07.03.09 Issue #382 Forward This Newsletter To A Colleague
Team Accountability
New Income Opportunities

Not My Problem Mentality Holding Your
Practice Back?

by Sally McKenzie CEO
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Major corporations tend to put an emphasis on team accountability.  An individual will have goals, but they will relate to the success of the business as a whole. In dental offices, dentists too often view their practices as minor operations. They don’t believe they need the structure and systems of a “business.” The common refrain is, “We’re just a small operation.” But it’s that “small” mentality that creates huge frustrations. Invariably, these doctors wind up plagued with employee issues, production problems, significant stress, and career dissatisfaction. It is common for these doctors to say things like, “Sure, I’d love to adopt some new technology, but my employees will never go for it.” Or “I know our customer service should be better, but I just can’t seem to hire anyone who understands that.”

Meanwhile, new patient numbers languish, production suffers, and the schedule is a mish-mash of inefficiency and frustration. And the doctor, rather than taking action and insisting on accountability, defined practice systems, and overall staff improvement, views him/herself as a victim of circumstances.

Why do some practices succeed at instilling accountability as a core element of their culture and others fall short?  What can practice owners do to create a culture of accountability? A recent study of high performing businesses found that five specific actions have the most powerful affect on the ability to establish accountability among the ranks and achieve results. All five of these can be applied in the dental practice. 

First, take the broad concepts/priorities and translate them into specific objectives that are individualized for each person. For example, define the priorities of the business team. Spell out how each person’s responsibilities and objectives help to achieve those priorities and how they fit into the larger practice goals.

Second, as a matter of routine, monitor the individual areas as a team. Those responsible for each practice system are required to report on their areas at the monthly staff meetings. This keeps the individuals focused on the priorities and actions necessary to achieve them, allowing little room for the pettiness and blame games that plague far too many dental teams. Moreover, in “monitoring” each other, staff better comprehend the impact of one system on another and on the success of the practice as a whole. They are then far less likely to sit back and watch problems continue, further strengthening the culture of accountability and minimizing the “it’s not my job” mentality.  

Third, keep lines of communication open. Feedback, celebrating progress, group problem solving and troubleshooting all involve ongoing constructive communication. But it is more than keeping everyone informed. A culture of accountability is built on a culture of open communication, in which the cornerstone is a culture of respect. This is particularly important for the dentist or those whose personalities tend to dominate in the practice. As the leader of your team you may think nothing of your “direct” approach. However, when you bark, “No, you’re wrong” or “No, that’s a bad idea,” or “No, that will never work,” I guarantee you are viewed as rude and disrespectful. As a result, employees are far less likely to offer suggestions, input, or insights that could prove very beneficial in moving the practice forward.

Fourth, check your actions daily to ensure they are consistent with practice objectives, values, and priorities. Do not expect your team to follow you if you are not willing to live by the same values and support the same priorities that you require of others. 

If you expect your team to be accountable, you must model this behavior and take swift action when results are falling short. When problems are percolating, don’t dismiss them. It doesn’t mean you publicly berate employees whose systems may be struggling.  What it does mean is that you need to create an environment in which the team can address concerns, and, when necessary, they can count on you to make the tough decisions.

Finally, keep in mind that accountability is not something you make people do – it has to be accepted by the members of your team. However, the systems you establish directly impact your ability to create a culture of accountability. Moreover, the natural byproduct of effective working systems is a staff that assumes responsibility and accepts accountability as a matter of routine.

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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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Coaching vs. Therapy Confusion

Having been a therapist and a coach, I admit that the difference between the two is not always clear-cut. Many therapists are coach-like in their orientation and the two disciplines do share some common ground. Both can work with high functioning individuals who are facing difficult situations, and both professions focus on helping people make changes and accomplish goals that really matter to them.

Although I spent many years in psychoanalysis myself, when I was a practicing clinician I was drawn more toward behavioral forms of therapy. I often say, I’m not a ‘shrink’…I’m an ‘expander’. For me the joy of my work comes when people change the way they think and act. I am direct and practical. I love to see results, and to get there quickly. Therefore coaching is a natural fit for me and the way I like to work.

But the question still remains, how would a person know if he or she should pursue coaching or therapy? To help distinguish the two, I thought I’d share some real-life examples of clients I’ve coached.

Dr. Tom
A true entrepreneur, Dr. Tom works in a family practice. He saw the growth potential for the business, however he faced enormous challenges in influencing his father and sister (both dentists). There were huge differences in their temperaments. Dr. Tom is the youngest of the group but clearly the work-horse. He wants to establish the practice ownership but there are power struggles about who’s the boss. He sought coaching to improve his leadership competencies, particularly as applied to aligning his father and sister with his vision. He needs to identify their motivation for tightening operations and business systems. Of course there are emotional issues involved, but the focus of our conversations is for Dr. Tom to develop the skills to influence his family constructively and deliberately. He’s currently working on that.

Dr. John
For Dr. John, the catalyst for coaching came when his Office Manager noticed discrepancies with deposits. But this was just the tip of the iceberg. There was high staff turnover; employees were hired quickly and resigned repeatedly. Exit interviews identified Dr. John as a “moody micro-manager.” On the positive side, Dr. John had good values and the need for integrity in the office. He had a highly effective chair-side manner, particularly with children in difficult situations. He disclosed that he had a mid-western background and a very strong work ethic. He drove himself hard. Coaching was focused on extending Dr. John’s patient skills to his staff. When an employee did not act in accordance with his standards, he learned to take time to think before responding. He asked questions and remained outwardly calm and objective. He stopped voicing strong opinions, especially negative ones. By improving his reactivity, he was able to give feedback to employees, to teach them what he wanted them to do and how he wanted them to do things. He increased his team’s loyalty and their longevity. He also increased his bottom line by stopping the revolving door.

