I Can't Fire Her - She Knows Too Much
We’ve heard the phrase many times… “Familiarity breeds contempt.” The new employee “Rita” comes on board. She is bright and enthusiastic. Her responsibilities increase over the years. She has her way of doing things. Before you know it, she’s been there 15 years and knows the practice better than the doctor does.
The problem: That once bright, young, enthusiastic employee has turned into a stubborn control-freak. She challenges the doctor and staff regularly. She’s negative, difficult, and regularly refuses to comply with routine requests - and the doctor has finally had enough. He spent the better part of the last two years - yes, two years - making excuses for her to the remaining staff who actually didn’t quit in disgust. “She’s going through a difficult time.” “She really is (was) a good employee.” “You just have to look past her shortcomings.” “You have to admit, she’s very good with the schedule.”
According to Mike Moore, Director of McKenzie Management HR Solutions, this is a common scenario. “The doctor hands over so much responsibility to a key employee that the individual becomes central to the continued operation of the practice. This person, over the course of weeks, months, years, begins to change and the issues surface.”
In the case above, the doctor wanted to dismiss the employee. Somehow Rita learned of the doctor's desire to terminate her and threatened to sue him for 15 years of back pay and overtime. The doctor was terrified. Sadly, he spent months paralyzed from fear and trying to convince himself he could just live with her disruptive behavior. He couldn't. This one employee was running his practice into the ground.
Eventually, he sought legal counsel and learned that he lived in a state where an individual had only one year to sue for back wages. But even at that, it was still far more than the doctor wanted to pay. Moreover, the entire ugly situation could have been avoided if the doctor had established office policies and procedures in place. He didn't think he needed them, until he needed them.
Difficult employer/employee relationships can also surface when a doctor buys a practice. “We recently worked with a doctor who bought a practice and discovered early on that one of the staff was a very poor employee. The doctor was in the process of implementing policies and procedures. Suddenly he was hit with an OSHA complaint and received a call from the state board of dental examiners. It was never proven that the disgruntled employee was the source of the complaints, but she didn’t like the direction the doctor was heading. For three months the doctor had to document the employee’s performance and give her the opportunity to improve. Eventually, she was terminated,” explained Mike.
When faced with situations in which an employee must be terminated, first and foremost, practices must have established policies and procedures, emphasizes Mike. Second he urges doctors to offer severance agreements. “Severance agreements in which employees give up all rights to sue are valid in every state. Offer a severance agreement with a modest amount of money to put the issue to bed and send the employee on his/her way.” Additionally, notes Mike, the agreement is an assurance that the employee will not disclose confidential practice information or trade secrets. “If someone has been in your practice for a considerable amount of time, they are privy to information that could be useful to another doctor. Unfortunately, we see this in litigation - an employee offers another doctor information in exchange for employment.”
This can be taken care of up front when the employee is hired and confirms that they have read the policies and procedures manual with their signature. “There’s a confidentiality provision in the handbook and they must sign off that they are aware of it and agree to follow it. The same thing can be applied in a severance agreement.”
Mike notes that the amount of severance awarded will vary based on the employee’s position in the practice and how long they have been there. “You may be paying 3-5 months’ salary, but when you’ve been dealing with ‘the employee from Hell’ most doctors would cut their arm off to be rid of this person. A few months’ salary is well worth it.”
Next week, dress codes and other key policies.
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The Importance of Tracking Appointments
“Boy, I have really slowed down over the past 12/24/36 months.” We are hearing this every day from concerned dentists calling in for assistance. Yes - we understand. It seems that when a practice is “busy” (making enough money to pay the bills, fund retirement and go on vacation annually), all is right with the world. On the flip side, when the practice is “not busy” (struggling to meet payroll, having to put the vacation on the credit card and then worrying about how to pay it back, and forget about funding retirement…you are lucky to pay yourself!) all is now NOT right with the world.
I would like to propose that what is broken in your practice now was broken in your practice 1-3 years ago - or more. You just didn't notice it then because you were making enough money to cover it all up. Now it has become much more evident that something different must be done to at least determine what you are doing and what you need to do differently. That is the key!
How many patients are present at the front desk for a recommended appointment each month? How many of them make an appointment and how many don’t? If they didn’t, do you know why? You should! If you are not as “busy” as you used to be and the number of new patients has not really changed that much, then something is wrong. Let’s see if the following scenario applies to your practice:
Mrs. Jones needs a crown on #15. The hygienist found part of the distal cusp fractured, took an intraoral photo for Mrs. Jones to see and brought it to your attention when you performed your periodic exam. You recommended a crown and told her that everything else looks good and you will see her again sometime. Mrs. Jones is “passed off” to the Schedule Coordinator, who is then informed by the hygienist that Mrs. Jones needs a crown on #15 and the hygienist bids Mrs. Jones farewell. The Schedule Coordinator asks Mrs. Jones if she would like to schedule an appointment for her crown and Mrs. Jones smiles and says that she “will think about it” and call back. Mrs. Jones is dismissed.
What kind of record is there of this transaction? At best, the hygienist created a treatment plan for a Crown on #15. Second best, the Schedule Coordinator created a treatment plan and maybe the patient signed it.
