RS MGMT CH 6 Legal Aspects of Healthcare Management

Progressive Discipline Step One: Verbal Warning

1. Verbal Warning At this time, it should be made clear what the expected behavior was, what the incorrect behavior was, and what the consequences of the incorrect behavior are, as well as consequences of continued incorrect behavior. The employee should be given an opportunity to explain his or her behavior and verbalize understanding of the possible consequences. A corrective action plan can be developed with both the manager and employee offering suggestions for improvement. A corrective action plan is a written plan of action to be taken in response to identified issues. The details of the verbal warning should be documented in writing, signed and dated by both the employee and the supervisor, and placed in the employee's department file. Sometimes an employee will refuse to sign a warning document. An employee's signature does not necessarily mean they agree with the verbal warning but indicates that they were present at the meeting. If the employee still refuses to sign the document, the supervisor should write "employee refused to sign" in the signature space. Generally, the verbal warning is not forwarded to the HR department, but some organizations may request that this be done.

Progressive Discipline Step Two: Written Warning

2. Written Warning If the corrective action is not successful and the behavior continues, a written warning is the next step. The same procedure is followed as for a verbal warning, but this time the written document is forwarded to the HR department. Written warning does get forward to HR and Verbal Warning does not get forward to HR. Some organizations also provide the employee with his or her own copy of the written warning. At this time employees are also warned that repeated behavior will lead to further disciplinary action, up to and including termination.

Progressive Discipline Step Three: Suspension (with or without pay)

3. Suspension (with or without pay) After the written warning, progressive steps are suspension (with or without pay) and, finally, termination. For each of these steps, follow-up employee meetings should follow the basic procedures as the verbal and written warning sessions. Once behavior has escalated to the point of suspension from work, it is advisable to have a representative from the HR department or another manager present when discussing this with the employee. If a representative from HR is not available, an HIM manager should review the suspension and termination procedures carefully with someone from HR prior to scheduling the meeting with the employee. In all cases, discipline should be handled fairly and honestly, but it is possible that the progressive discipline process will not be followed in exactly the same way for each infraction. (For example. two verbals and then a written or directly to written, so on) An organization's policy and procedure manual should list possible infractions and their resulting disciplinary action. In addition, the previously discussed laws must be taken into consideration so that a manager does not appear to be acting in a discriminatory manner.

Progressive Discipline Step Four: Termination for Cause and Due Process

4. Termination for Cause and Due Process Termination (or dismissal) for cause is generally the last step in the progressive discipline process. This occurs when an employee has been taken through the progressive process, but behavior has not changed enough to warrant continued employment. Termination at this point should not be a surprise to the employee, as the documentation should have been clear that termination was the final step. Termination for cause can also be used for immediate dismissal. In this case, the progressive discipline steps are not implemented. An HIM manager who believes that they have an immediate termination-for-cause situation should contact the HR department for guidance. In most cases, an employee will be suspended (with or without pay) so that the situation may be investigated. Reasons for immediate termination for cause vary from one institution to another. Some examples of cause for termination are: • Abuse of a patient, resident, or another employee • Falsification of health records • Falsification of employee records • Theft • HIPAA violation of patient privacy • Use of illegal drugs or alcohol while on the job • Carrying a weapon while on the job In all cases, a thorough investigation must be carried out with documentation occurring along the way so there is no question as to the appropriateness of a termination. The HR department must be involved so there is a third party making sure all procedures are correctly followed and no discrimination has occurred. However, in most organizations, an employee has the right to due process in a termination decision or any progressive discipline measure. Due process means that the employee has the right to make sure their disciplinary action was carried out in accordance with the organization's policies and procedures. Employees should be able to file a grievance or ask for an investigation without the threat of retaliation.

Arbitration

A second type of alternative dispute resolution is arbitration. Arbitration, like mediation, involves a neutral third party. However, in the case of arbitration, each party presents their side, and the arbitrator makes the decision. The arbitration decision is binding, meaning that prior to the start of the arbitration both parties agree that the arbitrator's decision will be final, and both agree to abide by the decision in this matter.

