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Are your employees fit for duty?

By Rowena Valtairo Coliflores and Brian Kleiner

Executive Summary
Employers who want to use a Fitness for Duty Evaluation (FFDE) must pay close attention to ethics and the law. FFDEs can tell an employer whether workers have psychological or psychiatric conditions that prevent them from fulfilling their duties. It is incumbent upon employers to stress that such testing is not a punishment, but rather a suitable treatment for personality changes that might have led to declining work performances.

Psychological well-being often is not recognized as a disabling condition. In today’s society, the longevity and tenure of an employee within a small family-run business or a large corporation should not be the decisive factor in determining the continued status of employment. After all, the true value of a company is determined not by the product or service provided, but by the network of people within the organization working together to achieve success. To maintain structural integrity and continued success, companies can benefit from a Fitness for Duty Evaluation (FFDE), which identifies increased risk of harm to self or others as a result of psychological or psychiatric conditions.

An employer requests an FFDE to determine if a current employee is or is not able to achieve essential job functions because of psychological or psychiatric conditions. A risk assessment includes the elements of an FFDE, with particular importance on identifying characteristics that are associated with increased risk of harm to self or others. Consultants are called upon more and more by clients who are challenged with the potential safety and financial hazards of impaired employees. The risks include violence to self, co-workers and customers as well as judgment errors leading to accidents or significant financial miscalculations. These possibilities stem from a variety of psychological conditions, such as depression or post-traumatic stress disorder, and physical conditions, including stroke or brain injury acquired either in the course of employment or developed during an employee’s tenure in a nonworking situation.

An approach for minimizing these risks and for enabling an impaired employee to function at maximum productivity can be established by using the FFDE. Subsidized by the employer, this assessment tool determines whether a person can perform a specific role safely. When a worker’s condition compromises his cognitive, emotional or behavioral functioning, an FFDE involving neuropsychological testing usually is specified. This comprehensive set of procedures assesses several capacities: core processes, including attention and concentration, memory and new learning ability; executive abilities, such as problem solving, planning, anticipation and judgment; and emotional intelligence, which incorporates emotional regulation and impulse control. These abilities are important components of almost all forms of productive employment, mainly in white-collar and executive positions involving customer relations, supervision of others and financial decisions.

As an assessment tool for employee growth, the results of an FFDE affect an employer’s decision whether to place a worker on disability leave, discontinue that status, return a worker to a prior position, reassign her to another job or site, or modify the position in accordance with the Americans with Disabilities Act (ADA) of 1990. In addition, the FFDE can be used to design job changes that allow employees to work around their deficits, assist management on methods to handle these workers better, and recognize job tasks that employees are not able to perform any longer. For a cognitive impairment such as deficient dual attention, also called multitasking ability, a job modification might include a series of tasks to be completed rather than requiring simultaneous performance. In the presence of problem-solving impairment, assigning routine familiar tasks instead of ones that require creative problem-solving or significant decision making might be appropriate.

The following case study is based on a collection of events that demonstrate the advantages of FFDE to the company, the employee and the community, as well as the role of a consultant. The 62-year-old founder and chief executive officer (CEO) of a midsized family-owned manufacturing firm returned to work after an eight-week leave due to a minor stroke that left no readily observable limitations. Almost immediately, however, key family members and employees noticed such changes as heightened irritability, impulsive and autocratic decision making, inflexibility and questionable assessments about the market climate for new products. Key customers also commented about the founder’s abruptness and reduced mental sharpness, according to S.E. Rothke in Consulting to Management in 2004.

Family stakeholders didn’t know what to do. Family issues and guilt interfered with their willingness to take action. A family business consultant helped the remainder of the management team recognize how emotional factors hindered their decision making and how not acting posed significant financial risks. The consultant, together with management, also helped influence the founder to undergo an FFDE as part of a series planning process given his recent health difficulties. The evaluation showed impairments in many areas, including memory, flexibility of thinking, decision making and self-awareness of errors and of the impact he was having on other people.

The neuropsychologist and business consultant held several feedback sessions with the CEO alone and with the family all together. They convinced the founder of the financial risks he posed to his company by remaining in his position. It was time to relinquish the leader and hero role that founders of family businesses often find themselves in. The company created a position where he could counsel the new leadership behind the scenes while not providing direct input into operations or strategic planning. He applied his expertise, maintained his self-esteem and minimized family guilt about the need for the CEO to step down before his time. The business consultant helped reassign roles and establish new reporting relationships in the firm. About one year later, the founder retired.

In today’s times of increasing personal injury and commercial litigation, the problems of employment decisions on upper management are considerable. The FFDE is a tool for direct assessment of cognitive abilities and emotional functioning. In agreement with an organizational consultant, results of an FFDE can help management minimize risk due to an employee’s impairment and help enhance performance and productivity following a proposed change process.