What should happen from a tracking/training standpoint?
Second - the hygienist should print a copy of the intraoral photo and give to the patient so she can see the crack (even circle it with a red pen) and keep the photo as a reminder of why she needs the crown in the first place. Ok - I know that some patients don't like to look at their own teeth since they are in denial. Those are the exceptions… and the ones that need to see the photos the most!
Third - The Schedule Coordinator should be more responsive to Mrs. Jones’ statement of “I will call you.” She could say something like, “Mrs. Jones, I know that Dr. Brown is concerned about this tooth since it is cracked. We don’t want it to crack more and become more difficult to repair. I have a great early morning appointment available on Thursday. Would that work for you?”
At least she should have offered to follow up with Mrs. Jones in two weeks. “Mrs. Jones, I know that Dr. Brown is concerned about this tooth due to the crack. Should I not hear from you in a couple of weeks, I know that he will be asking. May I call you if I don’t hear from you?”
The Schedule Coordinator should then confirm that she has the photo of the tooth that needs to be repaired. Maybe even paperclip a blank appointment card to it and tell Mrs. Jones that when she calls in a few days, she can write her appointment on the card. Upon the patient’s dismissal, the Schedule Coordinator “tracks” this transaction on the Appointment Tracking Form, which indicates the date, the patient’s name, the type of appointment it was, whether or not she scheduled, and if not, the plans for follow up.
You may discover that you have a 90% acceptance rate but you are not presenting enough treatment. Maybe your patients don't need treatment. On the other hand, maybe your treatment acceptance is only 60% and the primary reason is financial. You can't fix your problem if you don't know what your problem is. Start tracking your appointment acceptance today!
Is There A Disconnect in Your Practice?
Teaching dental management systems that are the nuts and bolts of the dental practice may sound like a “no brainer” to some dentists who think that the front desk position is about scheduling and confirming appointments. The following is an illustration of what can contribute to failed appointments other than the business coordinator.
Dear Belle,I have too many cancellations and no shows on my books. I get on my front desk person daily about this and I still don't see any improvement. I am getting ready to let her go and look for someone else who can do the job. What kind of person am I looking for?
Dear Dr. Frustrated,
This is an issue that is not that simple to solve. The reason is that it may not be your business coordinator who is responsible for the lack of compliance of your patients. Certainly it is key to choose someone who has the right temperament and skills at motivating patients to accept and commit to the appointment, but what if there was a disconnect before the patient was dismissed to the desk? Take the following scenario (fictional account) and ask yourself if any of this applies to your practice.
Dr. A's office:
CC the dental assistant walks up five minutes later and escorts the patient to the treatment room. She immediately bibs the patient and says that Dr. A will be right there to see her. Dr. A is in the adjoining treatment room talking to another patient about ballgame scores. Ten minutes go by and no one has checked in on Mrs. Bee. The slightly crooked head rest is beginning to become annoying and she has time to look around for signs of unseemliness and notices the stained ceiling tile.
Suddenly, Dr. A enters the room apologizing for making her wait and begins staring at the computer intake screen. “I see that you were referred by Jake T. That was kind of him to send you over. Now what can I do to help you today?” After a brief conversation, Dr. A asks his assistant to take a full series of radiographs on Mrs. Bee. The assistant is not ready, as the hygienist is using the sensor, and she attempts small talk. It is about 4 minutes later that she is ready to take the FMX. CC tells Mrs. Bee that the doctor will be right in to tell her about the x-rays.
Three or four minutes go by and Dr. A arrives, gloving up behind Mrs. Bee. “Let’s see here, Mrs. Bee, I will be calling out some numbers to CC and we will get the information we need to complete your examination.” After this process, Dr. A begins to inform Mrs. Bee of what he has seen in the x-rays. He explains the recommended treatment and tells her that J, the Business Coordinator, will be able to give her an estimate. “We should get started on this upper tooth first as this one is in the worst shape and of course you need to have the scaling and root planing done as well to make sure the foundation is healthy prior to any more treatment. You are scheduled for a routine cleaning today with our hygienist, however, we can instead start with one quadrant of the scaling and root planing. Do you have any questions? Okay, we will get you over to our hygienist, Lee, and he will get started immediately.”
Lee, the dental hygienist, explains what he is going to do today and begins. Afterwards, Mrs. Bee is dismissed and walks to the desk to get scheduled for more quadrants of scaling and root planing. The Business Coordinator finds a 90 minute appointment five weeks out and offers to put Mrs. Bee on a waitlist should anything open up sooner. Mrs. Bee pays for her services that day and leaves the office. She accepts the urgency of the needed treatment but doesn't see that any effort was made to schedule sooner or address the needs of the upper tooth. She is not impressed with the attention and level of customer service that she received, and is not sure that she wants to keep that next appointment. After waiting four weeks and receiving no call from the office, she schedules an appointment with another office and requests her records sent.
How many people were in contact with this patient, and what could have been done to make this a better experience for Mrs. Bee? To prevent disconnects in your practice, enroll today in the Treatment Acceptance course offered at McKenzie Management.
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