to positively influence their thinking and behavior to achieve a desired level of performance.


* A Manager Asks: "She Is Never Wrong-Just Ask Her" presents the collective advice of several managers for addressing the problems presented by the occasional employee who is "always right."