Applying Equal Employment Opportunity Principles to Health Information Management Personnel Polices

All employment laws and their corresponding guidelines should be detailed in an organization's policy and procedure manual. A policy is a governing principle that describes how a department or organization is supposed to handle a specific situation or execute a specific process. In the case of employment law, there should be a policy covering the law itself and additional policies to cover aspects of the law that will need to be handled appropriately. A procedure is a series of steps that details the prescribed manner of implementing a policy. A policy addressing sexual harassment should further detail the procedures, or steps an employee would take, to report an incident of sexual harassment, the steps that should be taken by the person responsible for investigating a claim of sexual harassment, and the steps for taking corrective action once a claim has been investigated. Policy and procedure manuals are usually developed by the HR department in conjunction with attorneys specializing in employment law. Manuals should be reviewed annually at minimum, or whenever changes are made.

Health Insurance Portability and Accountability Act of 1996 (Wage and Benefit Regulation)

HIPAA is federal legislation that was enacted to provide continuity of health coverage, control fraud and abuse in healthcare, reduce healthcare costs, and guarantee the security and privacy of health information. HIPAA limits exclusion from health coverage for pre-existing medical conditions, prohibits discrimination against employees and dependents based on health status, guarantees availability of health insurance to small employers, and guarantees renewability of insurance to all employees regardless of the size of the organization. The HIM department is usually the department within an organization charged with the responsibility of safeguarding and releasing patient information. HIPAA Title II Privacy Rule & Security Rule Title II of HIPAA, Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform, details the Privacy Rule. -The Privacy Rule requires that a patient's protected health information (PHI) be made available only to the providers that have a proven need for access in regard to treatment, payment, and healthcare operations. PHI is individually identifiable health information and contains a piece of information such as patient name, address, phone number, or Social Security number that allows the patient to be identified. The most familiar understanding of PHI is that it applies to patient records, but PHI also applies to employee health records. Unauthorized release of PHI by an organization can result in legal action and fines. -Consequently, an organization must provide HIPAA awareness training to all employees and implement policies and procedures that prevent privacy breaches. Disciplinary action taken in the case of a privacy breach must be clear and disseminated to all employees. -Policies and procedures must be in place and updated annually, and appropriate disciplinary action must be carried out for privacy violations. HIPAA Title II also covers the Security Rule. -The Security Rule is similar to the Privacy Rule in that it applies to PHI, but the Security Rule is different in that it applies to PHI only in an electronic form. -The Security Rule maintains that employees who need access to electronic PHI (ePHI) must be granted access, but employees who do not need access must be prevented from accessing the PHI. In an electronic environment, a manager must decide the level of ePHI authorization for each position in the department. -Security awareness training must be done, and policies and procedures unique to electronic access must be developed. Policies and procedures for changing passwords, computer virus detection, and log-in attempts are examples of what must be covered. HIPAA also addresses the issues of employee health insurance portability and accountability by allowing employees to move from one job to another without losing insurance coverage or being penalized for pre-existing medical conditions. The intent of the law is that health insurance coverage continues without a waiting period when an individual leaves one employer for another. In addition, an employer cannot deny coverage of a pre-existing medical condition to a new employee who was covered by health insurance at their previous employer. In most cases, such benefits are managed by the HR department in conjunction with the insurance carrier. Enforcement of HIPAA is covered by the Office for Civil Rights (OCR), an agency of the Department of Health and Human Services.

Progressive Discipline

In some cases, counseling is done as part of disciplinary action. when poor behavior is allowed to continue, it negatively affects the morale of the employees who witness the behavior and see that no action is taken. Most organizations use some form of progressive discipline to correct unwanted behavior, meaning that the first few infractions are treated with less severity than later infractions. Despite the negative connotation associated with discipline, the intent of the process is to help the employee correct the behavior and improve. Figure 6.1. Typical progressive disciplinary process steps see image

major laws impacting the US workforce and the implications the laws

Many provisions of the laws overlap one another. What is prohibited under one law may also be prohibited by other laws. Knowledge of employment law allows a manager to act with confidence and assurance but should never be a substitute for advice and recommendation from a human resources (HR) department or legal counsel. When in doubt as to how to proceed on any legal matter in the workplace, consulting with an expert in employment law is the first step to take in making a decision. Enforcement of many employment laws is handled by the US Equal Employment Opportunity Commission (EEOC). The EEOC is a federal agency with the authority to investigate discrimination claims, render decisions, and file lawsuits if necessary. The EEOC works to prevent discrimination through training and education on employment laws.

comparative chart describing the traits of both mediation and arbitration.

