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3.03.06 Issue #208  
If You Talk the Talk They'll Walk the Walk

Sally McKenzie, CEO
The McKenzie Company

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 “Feedback? Well, of course, I give feedback, each year during the salary review.” Sound familiar? Many dentists believe that the annual performance/salary review constitutes feedback. What they don’t realize is that the two are and should be, completely different exercises. The salary review is a once-a-year discussion about the employee’s pay. Feedback is an ongoing discussion about the employee’s success.

It’s not uncommon for doctors to save up 12 months of what should be day-to-day feedback for that brief annual session, yet they can’t comprehend why the employee doesn’t seem able to maintain any lasting improvements in their performance. They might get better for a short time but before long they’ve fallen back into the same poor habits. What the doctor doesn’t realize is the annual feedback approach is a bit like committing to an exercise program one day a year and wondering why your pants are still too tight for the remaining 364.

In other cases, the doctor sees no need to engage in much of any discussion regarding performance with the employees. The practice is moving along just fine. The staff gets their yearly pay hikes and everyone should be happy, reasons the doctor. He’s provided all the feedback necessary to employees. What could be clearer than cold, hard cash?! Many things, but for starters, money is not feedback, and it’s not the motivator you may think it is.

In fact, a recent article in Fortune magazine reported that the top three workplace motivators for the GenX workforce, those employees born between 1964 and 1977, are not cash, money, and greenbacks. They are “positive relationships with colleagues, challenging work, and continuous opportunities for learning.” Money was ranked third from the bottom on the list of 15 job characteristics. Certainly, for many dentists it’s much easier to tack a few extra percentage points on that annual salary review and call it “feedback.” Now employees want relationships! What’s next, group hugs!

Actually, employee feedback is an excellent tool for building solid employee relationships and can provide multiple learning opportunities. What’s more, it can enable dentists to make huge strides in shaping a quality team. But it requires that you look at employee feedback not as an annual task but rather an ongoing process. “But Sally, if someone is doing something wrong I tell them.” Unfortunately, that would be the second worst type of feedback to give employees.

The only feedback to rank lower on the scale than negative feedback is no feedback at all. If employees only hear from you when things are not right they become resentful and defensive. And when there is no feedback teams are left to wonder about how they are doing in the eyes of the doctor, they begin to fill in the gaps themselves. You may be perfectly happy with an employee’s daily performance, so you never mention anything. All is well from your standpoint. However, the employee may perceive your silence as quiet discontent. They feel their contribution is not valued and are more likely to explore other employment options where they believe they can contribute to the success of the business and grow as a professional.

Employees want to know where they stand. They want to know how they are doing on an ongoing basis. Constructive feedback given regularly helps employees continuously fine tune and improve the manner in which they carry out their responsibilities. It’s also the dentist’s most vital tool in shaping and guiding average employees into effective, high-performing team members. But expecting anything constructive or positive to come out of annual or biannual doses of feedback is like expecting a well-toned physique after a couple hours in the gym.  Doesn’t happen.

Next week make the most of every opportunity for feedback.

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

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To Have...or Not To Have an Office Manager
A McKenzie Management Case Study

Nancy Caudill
McKenzie Management
Senior Consultant
McKenzie Management

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This two doctor, middle America, general practice contacts McKenzie Management with concerns of “things not getting done.”  The names have been changed to protect the guilty and the innocent!

Drs. Bowman and Jones’ Story:

Dr. Bowman called and was very stressed and anxious!  “We have three employees at the front desk and nothing seems to get done.  Cheryl, one of the three, is our office manager. She has been with us for a long time and is very loyal but……. she doesn’t seem to really know what the other two are doing.”  “We never know if tasks are getting accomplished.  We communicate our concerns to her so she can address them with others but we don’t see any improvement.”  “We realize that she is busy scheduling patients and answering the phone but she IS the Office Manager!  That’s what we hired her to do!”

The “facts: of the matter:

  • 2 dentists, 2 hygienists, 4 assistants, 3 business staff
  • Dentists also own small apartment complex
  • $300,000 in outstanding insurance claims
  • 4 days of hygiene
  • In practice 22 years
  • Low production by all

In-office Observations:

Cheryl had been working with the doctors for a few years and the patients liked her.  Her work station was the “hot seat” where patients are checked in and out.

