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Crucial Conversations for Accountability

Confronting a Sick Colleague

Dear Crucial Skills,

With the recent H1N1 scare, I would appreciate any advice on approaching colleagues in a healthcare institution—usually managers and MDs—to stay home when they are sick rather than feel obligated to come to work. I would also appreciate any advice on motivating them to get immunized against the flu without having to force them.

Fighting the Flu

Dear Fighting,

The recent H1N1 situation illustrated the importance of motivating someone to do something they don’t want to do.

What can we learn about motivation from looking at the situation where people are sick but feel obligated to come to work? As we discuss in Crucial Accountability, there are a few key concepts that provide the foundation for this discussion.

Consequences Motivate. There are consequences that occur naturally, and there are consequences that are imposed or enforced by others. People make decisions to act based on the consequences they anticipate. As a result, motivation is personal because people see and anticipate different consequences. Almost subconsciously, people assess the positive and negative consequences that are most likely to occur and then they act based on those assumptions.

Help Others See Consequences. We can motivate others by helping them see both the obvious and the more obscure consequences. In your situation, this includes consequences to self, to coworkers, to patients, to coworkers’ and patients’ families, to finances, to reputation, and to the quality of work. When we help others see and feel the consequences, people can change their desire to act in certain ways.

So let’s separate some of the issues in this case. For example, the manager is aching and coughing and trying to decide if she should go to work. What are the consequences of staying home? Positive consequences are that she will feel better physically. Sipping hot chocolate and lounging around the fireplace sounds pretty good. Also, she won’t get anyone else sick. However, she’s not sure she’s that sick and she assumes the probability of getting someone else sick is fairly low.

Negative consequences include not getting paid because she has exceeded her paid time off. This is particularly glaring because she has several bills that are due. She will also miss two meetings because delaying them is impossible. Catching up when she returns will be next to impossible. And while some people might have bad thoughts about her coming to work sick, she can probably avoid these people. Even if she doesn’t avoid them, they probably won’t speak up any way.

The combined value of the anticipated consequences makes the decision easy. If she goes to work, she will get paid, get important work done, and it is highly unlikely she will get anyone sick. More importantly, no one will say anything to discourage her decision. Take note that for a doctor, the financial and productivity consequences might be even more costly and the likelihood that anyone would speak up to the doctor is almost nil.

So as someone who cares about the consequences of spreading germs, what do you do? Here is some advice.

First: Manage expectations as a group around not coming in when sick.
Excellent performance begins with clear expectations. When we make agreements, we often agree on the who, the what, and the how; but we would improve motivation if we focused on the why. Have a discussion about the reasons you are making this agreement and clarify the possible positive and negative consequences. Why should people not come to work when they are sick? Why should they get immunized? Look at it from the perspective of the sick person. What will they lose? What will they gain? What will happen to colleagues and patients?

In addition to sharing the facts, share real stories of what happened in your hospital. Share the story of the nurse who picked up a virus at work and passed it on to her mother who was now in the intensive care unit. Where did the problem start? Usually with colleagues who came to work when they were sick.

Also, talk about the financial consequences or about the trust that might be lost if a colleague makes a commitment. Helping people understand and feel the weight of both clear and obvious consequences helps them make more balanced decisions.

Second: Agree to hold one another accountable.
As a part of your discussion, agree to hold each other accountable and speak up to individuals who come to work sick. Part of that agreement should be that everyone will talk in a way that is safe and professional; they will try to understand and help. Speaking up and holding others accountable is not just the boss’s job; it is everyone’s job.

When we make agreements, clarify expectations, outline natural consequences, and feel able and motivated to speak up, we reap the benefits of having a crucial confrontation. The difference between good teams and organizations and the best teams and organizations is how rapidly and respectfully problems get resolved. Individuals in these teams don’t let issues fester and they don’t let issues destroy relationships. They quickly and respectfully put them on the table and reach a resolution.

