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Reimbursement and Practice Management

Looking Good – Employee Attire

Patient perceptions are defined by many factors in addition to medical expertise and “bedside manner.” The appearance, behavior, and courtesy of the entire staff make lasting impressions on patients as well.

After reading this article you will be able to:

  • Determine the importance of dress in defining patients’ perceptions about your practice
  • Recognize the components of a dress code
  • Create a human resources policy and procedure reinforcing professional employee dress and appearance
  • Identify options for and alternatives to requiring uniforms practice-wide

View related pearls

Patients’ perceptions are defined by many factors in addition to your expert medical advice and personal manner. Indeed, the behavior, courtesy and appearance of the staff at your reception desk and elsewhere make indelible impressions on patients arriving at your practice’s facility. Portraying a professional image is critical to developing and reinforcing each patient’s confidence in you and your practice. That confidence plays a pivotal role in your practice’s efforts to continue to attract patients and stay competitive in these difficult financial times for the health care industry.

Considering the casual nature of society today – where suits are out and casual wear is in – it’s an unwise bet to assume that everyone on your staff shares your standards for professional work appearance. If you don’t want to have your patients turned off by an inappropriately dressed employee at your front office, then you must take steps to ensure that your staff – and thus, your practice – looks their best by establishing a dress code. If you already have a dress code, plan on revisiting it soon if you haven’t done so in the past few years.

Create a written policy that defines the basics of what you expect your staff to wear – and not just in regards to clothing choices but also for jewelry, body art, hair and nails. Here are the basic elements of a dress and appearance code for your employees.

Clothing. Decide who must wear clinical garb and who does not. Simply allowing employees to pick their own clinical wear may lead to a visual confusion as the choices of styles, colors and patterns seem to grow by leaps and bounds each year. Many practices opt to establish a uniform for all employees except, perhaps, those who work in the business office or elsewhere with little or no contact with patients. If you go the uniform route, either purchase a full set of uniforms (a minimum of four are recommended) for each employee or provide them with a uniform allowance that reimburses between 50 percent and 100 percent of purchase costs. Maintain quality by narrowing the selection to a line of wear from a major catalog, Website or local uniform store. To maintain a consistent look, limit the style and color options with the selected line of wear.

Presentation. Make clear to employees that work clothing must be kept clean, neat and in good condition. Don’t be shy about defining “good condition” with a statement, such as: “Uniforms must not be worn that are torn, stained, soiled, excessively wrinkled or have buttons, zippers or other materials missing.” Don’t overlook the proper placement for name tags either.

Footwear. Because footwear is a safety concern as well as an appearance issue, be specific about what you want. Many practices require employees to wear shoes (not sandals) that are closed-toe, with medium or low heels and non-slip soles. Offer recommendations about style and, perhaps, the typical brands and stores to visit for purchasing footwear.

Personal Hygiene. Dress codes should advise employees to maintain clean personal hygiene and to refrain from wearing perfume. State simply that hairstyles, hair color, fingernails and cosmetics must adhere to the practice’s professional image. Don’t be shy about requiring employees to keep their hair clean, neatly trimmed and contained so that it does not come in contact with patients. Address fingernails by insisting that they be kept clean, well-manicured and moderate in length. Consider adopting the guidelines from the Centers for Disease Control for hand hygiene in health care settings for those making direct contact with patients – or practice-wide if you wish. Those guidelines advise against any artificial nails or extenders, and suggest that natural nails be kept to less than a quarter of an inch long.

Jewelry. State that jewelry must be small and simple, cannot obstruct work or movement, and may be visible on the ear only (which eliminates facial jewelry such as nose, eyebrow, lip, etc., piercings). Require that any tattoos be covered at all times while on duty.

There is no use spending the time and effort to define expectations if you do not also establish what happens when dress code policies are breached. In a separate and clearly marked paragraph, state that an employee who violates the policy will be required to change into appropriate wear, even if it means returning home and losing pay for the time missed. Determine how many times the employee can violate the policy and what the progressive disciplinary process will involve for repeat violators.

Although adopting a uniform is the easiest route, some practices prefer to give their administrative and business office employees more latitude in work wear. A uniform that is comfortable, professional and modern does not have to be scrubs. More practices are moving to monogrammed shirts or sweaters, combined with an employee’s own slacks or trousers, such as khaki pants. With so many choices today, you may be able to determine a uniform or casual wear line in a color scheme that best reflects your practice.

The most important steps in developing an effective dress code are to put it in writing, require employees to acknowledge it (and any changes) with a signature, and stick to it. If the dress code is important enough to put in your employee handbook, then everyone in the practice – from the senior physician to the new receptionist – must follow it. And those who willfully and repeatedly disregard it should face consequences up to and including termination.

Don’t let the issue of proper attire and appearance become a source of confusion or dissent in your practice. Saying, “Wear nice clothes” simply doesn’t work nowadays, if it ever did. If you don’t have the time to monitor each employee’s outfit each day, don’t want to open your practice up to accusations of unfair enforcement, or just put up with whatever walks in the door that day, a written dress code is for you.


Portraying a professional image is critical to developing and reinforcing each patient’s confidence in you and your practice. That confidence plays a pivotal role in your practice’s efforts to continue to attract patients and stay competitive in these challenging times for the health care industry.

Pearl 05/21/14

Dress Code Discussion
Your policies stand a better chance of succeeding if your employees take them to heart willingly. Encourage buy-in by allowing employees to vote on their choice from your final selection of colors and work wear. Consider holding an open forum to discuss clothing selections but avoid the mistake of trying to write your dress code policy by committee.

Pearl 05/014/14

Bling Code
Make sure that in your dress code policy you reserve the right to determine if jewelry, makeup, hairstyle, perfume or clothing is appropriate. Encourage employees to consult supervisors if they have questions about what constitutes appropriate attire.

Pearl 05/07/14

Dress Code Don’t
Be proactive by stating specific examples of inappropriate wear but also warn that these are only examples and not a full listing. Inappropriate dress may include:
• Soiled, tattered, torn, frayed or ripped clothing
• Shorts of any kind
• See-through garments, or those with plunging or revealing necklines
• Spaghetti straps, low-cut or off-the-shoulder shirts or dresses
• Any clothing with slogans, advertising or questionable or suggestive logos or emblems

Pearl 05/01/14

Dress Code Do’s
Use a general statement of purpose to get your dress code update or revisions off to a good start. For example: “It is the policy of Medical Practice Associates to require every employee to dress professionally and appropriately for his or her position. Because each of us is responsible to inspire confidence in our professionalism and high quality of care, employees are expected to reflect the practice’s standards through professional dress, grooming, conduct, language and decorum.” (Operating Policies & Procedures for Medical Practices: 3rd Edition, by Elizabeth Woodcock and Bette Warn)

United States