As people around the hospital know, I have a personal dress code that says that from Memorial Day to Labor Day, when the temperature is above 80 degrees (Fahrenheit), neck ties are out. Maybe this is just because, in my family, the custom was to wear guayaberas even in formal work and social settings -- and I am always looking for an excuse to do so.
At a recent event, I mentioned this personal dress code and later received the following note:
You opened the event by talking about your desire to have a no neck ties when the thermometer is over 80 rule at BIDMC. I mentioned this to a number of my co workers who all expressed support and in some cases great excitement about this proposal. About 15 years ago Mitch Rabkin sent out a letter declaring casual Friday's with rules (this is from memory so I hope I have the facts correct). You may not see it in your contract, but you are not only Chief Executive but also Chief Fashion Icon, therefore it falls on your shoulders to push this tie thing into the rule book.
Since there is no "rule book" on this matter, I am posting it here for all to see! Go for it, guys....
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Nix all neckties! They're just fomites that spread MRSA. And when you reach over the patient to listen to their heart or lungs, they ALWAYS brush up against the patient or his or her bed or linens.
Article on Hospital Attire in UK from Wash. Post:
U.K. Hospitals Issue Doctors' Dress Code
By RAPHAEL G. SATTER
The Associated Press
Monday, September 17, 2007; 11:30 PM
LONDON -- British hospitals are banning neckties, long sleeves and jewelry for doctors _ and their traditional white coats _ in an effort to stop the spread of deadly hospital-borne infections, according to new rules published Monday.
Hospital dress codes typically urge doctors to look professional, which, for male practitioners, has usually meant wearing a tie. But as concern over hospital-borne infections has intensified, doctors are taking a closer look at their clothing.
"Ties are rarely laundered but worn daily," the Department of Health said in a statement. "They perform no beneficial function in patient care and have been shown to be colonized by pathogens."
The new regulations taking effect next year mean an end to doctors' traditional long-sleeved white coats, Health Secretary Alan Johnson said. Fake nails, jewelry and watches, which the department warned could harbor germs, are also out.
Johnson said the "bare below the elbows" dress code would help prevent the spread of Methicillin-resistant Staphylococcus aureus, or MRSA, the deadly bacteria resistant to nearly every available antibiotic.
Popularly known as a "superbug," MRSA accounts for more than 40 percent of in-hospital blood infections in Britain. Because the bacteria is so hard to kill, health care workers have instead focused on containing its spread through improvements to hospital hygiene.
A 2004 study of doctors' neckties at a New York hospital found nearly half of them carried at least one species of infectious microbe. In 2006, the British Medical Association urged doctors to go without the accessories, calling them "functionless clothing items."
Infection control societies in the U.S. don't recommend similar dress restrictions because there is no strong evidence that health care workers who don't wear ties or jewelry reduce the risk of infection, said Dr. James Steinberg, an Emory University infectious disease specialist.
Steinberg said that doctors and nurses who don't adequately wash their hands pose a far bigger risk to patients and that hand-washing should be the focus of infection control efforts in hospitals.
The federal Centers for Disease Control and Prevention does have guidelines advising doctors and nurses against wearing artificial nails in operating rooms and around high-risk patients. It says there is evidence that health care workers who wear fake nails have more germs on their fingertips both before and after hand-washing than those with natural nails.
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We do this at our facility as well, but we also include the ladies - no pantyhose for the summer! Of course, residing in a Southern state that's from Easter to about Halloween. :-) We also have been allowed to wear mid-calf pants (capris)and open-toed shoes (for non-clinical staff) aka sandals (but not flip flops).
Hi Paul,
First off, a very interesting blog. I am taking a leadership class for an MBA program, and we are using your case study. We are currently looking at an article about adaptive leadership.
One of the principles of adaptive leadership, according to this article, is giving the work back to the people. One quote from the article that highlights this idea is "Letting people take the initiative in defining and solving problems means that management needs to learn to support rather than control."
I stated that, in the case study, you did not encompass this principle as much because the hospital was in desperate times, and you were very much in control of the day-to-day operation.
First off, do you agree with that statement? Secondly, how do you encompass that value now that the hospital is successful. Thank you, Paul.
Mike
A guayabera in a Boston institution? What a perfect symbol of applying diverse solutions to old problems - thinking outside the cultural tie!
So if you were a woman, would you say open-toed shoes could play the role of guayaberas? Because, you know, the no-tie rule is not that helpful for us...
Interesting policy. When I worked in the hospital environment, every day was considered to be important enough to dress professionally. Many leaders were concerned about a dress down policy's impact on patient perception that the hospital was just a little less focused/dedicated/informal on a Friday or hot day than it normally was. And then patient satisfaction scores would go to hell in a handbasket, the coming of the 4 horsemen, etc.
There is a certain degree of informality associated with a leader who is sans tie (even in the presence of a jacket). While that may be ok for those in software, marketing, advertising and other industries, medicine and healthcare seems like one of the those more traditional business lines that dictates a 24/7/365 full scale attire.
While I'm all for this, there's still the issue of patient expectation.
When I was a postdoc at Harvard, I thought it was really cool to see my mentors, these people I knew to be super brilliant, in torn shorts, tees and baseball hats. The key concept for me is the knowledge about them I came with.
However, I'm not so sure this would be appropriate with patients. Indeed, a persons choice in clothing is perhaps the best way to get a quick and dirty assessment of their physician's (and the institution's) personality (e.g. conservative, risk taker, sloppy).
A known CEO in a guayabera and baseball hat is totally cool. Especially one as effective (and affective) as you.
An attending oncologist on the other hand during a first visit, not so much.
JMO - I could be completely wrong.
I actually worry a bit about wearing a tie (I am an MD). As noted above, there is concern that ties (at least "regular" ones - I think I recall seeing bow ties might be OK) may contribute to the spread of resistant bacteria.
My understanding is that the level of evidence that this is true is relatively weak. On the other hand, i'd be surprised if anyone has done a really good study on this issue.
But do ties really serve any purpose?
I think it is true that some patients may perceive a level of casualness that could worry them. I really can imagine a patient thinking a doctor with a tie might be better than one without. In my own practice, I see almost entirely patients I've known a long time, so I _think_ they already trust me, tie or not.
I might get some bow ties, though...
Paul,
Great blog.
My question is: First blackberries, now ties....what's next?
Maybe my slide rule . . .
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