Four strikes, you're out


How to implement the "four strikes" method of enforcing safety rules in your practice.

No matter how well you train team members, it's likely that someday an employee will intentionally violate safety rules. That's one reason why every practice needs a disciplinary policy. Many administrators subscribe to the four strikes method of discipline. Here's how it works:

Strike one is a verbal warning. The supervisor should be specific. For example: "Joe, you have been directed to use specific gloves and an apron when taking radiographs. If you continue to disregard this rule, further disciplinary action will be necessary."

You can't be laid-back about this. If a supervisor goes to Joe and says, "Dude, you're going to get me in trouble if you don't wear that stuff," that's not a verbal warning-that's negotiating.

Keep a record of when the warning was given and the exact words used. This can be as informal as a handwritten note in the team member's personnel folder. If after a few days the employee continues to disregard the rules, it's time for the second strike.

Strike two is a writing warning. When team members get one of these, they usually take it seriously and either straighten up or leave.

The safety director or supervisor should issue the warning report in person, not via e-mail or an envelope in the mailbox.

The written warning must be given during or immediately after the violation. This usually solves 90 percent of the problems; for the remaining 10 percent, proceed to strike three.

Strike three is suspension without pay. Yes, it creates a hardship for the practice, but no more than if the team member had called in sick at the last minute. The practice will survive, and the staff will probably be pleased that the offender is no longer getting away with breaking the same rules they have to follow.

The supervisor should issue the suspension as soon as he or she sees the team member violating the rule. The warning should be specific and unambiguous. For example: "Joe, you've received a verbal and written warning for failure to follow the safety rules. You are now on suspension without pay for two days (the most common recommendation for this type of infraction) for continued violation of the rules. Clock out and go home. We'll see you at your regular shift time on Thursday." This solves 9 percent of the remaining problems.

For the last 1 percent, strike four is termination. You must safeguard your hospital, your other staff, and your patients. And a team member who won't comply with one safety rule likely is ignoring others.

Of course, it's good to get the big boss involved early in the process, if he or she isn't the immediate supervisor. Many of these compliance problems can be solved if the practice owner makes it clear that participation in the safety program is mandatory and that disciplinary action will result if team members violate the safety rules. Then the owner has to follow through. Otherwise the rules aren't enforced, and you can bet the practice will be held accountable when OSHA comes for an inspection.

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