Bringing the Abusive Employee Back James Whitehead, M.A., M.B.A.

Linda Unger, M.Ed.

Abstract

In many health care settings, some dispute resolution process exists which limits the discretion of the employer to simply terminate an employee suspected of inappropriate or abusive behavior. On occasion, the working of such disciplinary processes results in an employee, who is viewed by management as having broken a fundamental trust, being returned to the workplace. In managing the return of these individuals, provider agencies must develop strategies to reduce the likelihood of any future client injury and to increase the chances of returning the employee to a productive functioning level. We surveyed employees returned to work after an abusive incident along with their supervisors to determine what specific supports each group saw as necessary for a successful return. As a result, an individualized, structured program was developed to deal with such returns and piloted. The authors'results indicate that the program might serve as one possible model for wider use.

Introduction

New York State has a unionized work force. For a number of years, part of the labor agreements with both the professional and direct care unions has been a specific contract article on the disciplinary process to be used in response to poor employee work performance. The contract article's focus is on correction. Termination is one of the available penalties but is clearly seen as a last resort. The process is legalistic and complex with the burden of proof placed on management, since it is always the management that initiates the disciplinary action.

While abuse cases are recognized in the language of some of the contracts as posing particularly difficult problems in terms of balancing patients' rights against those of employees, it is not unusual for an employee accused of abuse to be reinstated or returned to work, either as a result of a settlement between the parties or due to an arbitrator's decision. Such returns to d u t y - - what this article wil~term reintegrations - - are often awkward and troubling. The disciplinary process itself has a polarizing effect. Often, the normal supportive employee/employer relationship is fractured by the need to clearly demonstrate guilt. The employee feels maligned. The management feels a basic trust has been betrayed. The relationship is not automatically restored by a settlement or an arbitrator's decision. The problem of determining an appropriate reintegration assignment is compounded by the reactions of clients, families, advocates, supervisors and other staff to the employee's return to work.

Such returns are not an unusual consequence of a disciplinary case. New York State's Office of Mental Retardation and Developmental Disabilities reported the outcome of 191 abuse-related notices of discipline issued in its 20 discrete operating units during 1989-90 and brought to resolution by Jan. 1, 1991.1 Their findings indicated that only four cases (2.1%) resulted in the complete exoneration of

Address correspondence to James Whitehead, M.A., M.B.A., Deputy Director, Craig Developmental Disabilities Service Office, 3 Park St., Geneseo, NY 14454.

Linda Unger, M.Ed., is Deputy Director, Craig Developmental Disabilities Service Office. We gratefully acknowledge the assistance of the New York State Office of Mental Retardation and Developmental

Disabilities Employee Relations staff.

Canadian Model HENDERSON, VANIER, NOEL 143

the employee. Another 31 cases (16.2 %) ended in the employee's resignation or retirement. One hundred and fifty-six employees (82.7%) were found at least partially culpable, but only 13 (6.8%) were terminated. The vast majority (143 of the total 191 charged, or 74.9% of the original group) received some disciplinary penalty as a result of their actions but returned to work. Further, the situation is not unique to New York. Other states have similar labor agreements and appear to have comparable return rates. Robert McNamara, in reviewing a 10-year period for a facility in Delaware, indicated that 75% of the employees involved in abuse incidents returned to the work force after disciplinary action. 2 The significant potential impact on the organization and the frequency with which the need for reintegration was encountered convinced the authors that the issue deserved further study.

To explore how a return-to-work program might be structured, we initially looked to the professional literature on client abuse. We felt that if a set of common underlying causes for abuse could be identified in similar health care settings, a strategy to counteract them might be developed by using specialized training and more focused support programs. We conducted a literature search and talked to experts on child and institutional abuse. Surprisingly, there was very little material available. There were no simple universal themes that seemed readily applicable. Therefore, to move away from the theoretical, the authors decided to survey employees who had returned to work after an abusive incident. Supervisors who had received the returning employees were also surveyed to determine what they felt was needed to reduce the likelihood of a second abusive incident.

Methods

As a survey tool, separate but complementary, questionnaires were developed for the returning employee and the receiving supervisor. To identify a target population, personnel records for a four-year period between 1984 and 1987 were reviewed. Ten employee/supervisor pairs where both individuals still worked for the agency were found. Due to the small sample size, the authors decided to meet with each person individually, to administer the questionnaire, and then to conduct a follow-up interview to ensure that the responses were interpreted properly.

