Absence Management in Healthcare: A Strategic Perspective

The Problem: High Absenteeism in a Healthcare Setting

In any organizational setting, the relevance of human resources cannot be overstated. It follows that for an organization to accomplish its objectives and fulfill its mandate, it should maintain a skilled, committed, and effective workforce. There are a wide range of personnel-related factors that affect the effective delivery of services in healthcare institutions. One such factor is personnel absenteeism. The problem identified in the selected Federally Qualified Health Center (FQHC) relates to a high rate of absenteeism — with the facility having to grapple with, among other things, unscheduled absences of staff. This effectively gets in the way of effective service delivery and results in longer patient wait times, a higher-than-desired rate of patient readmissions, and loss of revenue. The need to rein in the high rate of absenteeism at the facility has therefore been identified as a priority.

The causes of the high absenteeism rate were identified through the development and dissemination of an employee absenteeism questionnaire. Specifically, the questionnaire sought to establish the reasons employees cite for failing to report to their workstations for periods deemed beyond the acceptable time span. The key cause of personnel absenteeism was identified as low employee morale. Other, less prominent reasons cited included sickness and family commitments.

To determine the absence rate at the facility, the following formula was used:

Employee absenteeism rate (%) = (Number of days absent / Total working days) × 100

Data from the most recent quarter — specifically the months of July, August, and September — was utilized. During this period, the facility was found to have an absenteeism rate of 18%. For the facility to continue delivering effectively on its mandate, the employee absenteeism rate must be reduced. This is especially important given that the current rate is substantially higher than the industry average. Available data from the U.S. Bureau of Labor Statistics (BLS) indicates that as of 2022, the absence rate among healthcare practitioners and technical occupations in full-time wage and salary workers stood at 4.1% (BLS, 2023). With a reduction in employee absence rates, the facility is likely to witness positive outcomes including decreased patient wait times, a lower rate of patient readmissions, and increased revenue.

One of the steps to successful change identified by Kotter and Whitehead (2010) is increasing urgency. According to the authors, this involves the identification of a significant opportunity by a large number of people, who then become highly motivated to pursue it. In the present scenario, the goal is to get the process moving by initiating dialogue about the current state of affairs and the need to institute measures aimed at reducing absenteeism. This helps ensure that all those involved take ownership of the process and possess intrinsic motivation to see the change through. According to Boyatzis, Smith, and Oosten (2019), research indicates that one way of ensuring that change is lasting is by ensuring that it is both intentional and internally motivated.

Towards this end, the facility's key stakeholders will be provided with data gathered from the computation of the employee absenteeism rate and the employee absenteeism questionnaires. The impact of such a high absenteeism rate will then be highlighted, with specific reference to its effects on patient wait times, readmission rates, and revenue. Scenarios will be developed to illustrate what could happen in the future if the problem is not addressed, as well as the benefits the facility stands to gain if it is. There is also a need to ensure that the interests of all key stakeholders are understood, with the intention of demonstrating how those interests will be advanced or curtailed by the chosen course of action. Interests mapping is of great relevance in bringing key stakeholders on board and has been identified by Lax and Sebenius (2007) as a tool of effective negotiation. In their words, "since your counterparts will say yes for their reasons, not yours, you need the maximum insight possible into how well their interests would be met by a deal versus their best no-deal option" (Lax and Sebenius, 2007, p. 3).

Vision and Desired Outcomes

Available evidence confirms that employee absenteeism has a negative impact on healthcare organizations. As Cole and Kelly (2020) point out, workers left to cover for absent colleagues often end up overworked, resulting in burnout and, ultimately, decreased employee morale. In their study on workload and burnout among healthcare workers, Portoghese, Galletta, Coppola, Finco, and Campagna (2014) found that "burnout among health care workers is associated with high turnover rates and absenteeism due to sickness, relative ineffectiveness in the workplace, as well as low job satisfaction" (p. 153). Unscheduled absenteeism at the facility therefore gets in the way of effective service delivery and results in revenue loss, high staff turnover, and low morale. There is urgent need to address the problem.

To achieve the vision, there is a clear need to boost employee morale — identified through the absenteeism questionnaire as the key driver of high absence rates at the facility. Proven methods and approaches will be applied to accomplish this goal. The proposed approaches include: promotion of work-life balance among workers, cultivation of a culture of teamwork within the facility, deployment of skill-enhancement training, and improved communication between those in positions of authority and frontline workers.

