The Health Care Manager

Volume 23, Number 4, pp. 290–301

# 2004, Lippincott Williams & Wilkins, Inc.

Workplace Deviance
Strategies for Modifying Employee Behavior
Marcia Pulich, PhD; Louise Tourigny, PhD

More than ever, today’s health care employees must perform their jobs as efficiently and ef-
fectively as possible. Job performance must integrate both technical and necessary soft skills.
Workplace deviant behaviors are counterproductive to good job performance. Various deviant
behaviors are examined. Areas and strategies of managerial intervention are reviewed which will
enable the prevention or modification of undesired employee behaviors. Key words: newcomer
socialization, organizational citizenship behavior, psychological contracts, soft skills, work-
place deviant behavior

ITH THE COMPETITION among health SOFT SKILLS

W care organizations today, it is impera-
tive that employees perform their jobs as The integration of soft skills in health care
efficiently and effectively as possible. This organizations enables people to work togeth-
includes more than just possessing necessary er smoothly so as to achieve common goals.
technical skills; it also includes developing Soft skills refer to learned capabilities and
and exercising soft skills critical to continued practical skills such as empathy, and social
organizational effectiveness and improve- competencies that enable employees to be
ment. Employees lacking essential soft skills outstanding in their work. The practice of
may act in a manner that is disruptive to the soft skills requires a high level of emotional
normal conduct of organizational activities intelligence which is the individual capability
and, consequently, prevent the achievement to manage one’s feelings so that they are ex-
of organizational goals. This article provides a pressed appropriately and effectively.1 These
review of the soft skills and employee be- soft skills may be differentiated into 5 emo-
haviors that health care organizations should tional intelligence areas: (1) self-awareness
encourage in order to achieve excellence. (knowing one’s preferences, resources, and
Furthermore, it provides a description of intuition); (2) self-regulation (managing one’s
workplace counterproductive or deviant be- internal states, impulses, and resources); (3)
haviors which, when displayed by too many motivation (developing one’s tendencies that
employees, can be detrimental to a health guide and facilitate goal achievement); (4)
care organization and its employees and empathy (being aware of others’ feelings,
patients. Finally, it proposes some areas and needs, and concerns); and (5) social skills
strategies of intervention that health care (inducing desirable responses in others).1,2
managers may use to prevent or modify un- Soft skills are associated with personal and
desired employee behaviors. social competencies that enhance the well-
being of the health care organization and its
stakeholders such as employees and patients.
Personal competencies include self-confi-
dence (self-worth), trustworthiness (honesty
From the Management Department, University of
Wisconsin-Whitewater. and integrity), conscientiousness (depend-
ability), adaptability (flexibility and openness
Corresponding author: Louise Tourigny, PhD, to change), readiness (initiative), and persis-
Management Department, University of
Wisconsin-Whitewater, 800 West Main Street, tence (optimism) among others. The most
Whitewater, WI 53190 (e-mail: [email protected]). important social competencies for health
290

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 Strategies for Modifying Employee Behavior 291

