The Fear of Change- One Gal’s Observation

Who Seems to Fear it More, the Clinical or Administrative Teams?

Ok, so I am going to date myself now and my hope is that my dental contemporaries out there are not shy to chime in.

Remember when x-rays required dipping tanks? We’d go into the small (very small) darkroom and carefully unwrap each x-ray taking care not to touch the film with our hands. If we were developing a full series we would clip them methodically to the rack and carefully dip the x-rays into the developer. We would slowly be sure to cover the tank so that no light streamed in, set our timer and slithered out of this tiny space. Usually we didn’t have to even wait for the buzzer to go off since we were so accustomed to this “drill” that knowing when the films were ready was instinctive.

We would then go in, dip the films in the water and place them in the fixer tank. This routine was repeated throughout the day and all of us on the clinical team worked together throughout the process. Boy, was that developer/fixer dangerous stuff! No matter how careful we were it was not unusual to get it on our uniforms (that were always white by the way). There were no other choices in colors and they were dresses! That’s right, no pants, no scrubs, no options.

Then came the birth of the Automatic Processor. It was a huge change for us, but we did adjust rather quickly and effortlessly. I believe that it was such a vast improvement to what we had before–damaging our clothes and staining our hands. That’s right, no one wore gloves back then or masks either for that matter.

This transition was really a pleasure and I can clearly remember my practice mates rejoicing as to how much cleaner and more efficient this new method was. It saved us time too, since the process was much faster than the old traditional way. There were lots of smiling faces walking the halls of the Medical/Dental Building I worked in on Long Island–happiness everywhere!

Of course, since then we have graduated to digital x-rays, intraoral cameras and a myriad of other technical advancements. For some reason, the changes that were developed for the clinical side of the practice appeared to be much more readily accepted than the improvements that were made to the Business Office. I don’t know why, and perhaps my assessment is not accurate but I can distinctly remember the fear that came over the administrative side of the practice when the peg board system was replaced by THE COMPUTER!

I can clearly recall one of my fellow front desk buddies refused to let go of the “One-Write” system and would enter her information both in the computer and on paper. “I’m terrified of losing information. Where does this all go? What happens if the computer breaks?” (crashing wasn’t even in our vocabulary back then). And if this wasn’t scary enough, what about replacing the Appointment Book with the computer? OH NO! This was frightening to the Business Team AND the doctor.

Technical transition can either make us or break us, at least this is how we felt. How many practices would you say continued to maintain both a computer version of the schedule and a hard-copy appointment book version? From what I observed, I would say perhaps 85-90% initially.

No secret that dental peeps fear change, but I have noticed that the advancements on the clinical side of a practice do not seem to rattle team members quite as much as advancements within the front desk. I’m really not sure why, but there seemed to be a little more resistance when it came to enhancing systems that pertained to the business office.

Of course, now in this day and age everyone is working with lots of technology. I can honestly say that with the hundreds of practices that I have worked with over the years, I don’t know of one that is not computerized—well for the most part anyway. There are still a number of practices that have slowly migrated to a paperless practice. As a matter of fact, as recently as 3 months ago I worked onsite with a practice that was actually making clinical notes in the paper charts as well as documenting all information in the computer.

I’d be interested to hear from you regarding your thoughts on the difference between the clinical side of the office and the administrative side. Do you feel one department is somewhat more resistant to changes than the other? The administrative team is often gun-shy with the possibility of more work, fear of crashes, and they “don’t have the time”. Whereas the clinical team often welcomes advancements and enjoys challenges.

 

How Did Things Get This Bad?

A referee isn’t the answer

I jumped in on a conversation that was streaming on one of the dental social media sites on which I participate. From what I could gather after showing up a little late, the question posed to the group was one in which there was an on-going feud occurring in one of the members’ practices. It was between a “strong” personality hygienist and a “want-to-take-charge” Office Manager. The doctor expressed his interest in wanting to keep them both, but really didn’t know how to resolve this problem. Based on what the latest “riff” was about, it appeared to me to be clearly a power struggle between them.

The way I look at these challenges is that the catalyst (or what perpetuated the challenges between them) is not always critical information to have in order to resolve their differences. It’s more about why they had been arguing and not necessarily what they had been arguing about.

From the little I had to go by, I felt as though they were having a power struggle. Their ultimate goals were the same–getting the patients to stay committed to keeping their appointments. The openings that were occurring at the last minute made the pressure and the stress of the moment take its toll on both of them. I did observe things that could have helped them both to be more successful, but I wanted to stay in my area of expertise so I really didn’t go into too much detail as to how they might remedy the issue causing their conflicts.

