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Critical Role of Managers and Administrators in a Medical Examiner/Coroner Office

Paul R. Parker III, B.S., D-ABMDI

Overview

There is no greater honor than writing the last chapter of someone’s life story. As medicolegal death investigators, that is what we do and, for the most part, we do it well. With seemingly innumerable courses, electronic mailing lists, and forensic science discussion groups, there is a plethora of available information on how to investigate just about every possible death scene and circumstance. Unfortunately, there is not a major focus on the management and administration of offices and personnel in the medicolegal death investigation field. With the exception of those offices under the law enforcement umbrella, many medicolegal death investigation managers and supervisors lack basic managerial training and the “big picture” purpose and role of a Medical Examiner/Coroner (ME/C) Office is often forgotten or overlooked not only by its employees, but by its administrators. The lack of managerial training and resulting substandard managerial performance; misguided managerial focus; and managerial inaction, to include the ignoring and/or avoidance of problem issues and personnel; ultimately results in the creation and maintenance of a toxic work environment and the “big picture” becomes foggy, if not completely invisible. In this environment, “cancerous” employees infect the environment to the point that good employees either leave or lose the motivation and dedication to a job well done.

The primary focus of most medicolegal death investigation managers, administrators, and supervisors is to ensure ME/C personnel properly determine jurisdiction, document deaths reported to the office, conduct scene investigations, perform death notifications, conduct postmortem examinations, certify deaths falling under its jurisdiction, and document the investigative efforts in comprehensive and factual reports, in addition to many other ancillary functions. We are fortunate to work with many outstanding death investigators and support personnel who choose to do the most noble of jobs in an under-paid, under-appreciated, and overly-stressed work environment.

• How much of their great work is being undermined everyday by inefficient and ineffective Division/Office management or frontline supervisors?
• How many employees would say that their managers/supervisors care about them, effectively communicate, set expectations, hold problem employees accountable, and actually treat employees as humans, not just a name or number covering a shift?
• How many front-line supervisors and managers lose more sleep over the performance, or lack thereof, of a problem employee than over investigating traumatic deaths and performing death notifications?
• Do the employees care about the job they do and the office’s role and how it is perceived by the public and its customers?

Despite the existence of these issues, job satisfaction surveys of ME/C employees almost universally reveal that the employee’s actual job brings high levels of satisfaction. It is, in part, the above-listed issues that undermine true job satisfaction on par or even more so than low pay and inadequate staffing levels.

In addition to an emphasis on managerial competency, there needs to be a focus on improving interpersonal relationships among co-workers, emotional well-being in the workplace, and the importance of communication, expectations, accountability, and rewarding performance. In addition, it is critical that all death investigation employees are constantly reminded about the “big picture,” which is centered upon the interactions we have with everyone, especially families and next-of-kin, how we present ourselves to and in the public, how our reports reflect our level of competence, and how we have many customers, not just the pathologists. The painting of the “big picture” starts “at the top” of every organization and is filtered down through the managers and frontline supervisors.

An administrator/manager/supervisor must ALWAYS:

• with the exception of what is already documented in personnel files, start with a “clean slate”
  • this is more difficult when promoted from “inside” as opposed to being brought in from outside of the agency.
• have a willingness to immediately identify and handle performance or interpersonal issues
  • never “look the other way”
  • “back the play” of personnel without jumping to conclusions
  • “toxic” or “cancerous” employees
  • “toxic” interpersonal relationships that negatively impact the work environment
• be able to effectively communicate, communicate, communicate
  • via various means, e.g., in person, email, etc.
    • use caution with email (keep it short)
  • clear (and documented) expectations
  • vision
  • upcoming changes and the rationale for the changes
  • “No Surprises”
    • keep employees in the loop, whenever possible, and be kept in the loop
  • be committed to continuous improvement
    • of the manager
    • of the employee
  • be consistent
  • be responsive
  • be dedicated to the mandate that everyone is accountable, all the time
  • believe in the importance of documentation
    • If it’s not documented, it did not occur
  • understand the perception that reports/documentation are a direct reflection of an employee’s competence
  • believe that the emotional well-being of medicolegal death investigation employees is paramount
    • truly care about the employee, even if the employee doesn’t want you to
      • acknowledge the difficulties of shift work
      • understand need for work/life balance
        • family emergencies, etc.
      • acknowledge birthdays, accomplishments, jobs well done, etc.
    • be available when on-duty and off-duty, when applicable
    • be willing to:
      • “roll up the sleeves” and jump in, whether that means assisting at scenes, counting medications, communicating with next-of-kin, or even covering shifts, if need be.
        • This action results in the highest levels of credibility and respect, as people trust and believe in someone who is willing to not just “talk the talk” but also “walk the walk” by coming out of the office and getting down in the trenches, so to speak.