Mediation - Includes a neutral third party - Helps both sides come to a mutually agreeable solution - Available at no cost - Parties sign a confidentiality agreement - Problem-solving approach - Allows for reduced workplace disruptions Arbitration - Includes a neutral third party - Both sides state their case but the arbitrator makes the final decision - Arbitrator's decision is binding - Both parties agree at the beginning of the process that the arbitrator's decision will be the final decision

Americans with Disabilities Act (Address Employee Discrimination)

Passed by Congress in 1991, this act banned discrimination against the disabled in employment and mandated easy access to all public and commerical buildings. The ADA prohibits job discrimination against people with disabilities. According to the ADA, a disability is defined as "a physical or mental impairment that substantially limits one or more major life activities" (ADA 1990). To be covered under the law, an individual must currently have the impairment, have a record of the impairment, or have been affected by an action that is outlawed by the ADA because another person perceived them as having the impairment. In addition, the impairment must be either long term (lasting for six months or more) or permanent. The definition also addresses the fact that the impairment must limit one or more major life activity. A major life activity includes but is not limited to "caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working" An individual must be able to perform the basic job duties of a position with or without reasonable accommodation. Accommodation in this case means a change or adjustment to a work environment that allows a disabled employee to perform basic job duties (ADA 1990). Reasonable accommodation means the adjustment cannot place an undue hardship on the employer. In other words, the accommodation cannot be too disruptive or expensive for the employer to implement (ADA 1990). The concept of an undue hardship will vary among employers. An accommodation that is too expensive to implement for a small physician practice may not be too expensive for a large healthcare system. Examples of reasonable accommodations are: • Job restructuring • Part-time or modified work schedules • Acquisition or modification of equipment or devices • Adjustment or modification of examinations, training materials, or policies • Provision of qualified readers or interpreters (ADA 1990) In most cases, identification of a reasonable accommodation will come from the impaired employee as they have the knowledge and experience to determine what accommodations will work best. If a reasonable accommodation is not readily apparent, a manager may ask an employee for suggestions as to what might assist the employee in performing the basic job duties required of a position. The ADA prohibits discrimination not only against individuals with disabilities but also against individuals because of a family, business, or social relationship with someone who has a disability (EEOC 2015a). Discrimination covers the following employment practices: • Recruitment • Pay • Hiring • Firing • Promotion • Job assignments • Training • Leave • Lay-off • Benefits (EEOC 2015a)

Civil Rights Act of 1964 (Address Employee Discrimination) Religion, Retaliation

Religious discrimination refers to a person's religious beliefs or lack thereof. In addition, the law requires employers to provide reasonable accommodation for religious practices. Examples of reasonable accommodations might be flexible scheduling to allow time off for religious holidays, providing a place to pray, or accepting religious dress or grooming practices. A manager should work with the employee to determine if an acceptable accommodation exists. Retaliation The Civil Rights Act of 1964 protects an employee or applicant against retaliation. This means that if a person complains to their employer, files a claim of discrimination, or participates in an investigation of their employer charged with discrimination, the person cannot be fired, demoted, or otherwise penalized for their actions. A person who reports discriminatory acts or other illegal activity is called a whistleblower. A whistleblower cannot have his or her pay cut, job reassigned, benefits reduced, or promotion withheld because he or she made a charge of discrimination. Likewise, an applicant cannot be refused employment for the same reason. Enforcement of charges of discrimination, harassment, and whistleblowing are provided by the EEOC

