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Associate Illusions: Wants vs. Realities
By Sally McKenzie, CEO

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We all want to be wanted. Dentists want their patients to want their services. New dentists graduating from dental school want hiring doctors to want to hire them. Practice owners considering associates want prospects to recognize the value of joining their practices.

In some cases, the wants may be so great that they cloud the realities. Sure, the hiring doctor believes his practice is a great opportunity for a new dentist and hopes the young doctor recognizes that. However, he also wants the new associate to take on those procedures that he really doesn’t care for, so he can devote his time to other priorities. He’s also hoping that he can hand over some of the management responsibilities to the new associate. Frankly, he’s tired of the headaches and he’s hoping that the new doc will be a big draw for prospective new patients because new patient numbers just aren’t where they should be.

Conversely, the new associate really wants to work in a practice where she can have a mentor and teacher. She wants to be part of a practice team that is committed to excellence, where everyone is focused on doing the very best job and the patient always comes first. She doesn’t want a lot of pressure to make money right away. She knows that she needs to improve her hand speed and gain greater experience in certain procedures. She wants the opportunity to learn sound management practices from a seasoned expert. 

He wants a cleanup crew, she wants a mentor and guide. Both need to be honest about their wants, or the reality is that this partnership will not serve either well. Doctors and prospective associates need to ask some  tough questions to fully understand the other’s priorities and objectives. The associate needs to understand the doctor’s approach to patient care and management. What is the employer’s philosophy and approach toward treatment planning? Is it something the new dentist is comfortable with? What are the patient base realities? Is this a practice that is struggling or saturated?

Ideally, a new dentist joins a practice that is “saturated,” which means the patient base is comprised of 1,500 to 1,800 active patients. Those are the patients that visit the hygienist at least once a year. A major advantage of becoming an associate in a saturated practice is that oftentimes the patient records are teeming with diagnosed but unscheduled treatment. Additionally, it is common to find many patients overdue for their professional hygiene appointment, which provides an excellent opportunity for the new dentist to meet patients in the practice and begin building relationships with them.

What type of feedback can you expect from the hiring doctor? If the doctor wants to throw you into the deep end and see if you sink or swim, politely exit the interview and explore other opportunities. You want to be in an employer/employee situation in which you are meeting with the hiring doctor weekly for up to six months. These meetings provide the opportunity to discuss difficult cases, management concerns, patient concerns, and other topics essential to ensuring open and honest communication. Committing to weekly meetings is critically important in ensuring that both doctors are on the same page and potential concerns are addressed promptly.

Once each month, the senior doctor and the associate should review key practice indicators including production reports and accounts receivables. The associate needs to know that collections on her procedures are given the same priority as collections on the senior doctor’s accounts.

Certainly, there are situations in which, for whatever reason, the arrangement is not working. Now what? You want to leave on good terms. If you have a signed agreement, it likely states that there is a 30-60 day timeframe in which you inform the hiring doctor of your plans to leave. This enables you to complete cases that you’ve started, with the exception of orthodontics. While you may be eager to exit the arrangement promptly, don’t burn bridges, regardless of your personal feelings for the doctor and/or staff.

For more information on this topic, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
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Nancy Haller, Ph.D.
Leadership Coach
McKenzie Management
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Deal with Conflict in Your Office
By Nancy Haller, Ph.D.

Conflicts between co-workers are a natural part of any business in every industry. However, the real problem in many dental offices is the tendency to avoid conflict. Employees who are drawn to a service profession like dentistry are often compassionate, sensitive people. When disagreements arise, the tendency is to personalize, to take a sharp retort as an attack. From there, mole hills grow into mountains.

Dental leaders typically see these team dynamics as annoying “high school drama.” They bury their head and hope that conflict will just go away. But 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 employees 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.

Comfort levels with conflict differ radically. Some people argue passionately. Some shout and even scream. Others are silent, hesitant to air even the mildest of dissenting opinions for fear of offending anyone. As the Dental Leader, one of your most important jobs is to develop your employees. Normalize conflict and help them to learn constructive ways of resolving their differences.

It's understandable that you may be shy and hesitate to take action. After all, you never know what could 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 might avoid conflict is that you want everything to be 'nice' and pleasant, for everything to run smoothly, for 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 relieved 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.

Don’t let your office become a battleground. Do yourself (and your wallet) a favor.  Address disagreements and problems as soon as they occur. Here are some recommended steps.

1. Adjust your Belief about Conflict
Conflict itself isn’t the problem; it’s the way you respond that escalates or resolves conflict. Certainly we know what “bad” conflict looks like: verbal, emotional, physical violence. But remember that conflict can result in positive change. We gained freedom as a nation in 1776, it enabled us to abolish slavery and women gained the right to vote. Accept that conflict is a natural part of life and deal with it upfront.

2. Communicate, Communicate, Communicate
Nothing gets resolved if people stop talking. Rather than trying to stop conflict, meet it head on. Explore what’s behind the frustration or anger that people are expressing with their words or actions. Ask open-ended questions.

3. Listen, Listen, Listen
It has been said that we have one mouth and two ears because we are supposed to listen twice as much as talk. The power and value of listening, especially in conflict situations, is monumental. When you are in a discussion about conflict, rephrase what you hear to show that you are listening and to assure you heard correctly. Refrain from trying to “fix it” too quickly. Strive for understanding before resolution. Show empathy. Acknowledging employees’ feelings and motives is not the same as agreeing with them.

