Leading Employee Compliance

Patient compliance with instructions is a valid desire, and yet it seems a goal that is hard to attain. If only patients would follow the directions given, which always seem so clear. It is not only patients who seem not to do as asked, however. What would it be like if staff members, nurses, techs, and others were all more compliant with the leader’s directions? Doesn’t compliance on the part of employees and those on the team make the leader’s job easier? The answer is yes, of course. Yet, in the same breath, leaders in healthcare and other areas believe compliance is achieved by stating a directive, followed by the intended confirmation of “Do you understand?” or “Does that make sense?” Both statements elicit conditioned responses in the form of “yes.” Patients and employees may nod their agreement, but this does not necessarily indicate that they truly do understand or that they will comply with any degree of initiative or willingness.

Many healthcare employees report that directions given by those in leadership are not clear.

People are not that precisely prescriptive. For instance, patients do not always do as asked, even when their health and well-being are on the line. For individual patients, this is certainly a problem, but noncompliance on the part of one does not typically impede the progress of the rest of one’s patients. Employee and team member compliance, on the other hand, can affect the entire department, center, hospital, or practice, or, worse yet, one’s license. And even though one might think having a job on the line to be a pretty compelling argument in favor of compliance with the doctor or leader’s wishes, this usually is not the case.

How does a leader obtain employee compliance? How does a leader get team members to do what has been asked, consistently? Unfortunately, employees are not like drugs and medications, and are not subject to definitive rules of interaction. When it comes to people and the team one leads, if compliance is the desired outcome, the effective leader must use a number of methods or measures. I believe the five actions discussed in the following sections are the most important and will have the greatest impact.

Be Explicit

Many healthcare employees report that directions given by those in leadership are not clear. This goes beyond directives in procedures and extends into areas that require “soft skills” or personal interactions or that relate to adherence to expectations. In each of these areas, it is difficult, at best, to comply when one does not really understand what to do or why. Assumptions, stress, and a lack of time for thorough explanation are most frequently to blame for what seems to be missing. Mitigate those and directions become crystal clear. Being explicit really is that simple—but, often, not that easy. Being clear so that employees are able to comply with directions and directives includes a dose of emotional intelligence, a dash of patience, a pinch of awareness, and a significant dose of self-management.

A leader who repeats Nike’s slogan “Just do it” in the belief that he or she has been clear is lacking the awareness piece. A leader who believes all employees are motivated by accomplishment, ambition, and the wish to do the right things right consistently is missing the emotional intelligence element. A leader who considers the personalities of those being led, his or her—and the team’s—level of stress, and everyone’s communication skills will find it far easier to give explicit instructions. Each person understands differently. Being clear requires: (1) understanding these differences; and then (2) translating one’s directions to make them clear to the specific recipient, thereby elevating that employee’s performance. Dissect directions and examine them against each of these elements to ensure that they are clear.

Provide Consequences

Once directions or requests have been made clearer, it is necessary to decide on what to do when employees do not adhere to the guidelines. In the absence of rewards or consequences, most people will do whatever is easiest, regardless of policies, procedures, or peer pressure. Even when the rewards or consequences seem obvious, if they are not immediate or do not seem attainable, they lose their effectiveness. One of the more tedious elements of the management of employee behavior is in the consistent application of consequences. The time it takes to observe behavior, determine the facts, apply swift consequences, and ensure they are appropriate for the action can seem overwhelming. Yelling is easier, and often tempting, but far less effective. Assign two to three consequences for each misstep or failure to comply with specific directions. Automate those consequences as much as possible, and, where not possible, deliver them quickly and consistently. If the appropriate consequences are delivered swiftly, the employee who chose to ignore directions the last time will make a different choice, quickly, the next time.

Monitor Progress

Managing human behavior takes a large amount of time. Nor do people respond as well to managing as they do to leadership. Part of leading a team is monitoring each team member’s progress in terms of compliance and making adjustments. Multiple factors such as consistency, structure, expectations, old habits, skill levels, rewards, consequences, and unwritten rules change behavior and behavior choices. Each factor should be considered when monitoring employee progress and determining what course of action to take next in order to ensure compliance. Situations change, depending on the circumstance in which compliance is expected. People change and grow. No human being fits neatly and cleanly into a single label or assumption or style. Stay on top of compliance deviations. Pay attention. Don’t let things stray out of hand, lest employees deduce that compliance is not expected. Then monitor and praise even small progress in compliance and performance.

Consider the Other Shoe

If while monitoring progress and attempting to manage compliance, the leader is given to explosive reactions when directions are not explicitly followed, it creates a sense of fear in those employees who are tempted to demonstrate even an ounce of initiative. What is the truly desired outcome? Does one desire employees with strong judgment, able to modify a direction when the circumstances warrant, or employees who follow orders to the letter and require a doctor or leader’s input in every instance? The key here is to consider the employee’s position, perspective, and experience. Although compliance is the desired goal, most likely there is a larger outcome at stake. Patient safety is the priority, and if that means a modification of your explicit directions, then the employee’s attention to what really matters is what should be praised. In order to see that perspective, however, one must put oneself in the employee’s place, time, and situation. Stop giving directions for a moment and look closely at the recipient’s reaction. Are there reasons other than what you assumed for the employee’s lack of rigid compliance?

Follow Through

Whether it is through considering the employee’s perspective, delivering consequences, or simply doing what one says one will, following through creates a sense of stability. Personality assessments have shown that a significant number of employees in hospitals, ambulatory surgery centers, and other healthcare environments originally chose this career path for the purpose of helping people and doing the right things to ensure help was provided. The personalities of people driven to help others and those driven to do the right things are the same personalities that crave structure, stability, routine, and the reassurance of a reliable, predictable leader. This means the leader must follow through on commitments he or she has made, consequences that have been laid out, the expectations that have been expressed, and what he or she has said will happen next to those who do not comply. The leader must follow through, or avoid making the commitment to do so, because a commitment made with no follow-through creates more damage than the belief that the leader has a God complex.

Conclusion

This five-part map could easily seem like five individual actions, each of which is quite complex. Compliance simply is not that difficult, however. It does take effort, and it does take consistent action. And it takes a leader willing to make leadership of the team, in addition to patient needs, a priority. To achieve that kind of leadership, it is necessary to tell those one leads how to do what is needed and why the need exists to begin with. Compliance will improve. Monitor how and what employees do, paying attention to their viewpoint with even the smallest dose of understanding, and compliance will continue to improve. Dole out appropriate consequences and follow through on what one says one will do, and employees and team members will move mountains to do what their leader asks them to do.