Lewin’s change theory

The change process provides a useful framework to consider future changes. Kurt Lewin, the founder of modern social psychology, established a theory of change that looks at systems to maintain a status quo. He uses forces that affect the system. The forces may be driving, which is the tendency to move, or restraining, which is the tendency to remain. When balanced, the forces are in equilibrium. The field is “frozen,” and there is no change. Altering these forces causes disequilibrium, the “unfreezing” and beginning of movement. During the “moving” stage, change takes place. When forces come to a new balance, equilibrium is re-established, and the field is “frozen” again. Any further shift of the forces will cause disequilibrium and result in change. These alterations of Lewin’s theory using unfreezing, moving and frozen phases are referred to as his force field analysis model. This model is a tool for managing change by manipulating individual forces to “move” a social process in a desired direction and “refreeze” when the desired field is achieved.

Lewin’s theoretical framework states that all change is the result of certain forces in a field or particular setting. Initially, field theory was developed in the physical sciences to explore events. Lewin expanded the notion to the area of psychology. He included psychological activities that arrange a shift toward an individual’s goal. Lewin’s operational framework, or force field analysis model for change, is based on the drive and purpose of individual or group behavior. Lewin identified two active, but differing, forces that affect change. Driving forces move change in a positive and encouraging direction. Static forces promote no change and are satisfied with retaining the status quo; they are identified as restraining forces.

A driving force might be the consequence of external forces persuading the change. It also may result from existing internal problems or the need to improve a situation. Restraining forces avoid change by creating barriers. Examples are past experiences with unsuccessful, negative or failed change, or just being comfortable with the present arrangement. For change to become successful, the driving forces must be supported in favor of the change while the restraining forces are lessened.

The theoretical framework of Lewin’s change theory can be applied in the process of change for employee growth. Lewin describes three steps in the process of change: unfreezing the current level, changing or moving to the new level and freezing at the new level. The literature today uses “refreezing” as the third step to describe this level.

The first step of Lewin’s process, unfreezing, is identifying the need or problem. In this stage, participants may exhibit feelings of discomfort, apprehension and distress. Using the previous case study, this phase is exemplified by the need fpr an FFDE to determine work-related impairment. Given his recent health difficulties, the founder and CEO was convinced to undergo an FFDE as part of a series planning process. The need and problems identified were the noticed changes of behavior such as heightened irritability, impulsive and autocratic decision making, inflexibility and questionable assessments.

Strategies were developed to support the driving forces and reduce the restraining forces. The driving forces in this case study were the FFDE results, which showed impairments in memory, flexibility of thinking, decision making and self-awareness of errors and staff impact. The restraining forces included the notion that the “hero and leader” shouldn’t relinquish his role before he wants to relinquish it.

The second step of the process includes changing or moving to a new level. This is where the actual change takes place and the driving forces have outweighed the restraining forces. Several feedback sessions with the CEO and his family convinced the founder that remaining in his current position carried a financial risk for the company. A plan to implement the change resulted in the founder’s new, behind-the-scenes position.

In the last step of Lewin’s process, refreezing, the change is secured at the new level within the group. This involved the CEO remaining involved, but in his new position. Through identifying the need of change as a result of the FFDE, Levin’s change theory was applied to implement this process.

A disadvantage in an effort to utilize the FFDE is illustrated in the following case study involving a salesperson for a major pharmaceutical company. The employee has been a star performer over the years in terms of annual sales and revenue generated. Suddenly, his performance begins to decline. The decline persists over a period of 18 months. Along with the decline in performance come the changes in his personality. The once affable individual becomes withdrawn. He begins to isolate himself and does not attend staff meetings. The employee does not indicate to supervision or management that his performance is affected by any mental problems, and he does not seek any accommodation. In reviews with his supervisor, the employee provides no explanation for his deteriorating performance and responds to further inquiries with angry outbursts.

Reflecting on the employee’s behavior, his supervisor begins to suspect that the employee may be suffering from depression or some other mental malady. The supervisor recognizes that if the employee’s performance continues to deteriorate, he may have to discipline or even dismiss him for poor performance. To avoid this outcome and to assist the employee in obtaining suitable treatment, the supervisor sends the employee for a psychological FFDE. The employee refuses to participate in any such examination, and the employer then dismisses him for insubordination, according to B. Wolkinson in Employee Relations Law Journal in 2003.

The problem arose from the employer’s inability to convey the importance and purpose of the FFDE to the employee. The FFDE, in this case study, was to be used as a suitable treatment for changes in his personality that led to the declining work performance. The employee’s unwillingness to participate in the FFDE could mean that he thought the examination would be used as evidence for termination rather than a way to help him. Failure to educate employees about the purpose of the FFDE can lead to such noncompliance.

The findings found in the use of an FFDE consist of legal and ethical aspects. The daily interactions between supervisors and employees with emotional or mental problems emphasize the difficult legal questions under the Americans with Disabilities Act. The scope and nature of an employer’s right to require that its employees undergo an FFDE as well as the implications generated by the exercise of any such authority is within the ADA statutory mandate.

According to the ADA, a covered entity shall not require a medical examination and shall not ask whether an employee has a disability or what the severity of a disability is unless such inquiry is job-related and consistent with business necessity. Under this provision, an organization has the evidentiary burden of proving that the examination is “job-related” and consistent with “business necessity.”