One of the most significant steps taken to ensure the success of this review was to involve the local union leadership with the survey and interview process. There was clearly a potential problem in obtaining honest, sincere responses from employees who could be expected to be hesitant because of a prior negative experience with management. The chapter leaders of both the professional and direct care unions reviewed the basic approach, offered suggestions and made introductory phone calls for us to increase the likelihood of employee participation. The direct care workers' union president was so interested and supportive that she even sat in on several of the interviews. While some employees were still unwilling to freely participate, the support received from the local labor unions translated into a significantly higher rate of participation than had originally been anticipated.

The questionnaire was quite straightforward. There were 10 multiple choice questions for the employee and 13 for the supervisor. They covered three major areas. First, did the supervisor or the employee receive any guidance in dealing with the return to work? Were expectations clearly outlined for either? Second, what were the specific responses to the return from the perspective of the employee, supervisor, peers within the work group, individuals receiving services, parents and advocates? Finally, the questionnaire attempted to solicit specific ideas having the potential to improve the existing process. While statistical tabulation of the respondents' answers to the various questions provided no clear pattern of response, the follow-up interviews did help to outline some specific themes.

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Results

The reactions encountered in talking to employees were fascinating and somewhat unexpected. In general, we assumed that most returning individuals would, at least initially, be embarrassed, uncomfort- able and ill at ease. While that was the case with eight of the 10 employee respondents, two seemed to feel quite differently. They felt that since they were back at work they had been vindicated and that the organization owed them some form of restitution for the wrongful treatment they had received. Each had been involved in a negotiated settlement of the disciplinary charge. They viewed that settlement as an exoneration, while management viewed it as a partial admission of guilt. No common ground had been established because each side wanted to see the agreement from their own perspective. Further, one of the individuals indicated that his fellow workers shared his perception. He said that staff welcomed him back as a hero who successfully stood up to an unfair system. Reactions similar to these seem to reflect little appreciation of the need to make behavioral changes. Even where there was recognition that something inappropriate had happened, it did not always produce positive change. One employee seemed devastated by embarrassment over what she had done. She sobbed throughout the interview; and talked about problems that had developed in her personal life as a result of the incident. You could not help but come away from the session with her feeling that we had produced a less fully functional care giver as a result of the disciplinary (corrective) efforts.

The supervisors' responses were only slightly less surprising. Often when returning employees were assigned to a new work location, very little information was provided about what had happened in the past. The intent was to respect the returning employee's privacy and to avoid prejudicing the new supervisor, but the impact was nearly always the opposite. Lacking any firm information, the rumor mill and the supervisor's own imagination almost inevitably filled the void with half-truths and innuendo. The frustration with the decision to return the employee to work often felt at the administrative level seemed to be carried down the bureaucratic chain of command. The message that reached the first-line supervisor was, as a result, frequently confusing and somewhat contradictory. "We think this individual is inevitably going to abuse clients again; but you had better see that nothing occurs." Left without good information or a clear message, the supervisor did not know how to react. Most complained about this lack of clear expectations and identified a need for better information and direction, more positive support and special training on handling such an unusual situation. It is interesting how similar these concerns were to those reported by Patricia Oweu and Jerry Spicer in their survey of the supervisory problems encountered in returning alcoholic employees to work after treatment. 3 The similarities perhaps reflect a commonality in the supervisory response to potentially awkward reintegration situations and intuitively strengthened our belief in the validity of our data. Ten employee/supervisor pairs, however, is an extremely small sample, and further work with a larger population is obviously needed.

Discussion

There were several elements of the existing unstructured process that worked against a successful reintegration. Management wanted to ensure client safety and to rebuild productive working relation- ships but was not communicating that goal effectively. There was no attempt to establish a common understanding between the supervisor and the employee of what had happened during the disciplinary process, the expectations for the future and the sorts of resources that would be available to assist the reintegrafion. To counteract the general confusion that seemed to characterize the process, we decided that there needed to be more active direction and involvement from higher level management. While returns to work after an abusive incident are often highly visible events, only a handful of such cases ever occur during a given year, so it seemed reasonable to set up a process that involved top management.

