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  11.05.04 Issue #139

Poor Patient Dismissal Tough Act to Follow

Sally Mckenzie, CEO
McKenzie Management

       Up goes the chair. Off goes the bib. “Good bye Mrs. Patient. Thank you for coming in to see us today,” says Doctor as he/she dashes out the door. The procedure is complete; get the patient out of the chair as quickly as possible; move on to the next operatory. “Be sure to give us a call if you need anything else,” says the happy assistant as she trots out after the doctor on her way to the next operatory. Anything wrong with how this patient dismissal act is going? What’s the big deal? It’s a perfunctory exercise that every office carries out over and over and over again. You have to keep things moving, right?

Meanwhile at the reception area, Ms. Front Desk is answering the phone, greeting incoming patients, and trying to fill a hole in tomorrow’s hygiene schedule. Here comes Mrs. Patient winding her way toward the front desk alone. Where’s the record spelling out what procedures doctor performed today? It’s not there and she’s not carrying it. Where’s the charge slip telling Ms. Front Desk how much she is to charge the patient? It’s nowhere to be found either. Is Mrs. Patient supposed to come back for follow-up care? Dunno.

Ms. Front Desk greets Mrs. Patient through her gritting teeth. Peering down the hall, she hears the instruments whirring away, quietly seething she wonders silently, “Where in the heck is that blankety blank chart.” Waiting for the patient record, she tries to fill the void with a little small talk. “Isn’t this fall weather gorgeous! I just wish it could stay like this all year.” Whirr, whirr go the instruments in the operatories, still no chart. Mrs. Patient is getting antsy. “Can I just go ahead and pay my bill? I really need to get to another appointment.”

Are you starting to see the problem? Doctor and assistant aren’t taking the time to finish up with one patient before they move on to the next. It’s their responsibility to make sure that the completed patient record is in the hands of the front desk staff before they dismiss the patient. Without it, Ms. Front Desk is stuck having to adlib. The spotlight’s on her to perform, but she can’t. She can’t collect from the patient. She can’t schedule the patient’s next appointment. Instead she can either ignore the patient, which is unacceptable, or she can engage in mindless, time wasting chatter with the patient, which is also unacceptable not to mention grossly inefficient.

Finally in a fit of total exasperation, she is forced to take matters into her own hands. Excusing herself, Ms. Front Desk dashes down the hall. She’s in search and rescue mode now desperately trying to get her hands on that patient record. Streaking in and out of operatories, she searches the lab, hygiene, even the break room before finally discovering the chart on the doctor’s desk - incomplete. There Mrs. Patient stands waiting and waiting. The phone has been ringing but no one is at the desk to answer it, and patients are scattered about the waiting room because no one was there to check them in.

The performance of Doctor and assistant in dismissing this patient is not just a tough act to follow, it’s virtually impossible for the front desk staff to perform at all. And the only thing Mrs. Patient remembers is she had to practically beg to pay her bill and get out of the place.

Next week, make sure you have your act together for patient dismissal.

If you have any questions or comments, please email Sally McKenzie at

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Are You Disciplining Employees Effectively?

Dr. Nancy Haller
Executive Coach
McKenzie Management

        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 putting yourself in a potentially confrontational situation. 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 using 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 then 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.

Recent research has identified perceived fairness as the key to effective employee discipline. Discipline has been found to result in positive attitudes and behavior when it is perceived as being applied in a fair manner.

Here are some practical steps to raise responsibility, promote accountability, and enhance learning.

  1. 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.
  2. Prepare.
    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.
  3. 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.
  4. 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.
  5. Document.
    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.
  6. Follow-up.
    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!

Dr. Haller is available to speak to your dental society or study club on subjects such as interpersonal communication, conflict management, and team building. If you would like information about any of her practice-building seminars, contact her at or 1-877-777-6151 Ext. 33

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The Beat Goes On

From the Patient’s Perspective

         During the late 1990s the “Mozart Effect” sent the long deceased composer’s piano sonatas to the top of the charts. A study at the time had indicated that listening to Mozart resulted in higher scores on certain IQ tests. Although skeptics disputed the Mozart theory, the powerful effects of music on people have long been

documented. While it won’t necessarily make you smarter, study after study demonstrates that in many cases music truly can “soothe the savage beast.” And when it comes to managing anxious patients or simply making patients more comfortable in the dental setting, music can be a supplementary analgesic of sorts.