care organizations include service orienta- ganization. Finally, they tend to perceive that
tion (focusing on the needs of others) and they are treated in a fair manner5 and that
collaboration (working well with others). their expectations toward the organization
The relevance of personal and social compe- and management are met.
tencies may vary according to the character-
istics and requirements of various categories Negative emotions
of jobs. In health care organizations, it is
Some employees lack the competencies
expected that employees who work exten-
associated with emotional intelligence. As a
sively with patients should develop both
result, they display less adaptability and
personal and social competencies that en-
withhold OCB. These employees usually
hance the quality of service provided.
develop negative job attitudes, and may ex-
Organizational citizenship behavior press or release some feelings in a manner that
is disruptive to the normal conduct of work,
Employees who are high in soft skills are thereby significantly affecting the effective-
usually more successful in their jobs and ness of the health care organization. This is
represent important assets to health care likely to occur when such employees are
managers. These employees generally con- motivated by a need to release or express
tribute to the well-being of the organization feelings of anger or frustration,5 which may
by displaying high levels of organizational be the result of perceived unfair treatment
citizenship behavior (OCB), which is volun- or negative affect (feeling distressed, fearful,
tary and informal behavior that contributes to hostile, and scornful). The release of anger
organizational effectiveness.3 OCB is com- may take the form of serious destructive
posed of 7 dimensions: (1) helping behavior behaviors such as verbal and physical aggres-
(eg, an employee helps a coworker when sion directed at coworkers, patients, or the
needed even if not formally requested to do health care organization itself. The expression
so); (2) sportsmanship (eg, an employee
of feelings of frustration that are associated
maintains a positive attitude, avoids complain-
with immediate negative job affect5 can take
ing, and sacrifices his or her personal interests
the form of various disruptive behaviors that
for the benefit of the group); (3) loyalty to the
undermine productivity and increase person-
organization (eg, an employee protects the
nel costs such as absenteeism, lateness, and
organization); (4) compliance (eg, an employ-
unauthorized extension of work breaks.6
ee obeys organizational rules even if no one
is watching); (5) initiative (eg, an employee
Organizational climate
goes beyond the call of duty by attending
functions that are not explicitly required); (6) Health care managers may feel powerless
civic virtue (eg, an employee makes construc- to take direct action to extinguish these
tive remarks); and (7) self-development (eg, counterproductive behaviors for a variety of
an employee voluntarily develops additional reasons such as a fear of resentment on the
professional competencies so as to increase part of employees or the possibility of in-
his or her individual performance).4 creased turnover. However, a lack of proper
Employees who regularly practice OCB managerial intervention may lead to the de-
are usually high in positive affect (feeling velopment of a poor organizational climate,
excited, active, enthusiastic, and strong) that is the shared perception of formal and
and job satisfaction (holding a positive atti- informal organizational policies, practices,
tude toward one’s job). Furthermore, they and procedures.7 A poor organizational cli-
tend to display high levels of job involve- mate in which employees believe that the
ment, which is the extent to which they formal norms are not properly reinforced
invest in their jobs, and organizational com- by health care managers is detrimental to
mitment, which refers to their acceptance of employee job involvement and organization-
the values and goals of the health care or- al commitment.

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292 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2004

Disturbances created by dysfunctional em- deviance from explicitly stated norms may be
ployees, if not corrected in a timely manner, related to a personal lack of motivation to
may lead to greater personnel problems such comply with them or to a motive to purposely
as high turnover among the more competent break them. In either case, health care man-
employees who would otherwise contribute agers are responsible for insuring employees’
to the effectiveness of the health care or- compliance with officially recognized norms
ganization. To remain competitive, health and maintaining a positive organizational
care organizations must be able to attract and climate through proper and systematic rein-
retain proactive8 employees who are high in forcement of the norms. To do so, health care
emotional intelligence, job involvement, and managers should be able to recognize why
organizational commitment, and who dis- and how workplace deviance is demonstrated
play desired OCB. When the well-being of a and understand its consequences.
health care organization is threatened by the Workplace deviance can be interpersonal
presence of too many employees who man- or organizational.9 Both are disruptive and
ifest counterproductive behaviors and lack can lead to dysfunctional outcomes. A treat-
the soft skills that are essential to enhancing ment of each category follows.
organizational effectiveness, it is very likely
that the better employees will seek employ- Interpersonal deviance
ment elsewhere. The health care manager
Interpersonal workplace deviance refers
thus faces the dual challenge of motivating
to both minor and serious harmful behaviors
and retaining the best employees by sustain-
that target specific stakeholders such as
ing a positive organizational climate, and also
patients and coworkers. Minor offenses in-
developing effective strategies of interven-
clude political deviance such as gossiping
tion aimed at eliminating counterproductive
about coworkers, blaming coworkers instead
behaviors that deviate from explicit organi-
of accepting one’s responsibility for failure,
zational norms.
competing in a manner that is nonbeneficial,
The next part of this article explains the
and showing favoritism. Serious harmful be-
manifestation of counterproductive or devi-
haviors refer to personal aggression such
ant workplace behavior, and discusses its most
as physical abuse, stealing from coworkers
common antecedents and consequences. Fi-
or patients, and endangering coworkers or
nally, potential managerial strategies for
patients by reckless behavior.9 Employees
modifying employee behavior are explored.
who display such behaviors are likely to
A mixture of positions such as clerical and
share two important characteristics in com-
nursing are included throughout, and cate-
mon: a sense of entitlement and a right to
gories of behaviors are highlighted that may
exploit others.
be relevant to these positions so as to pro-
vide general guidelines on effective strategies
Sense of entitlement
of intervention.
A sense of entitlement is reflected by one’s
DEVIANT WORKPLACE BEHAVIOR lack of self-restraint in responding to people
or situations. In other words, employees
Employee workplace deviance is generally who feel entitled usually tend to ‘‘act out.’’
construed as voluntary behavior that violates These employees are likely to feel justi-
important organizational norms,9 jeopardizes fied when they deviate from organizational
the achievement of organizational goals, and norms. A sense of entitlement may be root-
threatens the well-being of major stakehold- ed in one’s seniority, expertise, or previous
ers of the health care organization such as accomplishments. This sense of entitle-
employees and patients. Norms are derived ment is often accompanied by a feeling of
from formal organizational policies, rules, superiority and the perception that others
procedures, and ethical standards. Employee are not adequate or acceptable. As a result,

