Urgent message: Patients often infer quality on the basis of outward appearances. Adopting a policy that addresses clothing, grooming, and body art can help balance the need to project a professional image in the urgent care center and to ensure workplace safety with employees’ desire to express themselves.

ALAN A. AYERS, MBA, MAcc Practice Velocity
Remember the popular 1990s advertising slogan “Image is everything”? What was back then a trendy catchphrase created to peddle expensive gadgets is now synonymous with an entire marketing philosophy—one that has served as a foundation for many flourishing businesses. Indeed, image lies at the very heart of a brand, and how well the desired image is cultivated can be decisive
in the success or failure of an organization.

So crucial is image that it is not uncommon for organizations to allocate significant portions of their gross revenue strictly to marketing and branding budgets. Additionally, successful companies consistently demonstrate that crafting a stellar image is one of the keys to developing a highly coveted mind share. Capturing mind share within an industry, as any brand expert will tell you, ultimately leads to new customers, additional referrals, and, of course, increased profits. Health care, as fiercely competitive as ever, is one such industry; to thrive and prosper, health-care providers must absolutely place a high priority on projecting a favorable image to patients, who are in effect their customers.

This careful image cultivation must go beyond sporting a catchy logo and having immaculate facilities. In the urgent care setting, with its decidedly retail, walk-in business model, presenting a care team with a capable and professional appearance takes on heightened importance. After all, as owner or operator of an urgent care center, your aim is to attract patients, deliver great service, and keep them returning time and again. So take a hard look at the care team at your center, and then ask yourself: What does our collective image say about my urgent care facility?

How Physician and Staff-Member Appearance Affect Patient Perceptions
In urgent care, image-building efforts are usually geared toward producing a marketing result. Examples of favorable marketing results include the following:

  • Increased brand awareness: Consumers begin associating walk-in medical care with the center’s brand.
  • Increased mind share: The center becomes the first place consumers think of to go when an episodic health need arises.
  • Increased sales and revenue: Additional patient volume spurred by loyalty and word of mouth contributes directly to the center’s bottom line.

A health-care provider’s personal appearance must project professionalism and competence to engender trust in patients. Additionally, a professional appearance communicates expertise and authority, increasing the likelihood that patients will comply with care instructions—which results in improved clinical outcomes and patient satisfaction. For some anecdotal insight, there is a great article at the website TheDO (doctors of osteopathic medicine) that expertly addresses the issue.1 Draion M. Burch, DO, an obstetrician-gynecologist quoted in the article, sums it up thusly:

Even patients of a lower socioeconomic status want to see doctors who look professional. On the few occasions when I haven’t worn a [signature] bow tie, patients have complained. It’s part of my brand. Simply put, one component of being a health-care provider is looking the part. An urgent care center, with its brisk patient flow and customer-service orientation, should definitely ensure that its necessarily brief patient visits are positively reinforcing its image. When a care team is uniformly attired in a neat and businesslike manner, patients take notice. Conversely, staff members dressed in an unkempt manner hurt the center’s brand and hinder positive word of mouth.

Tattoos, Piercings, and Other Body Art
Members of generation Y—young, smart, brash millennials born in the 1980s and 1990s—are now crashing the workforce, and they are bringing their tattoos and piercings along for the ride. A recent Harris Poll survey showed that as of 2012, 1 in 5 U.S. adults has at least one tattoo, with nearly 50% of Gen Y-ers sporting some form of body art.2 No longer the sole province of bikers and gangsters, tattoos and piercings are becoming the norm in mainstream America. Yet they are still met with trepidation in traditional, image-conscious professions like health care. Here is Dr. Burch on tattoos and appearance:

The most outrageous example I’ve seen was a medical student whose neck is tattooed with his girlfriend’s name. He had to hide it under makeup. I’ve also seen a pierced belly button on a student who wore a blouse that was too short. If I had tattoos and piercings and wore jeans, my patients wouldn’t take me as seriously…[Not protecting] your brand can also affect referrals.1

By contrast, many medical practices do not mind employees having conservative tattoos and traditional piercings as long as they meet other professional standards. So where do you, the urgent care operator, draw the line in this burgeoning culture clash? Aside from new hires, how do you handle the situation when current employees come to work with new yet unprofessional body art? Does the law protect body art deemed by its wearer to be religious and/or ethnic self-expression?

