STAFF MANAGEMENT - 3 Ways to Successfully Manage Staff Time Off

Many practices have lost control of staff time off.  Too many “sick days”, poorly planned vacation time, chronic late arrivals, & more than one staff out at a time.  All create havoc to our schedule.

After struggling with this issue for years, we came up with a system that gave us most of what we wanted.

We realized that the old system contained disincentives towards good attendance. Staff had the luxury of taking “days without pay”.  So, anytime they felt they had something better to do than come to work, they’d forego their pay for the day without any additional penalties.

We wanted to create a system that would:

• work for the doctors,
• be fair to the staff, and
• benefit the practice & patients.

We also wanted to design a policy that would motivate the staff in the other direction – reduce absences. One in which they would have to make a hard decision to stay out, knowing full well the consequences of doing so.

The New “Time Off” Policy

Recognizing that no policy is perfect, here are the three ways we successfully managed staff absences:

1. We clearly defined the types & amount of time off

From the doctor’s perspective, there are only two types of “time off”:

• “Unplanned” time off (otherwise known as “sick leave” or “personal” time) in which the practice is given inadequate time to adjust the schedule, and
• “Planned” time off (vacations, holidays, & medical leave,) in which the practice knows in advance that a someone will be missing. This gives the practice time to adjust the schedule to accommodate being “short-staffed”.

The Problems with Sick Leave

We didn’t like the term “sick leave” because it always raised the question of “How sick is sick enough?” or what justifies being out. (“My child is sick, and I don’t have anyone to take care of him so I’m going to take a sick day.”) 

Also, I personally got tired of policing the use of personal and sick leave.  An employee would come to me and ask, “Can I take tomorrow off to (fill in the blank)?”  What she was actually asking me was, “Is this a good enough reason to be off so I don’t get in trouble with you?”

The final straw came when one of my assistants asked me if she could “take tomorrow off to bury my cat”.  Now, I love cats (we have two), but I quickly realized that I had become judge and jury as to what constituted a justifiable reason to take the day off.  She also wanted ME to accept the blame with the rest of the assistants for being “short-staffed”.  “He said I could take it off!”, she’d explain when they complained to her.

The Solution

So, we finally settled on granting one type of unpaid leave (Medical Leave) and three types of paid leave:

1. Holidays
2. Personal Leave (“unplanned” time off – anything with less than 30 days notice)
3. Vacation Leave (“planned” time off - which required greater than 30 days notice)

We gave a limited amount of Personal Time (“unplanned” time off) so our staff (who we considered adults) could decide for themselves whether their situation warranted being out.  We granted five “days” (or 5 times 8 hours) of paid Personal Leave which could be taken at their discretion.

If they need to leave an hour for an appointment or be late to work to drop their child off because their spouse is unavailable that day, that’s fine.  They can use some of their Personal Time, which the rest of the staff now knows is limited. Also, if they are chronically late for work for no apparent reason, it is recorded as “personal time” which is deducted from their yearly total.  The time is automatically recorded as such by Office Manager when reviewing the time cards for payroll.

Chronic lateness virtually disappeared.  Resentment from others also vanished because everyone knew that there was a consequence.

If someone is truly sick or contagious and does come to work, however, we have the right to send them home.  We explain that “Sorry, we can’t risk infecting the patients or other staff.”

Of course, there needed to be consequences to discourage overuse, so . . .

2. We set boundaries for overuse to reduce the impact to the practice

If we allowed our staff to “borrow” from Vacation Time for “sick days”, we’ve granted them virtually unlimited unplanned time off.  From my experience, it’s a mess!  We had one Treatment Coordinator who was averaging one day off every two weeks for months to take care of her child.  Others were “borrowing” from vacation time when they just didn’t feel like going to work that day.

One chairside repeatedly took Mondays off. Hung over?  Apparently, she was.  It was the worse kept secret in the office which I learned later when she was dismissed.

So, to discourage the overuse of Personal Time we added several caveats:

• Any Personal Time used by an employee that exceeds what would be expected to be earned for the year will automatically be deducted from Vacation Time at a 20% “penalty”. So, 1.2 hours of vacation time is deducted for every 1 hour of personal time overused.
• If their personal time exceeds the expected amount in the year, we require a doctor’s excuse (for the employee or family member). This note is due when they return to work and will be placed with their personnel records. Overuse of personal time may influence pay raises and excessive overuse may result in dismissal. 
• Any Personal Time taken beyond 100 hrs. per year total is considered excessive and is reason for dismissal.

Bottom line, they could “borrow” from Vacation Time but at a 20% “penalty” and, after more that 12 days of Personal Leave, they may be dismissed.  This policy had an immediate impact the year we implemented it.  Staff not showing up for work dropped by more than 50%.

Conversely, to reward those who did not use all of their Personal time during the year, we granted them a 20% bonus of vacation time to be used when the office is closed between Christmas and New Year’s Day (called Well-bonus Days).  For those who have no Personal or Vacation time left are then expected to cover the office during this time or be given time off without pay at the doctor’s discretion.

3. We made allowances for longer term Medical Leave (pregnancies, medical treatment, post-surgical recovery)

Since we don’t have 50 employees and therefore are not required to adhere to The Family and Medical Leave Act (FMLA), we still wanted to provide for up to 12 weeks of Unpaid, Job-protected Leave for prolonged medical or surgical reasons.

• For the birth and care of the newborn child;
• For placement with the employee of a child for adoption or foster care;
• To care for an immediate family member (i.e., spouse, child, or parent) with a serious health condition; or
• To take medical leave when the employee is unable to work because of a serious health condition.

But we made several stipulations in order to qualify:

• The medical leave is more than one week. (E.g., flu or necessary surgical recovery)
• They are required to tell us when they plan to return when they begin their leave (so we can plan the schedule accordingly)
• It requires an excused absence from their physician or surgeon documenting the need to be out of work
• If it is less than 3 months before they are to return (e.g., chemotherapy or serious accident), we will hold a position open for them (but possibly not the same position) until they return. Obviously, for this type of extended leave, we need to fill their position for the office to run smoothly.  In the few cases that this happened, we were able to reincorporate a valuable staff member back into the practice.
• For more than 3 months leave, they effectively have resigned, and we will do our best to have them return to the practice, but it is not guaranteed.

The transition to this more rigorous policy did not come without complaints.  Not unexpectedly, it was those who tended to abuse the former policy who were most upset.  The ones who were good about attendance were delighted that we finally did something about the abuse.  All along, they had resented the extra load placed on them by the others.  

Anytime this new policy was challenged, I would say that “Your decision to use time off is not questioned, but I need to be an advocate for the patients and be fair to the rest of the staff.  That’s the reason for these guidelines - to make sure that patient care doesn’t suffer, and you and others don’t have to deal with being short-staffed.”

Documents & Forms:

For Doctors -Time off policy explained

New Hires - LEAVE SUMMARY

LEAVE POLICY ANNUAL REVIEW

Requesting Time Off FORM

POLICY MANUAL Staff Working Hours