What May be to Blame When Medical Practice Staff Lacks Initiative

Physicians often complain that staff shows no initiative and is operationally passive:  "They won't do anything without specific instructions, every time."  Office productivity and morale benefit from understanding a likely cause of this behavior that many physicians encounter.

Learned helplessness occurs when a person repeatedly encounters a negative event he can neither influence nor avoid.  He will eventually learn that he is powerless in the situation and stop wasting energy trying to avoid the discomfort.  Passivity is the conditioned response. 

It is important to note that medical office staff is particularly prone to learned helplessness.  I know of no other environment where there is such a disparity in education, training, experience, and self-confidence between the person in charge and the people upon whom she depends.  A remark that seems emotionally neutral to a physician can feel very strident to a medical assistant. 

Consider three situations that, if they occur repeatedly and without explanation, will teach staff members it is best to lie low and not stick their necks out:

1. A patient has a UTI, but the physician's preferred medication is not appropriate.  Upon hearing "UTI" and before the physician has asked for a particular medication, the medical assistant anticipates the physician's request and presents a sample of the preferred medication. 

When the physician looks at the medical assistant as if she's crazy, the medical assistant resolves to wait for a specific instruction in the future.

2. A new patient calls for an appointment, but the practice is not taking new patients.  The receptionist offers the names and numbers of several other physicians.  The patient becomes angry and insists on speaking to the physician.  Following office procedures for this type of situation, the receptionist informs the patient that she will take a message and ask the physician to call the patient back.  The patient becomes angrier.  The physician chastises the receptionist when she sees the message.  The caller is a long-time family friend.

Now the physician is irritated because the receptionist did what she had been taught to do. When this type of situation arises in the future, the receptionist will have no idea what to do, and this is not a good time to ask. 

3. A patient is ready to be seen, but the physician is not in the office.  The patient says she is going to run to the pharmacy next door and will be right back.  The staff is agreeable, because they have not heard that the doctor is even in transit and it seems to be a way to make the patient's wait more palatable.  The doctor walks in the back door just as the patient walks out the front, and he is not happy to have no one ready to see.

Next time the staff will insist the patient sit in the exam room until the physician arrives.  They will not make any accommodations to smooth over a patient's experience.

Learned helplessness is a real problem and it occurs naturally in many medical offices.  Instead of becoming more valuable over time, staff becomes less and less productive.  The good news is that it has a corollary: learned industriousness.  That will be the topic of next week's blog.