10.22.10 Issue #450 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter
 

Hope for the Hiring Dentist
by Sally McKenzie CEO
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When I got off the phone with Dr. Rick recently, all I could do was shake my head and hope that this dentist would make use of the resources available to him and work his way through the crisis situation in which he had found himself. Dr. Rick was in the throes of what he diplomatically termed “a practice reorganization.” In actuality, it was a practice-wide personnel meltdown. The “reorganization” that was taking place, was, in fact, the departure of four employees over the course of six weeks: an assistant, a part-time hygienist, a business employee, and the office manager. He had hired another office manager who was on the job for 10 days and quit. 

Even in today’s economy, there is still no guarantee that your practice won’t experience staff turnover. But this is extreme! A string of bad luck for Dr. Rick? Perhaps. Poor hiring practices? Much more likely. During my conversation with him, we talked about his past hiring practices, how he advertised openings, what he looked for in applicants, and what he did to help them succeed once they were on the job.

Like dentistry, hiring and retaining staff is both an art and a science. Too often, dentists focus on one thing: previous dental office experience. They pay little attention to other key indicators of employee success, such as length of time in previous jobs. They rarely consider the types of employees they are attracting through advertising. Seldom do they test prospective applicants, and rarely do they create an environment in which the new recruit is set up to succeed rather than fail.

I learned that Dr. Rick had essentially hired people with previous experience that he had good feelings about. He considered himself a “hands off” kind of leader. In other words, if the employee came in with previous dental office experience, he expected them to be able to perform. If things were going fine, he didn’t feel the need to discuss performance with his employees. In fact, he preferred that if there were problems, the staff resolved it amongst themselves.

No question, Dr. Rick has been through the practice owner’s school of hard knocks. Now it’s time to put the lessons he’s learned to work for him. If not, personnel crises will continue to plague him throughout his career - I guarantee it. The following is a list of the most common reasons why efforts to retain quality staff are falling flat, and why new hires don’t succeed or merely become mediocre performers.

  • Job descriptions and/or job performance expectations do not exist
  • The personality types of the applicants are not considered
  • Interviewing techniques do not enable you to learn the most about the applicant and their qualifications
  • The dentist embellishes the explanation of the practice and the prospective employee’s opportunities for growth
  • References are not checked
  • The applicant’s skills/fit for the practice are not tested

Before you rush to fill a position or hire an additional employee, heed the now famous cliché: “first things first.” To succeed in the hiring process you must plan to succeed and approach the process as deliberately as you would a dental procedure.

  1. Take 15 minutes and think about what you want the person in this position to do.
  2. Update or write a job description for the position, so it is tailored to attract the kind of employee you are seeking.
  3. Assess what system changes you want to make before you bring in a new or additional employee. Maybe the business manager who just retired was averse to change; consequently, systems became inefficient. Now’s the time get the systems up and running as you want them to be.
  4. Plan to provide training. You are setting yourself up for disappointment and your employee up for failure if you do not provide necessary training. Like it or not, it’s reality.

With professional training, systems are integrated into the practice that establish the means to monitor and measure employee performance and results. Success breeds success, and when staff members can see the ways in which they can achieve it they are motivated to perform to the highest standard. People do not want to fail. Give your new hires the tools to succeed, and you give your practice the means to flourish.

Next week, hiring a quality employee requires planning, use of the right tools, and a methodical process.

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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Carol Tekavec, RDH
Hygiene Consultant
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I Donít Want X-rays!
By Carol Tekavec RDH

All dental clinicians have been faced with a patient who questions or refuses radiographs. What, if anything, can we do to prevent this?  What can we tell them to “convince” them they are necessary and safe?  What if they are worried about insurance coverage? Should the office refuse to treat a patient who will not accept the radiographic exam?

Let’s start with a brief review of a few of the reasons radiographs are necessary:

  1. Radiographs are the only way to reliably view the bone, roots, attachments, interproximal areas, and under and around restorations. Without radiographs, clinicians are working blind.
  2. Radiographs provide a starting point for what conditions exist today, and what changes may occur by the patient’s next appointment.
  3. Detection of harmful conditions such as cancer lesions and abscesses are often impossible without radiographs.

We understand that x-rays are necessary to provide appropriate diagnosis and treatment for patients. We have to have radiographs to do our jobs!

Preventing Patients From Objecting
Oftentimes, getting patients to accept necessary x-rays can be as simple as having the dentist “order” them. A patient may get the feeling that x-rays are being taken as part of a “routine” - that the same protocol is used for everyone.  This perception is common when a new patient is taken into a treatment room for x-rays or a prophy before meeting the dentist. Avoid this by making sure that new patients are met by the dentist in a private office or conference room prior to any diagnostics or treatment being performed.

Following this, an oral assessment can be accomplished by the dentist. After talking with the patient and getting to know his/her concerns, the dentist can say to the assistant or hygienist, “Please take decay detecting x-rays and a view of the patient’s entire mouth for me to look at.” In this way, the patient hears the dentist ordering the x-rays, reducing or eliminating the chance that the patient will refuse them.  If the patient has concerns, he/she can express them to the dentist rather than leaving the assistant or hygienist to address them.

In my experience as a clinical hygienist, when the dentist orders the x-rays, very few patients object, the schedule keeps on track, and it sets a positive rather than a negative tone to the patient’s first appointment. Additionally, current guidelines for exposing radiographs indicate that dentists should order them after evaluating a patient’s health history and a clinical exam. See “Guidelines for Prescribing Dental Radiographs” at www.ada.org. This can be interpreted as a requirement of a dentist’s exam prior to taking any x-rays.

