2.26.10 Issue #416 Forward This Newsletter To A Colleague

What Would You Do… More Importantly, What Can You Do?
by Sally McKenzie CEO
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 A popular ABC television limited run series that aired a while back used hidden cameras to observe how people behaved when confronted with a dilemma. It was a different twist on the old Candid Camera series. The show, Primetime: What Would You Do?, enabled viewers to watch the unsuspecting participants in what are typically uncomfortable situations and scrutinize their comments and their reactions.  

As armchair observers, it’s easy for us to sit in the comfort of our homes and say how we would handle these sticky situations, how we, in our infinite wisdom, would do things differently, or how the individual should have done this or that. Admittedly, it’s easy to be a critic. We can judge how others should do things, how they should carry out their responsibilities, what decisions they should make and we’re able to do so with such clarity. In the workplace, some employees view themselves as experts on how everyone else should be doing their jobs, but they seem to have little interest in improving their own performance.

The dental office is no exception. The fact is, it’s easy to become frustrated with the dentist. Staff will lament, “If only the doctor would do this.” “She really should take action on that.” “He needs to be a stronger leader.” “If I were her, I wouldn’t put up with this nonsense,” and the list goes on. Seemingly everyone has an opinion on how the boss should go about doing his/her job. Yet, few employees, if any, have any real understanding of what it takes to be “the boss.”

Consider one of the most common scenarios for second guessing the boss - compensation. Let’s say you are an assistant working in a practice and you feel that you deserve a raise. You reason that you’ve been with the practice for a full year, you work very hard, you are nice to everyone; therefore, you deserve to make more money. When the raise doesn’t come through, you reason that the boss is just cheap, doesn’t appreciate all your hard work, and you’ll just show him/her by finding a job somewhere else.

Now I’d like you to strap on your boss’s shoes and go for a stroll in them. First of all, your doctor may sincerely want to give you a raise, but the reality is that if practice revenues have not increased, she/he absolutely cannot do so. Unlike the AIG model of rewarding employees who drive a company into the ground, dental offices cannot afford to reward even the best team members if the practice is losing money.

Employees have a tendency to assume that all the money that comes into the practice goes directly to the doctor. Unfortunately, in many cases, dentists fuel this misunderstanding because they don’t educate staff on the true costs of running a dental practice. Moreover, in challenging economic times it is understandable for dentists to be very cautious with their finances. The local manufacturing plant may be looking at job cuts, insurance costs may be increasing, and more patients may be cancelling, not showing for appointments, or putting off treatment. The dentist simply cannot afford to increase employee salaries, even though the request may be seemingly minuscule.

The employee in this situation, understandably, is looking at her own circumstances and her own contribution to the practice. She feels she deserves the raise. Consequently, she slides into boss-bashing mode, which does nothing for the employee, the other team members, or the issue itself.  

Rather than beating up on the boss, consider this approach. First, prepare yourself for the fact that you may not get what you request. Although Wall Street may be improving, Main Street is still feeling the financial pinch. And if your doctor cannot afford to give you a raise, her/his first responsibility is to maintain the financial solvency of the practice, not put a temporary smile on your face. What you need to recognize is that raises are not an entitlement. They are a direct result of practice productivity. That being said, you can take steps to help the doctor recognize your increased value in the office by providing a written list of the contributions you have made to the success of the practice.

Next week, document your value to the practice.

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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BOSS Is Not A Four-Letter Word

Running a dental practice is becoming more high pressure and the workforce is becoming more high maintenance. This calls for strong people-management skills. As CEO of your company, you need to step up and be the boss. That's the job, no ifs, ands or buts. The sooner you recognize it the better. Being the boss entails certain responsibilities which cannot, under any circumstances, be delegated.

Remember, you have the ultimate authority in your office. You may be tempted to rationalize the responsibility away, deferring to your Office Manager as the one who “handles employee matters.” Before you do, consider the word rationalize - the ability to “ration lies.” You can come up with all kinds excuses of why you can’t be the boss – not enough time, you need to do dentistry not manage people, you’re planning to get around to it this year, etc. etc. In truth you may be feeding yourself small doses of lies every day to the point that you convince yourself not to act because you don’t like the thought of being the boss. Not feeling up to the task? You're not alone. For many, the greatest hesitation about becoming the boss is the fear of being seen as incompetent. Frequently people feel unprepared for the responsibility.

The boss’ job is to make sure everything goes right. Behavior is what drives performance and you have 100% control over the actions you take. By learning and practicing some simple techniques you can become the kind of boss your employees need you to be.

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Observe More, Never Assume
You can learn a great deal about how an employee reacts or responds by observing as others try to communicate with him/her. It’s so easy to assume that if you like a short and direct approach, your employees will respond well to that same style. Some people, however, might shut down very quickly if they feel they are being pressed too hard. Similarly, if you have a strong extraverted style, quiet employees may feel overwhelmed with your exuberance. Each person is different, therefore to be an effective boss you must determine how best to communicate with each team member.

Ask For Direction
A great way to get some initial ideas on how employees prefer to communicate is to observe. However, nothing takes the place of simply asking the employee his or her preference. Use open-ended questions such as, “Help me understand…”, or “Can you please explain to me...”, or “Am I correct in thinking...” etc.

