Employee Turnover at Academy Allergy Asthma & Sinus Center

By Neil Patel doctorneil@me.com MGMT 591: Leadership and Organizational Behavior
Professor Hallcom
Aug. 20, 2014

Introduction: The Academy Allergy Asthma & Sinus Center located in Pueblo, Colorado. I have been working there on and off for the last 15 years of my life in various roles. My father is an allergist there and has been helping patients in Southern Colorado with asthma, chronic cough, wheezing, food allergies, drug reactions, reaction to insects, hives, and rashes. My father trained at National Jewish Hospital in Allergy Asthma Immunology and finished his fellowship and set out to have a little piece of his American dream, a private solo practice. My father started the clinic in Pueblo in the 1980’s and slowly opened satellite clinics in Colorado Springs, Canon City, La Junta and Alamosa. Currently has one other physician, and a physician assistant working with him, with a support staff of roughly 30 employees. The support staff includes two receptionists, two insurance clerks, one transcriptionist, one marketing paid intern and approximately 20 nurses.
The market segment that this clinic caters to is lower-middle class, and middle class patients from the blue-collar town of Pueblo, CO. Most of these patients have Medicaid insurance. Patients come in as walk-ins many times without any prior appointments. Sometimes wait times can be longer than usual if many patients walk in at the same times, particularly during pollen season and flu season. When bottlenecks occur this precipitates many disagreements between receptionists and intake nurses. I’ve had various roles at this organization since the age of nine. At first I was helping at the front of office helping patients check in, then I slowly graduated to the position of a nurse and now, as I just graduated from medical school, I see patients; I diagnose, come up with a written plan and then present the patients to my father or his colleagues.
Problem Statement: Out of the approximate 30 staff at the clinic the longest tenured staff member has been there five years; the clinic has been around since 1984. Most of the nursing staff has been at the clinic for 2 years. The Insurance clerks and transcriptionist has been around a few years. The pattern of turnover in staff is such that they can handle the job for 3-4 years then they leave because the “stress and politics” of they job are too much to handle. Typically staff don’t leave for better jobs or for their career long-term goals, they make lateral position changes to other clinics. Nursing staff typically make 10% more at The Academy Allergy Asthma & Sinus Center compared to other clinics and employee bonuses are extremely generous, however, this is not enough to retain employees. Employee turnover is a problem because staff are constantly having to train new employees and once an employee is trained and the staff is 100% fully functional, someone else leaves and the person who is hired to fill the position has to be trained. This is extremely inefficient, especially during peak seasons when more patient walk-ins occur. According to our class textbook, employee turnover can cost companies a minimum of thousands of dollars, even for entry-level positions (Robbins 27).
In this paper I will analyze, review relevant literature, and come up with potential solutions that answers the question: Why there is such a high turnover rate in staff at The Academy Allergy Asthma & Sinus Center?
Literature Review:
The authors write passionately in “Improving the nursing work environment.” It is clearly an article written by authors with much experience in the nursing field. This article sheds light on the necessity of improving the nursing work environment. The article discusses hospital nurses but the research is still relevant to my father’s clinic because I notice similar feelings and conditions at the office.
Cramer, Staggs and Dunton write that there is a global nursing shortage and therefore conditions around the world have been poor in result. Similar to the other research, “An extensive body of evidence confirms the relationships among positive work environments, positive nurse outcomes of job satisfaction and retention, and positive patient outcomes” (Cramer 55). Something of particular interest to my research is the suggestion that nurse managers concerned about turnover could consider limiting the need for overtime and cutting back on mandatory floating. Limiting overtime is a strategy I did not consider. Offering other forms of incentives may be more beneficial because the nurses are less tired and potentially more positive and alert. This would help the patients, individual nurses and the organization. Quality and consistency is important when running any type of business. Another interesting point in the article was the importance of nursing leadership--specifically, teamwork between leadership and staff. Leadership can offer sustained improvement.
