It seems counterintuitive—that the higher the turnover, the higher the performance level.  But that’s what the MGMA (Medical Group Management Association) found in its most recent benchmarking survey—better performing practices (medical groups) had higher staff turnover than the average ones.

Think about it, though. The best-performing practices operate like a business—not like a family. By that, every family has the uncle “you can’t take anywhere.” But you love him anyway because he’s family. You’ve just got to love him, right? A hum-drum organizational culture enables the “embarrassing uncle” to remain within the organization, because he’s almost a fixture of the organization—not because he’s good for the group (in fact, he may have a track record of costing the group business).

The practice that operates like a business doesn’t have protected uncles, sacred cows or “golden children”—whatever you want to call them. No one is untouchable. That’s because there is a culture of accountability — clear expectations laid out for each team member. If you, as a member of the team, aren’t pulling your weight—you’re called out for it. There is an intervention. You’re confronted and the issue is addressed. If you, or any other person for that matter, don’t meet expectations, there will be consequences (up to and including termination).

Practices that do not have clearly defined expectations or, moreover, staff accountability (what good are expectations if there is no check and balance in place, after all?) are really tolerating mediocrity. What is in fact fostered by tolerating such mediocrity is a team with no respect for its leadership.

The high achievers within the organization will eventually grow disgusted and disenchanted, because they have to pull the “dead weight”—that individual who miraculously remains employed, even though he or she does the bare minimum.

OR, even worse is the “bully”. This type has a tendency to be confrontational, combative, territorial, manipulative (you get the picture) and leadership is unwilling (or scared) to address the matter.

In either situation, the dead weight and the bully will only further be encouraged to do the continue the pattern of behavior if there are no repercussions for their actions.

I have lived this lesson multiple times over the years.

The first time was in the first year of my first leadership post. It was then that I encountered “Tracey.” She worked out of a small satellite clinic, where the team was literally Tracey (a nurse), a physician and a receptionist. Because it was such a small environment, it was all the more important that everyone carry their own weight. Tracey didn’t. And because of Tracey, the clinic was suffering.

Everyone was miserable.

Tracey needed to go.

Letting her go was no doubt hard—not just because it’s always hard to fire someone but because of the resources and energies that must be dedicated to find a replacement. It had to be done, though, and in the end her associates were relieved and grateful, and respected the dismissal.

It sounds harsh, but disengaged team members really can be like cancers. Their negativity or underwhelming performance is malignant, and will spread from person-to-person until the entire organization is sick.

Unless there is an intervention.

As a strong leader, you are the one that is tasked with the intervention, for the sake of the whole organization. Turnover is not an ordinary organizational goal. But, sometimes it is the right choice.

Once you’ve set the “tone” for the office—creating a culture whereby ALL team members are held to a high standard—the revolving door will inevitably be out of commission. That’s because all the bad apples will have been weeded out. It usually only takes one example of zero tolerance, and soon everyone understands that you mean business.

It is never easy. But, it is often necessary.

Leadership takes courage.

But, this matter is a classic case of short term pain, long term gain.

Don’t be afraid to make the right move.