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Why Performers Underperform...

Healthcare organizations in the 21st century face a multitude of challenges, putting staff under immense personal and professional pressure. If left unaddressed, this can lead to widespread underperformance across an organization.

ADVANCE asked four experts to state reasons why a performer might underperform, and then offer advice a manager can use to resolve this issue.

A lack of mental toughness.

Resolution: Many of the challenges linked to delivering world-class healthcare relate to how leaders create the performance environment within which staff can feel inspired to deliver high performance and sustainable care in today's difficult times, said Graham Jones, PhD, cofounder and director, Lane4 Management Group, Princeton, NJ. This responsibility includes developing mental toughness, their own and that of their team, to help cope and even thrive under the inevitable pressure their roles involve.

Mental toughness is the capacity to respond positively to multiple and sometimes conflicting pressures to deliver consistently high levels of performance. Mental toughness can be developed and is underpinned by four core skills:

• Finding ways to keep any symptoms of stress under control, learning how to reframe negative thoughts into positive ones and identifying what is within your control and what is not so you can exert as much control as possible.

• Maintain robust belief and confidence in your qualities and in your ability to achieve performance goals under pressure.

• Ensure your desire and determination to succeed is founded on positive and constructive motives.

• Maintain your focus on the things that matter.

A lack of recognition.

Resolution: Perhaps an employee has performed well in the past without receiving any recognition. He looks around and sees others who are getting by just fine and doing marginal work. Soon, the employee determines he doesn't have to overachieve to survive, surmised Roberta Chinsky Matuson, president, Human Resource Solutions, Northampton, MA.

A manager should take a close look at the performance levels of everyone under her supervision, Matuson suggested. If employees are underperforming, then it is up to the manager to inform the employees of their expectations and hold them accountable if they fail to perform. This includes terminating employees who have no interest in giving their all. The manager must also acknowledge employees who are going above and beyond the call of duty, even when reduced budgets make it difficult to financially reward the strong players on their team. It costs significantly more money to replace a strong performer than it does to provide recognition for a job well done.

A lack of skills to do the job.

Resolution: Ask yourself, could the employee do this job if his life depended on it? If the answer is no, then you have a skills problem. Figure out what type of skills training the employee needs and provide the employee with the training, Matuson advised. Closely monitor his progress and provide feedback.

If the employee could do the job if his life depended on it, then the problem is behavioral. The manager will have to discover the root of the problem, so she can determine if the situation is fixable, Matuson said. For example, if upon reflection, the manager realizes the employee has always done the minimum amount of work to get by, then it's unlikely this situation will change. However, if the change in performance can be directly linked to an event (e.g., new supervisor, budget cutbacks), then there is a stronger chance the manager will be able to work with the employee to help him bring his performance up to an acceptable level.

Perhaps the employee is going through a tough time in his personal life. Suggest the employee seek help from an employee assistance program if you have one. If not, let the employee know his personal life is impacting his performance. Ask him how he plans on handling this situation so he can perform at an acceptable level.

A lack of integrity.

Resolution: Think of integrity not as a moral issue, but as a factor determining workability, suggested Dave Logan, PhD, professor, Marshall School of Business at the University of Southern California, Los Angeles; and senior partner, CultureSync, Los Angeles. You wouldn't want to drive over a bridge lacking integrity--that isn't "whole and complete" (one definition of the word). Driving over such a bridge doesn't work, and it puts you in peril. Likewise, careers without a commitment to integrity put performance in peril.

Unfortunately, most careers are not built on integrity, but rather, focus on seeking to be liked, winning approval or avoiding unpleasant situations. "In one moment, we present ourselves in a certain way, and in another moment, to gain an advantage or protect ourselves, we show another side," Logan said. "If we're honest, we can see we often say what we are expected to say, and end up giving our word and not keeping it. " Building a career built on integrity means:

• Being truthful and honest.

• Doing your work as it was meant to be done, without cutting corners.

• Doing what you know to do, on time, and what others expect us to do, even if we haven't said we would do it.

A sense of distance or that something is off.

Resolution: The Vanto Group refers to these feelings as "incompletions," said Steve Zaffron, CEO, Vanto Group, San Francisco. Two dictionary definitions of "incomplete" are ''lacking a part or parts, not whole" and ''not concluded."

Some areas you can look for incompletions are resentments, regrets, integrity issues (such as broken agreements), lack of acknowledgment for your or another's contribution or participating in gossip (which diminishes the person who was the target of the gossip).

To get to higher levels of performance, create an environment for people where issues are "completed," rather than left unconcluded. There is no recipe for creating completion, Zaffron said, but there is a basic movement for this kind of conversation.

Follow these three steps:

• Start a conversation with the person with whom you need to complete the issue. Create a frame in which completing the issue benefits the relationship.

• Address what happened--what you decided, what you did or didn't do--that's between you and the other person.

• Take whatever action is necessary, such as apologizing or giving something up. When we give something up, forgive or are forgiven, a new space opens up.2

Final Thoughts

Sometimes the biggest favor you can do for an employee who appears to be underperforming is to release the employee from her job. "In many cases, the employee is unhappy with the work she is doing or is dissatisfied with the company," Matuson said. "She just doesn't have the guts to throw in the towel. If it's not working out, mutually agree to terminate the relationship. In the end, you will both be better off."

If you find you're constantly spending time dealing with people who are underperforming, then perhaps it is worthwhile to take a closer look at your hiring process, Matuson added. If you hire well, you will spend considerably less time dealing with performance issues.

Karen Appold ( is an editorial consultant in Royersford, PA. Visit her website at


1. Jones G. Thriving On Pressure. Easton Studio Press, August 2009.

2. "Completion" as used here, and in The Three Laws of Performance, is material owned by Vanto Group, and used with permission.

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