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Setting the standard for the face of your practice

For many patients, the first impression of a physician’s office helps determine the course and duration of their relationship with that practice. Their initial interactions with employees often set the tone for that visit and whether there will be a second, a third, and so on. So for dermatologists and practice managers, considering the topic of employee appearance is vital. Though the sentiment is cliché, it remains true that there’s only one chance to make that first impression.

First Impressions

In focusing on employee appearance, according to dermatologist Matt Leavitt, DO, who runs multiple Advanced Dermatology and Cosmetic Surgery locations in Florida and Ohio, it’s vital to recognize the importance of non-verbal interaction between staff and patients. Employees with the right demeanor and appearance put patients at ease even before they’re able to offer assistance. 

“People in general have a very short window on the first impression. It’s usually pegged at three to four minutes,” Dr. Leavitt said. “And some of that time might include a patient watching an employee or seeing how they interact with someone else or carry themselves. That’s one of the things that we try to teach our employees. The dress really has some significant influence on those first few minutes before they even talk to the patient.” [pagebreak]

Dr. Leavitt’s stance puts him in stride with much of the pop-psychological work done lately on the topic of first impressions, such as author Malcolm Gladwell’s claim in Blink that first impressions occur so quickly, we often “think without thinking.” It also puts him in sync with research done by social psychologist Amy Cuddy, PhD, assistant professor at the Harvard Business School. According to research first presented at the annual PopTech conference in 2012, people forming first impressions of another person are unconsciously gauging two areas — how warm and trustworthy the person seems and how competent they are. Dr. Cuddy said that these two areas account for between 80 and 90 percent of one’s overall first impression.

The importance of well-dressed, friendly practice employees cannot be overstated, according to Dr. Leavitt. Codifying a standard of appearance, he said, helps reach across cultural and generational lines more effectively.

“We see everyone from little kids to older people, as well as men and women from different religions and cultures. There’s a tremendous variability in terms of who walks through our door. What is acceptable to someone of one age, culture, or mindset might not be to someone else,” Dr. Leavitt said. “One of the things we try to explain to people is that we don’t want to offend anyone by the way we dress, but even more so, we dress in a similar way and it’s very consistent, and we try to go for something seen as very professional.” The goal, similar to keeping the office clean and answering the phone promptly, is to convey competence through mastery of the basics. “It’s all about how people view our practice,” Dr. Leavitt said. [pagebreak]

Employee investment

Most practices have, at the very least, an informal set of dress regulations. Many have a written policy, especially in larger practices. In creating a formal dress code, according to human resources expert and About.com columnist Susan Heathfield, it’s much more productive for managers to farm the job out to a diverse group of practice employees representing each area of the office.

“Creating standards for dress this way involves building support for it across the whole organization, no matter the size. What’s interesting is that most of the time, the physicians will get back a set of standards that are higher than they would have set themselves,” she said. “When a wider group of employees creates it, they feel some degree of responsibility for monitoring it.”

When creating a dress code, according to Cinda Cannon, director of quality assurance for Skin and Cancer Associates/Advanced Dermatology Management in Miami, it’s less important to focus on the term “dress code” and more important to consider it a baseline standard of professional appearance.

“Every one of our offices tailors their own dress policy, but the main thing is that it’s professional-looking, whether it’s scrubs in the exam rooms or a front office outfit. Inform your staff at the beginning of the hiring process to avoid low-cut attire in the office setting. Communicate with them as to what is considered acceptable jewelry to include piercing that is visual or affects ones communication,” Cannon said. “The physicians feel that it’s very important to recognize that no matter if you work in the front or back, your appearance is the first thing that will catch a patient’s eye and assist in their impression in addition to any services rendered.” [pagebreak]

While it may be tempting for physicians or even practice managers to create, enact, and enforce the dress code themselves, Heathfield said that those who do often regret doing so.

“You don’t have to have one or two physicians or managers trying to be the people that keep everyone in line if the employees have investment in the process,” Heathfield said. “Every physician I know wants to see patients; they don’t want to be the dress code police. Even for a practice manager, creating that role for yourself is one of the worst, most frustrating things you can do.”

Once the standards have been set by existing employees, Cannon said, it’s important to make them clear to new hires during the hiring or training process. Doing so, she said, will eliminate the sort of cultural or generational differences that might lead someone to think a manner of dress is acceptable when it isn’t allowed in the practice.