Civil Rights Act of 1964 (Address Employee Discrimination) Sex

Sex Discrimination on the basis of sex refers to gender and is expanded to include pregnancy in women. Discrimination may not occur based on pregnancy, childbirth, or related obstetrical medical conditions. Discrimination on the basis of sexual orientation is not specifically covered by the Civil Rights Act of 1964; however, the EEOC has clarified the interpretation of gender to mean lesbian, gay, bisexual and transgender individuals (EEOC 2016). Laws regarding sexual-orientation discrimination are also passed at the state and local levels of government. Sexual harassment is also considered a type of sex discrimination. The EEOC defines sexual harassment as unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when: • Submission to such conduct is made, either explicitly or implicitly, a term or condition of an individual's employment • Submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such an individual • Such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile, or offensive working environment (EEOC 2014) Types of sexual harassment One type of sexual harassment is quid pro quo. Quid pro quo is about one person using their authority over another to demand some kind of sexual favor in return for job actions such as promotion, hiring, or continued employment. The second type of sexual harassment is creation of a hostile work environment. This example of sexual harassment is less obvious than quid pro quo. A hostile work environment occurs when one employee's behavior is interpreted as being offensive by another employee. -In general, there must be a pattern of unwelcome actions. -A coworker who makes one lewd comment about another is not perceived by most reasonable people as creating a hostile work environment. -However, making continued comments, especially after being asked to stop, could result in a charge of sexual harassment. Any charge of sexual harassment must be taken seriously and investigated. The EEOC definition identifies three areas of consideration for a manager to use when trying to determine if sexual harassment has occurred: (1) the actions must be unwelcome, or uninvited; (2) the actions must be severe enough to interfere with the employee's performance; and (3) the employer must know, or should have known, about the actions. Managers must also be aware that harassment may occur on social media sites. An organization may be held liable for charges of sexual harassment if the employer knows of the action on social media, or if the harassing is being done on employer-owned devices. An effective preventive program should include an explicit policy against sexual harassment that is clearly and regularly communicated to all employees. The policy should detail a procedure for all employees to follow when reporting harassing behavior and be clear about the punishments for harassing behaviors. Corrective action should be prompt and thorough, following policies and procedures. The intent of the corrective action should be to stop the harassment, make appropriate amends to the victim, and prevent the behavior from recurring. Any punitive action should match the seriousness of the offense. Finally, the concept of harassment does not only apply to sexual harassment but extends to behavior in cases of race, color, national origin, religion, and disability.

Employment Laws Impacting Healthcare

Some states have enacted their own similar laws, but unless the state laws are more stringent, the federal laws take precedence. Address Employee Discrimination -The Americans with Disabilities Act, -the Civil Rights Acts, -the Age Discrimination in Employment Act Wage and Benefit Regulation -The Family and Medical Leave Act, -Fair Labor Standards Act, -Health Insurance Portability and Accountability Act (HIPAA) -Consolidated Omnibus Budget Reconciliation Act (COBRA)

Age Discrimination in Employment Act of 1967 (Address Employee Discrimination)

The Age Discrimination in Employment Act (ADEA) prohibits discrimination on the basis of age against individuals age 40 and older. Interestingly, the ADEA permits employers to favor older workers based on age even when doing so adversely affects a younger worker who is 40 or older -In other words, a 47-year-old employee cannot claim that they were discriminated against on the basis of age if a 53-year-old employee was favored in a hiring or promotion situation. -An amendment to the ADEA stopped this practice, and now organizations must offer equal benefits to employees of all ages. The ADEA also affects retirement issues. Mandatory retirement was initially required by the ADEA at age 65, but the ADEA raised the age to 70. -In 1986, an amendment to the ADEA removed a mandatory retirement age altogether as long as a person is able to perform the job. Because of certain job requirements, some professions such as police officers and firefighters are allowed to mandate retirement by a certain age. Older workers are sometimes offered early retirement incentives. In these instances, employees are usually asked to sign a waiver that prohibits them from filing a claim under the ADEA. The ADEA offers protection to employees by publishing minimum requirements that state such waivers must: • Be in writing and be understandable • Specifically refer to ADEA rights or claims • Not waive rights or claims that may arise in the future • Be in exchange for valuable consideration in addition to anything of value to which the individual already is entitled • Advise the individual in writing to consult an attorney before signing the waiver • Provide the individual at least 21 days to consider the agreement and at least seven days to revoke the agreement after signing it. Like the antidiscrimination laws already covered, employees age 40 and older are also protected against retaliation should they make a claim of discrimination.

Civil Rights Act of 1964 (Address Employee Discrimination) Race and Color, National Origin

The Civil Rights Act of 1964 is an antidiscrimination law that prohibits employment discrimination because of race, color, religion, sex, or national origin. Discrimination is not allowed in hiring, promotion, termination, compensation, training, benefits, or other privileges of employment. Race and Color Race and color are not the same thing. Discrimination based on race includes skin color as well as other race-related characteristics such as hair texture or facial features. Skin color can vary among members of the same or different races or ethnicities. Discrimination is not allowed on the basis of the lightness or darkness of skin tone. National Origin National origin refers to the ancestry, birthplace, culture, or language characteristics of an individual. Language characteristics include accents and English-fluency. Accents and fluency may be considered in hiring practices if they interfere with job performance. For example, an accent may not affect the job performance of a clinical data analyst, but English-fluency may impact the job performance of an HIM professional hired by a vendor to give product demonstrations or provide customer training.

