We have all dealt with them—clever chameleons who “knock down, but kiss up.” They belittle, shame, manipulate, and humiliate. Fire them? Not so fast! What if they are your top performers?

This dilemma is rampant in all kinds of healthcare environments—hospitals, medical practices, healthcare manufacturing, and professional associations. In a research study I conducted with co-researcher, Dr. Elizabeth Holloway, an alarming 94% of leaders reported that they have worked with a toxic person within the past five years, while 64% reported they currently do. On a 10-point “pain scale”, 92% said the toxicity ranged from 7 to 10.¹

 

Who are toxic people?

In my latest book, Why I Don’t Work Here Anymore: A Leader’s Guide to Offset the Financial and Emotional Costs of Toxic Employees, I define toxic people as those who demonstrate disrespectful, uncivil behavior with wide-ranging effects to our psyches, individual and team performances, and the bottom line.² They are bullies, narcissists, manipulators, and control freaks; they’re people who shame, humiliate, or take credit for the work of others.

With over 400 leaders in our study and 39% from healthcare, I was personally troubled by this reported incivility. It’s much easier to deal with them when performance is poor or mediocre. However, with high performers, evidence-based practices will increase your probability of successfully handling these toxic, albeit super, performers.

Related Content: A Guide to Recognizing and Dealing with Toxic People

Consider the hard data in healthcare

In 2008, researchers Alan Rosenstein, MD, and Michelle O’Daniel reported the devastation of disruptive behaviors in healthcare.³ In their study of 4,530 participants, they found that a whopping 71% reported there was a significant association between disruptive behaviors of professionals and medical errors; twenty-seven percent (27%) saw this link leading to patient mortality. And 75% said that this medical error and subsequent patient death could have been prevented. Some of the behaviors they identified were intimidation, hostility, fear, lack of respect, passive-aggressive behaviors, undermining others—all toxic behaviors.

In a recent keynote address I delivered about the power of incivility in the workplace, I mentioned these healthcare statistics. A gentleman raised his hand and said,

“My wife is a nurse and has been continuously intimidated by a physician. When she questioned the medication order, rather than go to the physician issuing the order, she went to three colleagues to interpret it!”

Thankfully, it was interpreted correctly.

 

You can determine the financial cost of toxic people

Most individuals are not aware that toxic behaviors can also impact your bottom line! Consider the fact that 51% of targeted individuals of the incivility reported that they are likely to quit because of a toxic person. Truth be told…I quit a great job because of a toxic person! When I handed my boss my resignation, she attempted to talk me out of my decision. She could not understand why I was resigning since I had outstanding performance reviews. Because I feared how this toxic star could retaliate by spreading my name as mud in my new organization, I lied. I gave my boss a fictitious reason why I was resigning.

By the way, I was not the only who quit because of this toxic person; others left as well. Because of her “star status”, her behavior was not on my boss’s radar screen. This is not unusual. By being chameleons who can “knock down but kiss up”, many toxic people can cleverly conceal detection from those in power.

To show the financial cost of these toxic stars, I have developed analytics based on the average compensation and the number of employees in the organization. To calculate these costs, Figure 1 shows a blank version The Kusy Toxic Cost Worksheet©. These are explained in greater detail in my book Why I Don’t Work Here Anymore. You may also obtain a complimentary “live” version of this template by visiting my website (www.mitchellkusy.com) and use it within your organization. Figure 2 demonstrates a completed version of this Worksheet. Using this template, I have found that leaders quickly understand how toxic behaviors impact their organization’s financial condition with costs up to 4% of total compensation costs.

These statistics create awareness. When leaders understand that even their toxic stars cost money, they are more apt to take action. As well, sharing the specific financial costs of these toxic people with other leaders will help them understand that something must be done—they can no longer “turn the other cheek” and enable the behavior for the “cause” of organizational productivity. It is a call to action that we need to do something—immediately—because toxic stars cost money; this Worksheet helps identify these costs.

 

Toxic stars violate organizational values

In a keynote presentation I gave recently, I started with three questions:

• Question 1: How many of your organizations have a performance appraisal process?

Response: 95%.

• Question 2: Of this 95%, how many have organizational values identified on this form?

Response: 20%.

• Question 3: Of the remaining 20%, how many measure how employees perform on these values?

Response: 5%.

Figure 3 demonstrates this breakdown of values engagement in the performance management process.

If organizational values are so important, why don’t we hold employees accountable to achieve these with the same rigor as any other task they have? Toxic people often violate the organization’s values. And by not holding them accountable for these values, it’s difficult to fire them—especially if they are high performers. Assess these values with the same rigor you evaluate task performance. Try using a 70-30 split: 70% of the performance review relates to task achievement and 30% to values achievement.

And it’s not just within the performance appraisal process that values should be incorporated. Integrate values discussions at every team meeting. This is not only good for high performers who are toxic but everyone in the organization! In these meetings, take at least five minutes to talk about how someone went out of their way to achieve a specific value this week or how someone experienced an obstacle to achieving this value. This helps values come alive and will reduce the probability of allowing anyone to get away with bad behavior.

