3.30.07 - Issue # 264 Forward This Newsletter To A Colleague
Staff Cliques
Conflict Resolution
McKenzie Case Study

Are You Running with the ‘In’ Crowd?
by Sally McKenzie CEO
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As the saying goes, birds of a feather flock together. Understandably, it’s common for those with like interests, backgrounds, and experiences to form friendships and alliances. But what may seem like staff camaraderie on the surface can be the root of practice factions, otherwise known as cliques.

It’s not uncommon to see divisions between clinical and business staff, between a group of the “favored” employees and the rest of the workers, or between the longtime personnel and the new recruits. Regardless of the makeup, staff cliques can be a powerful undertow in your practice manifesting in poor morale, ongoing conflict, and increased staff turnover all of which compromise practice productivity and profitability.

Take the case of Liz, Ellen, and Tom. They’ve been with the doctor since day one. They feel that because of their seniority in the practice they run the show, and that would be how the rest of the team sees it as well. The doctor doesn’t make a change unless those three are on board.

Liz, Ellen, and Tom lunch together, have coffee together, socialize together, and think nothing of the message of exclusion they send to the other employees who, by the way, turn over pretty regularly. They justify their failure to include new employees because the chances that the latest recruit will stick around for more than a year are slim to none.  Gee, I wonder why.

In staff meetings, which are few because Liz, Ellen, and Tom pull the doctor aside whenever they feel something needs to be addressed, new employees are seldom asked for input. They tend to fall into the role of spectator merely watching the doctor and the trio banter the issues about. If they do speak up, their ideas are greeted coolly. Unless the threesome comes up with the concept, it’s likely someone else’s slightly different approach will interfere with the way they like to do things, which, they argue, seems to be working just fine. And it is, at least for the three of them.

The doctor…she’s a really nice person and although she acknowledges that Liz, Ellen, and Tom “aren’t perfect” she doesn’t want to confront the issue. She prefers to just look the other way, telling herself there is really nothing she can do about it anyway.

Certainly, strong relationships among longtime employees can be tremendously beneficial for practices that rely on small cohesive teams; however, if new employees feel unwelcome or excluded it’s likely these “loyal” workers are actually generating far more traffic than you want through that revolving door.

Cliques can be extremely counterproductive and, consequently, expensive. These non-productive units of exclusion reject key players, making it impossible to establish a true team that works effectively together. The problem becomes particularly serious if critical practice decisions are being made without input from those who are not part of the clique, or if essential information is not shared with those who need that information to effectively carry out their job responsibilities and duties, or if the treatment of some staff is noticeably different than the treatment of other staff.

Teams, not cliques, make the dental practice successful. While personalities, work styles, and interests may differ, each member of the staff needs to be given the opportunity to contribute fully.

Dentists, as leaders, set the example for the team and can unwittingly strengthen cliques. For example, allowing a few to monopolize the conversation in staff meetings rather than insisting on input from across the team can send the message to the others that their input either isn’t welcome or has a lower value than the “chosen” participants. Sharing personal information with a select few members of the team conveys to the rest that only the favored few have the ear of the doctor. Socializing with certain members of the staff outside of work also conveys the message of favoritism and encourages a sense of exclusivity among those who see themselves as part of the doctor’s social circle.

Pay attention to the lines of demarcation that may be drawn in your office and take steps to erase them promptly. Those quietly warring factions are chiseling away at your practice infrastructure and subtly undermining your every effort to establish a practice that is built on excellence.

Next week, “outing” the “in” crowd..

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club? Click Here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Get Your Head Out of the Sand:
Take a Stand on Conflict

The hygienist, Carol, got mad at the front desk, Lisa. They had words. Lisa cried and said that Carol jumped on her case and was rude to her. Carol feels that she just works her butt off cleaning teeth and smoothing problems over with the patients (problems they have had with the front desk about scheduling or getting phone calls about money). According to Carol all the front desk does is look at magazines, talk and tick off patients.

Conflicts between front office staff and clinical employees are common. However, the real problem in many dental offices is the tendency to avoid conflict. Dental leaders typically see these team dynamics as annoying “high school drama”. They bury their head and hope that conflict will just go away.

However, ignoring conflict doesn’t work! Bad feelings intensify. Things get blown out of proportion. Rumors flourish. Simple workplace misunderstandings become major obstacles to efficiency and productivity. Before long, the tension between Carol and Lisa escalates into an office battleground. This costs you inordinate amounts of money in staff-hours and in hidden expenses such as turnover, recruitment and training.

Why do you shy away from conflict? In most situations, you can never be sure what’s going to happen. People might cry, get angry, stomp out, get defensive, blame others. That’s a lot of uncomfortable feelings. And most dentists and their employees don't like uncomfortable feelings.

Another reason you avoid conflict is that you want everything to be 'nice' and pleasant, for everything to run smoothly, and everyone to get along. So, you don't do anything and hope it all fixes itself. 

If you are going to have an effective practice, you absolutely need to deal with conflict head-on. That means being courageous. Accept those uncomfortable feelings and do it anyway. In many respects, resolving conflict is similar to how some of your patients feel about going to the dentist - they hate the idea of it, they wait forever to make the appointment and they are relived when it's over. In the end, it wasn't so bad after all. And facing conflict up front can prevent bigger problems down the road. Just like getting your teeth cleaned.

As the dental leader, your goal is not to make Carol and Lisa like one another but to be able to work together. You need to help them reduce the emotions and get to a resolution .

