Catching up on the office gossip. Two female colleagues sharing the latest office gossip at work


We all do it.  Friendly banter, weekend stories, emerging relationships and other topics can be the subject of many “watercooler’ discussions.  There can even be factual information shared with coworkers or patients.  Casual conversations happen all the time.  Is this harmless chitchat or gossip?  Is there a difference and does it matter? 

Establishing connections in the workplace is a crucial element of job satisfaction.  It is a critical aspect of organizational culture.  As social beings, verbal communication is the most common way of connecting with one another. Informal conversation that is not tied to work activity helps people feel more connected.  Most of us like to share stories, experiences, passions, interests and ideas with others.  This builds bonds, creates trust, and can even create friendships. These conversations can help your employees and patients to build morale, to feel more rooted in and loyal to the company, and to feel like they are an integral part of a caring community. In short, chitchat is not harmful and is most likely beneficial for both the individuals and the company. 

Gossip, on the other hand, begins when the conversation turns to other people’s private lives.  The Cambridge diction goes on to qualify that definition to say that discussion might be “unkind, disapproving, or not true.” But I think the minute we start talking about the private life of someone who is not part of the conversation we have crossed the line between chitchat and gossip, regardless of whether the comments are unkind, critical or untrue.   And in the work environment, I can argue that talking about a coworker, unless you are singing their praises, is probably a topic to be avoided. 

There is a “test of three,” attributed to Socrates that asks three questions to determine if something is worthy of discussion. “Is what you have to share with me true?” “Is this information good news?” and “Is what you have to share with me useful to me?”  When we are having casual conversations, with the exception that it’s not always about me, these are good things to consider before sharing something.  Obviously describing my ski vacation would fail the test but is still positive.  So take it with a grain of salt. 

Gossiping, like other negative human habits and behaviors, is not something you can simply tell people not to do and leave it at that. Your employees will need to understand what gossip is, why gossip is so alluring, and why they must take care not to spread it or be drawn into it by another person. 

But there is nothing at all wrong with making our conversations positive.  There is enough negativity out there that if we were to make a conscious effort to have meaningful, positive conversations with our peers and friends, you might be surprised how that lifts everyone’s spirits. 

User login on screen

Things Change (or Maybe They Don’t)

I am old enough to remember when the internet wasn’t.  I can spin all kinds of tales about life before the internet and cell phones and things.  But we will save that for the bar at the Academy meeting! Today, I am on a roll about security.  Yep.  Let me start with some statistics. In 2022, hacking accounted for nearly 80% of all healthcare data breaches. And yes, you are a healthcare provider.  That can be topic number two at the bar.  According to the HHS Office of Civil Rights, in a report they released on 1/23/2023, this represents a 45% increase from just 5 years ago. 

It is easy to discount the risk of a data breach at your company, after all, in the scheme of things you’re a relatively small fish, right? But in the eyes of the malicious actors, you are a prime target.  Healthcare entities are about 2/3rds more likely to pay a ransom to recover their data than non-healthcare entities, according to a new report by SOPHOS.  

If cybersecurity is not enough to get you to take notice, there is this other thing out there known as HIPAA.  You are a “Covered Entity” whether you like it or not, and there are obligations that go along with that status.  So whether you have a hacker come in and steal your data or you have a worker who leaves a screen in a position that can be read by prying eyes, or multiple people logging into an account with PHI, your penalties are the same. Most HIPAA violations are the result of negligence, such as the failure to perform an organization-wide risk assessment.  

A password is a standard way of authenticating access to digital services and systems. It is supposed to be secret to ensure that only the account owner or those granted rights can view or modify important data. Unfortunately, there are individuals who can be lazy in safekeeping passwords, making their accounts vulnerable to hacking and other attacks. The following chart may surprise some of you (click the image to view full chart): 

When reasonable precautions are circumvented or not implemented and a disclosure of PHI occurs, it will most likely be deemed a “Tier 2” violation which carried (in 2022) a MINIMUM fine of $1,280 PER VIOLATION (2 disclosures is 2 violations) with a maximum penalty per year of $1,919,173.    