 

Don’t hire toxic stars in the first place!

Many toxic stars often show their full faces after they are on board—not during the recruiting process. As chameleons who can “knock down” to those without perceived power but “kiss up” to perceived influencers, these individuals need to be detected early. One candidate who was recently interviewed was indifferent towards the company’s cafeteria personnel but highly respectful of the hiring manager. In another situation, the candidate “chewed out” the company driver who forgot a notepad in the trunk. You may not see these behaviors in the formal interviewing process.

I suggest sending an email to any of these individuals or talking with them personally and asking them to take note of the following:

• How effectively did the candidate engage you in conversation?
• How effectively did the candidate engage our organization’s values?
• Is this the kind of person with whom you believe you would like to work with?

Individuals who might receive this may include administrative assistants, maintenance staff, drivers, cafeteria workers, and receptionists—literally, anyone you believe might have an opportunity to interact with the candidate and will help you better understand how the candidate reacts in informal situations. Be sure to review their responses with the interviewing team. This will allow you to quickly detect chameleons who show their true faces among those they perceive without power.

 

Many toxic stars are clueless

Giving feedback to a toxic star is painful. They often don’t “connect the dots” as to how their behavior impacts others. In my book, Why I Don’t Work Here Anymore, I provide templates for structuring this feedback—based on whether the person is your direct report, peer, or boss. For this article, let me summarize some differentiating factors for each of these positions.

With direct reports, first, do not use your power to induce action. Instead, appeal to your observations of the impact of their behavior on others and/or the organization. If they counter this with excuses, relate the fact that intent or rationales will not help change the situation; the behavior must change. Be sure to engage any statistics that may be relevant, for example, statistics regarding retention of people who quit as a result of their behavior or patient safety statistics. Power is the second resort if this fails. With one physician department head, she eventually had to say, “Even though your practice is highly lucrative for us, you are putting our practice at risk. I will not allow this behavior to continue. Here’s the plan that I will follow with specific consequences if you do not.”

For peers, the most important dimension is to begin with the fact that this is a very difficult conversation for you as a peer. Then, identify how the behavior has impacted you before moving on to how it may have impacted others. Create an opportunity for dialogue. Explain how you may have tried to resolve this in the past, but it has not worked. Consider behaviors that both of you can do. For example, the toxic star may concede to not belittle team members in public; you share that, if you witness this, you will talk with her privately afterward and give your perceptions of what occurred. If necessary, the next step will be to bump this up to another individual to handle.

Giving feedback to the toxic boss is the most difficult of all three strategies because, with the boss, power is not in your favor. Start with your commitment to your boss and the organization. Share your understanding of the pressures your boss may be facing. Do not describe what is bothering you with absolute phrases such as “You never… You always… 100% of the time…, etc.” These can set up defensive reactions that will go nowhere. Share your views in a direct, respectful way. And just because someone is the boss, there’s a tendency to not follow up with her/him. Tell your boss you would like to follow-up after a certain period of time to check and share your perspectives. And there is power in numbers. Most likely, a toxic boss has impacted others. Use this to your advantage. All those having difficulty with a toxic boss should approach the boss as a team. If fear of reprisal is a concern, it is the rare boss who will retaliate against an entire team!

 

Revise your exit interviews

Since 51% of individuals who are targets of toxic behaviors are likely to quit, you want to know why! And with a typical exit interview process, you may not know this because exiting folks are fearful of the repercussions if the truth is told. So, they keep honest feedback to themselves.

Conduct exit interviews anywhere from three to six months after the individual has exited to avoid this: “What if my boss tries to derail me by sharing his thoughts about me to folks in my new organization?” An exit interview three to six months after the person has left will reduce the probability of this occurring because the person will likely have established a new, and hopefully, positive reputation. So, what you’ll need to do is ask the individual if you may speak with him/her six months after they have left, providing an opportunity for them to be more relaxed, honest, and direct.

 

Build norms that make a difference

By taking any one of these strategies and integrating them into daily practice, you will be building new norms of respectful engagement that offset toxic behaviors. And don’t keep what you are doing to yourself. Share what you are doing to promote everyday civility that impacts individuals, teams, and organizational performance.

To be a leader is to teach. If you’re not teaching, you’re not leading.

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References

1. Kusy, M., & Holloway, E. (2009). Toxic workplace: Managing toxic personalities and their systems of power. San Francisco: Jossey-Bass.

2. Kusy, M. (2017). Why I don’t work here anymore: A leader’s guide to offset the financial and emotional costs of toxic employees. Boca Raton: CRC Press/Taylor & Francis Group.

3. Rosenstein, A., and O’Daniel, M. (2008). A survey of the impact of disruptive behavior and communication defects on patient safety. Joint Commission Journal of Quality Patient Safety, 34 (8), 464-471.

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This article is adapted from Mitchell Kusy (2017) Why I Don’t Work Here Anymore: A Leader’s Guide to Offset the Financial and Emotional Costs of Toxic Employees. Boca Raton, FL: CRC Press / Taylor & Francis Group.