An ambulatory surgery center needs to run like a well-oiled machine to achieve its clinical and financial goals. However, an under-performing employee can throw a wrench in the organization's processes, and managing them requires a deep well of tact and a deft hand.
"Poor attitude and behavior is contagious; it will eat away at a healthy, happy culture," says Amy Hanisch, director of human resources at 
Surgical Management Professionals.
Underperforming employees can cause otherwise hardworking employees on your team to become disengaged, particularly if they see no repercussions for slacking off. Unfocused employees can take the life out of an organization, which is why it is up to the facility's leaders to curb this attitude. "As leaders, if we manage effectively we can mitigate poor attitude spreading into our culture," she says.
An underperforming employee typically displays a number of telling characteristics, according to Ms. Hanisch. You can identify such an employee by their body language, tone of voice, lack of follow-up and general attitude. "They can appear unfocused and depressed, showing lack of motivation and you can see this in the way they carry themselves," she says. "Another characteristic is avoiding confrontation with you as the leader."
Here are six ways to get an underperforming employee to put his or her best foot forward:
1. Identify the problem. Invest in having conversations with the employee regarding his or her performance. It is important that ASC managers understand the root of the problem. Ms. Hanisch suggests asking questions such as "Why do you think that happens?" and "How might you manage that differently?" These questions will prompt analytical reflection and help you understand their decisions and behavior, she says.
2. Challenge underperformance. "Conversations with underperforming staff are often difficult, uncomfortable and sometimes distressing, but they are at the very heart of our role and responsibility as leaders," says Ms. Hanisch. But it is necessary that leaders have this conversation, as it is the only way to ensure improvement. Give specific details to the employee about his/her actions and behaviors and which organization standards have not been met by those actions, she says.
3. Coach the employee. According to Ms. Hanisch, coaching and feedback is essential when dealing with an underperforming employee. Once you have uncovered the reason for the lack of performance, see if there is anything the ASC administration can provide to improve it. "You as the leader need to understand if the employee can't do their job, won't do their job or if they don't know how to do their job," she says.
4. Set clear expectations for the future. When discussing the issue of underperformance with an employee, it is important to focus on the future. Come up with an improvement plan for the employee that lays out what needs to change and be improved upon, suggests Ms. Hanisch.
5. Follow up consistently and provide feedback. Once a plan for improvement is set, make a plan for following up. Set dates and times that you will meet again to discuss progress, says Ms. Hanisch. Providing feedback, giving encouragement and keeping tabs on improvement is just as important and setting expectations and creating a plan.
"Successful leaders hold their employees accountable," she says. "Most people will appreciate the feedback, but be sure you give the good feedback as well. Often a simple mention of 'Thank you' or 'Well done' goes a long way."
6. Be sure to document. Document the entire process, from the first conversation to the plan for performance improvement to the deadlines for follow up. Tell the employee clearly that if the issues are not improved, it may result in additional corrective action, up to and including termination of employment, according to Ms. Hanisch, and make sure you document this. "As a HR professional, nothing is more frustrating than when a manager demands an employee be fired and yet their last review tells me they are a stellar employee," she says.
When should you let go?
However, despite a manager's best efforts an underperforming employee may not improve. According Ms. Hanisch, it is important for leaders to be realistic and ensure that they are holding up their end with follow-up and feedback, based upon the timeframe you set. The timeframe can vary based on the complexity of the employee's problems with performance.
While letting someone go is never ideal, it may become essential. Keeping an underperforming employee on staff can result in a ripple effect of negativity through the entire surgery center. "Again, be clear on your expectations, if you are terminating someone for underperformance there should be no surprises," adds Ms. Hanisch.