Civil Rights Act of 1991 (Address Employee Discrimination)

The Civil Rights Act of 1991 upholds and strengthens the Civil Rights Act of 1964. Under the 1964 law, an employee has the right to make a claim for discrimination against his or her employer. The EEOC then investigates the claim and decides a resolution. If discrimination is found to have occurred, depending on the charge, the employee could receive back pay, be reinstated, or be awarded a promotion. The Civil Rights Act of 1991 takes possible actions by the employee farther, by allowing for jury trials and increased monetary awards for employees. Employees may now receive compensatory damages for discriminatory actions against them. Compensatory damages cover the actual financial loss of the employee and could cover repayment for lost worktime or payment for medical bills. Punitive damages may also be awarded to the employee as a way to further punish the employer and prevent the employer's discriminatory behavior from continuing. It is important that the punitive damages are large enough to deter the employer from allowing the discriminatory behavior to continue. The employer may decide to implement sexual harassment training or start a diversity program to correct discriminatory practices in the organization.

Consolidated Omnibus Budget Reconciliation Act (Wage and Benefit Regulation)

The Consolidated Omnibus Budget Reconciliation Act (COBRA) affects employment practice because it offers continuing health insurance coverage for qualifying employees that have lost healthcare coverage. The employee must assume payment for the insurance premium but does so at the organization's group rate. An employee must qualify for this benefit; it is not automatically applied. An employee qualifies for COBRA benefits due to any of the following events: voluntary or involuntary job loss (for reasons other than gross misconduct), reduction in the hours worked, transition between jobs, death, divorce, or the employee becomes entitled to Medicare coverage (COBRA 1986). There is also a time limit on how long an employee can receive COBRA benefits. In most cases, an employee may receive COBRA benefits for up to 18 months from the time they qualify, but special qualifying events such as eligibility for Medicare coverage may extend benefits to 36 months. An employer may elect to continue coverage for longer than the law requires. Like the FLSA and the FMLA, COBRA is overseen by the Department of Labor.

Mediation

The EEOC also offers the option of mediation as an alternative to the traditional investigative or litigation process Mediation involves both sides of the claim sitting down with a neutral third party and reaching an agreement. The mediator does not decide the issue but rather helps both sides come to a solution together. Benefits to mediation include the following. • Mediation is available at no cost to either party • Each party has an equal say in the process and the settlement terms and there is no determination of guilt or innocence • All parties sign a confidentiality agreement • If mediation occurs early enough in the process, many are completed in one meeting, saving time and money • The intent is to avoid a more expensive investigation or even a litigation • Mediation uses a problem-solving approach that allows for reduced workplace disruptions, and this can lead to positive feelings after the issue is resolved as each side has had a fair chance to present their side and work to arrive at a joint solution

Fair Labor Standards Act (Wage and Benefit Regulation)

The Fair Labor Standards Act (FLSA) is more commonly known as the wage and hour law. The FLSA is a federal law and is the basis for many state wage and hour laws. When the FLSA conflicts with a state law, the more stringent law applies and is administered by the Wage and Hour Division of the United States Department of Labor. The intent of the FLSA is to determine minimum wage and overtime pay rules as well as to establish a definition of a work week. The FLSA defines categories of employees as those that are exempt and nonexempt from overtime pay. Nonexempt employees do receive overtime pay. Overtime pay is currently defined as one and one-half times the regular rate of pay for all hours worked over 40 hours in a workweek. Overtime pay also becomes an issue for a manager when working with flexible scheduling. A manager must be aware of overtime regulations when using compressed workweeks, flextime, or job sharing. -A compressed workweek is a work schedule that permits a full-time job to be completed in less than the standard five days of eight-hour shifts. -Flextime is a work schedule that gives employees some choice in the pattern of their work hours, usually around a core of midday hours. Generally, there are specific hours that must be worked during the day, and as long as these hours are covered, the start and end times are flexible. -Job sharing is a work schedule in which two or more individuals share the tasks of one full-time or one full-time-equivalent position.