As a general rule, employers have wide discretion in setting appearance standards that have their basis in social norms. Policies against employees having tattoos or piercings on the face, neck, hands, or uncovered arms are allowable and not considered to be discriminatory in nature. If, however, these policies differ between the genders (such as allowing body art for men but not for women), there may be valid grounds for legal action.

For instance, one employer was discovered enforcing a policy that discriminated on the basis of gender. It allowed male employees to have tattooed forearms but discharged a female employee for having similar body art. What made the policy illegal was that it was clearly gender-biased and not related to the content of the tattoo. Conversely, a visible tattoo that is deemed to be vulgar, obscene, or hate-oriented (such as a swastika) can be disallowed in any circumstance.

The bottom line here? Employers have the right to enforce policies against tattoos if

  • They are conspicuous and clearly visible to the public
  • There exists a reasonable belief that tattoos hurt the company’s image or public relations3

 

Sidebar 1. Practical Considerations in Developing a Uniform Policy
  • Employee appearance should be consistent with patients’ expectations for the facility.
  • Consider the demographics of the patients served and whether they would feel comfortable interacting with the center’s employees.
  • Employees should wear uniforms and not their own clothes to work.
  • Uniforms create the appearance of a cohesive team.
  • Uniforms reinforce employees’ positions in the center.
  • Wearing street clothes creates a safety hazard because pathogens—including Staphylococcus and methicillinresistant S. aureus—harbored in clothing fibers can contaminate the clothing of other family members if the clothing is washed in cold water.
  • Uniforms should be compliant with the regulations of the U.S. Occupational Safety and Health Administration.
  • Uniform fibers should be resistant to absorbing blood and other bodily fluids.
  • Uniforms should fit well, shield the body from splashes or spills, and avoid any decoration that could create a safety hazard or obstruct an employee’s ability to perform tasks safely.
  • Employee uniforms should be selected for durability and wearability.
  • The difference between $14 scrubs and $40 scrubs is an investment in quality. Higher quality scrubs last longer and are less likely to fade, fray, or tear. They are also more comfortable for employees.
  • Employees are more likely to comply with dress codes if they like the uniform.
  • Employers should provide a set of uniforms for employees upon hiring and annually at their hire date.
  • Forcing employees to buy their own uniforms increases the likelihood employees will not replace worn or faded uniforms and/or will wear noncompliant clothing to work.
  • If the difference between an employee’s salary and the uniform cost pulls the employee’s total compensation below the minimum wage, the employer can run afoul of wage laws.
  • To ensure that employees have a clean appearance, they should be provided a sufficient number of uniform sets to last 1 week without doing laundry.
  • Dress codes must not be discriminatory unless there is a compelling safety or business justification.
  • Uniforms must be available from a vendor offering a wide range of sizes, from petite to XXXXL.
  • Dress codes cannot arbitrarily treat men and women differently and cannot create additional burden on any specific group, except when gender differences (i.e., makeup on women but not on men) are rooted in social norms.
  • Women must be offered a choice between skirts and pants.
  • Beards must be permitted for religious or medical purposes.
  • Head scarves, native dress, and other recognized religious expressions must be permitted.
  • Uniforms must be adapted for individuals with disabilities.
  • A name tag should be part of the uniform and should include the employee’s name and job title.
  • Guidelines should be provided regarding “flair”—pins, buttons, or additions and modifications to the uniform.
  • When in doubt, or when questions arise, engage legal counsel. Uniform and dress-code issues can be cause for claims under numerous state and federal laws.

 

Sidebar 2. Clarifying the Dress Code for Health-Care Providers and Staff Members
Even when an urgent care center has adopted a uniform and dress code, employees still take great latitude within the bounds of the policy. As a result, further clarification is required as to management’s expectations for personal appearance, including grooming; tattoos, piercing, and other body art; and adornments like jewelry and perfume. The following is an example of how one urgent care center communicates its expectations to healthcare providers and staff members.

 
Hair (Including Facial Hair)

  • Hair should be neat and clean.
  • Facial hair must be moderate in length for beard and mustache, and must be appropriately trimmed and groomed. Growing a beard and not shaving are two different things.
  • Barrettes, headbands, and so forth should be plain and closely match the hair color.
  • No extreme hair colors (e.g., blue, purple, pink, orange).
  • No excessive hair bleaching or streaking. Any highlights must be an appropriate color that complements the team member’s existing hair color.

