Termination Is a Leadership Event. Most Hospitals Have No System for It.
The conversation where you end someone's employment is not the hardest part. What happens on the floor in the following 48 hours is.
Most veterinary leaders have terminated an employee without a system for it. They went into the conversation with a rough outline of what they intended to say, improvised when it didn't go as planned, and then walked back onto the floor to manage whatever came next. What came next is usually the part that does the lasting damage — to the remaining team, to trust in leadership, and to the hospital's ability to hold a standard that anyone believes in.
Termination is a leadership skill that veterinary training does not cover. The first time most medical directors or practice managers conduct one, they are constructing the process in real time. That's not a character failure. It's a system gap — and it is a gap that creates measurable, avoidable consequences every time it runs without structure.
A termination handled without structure creates legal exposure for the hospital, narrative chaos for the remaining team, and a lasting signal to every other employee about what this organization does when its systems fail. It is not a personnel event that only affects two people. It is a leadership event that affects everyone who witnesses how it's managed.
What the Research Actually Says
VitalSmarts "Silence Kills" research found that healthcare workers who avoid accountability conversations cost their organizations approximately $1,500 per employee per week in lost productivity and compounding errors. Most terminations occur at the end of a long avoidance sequence: the issue was identified, the conversation was deferred, the behavior continued, and the formal response arrived far later than the situation warranted. By the time termination happens, the cost of the delay has already accumulated — in team friction, in clinical risk, and in the signal sent to the floor about whether standards actually apply.
The Joint Commission has identified communication failure — including unclear accountability and undefined role expectations — as a contributing factor in 80% of serious medical errors in healthcare settings. A team that has watched a performance problem be managed inconsistently for months has not been spared the cost of that inconsistency. The inconsistency itself is the cost: reduced confidence in leadership, reduced willingness to raise concerns, reduced belief that the standard applies to everyone.
Gallup's research on performance management found that only 26% of employees report their organisation's approach motivates outstanding work. The remaining 74% are operating inside a system that does not consistently define or reinforce expectations. A termination, when it finally arrives, is often the first unambiguous signal the team has received that standards exist and have limits. By that point, the signal is arriving very late.
Why Termination Arrives Late
The pattern before most terminations follows a recognizable sequence. A performance issue is identified internally, labelled as serious, and then deferred. A conversation happens eventually — usually after the behavior has repeated enough times that the leader feels they have sufficient grounds to raise it. That threshold is almost always higher than it needs to be.
The deferred timeline creates compounding problems. The person being managed receives inconsistent signals about whether their behaviour is acceptable. The team around them watches leadership avoid the issue and draws their own conclusions about what accountability actually means in this hospital. The documentation that would support a defensible termination, if it exists at all, was collected too late and too sporadically to tell a coherent story.
By the time termination occurs, the hospital has usually paid the cost of the issue three or four times over — in team friction, in reduced floor performance, and in the accumulated hours leadership spent managing around the problem rather than addressing it directly.
The termination is not the failure. The absence of a system that would have caught it earlier is.
The Three Failure Modes
Termination without documentation
The employment relationship ends without a paper trail that predates the conversation by weeks or months. What exists instead is a general internal awareness that performance was poor and a single formal meeting that was both the intervention and the outcome.
Documentation is not primarily a legal instrument, though it serves that function. It is a record of what standard was defined, when it was communicated, how the person was given the opportunity to meet it, and at what point it became apparent they could not or would not. Without that record, the termination reads — to the person being terminated and to any external reviewer — as sudden and unsupported, regardless of how long the issue has been running internally.
What this costs: Legal exposure, potential claims of unfair dismissal, a termination that cannot be defended if challenged, and a precedent that erodes the credibility of the hospital's accountability system.
Termination without communication
The team learns about the departure through the grapevine, through the absence of a name on the next schedule, or through a brief and vague announcement that answers nothing. Leadership loses control of the narrative before it has a chance to shape one.