In 2022, over 80% of the fines and penalties levied were for violations involving a single individual. For example, one physician was fined $50,000 for “Impermissible disclosure on social media.” 

As an owner, if you think your risk is low, you should look at the chart above. The Office of Civil Rights is expected to continue to aggressively enforce HIPAA compliance in 2023 after a record-breaking year of HIPAA fines and settlements. Ensure your staff have protections in place to limit the ability of improper screen viewing. Make sure people do not share passwords, that they log off systems when not actively using them, and that they don’t write down passwords on a piece of paper! I know it’s a pain, and time-consuming, but not nearly as big a pain as it would be if you have a data breach or cyber attack. It is time to change our behavior and awareness. 


The Changing Meaning of Words

I had a language professor in college who taught us that American English is a very dynamic language; it changes quite rapidly at times. It is both a blessing and a curse. That dynamic aspect means that it is always in tune with the cultural influences of the day, but it also means that people can be left in the proverbial dust in understanding what is being communicated. Two people can use the same words, but the meaning behind the words is entirely different. My professor referred to this dynamic nature as the “dumbing down” of the language because new words and new meanings were often coined by people who did not know that a word already existed, or the existing word was too hard for them to speak or spell. 

The French have the Académie Française that started in the early 1600’s to ensure that the French language had “exact rules” to keep communication unambiguous. We have no such thing here. Our language morphs. In September 2022, Websters added 370 new words to its dictionary. The study of words and their meaning is known as “lexicography,” and they are quick to point out that the meanings of words are constantly changing. (The study of language is a fascinating rabbit hole you can explore on your own!)  

But words matter. Today, there is a cultural effort underway to fundamentally change the meaning of the word “Equity” and then replace the word “Equality” with Equity. According to Websters, Equity means “freedom from bias or favoritism;” and equality means that we “regard or affect all objects in the same way.” Those two legacy definitions have very similar meanings. But today, according to the National Association of Colleges and Employers, Equity  “refers to fairness and justice” and should take into account “systemic bias.” Let’s give an example. 

Two potential patients come to your practice for care. They both are recent amputees and have expressed a desire to ambulate in the community. One is a health nut, a nutritionist, and a runner. The other is morbidly obese, diabetic, and an armchair quarterback. You have all the documentation you need, and they both have adequate coverage so you conduct your clinical assessment. You find that one patient is a K4 candidate and the other is an iffy K2. You create a treatment plan that leverages all the tools at your disposal to help each patient maximize their ambulatory potential. You have approached each patient without bias or favoritism and you provided equal effort to both patients. Both are able to ambulate and have met their goals. A great outcome. Based on how we have traditionally understood equitable treatment, you have clearly provided that. 

Let’s shift our mindset to our emerging cultural definition of “equity” so that we get a “’fair and equal outcome” for all patients. This worldview might say that it is not fair that one of these two recent amputees is limited to short walks to the local convenience store while the other is able to run competitively. We need to overcome the bias or disadvantage that one patient is facing. To be “fair,” we need to provide both patients with the same outcome. This is achieved either by elevating the disadvantaged patient to the higher level or changing the goals of the other patient so that they match the lowest common denominator. Given that K2 is the best we can achieve with one of them, K2 is what we need to deliver to both of them. This way we have achieved an equal outcome and our culture can give us a checkmark for our “Equity” efforts.   

We don’t have an American version of the Académie Française, but as we go about our business, pay attention to the words people are using and the meaning they are applying to those words. If we are not careful, our good intentions could turn around and bite us.


Plan the Visits!