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 Strategies for Modifying Employee Behavior 293

these employees frequently behave in a personnel problems that may affect the or-
manner that displays anger and contempt ganizational climate. Although absence may
and is disrespectful toward others. be a coping mechanism that alleviates stress
and helps restore one’s physical and psy-
A right to exploit others chologic equilibrium, its excessive use may
A sense of entitlement is often associated reflect one’s lack of commitment to the
with exploitation, that is, the right to take organization or intention to quit.11
advantage of others for one’s personal benefit. Health care managers need to assess how
Employees who are exploitative may be these behaviors are affected by role stressors
disrespectful to coworkers, managers, and such as role overload (the perception that
patients, and are frequently rude and argu- there is too much work for one person to do),
mentative as well. They think nothing of role ambiguity (the lack of clarification of
‘‘telling someone off,’’ using derogatory lan- one’s role), and role conflict (the reception of
guage, talking down to others, and informing contradictory messages about one’s role from
others something is their fault even if that is different sources). Furthermore, they need to
not substantiated by actual facts. Employees analyze how the organizational climate itself
on the receiving end of these behaviors then may trigger these withdrawal behaviors.
spend time venting their displeasure to their Employees who perceive a poor organization-
managers or other coworkers, and perhaps al climate may be more inclined to be absent
even patients. so as to escape negative working conditions.
Withdrawal behaviors are often triggered by
Organizational deviance job dissatisfaction, unmet job expectations,
and perceived unfair treatment. Employees
Organizational deviance includes produc- who have a tendency to withhold desired
tion and property deviance. Production de- OCB may be more likely to use withdrawal as
viance is viewed as behavior that violates a means of showing their discontent with
formally prescribed organizational norms some aspects of their jobs. When employees
with respect to minimal quality and quantity are dissatisfied with their jobs, they may lower
of work to be accomplished as part of one’s their job involvement as well. As a conse-
job.10 Property deviance refers to instances quence, they may consider absence or late-
where employees either damage or acquire ness as a means of compensating for poor
tangible assets from the health care organi- working conditions. They may feel that there
zation without authorization.10 Some internal is nothing wrong with using all their sick leave
control systems may prevent property devi- even when not actually sick. Even when sick
ance (eg, electronic surveillance, time cards). leave is exhausted, they may still be absent or
However, these control systems may not come in late. This certainly plays havoc with
always prevent production deviance (eg, em- work schedules and may force the organi-
ployees who intentionally work at a slower zation to hire temporary nurses or other
pace). Therefore, health care managers employees to cover shifts, thus increasing
should be aware of effective existing control personnel costs. Very often health care
systems and potential areas of organizational managers may be reluctant to call this to
deviance that may not be under proper the attention of employees for fear that they
control. The following subsets of organiza- will quit.
tional deviance can have a detrimental effect It is essential to find out whether an
on the normal productivity of employees and employee experiences high levels of stress
work units. and needs to recover, or simply withdraws as
a means of manifesting job dissatisfaction or
Absenteeism and tardiness
escaping a poor organizational climate. These
Employee withdrawal behaviors such as two major causes of withdrawal behaviors
voluntary absence and tardiness are costly call for different solutions and usually lead

