How your medical practice can avoid a holiday that's fa-la-la-la-lousy

The end-of-the-year holidays can be a happy, wonderful occasion, when staff can celebrate 12 months of hard work with a party, some tasteful decorations, and a few days off. Or a medical practice can become a place of rancor when celebrations hit an off-note, staff get injured decorating the office, and vacation policies result in time off being allocated in a way that is perceived as unfair.

Experts say your practice can foster the first scenario and make the latter less likely by asking the staff how they want to celebrate and doing so in a way that reflects the values of the practice.

"There's enough stress on everyone. You don't want to add to it," said Demetrian Dornic, MD, medical director of the Eye Specialists of Carolina in Raleigh, N.C.

"We look at our employees as very valuable. I want them to feel appreciated."

This can manifest in different ways. Last year, employees at the East Tennessee Medical Group in Alcoa decided to forgo a holiday party and contributed those funds to Habitat for Humanity.

"We're going to celebrate by giving to the community," said Ron German, the group's chief executive officer. "Our employees have donated their time and their money, and these ideas are from the bottom up. They are not from the physician-owners." The group also contributes throughout the year to several other organizations chosen by the staff.

Spreading good cheer

Plans made only by the boss, as well-meaning as the intent may be, can lead to a holiday party no one appreciates.

Crystal Reeves, a consultant with Coker Group in Atlanta, gave the example of a Las Vegas physician who threw a lavish party at a casino, complete with limousine transportation for staffers. Employees were less than thrilled. Staff members had to dress up and were uncomfortable with the ostentatiousness.

"He thought he was doing something wonderful for his staff. It didn't come across as positive," Reeves said. "It's important to ask staff members what they want to do to avoid a lot of disappointment on both sides."

If staff opt for a gift exchange, it should be with small tokens of appreciation. And participation in any "secret Santa" or grab bag gift program should be voluntary. Expensive presents given publicly to some and not to others can give rise to resentment.

In addition, anything that can be converted to cash, such as gift certificates given by an employer to an employee, must be reported as income, and taxes on it must be paid.

Dreaming of a day off

When many staffers request time off, deciding who gets it can be a source of strife. The end of the year may be especially problematic for scheduling, as practices can be busy with patients wanting to see the doctor before their health care deductible resets. Add in respiratory illness season, made busier because of influenza A(H1N1), and many waiting rooms will be filled.

Experts suggest establishing a rotating system for time off, based on seniority, a lottery or other means, but not adopting a first-come, first-served approach. Staff will be happier because everyone will, in theory, have a fairer chance at getting prime time off.

For medical practices that are open on Dec. 25 and Jan. 1, experts suggest allowing employees to take off one or the other or providing a floating holiday. Ask for input from the staff. Some employees prefer to work on Christmas and New Year's Day and take a different day off.

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Experts also say that care needs to be taken in decorating and expressing holiday cheer.

"If [employees] want to wear Christmas sweaters, that's fine," said German of the East Tennessee group. "You have got to have a little levity in your work place."

But it's important to remember that not everybody celebrates Christmas. While the majority of Americans do, some observe Hanukkah, St. Nicholas Day, Boxing Day -- or nothing at all.

Everyone likes a party, but religious overtones may make some uncomfortable. Mandating employee participation in something that could be viewed as a religious event also might run afoul of anti-discrimination statutes, experts said.

Decking the halls

Beyond the emotional impact, holiday decorations also present potential risk of injury or infection.

Experts say it's important to know when to call in professionals to hang decorations. If a staff member breaks a bone after falling from a chair while trying to hang holiday lights, the season can turn particularly miserable.

No numbers are available on how many employees have been hurt decking the halls of physician practices, but an analysis in the CDC's Morbidity and Mortality Weekly Report estimated that in 2004, 5,822 people ended up in the emergency department as a result of injuries sustained while hanging holiday decorations.

"We have maintenance people hang decorations," said Randy Stevens, MD, a family physician and medical director of the Center for Occupational Health in Terre Haute, Ind. "We don't require anyone else to climb ladders or stand on a table."

The influenza pandemic that is hanging over this holiday season means that additional thought needs to be given to infection control. To reduce flu spread, the American Academy of Family Physicians recommends removing anything that patients may share, such as toys and magazines, from the waiting room. Holiday decorations that invite touching could fall in this category. The Centers for Disease Control and Prevention reported that influenza was widespread in 32 states as of Dec. 1.

The holidays don't have to be fraught with peril. Experts say if they are marked in a way that reflects the staff, there should be plenty of comfort and joy. Celebrations are also an opportunity to connect with patients.

For instance, Reeves said, the staff at one pediatric oncology practice marked the holidays by giving each patient a small gift. "It made it a special occasion," she said.

The children "were going through a lot, and this was a wonderful time to address their other needs."