A key part to success again was more employee engagement. The nurses and in particular the leaders need to be involved in unit decision-making. RN feedback in hiring nurse managers and other new positions, as well as in such day-to-day issues as scheduling and workflow can help create better working conditions for employees.
Staffing issues such as hiring additional support and ancillary staff, creating new positions, and adjusting staffing according to patient care are useful options. Nurse-to-patient ratios, changes in care-delivery models, and more time for RNs to spend in direct patient care can result if these options are implemented (Cramer 55).
More training and professional development seems to be a popular suggestion for much of my research. The authors suggest increasing support for advancing RN knowledge and skills. Initiatives to educate, inform, and communicate more effectively within the unit and provide additional support for continuing education and training opportunities too. Additional education should always be encouraged and implemented.
The “Creating Creative Minds, Passionate Hearts, and Kindred Spirits” article by F. Karakas explores positive management education, a practice-based teaching and learning model centered on positive organizational scholarship. Although this article is specifically looking at teacher-student relationships and strategies, many of the information found is insightful and worthwhile to my research. These topics all relate to fostering empowered employees with ample access to education and resources. Some of the results found in the sources are already being implemented in management education classes and work environments, and are results are promising (Karakas 200).
A strategy to transform a negative working environment into a positive one was to foster integrative and holistic thinking. This idea helps an employee in their work but also their personal life. Employees can gain skills in conflict-resolution and problem solving. Karakas states that during training and work processes it is key to design positive and nurturing learning platforms (Karakas 215). Another strategy suggested was to build a sense of community through high-quality relationships. Karakas focuses on individual mentoring and individual attention (Karakas 209). These types of interactions build personal rapport, compassion, empathy, concern, continuous feedback and counseling. (Karakas 210). These all help build a positive environment and positive energy. Like the other article examined, fostering flexibility and empowerment, was proven to be successful.
An excellent option was to develop creative brainstorming and skill building through innovative projects. Employees are able to get recognition for their own work and apply and develop new and existing skills (Karakas 211). The employees gain independent thinking skills and the work is meaningful and exciting. This option also is flexible and allows a wide range of employees with diverse skill sets to flourish. It is rewarding for the company and the employee (Karakas 212). Individual performance evaluations can be sent to the employee after each project. This allows opportunity to give developmental feedback and suggestions on work performance. Karakas also writes a personal letter to his students, with a constructive tone. This would be a great way to personalize the feedback and enhance relationships. On the second project his students always present better work and the practice itself sets a positive tone for the environment (Karakas 217). The scholarly journal “The Role of Work Place Spirituality and Employee Engagement to Enhance Job Satisfaction and Performance” demonstrates that workplace spirituality and creative process engagement is required for job satisfaction and higher employee performance. According to the article, “workplace spirituality” is defined as work situation by which leaders and followers have high spirit towards work completion and achievement of organization objectives. When employees model the values of altruistic love for another and develop a common vision all team members have increased willingness to “do what it takes” to finish the job with quality. The article suggests that then in turn the employee feels they made a difference and believes their life has more meaning. Additionally, all members – leaders and followers, gain a sense of mutual care and concern, feel understood and appreciated in the organization (Adhiatma 18). Furthermore, when employees get along with each other, communication is easier and more effective. All team members care for each other and for the task at stake. When the workplace spirituality is high, so is the employees personal well-being which in return, influences organization outcomes. Employees also want their work to mean something and be valuable. Another interesting factor in the article relates to the articles above. According to the authors, supervisor supportiveness is another variable that is also important in leader-employee engagement. This particular article specially examines the importance of goals. Supervisors can set and manage goals for each employee (or group of employees). This way they can teach the employees each skill set and an open conversation about the task will help performance and job satisfaction (Adhiatma 19).
This article also says fostering employee voice and taking action on the concerns is fundamental to employee engagement and job satisfaction. This adds dignity and meaning to the task in the views of most employees. Employees need to trust their supervisor in order to provide feedback (Adhiatma 30).
