Susan Rapp “moonwalks” (badly, she admits) in the hallway, blares dance music before the office opens, and begs her patients to tell her funny stories.

She’s serious about her work as a primary-care physician but believes a fun atmosphere means that she, her coworkers, and her colleagues actually enjoy coming to work in the morning.

“It is really important to keep the enthusiasm going,” says Rapp, who practices in Walnut Creek, Calif. “And to support the people who support you. I do different things to motivate the staff. It is important to me to have a peaceful atmosphere.”

A negative, tension-filled office can cripple a practice. But by being lighthearted and better organized and by showing more appreciation to your staff, you can cut down on gossiping, back-stabbing, and other behaviors that, whether you realize it or not, get in the way of patient care and cost you money.

Misery loves company

You typically need a diagnosis before you can begin treating a medical problem. The same is true for an “unhealthy” office. So why are your coworkers unhappy?

“I can pinpoint three reasons,” says Rapp’s sister, Karyn Buxman, a nurse and president and founder of HumorX, a consulting firm in La Jolla, Calif. The first is what she calls the “Negative Nellies,” whose “mission in life is to be absolutely miserable, and it is their vision to see how many people they can bring down with them.”

A feeling of powerlessness can also darken moods. “What we see a lot in healthcare, from the nurses’ perspective especially, is a lack of respect and a lack of engagement. They don’t feel like they are pulled into the decision-making process, whether it is policies or office design,” says Buxman.

“The third thing is the overall umbrella of stress. They can’t bring in enough qualified staff. The mantra we hear is ‘We have too much to do and not enough time,’” she adds.

In addition to work overload, frustration builds when the division of duties is unequal or is perceived to be unequal. “There are types of people who will relinquish their task to another person, and this person will do more and more until they have a nuclear meltdown,” says Katharine White, RN, MS, a practice consultant based in Cranston, R.I. “You have people who stand around and gossip because their schedule is not matching what the office needs.”

White adds that the “cottage industry” nature of many small offices contributes to an unruly or nonproductive atmosphere. Practices that lack formal, written job descriptions, fail to conduct performance reviews, or suffer from a lack of leadership, will also have a difficult time keeping employees on track, she says.

Conversely, there may be an administrator who takes action, only to be undercut and “chastised” by the practice’s physicians. That allows problems to continue, White says.

Meanwhile, many employees focus so much on patients that the business or administrative aspects of the office get scant attention, which can rile other staffers.

“We have a lot of people who care so much about patients, to the detriment of themselves, so that they don’t really have anything to give anyone who is a colleague or a peer,” says Julie Fuimano, MBA, a nurse and an executive coach with Nurturing Your Success, based in Whitpain Township, Pa. “They may also have poor communication skills. They don’t know to deal with the woman who’s screaming, or maybe they do it themselves.”

Left unchecked, these factors cause relationships between office staff to devolve. “People end up in subgroups trying to figure out what to do, and more often than not they end up venting or complaining,” White says.