In the adoption process, Heathfield said, some of her clients have partnered with local retailers to demonstrate different examples of the professional dress standard via an impromptu “fashion show” in the office during a lunch period or after hours. [pagebreak]

Correcting course

Correcting an employee’s job-related actions can prove difficult for a physician or practice manager unused to the task. With employee appearance, doing so effectively is essential for continued success or measurable improvement. In areas of dress code enforcement, the issue should be addressed as quickly as possible, according to Cannon.

“When you have staff that come in with too much perfume, have them wash it off to minimize the smell, or if they’re wearing scrubs that don’t look pressed or professional, have them take a break when not disruptive to the patient flow, get a change of clothes, and come back. Most staff who wear scrubs will normally have a spare pair available so the disruption should be minimal. It’s important to keep to your standards,” Cannon said.

Addressing issues of grooming or hygiene, however, can be a veritable minefield of hurt feelings and resentment. Hygiene and personal appearance standards, according to Cannon, are often standards that employees are not aware they were failing to meet successfully. Actions taken to address the issue, she said, must be done quickly, honestly, and privately.

“You don’t want to offend an employee or spark any issues with co-workers. It’s counter-productive. To me as a manager, it’s how you present the information,” Cannon said. “Don’t make them feel as though they’re being put on the chopping block.” [pagebreak]

In addressing hygiene specifically, Heathfield said, it’s imperative that the manager or physician take immediate personal responsibility for corrective action. Leaving the issue and hoping it will correct itself, she said, often leads to resentment among employees and the worst-case endgame.

“This can be one of the worst things a manager has to deal with. What many managers do, which is the wrong approach, is say a bunch of people have complained to me about the fact that you don’t smell very good.’ The employee immediately goes on a mission in their mind to hunt down all these co-workers who would say this about them,” Heathfield said. “Instead, take responsibility for expressing the opinion and asking the employee if there is a medical reason why this might be so. The employee might in fact share a reason. It’s not about trying to loop in the rest of the office. Tell the employee that for him or her to succeed in the current work environment, there needs to be a change.”

Worse, Heathfield said, is when a manager fails to take any action and allows employee displeasure to curdle into resentment. When employees begin gossiping about a co-worker’s hygiene, she said, they tend to “mob together,” and end up attempting corrective actions that only make the office environment toxic.

“First they gossip about it and then they agree on a very bad solution. They do things like leave deodorant or a nasty anonymous note in their desk or mailbox,” Heathfield said. “Any manager that is not willing to address these problems directly, honestly, and with compassion is leaving themselves open for this.” [pagebreak]

Seeing results

Though progress in addressing employee appearance happens incrementally, the results over time can often be dramatic, according to Dr. Leavitt. Four years ago during his multiple weekly visits to the various practice locations, he said, he was usually confronted with an employee appearance issue each time. The fault, he said, was with himself and his partners for failing to adequately train and develop the skills of the middle managers who handle administrative duties at the individual practices.

Through better training and a focused effort to address office dcor and cleanliness and employee appearance — and better trained practice administrators to handle such issues — things have improved dramatically. Now, he said, seeing or hearing of one issue in a month would be rare. Blind surveying of patients, he said, helped to measure the interim results of the change and suggest new directions for improvement.

“What’s worked best for us by far, especially lately, is getting everyone to try to see themselves as a team,” Dr. Leavitt said. “They’ve begun to see that how they look, act, and treat each other makes a big impression with the patient.” [pagebreak]

Measuring results, according to Cannon and Heathfield, can be as simple as looking around the office and asking oneself if the environment presented is the one they themselves would like to see as a first-time patient. If employees who have to be talked to about their dress correct the action without attempting to push the limits of the dress code, Cannon said, they’ve internalized the importance of the dress code and the fact that it’s taken seriously in the office. From there, Heathfield said, a quarterly meeting with employees to solicit feedback provides a marker to use for measurement of progress and an occasion to consider change.

The bottom line, Dr. Leavitt said, is creating a welcoming environment that turns first-time patients into long-term visitors to the practice.

“The last parameter we ask patients on our feedback surveys, the one which we consider the biggest signifier, is if they would refer another patient to our practice,” Dr. Leavitt said. “It gets more challenging as many patients get to primary care first for a number of dermatologic issues. There are challenges to be overcome, and we try to go really deeply with the idea that every patient must be treasured.” 

Online-only employee appearance slideshow

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Online-only employee appearance slideshow