Put Your Ego Aside
When you’re the boss, it's not about you looking good. In fact, 60 percent of employees said the most respectable quality in a boss was their ability to help them succeed. In essence, the job of a boss is to help your employees grow. Effective leaders relinquish the spotlight and put others there instead. No doubt it is a stressful transition going from being judged on your own accomplishments to those of your team, but being a boss means helping employees shine by making their success as important as your own. 

Be Supportive Yet Firm
Being a good boss is really like being a good parent. Your job is to teach, to encourage, to hold them accountable. It is not your job to be their friend. Open and respectful communication is key to ensuring that you are able to make steady progress. There will no doubt be times when you need to counsel an employee because he or she is not meeting your expectations. If an employee does something you’re not happy with, say it as soon as possible and in private. Don’t keep things on your chest while saying to yourself “they should’ve known better.” When communicating to employees, it’s crucial that you always maintain a healthy balance in your message. While you need to be firm, you also need to convey support. Your comments should be specific and focused on performance or behaviors that you’ve identified. Always keep it strictly professional, never personal.

Filter Issues For Them
While some degree of feeling pressure on the job is healthy, especially in a quick-paced, ever-changing, competitive working environment, bosses should never lose sight of the fact that people can become overwhelmed. Filter issues for them on an as-needed basis. Teach them about “so what” and “how does this relate to the bottom line.” Teach them about things that matter to you so they will know how to meet your expectations. Continually assess whether or not the team has their priorities in place and are spending resources wisely at all times.

Boss is not a title, nor is it a dirty word. It’s something you develop. With practice you can expand your skills and become the kind of boss that employees appreciate… and your practice deserves.

The potential to become a better boss is well within your capability! Contact Dr. Haller at coach@mckenziemgmt.com.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn 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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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Is It Root Planing or Full Mouth Debridement?

There are offices that are probing new patients and continuing to follow the old way of thinking that only 5 mm or above need to be root planed. These offices use the code for full mouth debridement, have the patient return for a prophylaxis in 2 weeks, and then come back in 3 months for their continuing care. The problem with this is that the patients being billed out as full mouth debridement probably need to be treatment planned for root planing, whether it is one to four quadrants, 1-3 teeth or 4 or more teeth. They are not entering the correct insurance code with the treatment needed.

The code for a full mouth debridement is very specific in its use and I may see only two patients in an entire year that require this code. Misusing the full mouth debridement code is not doing a favor to your patients, hygienist, or practice production. Using this code is usually under-treating a periodontallyinvolved patient, and makes the hygienist work twice as hard at half the cost that it should be done. It usually costs the patient more out of pocket money also, as many insurance companies will not even cover the full mouth debridement code, and even if they do it may only be covered once in the patient’s lifetime or may only cover a portion of the amount. Then there are the insurance companies that will cover it as a prophylaxis and when the patient returns for their 2nd appointment in order to complete the treatment, the insurance will consider this the second prophylaxis in a year and now the patient is out of benefits when it comes to future hygiene appointments.

Once a full mouth debridement is completed, it does not constitute future appointments being considered periodontal maintenance appointments. If this is done, the hygienist will once again find herself working twice as hard at half the cost at the patient’s future recall appointments. Also, the patient will more than likely have to pay for the entire appointment out of pocket because the allowable benefits for a prophylaxis were utilized. If the patient was not informed of all of these out of pocket expenses in advance, they are going to be upset with your office and could end up going to another practice. It’s never a good thing to have more patients leaving out the back door than you have coming in new through the front door! Unfortunately, this happens all too often and is not even noticed until the office is struggling.

Whenever you are considering treatment planning full mouth debridement, slow down and take a really good look at the 6-point probings, x-rays, bleeding upon probing, and amount of calculus to be removed. If the patient has even one or two 4 mm pockets in a quadrant, a lot of inflammation, and has not been seen on a regular basis, this may be a patient that should be root planed. There is nothing saying that every patient has to have four quadrants of root planing. Treatment planning the root planing will allow for better quality of care.

Many insurance companies require that a patient have at least two quadrants of root planing in order to return in 3 months as a periodontal maintenance appointment. It does not matter if they have two quadrants of 1-3 teeth or two quadrants of 4 or more teeth. There is a specific code for root planing 1-3 teeth, and it is recommended that your office have a specific fee for the code. Just like root planing 4 or more teeth, the fee is not decreased because you are only root planing 4 teeth rather than 6 or 8 teeth. The code is specific to how many teeth need root planing per quadrant, not half mouth.

Of course, insurance benefits and the patient’s employer decide what plan they choose to pay for and the limitations the plan has for the individual. Whenever your insurance person becomes aware of such limitations they may want to educate the entire office at a staff meeting about them. This is so insurance benefits may be maximized by your office for the patient. This is not to determine treatment needed - that is done by the clinician in the chair and the individual patients overall health and oral health presented at the time of services.

Treatment planning patients for root planing instead of full mouth debridement will usually provide better insurance coverage, less out of pocket expenses for the patient, and more time for the hygienist to provide quality care for the patient. In return, the office may increase production, patient retention, and reduce the stress level. Utilizing the correct insurance code, appropriate time and treatment needed when treatment planning your patient will benefit everybody. 

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

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