According to the Equal Employment Opportunity Commission, a medical examination is any procedure or test that asks information about an individual’s physical or mental impairments or health. Additionally, the EEOC maintains that there are two circumstances under which any medical examination, including a psychiatric or psychological FFDE, would be appropriate. One circumstance is when the employer has a reasonable belief, based on “objective evidence,” that a worker’s mental disability has impaired his capacity to perform essential functions. And the other situation is when an employer thinks the employee poses a direct threat to himself or others.

Conte v. Horcher (365 N.E.2d 567, 1977) addressed the issue of when a department or chief has the right to mandate that an employee undergo psychological testing. In this case, a police lieutenant, Thomas Conte, brought action against the chief of police, who required that Conte undergo a psychiatric evaluation. The basic issue was whether the order from the police chief requiring an employee to undergo a psychological or psychiatric evaluation was appropriate and lawful. It had been widely accepted that law enforcement agency administrators were within their bounds to order a physical examination to assess a law enforcement officer’s ability to perform her sworn duties. In this case, it was adjudicated that it is within a police chief’s powers to order a psychiatric evaluation and, moreover, it is the police chief’s responsibility to do so. Specifically, the case states: “It is the duty of the police chief to maintain a capable and efficient force. An examination, either physical or mental, enables the chief to ascertain the qualifications of a person to perform particular duties or to fill a particular position.” This law puts the burden upon the police chief to request evaluations assessing emotional or mental fitness if called into question through the law enforcement officer’s activities.

Ethical considerations are equally important when dealing with an FFDE. According to J.T. Super in the Journal of Criminal Justice, the primary ethical considerations shall be drawn from the American Psychological Association Ethical Principles of Psychology and Code of Conduct. There are three main ethical considerations affecting FFDE. The first ethical consideration is Principle A, which directly addresses competency to practice. Psychologists strive to maintain high standards of competence in their work by education, training and experience. The second ethical consideration is Principle B, which addresses integrity. According to this principle, psychologists avoid improper and potentially harmful dual relationships.

And third, Principle F, focuses on social responsibility. This states that psychologists try to avoid misuse of their work. For example, some agencies review psychological reports for issues unrelated to why the evaluation was conducted. This misuse of product has placed the responsibility upon the psychologist to inform such agencies of the inappropriate usage. It is the most longstanding and well-written document governing the conduct of psychologists. The primary purpose of the ethics code is to ensure, to the greatest extent possible, the welfare and protection of individuals and groups who seek psychological services or who are affected by the actions of psychologists.

There are also comparative views in the use of an FFDE by employers and employees. Compared with biological testing, performance-based fitness-for-duty (FFD) testing is potentially less invasive and better suited to identifying the substandard work before it occurs. In organizations that use FFD testing, employees who perform safety-sensitive jobs have their ability or fitness checked at the beginning of their work shift. Employees whose tests indicate impairment are sent home or reassigned to tasks that are not safety-sensitive, according to D.R. Comer in the Journal of Managerial Issues.

FFD tests have limited application, but can be effective in safety sensitive positions in industries such as transportation, manufacturing and refineries. FFD tests may be viewed positively by employees who consider drug testing an excessive invasion of privacy. FFD also has the advantage of detecting the use of alcohol, whereas drug testing fails to do this. The brief tests don’t take a lot of time, another positive advantage. As employers recognize the need for proficient and capable employees, they are also acknowledging methods to obtain and keep the best people.

The outcomes and implications for FFDE at work indicate a need for its utilization. In today’s competitive business environment, it is imperative that employers hire the most competent and stable employees. Many factors contribute to the success of a business, but in the end all achievements of an organization come back to the force behind them: the people.

Testing employees both before and after initial employment has become synonymous with success in the business world. The importance of an FFDE is not just determining whether employees are competent or capable of performing their duties, but in using the test as an assessment tool to help employee and employer deal with performance changes.

Thus, an FFDE can be a positive assessment tool to recognize deficiencies of employees, deficiencies that can be ameliorated to maintain both individual and organizational integrity. A foundation study by A. Lohrasbi in the Journal of American Academy of Business found important issues regarding the improvement of productivity in service centers that measure worker output. One effective way of measuring productivity is through performance reviews or performance appraisals, which can include FFDEs. Performance appraisals and FFDEs must specify what is expected of the employee. Both employee and employer must set performance goals or changes that are realistic and well-defined. To make positive change in efficiency and cost reduction, Lohrasbi suggests and implements the following traditional, rational decision-making model for a small business: define the decision issue; gather and analyze information about the issue; develop alternate solutions or strategies; evaluate and select the best alternative; and implement the solution. Accomplishments are inconceivable without objectives; the goals of an organization are its objectives.

Rowena V. Coliflores is an assistant professor of nursing at Santa Ana College in Santa Ana, Calif., and charge nurse for urgent care at Kaiser Permanente in Downey, Calif. She previously was assistant clinic director/educator for Kaiser Permanente in Bellflower and Baldwin Park, Calif. She has a bachelor’s degree and a master’s degree in nursing from California State University, Fullerton.

Brian H. Kleiner is a professor of management at California State University, Fullerton. He received both an M.B.A. and a Ph.D. in management from the University of California, Los Angeles (UCLA).

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