An administrator/manager/supervisor must NEVER:

• compromise on integrity issues, e.g., lying, falsification of reports, timecards, etc.
• show favoritism
• gossip
• bully
• violate an employee’s confidence
• take credit for the work of others
• act in a way that contributes to or creates a hostile work environment
• micromanage

Additional Management Priorities

Upon hire/promotion, a new manager must hold a mandatory meeting attended by all persons reporting to the new manager. During the meeting, the new manager should provide an overview of the following:

• manager’s background
• manager’s core beliefs
• plan of action (0-60 days, 61-90 days, 90+ days) to include:
  • meeting/riding with/shadowing each employee
  • assess procedures, operations, staffing and personnel allocation
  • solicit feedback (after all, the people doing the job usually know what’s working and what isn’t)
  • building relationships with all applicable parties

Management personnel must be committed to:

• ensuring the office and its personnel are viewed as professionals, not merely “body snatchers” or a transport company
• justifying appropriate staffing levels
• implementing an appropriate employee selection process
  • recruit
    • to include written and emotional well-being components
  • train
    • remedial training
  • maintain
• using an employee’s probationary period to assess the employee but also allowing the employee to assess the office and his/her role in it
  • we want to identify those folks that do not or cannot do the job during this period
  • we also want them to assess whether we have created an environment in which they’d like to work
• fostering positive and productive relationships with:
  • Human Resources representative
  • other Department/Division head

• implementing and maintaining:
  • current and comprehensive policies and procedures
  • training manuals/guidelines
    • new employees, e.g., field training program, etc.
    • current employees, e.g., report guidelines, feedback/review of every report, training bulletins, external training opportunities, ABMDI certification, etc.
  • providing timely performance appraisals and appropriate goal setting
    • the content of an employee’s appraisal should never be a surprise and unveiled for the first time when reviewing the appraisal
      • constant communication during the rating period is essential and fair to the employee
    • establishing a work environment that exhibits and is built upon consistent practices
    • conducting outreach efforts to law enforcement, health care providers, mortuaries, etc.
    • implementing and monitoring workplace safety programs (physical and emotional well-being)

Chief Medical Examiners, Deputy Medical Examiners, Directors, and Administrators must be proactive and establish lines of communications and continual educational opportunities for and with:

• appointing authorities, i.e., Boards of Supervisors, State Legislators, etc.
• other Department Heads within the same entity, i.e., State or County level
• media representatives.
  • Yes, media representatives.
    • Who better to present positive, proactive stories about the office and its real mission and duties, as opposed to the public perceptions promulgated by the CSI Effect?
    • If outreach is conducted with the media, when a “problem” arises, allegations of misconduct are made, or if the office actually “drops the ball” on an issue, having fostered relationships with the media and your entities media liaison will “soften the blow”

Managers and employees are equally responsible for the success of employees and the office

Employers must ensure that the employee is provided the skills, knowledge, resources, guidelines, and tools to successfully perform the job; employees must ensure they are dedicated to using them with the ultimate goal of providing the best possible service in conjunction with continuous personal and professional growth. It is easy for employees to blame management for whatever ails them but it is helpful for truly dedicated employees to consider and act upon the following issues:

Value

Each employee must place an emphasis on value, specifically how to add value in every interaction while on-duty and representing the office.