If you are like most of the people I know in O&P, you are coming off of a hectic time as you and your patients tried to squeeze in office visits and deliveries before the new year began.  Based on many conversations I have had; October and November are the months that people are a little apprehensive about year-end revenues. I think that apprehensiveness results in patient callbacks.  We start reaching out to the patients who may have needs and we get them scheduled.  Thus, we have a busy December. 

There is a lot we need to focus on as we run a business and attracting new patients (customers) is certainly key.  Everyone knows that if we have no customers, we have no business.  But a new customer and a retained customer are not the same thing.  Customer, or patient, retention is a critical part of a successful practice, and it is a risky position if we assume the patients will come back when they are ready.  Yes, there is a certain stickiness, especially for our chronic patients, but what if you made a concerted effort to focus on patient retention? 

As a care provider, our patient’s well-being should be a factor in our clinical and operational decisions.  I know that once a delivery is made, that pretty much sums up the revenue side of the prescription. I also understand that customers are nice, but paying customers keep the lights on.  We have to have that healthy mix.  But just because you have delivered a device does not mean the revenue stream from the patient is over.   They have entrusted you with their healthcare needs once.  Odds are good they are going to need care again.  And they may even know someone who needs your services.  Don’t you think it is important that yours is the first name that comes to mind for them? 

By maintaining a consistent level of communication with your patients, you can stay apprised of their well-being, you can monitor physical changes that may require a new liner, or socks, or excessive wear on an orthosis, or any number of things that allow you to keep your patients on track.  With proper documentation and established medical necessity, you may have the ability to provide your patients with the level of care to which they are entitled and still get paid for it!  Proactively managing your patients in this way may also allow you to level out your business and make your revenue generation less cyclical. 

Think about innovative ways you can more actively monitor your patients’ well-being and identify opportunities to provide the appropriate care at the appropriate time in conjunction with the other health care professionals in your patient’s sphere. 


Scientific Rigor

Welcome to 2023!  I hope you were able to accomplish everything you needed to do in the last half of December.  As we open a new calendar, I also hope you see twelve months of opportunity ahead and not just more of the same! In the last couple of blogs, I focused on intentionally connecting with the people who work with and for you.  The most important attribute of a successful business is the people who work there.  EVERYTHING derives from that.  If you want excellence, you will never get it from people who do not also strive for excellence.  If you are ok with mediocrity, then hire mediocre people but don’t expect more from them than that! 

This is the time of year when many of us set goals and strategic objectives.  My advice is to create measurable small steps.  For instance, if you want to reduce the number of patient no-call/ no-shows, document how many you had on average in 2022, either as a percent of total visits or just a number.  Set a goal to reduce that by one-fourth in the next 30 days and encourage the team to proactively reach out to patients ahead of their scheduled visits to ensure they are planning to come.   

Or maybe you want to shorten the time between eval and delivery for your custom orthotics and your prosthetics.  Get your team together and think about what you can do…are you waiting to schedule the delivery appointment until the insurance company verifies payment? Or are you waiting until the C-Fab has shipped the device? Or until your lab is done?  If so, these can result in unnecessary delays.  You should have data that tells you, on average, how long those steps take, and you can set a delivery appointment with your patient at or shortly after the eval appointment, or at least set the next visit appointment.  This helps keep the process moving forward and limits the time wasted trying to communicate and coordinate with the patient when they are no longer physically present. 

You will be amazed what a difference either of those two actions can have on reducing stress and unexpected events in the practice.  As you think about what you want to accomplish, remember that it is important to focus on a fewer number of manageable objectives rather than many or nebulous objectives.  

It is important to be able to determine when and if your improvements are having an impact, so as in the examples above, understand your baseline, or where you are starting, and then be able to show the change.  Running your practice is very much like managing a patient.  In patient care, you start at a certain point on a continuum of mobility and then you move that patient to a higher level of mobility (hopefully).  The way you know you have done it is through your objective measures, whether they are focused on balance, range of motion, locomotion, ability to perform functions, etc.  You all know when your change has had the desired impact on your patient.  So why would you want to manage a practice that cares for many patients with any less scientific rigor? 