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294 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2004

to different consequences as well. When obvious when two people begin by dis-
withdrawal behaviors are associated with cussing a work-related matter but digress to
increased occupational stress, employees non–work-related matters. Unless a manager
are likely to develop job burnout wherein overhears the conversation, he or she may
they feel emotionally exhausted and inade- not realize what is actually taking place
quate to perform their duties. They may also unless these employees are observed on nu-
depersonalize other employees and patients merous occasions. Employees may feel that
as a means of creating psychologic barriers conversing with patients is part of their job.
between themselves and others. However, Health care organizations should encourage
when withdrawal behaviors are related to job employees to inquire about patients’ needs
dissatisfaction, low job involvement, or low and extend those extra gestures that make
organizational commitment, it is likely that patients or others feel special. However,
employees will show their dissatisfaction by managers should make sure that employees’
displaying other counterproductive behav- communication with others is carried out in
iors as well. If such is the case, the problem a reasonable period.
extends beyond controlling absenteeism and
tardiness. Intrusion of personal problems into
the workplace
Unauthorized extended break and lunch times
Everyone occasionally experiences a per-
Although breaks and lunch times can serve sonal problem and may benefit from talking
as a means of developing one’s network to a valued coworker. However, there are
and discussing work-related problems with employees who continually bring their per-
others, some employees may extend these sonal problems to work and discuss them
breaks and lunch times to such an extent with anyone who is willing to listen. Man-
that it becomes counterproductive. Experi- agers may be hesitant to say anything for fear
enced health care managers will recognize of being considered unsympathetic. They
that this is not a novel problem. However, may even feel that it is not appropriate to
for newer managers, it can come as a shock intervene in someone’s private life. Howev-
when employees extend their breaks and er, managers need to realize that these em-
lunch periods without appropriate authori- ployees hinder others from accomplishing
zation or any valid reason. When employees their job duties.
take longer breaks or lunches, they generally
do not make up this time. This increases Not following performance guidelines
personnel costs because these employees are
compensated for time not worked. Further- Employees may deviate from normal pro-
more, this may also engender a need for cedures for handling specific tasks. For ex-
overtime in a department or work unit be- ample, they may not return telephone calls in
cause they are falling behind in their regular a timely manner or deliver proper care to
duties. Finally, it may increase the workload patients as scheduled. Ultimately, other em-
of those who are highly involved in their jobs ployees may be forced to compensate by re-
and conform to organizational norms regard- doing or performing unnecessary work. Not
ing hours of work. only are these deviant behaviors costly to
the health care organization, but they also
Excessive socialization time engender frustration among loyal employees
This situation may encompass excessive now performing the tasks of two or more
time spent socializing with coworkers and employees.
customers or patients. Time spent with co-
Waste of time and resources
workers may be blatant such as when col-
leagues are obviously not working but In many organizations, managers report
‘‘standing around’’ talking. It may be less an increasing problem of inappropriate or

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 Strategies for Modifying Employee Behavior 295

excessive personal use of computers and tion, and of one’s perception of these ex-
telephones. These situations may include pectations toward oneself. Because of its
excessive incoming or outgoing personal tele- implicit nature, the exact terms of a psycho-
phone calls, paying one’s bills online, track- logical contract are never fully specified.12
ing stock prices, playing games, and surfing However, an employee refers to it when
the net including visiting inappropriate web- analyzing work outcomes and it becomes an
sites. Employees may feel that because this important determinant of employee behav-
equipment is available it costs nothing for iors. Therefore, managers should make a
them to use it. However, the problem is that conscious effort to clarify the terms of em-
employees are being paid for not working. ployment and inquire about the expectations
of their employees during the hiring process.
Sabotage and theft
When employees perceive that there is a
Employees may voluntarily damage equip- breach of contract, they may think that they
ment to work more slowly, release their are not being treated in a fair manner and
anger, vent their frustration, or seek revenge. cultivate resentment toward the organiza-
This may be related to the perception of tion. Unfulfilled expectations such as train-
unfair treatment by management or the ing that was promised and never provided,
health care organization itself. Employee or inadequate performance appraisal com-
theft may be related to a perception of a pared with what was communicated at the
lack of appropriate compensation. As dis- time of employment, have serious implica-
cussed previously, a sense of entitlement tions for work attitudes and behaviors. The
may lead employees to believe that they are psychological contract is associated with
exercising their rights when they deviate positive and negative attitudes such as job
from norms with respect to the treatment of involvement, organizational commitment, and
organizational property. Sabotage and theft job dissatisfaction. These attitudes affect
preclude the well-being of the organization the occurrences of OCBs and the manifes-
and increase replacement and repair costs. tations of workplace deviant behaviors as
well. Therefore, managers should use all
STRATEGIES FOR MODIFYING possible means to clarify the psychological
EMPLOYEE BEHAVIOR contract. Some suggestions follow.