 
Jewelry

  • Earrings: No more than 2 earrings per ear worn in the earlobes. Stretching of the earlobes is prohibited.
  • Dangly and hoop earrings must be 0.5 inch or shorter for direct patient-contact areas and 1 inch or shorter for non-patient-contact areas (measured below the earlobe).
  • No large costume jewelry.
  • No visible body piercings (must be covered or removed).
  • No tongue piercings.
  • Rings should be tasteful, and they should be worn in moderate numbers.
  • Bracelets: In patient-contact areas, 1 per arm, no porous bracelets, no large bracelets, and no charm bracelets. Bracelets should not be a threat to clean or sterile areas. In non-patient-contact areas, bracelets should be moderate and tasteful.
  • Watches are allowed.
  • Necklaces: Two necklaces are acceptable for patient-contact areas, but they must be no more than 18 inches in length. In non-patient contact areas, 2 necklaces are acceptable, but they must be moderate in length.
  • Ankle bracelets are acceptable for all areas.

 
Shoes

  • Shoes must be all one color or mostly one color. If the first thing someone notices about you is your shoes, then they are too bright.
  • Shoes must be clean and in good repair.
  • Laces must match shoes.
  • No flip-flops, sandals, or slippers.
  • Closed-toe shoes are required in clinical areas.
  • Socks must be worn with sneakers.

 
Tattoos

  • All tattoos must be covered by sleeves, bandages, or other means.
Perfumes

  • Because strong fragrances can cause respiratory distress in patients and other staff members, perfume, aftershave, and deodorant should not be noticeable.
  • Good personal hygiene is expected of all employees—no body odor.
  • Cigarette-smoke odor is not acceptable.

 
Clothing (Patient-Contact and Non-Patient-Contact Areas)

  • Clothing must fit properly, be neat, and be clean.
  • No midriff tops.
  • No tube tops or tank tops.
  • No T-shirts unless worn under other garments.
  • No shorts.
  • Slits in skirts and dresses should not be any higher than 2 inches above the knee.
  • Skirts are acceptable if they end no more than 2 inches above the knee.
  • No spandex tops or pants, no leggings, and no sweat suits, jogging suits, wind suits, or any other exercise attire.
  • Jeans are not allowed to be worn unless approved by the manager (special days).
  • Appropriate holiday attire is acceptable in patient-contact areas.
  • Long-sleeved or short-sleeved, collared dress knit shirts or sport shirts are acceptable.
  • No gloves of any kind other than medical gloves (i.e., no knit gloves with or without fingers, no solid or print trendy gloves).

 
Nails

  • For infection control and patient safety, fingernails should be an appropriate length (not longer than 0.25 inch in direct patient contact areas), be clean, and be well manicured.
  • No artificial fingernails in clinical areas.
  • Nail polish should not be chipped and should be subdued, tasteful, and complementary to your complexion in color.
  • No nail jewelry.

 
Name Tags

  • Name tags must always be worn on the outermost garment on the upper chest area in order to be easily read.

 
Scrubs

  • Scrubs must be clean and pressed; no outside uniforms or jackets.
  • Solid white crew neck T-shirts or long-sleeved shirts can be worn under a scrub top.

 
Logos

  • Clothing and jewelry with advertisements, sayings, causes, campaigns, or logos of other organizations are not permitted.
  • Politically oriented material is prohibited.

 
Lockers

  • Lockers are to be used to store and secure all personal items.
  • Cell phones will be turned off and/or kept in your locker.

Although employers’ right to set grooming standards for their employees is protected by the law, there should be room for case-by-case discretion. If you run an urgent care center, you do a disservice to your staff members, health-care providers, and patients by disqualifying talented and credentialed yet discreetly tattooed candidates right off the bat. Talent is hard to find, and even harder to keep.

The Importance of Developing a Uniform Policy
A great way to support your health-care team in furthering the center’s image and brand is by implementing a dress code that includes a uniform policy (Sidebars 1 and 2). In fact, you will achieve greater consistency in the appearance of health-care providers and staff members by implementing a dress code that balances business needs (including promoting the center’s brand) with job function and legal requirements. The law actually gives employers a lot of flexibility in deciding what they can require employees wear to work, so you will have some creative control over the process.