• What is employee’s value to other office personnel?  To next-of-kin?  To law enforcement?  To hospitals?   To funeral homes?
• How does the employee highlight, capitalize, and increase his/her value to co-workers and customers?
• How does the employee minimize his/her personal biases and treat all customers professionally and with respect?  If s/he does not, what needs to be done to do so?

Dedication to continuous improvement

Each employee must be dedicated to this concept. Truly successful people embrace continuous improvement and are always educating/improving themselves, however possible, as opposed to maintaining the status quo.

• What does an employee do to continually improve his/her investigative and customer interaction skills?
• If the employee does not, when will s/he start, as there is no choice but to do so!

Dedication of office’s roles/responsibilities/mission/vision

Each team member must be dedicated to these issues.

• Is the employee dedicated to positively impacting where the office’s direction and service?  If not, the supervisor must meet with the employee immediately!
  • Remember, not everyone is cut out to work in the medicolegal death investigation field. I am always dedicated to helping people find jobs for which they are most suited; if that’s not in the medicolegal death investigation field, so be it. We need to ensure that only people who want to positively impact the office continue to work at the office, as co-workers and the family members of the decedents will either reap the benefits of a dedicated employee or suffer the consequences of an employee who should not be in our line of work (in the case of family members, those negative consequences may last a lifetime).
• How does the employee demonstrate dedication to the office?  To co-workers?  To law enforcement?  To next-of-kin?  To hospitals?  To funeral homes?
• Does the employee do anything that may demonstrate s/he is not dedicated to where the office is going, what it is supposed to be doing, its mission, or its vision?

Performance competence/skills/knowledge

Each employee must display competence in his/her respective area.

• Does the employee strive to be best the (job title) s/he can be?
• What is s/he doing to attempt to attain that goal?
• Is the employee flexible in thought and conduct?  Is his/her way the only correct way?

Documentation competence/skills

Each employee must be willing and able to document, in writing, what it is they do pursuant to the guidelines/instructions provided.

• Does the Investigator document every death reported to him/her?
• Does the Investigator document the deaths in a timely fashion?
• Does the Investigator thoroughly document the deaths pursuant to standardized guidelines?
• Does the documentation make sense? Does it tell a legible, coherent story? Are pertinent negatives addressed, etc.?
• Is the documentation complete before going off-duty?
• Are Investigative Narrative Report Performance Measures in place and, if so, does the Investigator meet those measures?

Investigative scene response

Each Investigator must appropriately triage and respond to scenes and, upon arrival, act in a professional, appropriate, and confident manner.

• Does the Investigator respond to scenes in an expeditious, yet safe, manner?
• Does the Investigator prioritize/triage multiple scene responses appropriately?
• Does the Investigator “think outside of the box” when confronted with competing interests?
• While on scene, does the Investigator conduct himself/herself in a professional manner?
• Does the Investigator view himself/herself as the expert in medicolegal death investigation or does s/he allow others to dictate how to conduct himself/herself and/or the investigation?

Interaction with customers

Each employee must act in a compassionate, professional, competent, and appropriate manner when interacting with an office’s various customers.

• Does the employee model professional conduct during every interaction with every customer?
• Does the employee provide accurate information to customers?
• How does the employee “come off” to co-workers?  To next-of-kin?  To law enforcement?  To funeral homes?
• Does the employee sound compassionate, professional, competent, and appropriate during telephone conversations with various customers?
• Does the employee allow biases to “bleed through” and become obvious to those with whom s/he is talking to or interacting?

Maintain a Focus on the “Big Picture”

 While it is true that ineffective management results in ME/C personnel losing sight of the “big picture,” as the focus is ultimately placed on those problem areas/personnel not being addressed but left to create the “toxic” environment in a workplace already made stressful enough by the basic responsibilities of the job, it’s possible to lose sight of the “big picture” even under the most ideal of circumstances and best management practices due to the inherent nature of the job. With a focus on professional appearance, interaction with next-of-kin, professionally authored reports and an understanding that they are obtained and read by numerous entities not just the pathologist, and emotional well-being, the “big picture” should remain clear.