I found a lot of similar attitudes in the article “Does It Make Sense to Be a Loyal Employee.” However, this article took an interesting perspective on the topic, the study looked at the advantages from an employees loyalty to an organization.
The definition of “loyalty” used is “A deliberate commitment to further the best interests of one’s employer, even when doing so may demand sacrificing some aspects of one’s self-interest beyond what would be required by one’s legal and other moral duties” (Elegido, Juan M. 496).
According the study, the employee becomes more trustworthy and more valuable to an establishment, meaningful relationships in other areas of the employees life is easier to form, the employee’s fields of interests and identity is much more enriched, provides greater motivation for the employees work, a strong sense of unity in the employee’s life occurs, the organization thrives, contributes to the protection of valuable social institutions, and there is a sense of community at work (Elegido 495).
These qualities are examined in detail and then the author briefly offers perspective on the opposite side. One of the reasons that I found interesting was that such loyalty to work hinders other relationships in an employee’s life. But research shows the other advantages outweigh that criticism and actually fosters more of a positive influence on relationships. It is obvious that organizations want loyal employees, but it appears that employees benefit as well. Like the other articles, employee satisfaction, intrinsic motivation and employee engagement is key to successful working environments- and keeping loyal employees. According to the author, in the present global world it is not often for employees to stay with one employer. It is more likely that employees move around and relearn new jobs (Elegido 499). It is noteworthy that the study advises employees to be picky with which employers and organizations to be loyal to. Loyalty is not appropriate with all employers and employees should look carefully for an worthwhile organization that encourages mutual commitment and respect (Elegido 509).
Elegido states that a committed and loyal relationship between employee and employer is desirable for the above reasons. Keeping loyal employees is not addressed thoroughly in the article, so that is where my other articles help my research.
The article “When Does Voice Lead to Exit” examines relationships between employee voice and exit from multiple sources of data collected over two time periods in 136 restaurants. Results demonstrate that a high turnover is related to lack of employee voice. The study found three managerial characteristics that encourage positive work environments and more employee satisfaction: team change orientation, manager participation in decision-making, and manager access to organizational resource.
The study suggests that it is important that employers and organizations alike become increasingly more focused on improvement-oriented input by employees. It is also important to understand the dynamics and reasoning for employee turnover (Burris 525). Burris, Detert and MCclean state that the very nature of voice is as a prosocial behavior that offers improvements stemming from ones input. Most companies rely on a small number of individuals at the top of the company to make decisions. The article argues this may not be the most productive organization style. Change-oriented comments can better a situation or problem. The study notes that outcomes include: better error detection, innovation, and change effectiveness (Burris 525).
However, if employees or team members speak up and their voice and opinions are ignored or the employees continue to experience dissatisfaction, negative outcomes can result. Burris, Detert and MCclean emphasizes the importance of collective improvement, when employees in all levels feel they have some control over outcomes then more employees are more satisfied with outcomes and thus more likely to remain at the organization. Employees that feel hopeless in nonresponsive or non-improving conditions may give less effort, may engage in deviant behavior, consciously or unconsciously (Burris 525).
Manager’s access to decision-making is necessary to improve the workplace atmosphere. If the employees are offering their opinions but the management is unable to take action, satisfaction may potentially decrease. Management must have access to organizational decision-making (Burris 526).
Manager’s that have access to resources can offer a more positive working environment. Burris, Detert and MCclean say that the use of training and development programs, marketing, or new process implementation are necessary for improvement and adaptation in organizations. Manager’s that use organizational resources effectively are more capable of making decisions because they have necessary capital, whether human or financial, to devote to the activities (Burris 528). An organization that runs effectively has more time to spend on trying innovative practices and policies to benefit the organization and employees. Manager’s that lack access to resources can frustrate employees and lead to more job dissatisfaction (Burris 529).
