4.30.10 Issue #425 Forward This Newsletter To A Colleague

If that New Employee Isn’t Working, Whose Fault Is It?
by Sally McKenzie CEO
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It’s an exciting day when new employees come into the practice. If you’ve hired right, there is a very good and positive energy that they bring to the practice, along with fresh ideas and perspectives. Unfortunately, in too many cases, the “honeymoon” is over in about six months. You’re shaking your head and wondering how you could have been so wrong about someone who seemed so right.

Let’s rewind the tapes and consider what has transpired since that employee was brought on. Was she/he given a job description, training, feedback, and performance reviews? Or was she sent to the front desk and told that “Cari” the other business employee will explain everything and take it from here. But Cari has enough on her plate and doing the job herself is just easier than taking the time to try to explain everything that needs to be done. Cari does not know how to give appropriate direction or feedback. And performance reviews? The doctor doesn’t really like them, so they never get done.

All the while, the new employee drifts along growing more frustrated. She can pick up kernels of information here and there and she’s doing her best to figure things out. But, understandably, important details are falling through the cracks. The problems only escalate and rather than examining the systems, the doctor is looking for someone to blame - the new employee is on the firing line. What should have been a positive experience has turned into a hiring disaster that could have and should have been avoided. Implementing a few common sense human resources strategies can ensure that new employees quickly become key contributors to the success of your practice.

  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 your employees 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.

Certainly, 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 many 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. 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.

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
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Do You Offer Alternative Office Hours?

This article is one that I thought I would never write. Historically, in my 30+ years of dental experience, working evenings and weekends was never as profitable as “normal” office hours because it sometimes required overtime for the employees and the rate of appointment changes and no-shows was always higher than the normal hours. In the “good old days” patients had family commitments and interruptions in the evenings that prevented them from keeping their appointments. If the sun was shining on Saturday morning instead of raining, patients were outside working in their yards, on the golf courses or at the beaches.

In these times, however, I am finding that patients and their families are always looking for ways to save their hard-earned dollars. They are eating at home more, driving instead of flying to vacation spots - if they are lucky enough to take vacations. Employers are cutting back on employee benefits such as medical time off, dental benefits and sick leave for doctor appointments. Many households only have one employed family member now instead of two and are always looking for ways to avoid having to miss time from work.

As I fly around the country and chat with my seatmates on planes, we discuss our respective careers. Out of curiosity, I ask these “dental patients” how they would feel if their dentists had evening or Saturday hours. The response is always, “I only wish he/she would. My spouse and I both work and it is so difficult to leave. We are working with a skeleton crew at work to keep costs down so when someone is gone, it really places a burden on the remaining employees.”

I started thinking about this and it is so true. I have written several articles about working “leaner and meaner” and trimming the fat of excessive employees.  Instead, pay the employees that remain and work harder more money. It is a win-win for everyone. You may know from your own experiences in your office that when a key employee is out of the office due to illness, a doctor’s appointment or their child’s doctor’s appointment, it puts a damper in your daily routine and you are not as productive.

Does This Apply To You?

  • You are seeing just as many new patients now as you were a year ago.
  • Your production and collections are still strong or at least equal to last year.
  • Your hygienists are staying just as profitable as they were a year ago and the rate of unscheduled time units has not increased.

If you can answer “yes” to the above statements, you don’t need to read any more of this article because it doesn’t apply to you. Congratulations for surviving these economic times and keep up the good work. However, if you are answering “no” or “are you kidding?”  to the above questions AND have already implemented all the McKenzie Management Systems that we write about every week, then you need a new strategy. If you want a different result – you need to do something different!

More Convenient Office Hours
I see marketing pieces in the mail from local dentists touting their “convenient hours” from 8:00 am-5:00 pm. Please tell me what is so convenient about these hours when 80% of your patients work during these hours. I don’t get it! The real question is: what are convenient office hours for YOUR patients? The best way to find out is to ask. With all the electronic ways of reaching your patients in this technological world, it is very easy to send surveys, newsletters, text messages and emails to your active patients to ask them what works best for them.

When your Hygiene Coordinator is calling the 56 patients that are 30-days past due for their professional cleaning and exam appointments and the patient returns the call and leaves a message on the answer machine in your office stating that they can’t get off work right now for their appointment, this is a prime opportunity to contact the patient and ask, “Mrs. Jones, we are concerned that due to our current office hours, you are limited to the time you have for your doctor and dental appointments. If we considered offering alternative hours, what would work best for you?”