Dr. Keith
Like many dentists, Dr. Keith’s goal was to be more productive and profitable. Patients loved the care they received in the office. The practice was in a good geographical area with lots of opportunities for expansion. Dr. Keith is a “gentle dentist” with a compassionate style. He thinks of the patients’ best interests. The trouble was that Dr. Keith didn’t think of his own interests. His communication style was indirect and he took responsibility for their financial situations. Consequently he under-prescribed treatment, which ultimately back-fired and reduced his image of credibility. He also talked too much. He loved to educate and teach, but unfortunately his expressiveness in the operatory impacted patients negatively and backed up the schedule terribly. In my work with Dr. Keith I learned that his wife was the Office Manager. There were marital tensions between them, largely related to the way each of them wanted to run the office. Because their interpersonal issues were outside the scope of coaching, I referred them for couples’ counseling. Sometimes coaching is not the answer. However, when they resolve their marital friction, or Mrs. Keith resigns as Office Manager, Dr. Keith and I will resume coaching.

Many of the doctors with whom I work want to learn to communicate more objectively. Other common categories of coaching topics are training and developing employees, promoting trust and collaboration within the team, and developing a culture of feedback in the practice. In the process of working on these goals we do talk about emotions. In fact, I have coached dentists who have had rather volatile tempers. One was referred to me after throwing instruments. I want to help you to raise your work satisfaction and your bottom line. Give me a call and we’ll have a brief, complimentary discussion about whether coaching would help you to do the same.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like information about any of her practice-building seminars, contact her at coach@mckenziemgmt.com

Interested in having Dr. Haller speak to your dental society or study club? Click here.

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Carol Tekavec
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Possible New Income Streams: SCHIP and Implants

The recent federal reauthorization of SCHIP (State Children’s Health Insurance Program) may have a bearing on the future coverage of dental care for many children in your community. According to the legislation, SCHIP includes a dental benefit guarantee for the first time. In addition, oral disease prevention services and restorative and emergency care for children who do not have private dental insurance is included.  According to the organization, Oral Health America, the department of Health and Human Services will be working with states and dentists to set up lists of covered benefits and willing dental providers.

The type of coverage offered will apparently be based on “benchmarks” in order to identify adequate plans. These benchmarks include: the dental plan chosen by most state employees with dependents, the dental coverage most often selected by federal employees with dependents, or the largest non-Medicaid private dental plan in the state. In some states Delta Dental is handling the program.

Currently there is a web site, www.insurekidsnow.gov and a phone number (877)KIDS-NOW, where information is available. Each state will offer its’ own plan, however, most of the states will be offering uninsured children through age 18, free or low-cost dental insurance. Typically the child must be a member of a family of four or more that is earning less than $34,100 a year. Many of the states will also offer insurance that pays for physician visits, prescription medicines, hospitalizations, eye care and medical equipment.  An important distinction is the fact that children who fall under guidelines making them eligible for Medicaid, even if they are not actually on Medicaid, are not going to be eligible for the SCHIP coverage.

Why does this matter to you? Some practices are looking to supplement their current patient pool. Whether you have dealt with Medicaid in the past or not, SCHIP is not Medicaid. The SCHIP plan might fit into your practice and provide an additional income source. To find out more about participating as a dental practice, you may contact your state children’s health insurance department or the numbers previously listed in this article.

According to Dr. Gordon Christensen, more general dentists should be providing their patients with implants. His estimate is that only 5-15% of dentists are placing them now. During the ADA Meeting last October, Dr. Christensen was quoted as saying:

“There are many things that are more aggressive and more threatening than doing an implant in a healthy person with good bones. It’s simpler than doing a third molar extraction.  There is far more legal activity around third molar extractions than in implants.”

Mini-implants are technique sensitive, as just about anything in dentistry is, but very patient friendly. If one fails, another can be placed without much trouble. If you have been holding off on providing implants in your practice, now might be the time. 

Once you are ready, arm yourself with answers to the most common questions that your patients will likely ask you about implants and what they can mean to them. Be prepared with simple, yet effective responses. You want to maintain a positive tone, but you also want to be completely “above board.” It is important that you and your staff are on the same page concerning how you present information about implants. A good patient education brochure can back up your explanations while being very inexpensive.  Remember, educated patients say “yes” to treatment.

Here are some examples, excerpted from my brochure Implants and Others…When Teeth go Missing:

Q) How do I know if I am a good candidate for implants?

A) A person needs to have enough bone to hold an implant in place. If your bone is not thick enough you can still get an implant, but a bone graft may be needed first. Severe, ongoing periodontal disease may also be a problem, as may a traumatic bite and smoking. Certain systemic health conditions must also be taken into consideration. 

Q) Will my insurance pay for my implants?

A) More and more dental insurance plans are including implants in their contracts within the confines of applicable yearly maximums. Under some contracts, even if the implants are denied, the crowns or bridges placed on top of them may be covered. Implants are popular and effective. We can help you file your claim to get the best coverage for which you are eligible.

Now, more than ever, dentists need to be aware of any possibilities for better treatment for their patients and more income for themselves. SCHIP reauthorization and the popularity of implants are two unrelated, yet potential, sources of increased income for the practice.

Carol Tekavec CDA RDH is the president of Stepping Stones to Success, and a practicing clinical hygienist.  She is a consultant to the ADA Council on Dental Practice and was the insurance columnist for Dental Economics for 11 years.  She is also the author of the Dental Insurance Coding Handbook and the creator of the “First Encounter™” Chart.  

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