Smiling senior woman patient in doctor's office counseling a male doctor

Leadership: Starting Where The Person Is

Over the weekend, I was talking with a friend who is getting a certification in counseling.  He had just finished an exam and we were talking about the class.  He said the teacher had made a comment one day in class about the importance of making a connection with the client so that you can help them. Her phase was “Are you meeting the person where they are, or are you starting where the person is?” I cocked my head to the side and raised my ears like a dog and said “Huh?” 

One of the things I discovered as we were talking about the tenets of rehabilitation counseling is that they are very closely aligned with leadership principles.  So, when he was talking about helping the person adjust to their new situation and prepare for their next step, I immediately went to employee development and career growth. I asked him to help me understand the distinction between the two phrases.  I really don’t want to get hung up on the words as much as I want to emphasize the concepts. 

The teacher explained that “meeting the person where they are” represents the idea of approaching the person from your own perspective.  As you mentor, coach, support and offer advice to your employee or mentee, you accurately assess their current situation and you help them figure out where they want to be, but you do it from your perspective.  Your worldview.  This is the most common way we tend to interact with people, and it is by far the easiest way to help.   

“Starting where the person is,” she said is understanding their worldview and approaching the challenge from their perspective, not yours.  This empathetic approach allows you to create a close, visceral understanding of the other person’s experience. We feel with the person. We literally take on the emotions of the other person and make those feelings our own. This level of understanding is important to creating the trusting relationship we need to reach and ultimately help that person achieve their goals.  But there is a common trap with empathy.  Paul Polman, former CEO of Unilever, puts it this way: “If I led with empathy, I would never be able to make a single decision. Why? Because with empathy, I mirror the emotions of others, which makes it impossible to consider the greater good.” 

As a leader, you are not there to solve problems but rather, to help your employee solve their problems.  Empathy lets you feel their strife, but we have to shift to a compassionate approach to make a difference.  A leader without empathy is like a prosthesis without a socket — it simply won’t engage. Empathy is essential for connection and then we can leverage the device to move forward with compassion. 

Empathy is inert, compassion is active.  Make the emotional connection but be careful not to get mired down in emotion.  You have to “pull yourself out” of that empathetic response to create an objective, goal-oriented pathway for growth.

Statue of Sokrates at the Academy of Athens in Greece

Success to Significance

As much time as I spend reading, writing and trying to practice what I preach, an interview with former University of Florida quarterback and Heisman Trophy winner Tim Tebow a few weeks ago put a point on things for me.  He said something to the effect that success alone is unfulfilling.  You need to move from success to significance.  That piqued my interest…what’s the difference?  

Wikipedia tells us that Socrates was a Greek philosopher from Athens who is credited as the founder of Western philosophy and among the first moral philosophers of the ethical tradition of thought. One of the many quotes attributed to him is “an unexamined life is not worth living.” In his time, the people were generally set in their ways. Their government had developed beliefs which dictated their thoughts and challenging the system was punishable by banishment or even death.  

I don’t think anyone is going to be killed over their leadership style (at least not in O&P), but the idea creates a solid foundation for personal growth.  In fact, leadership expert John C. Maxwell wrote a book about this called “The 5 Levels of Leadership” in which he details a path people can take as they grow in their position.  We have talked about this in several blogs, but Maxwell summarizes the process well and provides some interesting insight into the stages.   

Maxwell, Tebow and Socrates are all saying that we have to be willing to let go of our personal ambition in order to be significant.  It is counter intuitive.  People often believe they are successful because they have everything they want. They have added value to themselves. They have created or run companies.  They have professional and monetary success.  They are firm in the belief that success is a personal attribute.  And it is.  But is it enough?  Is success sufficient?  This is what Socrates was asking.  Is this all there is?  He answers that with a resounding “No.”  We strive to be significant.  Without significance, success should feel hollow. 

