DOCTOR’S VISIT ETIQUETTE

What you say or record, visually and acoustically, may violate someone’s privacy.
I saw a recent article about this topic, and I thought it interesting enough to address in my own article. Specifically, the issue is whether or not to allow smart phone camera usage in physician’s waiting rooms or examining rooms.
There are two issues, really; one is a liability concern for the professional, and the other is about interpreting and following HIPAA regulations. If you were a physician, would you allow a film crew in your exam room to record your treatment/exam of your patients? Short of a dozen signed, witnessed and notarized liability waivers, I don’t think that is happening, unless for a positive news story or to highlight an honor to be received at a banquet. It is not such a stretch when one considers the apps and capabilities of today’s smart phones in the hands of a patient.
I think there are times when a senior patient might want to include a daughter in a discussion, or a parent might be texted a picture of a bump on the head that the doctor is saying needs attention. But generally, using a camera phone or other recording device in a doctor’s office should be limited by necessity as defined by the practice.
The other matter is a privacy concern. Although I have never seen this problem occurring, I’m quite certain that somewhere in this country there are a couple of teenage girls who, passing the time in a doctor’s waiting room, are taking numerous cheek-to-cheek face shots. Banning smart phone camera use in medical settings helps protect the privacy of individuals who are not interested in being the subject of someone else’s photo array on Facebook. It also reduces concerns that the privacy of patients’ names or files might be violated by an inadvertent focus or background appearance.
I think it is also good policy to post a sign asking patients to step outside if they have to accept or initiate a call. I for one do not want to have to listen to the details of Aunt Bobbi’s condition, or the latest gossip about you-know-who was seen with what’s-her-name. For that matter, I hate having to listen to someone else’s phone conversations, wherever I am. It is bad enough I have to listen to myself speak.

Remind Me Again Why I Got Into Home Care

It can be surprisingly easy to forget why we got into the home care industry in the first place, with such fierce competition for customers and employees, yearly increases in insurance rates, and more and more regulations.  We are always under pressures–to hire and retain better employees, to meet payroll, to grow census, to increase profitability, to keep clients and referral sources happy, to perform.  Even our elected officials often treat us with hostility, sometimes appearing as if they think that the home care industry is a license to steal or commit fraud.

I have had to remind myself and my staff what a privilege it is to be chosen–to be trusted–with the health and welfare of families’ loved ones.  This is a difficult and challenging business we are in.  It requires continuous attention to a myriad of details and needs that make each client unique, and that make each case uniquely challenging.  Of course, it not only involves providing the direct services, but following all of the countless policies and procedures exactly as written in order to receive reimbursement.

In the course of our day we do so many things at many levels.  For example, when we apply an attendance policy, it is not just to keep employees in compliance; it is to assure that we are doing what we say we will do.  Our clients depend on us being there to help them with their daily activities.  These policies are in fact our values in action.

We agree to take on these tasks because it is our jobs to do so, but couldn’t we find an easier way to make a living?  Of course we could.  We all know how difficult this industry is to perform well.  I am in awe at the sales skill that national franchises display in their abilities to sell so many overlapping private duty business franchises (more on this later).  They promise some big returns, and with a lot of hard work and the right attitude, all things are possible.  But I think that many of these entrepreneurs go into the home care industry because underneath they have a need to do some good in the world, and they have no idea how hard it can be.

But it can feel great!  What home care owner/manager has not experienced the feeling of complete satisfaction in knowing that all of our hard work, all of our careful selections and training hours and check-up calls have resulted in happy and safe clients?  The work that we do really matters.  What we do is not only rewarding for us personally—it is important.  Hundreds of thousands, probably millions of seniors count on us to help them with their housework, a bath, a hot meal, and a friendly smile.

Knowing at the end of the day that what we have done—despite all of the frustrations and the energy-sapping challenges—has served people who need us and that we have made a difference, is really quite a return.  And you and I can take that to the bank.

Are You Smarter Than a Fifth Grader?

Recently KMOV’s Vickie Newton’s blog mentioned the problem of job applicants being told that they are overqualified for the job for which they have applied.  We’ve heard this for years, but never have so few jobs been offered to so many, for so little–to paraphrase Churchill.  One must conclude that 1)the applicant actually would like to be seriously considered for the position, and 2)the company would be obtaining a more highly skilled employee for less.  So where’s the beef?

I talked to a large employer about this, and he spouted the typical conventional wisdom, which is, “if we hire an overqualified person, then they will be either bored or resentful, and they might leave in a year or two.”  I asked him what his current retention rate was, and he stated, “about 2.5 years.”

“So,” I smugly stated, “the idea of the long-term employee is just a myth.  People leave anyway. “  He shrugged and indicated that he guessed that there was some truth in that.  Not to mention points 1 and 2 above.

Just yesterday one of my clients expressed an interesting dilemma.  Her previous job title was Executive Producer (of large-scale corporate events).  She lives in southern California, where everybody knows somebody in the movie business, but nobody seems to know anybody who can actually help you to get in to the movie business.  A couple of recruiters saw her resume and one asked her what movies she had produced?

“No, I’m sorry, you have misunderstood.  I’m not a movie producer.  I’m an event producer.”

“Oh, now I see.  Did you produce  Michael Jackson’s memorial?  That was beautiful–you must be very talented,” exclaimed the enthusiastic recruiter.

“No, I’m afraid I’m still not being clear.  I produced new model automotive shows.”

“Car shows?”  questioned the recruiter.  “I’ve been to a car show.  But the cars just sit there.  They don’t have any lines, or sing, or even honk.  What is there to produce?”