Music has been shown to be effective in distracting patients from pain or discomfort and as a means of prompting relaxation. In a report issued by the University of Iowa, the author noted that “Music can act as a competing stimulus to pain, thus reducing perceived intensity of pain. Music with a slow, steady tempo can also be used to cue slow, steady breathing and can trigger a relaxation response. These uses of music can be integrated into cognitive pain management protocols during surgical and other medical procedures, (and) during dental care …”

Not only does it benefit the patients, depending on the selection, it also might affect the productivity of your staff. A 1994 study reported in the Journal of the American Medical Association found that when people listen to music in the background, it is very important that they listen to music that they are familiar and comfortable with. While you may choose what you consider to be relaxing music, it won’t necessarily have that affect on your team or your patients if they are not familiar with it or if they don’t like it.

A study of 50 male surgeons was conducted to see if they performed a basic surgeon-related task better and more efficiently while listening to music chosen by the surgeon, “experimenter-selected music,” or no music at all. The test monitored the surgeons’ pulse rate, blood pressure, speed, and accuracy. The selected music was Pachelbel's Canon in D. The studies with music showed significantly better results than the study without music, but the study in which the surgeon selected the music the effectiveness was even greater.

What kind of music is best for your practice? For your patients? That likely depends on a number of factors from age, to socio-economic factors, to geographic location of the practice. What’s more, it’s likely that the selection can’t be narrowed down to just one type of music.

Considering first the patients, although you may or may not have any savage beasts coming into your office, you do have patients that need to be soothed. Many practices have invested in the therapeutic benefits of music by supplying patients with individual listening devices and a choice of musical selections.

Musical preferences are likely to be as varied as your patients. For example, teens and young adult patients may prefer Hip Hop and Rap. These have a strong, fast beat and extremely fast vocal sounds and rhythms. The rhythm can be catchy and people have a tendency to get caught up in the beat.

Or perhaps Country music is the selection of choice. Today country music is perhaps at its highest peak in popularity thanks to mega-stars like Garth Brooks, Reba McIntire, and Faith Hill. Or maybe Elvis is in your building. Rock and Roll continues to enjoy enormous popularity. Your staff may lean more toward Hip Hop and Country, but your baby boomer patients are probably going to be looking for their selection of favorite rock and roll tunes. Swing, of course, would be the music of choice for many WWII generation patients along with crooners such as Frank Sinatra and Bing Crosby.

Blues, Jazz, Classical, New Age, Easy Listening, Honky Tonk, Reggae, there are numerous types of music that can be enjoyed by you, your patients, and your staff. Maximize the therapeutic effects of music by giving patients access to music they are familiar with and enjoy. Consider trying different types of music in your office to determine which provides the soothing or energizing effect you are looking for.


I look forward to each new day with my team, and what we will accomplish today that will create the tomorrow that I want. I am happy because I feel in control again. I am happy because I understand my and my team’s role. I am happiest to have my feelings of fear, for the future of my practice, diminishing daily and being replaced by confidence.

I am looking forward to having my finger on the pulse of my practice again. Thank you McKenzie Management.


Performance Measurements

An easy and effective method to measure your dental employee’s performance

Rating employee performance is a dreaded task for most dentists. Now it will be easier using objective performance measurements that are specifically designed for the dental practice. These extensive, ready-to-use appraisal forms help you measure an employee's performance based on everything from Job Descriptions to Productivity to Work Ethics and Cooperation.

Your Performance Measurements kit includes an extensive workbook with copy-ready appraisal forms and measurement graphs to use for each employee. In addition, you will learn how to determine the number of employees needed for a successful practice, how to design results-oriented job descriptions for all business and clinical staff, use performance charting to objectively measure your employees, and make sound hiring and firing decisions.

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Sally's Mail Bag

Dear Sally,
My employer wants me to sell hygiene related products to the recall patients. I don’t think it’s professional. What is your opinion?
Hygienist from Pennsylvania

Dear Hygienist,
Obviously when your employer asked you to sell products chairside, she did not expect you to dismiss the request. You work for and are paid by the dental practice and if the practice will do better through the sale of products, it is incumbent upon you to do your part. Believe me, when chairside sales are conducted professionally and appropriately, they can be a win-win for both the practice and patient. Look at this example, if you were at your favorite pancake house and you tell the waitress how much you love the flavor of the blueberry topping. She mentions that they have had so many compliments and requests for toppings “to go” they now have bottles of it available for purchase. Do you feel like the waitress is “selling” you? Of course not! She is just providing a “news flash” about the availability of something you might enjoy taking home. This is the key to chairside product sales – offering patients premium products that would otherwise be unavailable to them. Just having the products displayed in your operatory and having the patient use some of the products usually prompts conversation quite naturally. “I am going to recommend that you use this toothbrush, dentalfloss, mouthwash or toothpaste. Just give this “prescription” to Mary at the front desk and she will be happy to fill it for you.” You’ll be surprised by how many patients return thanking you for the recommendation.


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