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.

Eighty percent of practices are losing more patients than they are gaining new patients. It’s easy to assume that patients you’ve had for years will continue to return, and it’s also easy to fall into the trap of thinking that those patients will raise questions and inquire about treatment options without your prompting. What happens far too often is teams fall into the “Transaction Mindset.” The patient is coming in for a routine oral hygiene appointment and exam. Everyone clicks into autopilot, after all this is merely a routine transaction. Wait! Wake up! This is one of only two contacts your office will have with that patient in the next 12 months. This isn’t a mere transaction. It’s your brief opportunity to strengthen your relationship with this patient.

In many cases, the six-month visit is the only time the dentist is going to have the opportunity to sit down with the patient and assess not only his/her their oral health condition, but also the individual’s oral health concerns and interests. What do you do during every routine visit to WOW the patients, further educate them on the importance of oral healthcare, and inform them of the services that your practice provides? Anything? In about eight months, you might be wondering why you haven’t seen this or that patient in your practice for a while. Can you figure it out? Maybe they were tired of being treated as simply just another “routine transaction.”

Great “potential” won’t guarantee employee success. Give staff the tools and training they need to thrive, and you’ll virtually ensure that your rising stars will, indeed, become superstars. Consider your office manager. Is s/he prepared to handle the responsibilities outlined below?

- Evaluating practice numbers vs. industry standards
- Managing practice overhead (personnel, rental/maintenance of office space, administrative expenses, equipment/ furnishings, clinical supplies/lab, office supplies, marketing)
- Determining hygiene availability
- Assessing new business vs. lost business

Staff Management
- Drafting specific job descriptions
- Overseeing employee policies: vacation, jury duty, sick leave, etc.
- Managing team planning meetings
- Implementing employee warning systems

Systems Management: Watching the Numbers
- Calculating patient retention
- Monitoring cash flow management, accounts receivable, over counter collections, delinquent accounts, financial arrangements
- Ensuring effective recall
- Using computer reports effectively
- Implementing new patient protocols

Too many “office managers” are tossed into the position and never given the tools and training to succeed, costing the doctor and the practice thousands in untapped potential. If your office manager is not prepared to handle the responsibilities outlined above, get them the training they need to take your practice to the next level.