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All may be well for the manager, or at least will seem well most of the time, when all employees in the group follow the same rules. But all employees do not always stick to the rules, and the occasional employee will behave as though he or she is the deserving exception. One such employee was offered as a case in point by the manager who said, "Whenever a new rule is presented or a new policy is explained, he gives me the impression that he understands and doesn't have a problem with it. But when it comes to following the rule or applying the policy, I can always count on him to come up with long, convoluted rationale for why it shouldn't apply to him. To hear him tell it, he's always a 'special case.'"


In most instances of such behavior, the manager's response to the employee should be, "Yes, it does apply to you as to everyone else." But the employee always deserves to know the reasons why it applies. These reasons might include the following:


* Rules are not established arbitrarily; they are created for sound reasons. Under normal circumstances, they are meant to apply to everyone. To ensure that the rules work as intended, it is necessary for the manager to see that they are applied consistently.


* At one time or another, almost every employee might be considered an exception to some particular rule. An exception, however, cannot be made without sound justification. If a rule does not seem to apply to a particular individual without clear justification for the exception, other employees may conclude that the rule means little or nothing. Some of their observations will lead them to assume that they, too, should be able to get away with noncompliance.


* Once the door has been opened to an unjustified exception, a precedent has been set, paving the way for the destruction of the value of the rule.



A number of possible reasons exist for the attitude of the person who is forever the self-assumed exception. This employee may:


* have always been accustomed to being an exception outside of work, perhaps having grown up under such circumstances or having been treated as an exception in other settings-such might lead a person to believe, either consciously or otherwise, that he is "special" and should automatically stand above most rules;


* have been treated as an exception by past managers to the extent of coming to feel that special consideration should be the norm;


* have simply assumed exception status through assertiveness and force of personality and have gotten away with this for so long that the "rightness" of this behavior has become ingrained through regular reinforcement; or


* basically be a nonconformist of sorts, seeking a form of recognition or status by being different from the others who work in the same setting.



In preparing to deal with the self-styled exception, the manager should try some self-examination by first coming up with honest answers to these 2 questions:


1. Have I, in any way, deferred to any characteristics of this person's personality or performance and actually provided special treatment that would seem to set this employee apart from others?


2. Have I repeatedly allowed this employee to get away with assuming exception status?



The manager who is compelled to answer yes to either of these questions will then have to reexamine the elements of his or her relationship with this employee. It may be necessary for the manager to consciously work on altering the manager-employee relationship in such a way that future treatment of this employee will be fully consistent with the manager's treatment of all others.


Keeping in mind the ever-present need for consistency in dealing with employees, other suggestions for the manager to consider in dealing with the self-styled exception include the following:


* Whenever it is necessary to establish a new rule or alter an existing rule, this action must be thoroughly communicated to all members of the workgroup such that all who are affected know the manager's expectation of them. It may also be wise to provide individual follow-up with the troublesome employee to reinforce the reasons for the new or revised rule within the context of a clearly focused one-on-one discussion.


* If the self-styled exception's behavior continues to present problems, this person should be talked with frankly about how he or she is coming across. The manager should ask the employee for specific reasons why he or she feels that an exception is warranted. In this process, the manager should go to whatever extent necessary to communicate the belief that a rule must apply to everyone unless justifiable cause exists for an exception.


* If the employee is ordinarily a good performer and presents no problems other than the "exception" difficulty, the manager can approach this single behavioral problem by focusing on the employee's positive attributes. As always, performance deserving of praise should be praised. This employee, however, needs to learn that he or she is not a lone performer but rather is part of a team-and that which applies to the team as a unit applies to each member as an individual.



To further enlighten and assist the working manager, this issue of The Health Care Manager offers the following:


* "Assessing Cultural Competence at a Local Hospital System in the United States" presents the findings of one hospital system's cultural competency assessment, suggesting that cultural competency cannot be achieved unless a number of critical factors are given serious consideration.


* "A Bundle of Best Bedside Practices: Field Evidence" relates how a sequential, evidence-based bundle of 10 best bedside practices serves as a template for professional practice and becomes a shared language and standards for interdisciplinary team communication and development.


* "Health Care Globalization: A Need for Virtual Leadership" provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges the "virtual leaders" and "virtual teams" face of employee isolation.


* "Creating a Culture of Accountability in Health Care" presents 6 methods of creating and maintaining a culture of accountability for improving quality and efficiency by using performance management systems and quality improvement initiatives.


* "Chief Executive Officers in US Hospitals: An Examination of Workforce Demographics and Educational Issues" reports on a study undertaken to analyze retirement patterns and the current sex mix of chief executive officers in hospital settings within the United States.


* The Case in Health Care Management: "To Tell the Truth?" asks the reader to how to go about sorting out the elements of a situation in which 1 or perhaps 2 people were either shading the truth or misunderstanding each other.


* "Schedule Quality Assessment Metrics" addresses the creation of quality work schedules that balance unit needs for adequate staff across multiple skills against employee needs by honoring as many employee requests as feasible.


* "Blogging and the Health Care Manager" examines the phenomenon of blogging, presents a simplified step-by-step process to set up a blog, and offers a list of blogs recommended for every health care manager.


* "The Value Analysis Team: A Shared Mental Model" examines what managers need to consider before forming value analysis teams, how to guide the work of such teams, and the qualities and qualifications of the people who must be involved to make the process effective.


* "Energy Management: Another Growing Concern for the Department Manager" brings up to date some pressing concerns about energy and its cost and suggests that much of energy management at the department level is a matter of awareness and attitude and the presence of an energy-conscious manager.


* A Manager Asks: "Dealing With the Troublesome Employee" addresses several questions asked by working managers about the problems presented by certain troublesome employees and offers some possible solutions.