Navigating Workplace Challenges in Health Care

The health care industry is influenced by an array of stakeholders, including patients, providers, payers, employers, and regulatory and accrediting bodies. To balance the different needs of these groups, managers set policies and practices that streamline operations.

But these policies and practices may also conflict with the clinical judgment and autonomy of speech-language pathologists (SLPs) and other providers. When given an administrative mandate that negatively impacts clinical care, SLPs can advocate for services—and their own well-being—by using facts and data to support alternate solutions.

A manager asks you to do something that conflicts with your clinical judgment and/or autonomy. What are your next steps?

Confirm the policy, and ask questions.

A manager may see a solution to a problem or a way to increase efficiency that has unintended consequences for clinicians. That manager may be responding to financial pressures, or they may not be familiar with speech-language pathology services and how they differ from those of other allied health professionals. Confirming the request and asking questions with respectful curiosity is a first step in understanding their point of view.

Get the proposed policy or directive in writing.
What is the background and/or rationale for the policy?
What is the problem that this policy targets or solves?

Examine the problem.

Once you understand the manager’s perspective and rationale for the policy, you can explore it from different angles.

Consider if the request is supported by or in conflict with
- federal, state, or private payer policy;
- employer policy;
- applicable scope-of-practice guidance from your state’s practice act and from ASHA;
- preferred practice patterns for the profession; and
- applicable professional codes of ethics from your state’s licensing board and from ASHA (applicable to ASHA Certified Members only)
Identify the impact of the policy on
- individual patients’ rights, outcomes, and safety;
- patient care across your caseload and clinical workflow;
- interprofessional team collaboration; and
- cost, risk management, and compliance at the facility level.

ASHA staff can help you think through different considerations and can connect you to resources for your unique situation; contact healthservices@asha.org.

Develop your talking points.

Use your research to lay out a business case using language and terms that mirror the manager’s rationale for the policy. Consider using a framework in which you

restate the requested action or policy and the underlying rationale;
detail the impact of the policy based on your research;
provide supporting background or other information; and
suggest an alternative to the problem, when applicable.

Communicate with your manager.

Consider which format, place, and time will most likely allow the manager to focus on the discussion. Send information and supporting documentation ahead of the meeting for their review, if appropriate. Use your talking points to present your case in a positive, collaborative manner—with an emphasis on solving the problem underlying the policy. Encourage the manager to take time to consider the information you’ve provided; return to the discussion at a later time, if needed.

Stick with it.

If your direct communication with the manager has not been effective, consider getting others involved. Talk with a director or other administrators for guidance on the appropriate steps for escalating your concerns in your facility. This may include Human Resources, your facility’s compliance officer, or an external ombudsman.

Making a Case Resources

These resources offer step-by-step guidance for navigating common workplace decisions that affect the quality, safety, and efficiency of care. Each resource helps you gather supporting information, frame the underlying need, and link your message to organizational priorities so you can make a strong business case to leadership.