Before You Manage Them Out: Reclaim Employee Engagement

The CMO who stopped pushing back in exec meetings. The new grad who never seemed to click with the unit. Or the opposite: The department chair who second-guesses every system decision, the physician who’s short with staff, the RN whose sarcasm sets the tone at handoff.

We label them “burned out,” “not a culture fit,” or “difficult.” Then we start quietly managing them out, in an industry that can’t afford to lose anyone.

Early in my career, I worked with youth in high-risk situations, including running away from home, living on the street, criminal acts, drug use, and dropping out of school. The most effective programs focused on the root causes of the behavior.

Reading Reclaiming Youth at Risk by Larry Brendtro, Martin Brokenleg, and Steve Van Bockern changed how I thought about these behaviors.

The book is about young people, not clinicians, but its central idea travels remarkably well. The authors argue that behavior we read as defiance, apathy, or dysfunction often signals unmet needs. Their framework, the Circle of Courage, draws on Lakota traditions of raising children, in which every person is developed through four connected needs: Sense of Belonging, Sense of Mastery, Sense of Independence, and Sense of Generosity.

When the circle is broken, people don’t need to be discarded. They need to be reclaimed. With tight margins and a thin labor market, recovering an employee costs far less than replacing one.

Two Warning Signs: Dropping Out and Acting Out

In healthcare, unmet needs tend to show up in one of two ways. I think of them as dropping out and acting out.

Dropping out is withdrawal. The person pulls back to avoid being hurt, judged, or ignored again.

• Goes quiet in huddles and handoffs, or answers “whatever works” to everything

• Does exactly what the assignment requires and nothing more

• Stops asking questions, asking for help, or speaking up about safety concerns

• Rising call-outs, late arrivals, or a slow drift in follow-through

Acting out is pushback. The person fights the discomfort instead of hiding from it.

• Sarcasm and cynicism at handoff or in the break room

• Publicly challenging the charge nurse, the manager, or a decision already made

• Recurring conflict with peers. Blaming other shifts or units.  Guarding credit.

• Skipping steps or building workarounds around protocols

Healthcare’s own safety literature recognizes both patterns. The Joint Commission’s alert on behaviors that undermine a culture of safety describes overt actions such as verbal outbursts alongside passive ones, such as refusing assigned tasks or quietly showing an uncooperative attitude.  The 2021 update notes that intimidation leads clinicians to stay silent rather than question a colleague, putting patients at risk.

What Disengagement Costs Your Organization

The tendency is to blame the person. Personal accountability matters. But before you decide the problem is the person, look at what the job is giving them.

Sense of Belonging: “Do I matter here?”

We’re social beings. Human connection and the belief that you’re part of a bigger team are wired into us. For some of us, the pack mindset drives us more than for others.

What matters is whether they believe they belong. Often withdrawal is self-protection. Someone who has been sidelined, snapped at, or burned by a past unit learns to expect rejection and gets there first. They may stop trying to belong.

Sense of Mastery: “Can I actually succeed here?”

It looks like a motivation problem, but it’s often a competence problem wearing a disguise. In a field where mistakes can hurt people, one bad event can turn a confident clinician into a hesitant one. After enough failures, or enough public criticism, people stop trying, because trying is where the risk lives.

Sense of Independence: “Do I have any say?”

Healthcare especially can be a system of rigid schedules, mandatory floats, protocols, and layers of approval. This dynamic teaches people to ask permission before acting and never push back. Over time, it erodes critical thinking and the capacity for change.

The U.S. Surgeon General’s 2022 advisory on health worker burnout lists limited autonomy and voice among the organizational contributors and urges leaders to involve health workers in improving the processes and workflows they live inside. When people have no say over their own practice, they either comply in silence or push back loudly.

Sense of Generosity: “Does my contribution matter?”

This one surprised me. Generosity isn’t the first element that comes to mind when you think about personal needs. On deeper analysis, generosity is about purpose and contribution. It’s what happens when someone stops believing they have anything worth giving or that their unique skills are not wanted or needed by the team.

People who feel needed rarely disengage. Purpose is often the fastest way back into the circle, and it’s the reason most people chose this work in the first place.

What Can You Do to Reclaim

• Check in with your direct reports - C-suite executives and physician leaders have the same basic needs and show the same drop-out and act-out behaviors.  Before your next check-in conversation with a struggling leader, replace “What’s wrong with this person?” with four questions:

• Belonging: Do they have at least one genuine connection on this unit?

• Mastery: When did they last experience a real win? What tasks leverage their unique skill?

• Independence: Where do they have meaningful control? Authority to decide?

• Generosity: Do they see benefit from their work? Do they add to the mission? Do they know it?

Usually one quadrant is broken, and that tells you where to start.

• Employee Performance Issues - Require a "circle check" before any improvement plan (PIP) for someone who used to be a strong performer.

• Engagement Surveys - Map existing engagement survey items to the four needs so it can be measured.

• Stay Interviews - Add the four questions to stay interviews.

• Exit Interviews - Review your last five voluntary departures through the four needs, and see which need was broken most often.

When This Framework Isn’t the Answer

Signs are signals, not diagnoses. Withdrawal can also mean burnout, moral injury, illness, grief, mental health challenges, or trouble at home. Pushback can be legitimate dissent or a sound reaction to unsafe staffing. Before you assume the problem is the person, check whether the environment is giving them a reason.

Reclaiming is also not a substitute for accountability. Anything involving patient safety, impairment, harassment, or a policy violation follows your organization’s formal process, right away.

The goal isn’t to fix people. It’s to remove barriers and rebuild the conditions in which they can thrive. Some situations involve real performance gaps or misfit that no framework will solve. But you can’t make that call fairly until you’ve checked whether the circle was ever whole to begin with.

If you lead managers who are losing good people this way, we'd welcome a conversation. Reach out to True North Leadership Partners or on LinkedIn.

Written by Joe Kenney, M.Ed., SHRM-SCP, ACC

Executive Coach | Human Capital Strategist

True North Leadership Partners

Joe Kenney is an executive coach and human capital strategist with nearly 25 years of experience helping healthcare organizations strengthen leadership, align teams, and build healthier cultures.