4.  Be Curious, Not Furious
Our natural reaction to conflict, especially if we feel threatened, is to become defensive. Manage yourself. Stay calm. Use a neutral voice, even if the other person is heated up. Move the discussion to a private area, especially if there are patients in hearing range. Give the other person time to vent. Don’t interrupt or judge what they are saying. Thank them for letting you know how they are feeling and what they are experiencing. Rather than attempt a premature remedy, agree to talk about it after a “cooling off” period.

5.  Work the Issue, Not the Person
When you are convinced that you fully understand the problem, acknowledge where you agree and disagree. Avoid blaming. Use “I” not “You.” Talk in terms of the present as much as possible. Ask, “What can we do to make things better?” Identify at least one action that each person will do, and get commitment for the plan. Set up a future meeting to discuss progress.

Keep the attitude that holding different views is both normal and healthy to a group. Help employees to open lines of communications. Consider an off-site team retreat to improve understanding, tolerance and skills for managing disagreement. In some cases when the conflicts are serious or longstanding, it may be necessary to hire a trained consultant. The bottom line is this: don't ignore conflict. While negative outcomes are possible, well-managed conflict can improve working relationships, help drive creativity and improve productivity.
 
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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Carol Tekavec, RDH
Hygiene Consultant
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Hygiene Production - More than Todays Numbers
By Carol Tekavec RDH

A hygienist is an expensive employee; which is why it is always important to consider his/her compensation against actual production numbers generated for the day. One third of the hygiene day’s production goes for compensation, two-thirds goes to the office. This formula can keep the hygiene department profitable. However, the true picture of what a hygienist can generate in terms of office production is not completely revealed by these numbers. For example:

Sam, age 60, is the owner of a small business, and as such does not have dental insurance. He comes in faithfully every six months, but has been adverse to addressing some of his dental issues. His attitude has been that since he is “old” his teeth don’t need to last too much longer. He has good home care and a nice smile. However, he is missing #19 and the teeth on either side are tilting, as well as some extrusion into the gap from above. His hygienist, Jennifer, has been telling him about implants during his last eight hygiene visits. Sam has said that an implant is too expensive, that the gap doesn’t really show that much, he is eating just fine, and besides that, “I’m too old!”

Not discouraged, Jennifer continues to let Sam know that getting an implant is an option. She explains that it will stop the adjacent teeth from continuing to tilt, the top teeth from continuing to extrude, and that the presence of the implant body will help keep the bone around the gap from deteriorating. Today Jennifer shows Sam a radiograph of the area (just as she has many times in the past) and talks more about the relationship between roots and bone. For some reason, today the explanation strikes a chord. Sam says that his father had a removable partial that he hated. He tells her that the partial got looser and looser, in addition to some of the anchor teeth deteriorating. His father ended up with an unsatisfactory denture. Sam does not want this to happen to him. When Dr. Smith comes in for his exam, Jennifer tells him what she and Sam have been talking about. Dr. Smith explains what Sam might expect with an implant procedure and how his treatment would be handled. Sam agrees to the implant and crown and Jennifer takes him to the coordinator to arrange for appointments and payment.  Why was today different? Why did Sam “suddenly” agree to treatment? 

Sometimes, repetition is the key to treatment acceptance. Other times it is introducing an aspect of care that perhaps had not been emphasized. Both seem to have been at play in this patient’s situation. Jennifer had told Sam many times about the value of implants and how they help preserve bone. However, today’s discussion about losing bone seemed to “click” and be important to his decision. All of our patients have their own primary concerns and when we address them, treatment acceptance will likely follow. 

Joanie, 45, is a professional woman with a busy, busy life. She makes time for her recall appointments, but she is also “that patient” who never puts her cell phone down. Jennifer notices that two of Joanie’s molars are showing cracks in tooth structure adjacent to existing resin restorations. She talks about these while performing the prophy, and when finished, takes two photographs for Joanie to look at. Joanie can see the cracks in living color and huge detail on the television mounted in the treatment room. Jennifer tells Joanie it’s likely that Dr. Smith will recommend full coverage crowns for these teeth. Otherwise cusps can break and nerves can be exposed. While Jennifer talks about what might be recommended, she also explains that Dr. Smith will make that determination. When Dr. Smith comes into the treatment room, Jennifer tells him what she and Joanie have been talking about and shows him the photos. Dr. Smith confirms that full coverage crowns are recommended. At this point Jennifer interjects that Joanie is so busy…what might be done to expedite her time. Now Dr. Smith can explain that the office CAD/CAM capability will allow for a one-day prep and cementation for the crowns, a big plus for Joanie. She agrees to the crowns and schedules an appointment for next week.

A hygienist gets to know patients and often grows to understand what is important to them. Knowing Joanie’s time constraints enabled Jennifer to help Dr. Smith highlight the fact that crowns could be prepped and cemented in one day. This made it much easier for Joanie to say “yes” to treatment.

While both Sam and Joanie were scheduled for adult prophys, four bite-wings, and a recall exam, far more was accomplished during their appointments. Just for discussion’s sake, let’s say that the total logged into production was $215 for each appointment; ($100/prophy, $55/4 BWS attributed to hygiene production and $60/recall exam attributed to doctor production). While those figures show what was generated today, what about what will be generated next week? For example, $1200 for implant placement, $1000 for the implant crown for Sam. For Joanie, $1000 x 2 for two full coverage crowns is scheduled. Total production = $4200 for the office. 

The hygiene department provides a valuable service by providing patients with preventive and therapeutic treatment. In addition, identifying concerns and possible solutions helps patients to receive the restorative treatment they need. Hygiene services plus input on necessary treatment makes the hygiene department very important to overall production. Hygiene production is not just about today’s numbers. It is about continuing to support and fuel general office success. For more information on how you can improve the hygiene department in your practice, view our Hygiene Performance Program HERE.

Carol Tekavec 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.

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