My suggestion was to have them work out their differences on their own, given a time frame in which they either come together and make amends without any future repercussions. Or if they are unable to work things out–remember that everyone is replaceable.

I feel strongly that unless the two of them come together without anyone else facilitating their truce, they and the rest of the team will never learn or understand that, as adults, childhood behavior is not acceptable. Behaving poorly sends a terrible message to the other team members, as well as the patients and there is no reason why adults in a professional working relationship should not be able to work in harmony.

I was shocked when the doctor who posted this thread responded with, “Well, I can’t leave them alone to cuss and scream at each other. I need a facilitator or “mediator.” Coincidentally I happen to be trained in Mediation and Arbitration and so I know that the purpose of a mediator is not to solve the problems, but to

guide the subjects in conflict to come to a decision on how to settle their differences on their own.

And how did this problem reach such proportions? Cursing and screaming at each other? Truly? How could an employer let their differences escalate to such a level? What about the team members that DO get along? How do they turn their heads the other way when they have to witness some of this aberrant behavior? Then there are the patients, many of them have had to observe these encounters.

My question is: How long as an employer, should you allow employees to not get along? If they can’t mend their fences and resolve their differences, then it’s time to move on. You are running a business, doctor. Who has time for this type of behavior in a professional environment? Why is it that you have so much difficultly abruptly ending this drama before things get so out of hand that it may require a referee?

Deb Roberge has been coaching and writing about dental team development and related areas for the past 25 years. During her onsite visits to numerous periodontal practices, she quickly recognized the very specific challenges that were prevalent in this particular specialty. She felt it was important to step up and support not only these clinicians, but the team members that work alongside of them, as well as the referring generalists and their teams. OurPerioTeam cloud-based software was created with Deb’s input along with perio practices and teams across the country. OPT is changing the way both periodontists and their referring generalists interact, as well as how they measure their mutual successes.

THIS is What Raises are Made of!

No team member should have to ask for an increase when they have clearly earned it

I talk about the value of team members all the time. I can’t stress enough how important it is to be able to clearly identify the employees that pull their weight “and then some.” I’m referring to those employees that get as much or possibly more satisfaction than you do when they can see their efforts paying off.

I recently worked with my wonderful “work sister”, Cyndee Johnson of scaler2schedule fame, and assisted one of her clients with a couple of team dilemmas. In this case the client believed that one of his business office personnel was not managing her post very well and with that, he asked that we review the additional office employee whom he thought was having her own difficulties with insurance filing and billing. These happened to be her primary responsibilities.

Upon conducting our usual due diligence, it was quite easy to see that there were even bigger problems than anyone expected, but the proof was in the numbers, and with comprehensive research we uncovered a myriad of unsettling issues.

Pre-determinations were filed, approved and tucked away with no appointments scheduled and apparently no follow-up calls even made to those patients that had their paperwork submitted and returned. There were 9 pages of problematic insurance issues that were never addressed where many simply needed an additional x-ray or even a simple narrative. Some claims that were discovered dated back to 2015!

Then there were the statements that had not been generated for a couple of months. And did I mention the major ADA code discrepancies? These were bogus codes obviously fabricated by past employees that were used periodically and sat in the system for years. No one seemed to know the origin of this.

Once we delivered our findings to the doctor (and administered his CPR), I knew it was time for us to now take charge and get his practice back on its feet again. Unfortunately, we had to dismiss the 2 team members, but we had clear documentation that they couldn’t defend, and apologized for not asking for help. They left the practice with the understanding that it was time.

To support the doctor, he like so many others in my experience hired quickly without properly checking to be sure the knowledge required to fill the positions was present. He also neglected to check on status, reports, numbers, etc. He loved his dentistry, was good at it, and felt he could count on his team to handle the business segment of his practice efficiently. This too is not uncommon. No strong hiring protocols, hiring with no formal systems, no information tracking, no period reviews and basically assuming all would be well.

I knew the caliber of candidates we needed to locate, and although it took about 6 weeks to find two great team members, the 2 we were fortunate to find were both perfect for the position. Both had ideal skill sets, terrific attitudes and worked extremely well together! We conducted our interviews with all my “road tested” systems in place, dotted all of our “i”s and crossed all our “t”s. Yes, it took time, but it was so worth it.

Here we are 2 weeks into the Superstar Front Office Team’s partnership and I got a report today. You see, we track the progress and we make sure the team members track their activities as well. We look at the challenges acquired and meet them head-on.