Those who will serve as guides for the proposed change will be carefully selected. This group, according to Kotter and Whitehead (2010), could comprise "some people who have credibility with others, or have connections to the various parts of the organization, or leadership skills, or formal authority" (p. 182). Several key stakeholders will be invited, engaged, and involved in framing the problem and identifying possible solutions. These include: facility management; staff such as physicians, nurses, and caregivers; federal and state government representatives; and representatives from the underserved community. Facility management was selected because it is a key custodian of resources and is actively involved in planning and decision-making. Staff members are those most directly impacted by the proposed changes and their insights into the causes of high absenteeism are essential. Involving staff will also help reduce resistance to change during implementation. Representatives from the underserved community can help shape solutions, as they have firsthand knowledge of how caregiver unavailability affects the delivery of health services. Federal and state governments are key external stakeholders because the facility receives grants from both levels of government and may thus be considered crucial change guides.

According to Kotter and Whitehead (2010), it is the guiding coalition that plays a central role in not only creating a change vision but also adapting and modifying strategies. In developing the vision, the core values deemed crucial to the proposed change will first be outlined. These have been identified as inclusivity, effective communication, and teamwork. The desired state of the facility following the implementation of change will then be described. Reduced employee absence rates are expected to yield improvements across multiple dimensions, including decreased patient wait times, a lower rate of patient readmissions, and increased revenue. A strategy will then be formulated for executing the vision, with the coalition familiarizing itself with the vision to ensure successful implementation.

Kotter and Whitehead (2010) indicate that to ensure no one is left behind, the coalition must communicate the vision in an effective format. Philips and Klein (2022) point out that the viability of a strategic vision depends not only on how effectively it was developed, but also on whether it is communicated constructively. In their words, communication involves "the process of sharing your vision with your team and stakeholders, explaining its rationale, benefits, and expectations" (Philips and Klein, 2022, p. 190). Thomas and Inkson (2009) describe communication as an essential social experience building block and restate its relevance in engagements such as teamwork and negotiation. In this context, the following approaches will be used to communicate the vision: group presentations, team meetings, and notice boards.

Kotter and Whitehead (2010) point out that obstacles are largely inevitable in efforts to bring about change and that the guiding coalition must work to eliminate them. Several barriers have been identified as having the highest potential to inhibit the successful attainment of the desired outcomes.

Barriers to Success

The first barrier is managerial attitudes. It was discovered that those charged with decision-making at the facility often formulate and implement initiatives without the insight or input of subordinate staff. This reflects a lack of empathy — identified by Goleman (1998) as one of the key characteristics of effective leadership. Seeking the insights of all those involved is crucial to ensuring the vision and desired outcomes are achieved, as it allows concerns and reservations to be addressed, ensuring full commitment and minimizing resistance to change. To eliminate this barrier, communication lines between management and subordinates will be opened and the need for regular communication reinforced. Weekly meetings between subordinate staff and departmental heads can facilitate this, as can a robust two-way feedback mechanism. As the Forbes Coaches Council (2021) notes, in an organizational setting all kinds of feedback — positive or negative — should be embraced.

The second barrier is insufficient resources. As with many organizational initiatives, implementing the proposed vision is likely to be resource-intensive, and the facility has other competing priorities. To address this challenge, the facility will reach out to private-sector donors and funding sources.

The third barrier is poor cross-functional teamwork. The facility struggles with effective collaboration among physicians, nursing teams, and caregivers. As Crocker, Cross, and Gardner (2020) point out, "most organizations don't manage internal collaborations productively" (p. 44). Philips and Klein (2022) are clear that a lack of collaboration and team spirit can undermine any change initiative. Deliberate measures will therefore be taken to improve cross-functional teamwork by identifying and addressing factors that hinder a collaborative culture and by rewarding collaboration. Creating a trusting environment, as Crocker, Cross, and Gardner (2020) observe, can also foster collaboration within an organization.

In the words of Kotter and Whitehead (2010), "empowered people, feeling a sense of urgency and guided by the vision and strategies, focus their actions on achieving a continuing series of visible and unambiguous successes, starting as quickly as possible" (p. 184). The importance of these short-term wins cannot be overstated, as they generate momentum for sustained change. Two short-term wins have been identified, both expected to be realized within one year.