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Updating your employee manual: the latest and greatest (Proceedings)


Your manual is a tool to communicate information to your employees regarding your hospital's policies and practices, benefits, guidelines, leave procedures, expectations of conduct, equal opportunity employment and employment-at-will.

Why do you need an employee manual?

Your manual is a tool to communicate information to your employees regarding your hospital's policies and practices, benefits, guidelines, leave procedures, expectations of conduct, equal opportunity employment and employment-at-will.

When was the last time you read through your manual in detail? As you review your manual, think about the following issues:

  • Do you follow all your policies consistently? If not, they need to be changed

  • Are any policies and procedures outdated?

Are you current on

  • HIPPA privacy rules

  • Guidelines for cell phone and texting

  • Email and Internet policy

  • Workplace privacy and/or surveillance issues

  • Discrimination and Harassment Policies

  • Employment-at-will statement

Drug free workplace policy

Employers can either chose to ignore or address the issues of drugs in the workplace. There are many benefits of a drug free workplace policy. These include

  • Reduced absenteeism, tardiness and sick leave. Drug users consume almost twice the medical benefits as nonusers. Drug users are absent 1 ½ times more often than nonusers.

  • Reduced employee discipline problems

  • Reduced workers' compensation costs. Drug users make more than twice as many workers compensation claims. Also, many workers' compensation carriers provide a discount to employers who (1) have a drug free workplace policy and (2) drug test applicants as a condition of employment and (3) drug test any employee injured on the job.

  • Improved productivity

  • Improved employee morale and motivation

  • Improved community image

To begin a drug free workplace your hospital will want to follow these next steps

1. Create a written policy

2. Work with a drug testing clinic to set up the drug and alcohol testing procedures that work best for your hospital's size and needs

3. Consider an employee assistance program

4. Educate your employees about the program. It is a common practice to inform employees 6 months prior to implementation of the policy. This allows employees time to seek help if they have a substance abuse problem.

5. Begin training your managers and supervisors.

6. Begin testing of all new employees

7. Where applicable, test current employees

8. Provide assistance and rehabilitation

9. Evaluate your program - make changes as needed

10. Stay current with all federal and state laws and regulations including:

  • Title VII of the Civil Rights Act

  • State drug testing laws

  • Americans with Disability Act

  • State workers' compensation laws

As hospitals establish their drug free workplace policies or make the choice not to establish drug free policies they should remember that employees have rights to privacy. Employees have rights from unreasonable searches. Clients expect their pets to be well cared for. Employers have been sued for negligent hiring and for negligent retention of employees with substance abuse problems. A drug testing program that follows appropriate standards for your state will help to protect your hospital, your clients and your other employees.

Employee conduct

Violence in the workplace

Violence includes threats of any kind, including threatening or violent behavior such as intimidation of or attempts to instill fear in others. Supervisors should be educated to be aware of employees with behavior that suggests a tendency towards violence. This includes employees who use belligerent speech, excessive arguing, theft or sabotage of hospital property or employees who refuse to follow policies and procedures. Your policy should include a list of examples that are considered inappropriate workplace acts such as defacing hospital property, bringing weapons of any kind on hospital premises and parking lots, theft, not following policies, belligerence. Your policy needs to include information on how an employee will report acts of violence, how this will be investigated and any corrective action and discipline that will be taken.

Domestic violence and the workplace

There have been many incidents of domestic violence that have carried over into the workplace. Employers need to be proactive rather than reactive to this concern. As an employer, you can train your managers on the early warning signs of domestic violence. Implement a prevention program that includes a policy and guidelines for dealing with violence and domestic violence. It is very important that this information be communicated to employees not just through the employee manual, but also during team meetings. Your hospital wants to know when there are threats or incidents. Make sure your employees know that the hospital is serious about handling these problems.

You can protect your employees by controlling access to your building. This means that all persons who are not employees must enter through the front door. No one, including family members, is allowed past the reception area to the back, laboratory or offices. Depending on the size of your practice, you will want to assign one or two team members as the 'go to' person(s) for communicating any concerns.

Protecting your employees begins with hiring the right people. Protect yourself from negligent hiring by requiring positive background checks including criminal history, character and work history on all successful candidates as a requirement for employment.

Protect your practice from complaints of negligent supervision. This includes:

  • Failure to exercise reasonable care in supervising employees when concerns exist for assaults or threats.

