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Mindfulness: Is it poor staff performance or a personal crisis?

It’s safe to say that if you’ve asked anyone in a GP practice how they feel about the last couple of years, almost everyone would say they are burned out and fatigued, with some confronting obstacles both professionally and personally, unlike anything we've seen before.

For a practice manager or employer, it can be difficult to know what to do to ensure that your practice runs smoothly, while also encouraging vulnerable members of your team to seek adequate care if they need or want it. Whether it's due to staff shortages, compassion fatigue, or the high-stress/high-stakes, the non-stop nature of patient care is a big contributor to the self-care crisis among healthcare workers.

Why is this hard on managers?

None of this would be an issue if it were as simple as alerting someone that they might need help. The fact is that hearing an employee is in distress is difficult, because we care about them. But as people managers, we also have to be the ones to inform them if they are not performing properly. As a result, managers are put in the difficult position of having to strike a balance.

The first step is to recognise that there could be a problem and consider what you could say to encourage an employee to make a change.

Let’s be clear – as the PM, it is not your job to fix all of your staff members’ issues for them (nor should it be), but it is in your best interests to help them to know when they need some help and encourage them to get it as soon as possible.

What does a crisis looks like?

While there are a variety of stressors that can affect people at work, the following are some common indications of a personal mental health crisis:

  • Expressing hopelessness
  • Fearfulness
  • Feeling trapped
  • Extreme guilt
  • Big mood swings (euphoria, rage, or tearfulness)
  • Increased alcohol or drug abuse
  • Irresponsible or rash actions
  • Poor personal hygiene
  • Social withdrawal
  • Difficulty concentrating

You might see instances at work where someone has been negligent, your nurse practitioner may have forgotten to write up several patients' notes, or they are having trouble concentrating and prone to panic attacks. This is why it's critical to engage directly with the employee—take some time to sit down and openly discuss any changes in their job performance or personality that you've seen in the context of their job responsibilities.

This gives them a chance to open up or verbalise something about whether they are experiencing a crisis. If they are, then you may be able to talk to them about how to deal with it, which can include seeking treatment.

How do I address it?

People don’t always feel comfortable telling their boss that a parent is gravely ill or that they feel stressed out in the wake of a crumbling relationship, or that they’re just overwhelmed with work and don’t know how—or are too scared—to ask for help. They may be worried or embarrassed that it is causing them to be late repeatedly or to miss deadlines.

You might feel that you're being intrusive or overly personal, but as the employer/manager, it's perfectly within your remit to inform them that you're concerned about them – but be mindful of being tactful and put things in a constructive way to resolve things. "I'm extremely concerned about you," rather than "Why don't you take showers anymore?" is a better place to start when it comes to an effective intervention.

After you've expressed your concern, list the items you've noticed that have you worried. When confronting employees, focus on the facts and don’t be tempted to share your own personal views. "You're not paying enough attention lately, Alex," if an employee is having trouble focusing, may make the person feel scrutinised and defensive.

Concentrate on providing the facts rather than making value judgements. "As I was speaking to you yesterday, it seemed like you weren’t paying attention, or you didn’t understand what I was saying. You left two patient registration forms half-completed today, and I'm wondering whether you're having problems concentrating."

Listen first, then suggest second

Listen first before pushing for a certain plan of action when speaking with an employee about their present difficulties. They may just want a sounding board for their concerns about caring for a sick family or an opportunity to discuss how a divorce has impacted their attention span. If you recommend they take a leave of absence or change their schedule right away, they may be turned off if that wasn't their first thought. Instead, inquire as to what you and your partner can do together to address the issue of performance at this trying time.

Use the term "we" wherever possible, as in "How can we assist you?" The employee may offer a suggestion for a temporary solution that you can accept.

Knowing your Limits

You could be more than happy to give a mourning colleague several weeks off or allow someone with a high-risk pregnancy to work from home, but the choice isn't always yours.

Of course, if you have the flexibility to be creative with a flexible schedule, a reduced workload, or a temporary work-from-home arrangement, do so. Before offering anything to your employee, make sure you understand your constraints on short/long-term leave, as well as any cover arrangements you may need to have in place. Explain that, before you both agree to an arrangement, you need to sort out what's doable.

If the employee requires any specialist support such as counselling, you may be able to refer them to options offered by your occupational health provider.

Check in regularly to make sure they’re doing ok

Check in with your employee on a regular basis, whether you've decided on a solution or not, by dropping by their desk (keeping their privacy in mind) or sending a quick email. Not only will they appreciate your concern, but you'll also have a greater understanding of how they're doing.

Some Do’s and Don’ts to Remember

Do:

Set a supportive and compassionate tone in the office. It will not only give your staff the confidence to come to you with problems, but it will also enable you to recognise warning signs.

Be creative with your solutions. A flexible schedule may allow a person to maintain their output without much disruption.

Check in with them from time to time, both to reassure the employee and to make sure that there is progress, and that there is no need for further adjustments.

Don’t:

Remember that you’re the manager, not a therapist. Your heart may be in the right place, but it isn’t your job to get involved in your employee’s personal problems.

Make promises you can’t keep. Make sure you understand your practice policies before you offer time off or alternative work arrangements.


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Closing Date: 5 July 2022

Salary: £60,000+ (depending on experience)

Practice Manager - New Mills

Closing Date: 14 July 2022

Salary: £42,000 - £47,000 per annum, depending upon experience

Practice Manager - Pembrokeshire

Closing Date: 14 July 2022

Salary: £40,000 - £45,000, negotiable depending on experience

Assistant Practice Manager - London, N17

Closing Date: 1 July 2022

Salary: Dependent on experience

Practice Manager - Romsey

Closing Date: 5 July 2022

Salary: £60,000+ (depending on experience)

Practice Manager - Deeside

Closing Date: 6 July 2022

Salary: In the range of £25,000- £40,000 (pro-rata) per annum depending upon experience

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