When patients come for their recall appointments, we might say, “As Dr. Smith requested after your previous exam, I am going to take your x-rays now.” Avoid saying something like, “I’m going to take your x-rays now.  Is that ok?”  We don’t want to ask permission or pose a question that the patient can refuse.

“Convincing” Patients That X-rays Are Necessary And Safe
A patient may tell you he/she is worried about radiation. If it is the dentist’s opinion that x-rays are necessary today, the assistant or hygienist might explain: “We cover you with a lead shield to be sure we only expose the areas around your teeth that we need to be able to see. If the dentist does not have these pictures, he/she will only be able to look at the tops of your teeth. He/she won’t be able to see anything else, such as a cavity that is beginning between the teeth. It would be like taking your car to a mechanic and asking what is wrong with the engine without opening the hood.”

Patients May Be Worried About Insurance Coverage
Be ready with an appropriate response when a patient asks, “Will my insurance cover these x-rays?” At the morning meeting, try to determine whether the patient’s insurance typically covers x-rays at today’s appointment interval. If yes, we might say, “While we can’t ever be positive; your insurance usually covers decay detecting x-rays once a year.” If the insurance probably will not cover them, then, we can say, “Your insurance will probably not cover these x-rays. However, it is our job to take care of you properly. It is the insurance carrier’s job to pay only according to your employer’s contract limits, regardless of what you actually need.”

Should You Treat A Patient Who Won’t Accept Radiographs?
Although this may seem drastic to some, from a legal standpoint this may be the best policy. Even if a patient has signed a form stating refusal of x-rays as a personal preference and understands that the dentist cannot treat him/her properly; no patient can legally give consent for a dentist to be negligent. The dentist is liable for improper diagnosis and treatment, even with a “refused x-ray consent form.” A patient can always refuse any treatment or procedure; however, the dentist may also decline to treat that patient. If this happens, elaborate documentation in the patient’s record is recommended. A dismissal letter should also be sent to the patient with wording emphasizing failure to treat some dental conditions may result in “permanent, irreversible damage to your dental health.” Offering appropriate care for patients is a basic function of a dental practice, and dental x-rays are a necessary requirement for accomplishing this.

Carol Tekavec CDA RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com

Carol is also a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

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Imprive your hygiene performance one day... in your office


Nancy Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Are You A Boiling Frog?
By Nancy Haller, Ph.D., Leadership Coach McKenzie Management

It’s been said that if you drop a frog into boiling water it will instinctively jump out. But if you place the frog in a pot of cold water and gradually increase the temperature, the frog won’t notice the water getting hotter; it will sit there until the water boils. The fate of that poached frog may be like some dental leaders who settle into a routine or let small conveniences solidify into large habits — and allow inertia to set in.

According to zoologists, the story is folklore. An actual frog submerged and gradually heated will jump out. However, some research experiments appear to corroborate one underlying premise - that a submerged frog will stay still when heated, but only as long as the heating is gradual enough.

What this metaphor does illustrate is the danger of not reacting to small but important performance problems. In my work with dentists, I frequently hear, “I just want to do dentistry.” The last thing they want to deal with is the “problem” of having employees. I am called into crisis situations because many doctors avoid the reality and necessity of being a leader. They abdicate their responsibility.

If you’re like many dental leaders, you have a common reaction when one of your employees is a problem… let’s say one with a “bad attitude.” Rather than concentrate on the specific behaviors sending your blood pressure into the stratosphere, you find someone to vent to about it. It might be a colleague or a friend and almost always your spouse. In a moment of courage you might make a subtle comment to the difficult employee, hoping they “get the hint.”  If the timing is lucky, you may include some kind of vague statement in a performance review. The bottom line is that it’s more comfortable to avoid talking about it.

No one relishes the idea of giving bad news, especially when it has to do with someone’s poor behavior. Unfortunately when dental leaders hesitate, procrastinate or even abandon their leadership role, problems gradually get worse. The people who experience the bad behavior, first-hand, have a drop in morale. The doctor loses credibility for not taking constructive action. Loss of production and productivity follow. Before long, patients notice the tension in the office environment, and the stakes grow higher and higher with each passing day. Poor behavior that doesn’t get addressed early on will heat up if ignored. Like it or not, you are the dental leader and it’s your job to deal with people problems. All too often crises happen because warning signs are ignored, overlooked or minimized. That sends a message that unacceptable behavior is acceptable.  Situations that are “mole hills” grow into “mountains” when you don’t address them quickly.

Remember that every situation offers choices about how you choose to frame and interpret your employees’ actions. And, choices about how you will respond. Choose to act from a rational approach, one that is based on objectivity. When you open a dialogue with your staff, you collaborate with them to find a solution.

To improve your skills in being a leader, focus on one or two actions that seem most promising.  Be patient with yourself. New skills seem awkward at first. With practice, you will begin to feel more confident. Most importantly, recognize the progress you make. Celebrate incremental steps toward fighting complacency.

It takes just as much effort to be a good leader as to be an ineffective one, and it's a whole lot more pleasant and rewarding. Since you are a leader anyway, you might as well be a good one. Set upon a course of self-development that includes improving your leadership skills. Remember that you have two jobs – 1. You must accomplish the dentistry, and 2. You are responsible for leading your team of employees. Be sure to develop the skills that will help you be better at both. 

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

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

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