Problem Staff - Are You In Denial?
Dr. Timothy sat across the table from Erica. It was a conversation that was long overdue. Erica had been with the practice for eight years. She was a bright woman. She brought many good ideas. When she was “on” she was impressive. As the cliché goes, she could sell ice to an Eskimo. A patient would be on the fence about treatment and she would start talking to them about the process and the outcome and how the doctor is an expert at the procedure, and invariably the patient would hop off the fence and on to the schedule.
For the most part, patients loved her. The staff, however, not only saw the other side, they felt it, day after day. From where they sat, Erica was a classic manipulator. She was controlling and narcissistic. She had held a variety of roles in dental practices over the years. She started out as an assistant, but didn’t care for the hands-on patient experience. She went to college and got a degree in business with a minor in marketing. She saw herself as an expert on both clinical and management issues. And she eventually talked Dr. Timothy into naming her office manager.
In staff meetings she took over. Dr. Timothy would dutifully gather the team once a month. Each person would be charged with reporting on their respective areas, offering ideas, suggestions, areas to consider for improvement. And there was Erica, never without an opinion, never at a loss for words, or criticism, or thoughts on how all the others should be performing their jobs differently. She justified her behaviors by regularly reminding the group that as office manager, she felt an obligation to ‘clarify’ or ‘set the record straight’ or ‘point out’ … and then she would launch into her latest diatribe.
Dr. Timothy would try to gently redirect Erica, but this high-speed locomotive ran right over the good doctor each and every time. After the meetings, team members would retreat to their respective areas. Dr. Timothy would do damage control and patch the wounds as best he could. Erica would return to the front desk and carry on as if she were queen.
Erica had been a hard worker, but issues arose over the past couple of years that went well beyond her abrasive behaviors with colleagues. She was frequently late for work. She would miss the daily huddle at least twice a week. The office needed another business employee, but no one could work for Erica. The practice had spun through three well-qualified business employees in the past 18 months. The rest of the staff did their best to steer clear, but in a dental practice avoiding a coworker is practically impossible. At least every other week a group of staff would be in a closed-door meeting with the doctor about Erica’s latest affront.
Dr. Timothy had his own frustrations. He wanted to grow the business and was intent on implementing management systems that would enable him to do so. Erica continued to erect barriers. Dr. Timothy wanted to explore cloud-based practice management software options. Erica would promise to do the research, but never followed through.
The list of issues with Erica only grew. The culture in the office had become so toxic that some of the others began to claim that Dr. Timothy was giving Erica preferential treatment and the office was bordering on a hostile work environment. Dr. Timothy knew he had been in denial. He had hoped that the high-performing Erica he once knew would return. He tried to talk to her on multiple occasions asking her to make improvements. Each time, Erica promised she would change. And she would improve for a while, but invariably the difficult behaviors would return.
From where Dr. Timothy stood, he felt he had two choices; neither option was appealing. He could continue to make excuses for Erica and hope that she would change, or he could begin termination procedures. It would be the most difficult and anxiety ridden exercise he would ever face. And it was one that he had tried to dodge for months, if not years.
Sadly, he knew full well that he had become a sideline spectator. He watched as low morale and employee turnover turned his respectable practice into a mediocre office.
Next week, don’t want to fire an employee? Do this instead.
For more information on this topic and more, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
Leadership – How Do You Score?
While traveling in the Midwest this summer, I had the opportunity to visit one-on-one with several dentists at all stages of their careers. One of those conversations was with Dr. “Jacob.” He had called me a few times to talk about some of the McKenzie products and services, but was unsure of what would be best for his practice. When I had the opportunity to sit down with Dr. Jacob, it was immediately clear that he was frustrated and confused.
He explained that he purchased his practice about five years ago in a very nice complex that has various medical and dental services and serves an upper-middle class to higher-end demographic area. His office is modern. The equipment appears to be state-of-the art. The area is stable and is enjoying growth. From all external indicators, he’s well positioned to be very profitable. So, what’s the problem? According to Dr. Jacob, “the competition is killing him.” The other general dentist in the complex is doing extremely well, but Dr. Jacob is struggling.
I asked him several questions and listened carefully as he answered. It became clear very quickly that he didn’t like the direction of the questions, and he really just wanted me to tell him how to fix “the problem.”
Unfortunately, “the problem” is that Dr. Jacob struggles with leadership. He takes continuing education courses maybe once a year, when he can “afford” it. He relies on his business employee to provide him with necessary management reports because he doesn’t know how to navigate the practice management software. He has trouble keeping staff in general, and particularly business staff. He’s says he just hasn’t found the “right” employees. And he laments only half-jokingly that those he has “aren’t exactly the sharpest tools in the shed.”
