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12.02.05 Issue #195  
Holiday Bonuses Have you Seeing Red or Green?

Sally McKenzie, CEO
The McKenzie Company

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Ah yes, the holidays are upon us. They should be the opportunity for doctor and staff to celebrate another successful year as a thriving and productive team. They should provide the chance for the group, which has carefully monitored the systems, to plan a celebration that the practice can afford and the entire team, including the doctor, can enjoy. And a round, bearded man in a red suit should soar through the moonlit night bringing gifts to all and to all a goodnight.  

Unfortunately, what should be seldom is. December is often the most stressful month of the year and it’s not just because you’re busy checking the list of who’s naughty and who’s nice. Production looks as bleak as mid winter. Patients are canceling appointments giving you as many silent days as silent nights. The clinical staff is more interested in decking the halls than dealing with patients. And collections are still, still, still not happening.

Doctors, meanwhile, are feeling added pressure. It’s the time of year in which you are expected to show appreciation to your team members. Scrape your pockets, dig under the seat cushions, and hand over a chunk of cash. It may feel like a pound of flesh, but at least you’ve fulfilled your obligation.  This is no easy undertaking. Like Santa’s overflowing bag of goods, many have to stuff a year’s worth of thanks into one single gift, hence the pressure to make it really, really special – more zeros than you can begin to afford.

Indeed, often doctors use this season of giving in a desperate attempt to make up for the long days, 15-minute lunches, lack of leadership and direction, and near total absence of team appreciation that is standard operating procedure the rest of the year.

But you have it all planned out. You’ll treat them to a nice lunch, maybe order something in from the sub shop down the street. You’ll put on the red hat, maybe throw in a little “Ho, Ho, Ho,” And you’ll hand each individual employee their very special bonus gift.  You can see the looks on their faces now, each one carefully opens the envelope and examines the amount written on that nice, fat bonus check. Yes, siree, Santa Claus has come to town. And you should be numero uno boss in their eyes … for about the next 30 seconds.

Unfortunately the reception to your outpouring of generosity is more likely to feel like someone just let Frosty the Snowman in. Even if you do it up big with limousines and expensive dinners and gifts, showing appreciation once a year will cost you far more than if you would step back and take time each day to recognize the work of your team. Congratulate Dianne on her excellent performance when she fills that last minute hole in the schedule. Recognize Mary in the staff meeting for whittling accounts receivables down to acceptable levels. Thank your assistant in front of the patient for taking truly superior bitewing x-rays. Celebrate your hygienists’ success in incorporating an interceptive periodontal therapy program. 

Next week, the perfect gift isn’t always green.

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Doing the Right Thing and Getting Results!

Dr. Nancy Haller
Executive Coach
McKenzie Management

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Dear Coach,

I’m trying to ‘do the right thing’ from a management perspective – to counsel and develop employee relationships - but I keep losing substantially, income and emotion.  I keep thinking about my old retail supervisor – he was tough, told people he was tough up front, they could get on board or transfer to another department. He was one of the most successful people with the most loyal employees. I really wish that strategy worked today. Do straight shooters ever get ahead now-a-days?  

Yes, straight shooters certainly do win. Direct communication is an essential skill for dental leadership. A successful practice means dealing with problem employees firmly and in a timely manner. Successful dental leaders also need to make negative decisions when all other options fail. Dealing effectively with troubled staff is a leadership job requirement.

Keep in mind that it’s not only ‘what’ you say but ‘how’ you say it that impacts outcome. The smaller the gap between ‘intention’ and ‘impact’ the more constructive your message will be.

Intention is the purpose or goal of your communication. It is the essence of what you want to tell someone else. The impact of that message is based on ‘how’ you express the information. And it is the impact more than the intention that gets results.

It sounds to me that you have been living under a cloud of frustration and fear. That is likely to widen the gap between intention and impact. The biggest challenge in communication comes when you are under stress, when you have unmet expectations. If you try to talk in the heat of the moment, you are likely to say things that you later regret. The message gets lost in emotion.

To increase the likelihood that your intention matches your impact:

1. Clean your ‘filter.

Just like routine maintenance on your car, take time for self-reflection  Leaders first and foremost need to examine themselves…how they think, behave, impact others. Your message passes through a filter, just like the oil in your car’s engine. If the filter is clogged with debris, the communication outcome is dirty too.

2. Be a straight shooter but don’t shoot from the hip.

Think through the main idea you want to express. Prepare and plan how you want the exchange to go. Organize supporting thoughts or facts so that they lead to your main point. By being concise and clear you increase the likelihood that you have a positive impact and your message will be heard.