The main concerns were the time-sensitive issues, such as insurance re-filing. I spoke with the person who is managing the insurance this morning, and in only 2 weeks time she has recovered $6,000 of back claims and took the print-out list down from 9 to 7 pages! She has managed more in two weeks than the prior business team handled in 2 years. They actually moved the production back rather than forward.

This is an example of how increases are deserved and earned without a second thought or hesitation from the employer. My Progressive Salary Program is built around this premise and Suzie (not her real name) hit her first benchmark, exceeded her first goal, totally hit it out of the park . So…Suzie’s next pay check will reflect her first 2-week increase!

Deb Roberge has been coaching and writing about dental team development and related areas for the past 25 years. During her onsite visits to numerous periodontal practices, she quickly recognized the very specific challenges that were prevalent in this particular specialty. She felt it was important to step up and support not only these clinicians, but the team members that work alongside of them, as well as the referring generalists and their teams. Ourperioteam cloud-based software was created with Deb’s input along with perio practices and teams across the country. OPT is changing the way both periodontists and their referring generalists interact, as well as how they measure their mutual successes.

Are You Totally Prepared to Jump In?

Changing your wrong hires and short-term hires to winning employees!

The majority of dentists, when realizing it is time to hire a new team member, will either contract with an agency, search internet “resume clearing houses”, write an ad (or assign someone in the practice to construct one), or simply start asking local colleagues and dental peers for referrals. And let us not forget asking patients if they “know someone” (which I believe is the worst mistake of all).

No matter what avenue you take or the vehicle you use to attract candidates, the same applies in every case and that is that you need to have a well-developed plan in place prior to starting the process.  It isn’t simply ” Okay, let’s start interviewing people as soon as we start to see some good resumes or responses coming through.” I think not! It’s a bit more involved than this.

That is “if” you are seeking the best employees for you and your practice.  That is “if” you are wanting to hire passionate, honest, high integrity employees and “if” you can expect them to stay with you as long as possible.  You see, anyone can locate interested personnel, but are they the right people for your practice, do they align with your practice culture, philosophy and business model?  These are the things that will help assure you of not just filling an opening, but bringing in the quality employees you are truly seeking.

It may seem like a waste of time and effort, but honestly once the groundwork is laid and the systems and protocols are in place, it’s just a matter of reusing these materials each time you require additional team members and tweaking them to fit the specific requirements of the new employee. Although following this methodology will add this type of discipline into your hiring routine, you will probably find that you will not be going through this “drill” nearly as often as you have prior to working with structure in your hiring process.

I will list for you chronologically what you will require to change things for the better:

  1. Know exactly what you are looking for. Create a thorough, comprehensive Job Description for this position before you do anything else. Type it out with your letterhead.  This should be presented to every candidate that makes it in for a face-to-face-interview.
  2. Be prepared with a salary range (this is a RANGE that can fluctuate based on candidate).  This means that you do your homework.  Know what skill sets they MUST have to begin with. What licensures they MUST have.  Whether they will be working alone or have someone else with them (this can affect salary either up or down). Be well prepared and knowledgeable here even if you must conduct some due diligence.
  3. If you insist upon the traditional “Working Interview” (with which I discourage, by the way), I prefer a “Skill Assessment”, which is conducted during non-patient hours and is simply an extension of the interview process. If you have them in for a Working Interview then be prepared in advance with a compensation amount and paperwork that supports the time spent. This release should be signed by the doctor and the job applicant. You should have an amount per hour for this day preset so the candidates are aware of this prior to coming in. I can supply you with a sample if you email me @ deb@ourdentalteam.com Remember to have the WI overseen by a reliable team member or one of your family members.  They should not be alone to have access to patient records or information of any kind.
  4. Be prepared to supply the strong applicants with an overview of the hours and days that they will be responsible for.
  5. Having the finalists (you may have more than one) have lunch or coffee with your present team (without doctors). This is an excellent opportunity for the team to get a better feel for the candidate.
  6. If you don’t have a reputable company to conduct background checks and drug tests, please find one. This would be one of the very last steps prior to determining a starting wage. Until you have all these pieces completed you should not be offering anyone a position.
  7. Checking references is a tough one, although I do have a protocol I created a number of years ago.
  8. When everything clears and you and your team feel comfortable to offer this person the position, a Job Proposal should be created with every bit of information pertaining to their involvement with your practice.  This is when you should have them review your Employee/Practice Manual.  You must encourage them to read it and initial each page.  In it you should include things such as dress codes, CE courses, vacation information, well days, etc.  They should have everything understood and sign off on it all which will save you from those questions about time off, bereavement pay, etc., that so often comes up later.
  9. Your Job Proposal should also be thorough and comprehensive with regard to when checks are cut.  If you utilize my Progressive Salary Program System that gradually brings salary up as new skills are successfully acquired.
  10. Bringing in a new team member should also be an Office Event, especially when you find you are not hiring as often. Make their presence a big deal.  Balloons? A bio and picture of them set up in the Reception Room? Make sure every team member introduces them to each and every patient, vendor, mail/delivery people and others.