Appearance

 One of the most important “big picture” ME/C issues is the appearance of those employees who interact with the public (primarily the Investigators but also employees who work at the front counter, property clerks, chaplains, etc.)

• Do they look sharp or like they just rolled out of bed?
• Do they walk with confidence or slouched over dragging their feet?
• Are their verbal public interactions and over the phone with all customers professional and respectful or do they come off as uncaring, inflexible, dispassionate know-it-alls (or maybe even worse, crass or vulgar)?

 My training and experience revolves around a concept called command presence, which is basically presenting oneself as a confident and competent authority that can be trusted and respected.  Physical appearance, body language, and verbal skills contribute to this command presence and people are oftentimes viewed, positively or negatively, based upon one’s overall grasp and control of those attributes.

 Investigators are the visible representation of an ME/C office and are the basis for the public’s, law enforcement’s, and hospital’s perceptions or beliefs about the office. Investigators must exude command presence, confidence, and pride when observed (and heard) in public at all times, whether that is at a scene, re-fueling a vehicle, walking into a convenience store, etc.

 We are responsible for investigating the death and subsequently taking custody of a decedent.  When you look professional, you tend to act professional, and are subsequently treated as a professional.  I’ve found that wearing professional or uniform attire appropriately, i.e., tucked in, clean, pressed/shined, etc., not only results in increasing both the level of respect shown to ME/C personnel and positive thoughts of their professionalism before saying one word to an officer or family, but it also results in ME/C personnel being more respectful to customers and the decedent.  I know it may be difficult to keep clothing in that condition after a scene call or two but that doesn’t mean personnel should begin the shift looking as if they have already been to several scenes.  Dedicated ME/C personnel must be provided the opportunity to shine in the eyes of the families, officers, hospitals, and the general public without the automatic formation of a less-than-ideal opinion of them as soon as they are seen or heard.  First impressions are very hard, if not impossible, to change.

Interaction with Next-of-Kin

 The next-of-kin and families of decedents are probably the most important ME/C customer.  ME/C personnel should be the primary contact with next-of-kin and meet with them at scenes—to obtain information tending to assist in the thorough documentation of that “last chapter” and to provide them information about “the next steps” and making them aware of the appropriate resources, grief or otherwise—or immediately call them if they were not at the scene (after they are notified, of course, but being able to effectively and compassionately interact with them if they happen to call the ME/C office “cold”).  As the “point” people and the sole external face of the Office, Investigators primarily experience this oftentimes stressful interaction.

We are not Grim Reapers swooping in to collect “a body” and then disappear back into the ether, leaving no trace of our existence.  We are professional independent medicolegal death investigators, who should be more knowledgeable in reactions to death, the grief process, and the importance of communication (as information not provided to families and unanswered questions of families will result in them filling in, on their own, with what may or may not be true).  Everyone we come into contact with should somehow be educated about the role of the ME/C office.  Whether it’s as they watch us professionally perform our legal duties or during the conversations we have with them while performing those duties, every contact matters, every time.

• Management should strive to publicize to all personnel the positive comments received from next-of-kin. I was always amazed how many next-of-kin took time, despite all they were experiencing, to write a “Thank You” note to an Investigator or any employee who treated them (and the decedent) with compassion, dignity, and respect. To me, that spoke volumes about the level of service provided and the content of those notes were oftentimes heartfelt, touching sentiments that truly painted the “big picture” of why we do what we do.

Reports/Documentation – Direct Reflection of an Employee’s Competence and Numerous Readers

 An Investigator can be the best one in the agency but if his/her reports contain spelling errors, misused words, and grammatical errors, no one will ever know it and, worse yet, the credibility of and confidence in the medicolegal death investigation will be undermined.

