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12.30.05 Issue #199  
The TEAM Troubled or Terrific?

Sally McKenzie, CEO
The McKenzie Company

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Think about yours. Are you shaking your head in despair or nodding in affirmation? They’re good. They’re bad. They’re so-so.

We spend a lot of time talking about dental teams - their effectiveness, their cohesiveness, their efficiency, their productivity, etc. Google the word “teamwork” and you’ll get 21 million hits. Search for books on teamwork on and you’ll find some 877 to choose from. For all of our interest in teams – dynamics, operations, successes, structures, advantages, challenges, the team is largely in the Neanderthal stage in it’s evolution, still lumbering along. As Ken Lencioni, leadership guru and author of the best-selling book The Five Dysfunctions of a Team, describes it, “Teamwork remains the one sustainable competitive advantage that has been largely untapped.” 

What’s more “teams” are frequently comprised of individuals whose skills are vastly under-utilized. According to J. Richard Hackman, author of Leading Teams: Setting the Stage for Great Performances, most teams generally leave unused enormous pools of member talent.

Many dental teams struggle to truly maximize their effectiveness. They face daily challenges of merely getting everyone on the same page let alone heading in the same direction. Often they simply avoid taking action necessary to create high performance teams. Dentists become frustrated with team members because they don’t like the way employees handle certain procedures, tasks, or patient interactions, yet they routinely make excuses for those individuals rather than constructively directing them. “Patty is new, so there’s a learning curve we have to consider.” “Ellen is great at what she does, but she has difficulty dealing with some people.” “Joe is a really nice guy, but he’s afraid to mention a problem until we have a crisis.”

Conversely, team members complain that dentists don’t give enough direction, feedback, or refuse to hold others accountable. They’ll assert that certain team members get preferential treatment or that the office politics interfere with any real effort to change or improve systems. Some team members will become immensely frustrated with their inability to fix what they see as a problem or inefficiency because the practice has “always done it this way.” Others shun discussion of those issues that make fellow team members or the doctor uncomfortable for fear of making waves.

In reality, oftentimes that group of people you casually refer to as “the team” is actually several individuals doing their best to tolerate each other for 8-10 hours a day. But how do you build the team that not only works together but truly excels together? It starts with a clear vision and a solid plan to implement the vision. The team has to know where they’re going before they can be expected to actually travel in the same direction.

Take a look at your practice environment. Does your office foster a culture of teamwork that is built on trust and respect or does it operate more like a workgroup? Many dental “teams” function more like workgroups. In workgroups, people are primarily concerned with their own job and output. There is little or no interest in what their coworkers are doing. In fact, they see their coworkers as their competition, and they’ll do little to support the competition. This ineffective attitude leads to a loss of efficiency and production. The office often feels disorganized, there is a general acceptance of poor or mediocre performance fueling a –“that’s just the way things operate here,” attitude, and high turnover is common.

Effective teams work toward a common purpose and hold themselves and each other accountable for the team’s effectiveness and efficiency.

Next week, how to make 2006 the year of your high performance team.

Interested in having Sally speak to your dental society or study club? Click Here.

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Auld Lang Syne

Dr. Nancy Haller
Executive Coach
McKenzie Management

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It’s the end of 2005. Another 365 days of life experiences. The completion of a cycle of seasons. And the beginning of a new year, filled with hope and possibility.

Of course this also is resolution-time. December 31st. When people make all kinds of pledges… to exercise regularly, lose those pounds, to refrain from favorite vices. Unfortunately your promises are likely to fall by the wayside rather quickly unless you forget about making resolutions. Instead set smart goals and give yourself a better opportunity to succeed.

As sincere as your spirit might be, talk is cheap. Protestations of positive but vague improvement give you very little direction. To maximize your own development, you need a plan.

Schedule two, 30 minute meetings with yourself in the coming week. These can easily take place in your office or home but consider doing at least the first ‘session’ in a more unique setting. Pick a location that inspires you.

Since I am fortunate to live near the Pacific Ocean, for me it’s an early morning walk on the beach. The sights, the sounds and smells of the sea are as humbling and comforting as they are motivating and invigorating. You might find your inspiration during a hike in the mountains, a quiet walk in the snow, or on a Harley, perhaps a Jacuzzi or bubble bath. The point is to help yourself feel calm and relaxed, and to draw in all your senses.

The purpose of the initial 30 minute ‘meeting’ is to consider the things you want to improve in your life. What do you wish for in 2006? It’s okay to dream and have lofty ideas but then whittle your plan down for the coming year. In other words, be realistic about what is reasonable for you to accomplish in the next 12 months. You might want to take a small notebook or tape recorder to capture your thoughts.

