10.9.09 Issue #396 Forward This Newsletter To A Colleague
Improve Performance
Increase Your Recall
Feedback in Your Office

Strengthen Your 'Core' Performers
by Sally McKenzie CEO
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Extremes. We’ve seen plenty of “extremes” in the last few years, extreme cosmetic surgery, extreme home improvement, extreme weather, extreme sports, extreme weight loss, there’s even an extreme pizza. Obviously, “extremes” attract the most attention, which is why extreme this and extreme that seem to be virtually everywhere.


In the dental office, while the scale of extremes may be smaller, it’s still the extremely good and the extremely bad that get the most notice, particularly when it comes to employees. The star gets the accolades, the slacker seemingly gets away with murder, and those in the middle –the core of your team - are often left to simply muddle along. They see that the star is recognized, and the slacker gets attention of a different form. Yet it is those in the middle that are essential to your practice’s success or failure. Your average but loyal staff are frequently the ones with the capability and often the desire to excel, but in far too many practices they are merely drifting along. The question is, how do you build a stronger core? The answer is performance reviews. It’s like weight training for you and your team, and the benefits are many and lasting. 

Performance reviews can be an essential tool in not only weeding out the poor performers and recognizing the stars, but in developing your core of solid, committed employees who consistently perform well and inspire co-workers to do their best. But don’t just choose any performance review model. Be selective.

Some well-intentioned systems are poorly designed and actually discourage excellent performance. The most successful performance measurements are based on individual jobs. They focus on specific job-related goals and how those relate to improving the total practice. Used effectively, employee performance measurements and reviews energize the dental teams and give you critical information to make major decisions regarding patients, financial concerns, management systems, productivity, and staff. To implement a performance measurement system, take a few key steps and begin strengthening your core immediately.

Step #1
Create specific job descriptions for each employee. We explained this in detail last week. You need to define the job that each staff member is responsible for performing. Specify the skills the person in the position should have, and outline the specific duties and responsibilities of the job.

Step #2
Lay the groundwork for success. Provide the necessary equipment and tools to perform the job, and provide training to help team members carry out the job duties most effectively. Evaluate the number of staff to ensure the number is adequate, and explain what is expected of the employee and how their performance will be measured. For example, if you are measuring the performance of your dental assistant, you should be able to see the distal of the cuspid on every bitewing X-ray, you should never have to reach for an instrument on any setup, and the models the assistant pours should be free of defects. In addition, if you expect your assistant to achieve an 85% case acceptance, she/he needs to know this. If it’s your expectation that she give a daily report on post-treatment calls, she needs to be told. If you expect your assistant to convert 75% of emergency patients to comprehensive exam patients, and keep the cost of dental supplies at no more than 5% of practice collections, make sure that direction is abundantly clear to the employee.

Step #3
What gets measured gets done. Appraise employee performance using an effective performance appraisal instrument that evaluates key areas such as:

  • The employee’s ability to follow instructions.
  • Their willingness to help and cooperate with others.
  • The incidents of errors in their work.
  • Their initiative, commitment, and innovation in carrying out their responsibilities and improving work flow.
  • Their work ethics, their attitude, and their individual productivity.

Remember that the vast majority of employees, whether superstar or seemingly average, want to deliver a quality work product. They want to feel motivated to succeed and feel that that are doing their part to move the practice forward. Strengthen your core and watch the dead weight just fall away.

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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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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For the Love of the Recall System

There are many offices that are struggling to keep the hygiene schedule full or have never been able to keep their hygiene schedule full. Then there are those offices that have three to four full time hygienists that are able to keep their schedule full even if there are eight changes in the schedule the day before. It’s not that it is easier for one office than it is for another. It’s the way they work the recall system in their office, or should we say do not work the recall system. The recall system that keeps the hygiene schedule productive is one of the most important systems in dentistry. However, it is often the most neglected system in many dental practices.

The reason the recall system is one of the most important systems is because these are the patients that also help to fill the doctor’s schedule. New patients help too, but it is the existing patients that supply most of the work. How many times have you been told that there is nobody else left to fill an appointment? That all of the lists have been exhausted and there is nobody else to call? The days of having the hygienist work the recall system when she is able are over. So are the days of having any front office person work the recall system when they make the time to do it or think that they should work it a little. These are the days when there needs to be one person responsible and accountable for working the recall system.

The patient coordinator is the position that we are talking about. This is one position that will help pay for their own salary quicker than you think, especially once they have their finger on the pulse of the recall system. Let’s say that you are going to pay the patient coordinator $15 an hour, 3 hours a day, four days a week, and they are going to work evening hours because this is the time that most patients are able to be contacted. In a two-week period, this business expense is approximately $360 for a two-week period.

How many appointments would the patient coordinator have to fill in your practice to justify their position? If a prophylaxis, 4 bitewing x-rays, and a periodic exam comes to a total of $180, not many appointments would need to be filled to justify the additional income. The hard part is having this person stay concentrated on the recall system even when the hygiene schedule is full. The reason why is because the ASAP list and short call list may be created in order to have a place to go when you have last minute cancellations or no shows. Even when there is a full schedule, last minute changes are the ones that cause the most grief.

