What’s Up With Neckties in Healthcare?
It's a simple question: what's up with so many men wearing ties in healthcare? Are you / they wearing them because you like to, want to, or have to?
When I worked at a video game and computer software store in high school, I had to wear a shirt and tie. This was the era of the original Nintendo Entertainment System, Sega Genesis, and Windows 3.0. I also sold the original Windows 286 and Windows 386 systems. I'm old. I'm not sure how wearing a tie helped us relate to our customers, but that was the professional image the store wanted to convey, I guess. I didn't find it comfortable, but we all put up with it.
I worked as a summer college intern for Ford two different summers and had to wear a shirt and tie. When I started working at General Motors in 1995 after graduation, they had JUST switched to a business casual dress code. I got to wear Dockers or dress pants with a polo shirt or button down shirt. I was happy. My industrial engineer manager and many others who had been there a long time were at a bit of a loss. They were used to wearing suits and ties, so they generally wore what they used to wear, minus the tie.
Our quality and productivity were terrible compared to Toyota. It wasn't because we dressed more or less formally. Our performance was due to the management system, or lack thereof. I don't think I would have respected the old school, blame-and-shame command-and-control managers any more if they had been wearing ties. I don't think going back to suits and ties would have solved any “discipline” issues, as wrongly perceived by old-school management (they blamed workers and employees for our problems).
Suit and tie, or shirt and tie, was a tradition in the auto industry, as it was in many other workplaces. But, times change. For better or for worse, the United States is a much more casual country than it was 20 years ago (some time say “sloppy”). Beyond appearances and questions of comfort, neckties can be dangerous in factories, which a risk of strangulation that would occur if your tie got caught in moving machinery.
When I worked at different manufacturing companies and a previous software startup, I didn't feel unprofessional without a tie. I learned that respect and professionalism were behaviors, not an appearance.
When I switched paths into healthcare in 2005, I was really surprised to see that the widespread “business casual” memo had not been circulated at most American hospitals. Even today, almost ten years later, I still see most men in shirts and ties: senior executives, directors, managers, process improvement staff. In some hospitals, every man, including transporters and housekeeping staff, wear shirts and ties.
Why? Because they've always done it that way? Is that really a reason to keep wearing them?
Personally, I find a shirt and tie to be uncomfortable and constraining. I also have a bit of an annoying congenital neck issue, two fused vertebrae, that often gives me a literal pain in the neck. I'm happier not wearing a tie. I'm fine wearing a suit or a sport coat without a tie. I'm not sure, sometimes, which is dressier – a shirt and tie without a jacket or a suit without a tie.
Sorry to go into so much detail… which brings me back to the main point and question: does more formal attire matter the least bit for healthcare quality, patient safety, respect in the workplace or other factors?
When I was in The Netherlands last month, I visited three different hospitals altogether and didn't see a single person wearing a necktie. It didn't seem the least bit unprofessional there, as people still take their jobs very seriously.
In 2006, England and its NHS banned long neckties (among other “superfluous” items for men and women, in the name of infection control. When I was a visiting consultant at an NHS hospital, it didn't seem less professional than an American hospital. In 2013, some complained that “scruffy doctors” were creating problems in the NHS and that, for example, bans on white coats didn't help infection rates.
Hmm… in the spirit of Plan-Do-Study-Adjust, we should look at data and evaluate changes. Did banning ties help? That might not be clear. Does wearing ties help? I'm not so sure how you would determine that. If wearing suits and/or ties somehow makes people look more respectable and more professional, should doctors and executives dress even more formally? Wouldn't a three-piece suit look more professional? A top hat? Where would it stop?
Recently, I worked with a hospital client where most everybody wears ties. One vice president made a point of always wearing scrubs, because he thought that helped him fit in. He was trying to gain respect by NOT wearing a tie. Interesting. Again, I found him to be just as diligent, passionate, intelligent, and hard working as everybody else. I respected him because of his attitude, what he did, and what he said – not what he was wearing.
As a patient, my primary care physician is a woman, so ties aren't an issue. She dresses professionally, but what I'd call the dressier side of business casual. She's certainly not wearing formal women's business suits. My opthamologist wears ties. My dentist dresses like I used to in manufacturing — dress pants and a button down shirt (with a white coat). I respect all of them. I'm impressed with the tie and I wouldn't be turned off if they wore scrubs.
As a patient, I'm thinking about the value-added work and my own health, not what people are wearing. How about you?
How are things at your hospital? Do people justify and rationalize the formal attire for reasons other than habit and tradition? Are there voices that speak up about trying to be a little less formal, while still being professional? Should we lose neckties, fake nails, and jewelry that might spread infections and be hard to clean?
Or is this discussion a distraction from things that really are a pain in the neck – such as problems with patient safety, quality, waiting times, cost, and staff morale? What do you think? What is your ideal state for healthcare attire? And what it means to your patients or your staff? To your leaders? Would a change in dress code go hand-and-hand with an attempt at culture change or “Lean transformation,” as a visible sign that things are going to be different and we're shaking up the status quo in healthcare performance?