When the remaining team has to construct the story themselves, they will. That story will incorporate whatever they observed about the person being terminated, whatever they believe about the reason, and whatever prior experience they have with how this hospital handles endings. The version that circulates is rarely accurate and almost never the one leadership would have chosen.
What this costs: Erosion of team trust, speculation that distracts from clinical work, and a lasting impression that the hospital does not handle difficult situations with clarity or care.
Termination without transition
The role disappears from the schedule without a coverage plan. The remaining team absorbs the gap immediately, without advance notice, without additional support, and without a realistic timeline for when relief is coming.
This is the most common failure mode and the most damaging to morale. A team that has just watched a colleague leave — regardless of the circumstances — is now being asked to work harder. If the message that arrives alongside increased workload is "we're working on it," without a concrete plan to show for it, the team hears something else: that operational continuity matters more than their capacity to absorb what's being asked of them.
What this costs: Accelerated burnout among remaining staff, elevated attrition risk in the 30 to 90 days following the departure, and a team that is now watching leadership's next move very carefully.
What the Team Is Watching
Remaining staff observe how the hospital handles endings. This is not morbid curiosity. It is a rational response to a significant event in their professional environment — one that tells them everything they need to know about how the hospital would manage them if they were ever on the other side of a performance issue.
A termination handled with clarity, fairness, and a defined plan communicates that this hospital has functional leadership and that standards apply consistently. A termination that is chaotic, secretive, or disconnected from any prior intervention communicates that the hospital's accountability system is reactive and unstructured. Both messages are received clearly, and they are retained.
The team is also watching the timeline. A termination that arrives after a behavior problem the team has been navigating around for a year carries its own message: leadership knew, leadership waited, the team absorbed the cost in the interim. That message does not disappear once the person is gone.
The System a Termination Requires
A termination is not improvised well. The following elements need to exist before the conversation happens.
Documentation that predates the conversation. Performance concerns should be recorded at the point they are identified — specific incidents, dates, what standard was communicated and when. This record should tell a coherent story before the termination meeting is scheduled, not be assembled from memory the day before.
A defined conversation structure. The termination meeting should be factual, brief, and not structured to invite debate. The decision has been made before entering the room. The conversation communicates it, explains the immediate next steps — final shift, return of credentials and access, pay through a defined date — and closes. It is not an opportunity to relitigate the performance history. That conversation should have happened earlier and through a separate process.
A communication plan for the floor. Before the conversation happens, leadership should know exactly what will be communicated to the remaining team, who delivers that communication, and within what timeframe. The gap between the termination and the team communication should be as short as operationally possible. The message should be honest, bounded, and confident: someone is no longer with the hospital, the schedule is being managed, and team stability is the priority.
A coverage plan that does not punish the remaining team. Before the final shift ends, the schedule should reflect a concrete plan for the gap. It does not have to be a permanent solution — hiring takes time — but the team needs to see that leadership has a plan and is actively working it, not expecting them to absorb indefinitely.
A debrief for leadership. After the situation has stabilized, the question worth asking is not whether the termination was handled well, but when the outcome first became predictable — and what prevented the system from catching it at that point. The answer identifies where the next intervention needs to be built.
What This Looks Like in Practice
Before any future termination, these questions should be answerable:
Is there documentation of performance concerns that predates the termination conversation by at least several weeks?
What standard was communicated to this person, and when?
What specific opportunity was provided to change, and what happened?
Who tells the remaining team, what exactly do they say, and how quickly after the conversation?
What does the schedule look like for the next two weeks?
Who else on the team has been watching this situation unfold — and what are they likely to take from how it's handled?
If several of these questions don't have clear answers before the conversation is scheduled, the system is not ready.
The termination conversation is not the leadership event. The leadership event is everything that surrounds it — the documentation that makes it defensible, the communication that keeps the team intact, the coverage plan that doesn't punish the people who stayed, and the debrief that prevents the same sequence from running again.
A termination handled well does not feel good. It is not supposed to. But it is clear, it is defensible, and it is fair to the people most affected by it: the person leaving, and the team that stays. The way a hospital ends employment tells its team what kind of organization it actually is.
