Common Employee Handbook Pitfalls for a Medical Practice

So, let’s say that you are a practicing physician with your own practice, or maybe a couple of partners. And you have an Employee Handbook that you have distributed to all of your employees. You may be thinking that you are in good shape on this front, right? Well, you may well be, but maybe not.

It might be good to take a look at some of the most common pitfalls that physicians (and other employers) make with their Employee Handbooks:

The Wrong Introduction and Tone

The introduction of any multi-part document sets the tone for the entire piece. And the introduction of your Employee Handbook says a lot about you, your vision, your expectations, and your practice. It’s a good idea to start out welcoming new employees, and letting the staff know that their efforts as a team to build your practice and make it successful are appreciated.

A good exercise would be to read through the first section of your Handbook with an open and objective mind, and then ask yourself: How is that introduction going to come across to an employee? Does it sound like you are welcoming them, or admonishing them?

One tricky issue to navigate is determining the extent to which the language of the Handbook sounds like “legalese.” Certainly, there are a number of core legal / regulatory concepts you should include in your Employee Handbook (like “At Will” employment, in most states), but you don’t want to overwhelm your employees with heavy-handed tone and language.

Using Language That Is Too Vague, or Too Absolute

Obviously, you want an Employee Handbook that is meaningful. And to be meaningful, it should have structure and specifics. For example, stating that a good record of Attendance and Punctuality is important. And you want to give that policy some teeth by stating that employees who do not display good attendance and punctuality are subject to disciplinary actions that may lead to termination.

However, you don’t want to “paint yourself into a corner” by stating an absolute, something like “Employees who are absent 4 or more times within a month will be terminated.” Not only could there be legal reasons that you should not terminate that employee, but you shouldn’t be at the mercy of your own stated policies.

Only make statements in the Handbook that you are prepared to back up 100% of the time, for all employees. (Even your favorite employee, that medical assistant who has been your right-hand person for the last 9 years…) Because showing favoritism when administering your stated policies could easily lead to disgruntled employees.

Forgetting That Healthcare Is Different

One pitfall I see quite frequently is when a medical practice downloads a generic Employee Handbook that could just as easily apply to an auto parts store or a landscaping company. Healthcare employers have some unique issues that often deserve special attention.

For example, does your Handbook clearly address patient confidentiality and HIPAA expectations? Employees should understand that protecting patient information is not optional and that violations can have serious consequences.

Many medical practices also employ individuals whose jobs depend upon maintaining active licenses, certifications, registrations, or continuing education requirements. If a Nurse, Radiology Technician, or other licensed professional allows a credential to expire, what happens then? Spelling out the employees’ responsibility in this regard is a good, proactive practice.

Finally, some practices have vaccine policies or infection-control requirements that should be addressed in writing. Whether it is an annual flu vaccine requirement, an exemption request process, or other workplace health and safety expectation, it is generally better to communicate those expectations clearly before an issue arises, rather than after.

Not Getting Signed Acknowledgement Forms From All Employees

One of the most important functions of the Employee Handbook is that it serves as a compilation of important guidelines and expectations of behaviors that all employees will follow. To ensure that there is widespread understanding and commitment to follow those guidelines, you should ensure that all employees acknowledge that they have received a copy of the Handbook, OR, at the very least, have easy access to a digital copy, AND understand that they are responsible for complying with the stated policies.

Copies of those signed acknowledgment forms should be filed in each employee’s personnel file. Documenting employees’ receipt of your Handbook can be extremely valuable in unemployment hearings, employee relations matters, and employment litigation.

Ignoring Differences in State Regulations

As mentioned above, the concept of “At Will” employment is one of the most important elements that should be included and emphasized in those states where it applies. And it applies in almost all states. (“At Will” employment is the concept whereby the employment is voluntary for both the employer and the employee. Either party may choose to end the relationship at any time, for any lawful reason, or for no reason at all.)

However, there are states where that concept is conditional, rather than absolute. And there is one state (Montana) where it does not apply at all to employees after their probationary period.

There are also differences between the states in numerous issues like:

• Paid and unpaid sick leave requirements (which can change constantly, from year to year)
• Continuation of benefits after termination of employment
• Federal OSHA vs. state-level OSHA
• Granting time off for employees to vote… and more!

Ignoring Local Ordinances

Some markets, like New York City, Los Angeles, Chicago, and many other larger cities have local ordinances that need to be considered when constructing a compliant Employee Handbook.

But you know what? There are some smaller towns and cities that have differences that need to be considered as well. For example, Bloomington, Minnesota has its own sick leave time ordinance… Bernalillo County in New Mexico has paid leave requirements at a county level. So, it’s important to factor in local ordinances, where applicable, when formatting your Employee Handbook.

Forgetting to Update the Handbook When You Make Internal Changes

Many employers put organizational charts in their Handbook, or mention specific Managers or Administrators by name. Which of course, means the Handbook needs to be updated when individuals leave. Sometimes the changes are less obvious. You may decide to update your Benefit offerings to employees, change your office hours on Fridays, or decide you want to prohibit employees from wearing Meta glasses. All these operational changes might well warrant updates to the Handbook.

Not Being Aware of Changes in the Law

If you have not updated your Employee Handbook in the last 5 years, there’s a good chance you have not included mention of the Pregnant Workers Fairness Act (“PWFA”) or the PUMP Act. The PWFA became effective in 2023 and was based on many of the reasonable accommodation concepts of the Americans with Disabilities Act (ADA). This law applies to employers with 15 or more employees and requires employers to provide reasonable accommodations for known limitations due to pregnancy, childbirth, or related medical conditions.

The PUMP Act addresses reasonable break time for nursing mothers, also became effective in 2023, and applies to most employers.

There are other lesser-known revisions to laws that evolve over the years; For example, many employers are surprised to learn that employees generally have a protected right under the National Labor Relations Act to discuss wages and working conditions with each other. Yet many Employee Handbooks still say that discussing wages is prohibited and subject to disciplinary action, thus creating unnecessary legal risk for the employer.

Not Keeping Up With the Times

Sometimes the language within an Employee Handbook will prove just how outdated it is. Does your Social Media policy mention “Twitter”? Because that social media platform was renamed as “X” for years now. Or… your policy on non-smoking may mention “juuling” when, these days, it’s more commonly referred to as “vaping.”

And you might want to take a good hard look at your Dress Code policy. That is where I often find outdated concepts. From listing gender specific lists (“Ladies skirts should not be too short…”) , to some policies banning all tattoos. (Surely, many of your employees under the age of 35 will have tattoos, often very visible.) Times have certainly changed, and many practices will want to keep up with the times.

Not Communicating Handbook Revisions Effectively

When you do end up revising your Employee Handbook, there are a few HR-Best-Practice guidelines that should be followed. First, be sure to tag the revised policy or section with a Revised Date. If you make multiple revisions in various sections at the same time, compile a meaningful summary of the revisions and share it with your employees.

And finally, it is advisable to get each employee to sign a form acknowledging that they were notified of the revisions and have easy access to the new Handbook in its entirety.

HR Services at DoctorsManagement LLC

Employee Handbooks are not set in stone and really should be reviewed periodically for needed updates and other pitfalls. The good news is that we can help you with this task.

Updating Employee Handbooks is one of the many services we provide for our clients here at DoctorsManagement. Whether you just need a fine-tuning, or need to start from scratch with a whole new Handbook, we can tailor one for you that factors in your state/location, as well as the size of your practice and number of employees you have.

Please contact our Director of Human Resources at 865-288-9930 or complete this form if you would like to learn more.

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