One of your employees comes to speak to you concerned about one of the staff. The individual in question frequently calls in sick, their mood seems quite labile and today there is concern that they are intoxicated. What do you need to do immediately to respond to this concern, and how do you ensure the safety for the staff and patients?

Capacity refers to the loss of ability to effectively function due to temporary or permanent illness or substance abuse. Capacity issues may come to attention for multiple reasons such as frequent absences, decrease in performance, safety events, patient and staff concerns, and/or disruptive behaviour. The trigger for concerns may come from multiple sources and the key is to recognize capacity as a potential cause. As noted in my post on Disruptive Behaviour, capacity issues may frequently lead to behavioural concerns.

If capacity issues are raised, the first concern must be the safety of patients and staff. A recurring theme in my posts is that for complex issues, such as capacity, a formal policy should be available to ensure this issue is handled in a consistent and sensitive fashion. Unfortunately, capacity issues often occur in a crisis situation and/or after hours, which further emphasizes the need to have an explicit policy. Whoever has to respond to concerns should not be “winging it”.

If patients are at risk, this may require the need for the immediate substitution of an alternative caregiver. Also, leaders must ensure that the respondent is safe, either due to an underlying condition, such as mental illness, or as a consequence of raising capacity issues. The clinician needs immediate support and, in some cases, even suspension. Drug testing is a complex issue that varies by jurisdiction and circumstances, such as whether staff are unionized or not unionized. Early involvement of occupational health is essential for assessment and potential treatment and potential testing of the individual.

The focus of any policy should be protection of patients and staff, with hope for successful remediation and reintroduction of the staff into the workplace. If the clinician does not acknowledge the concerns, as discussed in my post on Competence, an investigation is usually required. However, often the clinician is relieved and actively seeks help. While having to respect the privacy of individual’s health information, formal communication among occupational health, the professional caring for the clinician, and the leader should be established. This usually requires the permission of the respondent. The involvement of all players helps during treatment and ultimately for planning and monitoring of reintroduction of staff into workplace. This permission allows the leader to provide context for the capacity issues such as workplace stress that may help with the remediation. The ability to converse between the clinician’s caregiver and leader is essential for the gradual and safe reintroduction of the member of staff back into work force.

Recalcitrant or recurrent issues of capacity such as drug abuse may require temporary or permanent restriction of privileges, such restrictions usually invoke reporting obligations to licensing bodies.

In summary, capacity issues may require immediate action with a long-term strategy to safely re-integrate staff back into the workplace.

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