Family Practice Management

Job Descriptions Balance Your Needs With ADA Requirements

Covered in FPM Quiz

Tool inside

Steve M. Cohen, EdD

There's no way around it. Some job functions require specific physical and mental capabilities. Your challenge is to comply with the Americans With Disabilities Act (ADA) of 1990 and yet hire and maintain staff members who can handle the physical and mental requirements of their jobs. To meet this challenge and to ward off potential lawsuits, you will find what might be called ADA-based job descriptions to be one of your practice's best tools.

To understand how ADA-based job descriptions help, you must know the basics of the law. ADA prohibits discrimination in the hiring or management of qualified disabled employees who can perform the essential functions of their jobs either unaided or with the assistance of a reasonable accommodation. The law requires you to provide disabled employees with reasonable accommodations to carry out their work in your office, accommodations that don't cause your practice undue hardship. Providing an enlarged-letter telephone keypad for a receptionist with a vision problem, for example, would be a reasonable accommodation. (See "ADA Compliance: How Are You Doing?" April 1995, for a discussion of reasonable accommodation versus undue hardship.)

ADA does not require you to hire or maintain the employment of someone who cannot mentally or physically perform the job's essential functions. Because what constitute essential functions can be open to interpretation -- as can so much of what the law deals with -- the issue provides fertile ground for potential lawsuits.

Elements of a job description

In listing essential functions, identify mental and physical requirements down to the minutiae.

Your best protection against charges that you are not complying with ADA requirements is to develop activity-based job descriptions that specify in writing the exact physical and mental requirements of, and the activities involved in performing, every position in your practice. In listing essential functions, identify mental and physical requirements down to the minutiae -- seeing, walking, hearing, speaking, sitting, standing, lifting, reaching, learning and thinking (see "Activity and knowledge requirements," page 62, and "A sample position description," page 65). Disabled persons who can perform the essential functions of a job cannot be denied employment just because they cannot perform the job's marginal functions, ones that can be delegated easily to another staff member with no disruption to the office. For example, your office needs someone to drive a delivery to the lab, and normally the receptionist would do that. However, your receptionist is visually challenged enough that she cannot drive but not to the point that she can't execute the essential functions of her job. It would probably cause no undue hardship to your office for someone else to drive the delivery.

Activity and knowledge requirements In designing an activity-based job description, you might find it helpful to consult a broad list of potential requirements, crossing out those that don't apply to the job in question and modifying others as indicated (for instance, changing normal to high where a job is particularly demanding). The following could serve as this sort of reminder list. See the accompanying sample job description to see how this list is modified for a receptionist position. Work environment Normal accessibility of all work sites required for the position. Normal exposure to weather and temperature extremes, cramped spaces, loud noises, chemicals and fumes, dust, heights or work safety hazards. Normal amount of overtime or extended work hours required. Physical effort Normal physical mobility, which includes movement from place to place on the job taking distance and speed into account. Normal physical agility, which includes ability to maneuver body while in place. Normal physical strength to handle routine office materials and tools. Normal physical strength to handle 50-pound object, taking frequency into consideration. Normal dexterity of hands and fingers. Normal coordination, including eye-hand, hand-foot. Normal endurance. Knowledge requirements Educational level appropriate to the position. Required work experience. Preferred work experience. Strong customer-service orientation. Strong team orientation. Mental effort Normal concentration/intensity, which includes prolonged mental effort with limited opportunity for breaks. Normal memory, taking into consideration the amount and type of information. Normal complexity of decision making. Normal time pressure of decision making. Communication Normal verbal communication. Normal written communication. Normal non-verbal communication. Sensory abilities Normal ability to see, distinguish colors, hear, smell and taste. Normal sense of touch.

When you interview job applicants, make full use of your ADA-based job description. The description condenses all the information you need to get from the applicant in one time-saving, easy-to-read document, making it less likely to miss questions about specific competencies or to stray into illegal questions about disability or other protected groups (see "Employment Interviews: To Ask or Not to Ask," Staff Management, February 1996, page 87). It also helps to keep you focused on the primary purpose of the interview, to gather information about the applicant and not to waste time giving information.

Ask applicants to review the job description and tell you which of the things listed that they can do. This will initiate discussion of the full scope of their competencies and experience, giving you a clear indication of their qualifications for the job. If there is something an applicant cannot do, ask what accommodation would enable him or her to perform the task. This will give you information on what accommodations the employee will want you to make if you decide this applicant is the best qualified for the job.

During the interview, also ask situation-oriented, open-ended questions. For example, give the receptionist applicant the following scenario: "A 40-pound box of specimen containers has just arrived at the front desk. It's an essential function of your job to carry the box to the storeroom, open the box and place the containers on the shelf. You would lift, pull, bend, stoop and stretch to complete the task. What would you do?" The applicant's response will tell you something about his or her physical capability to carry out the essential function as well as any potential reasonable accommodation requirements.

When you are ready to make a hiring decision, an ADA-based job description serves another function. It provides the structure for comparing all applicants. After all, you have taken them through roughly the same process by using the job description as an interview tool, so now you will be able to make reasonable, fair comparisons among applicants.