The following presents some areas of in- Accurate job descriptions

tervention that health care managers should There has always been a need for good job
concentrate on in order to reduce workplace descriptions but given the cost of a wrong
deviance and increase the likelihood that hiring decision, they are more important
employees will display desired OCBs. Inter- than ever. It is critical that they be accurate
vention strategies focus on the development and current. HR may ultimately have the final
of the psychological contract, socialization responsibility for developing and rewriting
of newcomers, acculturation of employees, these documents. However, managers can
principles of reinforcement, inducement, and play a proactive role in this endeavor by
managerial and organizational support. noting changes between actual job duties
The psychological contract and job descriptions, and bringing them to
the attention of HR.
The psychological contract is an unwritten Job descriptions typically contain several
implicit agreement between an employee elements. One is a listing of major job duties
and the organization that begins when the and responsibilities. Another consists of job
terms of employment are communicated to specifications which are the required person-
the job applicant. This contract is composed al attributes an employee should possess to be
of one’s expectations toward the organiza- successful in performing a job. It is important

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296 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2004

to not only include required skills as job and exercise an influence on the organiza-
specifications but also to give foresight as to tional climate. If these employees perceive
how to identify and measure them for hiring that they have been treated in an unfair
and retention purposes. The use of generic manner, they may in turn set lower implicit
statements such as ‘‘must have good interper- production norms as a means of showing
sonal skills’’ leads to difficulty in deciding their discontent. Thus, deviant behaviors
whether an applicant possesses them, and become institutionalized through the imple-
problems later on in evaluating performance. mentation and reinforcement of implicit
As specified above, performance appraisal is deviant norms by this group. The following
an area where unfulfilled promises can have are means that managers can use to improve
detrimental consequences for an employee their hiring practices.
and the organization. Therefore, care should Interviewing techniques. Structured inter-
be taken to be as specific as possible in views wherein managers use an interviewing
delineating the skills that are required for guide with all job applicants is a way of
successful job performance. It is only when providing consistency in the process. A list of
skills are stated appropriately and included in specific questions in a prearranged order is
the formal job description that employees and asked of all candidates insuring that man-
managers are reminded that they are impor- agers elicit the same information from all
tant components of a job. Later on, managers interviewees.
can legitimately criticize job performance Peer interviews where employees from the
when an employee did not display those work unit participate in the interview
required skills. process, especially in second interviews,
provide an opportunity for candidates to
Improved hiring practices meet prospective coworkers. Participating
The hiring process represents an oppor- employees can provide candid job informa-
tunity to select employees who will fit tion to applicants when managers are not
the organization. Managers have a respon- present. Job applicants may also be more
sibility to identify and evaluate the values of willing to reveal their expectations to pro-
prospective employees to determine whether spective coworkers than to managers.
they will comply with organizational norms Managers may also want to verify whether
and display desired behaviors once hired. interviewees possess necessary skills by
A health care organization may want to allowing a candidate to try out the job if
avoid hiring careerists or short-term insiders.12 feasible. When individuals are exposed to
Careerists are professionals hired as perma- actual job demands, they obtain a more
nent employees who focus on their own realistic depiction of the working conditions.
career progression as their major goal. Short- Use of problem-solving questions and work-
term insiders are employees who consider place situations can also convey a better
themselves to be permanent, but whose focus sense of existing job requirements and
is progression in the short run. Both types problems that may be encountered.
wish to gain personal benefits as quickly as Realistic job preview. Realistic job pre-
possible to progress in their career. Generally, views can increase the accuracy of the hiring
these employees present high job involve- process by providing applicants with infor-
ment but low organizational commitment mation about both positive and negative
when they do not achieve desired career job aspects. The purpose of a realistic job
progression. As a result, even if they maintain preview is to make applicants fully aware of
an adequate performance level, they may not the entire scope of a job so that they can
display requisite OCBs for lack of interest. make an informed decision as to whether to
Managers should also be very careful when accept a job offer.
hiring employees who are long-term insiders In a tight labor market, managers may be so
as they usually establish the implicit norms intent on promoting the jobs to prospective

