Accentuate the positive

Influencing emotions amongst practice staff can help reduce patient complaints. MDDUS senior risk adviser Liz Price explains how 

WHAT emotions do you experience at work? Whatever your own experience, you can be sure that your practice team experience the same variety – and probably others too.

All of us differ in how we feel about the expression of emotion in the workplace. Emotional displays can sometimes be difficult for managers and other team members to handle and they absolutely have an impact on others.

Although these impacts can be negative, evidence is building in support of the view that managers attending to, trying to understand and influencing emotions can be a useful risk management tool.

As a practice manager, you could try to ignore emotion but this can have negative consequences for yourself, other team members, the practice and your patients.

Emotions can have an impact on all areas of work within a practice, but I will highlight some of the ways emotions can impact on patient-service-related complaints. Following from these, there are some strategies managers can experiment with to help support the delivery of good patient service, and so reduce the likelihood of patient complaints.

Positive emotions

There is strong evidence that the incidence of complaints in general practice can be reduced if patients have a positive emotional experience associated with encounters across the practice team.

Many complaints practice managers deal with are prompted by behaviour exhibited by clinical and non-clinical staff, and the resultant feelings experienced by the patient. The degree to which patients like your practice and your team is a function of the emotional value you add to the relationship. Therefore, to deliver patient service which promotes a positive experience in the patient, members of the practice team must add emotional value during each interaction. This applies to telephone and face-to-face contacts, and also in writing.

Many practices have tried to improve customer service by ensuring receptionists answer the telephone or greet patients at reception with a smile. Some have tried to script patient encounters positively to improve the patient’s experience, and often this includes making contact with the patient at the end of each encounter.

Authenticity

It is not that these “improving customer care” initiatives are not useful. In fact the evidence is clear that they are. What causes them to fail is that these behaviours are not always displayed authentically. I am sure you will all have experienced the fake smile and “have a nice day” moments as a patient or customer yourself.

These inauthentic behaviours are very often related to the morale levels of the team members, the way they feel about their role and the way they feel about the practice. Research suggests that poor morale when delivering patient service predicts declining patient satisfaction.

Think about a receptionist. From their perspective, if they feel unhappy or under-valued in their role then any positive emotion they are asked to display is unlikely to be authentic. Their negative emotions may start to leak out and they may feel stressed by the conflict between what they feel and what their role requires them to display.

For a GP, eye contact during consultations can strongly influence how a patient feels about them. People who feel bad or stressed often struggle to maintain positive levels of eye contact, which can create a poor rapport with patients and perhaps provide them with a negative emotional experience.

From the patient’s perspective, when a receptionist offers up a fake smile, rattles out positive words in a negative tone, or doesn’t seem to be listening properly on the telephone, the overwhelming emotional impact of the encounter is negative. The patient may leave feeling that perhaps the receptionist doesn’t really like them, or is disinterested. Certainly no rapport is felt and so if something subsequently goes wrong, the patient is likely to be less tolerant and more likely to raise a complaint.

Worse than this though, research shows that if a patient is dissatisfied, only four per cent will complain. The other 96 per cent who have had a negative experience will tell others, perhaps tainting the practice’s reputation in the community. There is also potential for these unhappy patients to become difficult to deal with as they remain frustrated but feel they cannot do anything about it.

Effective teams

If a manager can influence the mood of the practice team and promote activities which result in positive emotional experiences at work, then this can improve the effectiveness of individuals and the team as a whole. Experiencing more positive emotions at work appears to have a direct link to increased cooperation and helpfulness within the team, feelings of satisfaction and motivation and importantly the urge to go the extra mile to please patients. Because when people feel happier they are much more likely to seem happier, which means displaying naturally positive emotions and associated customer care behaviours.

It is evident that positive emotions support improved practice performance and promote better team-working and individual feelings of wellbeing. So what can practice managers do to increase morale and ensure team members naturally feel more positive emotions at work?

Promoting positive emotions in individuals

Practice managers can take opportunities during performance reviews to try to increase each individual’s identification with their work role. Where individuals understand the positive impact of their role on patient care (and how it supports other team members), they often feel more positively about the work – even when it becomes more difficult.

Managers could include evidence about emotional competencies within frontline recruitment and selection decisions. For example, competencies such as agreeableness and extraversion (as opposed to introversion) are associated with more easily generating positive emotions. Also, helping each staff member to script positive responses to common negative messages should reduce negative patient responses. It can also make difficult encounters feel less uncomfortable and help the patient feel less frustrated.

Practice managers must do as much as they can to create the conditions which support positive emotions in individuals, but sometimes negative emotional experiences are inevitable. And if these emotions are not recognised and handled promptly they can escalate and infect other team members as well as patients. Being ‘present’ and ‘available’ to recognise negative emotions can be difficult to manage if your location is isolated from frontline services or where you are under pressure yourself.

Promoting positive emotions in teams

Identifying opportunities to promote a strong social identity within the team is important. Many practices encourage group activities to promote positive social engagement and cross-team comfort. Effective examples I have come across include: a running club, which aimed to have a group of willing team members complete a charity relay race in aid of a local hospice, and a practice social club that arranged opportunities both in and outside of work for folk to have a bit of fun together (e.g. monthly informal team get-togethers over home-baked buns where team/practice achievements are highlighted).

To avoid feelings of unfairness or resentment building up that will impact negatively on the rest of the team, their morale and patient service, it is important that practice managers have the ability to identify team conflict at an early stage and put in place effective conflict resolution.

Many managers find this a difficult area to deal with and it can be hard work – especially if you yourself don’t feel positive at times (we’re all human).

It can help to keep in mind that creating and supporting conditions in which individuals and teams feel a high proportion of positive emotions can promote naturally occurring positive behaviours and communication. This will then reduce patient dissatisfaction, the potential for ongoing difficult behaviours and ultimately reduce the likelihood of patient complaints.

Liz Price is a senior risk adviser at MDDUS