  1. Talk with Carol and Lisa individually. Be impartial, even-tempered and fair. Both employees will try to win you over to their side by blaming the other. Be neutral.
  2. Next, facilitate a conversation between Carol and Lisa. Identify common ground. In most cases, conflicted employees do not recognize that they share many of the same ideas and convictions. 
  3. Open the conversation by reminding them about the importance of good patient care and service. Never try to humiliate them into a resolution. Comments like, "You're both behaving like children," or "You both have really disappointed me" are condescending and will create further resentment.
  4. Give each employee one minute to say what they want from the other. Avoid discussion about who did what to whom because that is completely unproductive. Keep the focus on solutions. 
  5. Ask each employee to restate the other’s solution. Conflicts often begin over small details. Highlight shared viewpoints.
  6. Ask each to confirm the accuracy of the other’s restatement. Simply say, "Carol, is that what you said?" Each person needs to feel heard before you can move on.
  7. Maintain a problem-solving climate. Listen carefully to make sure you are getting a clear, detailed description of what they expect of each other. Be sure they are requesting specific and realistic behaviors.
  1. Listen open-mindedly to their suggestions since they will be more committed to solutions they come up with on their own.
  2. If their solutions are impractical, unacceptable or not forthcoming, you must offer your own opinion and solution. Offer any support you can to make the solutions work.
  3. Ask each of them to restate what they have agreed to do. This eliminates any misunderstandings. It's also a way to create a more binding agreement. End the meeting by scheduling a follow-up session. This lets them know you're serious about ending their conflict once and for all.

Help employees to open lines of communications. In some cases when the conflicts are serious or longstanding, it may be necessary to hire a trained consultant .  Stop being an ostrich - confront problems calmly and quickly.

Does your team need a tune-up?   Dr. Haller will conduct a detailed assessment of your office and get to the bottom of the problem.  She will provide you with detailed recommendations and work with you, and your team, to implement needed changes.  She can be reached at coach@mckenziemgmt.com.

Interested in having Dr. Haller speak to your dental society or study club? Click Here.

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Nancy Caudill
Senior Consultant
McKenzie Management
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Paper or Paperless?...That is the Question!

A McKenzie Management Case Study

Dr. Sandra Stieffel Case Study #619

A big question in many doctors’ minds is the paperless (chartless) issue.  “Do we or don’t we?”

“Nancy, I have a couple of dentist friends that are converting their practice from paper to paperless.  I want to stay up with the times.  From a practice management standpoint, what do you think?”  Dr. Stieffel  is a former client of McKenzie Management so we knew she had good systems in place.

Practice facts:

  • 15 year practice
  • Storage space was limited
  • Excellent dental software program with all staff members trained
  • Old x-ray processor on its last leg
  • Computers in the hygiene rooms only
  • Almost 2000 active patients

As a management consulting company we are always looking at major purchases for clients from a “return on investment” standpoint.  Based on the information that Dr. Stieffel shared regarding her current situation, it appeared that if she was going to consider making the change, now might be a good time to do it.  McKenzie Management recommended she seek the expert advice of Dr. Lorne Lavine who is President of Dental Technology Consultants, Inc.  Dr. Lavine would be able to help her choose the right equipment and ensure that it was installed correctly.

Here are a few of the things you need to have to make the change:

  • Computers in all the operatories
  • Digital radiography – including a Digital Pan if you take pans
  • A scanner to scan all the correspondence that you receive regarding your patient – remember, you won’t have a chart to put things in!
  • Well-trained and computer-literate staff because it takes organization to run a chartless office.  There are no “writing notes on sticky-pads and sticking it on a chart for later”
  • A plan of conversion
  • A reliable “back-up “ system for your computer

It was time for her to add additional computers to her operatories as well as hygiene.  Her team was computer literate so the transition would not be difficult for them.

She is limited in storage space.  Going chartless definitely frees up space after you decide what to do with your “old” charts!

She has a healthy active patient base and is seeing almost 40 patients a day.  This is a lot of filing and re-filing patient charts all day long.  You have no idea how many charts are touched a day by the business and clinical staff.  Being able to access all the information by a touch of a few keystrokes is amazing!

 What about the down-side of being paper/chartless? 

In my opinion, the biggest challenge the practice has when they are paper/chartless is when there is a new staff person that needs to be trained or a temporary staff person, such as a hygienist.  They will be completely lost and you will need to depend on your experienced staff to input the data.

The other challenge is making the transition.  My recommendation would be to transition the patients as they come in and all new patients.  Be sure to record in the existing patient chart that the clinical notes are continued in the computer and date it.  It is time-consuming to transfer the hard copy information from the patient’s chart to digital.  All the existing radiographs have to be scanned, as well as any written information that you want to have access to in the computer chart.  I would suggest a “checklist” to make sure that all the information is transferred completely and that each staff person is aware of what is to be transferred.

Do we use anything that is still paper?

There are a few  “paper” items that we continue to use.  The Routing Slip is the common bond for information about each patient and keeps the clinical and business staff on the same page.  We still print a treatment plan for the patient to review with the Financial Coordinator but we scan the signed copy into the patient’s computerized chart.

We also still print insurance claims that have attachments for those insurance companies that don’t accept electronic attachments yet. 

Dr. Stieffel made the commitment to make the transition.  We developed a “game plan”, asking for input from all the staff so everyone would feel they were a part of the change.  As we know, change is difficult and this change is no exception.  Over the course of six months, the majority of the active patient charts have been converted. 

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email info@mckenziemgmt.com.

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