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 Strategies for Modifying Employee Behavior 297

employees that they provide information only of the psychological contract. Too often, new-
on the positive aspects of the jobs and work comer orientation is left entirely to HR and is
units. As a result, accepting a job while disconnected from the specific requirements
holding erroneous expectations may lead to of a manager’s work unit. Managers should
job dissatisfaction due to a perceived viola- take an active role during this period because
tion of the psychological contract (eg, a nurse newcomer orientation determines how an
who expects to make rounds with doctors employee forms job attitudes and responds to
finds out that some doctors speak to nurses the work environment later on. The person-
only when giving orders).12 A high discrep- environment fit determines the extent to
ancy between expected and actual patterns which one will display OCB and experience
of work behavior for newcomers can pro- job stress. As a result, employees who better
voke job tension and elicit their intention to fit the job and the environment are less likely
quit or lead to psychologic withdrawal. This to voluntarily absent themselves and behave
may ultimately result in high turnover within in a counterproductive manner.
the first year of employment.12,13
Appropriate training
Socialization of newcomers
Training or postentry socialization serves to
Newcomer adjustment depends on the shape employee behavior. At this point, the
institutionalization of organizational social- health care organization invests resources in
ization tactics such as new employee orien- employees who themselves invest time and
tation, training, and acculturation. Intensive energy in learning how to fulfill their roles.
socialization facilitates newcomers’ learning The institutionalization of training practices
through the acquisition of adequate informa- signals newcomers that their jobs are worth-
tion pertaining to the job, and is associated while and that they can also make an im-
with the development of positive attitudes portant contribution to the well-being of the
such as higher job involvement and organi- organization. To shape employee behavior, a
zational commitment.14 Socialization tactics process of acculturation must take place
enable newcomers to master their roles and, where employees develop the belief that they
consequently, reduce role ambiguity and role can improve themselves by incorporating the
conflict. Socialization tactics further enhance values of the organization into their own
the development of trust in supervisors. personal value system.
Finally, institutionalization of the socializa- Use of formal mentorship programs can
tion process can foster the development of increase access to key political and strategic
patterns of behavior that fit explicit organi- information pertaining to the health care
zational standards. organization. Mentorships can also increase
the likelihood that newcomers will adopt
Newcomer orientation
core organizational values and understand the
Newcomer or new employee orientation organizational vision.
provides a unique opportunity to communi- Role modeling on the part of management
cate explicit organizational standards with is also critical as it provides opportunities to
respect to quality and quantity of work and observe desired behaviors. OCBs can be dis-
ethical behavior. Furthermore, it can provide played that are not specified in formal job
relevant information on specific managerial descriptions.
practices pertaining to the performance ap- Performance feedback provides relevant
praisal and reward system. Managers should information about one’s skills. Managers
communicate the organization’s mission, should not only give feedback about required
vision, and values to all newcomers so as to technical skills, but also explain how new-
increase their sense of belonging. It also pro- comers can enhance their performance by
vides a chance to further clarify the terms focusing on the refinement of their soft skills.

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298 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2004

Managers should provide detailed feedback hold different views about behavior. Taking
including examples of desired behaviors the initiative and voicing one’s concerns
relevant to the roles of newcomers. represent behaviors that are acceptable and
Goal setting can be used to help new- even encouraged in individualistic societies
comers actively participate in training by but not in communist regimes. Differences in
establishing learning objectives and time- behaviors are learned through the application
tables. Self-monitoring of goal achievement of reinforcement that is grounded in the
dominant societal culture. Therefore, em-
should be encouraged by providing access
ployees who were raised in a different cultural
to performance indicators when available. If context may not understand why certain
the health care organization surveys patients behaviors are acceptable and others are not.
to analyze how employees respond to their Thus, acculturation such as newcomer
needs, this information should be shared orientation should include a concern for di-
with employees so they can identify areas versity. Proper training should include de-
needing improvement and at the same time veloping knowledge of the new culture,
also capitalize on their strengths. integrating newcomers into the culture, and
Interpersonal support provided by long- acquainting them with expected behaviors
term insiders along with their acceptance of that fit the dominant norms.
newcomers will foster compliance with
implicit norms. When implicit norms be- Transformational leadership
come aligned with explicit organizational A transformational leadership style involves
norms and values, newcomer adjustment is influencing employees (followers) to become
fostered. Therefore, training provided by more motivated, develop new competencies,
long-term insiders is an effective means of and willingly espouse organizational values.
enhancing the acquisition of norms and The following transformational leadership15
fostering the integration of newcomers. skills can accomplish this by helping manag-
Furthermore, as part of the training process, ers enhance positive job attitudes, foster
managers should also encourage newcomers’ OCB, and prevent workplace deviance.
self-socialization tactics. When newcomers
volunteer for extra work-related activities, Idealized influence
managers should provide them with such Idealized influence15 refers to the delinea-
opportunities especially when they involve tion of clear principles that are grounded in
working with coworkers and learning addi- organizational values. It is absolutely essential
tional tasks. Additionally, newcomers who ac- to communicate the organization’s vision,
tively seek feedback are usually motivated to values, goals, policies and rules to all employ-
self-manage and modify their behavior. Man- ees. Managers should be aware of changes in
agers should use proactive tactics with these policies and rules, and communicate them to
employees such as asking for their inputs and employees in a timely manner. While rules
having them participate in decisions pertain- will be discussed under discipline, organiza-
ing to their jobs to the extent possible. tions generally have an employee handbook
specifying rules and policies which employ-
Acculturation
ees are expected to follow. Even assuming
Many health care organizations hire nurses that employees receive notification from HR
from a wide array of cultural backgrounds. or others, managers should also call these
An individual’s culture shapes his or her changes to the employees’ attention. This
beliefs regarding how one must behave ensures that important notices will not be
toward others and what constitutes the ignored as employees may already be over-
potential outcomes of one’s actions. Employ- whelmed by a multitude of messages.
ees who have worked in collectivistic so- Storytelling enhances communication by
cieties and former communist countries may increasing the amount of information employ-