 

On My Soap Box to Promote Elimination of the “Working Interview”

Opting for a Much Improved “Skill Assessment”

In my last blog post I posed the suggestion to do away with the traditional not-so-effective “Working Interview” that has become such an intricate segment of the hiring process within the dental profession. To reiterate my concerns, the structure for the day is generally non-existent with the job seeker coming in for the day or a few hours and is rarely given any guidelines as to where things are, little or no information on the operation and culture of the practice, no support materials to reference, and usually there is no one within the practice to answer their questions due to the fact that everyone is busy handling their personal assigned chores and duties.

Then there is always the issue regarding compensation.  How much is appropriate?  Must we pay them at all? Should we set them up as a hire, gathering all the necessary paperwork whether we hire them or not? And what about the fact that we are often exposing them to personal patient information (social security numbers, addresses, etc.).

My vast experience keeps telling me it is time for a change.  A change to safeguard these issues, along with giving us a much better picture of the candidate’s skill sets (or lack thereof) so that we have more substantial evidence in order to move forward and secure this hire or continue to search for additional candidates.

What I propose is to take an extra hour or two on a day without patients, perhaps a Friday if the office is closed, a weekend or even an evening if that is better. Having this event afterhours enables the doctor to pay close attention and observe the knowledge and ability of the job seeker. There is no need for concern over the confidential information that truly should not be shared at this point. With this planned extension of the hiring process, I recommend that you have a team member join you during this evaluation.  It would make the most sense to have your dental assistant present if you are seeking another assistant, your hygienist there to fill a hygiene position and someone from your business office if it is an administrative position.

You would pay the team member their regular hourly wage for the hour or two they are there, but you can also have your Employee Manual reflect this day and set a slightly different pay scale JUST for this particular segment of the process.  I’d much prefer that a current team member not only participate in this evaluation, but that THEY are paid for their time, in that this process should deliver much more valuable information than the old traditional “Working Interview”.

I would suggest that for whatever position you are looking to fill, you create a specific overview so that you are able to judge the ability they have for manual and hands-on dexterity, math skills, the writing and penmanship skills, as well as giving scenarios to assess how well they think on their feet and solve what could be difficult problems.

I encourage team involvement as much as possible when it comes to changing to new materials, new systems, new equipment and especially when it involves a new team hire.  Incorporating this additional step to the hiring process should not only assure you of a better chance for the right hire, it should also give you a much clearer picture of the capability of your candidate. Besides, I like the fact that your team member is not only involved in helping to make a more educated hiring decision, but that “they” will be the one to receive compensation for their time.  The evaluation is conducted during off hours and would be considered an extension of the hiring process so you are no longer at risk, nor is there any confusion regarding the job candidate’s compensation.

 

With this, I strongly recommend that you make sure to include reference (in writing) to a 30 day trial period so that you and the team are able to observe their interaction with all the team members, vendors and of course the patients.

Why not consider this new approach to hiring?  I’d be happy to guide those of you that might have additional questions.

Want to Join My “Movement”?

Replacing the Traditional “Working Interview”

I’m thinking it may be time for me to formally announce the fact that I am starting a “Movement!”

I am gathering fellow dental professionals to support my movement entitled NO MORE WORKING INTERVIEWS!

For as far back as I can remember there has always been confusion and controversy associated with working Interviews, or as I like to refer to them–Skill Assessments. Do we pay for them? How much must we pay the job applicant? Do you get the candidate onboard as an official hire prior to starting the process? Must we consider them as an employee and fill out all the necessary papers to make it official before we formally agree to permanently hire them? Can we give them a gift card in lieu of actually paying them? …and so on.

It occurred to me that when these “events” occur, the average practice has the job candidate in the office for the day. If they are applying for a clinical position they spend the day in the back office; or if it is a business position they are sequestered to the front desk. From what I’ve observed time and time again is that they receive very little direction, and often, due to the nature of the situation they show up and are required to navigate systems, protocols, and procedures on their own due to a lack of team members available to assist them and answer their questions.

