What would you estimate is the ratio of positive to negative statements in your office? Negative statements include unconstructive criticism, complaining, gossiping, blaming, and abusive language. Work environments with high levels of negative talk are often described as toxic. In a caring profession such as primary care, we hope that toxic environments are few and far between; however, even healthy practices have to be vigilant and guard against negativity. Yes, negative things happen and we all make negative statements at times, but we cannot let them become pervasive. Negativity is like a slow-moving cloud that eventually rains cats and dogs on your practice, affecting staff morale.

How can you as a physician help to create a more positive office?

1. Watch your body language. I once worked with an administrator whose facial expression shouted, “Don't bother me!” It was demoralizing to see her walking down the hall toward me, and I attempted to have as little interaction with her as possible. Of course, ignoring such problems in a medical office is not conducive to good patient care. Patients can sense negative feelings between workers if they are beyond a reasonable level, just as patients can sense a positive and affirming office that supports their healing.

2. Genuinely affirm others. In healthy marriages and families, individuals express genuine appreciation for one another, and I think this is true of healthy offices as well. Doctors who are affirming can lift the morale of the office, so take notice of employees doing good work and praise them. Some say it takes 10 positive statements to compensate for one negative statement.

3. Be reliable. Unpredictable personalities suffocate security and emotional safety. However, when doctors and administrators are steady, consistent, and reasonable, it helps breed confidence and trust in leadership. This can make even difficult conversations go more smoothly.

4. Address negativity. Do not bury your head in the sand hoping negativity will pass. It must be addressed swiftly. Otherwise, negativity can spread throughout the office like an infection. This requires addressing your own negativity as well.

5. Be careful with hiring. You should assess not only candidates' technical skills but also their people skills. In a primary care office where interaction with hurting people is the heart of what you do, a cold or gruff personality can severely damage the patient experience, your office's reputation, and the overall atmosphere.

6. Help employees develop a sense of purpose and meaning. When employees feel that what they are doing is important, they will work harder and complain less. Continually remind your employees of the noble mission you are all working together to accomplish.

7. Look for truth in the negativity. Is there a message embedded in the negativity that you need to hear? It may be time to do a careful assessment of what you're hearing and look for themes and underlying issues. Are employees feeling burned out? Are the work demands too great for even good employees? Are there one or two employees who appear to be the root cause of negativity? Are there systemic factors, such as the way the office is organized? Get to the bottom of it.

Negativity is prevalent in many places of employment and can cause untold damage. In a medical office, negativity must be kept in check if the practice is to serve its patients well and maintain a reputation as a caring and healing place. Physician and administrative leaders should model the expected behavior and make the changes necessary to support a more positive workplace.