Research & Education
How to stop loose lips and protect patient privacy, care, and trust.
“I was sitting in a dentist’s office when suddenly a patient storms out of an exam room and confronts the dentist in the hallway,” says Kristin Baird a practice consultant at Baird Consulting in Wisconsin and The Beryl Institute. “He said, ‘I’m sick of hearing your staffers talk about who’s dating whom, or who got drunk as a skunk last weekend. I won’t be back!’”
Indiscriminate tongue wagging — even seemingly harmless statements — can affect everything from staff morale to patient care. If you think your office is gossip-proof, you might be surprised. And if you don’t get a handle on the broad range of misstatements that could affect your practice, you could face serious consequences. Here’s how to recognize and fight gossip, rumors, and simply unwise remarks.
“Harmless” staff exchanges
Gossip is almost natural, especially in close environments. “We have six offices as of July 1 with over 75 employees, so it’s impossible to totally squelch office gossip,” admits Hilda Agajanian, director of the offices of The Oncology Institute in California. “People are always talking about the latest affair someone’s having, financial problems, who did/didn’t get a raise … there are all sorts of things that people bring up.”
In medical practices, there’s an added danger not found in other business offices: comments about the patients. “It doesn’t even have to be a word. It could be a sigh of relief, making it clear to colleagues how glad you are to see this pain-in-the-neck leave,” says Sue Jacques, aka “The Civility CEO,” who created the STAT (Stop Talking About Trash) program in Calgary, Canada. “Trust me, that gets your patients in the waiting room wondering, ‘What are they saying about me when I’m not here?’ That’s not a good image for a medical practice to build.”
Violating patient’s privacy
Consider this scenario: A nurse drops a folder by the front desk and says to the receptionist (in full earshot of the waiting room), “Stacy, please call the lab and see if we can speed up Mrs. Stevenson’s mammogram results.”
Then the receptionist, concerned about how Mrs. S is doing, asks her status. The nurse shakes her head and simply says, “It doesn’t look good.”
Starts getting trickier to define “gossip,” doesn’t it? Checking for or discussing a patient’s tests results so vocally can lead to rumors. “Brooklyn isn’t a small town, but the area in which we work is a relatively tight neighborhood. You never know when that patient is the cousin, best friend, or sister, for example, of one of your other staffers or someone in the waiting room,” says Russell Greenseid, DC, of Healthquest, a chiropractic/pain management practice in Brooklyn, N.Y.
It’s amazing how many ways there are to subtly create potential gossip problems. “Consider the light boxes in the hall. If your patients’ names are clearly labeled on the readings, your other patients can discover John Jackson’s had his hand X-rayed as they pass through,” says Baird.
At the very least, you’ve let others know John has been in for care for a broken hand, which is bad enough. Consider the patient who is seeking psychiatric care. “If Jane Doe has to leave her name displayed on a sign-in sheet at a psychiatrist’s office, think of the potential privacy issues,” says Shari McCartney, a lawyer specializing in healthcare compliance at Tripp Scott in Ft. Lauderdale, Fla.
HIPAA rules are a major reason more practices are now fighting gossip. “You’re discussing that colonoscopy in full earshot of the waiting room and the next thing you know, you’ve broken confidentiality,” says Mary Piece Brosmer, who provides practice cultural transformation through Consulting for a Change in Cincinnati, Ohio.
“Gossip at a physician’s office can rise to the level of a crime,” says McCartney. “Mr. Jackson can’t sue you, but he can report your office to DHHS or your state’s attorney general. I don’t know any doctor who wants the government to start investigating them.”
Besides, even office gossip isn’t good business — or good medicine. “The environment becomes negative, people can become paranoid,” says Jennifer Dominow, administrator of nursing services at Advocate South Suburban Hospital in Hazel Crest, Ill. When gossip is rampant, she says, “it’s hard [for staff] to deliver their best care — and that’s not what already vulnerable patients need from a health team.”
Methods of control
How do you stem these problems? “All our supervisors are trained in a warning system I established. It usually takes only one or two reprimands for our standards on gossip/privacy to become clear,” says Agajanian. “There are also numerous rules for insuring patient privacy. Example: All patients go by numbers, so someone calling from the front desk might ask, ‘Did we get the tests for M4562?’ instead of for Mrs. Stevenson.”
Baird heard the earlier dentist’s story while acting as a practice’s mystery shopper, one of her practice evaluation services to help identify potential privacy issues. Some of her other recommendations include: “Don’t have the doctor speak to the family in the waiting room, even if it’s good news. Make appointments in an area separated from the waiting room and use today’s technology to make follow-up appointments from the exam room.”
Jacques, a retired RN, teaches various control methods. “One technique is visual: Gossip starts with GO…so when you hear something you don’t approve of, get up and go. Don’t make a big scene, just leave,” she says.
HIPAA training, regular staff meetings (including those specific to the doctors themselves) and role playing are among the endeavors that keep Healthquest as close to a “gossip-free” zone as possible. So does addressing changes straightforwardly. “We brought the whole staff together and acknowledged it when there were going to be layoffs,” says Greenseid. “It still hurt, but it also squelched speculation and it let people look for new positions before they were let go.”
Brosmer actually encourages gossip, to a point. “I taught one office to incorporate a brief time during morning reviews for staff to discuss personal concerns. Saying it and leaving it, instead of banning it, worked well here,” she says.
Ultimately, experts agree, no method will work if the doctors don’t lead the way. They need to attend the training, be willing to listen to complaints — even about themselves — refrain from staff gossip, and catch themselves before saying anything about a patient outside a restricted environment like an exam room.
“Everything your patient comes in contact with should instill trust. We emphasize quality, but understand that your patients aren’t thinking quality as in clinical outcomes. They’re thinking more about the total experience,” concludes Baird.
By Wendy J. Meyeroff
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