The article “The Dark Side of Leadership: A Three-Level Investigation of the Cascading Effect of Abusive Supervision on Employee Creativity” examines how abusive supervision flows down organizational levels and hinders team member creativity. Liu, Liao & Loi admit that there has been limited research done about abusive supervision, but more and more research shows that employees are more unwilling to "go the extra mile" to perform behaviors that benefit their organizations, especially offering creative ideas (Liu 1187).
The authors note that after analyzing multiphase, multisource, and multilevel data, the findings prove the relationship between department leader and team member is negative. The authors define creativity as the development of new and useful ideas about products, practices, services or procedures. Creativity has become increasingly crucial for the survival and competitiveness in todays markets (Liu 1187).
According to the article, abusive supervision may undermine team member creativity because it reduces team member intrinsic motivation. The employees disengage with the activities because they do not enjoy them because of the external pressures. On the contrary, supportive relationships between supervisor and employee leads to enhanced intrinsic motivation. Intrinsic motivation is conducive to creativity because it encourages employees to challenge the status quo, come up with new and effective ideas, and adhere to innovative goals (Liu 1187). Intrinsic motivation is one of the pivotal psychological mechanisms that underlies creativity.
If employees experience public criticism, derogating comments, loud and angry tantrums, rudeness, inconsiderate actions, and coercions, they often feel belittled, humiliated, and undermined in the workplace. Employees can doubt whether the organization respects and values their work, and abuse often leads to low job satisfaction and sometimes cause employees to quit. The psychological distress can manifest into depression, anxiety, emotional exhaustion and employees tend to alienate themselves from their jobs. (Liu 1189).
The trickle-down effect of abusive supervision in organizational hierarchy draws on the social learning theory. The abusive supervisor triggers the team leader to use similar abusive behavior. The study used had three separate sample groups and found that team leaders would either consciously or unconsciously perpetuate the abusive behavior. The social learning theory suggests that how people act and respond are greatly subject to what is learned from peer influence or examples. The study thereby suggests that the abuse continues to go down all hierarchal organization levels.
The next part of the study examined the contingent effects of team leader attributions on the link between department leader abusive supervision and team leader abusive supervision. The social learning theory depends on three factors: retention of observed behavior, reproduction of observed behavior, and motivation to justify the initiation of the behavior. If the observed behavior showed positive results individuals are more likely to recreate the behavior whereas if the individuals expect a negative outcome they will be less likely to adopt the behavior (Liu, 1191).
The article provides relevant contributions to leadership, attribution, creativity and management. The authors plead for ongoing research in abusive behaviors in leadership and affects on creativity.
Analysis:
According to our class textbook, the correlation between employee turnover and job satisfaction is stronger than the correlation with turnover and absenteeism. This means that employees are more likely to leave their job based on the actual day to day dynamics, interactions, and problems than an employee being let go because they don’t show up to work (Robbins, 85). This is important to the Academy Allergy Asthma & Sinus Center because it means that nurses are leaving most likely due to job dissatisfaction. Satisfied employees who believe in the organization have lower rates of turnover and also perform better on the job (Robbins, 88). All of these conclusions and data show objectively that Academy Allergy Asthma & Sinus Center has low employee satisfaction and is most likely the reason for high employee turnover. Why are employees dissatisfied? Well according to our textbook, research has shown that narcissistic CEO’s of baseball organizations have a higher turnover of managers than non-narcissistic CEO’s despite the narcissistic CEO’s being perceived as more influential from other external organizations (Robbins, 140). What does this mean? In short, the owner/head physician of Academy Allergy Asthma & Sinus Center may have a “god complex” that is alienating and intrusive to the employees of the organization. When people always want to look good in the eyes of the public at the cost of co-workers emotional well-being this will lead to “dissent among the ranks”. The physician should not take the spot light and all credit in front of all patients, instead he needs to constantly remind the staff they are all integral to patient care and they all each impact patient satisfaction. Where does the “god-complex” like personality, narcissism, come from? In Indian Culture respect is commanded based on societal values/hierarchy. In India Physicians are treated as gods basically and people respect doctors too much. This sense of “god complex” becomes ingrained in Indian physicians and they feel that they can command respect from anyone who is not a physician. For example, In India if you tell people you are a doctor at a bank, people will let you skip the line because their time is” too valuable”, and when a business owner finds out that you are a physician they will offer massive discounts because you “are doing god’s work.” This mentality fosters a large egotistical attitude among Indian physicians. There is no one to keep their egos in check. It is my thesis, that Dr. Patel the owner of Academy Allergy Asthma & Sinus Center, has grown up with this Indian mentality and that his “god complex” state of mind is off putting to his western-mindset employees. Because he grew up in country with different societal norms and he has not adjusted his behavior to match the societal norms of the USA, his employees lose patience and get so frustrated that they move on from the organization, leading to higher than normal employee turnover.
