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.

 

Making Changes To Assure Success

 

Quick fixes Rarely Bring Long-term Results

Making adjustments to the way we run our lives and our businesses is never easy. So much of who we are is ingrained in the day-to-day manner in which we conduct ourselves and manage our lives. Fear can easily take over when we attempt to change our comfort zone. Making alterations to the way we operate and handle things can be a shock to our systems.

All of us know to some degree that if things aren’t working satisfactorily then the only way to turn things around is to make changes. Recognizing the importance of making necessary change is not so much the act of enacting it, but sticking with it! We begin with all good intentions and a desire to move forward quickly for immediate results on what is needed. Then why is it that more often than not this determination begins to fade out and eventually disappear, and before we know it our old ways have resurfaced.

We know we need to lose weight, so leap straight ahead with a burst of determination. We don’t just join a health club, but start off BIG by joining a spin class and perhaps a very aggressive Zumba group. We don’t just cut back on some of our poor food choices, but we instead go on a fast routine working to stick with 1,000 calories or less a day. We don’t stop smoking with the aid of a counselor or support meds, but we choose to throw the cigarettes out the window (including the carton we just purchased) and go it cold turkey.

So what’s wrong with these approaches? Shouldn’t we be commended for the strong desire shown and a demonstration that says “we really mean business”?

Yes, a statement is being made and to the outsiders looking in they are quite impressed with your expression of sincerity. Truthfully though, these examples of making changes in one’s life will most likely be short lived. Taking an aggressive approach may sound encouraging yet when it comes to change, change that will stick, it takes planning and at a pace that doesn’t overwhelm.

This same principle applies to changes we make to our businesses. Bringing in new systems, crafting new protocols and getting those “cultural” issues set up and spelled out in the brand new Office Handbook that you are excited to implement can be exciting. Many employers apply these new ways of managing their business and teams in the very same way. Now that they are ready and focused to make the changes they are recognizing as needing to be fixed, making the shift can’t come soon enough. They are ready to roll and can’t wait to implement all that is suggested as soon as possible.

Again, enthusiasm and the desire to get things going is a wonderful thing, but being anxious to get as many changes made as possible as quickly as possible is a prescription for a quick failure. Just as weight loss programs bring long-term success through a slow and steady process, so does the process of making changes in policies and programs that have been a part of a business model for years.

Take one new format at a time and don’t necessarily put a timeframe on what needs to be revised, that is unless you are changing methods that are causing immediate harm to the business/team in some way. When an advisor that you respect and admire offers you advice that you know you need to pay attention to and strongly consider for the betterment of your practice, don’t let any of it throw you.

Between the two of you, evaluate the priority order for the changes you need to make and then slowly integrate step by step. Slowly incorporating new ways of handling things is definitely not easy for most of us, but slowing things down as much as possible will help us to become more and more secure with the change.

Slow and steady DOES win the race.

Do You Hire for the Person Within or the Outside “Packaging”?

Talent may not be “visible”

I fear that we are seeing more and more superficial rationale when it comes to building a dental team. I find it so disturbing when a client paints a picture of the team member they envision and the first words they mention are that they should “look good”, which means what exactly?

While I would agree that taking care of one’s self from the hygienic standpoint as well as a professional presence is important, I don’t believe that we need to be seeking out potential beauty contest winners.

To me, it’s much more about professionalism, dedication, the ability to take direction, to work well with others, to think before they speak, and of course to not flood the office culture with unnecessary dialog or disrespectful banter. While presenting a healthy “look” would make sense in that we are in the healthcare field, I will never support refusing to offer a great employee a position based on some level of perceived physical attractiveness.

Are they neat? Are they well-spoken? Are they talented and skilled? Have they proven to you that they are perfectly qualified to manage the job that was offered to them? If all this fits then it’s not about them, it’s about you!

I realize that this is a touchy subject, but I’m at a point where I felt it was important to bring my concerns out into the open in the hopes that it will bring to light some very shallow thinking and stimulate some healthy assessment when situations of this nature are presented.

Don’t pass up an ideal team member based on superficial values. Many very special qualities are not visible to the naked eye.