Uses after the hiring decision

The ADA-based job description can also be used in coaching and evaluating employees, as a basis for wage and salary determinations and as a procedures guide for reconstructing a job step-by-step, should the need arise. You can even build the job description into a performance evaluation tool by adding a rating scale (for instance, Exceeds expectations, Meets expectations and Falls short of expectations) for each of the job functions listed.

The job description serves as an implied contract, too. An employee knows from the position description that his or her job clearly requires essential functions A,B,C,D and E. If that employee cannot perform a function, you must ask yourself whether you should change the job to reasonably accommodate the employee or make a staffing change to accommodate the essential functions of the job. For example, you might need to dismiss a physician assistant who develops vision impairment as a result of glaucoma and becomes unable to conduct most office visits, an essential function of the job.

As an implied contract, the job description also gives you legally defensible grounds for dismissing an employee for fudging or outright lying in the job interview about an essential-function capability. For example, the job may require someone who can lift 70 pounds, and the new employee can't budge the load. Without a weightlifting requirement in writing, you can't hold the employee accountable for an inability to perform the function. As you can see, the ADA-based job description also protects the applicant or employee from vague, unwritten job requirements.

This need for specificity is why traditional outcomes-based job descriptions, commonplace in the 1980s, won't work anymore. Those describe what the employee is to accomplish with no concern to how the job is done. Not specifying in writing the "how" of the job gives inadequate direction to applicants or employees, healthy and disabled alike. The "how-you-do-things" is also a legal issue because employers are liable for an employee's behavior on the job under what is called "the doctrine of respondent superior." The legal implications make ADA-based job descriptions particularly useful in helping direct how your staff does things.

Specifics are important, but give your job descriptions flexibility, too. Add a clause that allows you to ask employees to perform job-related tasks that aren't covered in their job descriptions. You may want an employee to run an errand to the pharmacy, for example, and a flexibility clause clearly gives you the right to request that and makes the employee responsible for complying.

It may be tempting to place the development and routine updating of job descriptions on the back burner for more urgent issues. In my experience, only 10 percent to 20 percent of practices use ADA-based job descriptions. Unfortunately, without job descriptions, you leave questions about the job's essential functions to be decided someday in a legal battle between your attorney and the one retained by a disgruntled job applicant or employee.

A sample position description Job title: Receptionist Reports to: Office manager Summary This position is responsible for staffing the reception area by routing all incoming telephone calls appropriately, scheduling appointments, greeting patients and streamlining patient visits. Essential functions Receptionist activities 95 percent of time Receives incoming telephone calls. Responds to requests for basic information. Determines calling patients' needs, and responds by scheduling appointments or directing calls to nurses or doctors. Determines needs of calling hospitals or consulting physicians, and directs calls to appropriate physicians. Schedules patient appointments. Determines reason for visit requests. Decides whether to schedule patient for visit or simple discussion with nurse or doctor. Schedules needed appointments appropriately. Receives and greets patients. Has new patients fill out form with general, medical history and insurance information. Pulls and places charts of visiting patients in time-sequence lineup for nursing staff. Monitors waiting patients, and attempts to resolve delays. Collects payment at end of doctor's visit. Assures patients have everything required for departure (receipts, prescriptions, patient education instructions). Tracks patient insurance information. Asks patients to update insurance information, and photocopies patients' insurance cards. Maintains patient chart files. Pulls charts for patient visits. Files charts after medical and nursing staff have adequately completed them. Asks for clarification on charts that seem incomplete. Receives vendors, verifies deliveries for practice, signs for deliveries, logs delivery and provides unloading instructions to delivery service. Sorts and distributes incoming mail. Processes outgoing mail. Sorts and distributes fax transmittals. Processes incoming and outgoing UPS, overnight mail service and courier service mail and packages. Other activities 5 percent of time Assists the office manager with a variety of other duties as assigned. The above specified tasks may not be the only duties assigned. Employees will be required to carry out any other job-related instructions requested by their supervisor, subject to reasonable accommodations. Activity and knowledge requirements Work environment Normal exposure to weather and temperature extremes. Normal amount of overtime or extended work hours required. Physical effort Normal physical mobility, which includes movement from place to place. Normal physical agility, which includes ability to maneuver body while in place. Normal physical strength to handle routine office materials and tools. Normal physical strength to handle 25-pound object, taking frequency into consideration. Normal dexterity of hands and fingers. Normal coordination, including eye-hand, hand-foot. Above average endurance. Knowledge requirements High school diploma or GED equivalent. Minimum of six months' receptionist and switchboard experience. Experience in a mailroom preferred. Must have strong customer-service orientation. Must have strong team orientation. Mental effort Normal concentration/intensity. Normal memory, taking into consideration the amount and type of information. Normal complexity of decision making. Normal time pressure of decision making. Communication Normal verbal communication. Normal written communication. Normal nonverbal communication. Sensory abilities Normal ability to see, distinguish colors and hear. Normal sense of touch.

Dr. Cohen is a senior consultant with Lawrence-Leiter and Co., a management consulting firm in Kansas City, Mo.

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