Solutions:
Solution 1: Employee should be able to voice disagreements or issues with out fear of losing their jobs. This is important because employees are a valuable part of the organization and their opinions can make an organization better. I think that an anonymous drop-box that employees can use to voice their opinions is a good option. The box can be opened privately by the office manager and physician or publicly. The anonymity ensures honest unfiltered opinions, and employees don’t have to fear for their job. This will help decrease turnover. Solution 2: This is the preferred solution according to my opinion. Positive re-enforcement is the best way to motivate, not by fear. Through out this course we learned that positive reinforcement is the best way to motivate employees to do a good job. Negative reinforcement is counter-productive. Employees do need to know when they made a mistake, however, reprimanding is not helpful and in fact can make things worse with that employee relationship. The saying that you catch more flies with honey than vinegar is so true. The use of positive reinforcement is the best managerial technique to motivate and cultivate long-term working relationships with employees. This will decrease turnover at the Academy Allergy Asthma & Sinus Center. Solution 3: Appoint a staff manager to handle schedules, sick days, coverage, etc. instead of the owner/physician. This will decrease many disagreements between staff and leadership. Not only is this more efficient for the physician’s time, but it will help eliminate the opportunities for disagreements with employees. This will definitely decrease turnover at the Academy Allergy Asthma & Sinus Center. Out of the solutions mentioned above solution 2 will yield the most results in the shortest amount of time.
Reflection:
As I will be taking over my father’s practice analyzing his business with this assignment has been invaluable to help me learn the obstacles he faces as a manager on a daily basis. This paper has helped me realize how I would tackle the obstacles of a being a Physician/manager in a private practice.

References: 1. Robbins, Stephen P., Timothy Judge. Organizational Behavior, 15th Edition. Pearson Learning Solutions, 01/2012. VitalBook file.

2. Liu, D., Liao, H., & Loi, R. (2012). The Dark Side of Leadership: A Three-Level Investigation of the Cascading Effect of Abusive Supervision on Employee Creativity. Academy of Management Journal, 55(5), 1187-1212.

3. Mcclean, E., Burris, E., & Detert, J. (n.d.). When Does Voice Lead to Exit? It Depends on Leadership. Academy of Management Journal, 56(2), 525-548. 4. Fachrunnisa, O., Adhiatma, A., & Mutamimah. (2014). The Role of Work Place Spirituality and Employee Engagement to Enhance Job Satisfaction and Performance. International Journal of Organizational Innovation, 7(1), 15-35.

5. Elegido, J. (2013). Does It Make Sense to Be a Loyal Employee? Journal of Business Ethics,116(3), 495-511.

6. Cramer, E., Staggs, V., & Dunton, N. (2014). Improving the nursing work environment: Using NDNQI[R] data, leaders can promote changes that lead to sustained work-environment improvement. American Nurse Today, 9(1), 55-55.

7. Karakas, F. (2011). Positive Management Education: Creating Creative Minds, Passionate Hearts, and Kindred Spirits. Journal of Management Education, 198-226.