Ann does her job, Caroline does hers, Dan is busy doing his. Everyone is working independently. So what’s the problem? It’s known as the “silo effect,” and it occurs in the workplace when individuals are focused almost exclusively on their own areas. Think of the farm silos, they stand next to each other, each performing its individual functions, but there is no link between them. That’s not a problem out on the farm, in the workplace; however, it’s a different story.

This silo effect can occur in the dental practice when there is a lack of communication and/or a lack of common goals among the different areas. The business employee unknowingly schedules the emergency patient at a time that puts significant strain on the doctor and the assistant. The doctor recommends an extensive treatment plan, not realizing that the patient already carries a significant balance on his account. The collections coordinator is to increase collections, but can’t control accounts receivables when the doctor is recommending costly treatment to patients with outstanding balances. The doctor, meanwhile, wants to increase treatment acceptance and is now offering more elective procedures. But there’s no effective communication between the silos.

Clearly, the collective interests of the practice as a whole are suffering. If there are common goals or a common purpose, they don’t have a chance in this environment until the silos are torn down and individuals focus on how they fit into the shared success of the entire office.

While stress in the dental practice neither can be nor should be eliminated, managing it is critical. Dentists and their teams need to identify those areas that cause negative stress and take concrete actions to reduce them. It all starts with changing the things you can. Staff can be changed, educated, and properly directed; schedules can be changed; collections can be changed; treatment presentations can be changed; business procedures can be changed – all to yield improvements and reduce strain on the practice and team immediately. Take these steps:

1. List the stressors starting with those issues that are most intense. Develop a plan of action to address the sources of stress through a procedure or system.

2. Meet regularly as a team to refine systems and procedures that continue to cause stress.

3. Clearly define staff roles and responsibilities.

4. Train your team to ensure that they can succeed in your practice.

5. Establish work schedules that are compatible with demands and responsibilities on the job. If “Julie” is responsible for delinquent account calls, but never is allowed time or a quiet space to make those calls, she cannot fulfill her job expectations. Make adjustments so employees can carry out the duties they are assigned.

6. Improve communications. If you are stressed out because cancellations and no shows have been on record pace the last few months, rest assured your team is worried too. Talk about the situation as a team and together develop strategies to address it.

7. Take time out for fun – an afternoon at the movies, the zoo, or a long lunch. A little fun can go a long way in reducing stress.

I have to admit that I really like the idea many dentists have of “cross-training.” Everyone on the team covers for everyone else. It’s a nice warm and friendly notion that team members just automatically step in and help whenever the need arises. But when I try to gather more details on how this works in their practices, what the protocols are, what training took place to prepare the staff to just “step in” when necessary, the answers are typically long on generalities and short on specifics. One of my favorites is, “Well they just do what needs to be done.” Oh, really? The fact is that when everyone has their hand in everything, no one is accountable for anything.

Instead of answers to problems, you hear the chorus of excuses. “I thought she was taking care of that. Oh, I didn’t realize that. When did we start doing this? Uh oh, how did that happen?” Not because your team is incompetent or unwilling, but because there are no real expectations, there is no delineation of duties, and there are no real measurements of performance. No one is taking responsibility or genuine pride in the outcomes of any one system because they are not allowed to do so.

You cannot ignore solid management practices or human nature for that matter. If staff are simply expected to “fill in” wherever they are needed, no one has the opportunity to take ownership, to shine because the focus is merely on getting the job done, not getting the job done well.

“Act as if what you do makes a difference. It does.” That is one of my favorite quotes from American philosopher William James.

Oftentimes, it’s the little things – the seemingly insignificant actions – that make all the difference. Our opinions of each other are often shaped by them. Our perceptions of the products and services we purchase are influenced by them. And our views of the people who are selling or delivering them are directly affected by them. Those seemingly intangible influences that give us a sense or feeling that this business or that office is a quality operation, that those people are truly a caring team, or a trustworthy group. Simply said, it’s the little things that reinforce what your patients already want to believe. They are merely looking for confirmation.

Patient opinions and perceptions are shaped by multiple variables, many of which tend to be subtle and vague. Often it’s the intangibles that have a very tangible impact on your success and practice growth. Want to evaluate the “intangibles” in your office? Start with the obvious – staff attitudes. Conduct regular “attitude inventories.” Evaluate your staff’s routine communication with patients – tone, body language, their command of the English language. If you cringe or bristle, consider communication training for your team. Telephone training and practice scripts ensure that the “little things” don’t derail the big opportunities in your practice.

The “middle” can be a challenging place. It is often the point at which you’re too far from where you’ve come to turn back, yet seemingly still a long way from your destination. The middle of anything doesn’t seem to denote much that is positive: “the middle of nowhere,” “middle of the road,” and the dreaded “mid-life crisis.”

Similarly, the mid-point in a dental career can bring great uncertainty, many questions, and frustrations. As the financial struggles, personnel problems and patient issues persist, is it any wonder that mid-career dentists find themselves asking: “Is this all there is?” Where’s the excitement, the enthusiasm, the career satisfaction?

Consider your position on this mid-career path. Are you enjoying the view from the pinnacle of success? Or are you frozen in place, stuck somewhere between merely average and truly excellent? And, if you’re not where you want and feel you should be, are you willing to take the necessary steps to change it? If so, the question then becomes, how? Look at those areas most likely to be sending your practice, and consequently you, into a mid-career slump, starting with team education and training. Nothing will stampede over a struggling practice and pound it into further turmoil than lack of instruction. In fact, the single, biggest contributor to practice inefficiency, mismanagement, lost revenues, and career dissatisfaction is a poorly trained team.