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.

When you join a practice as an associate, don’t be surprised to find the supervising doctor placing limits on the types of clinical procedures you can perform early on. This is a sensible move and you would be wise to embrace it. The fact is, the hiring doctor has not seen your clinical skills in action. S/he needs to assess your clinical abilities, particularly if you are a recent graduate from dental school. This is an excellent opportunity for you to learn and grow as a practicing dentist.

It’s understandable that the hiring doctor wants to ensure that a new doctor treating his patient base is well prepared. After all, the hiring doctor likely has a long and valuable history with his/her patients. Understandably, s/he wants to ensure that they will be cared for in the manner to which they’ve become accustomed.

Additionally, it will serve you well as a new hire to work with an experienced dental assistant. In addition to her/his clinical background, an experienced assistant likely has worked within the practice for some time, and knows the patients. S/he can be an excellent resource in helping you quickly build rapport with patients. Moreover, experienced assistants can be a wellspring of information with regard to proper record keeping ensuring and that you follow the established protocols in your new office.

Before considering an associate, make sure you have enough patients. Measure the number of truly “active” patients. Start with key computer reports, including the past due recall report, the missed appointments report, and the unscheduled treatment report.

1. Generate a report of patients due for recall from today’s date to one year from today. Indicate that you are seeking to identify all patients with and without appointments on the report.

2. Tally the number of patient records in the computer system and divide that by the number of patients in the recall system. For example, if there are 4,759 patient records on file and 1,737 patients in the recall system, patient retention would be at 36%.

3. Now subtract the number of active patients from the number of total patient records in the system. Using the example above that number would be 3,022.

4. Divide that number by the number of months the records represent. For example, if you believe that active charts represent the period from 11/09 through 2/13 that would be 39 months. In this scenario, the practice is losing 78 patients per month.

Obviously the patient base is shrinking. Now what? For starters, don’t hire a full-time associate. Instead, implement a patient retention program and look carefully at clinical efficiencies. When it comes to clinical efficiency it can never be compromised, but it can almost always be enhanced.

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.