Okay office managers, here's a scenario for you: Your practice's new nursing intern has been coming into work reeking of cigarette smoke. The 20-year-old college student doesn't light up on the premises, which is strictly prohibited anyway, but she smells like an ashtray. You know the problem needs addressing, so how would you handle it?
Would you:A: Ease into the conversation with some idle banter about the weather and last night's episode of 30 Rock.
B: Tell her in a direct yet non-confrontational tone that you really don't care if she smokes but that she can't smell like a cigarette when working in an environment where good health habits should be promoted.
C: Admonish her for engaging in such a nasty habit and send her home to change.
Actually, there really is no right or wrong answer. For managers – part of whose job is to ensure staff adhere to practice policy – answers A-C are all options. But if you ask office manager Mary Vanheck, who actually dealt with this same scenario, she'll nearly always pick the "direct, yet non-confrontational" method.
"She took it well," Vanheck said, recalling her discussion with the intern. "I'm blunt and I like to tell it like it is, but you can't approach it negatively. You really have to be somewhat compassionate because this is a sensitive issue."
Of all the duties assigned to a medical office manager, having to broach a delicate subject with an employee can be among the trickiest and most draining. It's what puts the "human" in Human Resources and often requires the manager to balance his or her business sense with a sense of compassion.
Chronic absenteeism, tardiness, inter-office dating and work performance are all behaviors that beg discussion. Perhaps most intimidating for the manager, however, are the confrontations that cut to the core of who an employee is. How do you tell a nurse she has offensive body odor, and what do you say to the employee with tongue studs, nose rings and tattoos running up and down his arm?
The answer, according to HR experts and office managers, is "it depends."
Some experts advise keeping the focus on the effect an employee's behavior or issue is affecting his future with the business. They suggest starting the conversation by asking the employee what his career goals are before easing into the subject at hand. Others recommend avoiding the superfluous questions or chatty conversation and getting to the point.
According to professionals at the Society for Human Resource Management (SHRM), the focus of the meeting should be on collaborative problem-solving, rather than punishment. The discussion, they say, should also be documented and should include setting expectations for the employee.
Vanheck, who works for Forest Hills Pediatric Associates (FHPA) in Michigan, is an advocate of problem-solving, not punishment. In her confrontation with the smoker, Vanheck refrained from attacking the intern's habit, instead focusing on the expectations of the healthcare industry.
"It wasn't about her, it was about a health issue at work," Vanheck said.
Have Policies In Place
Like FHPA, Tennessee's Green Hills Pediatric Associates (GHPA) documents its expectations for staff and providers in policy form, eliminating some of the ambiguity that leads to talks on smoking, fashion and other touchy subjects.
"We make sure the rules are listed up front, which prevents a lot of awkward conversations," said GHPA's Office Manager Michele Buffler, "and we go over things like the dress code with them in detail."
The more sensitive the issue, the more awkward the conversation, agrees Buffler, who recalled having to tell one well-endowed employee to nix the tight-fitting shirt, and another staff member that the white skirt she was wearing revealed the black thong underneath.
"They were both fine with it," Buffler said, adding that the woman in the white skirt didn't realize it was see-through and was grateful to get the message.
Buffler attributes these happy endings, in part, to a direct, yet casual approach.
"In the case of the lady with the tight shirt, I didn't call her into my office," said Buffler. "It took place in the hall and it was a really short conversation. I said something like, 'you look very nice today, but there are young teenage boys who come here and it's just not appropriate.'"
Of course not every confrontation, no matter how professionally-conducted,ends without hurt feelings. A former Green Hills employee, when confronted more than once about clothing that was torn and smelled of wood smoke, took the discussion as a personal attack.
"I hate that, but in an office setting there are standards, and I try to take the emotional side out of it," Buffler said. "I do care, but I can't let that get in the way of professionalism."