Managing Team Conflict

notlistening

Whose job is it anyway?

I Stopped at my favorite local Starbuck’s today and things were jumping.  Could it be coffee for your sweetheart on Valentine’s Day?  Nonetheless, after I placed my order I couldn’t help but overhear what sounded like a heated discussion between one of the baristas and the store manager, Erica.  The level of conversation was high and continued to escalate in spite of the crowds and cross-banter at the coffee bar that should have drowned it out.  I’m sure that not only could I hear the conversation, but I suspect many others could as well.

“She never picks up after herself”, said Trevor, “and with that she runs out the door as quickly as she can and the end of her shift and I never see her grab the garbage or do anything to help the rest of us. I’ve really had it with her. You need to address it as soon as possible.”

The body language was almost as interesting as the dialog, with Trevor leaning forward and Erica looking stunned with almost a glazed look in her eyes.  It appeared as though Erica was near tears and didn’t know how to respond.  I was hoping that with every word Trevor uttered she would be intentionally moving him toward the back room, but this never happened. With Trevor’s rambling, it was obviously difficult for her to get a word in, or move him away from the patrons at least. Erica was clearly very uncomfortable

My coffee was placed on the bar and as they called my name I grabbed it as I heard Erica say, “Okay, stay a little later with me and help me make a list of the things you want me to address with Stephanie. Is there anyone else that has similar issues with her?”

Whoa, really?, I thought to myself.  I see a couple of things here that are unacceptable and problematic at best.  Why not stop him right away noticing the crowd that had been forming in the store? Why not immediately take him to a quiet place for a moment so that others wouldn’t be privy to the conversation? And why oh why would you encourage this employee to continue his anger with you so publically? These aren’t your issues, they are between him and a fellow employee and should be resolved between them without any interaction from their managers, bosses or superiors.

My experience today reminded me of those I have witnessed while working in practices over the years. It’s the team members airing their issues and not always in the most healthy manner or most opportune time. It’s the dentist/employer who will stop and listen to this rhetoric getting much more engaged in the story than they should.

Have you established guidelines and very specific “language” in your practice culture overview or employee manual to manage issues of this nature?

Direct your employees to solve their own problems and become more self-sufficient, for if you continue to offer them a platform to vent, their problems will immediately become yours.

Outside of the Box Thinking

officeinabox

Must every employee be fulltime?

When I am asked by my clients to help them locate some strong candidates to fill a particular position within their dental practice, the usual request is that they require a fulltime dental professional to add to their team. While this is understandable the majority of the time, there are occasions when the questions I ask reveal the need for a permanent part-time employee and not necessarily someone on a fulltime basis.

Granted it isn’t always easy to determine the exact man/woman power to effectively manage the needs of a practice, but there are things that I like to consider when guiding my clients through the process. In some cases it’s based on the physical size of a practice and how the work area lends itself to the flow of activity during the work day; while in other situations it’s based on the lack of proper systems, protocols and efficiency measures applied within the business model.

More times than not, the lack of systems is one of the main reasons an employer/ dentist assumes that there is a need to hire more help; when truthfully without proper direction and protocols an efficient team can easily be mistaken for a group that just can’t keep up with the workload .

I encourage my clients to assess and evaluate the systems or lack of that they apply within their practice along with making sure that everything is clearly defined and every team member (whether it is in their job description or not) is aware of the methodology established within the culture of the practice.

I suggest taking a good, clear look at the structure and overall organization within the business and how it relates to running and managing the various duties that are distributed among the group.

Are the employees assigned responsibilities that they can not only manage properly, but thoroughly? Do their duties align with their ability?

Is everyone clear with exactly what they need to accomplish to successfully manage each day, each month and end of year?

Here’s a thought–what about seeking a permanent part-time employee to manage the overflow that may not necessarily require an additional fulltime employee? I will say that it’s a little more difficult to find a permanent part-time employee than a fulltime one, but once you and your team can pinpoint the specific area(s) that are lacking within the structure of the business, seeking out the necessary team support will be so much easier.

Part time permanent positions when designed correctly are very effective for both administrative as well as clinical positions. If the box is organized, it’s ok to think outside of it!