Maxwell wrote “success is when I add value to myself. Significance is when I add value to others.” Tim Tebow asks: “If all your dreams came true, whose life would be different?”  Brett Powell, a leadership expert says “Success is about making an impact here and now primarily by what you do and what you accomplish. Significance is about creating a lasting legacy by who you are and the edifying presence you bring to others.” 

One really awesome thing about the work we do in this profession is the visibility of the successful work you do.  It would be hard to argue that the work is insignificant.  But is that the driver?  And are you, at the end of the day, solely focused on the patient?   

In the office and at home, are you striving for significance?  Are you a leader by title, or do people follow you because of who you are and what you represent?  To achieve that level of leadership, one must embrace the idea of servant leadership, putting the needs of others before themselves.  But don’t cast your pearls before the swine.  You have to build the culture that supports your own ability to grow.  The concept is simple.  The execution is hard.  

Reaching the goal. Close-up of bright red bowling ball rolling along bowling alley

Balance of Power

I have had a lot of experiences in my life and one of them was bowling in a league.  I’ve played a lot of sports, so you can substitute pretty much any sport for this analogy.  But as you might expect, when I first started out, I was ok.  I was not setting the world on fire with my bowling skills, and the Professional Bowlers Association was not scouting me! I had fun, it was time with my wife and friends, so it was all good.  But I am a bit competitive.   

There were three key elements to my bowling game; my attitude, my delivery, and the bowling ball.  My competitive nature is such that I don’t like to be just ok at something.  I want to be better tomorrow than I was yesterday.  What’s fun about league bowling is that there are all kinds of people who are cheering for you…as long as you are not a threat.  They will help you with technique or point out flaws in your strategy.  They may even describe how you can place the ball to take out the 7-10 split. 

What I learned is that there is no one thing that you can do to move from “Ok” to a team leader.  It takes equal growth among three key elements: the person, the process and the tool.  If any one of the three is inferior, it will limit what you can do. To consistently hit strikes, you need to refine your process for sending your ball down the lane.  Your “process” includes how you hold the ball, where you start your steps, the number of steps you take, where you place the ball on the lane as you release it and how much spin you put on the ball.  

The more consistent we can be in delivering the ball, the easier it is to understand what we need to do to get better.  But there is a huge assumption here…that the ball is good. How do you know if your tool is a good one?  A lot of people will choose their bowling ball based on color, or glitter, or some other external feature because “It looks really cool.”  But the power and the consistency come from deep within the ball.  The things you can’t see are the things that really matter.  It’s the quality that is built into the ball that allows your skill to shine through.  But the best bowling ball won’t make you a great bowler.  You are still limited by your skills and technique. 

Let’s say a new router comes on the market.  It is super awesome looking…flashy LEDs, nifty buttons, and it even makes your coffee, too. You bought it and put it in the lab.  You show all your friends.  I mean, it looks really cool, really modern.  But when you turn it on you find a wobble in the shaft. I don’t care how steady your hand is or how good you are, the tool is going to limit your ability to create your best work.  You will never be able to outperform the machine.  On the other hand, you can have the best tools money can buy, but if you don’t have the right people in the right jobs following good processes, you won’t be able to leverage the tool to your advantage.  

So, as you think about practice management, no one item in your arsenal of People, Processes and Tools will solve your challenges.  But any one of them can be your Achilles heel. Substance is key.  We don’t hire people based on their appearance (thankfully), we don’t create a process because it looks cool, and we shouldn’t buy a critical tool because it looks good.  You have to drill into the core and make sure your mission won’t be limited because of appearances.  Balance your power. 


Values vs Beliefs and “Cultural Fit”

We know that a high performing team is a team that gets along well together and pushes each other to be the best they can be, in a supportive way. When creating that team, many ingredients need to come together and the best way to get them to gel into a team is by hiring people who are a cultural fit with your staff. Yep…I said it.  “Cultural Fit.” It is also well-documented that a high performing team is a diverse team with differing approaches to problem solving.  How on earth can we create a diverse team that is a cultural fit?  