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 Strategies for Modifying Employee Behavior 299

ees will remember and their understand- reinforcement occurs when an employee
ing of the message. It allows managers to elic- exhibits desired behaviors indefinitely. When
it moral emotions among employees such positive reinforcement attempts fail, manag-
as empathy and concern for others. The story ers may use inducement techniques such as
of the nurse who, after her shift ended, re- discipline.
mained with a dying patient can have an
immediate impact upon a newcomer. A good Positive reinforcement
story can increase employee awareness of
Managers should begin by carefully con-
the relevance of policies and rules. Success
sidering what behaviors they expect from
stories can change the perception of employ-
employees and then reinforce only those
ees and provide inspiration to them. As a
behaviors. Several means can be used to pro-
result, they may be motivated to voluntarily
vide positive reinforcement. While some may
modify their behaviors to fit organizational
think that effective reinforcement is based
expectations.
only on the use of financial rewards such as
Inspirational motivation pay increases, rewards can also be nonfinan-
cial. Managers may not have the autonomy to
Managers should act as role models and actually give employees pay increases but
show respect for organizational values and only to recommend them. Thus, although
norms. They should display innovativeness in financial rewards may serve as a means of
responding to the needs of employees and inducing proper behavior, it is not always
patients. Furthermore, they should commu- possible to use them. Managers already
nicate high standards of performance and possess the ability to use many nonfinancial
make it clear that they will not settle for rewards that can be compelling reinforcers.
lower standards.15 A word of praise or thanks can mean much
to an employee. Providing positive feedback
Intellectual stimulation
about specific behaviors shows employees
Managers should encourage divergent that their actions are noticed and important.
thinking so employees develop their own The very act of acknowledging employee
solutions to problems. They should provide behavior demonstrates that the manager was
them with proper training in decision-making paying close attention. Due to time con-
and let them develop strategies for dealing straints, managers frequently fall into the
with recurrent problems.15 careless habit of managing by exception; that
is, only negative behaviors are noticed and
Individualized consideration commented upon. Managers may be amazed
Managers should be attentive to individual at how much better their employees would
employee needs. They should coach and ad- behave when told they did something well.
vise them so as to foster their self-esteem.
Discipline
Employees should feel that their own con-
tributions are required and that they are Managers may use inducement techniques,
important members of the organization.15 that is, imposing formal disciplinary sanctions
when employees do not respond to attempts
Reinforcement and inducement to use positive reinforcement. Work prob-
Positive reinforcement is particularly use- lems may arise when managers do not
ful when managers want to inculcate new enforce work rules. Problems become exac-
habits among employees or modify their pres- erbated when upper-level managers do not
ent behavior. Positive reinforcement refers support lower-level managers. Long-term
to a desired outcome associated with one’s insiders may have become accustomed to
behavior and to the increased likelihood working according to their own dictates.
that one will repeat the behavior. Effective When this occurs, it is essential to take