Most urgent care clinics do in fact utilize a dress code, which typically requires scrubs for front- and back-office staff members, and white laboratory coats for health-care providers. Actually, scrubs are often preferred by health-care teams because they associate the wearer with professional clinical work, are relatively inexpensive, and are easily maintained. Although some owners of urgent care centers prefer khaki pants and polo shirts for the front-office staff, the frequency of cross-training between front- and back-office team members (i.e., a registration specialist who doubles as a medical assistant) leads most owners to require all non-providers to wear scrubs.

Regardless the type of uniform policy you decide to adopt, you should ensure that it addresses the following questions:

  • Does the appearance of staff members convey the professional image you desire for your center?
  • Do providers and staff members have the appearance of one cohesive team?
  • Are the common branding elements—such as color, style, and accessories—consistent in everyone’s appearance?
  • Would an off-site team member be recognized as an employee of the center solely by their appearance?
  • Does the dress code provide examples of what employees are expected to wear (i.e., blue scrubs, khaki slacks, polo shirt, closed-toe shoes) and what is considered inappropriate for the workplace (i.e., shorts, sandals, tank tops)?
  • Has the uniform policy been reviewed to ensure compliance with the regulations of the U.S. Occupational Safety and Health Administration and other health and safety authorities?

How Other Service-Oriented Businesses Address Employee Appearance
The whole “image is everything” concept is hardly limited to the health-care industry. In fact, employee appearance and how it can strengthen or weaken a brand is one of the hottest marketing topics in business today, particularly within the service industry. This issue seems especially important in “retail medicine” (i.e., the urgent care industry). If your business model places employees in frontline, face-to-face interactions with customers, then those employees necessarily become the standard-bearers for your brand.

How do other service-oriented businesses leverage employee appearance to promote their brands? Primarily through uniforms. Here is the take of Paul Mangiameles, president and chief executive officer of Bennigan’s4:
Employee uniforms are a great representation of where the brand is headed. They are creative, fun, and modern, which is what we want the atmosphere and décor of every Bennigan’s to be. I believe that having a cohesive theme throughout allows guests to get an accurate perception of our brand concept.

Most other customer-oriented service industries have a similar philosophy: Putting on a uniform places you in an at-work frame of mind and clearly distinguishes you as an employee of the company. You are there to serve and help create the most enjoyable customer experience possible.

Conclusion
When people seek out medical treatment, they want to believe that they have placed their health in the hands of knowledgeable, capable professionals. Right or wrong, it is human nature to associate expertise, authority, and clinical knowledge with a well-put-together appearance. Whether professionals wear a starched white laboratory coat with a dress, a skirt and blouse, or a shirt and pants and tie that are office-appropriate, or they wear a crisp pair of scrubs, those who meet with them subconsciously equate a well-crafted image with superior service. A care team that is clean-cut and immaculate will convey that image, and numerous studies show that such an image indeed does improve patient outcomes.

Furthermore, it is an inescapable truth that in service and retail based industries, frontline employees are often the primary shapers of a company’s image and, by extension, its brand. At your urgent care center—a decidedly retail business—your physician and care team members must always project a professional image to successfully promote your center’s brand.

References

  1. Schierhorn C. Is the world ready for tattooed, pierced physicians? TheDO [website]. Chicago, IL: American Osteopathic Association [published 2012 February 3; accessed 2014 January 4]. Available from: http://thedo.osteopathic.org/2012/02/is-the-world-ready-for-tattooed-pierced-physicians/
  2. Harris Interactive. One in five U.S. adults now has a tattoo [press release]. Rochester, NY; Harris Interactive [published 2012 February 23; accessed 2014 January 4]. Available from: http://www.prnewswire.com/newsreleases/one-in-five-us-adults-now-has-a-tattoo-140123523.html
  3. Can you be fired because of your tattoos? Lawyers.com [website]. New Providence, NJ: Martindale-Hubbell [accessed 2014 January 4]. Available from: http://labor-employment-law.lawyers.com/wrongfultermination/Can-You-Be-Fired-because-of-Your-Tattoos.html
  4. Dress code: the importance of employee uniforms and appearance. FSR [magazine]. Chapel Hill, NC: FSR magazine [published 2012 July 3; accessed 2014 January 4]. Available from: http://www.fsrmagazine.com/content/dress-code-importance-employee-uniforms-and-appearance
Image Check: Impact of Employee Appearance on the Patient Experience

Alan A. Ayers, MBA, MAcc

President of Experity Consulting and is Practice Management Editor of The Journal of Urgent Care Medicine
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