7.6.07 - Issue # 278 Forward This Newsletter To A Colleague
Employee Firings
Outstanding Employees

Employee Firings Need Not Burn
This is the third in a four-part series on hiring and firing in the dental practice.
by Sally McKenzie CEO
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It’s the stuff sleepless nights and angst-filled days are made of. For most employers, dismissing a staff member is the most anxiety ridden of all management responsibilities. In dental practices, doctors will go to great lengths to avoid even the slightest staff conflict and the thought of confronting an employee can be utterly paralyzing for those who got into this profession to “do the dentistry” and nothing else. Consequently, many dentists will tolerate low morale, inappropriate behaviors, and utterly ineffective systems as well as considerable personal misery. 

Certainly, every effort should be made to help employees succeed so that staff dismissal and attrition is minimized. In fact, if you implement a few common sense human resources strategies, you’ll make significant strides in reducing the number and level of employee headaches you’ll have to face. For example: 

  1. Provide clear job descriptions to employees, so they know exactly what is expected of them.
  2. Train new employees but don’t overwhelm them. The new hire will be far more likely to succeed if the training program allows them to assimilate information and tasks at a steady rate rather than a rapid-fire pace.
  3. Give the employee some form of personnel policy manual. This document spells out the office code of conduct, dress code, policies regarding tardiness, overtime, sick leave, office policies and procedures. All employees deserve to know the rules of the game and what they need to do to continue playing.
  4. Give ongoing direction and constructive feedback. Too many practices wait until there’s a problem or crisis before they give staff any feedback.
  5. Be specific. Don’t candy-coat the feedback and don’t beat around the bush. Tell employees what they’re doing well and what needs to be corrected. 
  6. Know when to cut your losses.

All that being said, there are times when an employee – new or long-term – simply must be dismissed. They may fail to follow established office policies; they may be dishonest, argumentative, or difficult to get along with. They may fail to carry out responsibilities, or they may refuse to be a team player. They may gossip about patients, the doctor, other team members or bring down the practice morale with snide comments and cutting remarks. They may be late routinely or divulge confidential information. They may not follow directions or they may be secretive about steps they take in performing their responsibilities so as to make themselves seem irreplaceable. Unfortunately, there are a multitude of reasons why some employees don’t work out.

Whatever the reason, problem employees need to be dealt with directly and clearly using a system of progressive discipline. Unless the employee’s behavior is so egregious that you are forced to take immediate action, the team member should be given the opportunity to improve her/his performance over a 60-90 day period. But don’t just call them aside and encourage them to try a little harder. Explain to the employee verbally and in writing the specific issues that are not satisfactory and document exactly what needs to change in the employee’s performance.

With the employee, develop an agreement that spells out what she/he needs to do to improve performance. It should be in writing, signed by both doctor and employee and placed in the employee’s file. Monitor the staff member’s progress, give regular feedback, and document every step and every conversation in the process.

If the team member is violating established practice policies, such as coming in late, leaving early, disregarding patient protocols, etc. note the incident with an “Employee Performance Notice” or similar document. The warning notice states specifically the type of violation committed. It also should include an area for the employee to acknowledge or deny the incident and provide her/his version of what transpired. The notice also should state exactly the type of disciplinary action that the practice will take – warning, suspension, termination, or other. In addition, it prescribes what the consequences are should the incident happen again. And, finally, it includes a signature line where the employee signs, confirming that they fully understand the notice, its purpose, and the repercussions.

Ideally, at the end of this 60-90 day progressive discipline plan the employee has had the opportunity to see the errors of her/his ways, make the necessary improvements, and everyone lives and works happily ever after. Unfortunately, the fairytale ending seldom occurs.

Next week, walking through the fire.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club? Click Here.
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Nancy Caudill
Senior Consultant
McKenzie Management
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Is Your Employee ‘Outstanding’ in Your Field?

Dr. Sam Stout – Case Study #127

  • Dr. Stout owns a general family practice in a midsize community in the western half of the United States.

Dr. Stout came to McKenzie Management with several concerns but one issue that was really nagging at him was expressed this way:

 “I have an employee that has been with me for 8 years.  I haven’t given her a raise for the past 2 years for various reasons.  She is asking for one now and I feel that we need to evaluate her salary.  I don’t want to pay her more than the “going rate” in our town.”

It is important to observe that experienced, peak performing, “top notch” employees generally are not paid… “going rate”.

Let’s look at some practice facts for Dr. Stout:

Dr. Stout’s practice facts:

  • 15-year old established practice
  • Renee, the Practice Coordinator has been with the practice for 8 years
  • Collection to Production percentage is 98.5%
  • Accounts Receivable ratio to Net Production is 1.2
  • Hygiene Retention is 85%

Renee was Dr. Stout’s only business employee and it was obvious during the on-site analysis of Dr Stout’s systems that she was good at what she did.  As I continued to analyze the practice statistics, it was also obvious that she knew how to collect money, stay on top of insurance claims, keep the hygienists and doctor busy, and manage the accounts receivables.

At dinner on Monday evening after spending the day with Renee, I said to Dr. Stout, “Doctor, Renee is an outstanding employee.  Did you know that?” 

“Well, the patients really like her and she has been loyal to me.  She always comes in on time and doesn’t miss very much work due to illness.”