How can you possibly determine the value of these candidates if they are lost and have no idea what is expected of them? Do those practices that regularly conduct Working Interviews “truly” feel as though they get all the necessary information required to make that confident final hiring decision?

I have recommended that when the situation doesn’t allow it, that my clients consider an Extended Hands-on Skill Evaluation. There are many times where it just isn’t applicable to schedule “my” structured Skill Assessment (working interview).

Perhaps we just can’t coordinate the time to have the job candidate spare a day with us. Perhaps the candidate can’t break away to come in for a traditional Skill Assessment Day, or maybe it is simply an awkward imposition for you and the team to have potential employees in during a regular business day.

I have often suggested we have the applicant in for what I call an Extended Hands-on Skill Assessment Interview. This can be set up for a couple of hours, but I don’t recommend that it be scheduled for longer than 3. The employer makes it clear that it will NOT be during the work day and that it is merely an extension of the interview process. The practice is not operational and there will NOT be any patient interaction at all. Another person should be present for legal reasons (typically a partner, associate, spouse or even a friend).

It is important that this been done after-hours or on a weekend when the practice is NOT rolling. There should be a blueprint and a structure in place for the evaluation. If it is an evaluation for a business

position, be certain that your patient base is not used and that you limit the applicant to only viewing areas that do not expose any patient information. I suggest that you utilize either a tutorial software piece or gather something from your software provider to use, and remember that any patient materials you might use should NOT have any private information.

If it is for a hygiene position, again you want to be sure that no patient records are opened or viewed. I would suggest that some “test” documentation be put in the system just for this purpose. Set up fictional information that can be reviewed and used as an aptitude assessment tool. The key to this review is that the job candidate does not see or have access to any patient information or practice records of any kind. Granted, a lot is missed by not having the hygienist physically working on patients, but I feel that with proper verbal reviews AND a structured timeline spelled out in the agreement as to the probationary period you will have a good sense of their skills and abilities.

Basically, what we are developing is an additional interview component that would be scheduled following the face to face interview that comes after the initial phone interview/screening. I have felt for many years that the average interview process for the dental profession has been less than adequate, so maybe it’s time to eliminate the traditional Skill Assessment (working Interview) entirely and change things up so that we are more compliant with the various state regulations and don’t set ourselves up for any additional penalties. Let’s consider doing things this way:

· A well-structured phone interview

· A well-prepared face to face interview

· An in-house (after hours) Skill Assessment that has been created to be able to see and view abilities, hear responses to typical office situations, and get a true feel for the applicant’s hands- on ability. This is to be conducted with another person present (preferably not a team member-perhaps a spouse or friend)

· A meeting for coffee or lunch ONLY with your team members and those candidates that continue to impress.

· In that it is an extension of the interviewing process and we make sure we have documentation signed by both you and the job candidate that this would be considered an additional segment of the interview process, there is no need to compensate for this review. Hence no concerns regarding a Working Interview or any similar “during-the-work-day” event.

If handled correctly, a lot more valuable information about your job candidates can be gathered and you now eliminate the concerns regarding how the onsite “working interview” is managed. In my next article, I will review how to set up this subdivision of the hiring process.

Who’s the Boss?

Take the reigns

“So Deb, I’d like you to please speak with Cathy and help her understand why we should not be sending out pre-determinations for basically every patient in the practice.”

“And Deb, can you also have a conversation with Suzie, my dental assistant regarding how important it is to stay in the room and sit beside the patient while I am in the other treatment room conducting a hygiene check?”

No matter how many times I hear this, it’s still mind-boggling to hear requests of this nature, particularly when I learn that these concerns are not new and current. It’s surprising how many dentists are working with employees that have handled things “their” way for years!

Why is this so prevalent in our business?

How can situations like these be ignored month after month and year after year?

I can make some guesses as to why. Perhaps the fear of confrontation? Could it be not wanting to enter into the hiring vortex if this employee refuses to manage the practice the way the employer wants things handled? Could it be that the employer doesn’t necessarily see any of this as a major concern? In practice, all of these examples are often reality.

Let’s review some of the fallout that could stem from turning the other cheek and letting this all go:

· Areas of the business that are left unattended means lost revenue

· The business will slowly fail due to unorthodox systems

· You can expect to compensate new and efficient team members at a high rate in order for them to fix the sad condition in which your incompetent employee left your business.

So please step up and become the boss. Lead the team based on your choice of systems, your choice of protocols and your cultural style.

After all it is Your Business!