Many times an Investigative report is drafted with the pathologist in mind. It is true that the pathologist will rely upon the content of the report to determine the extent of the examination and to focus it accordingly. There are, however, numerous other customers who will obtain, read, and rely upon the report to include, but not limited, to the following:

• Toxicologists
• Forensic anthropologists, odontologists, neuropathologists, and other forensic specialists
• Fellow investigators and other ME/C personnel when fielding calls from next-of-kin, etc.
• Next-of-kin (who will read it often and pass it on from one generation to the next)
• Law enforcement
• Prosecutors
• Defense attorneys
• Insurance companies
• Health care providers
• Medical facilities
• Fatality review committees/teams
• Media outlet
• Managers must ensure there are documented expectations for report content and that reports are reviewed and feedback provided.

Emotional Well-Being

 There are only a handful of people operating under the same laws and circumstances as medicolegal death investigation personnel, and therefore, only a handful of people who can even begin to relate to this job’s stressors.  In all probability, significant others, spouses, parents, children, and friends cannot begin to comprehend what it is we do, see, hear, smell, and experience every day. Think about it…if a normal person happens to come upon just one suicidal shotgun wound to head once in their lives, they would probably be traumatized, need counseling, and never forget the image.  I would bet each of you can’t even remember how many of these you’ve seen and dealt with.  Dead infants and children…forget it.  Yet, we deal with these situations on an all too regular basis.

In addition, it’s not one thing just to see a dead body, but we are the only ones who have regular personal interaction with grieving, traumatized, and devastated families and friends.  I guess it’s possible to have some kind of detachment or desensitization when just looking at a dead body or just talking to the loved ones over the phone days after the death, but when having to also personally interact (sometimes within minutes of the death or immediately after being notified of the death) with those folks who had strong feelings (one way or the other) about the decedent, the ability to distance ourselves from their pain and grief becomes nothing less than impossible.  On top of all that, we are left to cope (or at least attempt to cope) with the pain and grief that “normal” people experience in their lives in addition to the depression, grief, and pain that comes along with the inappropriate coping mechanisms (and their consequences) many of us “learned” over time.  I learned a long time ago that what we experience will not destroy our emotional, mental, and physical well-being and ruin our family life, friendships, and social structure; how we respond to what we experience determines the extent of damage inflicted or survival attained.

Unlike our traditional first responder partners, i.e., law enforcement, fire department, EMS, many times medicolegal death investigation personnel are overlooked when it comes to debriefings and other related services.  Although we usually do not have to make split-second life-or-death decisions, we are tasked with dealing with what is arguably the most sensitive of issues—death.  For us to do our jobs someone has to die and, about half the time, those deaths are not natural or expected.  We see just about every form of death imaginable (some not even imaginable) and yet we are expected to continually perform our jobs with the same proficiency and professionalism as we did during the first days of our careers.  In addition, it is assumed that we are capable of living “normally” when outside (and even inside) of the workplace.

 Treating people like humans, and not numbers or shift coverage entities, shows employees they are actually cared about and, in turn, will help them maintain balance, well-being, and focus on providing compassionate and professional death medicolegal investigation services. Unfortunately, I have witnessed first-hand an almost “burn ‘em out, throw ‘em away, and bring in someone new” mentality. Without proper management, guidance, and nurturing, I believe medicolegal investigation personnel have an effective “shelf life” of five to seven years, depending on call volume and that may be overly generous.

• A manager must constantly assess his/her own views and actions as it pertains to the emotional well-being of personnel.
• Managers should model and encourage the positive responses to the incredible stress experienced in this line of work and encourage participation in debriefing events and confidential counseling sessions.

CONTACT INFORMATION:

Paul R. Parker III, B.S., D-ABMDI

Parker Medicolegal Services, LLC

P.O. Box 20525

Fountain Hills, Arizona 85269

Telephone: 480-298-4981

Website: www.ParkerMLS.com

Email: Paul@ParkerMLS.com