  • Failure to train supervisors and managers on behavioral management, intervention and conflict resolution when there are concerns in the workplace

  • Failure to respond to complaints about employee behavior

  • Failure to investigate complaints

Protect yourself from charges of negligent retention and negligent security. Consider, as you deal with the day to day issues within the practice - do you or should you know that an employee has a tendency for violence? If so, do you have reasonable grounds to bypass progressive discipline and terminate the employee? Do you have concerns about former employees or family members or friends of current employees? As mentioned previously, evaluate access to your building. Look at your security hardware, locks, entryways and lighting. If these are outdated on lack security, it's time to fix it before you have issues.

Video surveillance

According to the American Management Association, over 50% of businesses utilize some type of employee monitoring including video surveillance. Practice owners are watching their parking lots and inside their clinics for suspicious activity. They are using surveillance to prevent burglaries and property crimes. They use the surveillance to protect employees who are working alone, to view the cash register, observe inventory and drugs and observe team members handling of patients.

The practice owners use these tapes to minimize theft within the practice, control alcohol and drug use, observe attendance problems and unsafe working conditions. These tapes help to provide evidence of a crime and help to train team members.

To implement a successful electronic monitoring policy you will want to

1. Determine if there is a legitimate need for your practice

2. Obtain written employee permission if appropriate

3. Set up video surveillance in areas that do not intrude on privacy.

4. Check very carefully into federal, state and city regulations.

a.Sound capture (audio) changes what you are allowed to do.

b.The wiretapping laws may apply.

5. Use visible cameras when possible.

6. Train any team member that might be reviewing electronic monitoring, recorded information or live feed about what are acceptable responses and observation methods.

7. Maintain confidentiality around all aspects of monitoring information.


Twenty percent of workers arrive at work late at least once a week, according to a CareerBuilder.com survey. The three most common excuses given for tardiness include traffic, lack of sleep and getting children ready for school. There are differences of opinion on the benefits of rewarding punctuality vs. taking punitive measures for lateness. Which of these methods works best at your clinic?

Employers can cut their involuntary turnover in half by increasing your focus on policies such as attendance during new employee orientation. Train your managers to provide continuous coaching feedback to your employees. Educate your employees on how they affect other employees and the bottom line when they are absent or tardy. It is important that your team members understand your hospital's policies on tardiness.

Dealing with employee offenses

As an employer, it is important to set clear policies and keep them current. Then, exercise these policies consistently with all team members. Train your supervisors to understand your policies and procedures and your expectations of all employees. Your supervisors should be able to treat all team members consistently.

Progressive discipline policy example

Although your employment is at-will (either party may terminate the employment relationship at any time and for any reason), the Hospital may utilize the following progressive disciplinary process:

  • The first incident shall be addressed by verbal warning.

  • The second incident shall be addressed by a written and witnessed reprimand.

Any further incidents may lead to suspension without pay, or immediate dismissal, if all of the above have taken place in any three month period.

Discipline will occur based on the circumstances surrounding each situation requiring employee discipline. Factors that will be considered during the disciplinary process are the nature and gravity of the offense, the staff member's work record, and any special circumstances which contributed to the breach of professional conduct.

Nothing in this progressive discipline policy is meant to alter the at-will employment of the employee with the hospital.

Computer, email and internet usage

Employees should not have the expectation of privacy in anything they create, store, send or receive on the computer system. Anything transmitted by, received from or stored in the email system are the property of the practice and employees should have no expectation of privacy in the connection with the use of the email system or the internet.

Educate employee that blogging is a form of public communication and must not violate any guidelines in the employee policy manual. Create a policy to include that employees must be careful to avoid disclosing any information that is confidential or belongs to the hospital. Employees must be respectful - their site or blog is a public space. The blog should not become a means for personal attacks on the hospital, its services, its owners, supervisors, coworkers, competitors, clients and others. Team members may not post any material that is obscene, defamatory, profane, libelous, threatening, harassing, abusive, hateful or embarrassing to another person or entity. This includes but is not limited to comments regarding the practice, its employees, owners, management or competitors.

Five states currently have statutes that protect an employee's lawful off-duty conduct and other states are considering this legislation. These laws prohibit employers from taking unfavorable employment actions based on off-duty legal conduct.

Cell phones and texting policy example

Personal cellular phones are not to be turned on while at work – this includes the use of the phone for texting as well as phone calls.

Emergency closing policy example

Although the company will make every effort to remain open for business on scheduled workdays, there may be instances where conditions make it impossible to do so.

These include, but are not limited to:

  • severe weather

  • declared state of emergency

  • utility disruptions

  • natural disasters

  • In all cases employee safety will be the primary consideration.

Your practice will want to list the procedures that your team members are to follow in an emergency.

