4 potential root causes of underperformance

How to address underperformance on your team

Kate Vonderhaar Johnson

Every manager knows how much work it takes to find, hire, and train new team members, so it's no surprise many leaders err on the side of retaining team members who are underperforming – particularly when the median hospital vacancy rate is already twice the rate seen in more typical times. But we often underestimate the costs of retaining team members who are underperforming and overestimate the benefits. Staff who aren't meeting expectations impact:

• Team performance – There may be work that must be re-done by others; a higher rate of mistakes that need to be caught and corrected; and/or customer complaints that must be resolved.
• Team engagement – As the article notes, staff who aren't meeting expectations impact morale, particularly of high performers. With so many people routinely going above and beyond to cover staffing shortages, it's disheartening to also pick up slack for underperforming team members.
• Manager capacity – Managers often spend a disproportionate amount of their time coaching low performing staff and mitigating the impact of low performance. That's time that could be better spent supporting and engaging the rest of the team.

Is it reasonable to have a higher bar for what constitutes underperformance warranting termination in the current environment? Yes—and not simply because of labor shortages. There are several reasons a team member may not be meeting expectations that can be resolved. Explore these potential root causes before beginning a formal termination process:

1. Unclear expectations: As organizations have responded to Covid waves, many responsibilities have shifted. Some expectations are explicitly put on hold during the height of surges and new ones are added. Given the pace of change, it's worth double-checking: does the team member understand what today's expectations are? It’s easy to assume staff know when to re-start tasks that were put on pause—but you need to be explicit about which expectations are back in play.
2. Priority overload: Given the high vacancy rate, many staff are pitching in to cover gaps. A staff member who appears to be underperforming could be a team member prioritizing the best they can among too many responsibilities. Work with them to get a full picture of what's on their plate and align on what their top priorities should be.
3. Burnout: Prolonged stress and burnout can absolutely impact performance. Staff experiencing burnout need support for their emotional well-being first, not a performance improvement plan. If you’re seeing unusual signs of underperformance from a team member who has typically been a reliable contributor, open a conversation about their well-being. This tool offers a useful guide for the discussion.
4. Wrong fit for the role: It's always a good idea to consider whether there’s an open role elsewhere in the organization that would be a better fit – and, as the article notes, particularly worthwhile to consider now. That said, be clear-eyed about whether changing the role is likely to lead to meaningful change in performance. Otherwise, you're simply shifting the costs of underperformance to another team and leader.

If you have a team member who isn't meeting expectations, you don't need to jump right to termination—but you do need to take action. The costs to your team are too high to avoid doing so.

By Blake Zissman and Monica Westhead

There is no question that providing the best quality care for patients requires more staff and less staff turnover. Staffing requirements for nursing homes, and linking those requirements to value-based payments, has been a long time coming for the industry. But the requirements being proposed by the Biden administration and CMS raise the question of where nursing homes and long-term care facilities will find those staff—or the funding to pay them sufficiently.

In a recent report by the Washington Post, roughly 420,000 employees in nursing homes and long-term care have already left the industry across the last two years. And in addition, a Health Affairs study found that nursing homes were the only site of care to not recover staffing levels from April 2020 to June 2021.

While we agree that these requirements will make care for seniors safer in the long-term, we're curious as to whether the proposals will include support to retain and recruit staff in the immediate, especially amidst a severe staffing shortage. Initial coverage of the proposals indicates additional funding for nursing home surveys but doesn't speak to any potential reimbursement changes that could facilitate higher staffing levels, or higher pay to retain staff.

There is a possibility that these changes will force poor-performing nursing homes to close their doors, resulting in an influx of staff who need jobs at other facilities. The promise of higher staffing level requirements may also bring back staff that have left due to concerns about understaffing.

What nursing home leaders need to do now is continue to sharpen their focus on retention efforts and improvements to clinical quality. These proposals by the Biden administration and CMS indicate that there will be increased attention put on post-acute care in the coming years, especially regarding quality of care—a goal the entire industry shares.

4 potential root causes of underperformance

By Kate Vonderhaar Johnson, Managing Director

Every manager knows how much work it takes to find, hire, and train new team members, so it's no surprise many leaders err on the side of retaining team members who are underperforming – particularly when the median hospital vacancy rate is already twice the rate seen in more typical times. But we often underestimate the costs of retaining team members who are underperforming and overestimate the benefits. Staff  who aren't meeting expectations impact:

• Team performance – There may be work that must be re-done by others; a higher rate of mistakes that need to be caught and corrected; and/or customer complaints that must be resolved.

• Team engagement – As the article notes, staff who aren't meeting expectations impact morale, particularly of high performers. With so many people routinely going above and beyond to cover staffing shortages, it's disheartening to also pick up slack for underperforming team members.

• Manager capacity – Managers often spend a disproportionate amount of their time coaching low performing staff and mitigating the impact of low performance. That's time that could be better spent supporting and engaging the rest of the team.

Is it reasonable to have a higher bar for what constitutes underperformance warranting termination in the current environment? Yes—and not simply because of labor shortages. There are several reasons a team member may not be meeting expectations that can be resolved. Explore these potential root causes before beginning a formal termination process:

1. Unclear expectations: As organizations have responded to Covid waves, many responsibilities have shifted. Some expectations are explicitly put on hold during the height of surges and new ones are added. Given the pace of change, it's worth double-checking: does the team member understand what today's expectations are? It’s easy to assume staff know when to re-start tasks that were put on pause—but you need to be explicit about which expectations are back in play.
   
   
2. Priority overload: Given the high vacancy rate, many staff are pitching in to cover gaps. A staff member who appears to be underperforming could be a team member prioritizing the best they can among too many responsibilities. Work with them to get a full picture of what's on their plate and align on what their top priorities should be.
   
   
3. Burnout: Prolonged stress and burnout can absolutely impact performance. Staff experiencing burnout need support for their emotional well-being first, not a performance improvement plan. If you’re seeing unusual signs of underperformance from a team member who has typically been a reliable contributor, open a conversation about their well-being. This tool offers a useful guide for the discussion.
   
   
4. Wrong fit for the role: It's always a good idea to consider whether there’s an open role elsewhere in the organization that would be a better fit – and, as the article notes, particularly worthwhile to consider now. That said, be clear-eyed about whether changing the role is likely to lead to meaningful change in performance. Otherwise, you're simply shifting the costs of underperformance to another team and leader.

If you have a team member who isn't meeting expectations, you don't need to jump right to termination—but you do need to take action. The costs to your team are too high to avoid doing so.