The second 30 minute period is dedicated to translating your images, words, ideas from session #1 into specific, measurable behaviors that have a finite time frame. These are concrete action steps that you are willing to commit time and effort to do. Enter these goals into your electronic or paper calendar as a testament to the self-contract you are making. Post a copy of your plan on your computer with its own icon so you’ll have quick access to it during the day. The more you remind yourself of your commitment, the greater your likelihood of success.   
Remember, set yourself up to achieve your plan by using SMART goals.

  1. Make your goals specific.
  2. Describe goals in measurable terms.
  3. Establish the actions that will enable you to accomplish your goal.
  4. Be realistic.
  5. Set time frames for goal achievement.

To track your progress, it is important to evaluate yourself periodically. A good span of time tends to be 30 days, or one month. Review your goals and the commitments you made for behavioral change. Be objective when you assess yourself. If you are courageous, ask others for feedback to know if you are working on the right action steps.
By dedicating a little time to design a viable plan you’ll be putting yourself in a much better position to get where you want to go.
Wishing all of you a healthy, happy and SMART New Year!

Dr. Haller is available for consultation, coaching and facilitating your Team Retreat. Let her help you with your 2006 goals. She can be reached at

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Starting to Utilize Your Protocol Chairside

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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This entire series of articles started with asking if, “Is it possible you have undiagnosed treatment in your existing patients charts, because you do not have a ‘written’ interceptive periodontal therapy protocol established for your hygiene department?”

We have briefly gone over how to establish an interceptive periodontal therapy protocol, and how to introduce it to new and existing patients. We have also mentioned that a protocol of when to refer to the periodontist, and when to treat in your own office would need to be established.

Now we are actually chair side and have to apply all of this information when treating our patients. We have reviewed our patient records at the morning meeting and are aware that Mr. Jones had root planing two years ago, has had adequate plaque control in the past, has been referred to the periodontist every time he enters the office, and has not gone. He has been coming in every three months for his periodontal maintenance appointment. The gingival tissue is still inflamed, pockets have not reduced, and there is lack of stability of clinical attachment. You are aware of all of this before the patient even sits in the chair because of the progress notes, and the multiple letters sent to the periodontist referring the patient out.

Now what? Upon arrival you greet the patient, seat them in your chair, make them comfortable, review their medical and dental history, take any necessary x-rays, (preferably periapicals or vertical bite wings) review past or current x-rays, complete an intraoral and extraoral soft tissue examination, including six point periodontal probing, and note all of this information in the patient’s record. Now, you may want to sit the patient up and explain to them the current status of their mouth. Confirm the need to go see the periodontist and make a notation in the chart if they tell you they will not go to a gum specialist. At this time you may want to recommend to the patient, Mr. Jones, we have been attempting to control your periodontal disease for the last two years by having you come in every three months for a periodontal maintenance appointment, this has been found to be effective in maintaining gingival health. However, you have not obtained the desired outcome of periodontal therapy, you have refused to go to the periodontist, which is the optimal treatment you need at this time. Therefore we need to look at alternative treatment. I must inform you that this is only a limited therapeutic program, and that the outcome with limited treatment may be less favorable. At this time if you are still unwilling to have surgical treatment then non-surgical treatment is another consideration. This will not be as effective as surgical but it has been shown to slow the disease progression. I recommend we go ahead and start root planing today. I will have Sandy, the financial coordinator, go over the financials portion with you.”  This verbiage is designed that you may modify the above words and find the conversation that best suites you.

 No matter what, treatment plan the recommended treatment and have the financial coordinator go over the financial options with the patient, and have the patient sign that they have been informed about their periodontal condition. If the patient refuses to do the treatment today go ahead and treatment plan the recommended treatment, have the patient sign that they have been informed about their periodontal condition and the recommended treatment, and go ahead with the periodontal maintenance. During the appointment reiterate the need for treatment and that they can start it tomorrow or within the next week. Remember you want to answer their questions and help to relieve them of their questions involving the need for the treatment, any fear, or financial concerns they may have.

Once treatment is complete if the desired outcome has not been reached you may want to re-refer the patient to the periodontist. If they refuse again, you may want to inform them at this time, Mr. Jones, as you know we are still recommending that you go to see the periodontist. However, since you have refused to go we may want to look at doing the root planing on a regular interval in order to continue to slow down the disease process. This is not the optimum care, but it may help you to keep your teeth a little longer. There is no guarantee on how long that may be. In the mean time if you change your mind about seeing the periodontist here is a referral card to the periodontist we recommend.” As the clinician, make sure you write or note the referral in the patient’s record.
Once you start utilizing your new interceptive periodontal therapy protocol chair side you will be amazed at the amount of treatment that you will be recommending to your existing patients. Constant evaluation and reevaluation of periodontal disease is required on all patients.

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