Inclement weather policy

In the case of inclement weather, it is the hospital policy for each team member to attempt to report to work. If you are unable to report for duty, you must call your supervisor. If conditions require the hospital to have a delayed opening or to be closed, a message will be available after 6:00 am of the morning in question on the Practice Manager's cellular phone voice mail.



In order to make benefits more flexible and provide team members with the ability to schedule personal time off, many hospitals have combined vacation time, personal time and sick time into Paid-Time-Off. Employers must decide if they will require the team member to 'use it or lose it' as far as any earned but unused paid time off at the end of the benefit year. In making this decision it is important to consider your state laws as well as the needs of the practice and team members.

Civic duty policies

Time off to vote - It is important to stay current with your state's requirements for time off and pay for employees who vote. A sample policy follows. This policy will have to be adjusted for hospitals in states that require paid time off to vote.

[Practice Name] encourages employees to vote before or after their work schedule if this is possible. If that is not possible, the employee's supervisor should be informed in advance so that work schedules can be adjusted as needed to ensure they have the opportunity to vote

Jury duty - Know your state requirements for time off and pay. The sample policy below will have to be adjusted as needed for hospitals in states that require employees to receive some compensation.

[Practice Name] realizes that a call to serve on a jury or as a witness is beyond the control of an employee and [Practice Name]. Absences due to jury or witness duty will be excused.

Bereavement leave

If a member of the employee's immediate family dies, employees who have completed at least 90 days of service may take up to 3 (paid/unpaid) days off work.

Define immediate family so there is no confusion. The employer may determine if these will be paid or unpaid and how this benefit affects full-time vs. part-time employees. If employee has vacation/PTO available this can be used.

Employee benefits at no cost to the hospital

Sometimes the only difference that a prospective employee sees as the distinction between one hospital and another are the benefits that are provided. Even when the hospital cannot pay for these benefits, and they are 100% employee paid, they provide one more marketing tool in hiring prospective team members and keeping current team members. Some of these benefits to consider are:

  • Dental insurance

  • AFLAC (or something similar)

o Short term disability

o Long term disability

o Life Insurance

o Cancer Insurance

Other benefits to consider

Employee incentive program

As an employer this is an opportunity to recognize that the contributions made by individual employees play a great part in the success of the hospital. The incentive program offers team members the chance to participate in an employee incentive bonus program. The purpose of the program is twofold. First, it rewards those employees whose excellent performance has been instrumental to the practice's continued success. Secondly, it encourages employees in their efforts to further promote the hospital and its services and to provide clients and patients with the highest quality of care and service possible.

The incentive program is a quarterly program. If the hospital realizes a profit during a quarter, then 10% of the increase in gross income from the same quarter of the previous year will be allocated into an employee incentive bonus fund. This bonus fund will then be divided among the employees of the practice based upon employees' individual performance evaluation scores. The better an employee scores on their performance evaluation, the larger their share of the bonus fund will be. Bonuses for part-time employees will be proportional to the average number of hours worked during the quarter.

In order to qualify to participate in this program, an employee must be employed during the entire quarter. If an employee is hired during the quarter or leaves their employment for any reason during the quarter, they are not entitled to any portion of the bonus fund.

Continuing education

Providing educational development is important to your team member's personal growth and the betterment of the hospital. This is an opportunity to encourage team members to take courses or training to increase their job competence and to prepare for future advancement. The hospital should set aside funds based on the employee's position to provide this benefit to employees.

Employee referral program

Great employees refer great employees. Setting up an employee referral bonus program will encourage your current employees to refer qualified friends and acquaintances to fill your open positions.


Employment-at-will means that either the employer or the employee may terminate employment for any reason or for no reason (except for a few illegal reasons) at any time. This means that the employee does not have a contract for employment and that the term of the employment is for an indefinite period of time.

It is important for your employee manual to include an employment-at-will statement. It is equally important for you, as the employer, to understand what this means and to understand your state laws. The most restrictive state regarding employment-at-will is Montana. Employees in Montana who have completed an initial probationary period are protected from being fired without cause.

Your employee manual should also include a statement that except for employment-at-will, the policies within the manual can be changed by the owners at any time.

Your legal counsel

There are three final steps in preparing or revising your employee manual.

1. The first of these is to take the employee manual draft to your lawyer or a lawyer in your state who specializes in personnel law. Have them review it.

2. Next, introduce the new/amended manual to your team members during a team meeting. Review changes that have been made. Educate employees on your policies. This may take more than one team meeting.

Last, implement your updated, latest, greatest employee manual!

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