“Doctor, I need to speak to you.” Don’t you just dread those words. Your first instinct is to run immediately in the opposite direction and avoid what is likely to be one of three unpleasant conversations: 1) The employee is about to give notice. 2) The employee is going to bend your ear for an hour about another team member and wants you to step in. Or 3)The employee is about to ask for a raise.
And you don’t want to be within 200 yards of any of those discussions. But there you are Mr./Ms. C-E-O ; the maker of the decisions – good and bad. We’ll cover conversations one and two another day, for now let’s tackle #3 that ubiquitous issue that can drag down the strongest of leaders and the most cohesive of teams – employee raises. What do you do when employees want more money?
First, what not to do: Don’t become defensive. Don’t tell them that you cannot afford it right now, or say that it would not be fair to the other employees, or say you’ll think about it and get back to the employee knowing that you never will. And DO NOT say “Sure, no problem.”
Your objective at this moment is to keep the good will of the employee and the financial standing of the practice fully in tact. Instead, of feeling pressured to give a “yes” or “no” answer on the spot, involve the employee in the process. Take this approach: Erin, to help me make an informed decision, I would like you to provide me with sound business reasons for paying you more. I would like a written list of the contributions you have made to the practice. The purpose of this is to educate staff on the fact that raises are not an entitlement. They are a direct result of practice productivity.
Erin should be able to document a list of recent problems or critical issues in the practice that she has resolved. She should also be able to point to new responsibilities that she has taken on since her last raise. In addition, she should be able to spell out what she has done to increase practice revenues and/or cut costs or save time. For example, has Erin taken the initiative to get patient treatment out of the files and into the schedule? Has Erin instituted a patient education program to inform patients about new or existing treatments that may benefit them? If Erin is the collections coordinator, what proactive steps has she taken to reduce accounts receivables and ensure that collections are at 98%?
Similarly, Erin should be able to expect a few things from you, doctor. Number one: a clear, results-oriented job description. If Erin is your dental assistant, her job description should include things like attending beginning of the day meetings, completing case presentations, reinforcing the quality of care delivered, directing the doctor to check hygiene patients, completing post treatment care calls, converting emergency patients to new patients, turning the treatment room around promptly, etc.
Erin should also know what quantifiable measurements will be used to gauge her performance. For example, she needs to know that you expect her to give a daily report on her post-treatment calls, that she should be converting 75% of emergency patients to comprehensive exams, and that she should be able to keep the cost of dental supplies at no more than 5-6% of practice collections. In addition, you should be able to see the distal of the cuspid on every bitewing X-ray, you should never have to reach for an instrument on any setup, and the models Erin pours should be free of defects. Get the idea? When you and Erin both know what is expected you can better assess if Erin is just doing her job or truly making a difference in the practice.
The other critically important factor in giving a raise is determining if the business can actually afford it. Wages should be in the 19- 22% range of gross collections, not including taxes/benefits, which is typically another 3-5%, or the doctor’s salary.
Next week, steps team members can take to show their worth.
Interested in speaking to Sally about your practice concerns? Email her at email@example.com.
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A McKenzie Management Case Study
Dr. Robert Friedlander- Case Study #279
“I seem to be seeing a sufficient number of new patients in the practice and I am grateful for that. However, I don’t see my production increasing.”
- 12 year old family practice
- Collection to Production rate is 99%
- 8 hygiene days with a 91% retention rate
- 60-day outstanding insurance claims no more than $2,000
- Accounts Receivable to Net Production ratio is 1.27
Sharon, Dr. Friedlander’s Hygiene/Financial Coordinator is doing a great job managing her departments, as noted from the statistics. Kathy, his Schedule Coordinator, does an excellent job of keeping the doctor scheduled to his daily goal of $4,250. However, she shared with me a little secret. “It is getting harder and harder to find treatment to schedule daily in order to meet the doctor’s daily goal. I am really concerned that it won’t be long before I won’t have the patients to schedule, even though we are seeing new patients every month.”
- The average treatment plan being presented to the patient is $3,200.
- Dr. Friedlander enjoys presenting his treatment options to the patients…and the patients understand them if they were a doctor or dentist!
- The treatment plans are not “phased”
- The doctor is concerned about HIS treatment agenda instead of the patient’s agenda
Unfortunately, Dr. Friedlander is not alone in his thinking when it comes to treatment presentations. “I want to dazzle my patients with my “big words”. The patient will be so impressed that they will want to schedule for this treatment that they don’t understand!”
Our observation has been that if a patient doesn’t understand what is being presented to them, they respond one of two ways:
- The patient will ask more questions in order to get more information in order to make a decision, or
- They don’t make a decision. Their response is, “I will need to think about it.”
Recommendations to improve treatment presentations
- Get the patient involved in their own dental conditions by using digital photos and intra-oral cameras.
- When reviewing the existing treatment, call the findings out loud to your assistant in terms that the patient can understand. REMEMBER: most patients understand dentistry on a 3rd grade level.
- Cavities instead of decay
- Old cracked silver fillings instead of fractured amalgam
- Tooth-colored filling instead of resin or composite
- Focus on the patient’s concerns. Dr. Friedlander was concerned about what HIS agenda was instead of the patient’s agenda. If the patient is concerned about a fractured cusp on the front tooth, THAT is their agenda. Give them what they want! Gain their trust.