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In each case, the deputy director for program services and the deputy director for administration met separately with both the returning employee and the receiving supervisor. The focus of each session was fairly similar. We reviewed the arbitralion decision or settlement agreement to ensure that there was a clear, common understanding. We also explicitly stated our intent that the return to work be successful and that the employee, the supervisor, clients and co-workers all be as comfortable and confident about the new assignment as possible. Both sessions also included a staff development specialist, and the treatment team leader responsible for the site sat in on the session with the receiving supervisor.

It might seem unusual to have executive-level staff involved in formulating a training plan for an individual employee. In fact, there was a degree of discomfort for most returning employees and receiving supervisors, but the meetings made a strong statement about the priority the project should receive. There were also some pragmatic concerns - - the high level of administrative support in these cases helped to ensure that a single, consistent message filtered down through the supervisory chain to the immediate supervisor. We also wanted to be closer to the process to monitor the reintegration effort. Finally, we wanted to ensure that both the returning employee and the supervisory staff knew exactly what was expected.

Each session concluded with the staff development specialist receiving a specific charge to work with the supervisor and employee to develop training packages for both individuals to support the return to work. Additionally, through a series of sessions, the staff development specialist was asked to facilitate the development of a joint agreement- - a sort of contract-- outlining what each of them could agree to do to support the other. The training component was tailored to special needs but usually had some common elements. In general, the training staff felt that the returning employees could benefit from the standard behavior management program provided to all staff on a periodic basis. Individualized follow- up could be used to target specific behavioral needs of clients in the particular residential program and to support the returning employee in dealing with the sorts of behavior that may have caused problems in the past. Staff Development also routinely suggested a couple of more introspective programs aimed at getting along with both clients and staff. One is entitled "How My Behavior and Work Performance Impacts on Clients" and another"How Others Perceive Me." Variable elements added to a particularplan could be markedly different depending upon the specific situation. Some Employee Assistance Program (EAP) referrals were made. Both structured and graduated client interaction exercises were also developed to test and strengthen interpersonal skills and offer specific procedures for opting out of a situation where the employee felt overstressed.

Most supervisors just wanted the reassurance of high-level support, a clear understanding of what had happened to cause the problem and a direct message that the return was expected to be successful. Some supervisors also asked for team-building sessions for their entire unit or programs on active listening/ effective communication. The employee/supervisor contracts simply clarified expectations by reducing them to writing.

During the past 30 months, the reintegration process has been utilized in five abuse-related cases. We again surveyed both returning employees and receiving supervisors using our original instrument coupled with individual follow-up interviews. Three of the five employees indicated that they were clear about what was expected of them as a result of the reintegration meetings and that support in the form of additional training or outside referrals had been made available to them. They felt comfortable in their new job and were positive about their prospects for the future. One employee acknowledged the potential of the reintegration process but still felt uncomfortable and unsure of himself and his new position. A final employee felt that the program was a waste of his time and offered no real benefit. He continued to feel that the abusive incident overshadowed his current work performance and affected his evaluations and the way others treated him in general.

The receiving supervisors were universally positive. They continue to view the placement of a returning employee into their particular work unit as an additional responsibility, but felt that they had

146 The Journal of Mental Health Administration 18:2 Summer 1991

the necessary information and support to handle the situation. Unlike the initial group of supervisors, they indicated that they were adequately informed about the initial abusive incident, had clear direction from management in terms of what was expected and received effective support in terms of available training and access to outside help if necessary.

We view the project as a success. Human service administrators are often discouraged or even angry when forced to return an individual to the workplace after an abusive incident. However, we feel strongly that the most productive response to that frustration is to do everything possible to avoid a reoccurrence and to enhance the individual's skill in appropriately and productively dealing with potentially difficult handicapped individuals. The three essential elements to successfully accomplishing that seem to be structure, communication and support. This pilot program demonstrated that a structured reintegration process offers excellent prospects for clearly communicating what is expected of both the employee and the supervisor and then supporting their efforts to fulfill those expectations.

References 1. Discipline Case Profiles; CY 1989/90. Albany: New York State Office of Mental Retardation and

Developmental Disabilities, 1990. 2. MacNamara RD: Freedom from Abuse in Organized Care Settings for the Elderly and Hamticapped.

Springfield, IL: Thomas, 1988. 3. Owens P, Spicer J: When an alcoholic employee returns to work: the problems for supervisors and

employees. Employee Assistance Quarterly 1986; 1:67-74.

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