Think Outside the Box
My seatmate this week was a “marketing guru” for large Fortune 500 companies.  He said to me, “I don’t see why dentists don’t work during the prime times of the day and close during the non-prime times.” I asked him to clarify his statement.  This was his concept of prime time: 7:00am-11:00am, and 4:00pm-8:00pm. Ask your Hygiene and Schedule Coordinators what times are the hardest to fill. We teach to fill the mid-day appointments with the patients that are retired, as they are much more flexible and usually don’t like to get up early anyway. The difficulty is that the majority of our dental patients are not retired.

Would I recommend that you work these hours every day? No. I would suggest that you try one day a week and see what happens after you have surveyed many of your patients. Is this going to be a hardship on you as the dentist or your team?  Possibly - but look at all the options when it comes to available employees in the work force right now. How bad would it be to have 5 hours off during the middle of the day to run errands, play golf, go fishing, etc?

Saturday hours: 8:00am-1:00pm for large cases and hygiene. If you are going to be there, make it worth your while. Some states don’t require that the dentist be on-site for hygiene visits as long as the patient is seen by the dentist once in a 12-month time period. Open your office with two hygienists and one front desk coordinator.

Before you start whining about how poorly your practice is performing right now, try something different.  McKenzie Management clients that are working “alternative” hours are finding that they have a high demand for their evening and Saturday hours and very few unscheduled time units compared to their “normal” work day. Tell your team that you want to try this and see what the results are. You might like it! I always say to market your practice by setting yourself apart from the other dental offices in town. This may be a great marketing tool if you market it correctly.

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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Belle DuCharme CDPMA
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Treatment Acceptance and Patient Satisfaction

Case File #342
Dr. Howard Blaine

“I haven’t collected a paycheck now in two months and I have to make a change,” lamented Dr. Blaine as he prepared to dismiss his Business Coordinator of one year. He continued to express his frustration, “My schedule is full of holes and my patients are complaining about having to pay in full at the desk when they haven’t had to do that in the past. I don’t think she gets it that it is not about the money.”

Perio Disease

Looking over Dr. Blaine’s reports from the past and current revealed that key systems concerning patient/customer service were abruptly changed with the arrival of Bea, the new Business Coordinator. Long time patients were being asked to pay at time of service instead of allowing them to be billed for current services. Co-payments from PPO plans were not being estimated correctly, causing patients to overpay. Not returning the overpayment in a reasonable period of time caused the patient to mistrust the practice. These were patients with a long history of compliance in payment and in keeping their appointments. 

It was discovered that recall cards were not being sent out as reminders any longer, causing a significant drop out of pre-scheduled patients. Patients like to know what to expect and also rely on the usual and customary, such as receiving a notice of upcoming scheduled appointments. Any changes to established systems need to be explained to patients ahead of time so that they understand what to expect in the future. Patients always have a choice to keep coming to you or go somewhere else for care if they are uncomfortable with the perceived quality of care.

When Dr. Blaine hired Bea, he asked her to collect at the time of service because the accounts receivables were too high. She did as requested without looking at the patient’s history in the practice. Her approach was uncompromising and a bit militant to Dr. Blaine’s established compliant patients. This approach was showing up in the treatment acceptance statistics as a failure of patients to book appointments out of fear of having to pay too much out of pocket and not being able to negotiate any other payment options. 

Trust levels were dropping in the recall department because the always relied upon notice was not being sent. Dr. Blaine decided to hire a new dental hygienist; one who shared his vision and his patient care philosophy. She reinstituted the recall notice, but changed it to be a letter type reminder so that she could insert a personal note and some educational material for the patient.  She also designed an email recall reminder for those patients who requested email. Her closing remarks to the patients at the end of the appointment always included what they should do upon receipt of the reminder letter and the importance of keeping scheduled professional cleanings and examinations.

To increase treatment acceptance, the hygienist took the intra-oral camera that was collecting dust in the corner, and began using it on every patient to demonstrate the necessity of the diagnosed treatment. The time worn saying of a “picture is worth a thousand words” is true when it comes to gaining treatment acceptance. Taking the extra effort to educate and demonstrate moved the patients from passive to action.

Staff turnover is not ideal unless it is a change for the better. Tell your patients that the change is to serve them better and share what the new staff member brings to the team to improve patient care. Before again going through the process of hiring, make sure to define the vision and mission statement of the practice. Hire someone who shares your philosophy and is willing to communicate daily on improving relationships with patients.

Happily, Dr. Blaine’s practice is moving in the right direction. Patients are happier and they are accepting the treatment presented by the doctor and supported by the hygienist, the dental assistant and the business coordinator, who all share a common philosophy of health and total patient care.

Before you hire, talk to McKenzie Management about taking an Advanced Business Training Course. You will learn how to attract and keep the best people for your practice, and thus avoid the expensive pitfalls experienced by Dr. Blaine.

If you would like more information on McKenzie Management’s Advanced Training Programs  to improve the performance of your team, email training@mckenziemgmt.com

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