Dr Mark HassedSome practices have a toxic culture.

I visited one recently where nurses were impossible to control. They were slow and late with almost everything they did. They arrived late, left early for lunch, returned late from lunch, never helped each other and frequently left the room mid procedure to get thing they'd forgotten. It was depressing to see how careless and disinterested they had become.

Obviously they had not gotten this bad over night. It had been a process that had been going on for years. Once things have gotten this bad the only way forward is to reboot the practice culture with multiple firings. The problem with doing that is that it is expensive and disruptive.

A far better way is to never let things get that bad in the first place. Practices need to have some non-negotiable standards that they hold employees to. Then, the instant the standards are violated the practice owner must pull the employee back into line. Letting things slide will only lead to further poor behaviour.

Work out the “non-negotiables” in your practice and then enforce them rigorously. For example, two of mine were punctuality and teamwork.

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