Staff Management

5 Steps to Righting Employee Performance

By Pamela Miller, OD, FAAO, JD, FNAP

August 4, 2021

Your employees can be your greatest asset–if they are properly trained, developed and guided toward improvements. Here are key steps to ensure your patients are well cared for and your practice stays profitable and in compliance with HIPAA and other laws.

To illustrate, let’s take the case of seemingly minor carelessness that could lead to HIPAA violations.

Identify the Small Stuff that Could Lead to Big Problems
A staff member speaking loudly with a colleague about a patient while other patients wait nearby may not seem like a big deal. However, this indiscreet approach to discussing patients could lead to a HIPAA violation. What happens if a patient in the reception area happens to know the patient being discussed, and they learn that this patient, whom they know, has been diagnosed with a sight-threatening eye disease?

Similarly, a computer screen with a patient file left visible to other patients while the practice employee gets up from their desk to attend to other matters may seem inconsequential. But this too could lead to a HIPAA violation. You never want to leave a computer screen with private, protected patient information easily available for viewing by anyone walking past a desk.

Correct Without Embarrassing the Employee
The first step is to make an immediate correction without embarrassing the employee. You want to catch this careless behavior before it leads to trouble. A pointed look with a finger to your lips to signal the need for quieter voices and discretion is a quick, in-the-moment fix. For the computer screen with a patient’s private information viewable, minimize the information on the screen, or click out of the file, yourself, if the employee is not at their desk and leave a note for them to see you.

When you have the employee in private, so as not to embarrass them in front of colleagues and patients, remind them of the importance of protecting patients’ privacy: “Sally, one area where we all need to be extra careful is in protecting our patients’ private information. During our hours of operation, when we have patients in the office, it’s best to discuss issues about specific patients in one of our backrooms, rather than out front. If you must make a quick comment about a patient while others are nearby, remember to keep your voice low. If you need to get up from your computer, be sure there are no patient files left unattended on the screen. It’s also best to keep your computer monitor turned as away as possible from the reception area. Patients depend on us to keep their private information secure, and if we are not able to do that, we also could be in violation of HIPAA regulations, and we could be fined.”

Consider the Employee’s Personal Circumstances
If an employee repeatedly makes the same mistake, or additional mistakes, take time to find out what’s going on in the employee’s life. If the mistakes just started happening, or have all of a sudden become much more frequent, there may be a reason for it. An otherwise great long-term employee can become careless when they are distracted by personal problems. It’s worth talking to the employee about a temporary change in their hours and role in the office, rather than setting an immediate timetable for improvement after which they will be terminated.

“Bob, it sounds like you have a lot going on right now at home. You’ve always done such a good job for us and our patients, I knew these recent issues weren’t like you. How about–at least temporarily–we cut back on how often you’re in the office? Then, when things ease up for you, we can talk about resuming your regular, full-time hours.”

Document Conversation & Course of Action Agreed to
Whether you decide the employee should be given a temporary accommodation, a timetable for improvement or immediately terminated, document the conversation and decision. Most U.S. states have at-will employment. That means an employer can terminate an employee at any time for any reason except illegal ones such as religion, race, age, pregnancy and other protected statuses.  However, that doesn’t mean the employee won’t sue for wrongful termination. They can claim you terminated for a reason other than poor performance. They could claim that you never pointed out the mistakes to them, and that you never tried to work with them to correct the performance issues. They may claim that the real reason you terminated them is because of their age. Documenting the conversation with the employee, and even having the employee sign a form stating that they were informed of the issues or concerns, and have agreed to the solution you proposed, may be a good idea. You want to be able to clearly show that the employee understood the reason they were terminated, and that it was not for any reason other than poor work performance.

Avoid Negatively Impacting Rest of Staff
Sometimes an accommodation to keep an otherwise great long-term employee on staff will impact the rest of your staff. For example, the employee who needs to step away from their usual working hours temporarily due to a personal crisis will need their hours and/or work filled by someone else. Who will that person be? Rather than make that decision on your own without consulting your other employees, hold a meeting to discuss.

“Bob will be temporarily cutting back on his hours, so for the next few months, we need to figure out a plan for covering the hours and work he would have done. Would anyone like to volunteer to cover his hours? Are there certain tasks Bob does that one of you might be willing to take on as an opportunity to learn new skills while helping the practice?”

It may turn out that there are no volunteers able and willing to take on the workload of the indisposed employee. “How do you feel then about bringing in a temporary replacement? Will you be able to help me train the person?”

The worst “solution” would be demanding additional hours or work from employees, or informing them that a temporary replacement, whom they will all be responsible for training, will be arriving shortly.

A collaborative relationship with your staff ensures that when a challenging employee issue arises, you will have a team, rather than adversaries, ready to help you find a solution.

Pamela Miller, OD, FAAO, JD, DPNAP, has a solo optometric practice in Highland, Calif. She holds a law degree and a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her:



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