- Focus on the next appointment and what is going to be done and how much time it will take. Avoid “selling” the patient the entire treatment plan. You will scare them away! If you doubt my statement, ask your staff!
- Here is your script: “Mrs. Jones, as you and I have discovered together, you have some dental concerns. Let’s start with your primary concern, the tooth on the upper left side that is broken. We will place a nice porcelain crown over it that looks like this (have a typodent or an actual model with a crown on it) and you will be very pleased with the results. The crown will serve you for a long time. How does that sound?”
Assistant’s Responsibility after treatment presentation by doctor:
- After Dr. Friedlander dismisses himself from the operatory, now the assistant becomes involved. She reiterates what the doctor has talked to Mrs. Jones about. “Mrs. Jones, do you have any questions about the placement of your porcelain crown that I can answer for you? Great…let’s go up to the front desk and ask Kathy to schedule your appointment.”
- Sharon walks with the patient to the Schedule Coordinator and repeats the information. “Kathy, Mrs. Jones and the doctor decided that the best option to repair her tooth on the upper left side is with a porcelain crown. She will be here about 90 minutes.”
Many patients don’t want to know the full price tag. Mrs. Jones is a perfect example. Her chief complaint was a broken tooth on the upper left side. Do you think that she wanted to hear about the other $4,000 worth of treatment that she needs? She doesn’t know if she likes or trusts you yet. The reason she left her other dentist is because the Financial Coordinator tried to sell her a large treatment plan over $5,000! Of course, performing treatment based on your skill and judgment is not to be overlooked but, listen to your patients and try to take one step at a time to build the level of trust with the patient.
If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email firstname.lastname@example.org.
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Are You Disciplining Employees Effectively?
People are human. Mistakes happen. No matter how skilled, savvy, or well-intentioned, your staff is bound to slip-up at one point or another.
It’s normal to feel uncomfortable with discipline situations because dentists are not trained to deal with the sensitive interpersonal dynamics involved in changing unacceptable employee behavior. There is a temptation to avoid conflict. But face it – a poor employee isn't going to get better unless he or she is made aware that there is a need to improve. By concentrating on the desired results rather than the employee's perceived shortcomings, you can improve the chances of a positive outcome.
The challenge is to use mistakes to impart knowledge, to expand skills, and to develop heightened awareness. Unfortunately for many, the word discipline conjures up negative images and knee-jerk reactions....memories of being grounded and privileges denied. But the word is frequently misunderstood.
The root of discipline is disciple…a student. To discipline means to teach. Discipline is to correct more than to punish behavior. If you want employees to be productive, you have to create a disciplined, teaching environment. Discipline is really a part of overall performance management.
Research indicates that perceived fairness is the key to effective employee discipline. It results in positive attitudes and behavior when it is perceived as being applied in a fair manner.
Raise your employees’ responsibility, promote accountability, and enhance learning.
- Review your personnel manual.
Every dental practice needs sound, straight-forward policies as well as clear and concise job descriptions. Failure to do so leaves your employment-related practices vulnerable to challenges, grievances and possibly lawsuits, particularly if you are inconsistent in how you apply your policies and your pay structure/system. Of course, be sure to communicate rules regularly to employees.
Only in a true emergency should you act without thorough planning. Do your homework. Research the situation until you have verified what the facts are and know that action is necessary. Anticipate how the employee will respond. Practice what you are going to say and in what sequence. Know your own communication style, how you are perceived, and how you will react in the event of a challenge or emotional outburst. The emphasis is on coaching the employee to do better. Knowing what you intend to cover in a face-to-face meeting, and sticking to the agenda, is much easier if you have planned in advance.
- Have a conversation with your employee.
Ensure confidentiality. Discipline should never happen in front of others. Remember the purpose is to teach not embarrass. Identify the problem as you understand it. Be brief but specific. Then offer the employee an opportunity to present their side of an incident. There may be a factor you didn't know about that will help the two of you to solve a problem jointly. Refusing to listen just builds resentment and makes improvement difficult. Be fair to the employee. Consider his or her side of the story and any evidence submitted. Never criticize the individual, but rather focus on the actual behavior.
- Stay focused on work-related issues.
You should act as promptly as possible while the incident is fresh, but you need to make sure you've got the facts. Parties may also need a little time to cool down. The conversation must be business-based to be appropriate. Also, avoid addressing more than one or two concerns at a time. If necessary, schedule another meeting.
There often is a misunderstanding about what and when to document. All disciplinary infractions should be recorded in some form. For minor, first-time offenses, write a note to remind yourself. The employee need not know about this, and it does not require formal entry into a personnel file. If the problem reoccurs or if it is a serious offense, be sure to formalize the process by having the employee sign the document.
Know how you will monitor the work situation to ensure that the behavior change occurs
Discipline normally follows a series of defined, documented steps of increasing severity. The usual sequence is verbal warning, written warning(s), suspension or layoff without pay, and discharge. Only the most serious offenses require immediate discharge, but after careful investigation and documentation. Always confront an employee whenever there seems to be a discipline problem.
You can learn to give feedback well. You must practice to improve your skill level until the complex process of putting together all of this material becomes second nature. Help your employees achieve the overriding mission – to be successful in their careers and in your office!
Questions or problems with your employees? Contact Dr. Haller at email@example.com.
Interested in having Dr. Haller speak to your dental society or study club? Click Here
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