It is recommended that the patient coordinator not be pulled off the recall system to help the business staff. The number one priority for the entire staff when there is open time in the schedule is to get it filled. However, it is always the number one priority of the patient coordinator. The perfect person for the patient coordinator position should have excellent telephone skills and communication skills. They should be trained on the software and know how to run recall/continuing care reports, look up accounts to evaluate money, understand insurance and limitations, understand periodontal disease and patient restorative needs, and how to create lists such as ASAP and short call list. They will also need to know how to look at all the patient information such as age, what they are due for, how to make appointments, and how to sell and educate patients about their dental needs.

The patient coordinator will be accountable for filling and keeping the hygiene schedule to production goal. This will be done by making notations in the patient record on the computer and keeping record of how many calls were made, how many appointments were made, and what patients were telephoned and their responses. The patient coordinator may be given additional hours once the hygiene schedule has no consistent openings. This would also increase the responsibilities to working treatment pending and taking care of new patient communications and follow up. However, at this time the number one responsibility will be keeping both the doctor and hygienist scheduled to goal.

As with all positions on the dental team, this is a very important position and should not be left to a person that is not highly trained as a dental professional.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Develop a Culture of Feedback in Your Office

As the dental leader and CEO of your practice, you are responsible for assessing important business data – what is your revenue to expense ratio for the month? What is your current production level and how can you increase collections? However, are you using the same rigor to evaluate your company’s most important capital: employee performance?

While all businesses today have a multitude of initiatives to improve performance, Jack Welch, former chairman and CEO of GE, says employee engagement has to come first. "No company, small or large, will perform in the long run without energized employees who believe in its vision and understand what they need to do to achieve it." In fact, he says "employee engagement is the best measure of the health of a company."

To get that kind of engagement requires feedback. The term “feedback” was originally borrowed from electrical engineering. In the field of rocket science, for example, each rocket has a built-in apparatus that sends messages to a steering mechanism on the ground. When the rocket is off target, these messages come back to the steering mechanism that in turn makes adjustments and puts the rocket back on target again. You don’t need to be a rocket scientist to see the parallels between launching missiles and leading employees. Your mission is to keep your staff on track with your practice vision. Feedback is the best way to ensure that your team is soaring toward practice goals. It is communication regarding the effect that a person’s behavior has on another individual and/or group.

Feedback tells people whether they are “on course” – keep doing what you’re doing, it’s working – or redirects them back “on course.” The problem is most people associate the term “feedback” with criticism, rather than information.  As such, it is met with reluctance or anxiety, or simply avoided. Yet the process of giving and receiving feedback is one of the most important communication tools you have to keep your employees efficient and productive.    

As an Adjunct Faculty at the Center for Creative Leadership, I have learned an excellent model for giving feedback. CCL has developed a feedback technique that is called S-B-I, an acronym for Situation-Behavior-Impact. When you use this model, you provide information so that the recipient knows whether they are “on track” or need to modify their behavior because it is not effective.

There are three components of the SBI model. The first is to describe the situation in which the action occurred. Be specific with date, time, and location. You want to capture the details so the person recalls the situation.

The next step is to articulate the exact behavior(s). This is essential and it requires a bit more thought than it might seem. Our tendency is to abbreviate and categorize what other people do. That leads to judgmental and critical messages. Describing Carol as lazy does not provide clear, tangible direction over which you have influence. “Carol is lazy” should be translated into “Carol needs to be more punctual with the weekly report.” In this way, you and Carol have a starting point and something that can be measured. No generalities - only specific, observable behavior.

The final step in the SBI model is to convey the effect that the other person’s behavior had on you. It might be feelings you had and/or outcomes that happened as a result of the person’s action. Practice giving positive SBI feedback first so you will become more skilled and familiar with the model. Be specific. Drive-by praise without behavioral examples is ineffective. Strengthen “great job” with concrete details such as “Thank you for taking quick action and filling the schedule when we had a cancellation this morning. It really made a difference in our daily production rate.

Here’s an example of a developmental SBI to your chronically tardy employee:

“Sara, you were late to the morning huddle twice this week. We had already reviewed the daily schedules by the time you arrived, but we had to go over it again for you. This was frustrating for me and your co-workers, and it delayed the team from starting the day.”

Delivering quality developmental feedback will take preparation on your part. Plan your words and your delivery. The more you build effective feedback on specific actions, the more your employees will benefit from your improved leadership in this area. Annual appraisals are insufficient for employee development. I strongly urge you to conduct monthly reviews with each member of your team. Even “star employees” need to meet with you at least once per quarter so they know that you value and appreciate them. Whether you are praising stellar performance or monitoring a problem employee, good feedback is behaviorally specific.

You can learn to give feedback well. You must practice to improve your skill level until the complex process of putting together all of this material becomes second nature. Build a climate of feedback in your office. Help your employees achieve the overriding mission – to be successful in their careers and in your office!

To assist you in building skills in feedback, read the new Ideas into Action Guidebooks published by the Center for Creative Leadership and offered through the McKenzie website.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like more 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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