Now doctors, this is NOT the definition of an “outstanding” employee.  This better describes the doctor’s pet dog…loyal, comes when you call, seldom sick, etc.! Dr. Stout has a Practice Coordinator that is out-performing many employees in a similar position and he doesn’t even know it.  I explained to Dr. Stout what  makes Renee outstanding:

Outstanding Practice Coordinator Abilities:

  • Patient retention at 80% or better
  • Accounts Receivables at 1x or less the monthly NET production dollars
  • At least 10 reactivated past due recall patients per month
  • No more than 12 % of the total A/R over 90 days
  • No outstanding insurance claims over 60 days
  • Collecting at least 45% “over the counter” at the time of service
  • …and she still has the time and patience to be professional and pleasant to everyone

THIS is an outstanding employee.  What is sad is that Dr. Stout didn’t even know that he had a special employee because he was not monitoring the performance of the practice, including the performance of his staff.  If he had, he would know what kind of work she was doing for him.

McKenzie Recommendations:

  • Review the % of staff gross wages compared to the practice collections for the past 12 months. The percentage should fall within the normal range of 19-22%.
  • Be proud of the fact that he has such a great employee and pay her for her performance.  It is NOT important to pay her the “going rate”….she deserves more that the average employee in your area doing what she does.
  • Dr. Stout was provided with an Employee Salary Review form to help him determine how much you can increase her salary and still maintain your gross salary overhead expenses to around 20%.  With an employee such as Renee, push your goal to 22%.  Not only is she worth it, but you should see a return on investment with system goals and monitoring.

Dr. Stout is an example of a doctor that has outstanding performers in his office and he doesn’t even know it.  It is imperative that you monitor your practice statistics to determine how your staff performs AND you reward them accordingly.

Many times a doctor will have an employee that is performing “within normal limits”, not outstanding, but they perform well enough that you don’t dismiss them.  They should be paid accordingly.

Please don’t leave your exceptional employee “standing in your field” getting rained on!  She/he will seek shelter elsewhere and you will be the loser.  Give them the umbrella that they deserve!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email info@mckenziemgmt.com.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Do you Work For a Perfectionist:
Managing a Micromanager

Does your boss give you detailed instructions on everything?
Are there memo-reminders everywhere?
Has there been a lot of turnover in the practice?
Are you thinking of leaving too?

If you said ‘yes’ to any of these questions, you’re likely working for a perfectionist. Intense style. Controlling nature. Obsessive attention to detail.

No wonder you’re thinking of exiting the practice in search of a more satisfying work environment. Perfectionists hurt productivity and morale—and often drive others away. Perfectionists also are often called “control freaks.” Yet, to really understand and deal with a “micro” boss, it’s important to separate the behaviors from the person. That is, unless your boss is a true bully, his/her behavior is probably due to ignorance more than malice.

1. The need to control stems from fear. Your boss may be afraid that he/she won’t succeed. Dental leaders have plenty of reasons to be vigilant about their practice. They also tend to be over-achievers and put themselves under intense pressure to be perfect. Unrealistic and negative thinking are common reasons for perfectionism. There’s a huge difference between trying to avoid failure and striving to succeed.

Disarm your boss by making it clear that your goal is his/her success. Remember that the source of intensity is a worrisome mindset. Find things that you respect your boss's position, hard work or experience, despite the micromanaging. This is a much better place to build trust.

2. Lack of trust is the main reason for perfectionism. Having relied on themselves throughout school, dental leaders often find it unsettling to depend on others…sometimes for the first time in their life.

Get your boss to be very clear about expectations. Ask good questions and take good notes. Work hard to earn his trust and confidence. When he sees that you pay attention to the details, he may begin to relax. Be patient – it will take some time.

3. Communicate, communicate, communicate. Although it’s natural to resist the intrusions of a perfectionistic boss, to build trust requires a lot of information exchange.

If she’s driven to know what’s going on, don’t wait to be asked. Find out what she needs to feel confident and comfortable, then get it to her—ahead of time. Carefully listen to her comments about how she wants things done. Give your boss proof of your abilities and skills. Be a trustworthy employee by demonstrating consistency and dependability.

4. Speak up for yourself - be assertive but respectful. Some bosses have no idea how they have been treating someone until that person speaks up. However, giving feedback to a perfectionist is delicate.

It doesn't work to confront your boss by telling her she's a micromanager. Instead, identify specifically what she’s doing that frustrates you. For example, When you continue to leave post-it notes all over my desk, it erodes my confidence. It would help me if we could set up a meeting each day to review the things you want to be sure I do.” Other possible questions are:

  • What is the end result you are looking for?
  • Is there something about my performance that you find hard to trust?
  • Can you coach me to show how you’d like it done?

Show confidence by expressing your wish to do a good job. Tell him/her your intention is to convey how certain behaviors affect you and your ability to meet his/her expectations. Be open to whatever they have to say. Have the attitude of discovery and cooperation. Instead of focusing on what you already know, focus on what your boss can teach you – if you let him/her.

It’s not your job to “fix” a perfectionist. However, it is your responsibility to do what you can to defuse the disruptive behaviors that upset you. You can't change the personality, but you can change the way you work together.

If you’d like information on building more trust in your office, contact Dr. Haller at coach@mckenziemgmt.com
Interested in having Dr. Haller speak to your dental society or study club? Click Here

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