3. Keep the balance between positive and negative feedback 3-to-1.

Feedback is designed to tell people when they are ‘on course’. Being tough is as vital as being appreciative. Catch employees doing things right. Let them know you noticed. Give value to that behavior by linking it to the overall mission of your practice. Even when you need to voice negative feedback, start the conversation by identifying three behaviors you appreciate about the person. Then define the one area where there is room for improvement. Be calm and objective.

4. Ask employees to give you feedback.

Create a culture of feedback. Negotiate.  Ask your staff to rate you on what you are doing well, what you could do more frequently, and what you should stop doing. By requesting their input, you build a “win-win” atmosphere.  As you listen to their feedback, remain non-judgmental.  Show concern and avoid interrupting.  Paraphrase what they have said if you need clarification, or simply to confirm understanding.

By integrating intention and impact, you will harmonize your interactions and create a more positive environment in which to work. People won’t remember whatyou said as much as how you made them feel.

Dr. Haller can be reached at  Dr. Haller provides Executive Coaching for McKenzie Management and conducts one-on-one leadership training.

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New Protocol.Existing Patients

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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Educating and teaching new patients about the office protocol is easy. These are patients that do not know what the original protocol was, and do not have an idea of how the protocol in your office works.

After practicing dental hygiene full time for 17 plus years I have to say that it is the existing patients that are harder to work with when introducing new protocol into the office. Yes, the trust is already established, but change is a scary thing for everybody. Many people are not tolerable of change and will fight all change in their life. So, it is up to the dental professionals to help the patient through this time, and to help with educating them on why change is good. This may take a little time, but it will be time well spent.

When asked by the existing patient, “Why hasn’t this procedure been done before?”, emphasis about advances in research and the development of new procedures is a great way to educate the patient.

Here is an example presentation that can be used as the framework to build on by the staff.
 “Ms. Jones, there have been many recent advances in research, resulting in the development of new and exciting procedures in dentistry! One of the most beneficial procedures is the screening process that enables us to detect gum disease in the earliest stages. As a result, a conservative therapy can be performed before the disease and infection are allowed to progress. Although we monitor your gums at your recall appointments, many factors can affect your health. If you have been experiencing stress or your immune system is depressed, the progression of the disease may be affected. It is our commitment to screen all our patients on a regular basis since treatment in the earliest stages is the most successful.”

This verbiage is designed that you may modify the above words and find the conversation that best suits you.
The patient may bring up the question, “How could my gums be this bad…they don’t hurt?Using the comparison of high blood pressure and how serious this medical condition can be is very effective. Most patients can relate to this and are aware that high blood pressure is often painless, yet possibly life threatening.

“Ms. Jones, gum disease is often painless until the final stages. Do you know anyone that has high blood pressure? That condition is often painless and until detected by your doctor may go unnoticed, yet it is certainly a very serious condition! Just as you would be concerned about your blood pressure and getting it under control, the same applies to the health of your gums and supporting bone. If undetected, the first sign of high blood pressure is often a heart attack! I would not want the first sign of gum disease to be the loss of your teeth.”  

Another very common question a patient may have is, “I have been coming in every three months for cleanings why do I need periodontal treatment now?

Your answer may be along these lines, “We have been trying to prevent the progression of the pockets in your mouth. Now we are implementing a new method that may reduce the pockets without surgery. Not all pockets will totally improve with this new treatment that we are providing now, but there is evidence that this procedure has had great success! However, we may still need to refer you to a gum specialist if we do not get the results wanted.”

Even when patients are found to have healthy gums it is a good idea to explain the office’s commitment and protocol to treating periodontal disease. Why? This may motivate that particular patient to continue the quality of home care they are currently doing in order to prevent them from ever needing periodontal therapy. In addition to motivation, it may incline them to refer their spouse in as a new patient in order to be evaluated for gum disease.

Brief presentations that address all of the patients concerns are best. I would suggest that the clinician not be the one that presents fees, insurance information, or any payment options. The Financial Coordinator best does this and then treatment will ultimately be scheduled with the Hygienist.

When treatment planning periodontal disease, it is always a good idea to remind yourself that, regardless of insurance and insurance limitations, the patient has the right to know what the optimum care is they should receive. It is their choice how they want to continue with treatment. It is our job as a dental professional to educate the patient so they can make the most informed decision.

Next, we will look at how all of the information provided thus far may be utilized to convert a prophylaxis hygiene department into a periodontal based hygiene department. 

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