In my 30 years of practicing dentistry, by far the biggest cause of sleepless nights and “intense work related discussions” with my partner (who also happens to be my husband) has been the negative effects of passive-aggressive behavior in the workplace. In many cases, open schedules, less than excellent patient care, general staff unrest, and even embezzlement can be directly related to one or more staff members (including the dentist) engaging in passive-aggressive behavior. Patients can also be passive-aggressive, and our ability to be able to recognize this characteristic in them will improve our relationships and decrease the stress involved in treatment.
People who exhibit passive-aggressive behavior appear to be cooperative, compliant, and supportive externally, but are actually non-compliant, discontented, and even, in some cases, outright angry and hostile. Their words do not match their deeds. They usually appear to be quite agreeable to supervisory advice but intentionally slacken their performance and sometimes even sabotage the goals set forth for them. When their goals are not met, they will assign blame to outside forces or even another party. Frequently someone who is passive- aggressive will falsify information and spread gossip to cover up his or her mistakes and make someone else look bad.
A passive-aggressive employee can slowly but surely destroy workplace equilibrium. If we allow the behavior to continue by ignoring it, it becomes contagious. Other staff members, who may at first attempt to make up for the lower productivity (always with an excuse from the low-level producer) start to figure things out and become resentful not only of their fellow staff member, but of the dentist who allows the behavior to continue. Over time, the entire staff may be affected, resulting in generalized misery for all.
We live in an environment where we are often judged based upon the poorest performer in our office. Just one encounter with a passive-aggressive staff member, particularly one who involves an adjustment of the truth to justify a poor outcome, may eliminate the trust our patients have in us, and even set us up for legal action. We have enough stress in the day-to-day running of a practice and the delivery of care. Who needs more?
So what are we to do? First of all, we have to recognize this behavior and deem it unacceptable. Sometimes this is the most difficult part. People who are passive-aggressive are very good a hiding their behavior from their bosses and very good at playing up the victim role. I won’t make any generalizations, but in my experience, women seem to recognize this negativity a little faster than men do. If one partner sees the behavior and wants to correct it and the other partner cannot see what is really going on and believes that the perpetrator is really a victim, stress among partners can occur. I know what I am talking about here! My husband Jim always wants to see the best in people and believe that they are telling the truth. I love that characteristic about him. However, because this dichotomy in effect “stalled” us, our failure to act and correct poor performance and negativity resulted in a lot of frustration among office staff, decreased office efficiency, and ultimately affected the way our patients were treated.
At one time during this period, we could not figure out why fewer than 40% of our patients were pre-appointed by the hygienists, as was the office policy. All of our hygienists had agreed to pre-appoint, and everyone realized the importance of pre-appointment to office efficiency. One of our hygienists - a lovely person otherwise; she was very young - would appear cooperative to my husband and to me, but had been spreading unrest with the rest of the staff and telling them that any efforts to hold them accountable for productivity would be unprofessional and demeaning. When she left the office, it was discovered that not one of her patients had been pre-appointed. When we added up the cost of trying to track down all of her patients to get them back on recall, Jim was finally convinced that we had to take action and begin accountability measures. By just keeping track of how many patients were pre- scheduled, our numbers went from about 40% per hygienist to more than 90% per hygienist in just three months. Unbelievable! That was about 10 years ago, and those improved numbers have remained at 90% ever since.
Once the negative behavior involved in passive-aggression is recognized, it is very important that the dentist take steps to encourage improvement, and to take those steps very carefully. First of all, it is important to include in the office manual accountability measures that measure performance and document action steps that will be taken if those performance measures are not met. It is important that staff members know that it is their actions, not just their words, that will be used in their evaluations. Make sure to keep a written log of their performance based upon these objective measurements, and include any negative behavior in their employee evaluations. Also write down “expectations and actions” steps necessary to continue their employment. A copy of these should be kept for your records and given to the employee. It would be a good idea to have all employees sign that they have received their copies.
Passive-aggressive people can be very manipulative and convincing, and they frequently adjust the truth to put them in the victim chair. When addressing them, it is a good idea to have another person (such as an office manager or spouse) present as a witness. Let them know that you would love to see them successful in your practice, but their behavior is unacceptable, and if they would like to continue to work for you they must make changes. Offer them help in making these changes, but make sure they know that they will be judged based upon their actions and not their words. Be firm but kind. Do not accept anything but the truth.
Be aware that many passive-aggressive people do not accept confrontation well and will try to veer away by blaming others and denying the obvious. Stay cool, stay kind, but stay firm. When confronted, some passive-aggressive persons may start to cry and/or run away from the discussion. This is a tough one. Depending upon the circumstances, you can offer them a tissue and speak kindly but firmly through the tears, or give them time to compose themselves and continue the discussion later. It is important for them to know that you have compassion for them, but the discussion will continue and the behavior must change.
All of us have passive-aggressive moments, so it is important that we try not to judge, and keep our focus on doing what will be best for staff morale and office efficiency. If the staff member in question decides not to change his or her behavior to meet the expectations of the job, a change out of your office may be in order. Most of the time, however, you will find that the staff member recognizes his or her mistake and takes measures to improve. By recognizing and addressing passive-aggressive behavior, you can increase the happiness and efficiency of your office, a course of action which will have a direct impact on your patients, relieve stress in your own life, and help in the personal growth of the staff member in question.