Best wishes,

You can learn more insights and skills like this in Crucial Conversations for Accountability

21 thoughts on “Confronting a Sick Colleague”

  1. Sophie

    I find the expectations work in the reverse of what you describe, among doctors. There is great resentment and gossip if someone stays home when sick, because of the real and immediate burden this puts on others who have to pick up his or her night time call and care of patients. We know that a sick doctor might jeopardize our own health, or our patients, but that’s theoretical and down the road. RIGHT NOW, a sick doctor at home means more work for me, today. And I’m already tired and burned out.

    That seems to be the thinking, anyway. I’ve overheard those judgemental conversations many times. “She’s staying home for THAT?” It makes me reluctant to stay home, knowing the same things will be said about me.

    It’s a dilemma, and certainly worthy of a crucial conversation (or even ongoing dialogue) among colleagues.

  2. Mary Symens

    I agree, management is not always the problem when deciding whether to stay home or not. Co-workers can add more pressure or guilt to a person who decides to stay home sick. I’ve seen co-workers can act like they are burdened to cover for someone who stays home. They can also be the one who comes to work because “they are not that sick” and look down on others who decide to stay home. How do you combat co-workers negative comments?

  3. Melissa Thomas

    I appreciate this article as it is one of my biggest peeves in the winter months. However,what I consider the best solution was not mentioned. In this day of telecommunications, there really is no excuse for anyone at a management level to come to work sick. Meetings that can’t be cancelled can be done via the phone, livemeeting, etc….For the hour or two or six that may be needed to accomplish the work of the day, doing this from your home via phone or computer keeps the work moving, you at home healing and not in the work place increasing the communicability epidemic we face with known and unknown germs.
    Thank you, Melissa Thomas

  4. Anne F. Reap

    Thank you Sir. I have a chronic cough, sounds terrible. I can isulate myself at the office but church is a different story. A parishoner got real angry last week, and I will stay away for awhile. The cough will not leave howevr. I think caring for oneself sometimes involves accepting the lonliness. That’s the flip and flop of this question.

  5. JJ

    I’m right where Melissa suggest I be….telecommuting from home this week as I’ve got a respiratory illness. I visited my doctor on Monday, got my meds and have told my teammates that I won’t be infecting them. It’s a courtesy to others if you can manage it, especially if no one has to take over your work wile you’re out. The situation is much worse when an ill team member comes in and subsequently wipes out half the department, with everyeone being too ill to keep up!

  6. Louise Macaulay

    This year at the hospital where I work, both the seasonal flu vaccine and the H1N1 were required for all staff. Administration set up a location on sight and have staffed it at various times of the day to accomodate all shifts and our physician staff. For those employees choosing not the vaccinated, they are required to wear a mask at work. We have had great success in getting a very high percentage of employees and physicians vaccinated. I wish I had the number to share with you. We are also seeing good compliance from staff who are required to wear the mask.

  7. Catherine

    “…advice on motivating them to get immunized against the flu without having to force them.”
    I took notice that the article did not address the issue of trying to manipulate another person into doing something with their body they choose not too. The concept of manipulation also comes into play (I believe you have another article about using crucial conversations for getting what you want), these are personal medical and sometimes religious and/or value based decisions…issues best left to the individual. Yes I do see that there are the practical issues of getting the job done but I presume we are not talking about first responders or healthcare workers putting other, already compromised, people at risk. Yes I received the H1N1 shot this year, but that was clearly my deciison as an informed adult understanding the consequences …I made my decision.


    If this “personal medical and sometimes religious and/or value based decision” to not get vaccinated against a disease that KILLS YOUNG PEOPLE, particularly the medically vulnerable, is that important to the person, than let that person quit their job and stay home (and away from church!) There comes a time when the public health, and the rights of others, have to trump the individual rights.

    The only legitimate excuse for not getting a vaccination is if the person is allergic to the vaccine. Anything else is a matter of “principle,” and as such, if you choose this principle, you need to also choose the consequences. In this case, if you work in a medical setting, you are morally obligated to not expose others to your illnesses and potential illnesses.

