By Karen Fisher
Employee policy and procedure manuals have been a staple in offices for years, but are they really necessary?
If you are like most physicians practicing in today’s chaotic healthcare environment, writing or updating policies is not at the top of your priority list. There is also a great deal of confusion regarding whether written policies are more helpful or hurtful to an organization.
Some experts say that having well-written policies and procedures communicates clear expectations of your organization. Other experts say that poorly-written policies could land you in court defending yourself against a workplace lawsuit.
Who should you believe? Take your pick. Both arguments essentially lead to the same conclusion. In order for physicians to best help their patients, they must first have a smooth-running practice. Therefore, the more informed your employees are, the more efficiently your practice will operate.
Written policies and procedures are not legally mandated. However, in today’s litigious society, having a formalized policy and procedure manual is simply a good idea. Leading contributors to employee and former employee lawsuits are lack of communication and inadequate policy guidelines for employees and management personnel.
Often, employees win workplace lawsuits when an employer takes action against them for violating company policy. This occurs because the employees are able to prove that they were not aware they were violating company policy. If polices do not exist, are vague or unclear, the EEOC will most likely side with the employee in such instances. Millions of dollars have been lost in legal judgments because of failure to inform or notify employees of company policies.
The purpose of a Policy and Procedure manual is to familiarize your employees with your practice’s specific mission, culture, expectations and benefits. While these manuals are not a contract, they do help to provide a clear, common understanding of your practice’s goals, benefits and policies, as well as what the practice expects with regard to performance and conduct.
“It is difficult to justify employee discipline or termination for failure to meet the practice’s standards if you cannot prove that the employee was aware of these standards,” said Dennis Hursh, Esq., of Hursh & Hursh, P.C.
It should be remembered, however, that it is possible to unintentionally create a contract by using words that imply hard and fast rules for every situation. It is best to steer clear of words that make a promise, and instead use more flexible terms such as “generally,” “typically,” “usually,” and “may.” It is also very important to always maintain management’s right to add, delete or modify any policy at any time.
Employee policy and procedure manuals also provide a level of comfort to your employees. It is natural that an employee will feel more comfortable knowing what is expected of him or her to comply with practice guidelines and fit in with the practice culture. It follows that employee comfort will result in improved productivity, decreased turnover and improved employee/management relations.
A typical policy and procedure manual has approximately eight sections, including the following:
• Employment Status & Records.
• Employee Benefit Programs.
• Work Conditions & Hours.
• Leaves of Absence.
• Employee Conduct & Disciplinary Action.
An introduction can include such things as an Employee Welcome Message and Introductory Statement, and an Employee Acknowledgement Form. This section is generally written in a friendly, conversational tone and is designed to make the employee feel welcome and comfortable. The purpose is to provide the employee with basic information about the practice, as well as its operating philosophy. The remaining sections are written to provide very detailed and precise language regarding the rights and obligations of both the employee and the employer.
Your manual must be guided by various state and federal legislation, such as Equal Employment Opportunity (EEO)—protected classes, Americans with Disabilities Act (ADA), Family and Medical Leave Act (FMLA) and Fair Labor Standards Act (FLSA)—exempt vs. non-exempt.
Listed below is a brief description of each of these laws.
The Equal Employment Opportunity Act (EEO) prohibits discrimination on the basis of race or color, national origin, sex and/or religion.
The American with Disabilities Act (ADA) prohibits discrimination against “qualified individuals with disabilities.” An individual is considered to have a “disability” if he or she has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment or is regarded as having such an impairment. Persons discriminated against because they have a known association or relationship with an individual with a disability are also protected. Discrimination is prohibited in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits and all other employment-related activities. The ADA applies to employers with 15 or more employees.
The Family and Medical Leave Act (FMLA) requires employers with 50 or more employees to allow up to 12 work-weeks of unpaid leave in any 12-month period for the birth, adoption or foster care placement of a child, or serious health condition of the employee, spouse, parent or child, provided the leave is taken within 12 months of such event. Intermittent leave is allowed if there is a medical need for the leave. Intermittent leave is leave taken in separate blocks of time due to a single illness or injury, rather than in one continuous period of time.
Under the Fair Labor Standards Act (FLSA), employers must pay overtime to their workers whenever they work more than 40 hours in any week. Under Pennsylvania’s state wage and hour laws, individuals employed in a bona fide executive, administrative, or professional capacity are exempt from the overtime provisions of the law. A test is available to determine the exempt vs. non-exempt status of your employees.
It is very important to remember to have your policies reviewed by your legal counsel to ensure that they are compliant with federal and state laws before they are distributed to your employees. It is also wise to remember that new laws, regulations and court verdicts can affect your policies. A yearly review of your policies is recommended. Use of a notification service or personnel publication can help to keep you updated on changes in the human resources climate. Each employee should be required to sign an Acknowledgement of Receipt of their manual to ensure that they have received and read the practice’s policies.
Procedure Manuals vs. Policy Manuals
Procedure manuals differ from policy manuals or employee handbooks in that they are used to assist employees in dealing with situations that may arise during the daily operations of the practice. Procedure manuals serve as a risk management tool for the practice and can include the following:
• A description of patient scheduling and registration processes, including handling of new patients.
• A description of the procedure for handling triaging of telephone calls (e.g., what type of information can be provided to patients over the telephone and who is authorized to provide this information).
• Handling of medical records, including retention of records.
• A description of the practice’s financial policies, including patient and insurance billing and collections, charge entry, posting of payments, handling of cash, bank deposits, daily and monthly reconciliation, etc.
• Handling of services such as lab tests, surgeries, referrals to other physicians, hospital admissions, etc.
• Policies to ensure compliance with HCFA requirements.
• OSHA policy and plan.
To format your handbooks and manuals, find a size that is easy to use. If it is too small, it will probably be misplaced. If it is too large, it will probably be stored out of the way and, thus, seldom used or lost. They can be loose-leaf or bound. Bound books are less expensive, but loose-leaf books allow for ease of replacement of pages when policies change. It is possible to use two different formats, such as a small bound “handbook” for employees and a loose-leaf policy and procedures manual for managers. Your manuals should be attractive and arranged in such a way that employees will want to read them. Each sentence should be 20 words or less and discussion of subjects should be limited to one page. The use of drawings, charts and cartoons (where appropriate) create a more interesting and easy-to-read manual.
To summarize, ask yourself if well-informed, content employees and a smooth-running practice are worth the time and effort necessary to create and maintain a well-written Policy and Procedure manual.
Karen Fisher is executive assistant for PMSCO Healthcare Consulting, a subsidiary of the Pennsylvania Medical Society.