Inquiring about her daily routine, Cheryl indicated that some duties had been passed down to her from a previous office manager and she was not comfortable performing them without proper training, i.e., accounts payable and managing the small apartment complex.  “There just isn’t enough time in my day to get it all done”, she cried.  “I don’t enjoy confronting other staff when the doctors come to me with business concerns.  I would rather just take care of it myself.”  It was obvious that Cheryl was sinking in quicksand!  Just because Cheryl had previous years of working in a dental practice before coming to this office, did not necessarily make her a human resource manager.  Her inability to confront employees would have been identified through pre-employment testing.

The other two front desk employees, Kathy and Janet, were also located in the same area at the front desk.  It was observed that none of the three knew what the other was doing or what they were responsible for.  Cheryl, Kathy and Janet were all answering phones, making appointments, posting checks, filing charts and anything else that needed to be completed throughout the day.

“Who is responsible for managing the hygiene recall system?” I inquired.  “Whoever has a few minutes,” was the response.  Oh my, the entire business staff was sinking in quicksand!

Recommendations to Drs. Bowman and Jones:

  • Office not large enough for an office manager.  Not necessarily physically, but providers and employees.
  • They needed to departmentalize the business office:
    • Schedule Coordinator – Cheryl
    • Financial Coordinator – Janet
    • Hygiene Coordinator – Kathy
  • Definitive job descriptions for all 3 positions with no overlap in duties
  • Training for all 3 job descriptions.
  • Each coordinator was to report at the monthly meeting on the performance of their own department with statistics relative to their job descriptions by using McKenzie Management’s Methodology.
  • Hire a part-time bookkeeper to manage Accounts Payable and the apartment complex.  While these are tasks that need to be done, the effort put to them does nothing to improve the growth of the practice.


The doctors now go directly to the coordinator of the department they have a concern with.  The business staff is empowered to perform to specific expectations and is held accountable. 

What gets measured……will get done!

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Three Demographic Facts You Ignore at Your Peril

Scott McDonald

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“I don’t need to look at my demographics. I already know my area pretty well.”

If only it were true!

People are a moving target. The patient base upon which all practices draw, changes far faster than most dentists assume. Many professionals with whom we work find that their new patient count is dropping with no explanation. Their tried and true marketing program doesn’t deliver any more. The basic assumptions of patient behavior seem to have shifted. Why?

“Demographics” is a dynamic science. In short, because people are changing the way they live and where they live and HOW they live. If one does not take a serious peek outside the operatory to see what forces are affecting their local practices, they may wind up with a nasty surprise.

So what do dentists need to keep track of from time-to-time in their communities?  There are three facts about EVERY practice area we believe need to be watched:

  1. Housing
  2. Employment/Economy
  3. Psychographics

Let’s look at each separately:

Most dentists have some vague notion of how many households there are within one mile of their practice. What they often ignore is the ratio of renters-to-owners, apartments-to-single family homes, and the cost of housing. When we see the percentage (and number) of renters increasing relative to the number of owners, there is often a dual change in the credit worthiness of the population (decrease) with an increase in the population. This usually goes along with a drop in the median age of the community. The cost of housing is a significant factor as it will likely effect the demographic character of a patient base more than anything, including the Employment/Economy of a practice area at least in the short term.

If the Dow Jones has a bad day, it will mean nothing to your practice area. If a company that employs 20% of your patients is threatening to close or move, it should get your attention. Nevertheless, we see remarkably few dentists know what the major employers in their area are doing. If an employer that has 2% of the available workers in a five mile area closes, every dental practice in that five miles will be affected, if only indirectly. To put it another way, a community with 25,000 workers would lose only 500 workers (2%). But we know that those 500 workers have a DIRECT impact upon 5,000 businesses and an indirect impact upon another 7,500 or more. While a dentist may have no patients who have lost their jobs, a mere 2% loss of jobs can greatly affect the practice. Where communities are dependent upon a single segment of the economy (agriculture, energy, manufacturing), a down-turn or an up-tick will directly affect the practice.

If demographics are what people ARE (gender, age, income, education, etc.), psychographics are what people DO. Their values and consuming habits will change based upon many real and imagined factors. As an example, if a once vibrant community has little new growth and local residents remain in their current dwellings, the median age of the population will grow older. Where once an orthodontic practice was greatly in demand, it may soon have a hard time filling chairs. The size of the population and the local economy may be stable but the lifestyles of the patient base has shifted.

Of all the most ignored changes, Psychographics may be the most dangerous if not monitored every five years or so.

If you are interested in a Community Overview Report that will help explain what your practice area is like NOW and what it is becoming IN THE FUTURE, go here.  Community Overview Report

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