    It could be argued that wherever you work or go, you will unavoidably contact vulnerable people who are undergoing chemotherapy for cancer, have immune system deficiencies, have children or family members who have conditions that make them vulnerable, and so on. So, if you choose to not get a vaccination for high-minded “principles,” stay home and never leave until the flu season is well and truly over.

    The chances that an ill administrator in a hospital will infect someone are outstanding. Walking thorough the hallway filled with people who are already sick or having or recovering from surgery, using a restroom that the same people will be using, coughing and drinking from the water fountain, eating in the cafeteria, and walking through a hallway with people who are visiting people who are already sick or having or recovering from surgery makes it very unlikely that an ill administrator won’t get someone sick. That person just most likely won’t know what damage s/he did!

    This is why many medical centers required vaccination, or stay home.
    Remember: Typhoid Mary just wanted to work so that she could feed her family!

  9. Dean

    I agree with JJ that you can make this a positive situation if you communicate that you are concerned about others. In my case, I have a standard team meeting item on my agenda every fall. I give my lecture on Presenteeism. Presenteeism is the overwhelming desire to come to work when you are sick. This discussion gives everyone a chance to discuss the pros and cons and ways to make the office safe for everyone. We can openly discuss the topic and then there are no hard feelings when someone stays home to benefit the rest of us.

  10. Steph

    @Catherine You should stick to advising people about work-related, not health and body-related issues. Advising a worker on how to pressure another worker to do something that may be detrimental to their health (such as getting a vaccine) should not be allowed in the workplace. The person pressuring does not know the individual’s medical history, has not seen their medical record, is not their personal physician, and you are supporting them in giving medical advice. Asking someone to stay home if they are sick is fine, that can’t hurt their health, but anything else is way out of bounds.

  11. Catherine

    “There comes a time when the public health, and the rights of others, have to trump the individual rights.” Saddly many things kill people everyday…young and old. We live in a society where the death rate / hospitalization due to family violence is higher than from H1N1 ……what solution would you suggest we impose? My point was simply that to use crucial conversation skills to make another person do something that is against their will (and is currently withing their rights in this country) seems to be a poor use of a very good tool intended to bring honesty and open dialogue to our interactions. @SLCCOM

  12. Sunny Rosario

    Wow! Please tread lightly on my personal beliefs about medicine and immunizations. I would be perturbed if someone at work told me to get immunized or to go to a doctor. There are some of us “radicals” who would never consider injecting ourselves and don’t believe in “traditional medicine”. For me, it comes from deeply rooted spiritual and religious beliefs about my body. If you are the type of individual who polices sick people at work, then you should consider also taking up the hobby at the grocer, the gym, your church… Let’s face it, human beings get sick. YOU may get sick. It’s part of life, let’s not make it another political workplace battle.

  13. Al Switzler

    I appreciate the comments and lively discussion brewing here. Certainly, it’s a difficult subject that we’ve all had to face in the past year. I have in no way advocated for or against immunizations and certainly, taking this step is a personal choice that should be respected.

    The point that I hope readers do not miss is the importance of setting expectations as a group and then holding to those expectations–no matter the costs. If you don’t wish to get immunized than creatively brainstorm with others alternative solutions such as staying home or working remotely. As teammates, the mutual purpose you should all have (especially in a hospital environment) is not spreading germs beyond what is necessary and by doing so, ensuring a clean, productive, and healthy environment for both staff and clients.

    1. Kim M

      In my place of employment, there is no personal choice. It is required unless you have a VALID medical reason not to get vaccinated. If you do not comply, you are fired, plain and simple. There is no right to chose here

  14. SLCCOM

    Nevertheless, someone who chooses to not get vaccinated is imposing their beliefs on others via knowngly taking the risk of imposing illnesses on them that are not necessary. As I said, if you choose the principle, you need to, if you are indeed an ethical person, choose the consequences. This includes not making others sick when it was avoidable. If this means it costs you money because you cannot go into work to avoid making others ill, then it should cost YOU the money,not some poor person who is innocently going about their business and gets sick.

    Rationalizing that “human beings get sick” is not a justification for imposing your decisions to risk illness and spreading illness on others. If I believe, due to deeply rooted spiritual and religious beliefs, that I only serve my god by running around carrying weapons just in case someone else needs defending, am I entitled to do that even though it makes others uncomfortable?