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300 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2004

corrective action. Using disciplinary means sequences of continuing to violate a partic-

such as punishment should normally de- ular work rule. They are placed in the
crease the probability that one will repeat employee’s official personnel file for a spe-
an undesired behavior. Many organizations cific period such as 6 months, and then
already have work rules in place to deal with removed at the end of that period when the
problem issues. Managers should periodically employee has improved his or her behavior.
remind employees that policies and rules Employees who continue to violate a rule
exist and that they are expected to follow may be suspended. Some organizations sus-
them. However, at times, it is essential to use pend without pay and some with pay for
disciplinary action. brief periods such as one day. Again, man-
Use of progressive discipline. Employees agers should consult their superiors and HR
who do not respond to informal reminders before taking any independent action.
from their managers become candidates for Finally, an employee may be terminated.
progressive discipline. A progressive disci- Organizations should handle terminations
pline system generally consists of oral warn- carefully for a variety of reasons, not the
least of which is a possible lawsuit. Thus,
ings, written warnings, suspension, and finally
managers generally do not make a termina-
termination. Before taking any disciplinary
tion decision independently without consult-
action, managers must consult with HR and
ing and working with their superiors and HR.
become aware of any legal aspects that may
Support of lower-level managers. A pri-
apply. [There are legalities which apply to
mary reason for lower-level managers not
private-sector unionized organizations which
enforcing work rules is the real or imaginary
are beyond the scope of this article. The fear that their managers in turn will reverse
intent is to discuss progressive discipline from their decisions. It takes effort to uphold rules
a broad perspective only.] and enforce discipline. Managers do not wel-
Oral warnings should be documented. come being embarrassed before their em-
Managers should ascertain from HR whether ployees when their superiors do not support
a form already exists for recording the dis- them. This weakens their authority and in
cussion held with an employee. Documenta- the future they are less likely to enforce the
tion prevents a situation from developing rules.
where employees allege that their managers
never spoke to them about some problem.
This also establishes a record in case further Organizational support
discipline is warranted. Employees may experience personal diffi-
Managers may discover that one meeting culties and need professional help that man-
with an employee, wherein a discussion is agers cannot directly provide because it is
held concerning the problem and how to beyond the scope of their expertise. Employ-
improve, is enough to prevent the situation ees who experience work-family conflict,
from occurring again due to an embarrass- deal with difficult problems in their personal
ment factor being involved. Often the rules lives (eg, divorce, sickness, or loss of a family
provide for multiple oral warnings so manag- member), or need to reconsider whether
ers must give the exact number of warnings they made the right career choice may need
before proceeding to the next disciplinary to be referred to appropriate existing service
level. providers.
For employees who need further improve- Many larger organizations offer some form
ment, written warnings are used next. Man- of an employee assistance program. An em-
agers should first consult their managers and ployee assistance program usually offers
HR so they are written in an appropriate counseling services or assists an employee
manner. Written letters usually reference in obtaining necessary services. Some devi-
previous oral warnings and state the con- ant behaviors lend themselves to counseling

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 Strategies for Modifying Employee Behavior 301

for correctional purposes. An employee who because it violates organizational norms, jeop-
is abusive to coworkers or engages in out- ardizes goal achievement, and threatens the
bursts of temper might be advised to enroll overall well-being of patients and employees.
in an anger management program. Deviant behavior is essentially selfish be-
Managers may be reluctant to suggest that cause it promotes individual self-interests
employees obtain help because they fear over those of the organization and thus mis-
they are intruding into an employee’s per- uses positive resources such as employee
sonal life. However, managers would not time and talent.
hesitate to recommend that an employee Managers can decrease the incidence of
receive further training when a technical deviant workplace behavior by following
skill is deficient. Why should managers not recommended strategies for modifying em-
counsel an employee to seek assistance ployee behavior. Most of these strategies do
when a ‘‘soft’’ skill is the problem, especially not represent new developments. Rather,
if termination may be a likely alternative? they serve as reminders that good managers
have always been attentive to organizational
needs and have not allowed individual
CONCLUSIONS employees to pursue their self-interests at
the expense of patients, other employees, and
Excellent job performance requires the the organization in general. For those manag-
integration of both technical and soft skills. ers who have experienced difficulties with
Soft skills are particularly critical because various employees, they also serve as a re-
they enable people to work together smooth- minder that it is never too late to assume
ly to achieve common organizational goals. control and begin to decrease deviant work-
Deviant workplace behavior is a serious place behaviors in the interest of improving
threat to today’s health care organizations organizational efficiency and effectiveness.

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