This is a concept that many will say runs counter to a desire for diversity and inclusion…that searching for a cultural fit limits you to like-minded people while excluding people who don’t look, think or act like you. I disagree. Once we determine the potential new hire’s competence, I think the most important qualification when thinking of cultural fit is shared values.  A couple of weeks ago in the blog “Leading Gently,” I talked about the importance of aligning the corporate values and the values of the people who work there.  But what are values?  I’ll bet we all think we know, but if I were to ask you what the difference is between your values and your beliefs, odds are you’d be hard-pressed to tell me with any certainty. 

How do we articulate and align values when we have a hard time explaining what they are? Values are not correlated to demographics like race or gender, but if you are a mature person, they are always right — for you. Your values define you and are formed by your lifetime of experiences, your religion, and other environmental factors. They are the principles by which you determine if something is good or bad or important.   

In our profession, you are probably aware of many people who believe that providing effective O or P care to people who need it is a good thing to do, and an important thing to do.  You probably like many of those people, but there are some you may not like at all.  But you share a value. So sharing a value does not imply or require homogeneity.  

If you think of your values as the things you seek to achieve (excellent patient care), you can think of your beliefs as the paths you can choose to achieve that care.  As long as everyone on the team shares the common core value that we want to do the best we can for a patient, we can have a healthy discussion about the best way to achieve that outcome without hostility.  Having a common value can transcend race, ethnicity, orientation and all the other categorizations we like to create.  When it comes down to it, does a person have the competency to do the job that needs to be done and do they share common values with the rest of the team so that they can work together respectfully and effectively to achieve the best outcome? 

What are your corporate values? Can you articulate them? 


Leading Gently

A couple of weeks ago I wrote about Michelangelo’s David. I challenged leaders and managers to look for ways to reveal and let flourish the aptitudes and passions of the people they work with: to chip away the marble that prevents them from being their best. It is a delicate process. I think the words of Philip Crosby apply here, “You have to lead people gently toward what they already know is right.”

So how do we do that? How do we take a person and help them realize their full potential? This is not about “changing” people, it is revealing what is already inside. Not every chunk of stone can be a David. So we must choose our stones carefully, and then find the treasure hidden inside. Everything starts with that first decision…choosing the stone. In this analogy, that means hiring the right people. So how do you choose?

Before you can choose, you must have clarity. You need to know what you are looking for and you need to know what your plans are. More than that, you need to be able to objectively describe your values, your vision and your mission. It is important to stress that I am not talking about what you want them to be, but rather, what they really are. You might be surprised to learn that they aren’t what you think they are. Once you have that clarity, then you can begin the selection process. Here, we need to be straightforward with the candidates to make sure they understand what they are getting into. Their value system and yours must fit well together, and they should have some passion for the company’s mission. If you can align at least those two things, then you are well on your way to a good hire. A final crucial element is that they must have the competencies to do the job. You can teach skills, but not competence.

With the David, three renowned sculptors tried but were unable to reveal the inner beauty. Not everyone can bring out the best in a person. There must be mutual respect, a willingness to learn, and the ability to teach. This again, goes back to the hiring process. A chunk of stone, or a warm body, may just ultimately waste everyone’s time. It is crucial that when the decision is made to hire, it is with open eyes from both sides.

Now that you have the right person in the position, you can start to gently sculpt them. They already know the right thing to do, because they share your values and are passionate about your mission. All you have to do is develop their skills and free them from the confines of their limited experience. You set clear expectations and coach them. You provide them with the opportunity to grow, gain confidence, and be the best they can be. Once the statue is free, you have to let it be seen. Don’t cover your people with micromanagement, but trust in your mentorship, in their skills and their passion.

People who care about what they do don’t mind accountability, but don’t confuse micromanagement with accountability.