    As Al said, the team needs to set expectations, and in a healthcare setting, the expectation MUST be to not kill vulnerable patients. And if there are no alternative solutions, then those who choose to not get vaccinated need to be the ones to pay the price for their decision.

  15. Dianna

    At my medical facility, they allow us 6 unscheulded absences per year, before initiating performance write ups. It is very considerate to stay home when sick, but if you have exceeded your alotment for one reason or another,or are anticipating some unscheduled absences, say for a dying family membe;,missing work can have serious consequences.

    I disagree with the idea of giving my employer the right to threaten my livehood, by giving untimatums,forcing me to take immunizations that I do not want. I feel like this could lead to other imposed restrictions by my employer,that I feel violate my personal rights and freedoms. Such policies might eventually place all employees at the mercy of their employer.

    To add fuel to the fire, many staff providing direct patient care, my unit in particular, have be given a blanket clasification called “designated employees”. This particular clasification requires that you arrive to work on time, even during severe weather conditions,and implies that absence is unacceptable. I was actually told by my supervisor that if you happened to be an employee with attendance problems, this might be all that is needed to terminate your employment.

    When employees feel threatened by their employers attendance and occurance policies, they may feel that they have no alternative than to go to work. The irony of the situtation is, that if you do go to work sick and they send you home, you receive an occurance as well.Even good employees fear the consequences of “occurance” penalties.

    Surely there must be a better way to address attendance issues.

    1. Kim M

      You are absolutely correct. We have the same system in place. I am a designated employee and I come to work regardless. Absences are not acceptable. If you have an appendage that is hanging off, sew it back on and get back to work. I wish I were joking. I actually ran to code one time, tripped on the edge of a rug, broke my arm and went to the ED. They casted it and sent me back to work, as an RN at the bedside. Not on light duty. There is no going home if there is no one to cover because that is patient abandonment and you lose your job and your license to practice. I am so glad I am retiring in a couple of years. I feel sorry for you younger folks…..

  16. Kim M

    Here we are in 2020 and this is just a prevalent as ever. This is our issue, however. I work in healthcare. If we are out more than 4 times (an occurrence) in any 12 month period, we are disciplined. On the 5th time we are fired. This is what happened to one of me. I was in the hospital in early January-regardless of the reason, it counted as an “occurrence” and so that was my # 1. In February, I came down with a flu like illness. I had to come into work, go to employee health, get tested for the flu (which was type A positive) and then was sent home. Had I tested negative for flu it would have been occurrence # 2, all in the first 3 months of the year. This is the nature of healthcare. You have to come in sick and be sent home with something contagious (flu/strep) or it will count against you. Many times I’ve dragged myself into work just so I could go to employee health to be sent home. Accountability is important, but so is keeping a job to feed your family. This is an at will state. They can fire you at a moments notice, and if your attendance is not up to par, it becomes part of your annual appraisal and follows you everywhere you may go in our health system. You are much better off from a policy standpoint to come in sick and have them send you home, which is the general attitude of all staff who work here. In fact, our policy is more lenient than that of a sister system here in town. This is how flu epidemics start. From a public health perspective, you can literally be the vector that carries the flu to an infirm person who dies because of it. Hospital systems fail miserably at caring for their employees.

  17. Amy

    I think talking about creative solutions is just important. Both sides have valid concerns. Perhaps you let people conference call into meetings. Give people projects that they can accomplish at home so they don’t lose pay. Allow them to make up the time for being sick without pay. Don’t just stop with motivating people. Provide real solutions.

  18. Carol Anderson

    Having worked in a medical environment in times past, the policy is often that employees do not get paid unless they are out sick for more than two day…thus discouraging call offs for reasons other than illness. It puts an employee in a tough position…come to work sick and potentially give it to colleagues and patients or stay home and lose pay. This is a fairly standard policy in the metropolitan area where I live.

  19. How to tell your colleague to stay at home when sick? - VitalSmarts India

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