Dr. Jacob also isn’t sure that the demographics of the area are “accurate.” It seems that his patients aren’t as willing to buy his treatment as he believes they should be. Yet, he dismisses the fact that the office hours are restrictive, employee turnover is regular, he rarely if ever meets with his staff, and he readily admits that he can come across as a little rough. But that’s “just the way I am, like it or not.” And evidently the patients don’t like it, and neither do the employees.
Dr. Jacob is looking for the easy solution, the one product, service, or idea that will “fix” all that ails his practice. What Dr. Jacob needs is to take a good long look at the man in the mirror.
Dental practice leaders are made. They are not born. They may be born to be excellent clinicians, but leadership is something that does not come naturally to most dentists. Yet invariably, it is leadership that distinguishes the thriving practice from the struggling one.
Do you have what it takes to be a great CEO/leader of your practice? How many of these questions can you answer with an unqualified “yes”?
1. I am always learning and taking CE multiple times a year on a variety topics, including clinical and business subjects.
2. I have team meetings regularly – daily, monthly, quarterly, and yearly. Each has a specific focus based on when the meeting is held.
3. I have utmost respect for my team members and they respect me.
4. My employees function as a team; they understand their individual roles and responsibilities. They work effectively together and support each other to get the job done.
5. My employees are engaged in the success of the practice.
6. My team is encouraged to always look for opportunities to improve the practice.
7. We are genuinely committed to excellent patient service. The patients’ needs and expectations are central to our decision-making process.
8. I always share credit for our success with my team.
9. I look at the key performance indicators in my practice at least once a month.
10. I can navigate the practice software easily and readily access the business reports to monitor key systems.
If you answered “yes” to fewer than 8 questions, it’s likely that your practice is not achieving its full potential, and you probably face a number of frustrations as the CEO of your business.
Ultimately, you alone must be accountable for the effectiveness of your leadership. If you believe that your team, your practice and your patients are always falling short of your expectations, take a long look in the mirror. Then commit to make a change.
Interested in speaking to Gene about your practice concerns? Email email@example.com
Recall System Needing an Overhaul?
Recent communication with a dental office manager revealed the following scenario: The dentist owner had decided to limit the number of new patients allowed on the schedule for the week to two, putting new patients on an appointment wait list. A system of calling patients who had not scheduled or had canceled a hygiene appointment had stopped a year ago. “We have no place to put them so why should we call? Our hygiene schedule is booked out for three months solid and new patients want a cleaning with their examination appointment. We have too many patients.”
The quandary is that there were at least one to two cancellations per hygienist a day. Some of these were no-shows, others were cancellations the day before or often the day of. “We can usually fill the opening with patients on our list, but often there is one a day per hygienist not filled.”
No one in particular was in charge of the recall system because it was assumed that if they were booked out, they didn’t need to do anything. On further evaluation it was noted that diagnosing scaling and root planing had dropped off and more patients were put on shorter recall intervals instead of scheduling them for the periodontal therapy. “The reason is the schedule, we don’t have appointments available for scaling and root planing and we have to put everyone on a wait list for those services too.”
Was there really an access to care issue in this practice? Do they really have too many patients? Should they stop the flow of new patients into the practice? Should they ignore the recall system because they are busy enough?
With each hygienist allowed an hour per patient, when an appointment opened up anyone could be appointed - even children under the age of twelve. This was convenient, but not the best utilization of the hygienists’ valuable time. Since they were pre-scheduling based on the assumption that patients would show, it would be more time efficient to schedule based on the individual time allotment needed by the patient. This system would create time to see more patients.
Management studies show that appointments scheduled within one to two weeks of contact have a far better retention than those scheduled six months prior. Many patients would rather you remind them to schedule a month before they are due than to pre-schedule. With the technology of patient contact solutions, it is now far easier to contact patients using limited effort of existing manpower - and at a fraction of the cost of employing an extra person to make outbound calls.
When patients are not pre-scheduled, there is more time to get new patients in to see the hygienist, and also time to schedule scaling and root planing appointments. If the practice continues to pre-schedule, it is prudent to consider blocking time in the schedule for anticipated new patients and for scaling and root planing. If the times are not scheduled, patients on the wait list can be called and offered these times.
With 65-85% of repeat business coming directly from the hygiene department, this is not a system to ignore. In small practices it is the Business Coordinator, in larger practices a Patient Coordinator who is in charge of the recall system. A goal of 25 new patients per general dentist per month in a practice is necessary for growth. Patient retention is often overlooked as important to practice health and growth. Each year there is patient attrition for many reasons, so there should be access to your practice to replace that loss.
In the book “Building a Successful Recall System” by Sally McKenzie, there is a formula for determining how many hygiene days you need per week in your practice. This eliminates the question of whether you have too many patients for the days you are open.
The recall system is the cornerstone of practice success. It is important for patient retention, treatment acceptance and practice promotion. Need help overhauling your recall? Call McKenzie Management today and find out about our Front Office Training Program.
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