My client is seeking help from another recruiter.

My advice was to alter the job title to something less idiosyncratic.   She asked if this was OK to do.  I explained that it would be doing both you and the target companies a favor by creating a title that was more representative of what you actually did, and more understandable to the hiring managers and HR people, who are the ones who invent titles.

Did you know that in very large companies there is usually a quiet division doing very secretive work in an isolated area of the building, whose sole job is to create position titles which are logically unrelated to the position they are supposed to describe?  This conscious obfuscation is yet another way for bureaucrats to deflect accountability that should be inherent in the position.  Which is why this division has so much inordinate power.  If a RIF occurs and any of the positions occupied by denizens of this secretive organization within an organization are slated for the chopping block, they simply decree themselves new job titles, thereby escaping the Grim Reaper of Employment.  Now there’s a group of  employees who have really good retention.

I suppose the moral of this story is that if you are not lucky enough to work in the Department of Titles, just act dumber than you are, and your chances of getting hired will improve.

How to Integrate Coaching into your Managerial Behavior

The following is an article I wrote last year, but now that it’s here, it’s a blog.

Think of a moment when a manager made a significant positive impact on how you handled your job or career. More likely than not, it involved coaching.

Many people think of coaching as primarily the domain of the External Consultant/Coach. This is not how coaching is most used. As we know, the external consultant contracts with a corporation or business owner to assist in moving the participants to a higher level of effectiveness and job satisfaction. These sessions are typically formalized and aim toward specific goals. In reality, coaching should be much more broadly practiced.  Good managers use coaching techniques frequently, and it should become part of your leadership skills repertoire.

Like most managers, my former positions as leader/manager of health care organizations provided me with many coaching opportunities, and coaching behaviors were typically a formal function of my role. For example, I used coaching techniques when discussing performance and with reports who needed help with their own subordinate relationships. It was also helpful when corrective action was necessary. This isn’t an external coaching model, as defined by a semi-collegial relationship, but is characterized in part by differential power positions. We can’t always be in coaching mode, not only because some employees are uncoachable, but because in some cases, it just makes more sense to “tell and sell.”

I used coaching techniques formally and informally when helping teach staff how to be more effective managers. I often used a Socratic method. I tried not to answer their questions with anything but a question. My philosophy was that if I had to make all of their decisions, why are they here? It was often frustrating as heck for them, but I needed to encourage them to take responsibility for the solution, to think clearly about the problem. For the ones that were worth their salt, this method really did help develop them into more effective, independent, self-confident managers.

These coaching formats were formal (in a review or encouragement meeting) and informal, when impromptu. The purpose was always to focus on effectiveness which may include relationship/group relations assistance as well as how to meet performance goals. We would include guidance on business or marketing strategies, but also deal with process issues: communication skills, handling conflict, giving feedback.

I also used a healthy dose of coaching with sales/marketing personnel.  The behaviors and activities which lead to successful marketing results are varied and require learned skills. These behaviors are especially sensitive to coaching.  Training is vital, and should include a strong element of experiential activities which naturally invite good coaching from the trainer. The coaching doesn’t just stop at initial sales training, but should continue so that sales people benefit from relearning, problem-solving, and encouragement during the course of the job.

Roles and Boundaries

There is a boundary issue that is important to point out whenever coaching people, whether internally or externally, and that is the difference between coaching and therapy. Therapy involves providing intervention and counseling to an individual who is having at minimum adjustment difficulties, and certainly in many instances more serious issues involving identity, coping, social behavior and relationships, and personality challenges. Coaching is centered on working with a basically healthy population and assisting them to move forward on the effectiveness scale. One should not take lightly the responsibility, skill sets, and licensing issues in dealing with someone whom you find needs professional help. The kind and proper thing to do is refer this individual to someone in the helping profession. A good start is the company EAP, if it has one. If you are their supervisor and their behavior has interfered with their performance, visiting the EAP may be part of the corrective action.

For me, the Manager-as-Coach model uses a blend of my experience in business/economic matters with my knowledge of Organizational Behavior. The models I use are informed by psychodynamic systems theory and the human potential movement,  but are more about generalized effective behaviors than any one theory.  I also consider the organizational realties facing the staff. If the company is going through a difficult time, I recognize where their needs and insecurities are, and work towards helping them alleviate worry enough to focus on solutions and engaging their intelligence toward achievable goals.

In this scenario, I would cross over a little bit into appropriate therapeutic methods to assist a subordinate in the moment to relax, think positively, and do what is commonly called “reframing.” Reframing is a powerful technique to very quickly refocus your employee back on positive aspects of any situation, and allows for positive movement.

The potential danger is in overlooking the importance of acknowledging the employee’s feelings. They must not be dismissed, but rather be put on hold temporarily so they can be actively redirected and encouraged to join you to work on positive activities and thinking about choices to work out the problems. If the negativity is pervasive and persistent, then you would want to suggest that the employee find a way to clear his or her head and focus on personal performance and the things that are within the employee’s control.

Coaching, as most experienced managers are aware, is not the exclusive domain of the external consultant, but a valuable tool that all good managers should utilize. There are many ways to develop your coaching skills, one of the best of which is to experience coaching yourself from a trusted mentor or consultant from whom you can model behavior. There are many courses and online programs to learn these skills and how best to apply them. Much coaching and learning to coach today is done asynchronously online and telephonically.   For example, I am part of an international Coach Consultant Consortium at ORGDYNE Global Village, where we have teleconferences, professional paper discussions, and comment boards to advance coaching as a practical science.