Family and Medical Leave Act of 1993 (Wage and Benefit Regulation)

The Family and Medical Leave Act (FMLA) allows employees to take unpaid time off work for specific family and medical reasons that include the following: • The birth of a son or daughter or placement of a son or daughter with the employee for adoption or foster care • To care for a spouse, son, daughter, or parent who has a serious health condition • For a serious health condition that makes the employee unable to perform the essential functions of his or her job • For any qualifying exigency arising out of the fact that a spouse, son, daughter, or parent is a military member on covered active duty or call to covered active duty status. An employee is eligible for this benefit if they have worked for their employer for at least 12 months and have worked at least 1,250 hours during the previous 12 months. An employee may take up to 12 weeks of unpaid leave during a 12-month period. An employee must continue to receive healthcare coverage but does not have to continue to accrue paid time off while on leave. Under some circumstances, such as for a planned medical treatment, an employee may take the leave on an intermittent basis rather than in consecutive weeks. This may have the effect of extending the 12-week period. Some organizations choose to offer paid leave, but this is not mandatory. Another provision of the FMLA is that upon return to work, "an employee must be restored to his or her original job or to an equivalent job with equivalent pay, benefits, and other terms and conditions of employment" The Wage and Hour Division of the United States Department of Labor oversees the FMLA, but some states have enacted their own family and medical leave laws. In the case where a state has its own law in addition the federal law, the more stringent of the two laws takes precedence. An HIM manager should work with the human resources department so that the correct laws are followed.

Interviewing

There are certain topics that are off limits during an interview unless they are a bona fide occupational qualification (BFOQ). A BFOQ is a job requirement that in most jobs would be illegal to discuss but in specific jobs is a necessity. Certain HIM jobs would appear to have BFOQs. A completely deaf person may not be able to be a transcriptionist, although a blind person could do the job. A manager cannot ask inappropriate questions of an applicant, and a manager cannot use inappropriate information gathered in an interview to make a hiring decision An applicant may be nervous or excited and volunteer that they are a single parent, a cancer survivor, from a certain country, or practice a specific religion. Despite the fact that the information is now known, a manager cannot use the information when deciding which applicant to hire. Table 6.1. Sample inappropriate questions for job interviews see page 116 If an organization decides to use social media for background checks, it is advisable to have a third party who has no part in the hiring decision capture only the appropriate information and present it for review.

Counseling

employee counseling sessions are looked at in the same way as interviews Despite these negative concerns, counseling is one management task that all managers have in common. Counseling is done for many reasons: • Heading off potential behavior issues • Addressing declining performance • Giving career advice • Training • Praising and encouraging • Coaching or mentoring If the meeting is to address declining performance, probe for an underlying cause such as inadequate training or a personal problem that might be distracting the employee from his or her work. Be careful not to get involved in personal problems. regardless of the reason for the counseling, a brief anecdotal note should be written and placed in the employee's department file. This helps the manager to track problems and be reminded of previous conversations.

Employment-at-will

means that employees can be fired at any time and for almost any reason based on the idea that, in turn, employees can quit at any time and for almost any reason. Over time, aspects of the employment-at-will concept led to discriminatory practices by employers: companies would not hire persons of a particular religion or nationality, and persons were fired for non-work-related reasons such as refusing sexual advances or developing a disability. The employment-at-will concept remains the principle by which most organizations operate, however, regulation modified the concept to say that an employer cannot terminate an employee for a reason the law says is illegal. The resulting laws and implications for healthcare management are intended to promote fairness and equity in the workplace.

Progressive Discipline Step Four: Termination for Cause and Due Process (Grievance)

see image Figure 6.4. Employee grievance process steps There are many different grievance processes, but the general steps are listed in figure 6.4 and include the following. • A grievance is generally brought by the employee to the attention of their supervisor. Here, the intent is to resolve the problem informally. However, sometimes the problem involves the supervisor, so an unbiased resolution might not be possible as the employee would feel that they will not get a fair hearing. In such cases, the next-level supervisor becomes the first step in the process. • If the first or subsequent steps fail, the grievance is then taken up the line to a department head or even to the vice president level. At each step the documentation is reviewed and facts are gathered to support the decision to either uphold or overturn the disciplinary action. Again, the intent is that resolution of the problem can occur at this level. • The next step is to involve the HR department. Generally, there are individuals or a committee appointed to hear the grievance and make a final recommendation. These individuals are outside the affected department and provide a neutral third-party review. • In extreme cases, an employee has the right to go outside the organization and file a complaint with the EEOC or the appropriate state division of human rights. The EEOC has the power to investigate claims under their jurisdiction (ADA, Civil Rights Act) and even to call for a jury trial if necessary. In addition, a prompt decision at each level lets an employee know that their grievance was considered and acted on in a reasonable time frame. An organization may offer, or an employee may request, that mediation or arbitration be used as a means to settle disciplinary action.