6.18.10 Issue #432 Forward This Newsletter To A Colleague

Traveling in Circles? Take the Direct Route to Practice Success
by Sally McKenzie CEO
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How often have you found yourself setting out to go somewhere, but you’re not entirely sure what route you should follow. You have a general idea where you are headed, but the further along on your journey you get the more frustrated you become. You find it’s taking you much longer to reach your destination than you anticipated. If you had first sought a little guidance, direction, or perhaps a map, double-checked the address or even grabbed the GPS you could have reached your target far more quickly and efficiently. We frequently find a similar scenario in dental practices. The doctor starts on his or her professional journey, and years later is still wandering on what may or may not be the right path, feeling as though it’s taking much too long to reach his or her goals.


Oftentimes, these dentists don’t realize that their staff are suffering from the same lack of direction and frustration. Understandably, between the busyness of the dental business and the chronic employee turnover experienced by many offices, ensuring that everyone is on course is no simple challenge. Unfortunately, it is common for employees to go along doing their own thing, carrying out their duties with little direction or guidance.

Ask these employees a few questions, such as: What are your responsibilities? What are you trying to accomplish? What is expected of you? What are the goals of the practice and where do you fit in? You may well find that the staff can offer little more than a good guess. It’s this professional disconnect that consistently yields lackluster results, fuels employee turnover, and manifests in stressful unproductive days for both doctor and team.

Typically, at the root of the issue are some very problematic assumptions among staff and doctor. Dentists commonly assume that their team members know what is expected of them and what they should be accomplishing day-to-day, and if they don’t they will speak up. Similarly, employees too often assume that the dentist will tell them if they have specific expectations or want things done in a certain way.

While doctors expect and team members want to be able to maximize their intelligence and their abilities, too often dental office employees are struggling to figure out the job, the systems, the practice and the doctor’s preferences on their own - hoping it’s right, but not really knowing for sure. It usually takes a serious problem, such as a major financial wake-up call, for the doctor to realize that he and his team are not only on the wrong path, but they are likely traveling completely different routes and are nowhere near the level of success the entire team is capable of achieving.

It’s time to stop the assumptions. Your team must know what is expected of them and how to achieve those expectations. If you do not know how to guide them in developing realistic objectives, goals, and job duties, seek help. Open the lines of communication regularly through staff meetings, ongoing feedback, and employee reviews. In reality, employees are far more likely to meet, if not exceed, the doctor’s expectations if they know exactly what those are and if there is a specific system in place to measure and review everyone’s performance and everyone’s contribution to the total practice success.

Much like the patient who sits in the chair and doesn’t say where it hurts, what they are concerned about, or what the problem or desire is - you have a far more difficult time satisfying the needs and expectations of this patient than you do the one who clearly articulates what they want and need. The same is true of your employees.

Next week, chart a direct course to achieve your goals by year’s end.

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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Michael Moore, Esq.
Director McKenzie
HR Solutions
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Cliques And Queen Bees Equal Loss Of Sleep
And Profits - Part II

By Mike Moore

In part one of this article, we discussed the various ways that things can go bad when the boss isn’t in control of the staff, and the impact this can have on the practice’s bottom line. I was discussing an associate’s case in which an office “queen bee” and her clique were actively obstructing and sabotaging the associate’s work, and the host doctor refused to step in. If we dig a little deeper, we will no doubt find that profits are down in this office because of the inefficiencies that result from such a situation.

I have not yet addressed the potential for a major legal claim if the associate is forced out because of the host doctor’s refusal to take action. There could be contract claims, discrimination claims, defamation charges, and a host of other legal theories a good litigator could bring to bear on the facts. Nor have I addressed the potential for patient complaints to the state dental board.

Without knowing any more about this practice, I already know that the host doctor neither has a written employment policy, nor has he ever taken steps to bring order to his office. His reaction – denial – is understandable. No one likes confrontation, and the host doctor either consciously or unconsciously recognizes that if he takes action, it is going to cause major headaches for him. What is happening is the result of years of neglect. And that is understandable as well, because in most situations, the doctor is the last one to learn that the environment has become toxic.

If the doctor is unaware of a deteriorating office environment, his potential exposure is growing each day. Some doctors have expressed to me that they haven’t any worries because they have never had a problem. But in today’s employment environment, nothing is as it has been. Employees are more and more conscious of the need to seek legal advice if they are fired or forced to quit. And if you consider that defending just one legal case will cost a minimum of $50,000.00, is that a risk that you want to take?

I have reiterated again and again that a written employment policy is the only way to reduce or eliminate the potential of the dysfunctional office that leads, at the least, to loss of profits. It is necessary to not only have this policy, but to ensure that it is consistently followed. But not just any policy will do. There are many policies available – some for a couple hundred bucks on the internet. But these are all punitive and paternalistic in form, and they do not accomplish the key goal – reducing the doctor’s anxiety level by increasing his or her knowledge of the office environment, and also by using non-threatening methods in discipline and separation of employees.

In writing the McKenzie Employment Practices Manual, I have drawn on twenty years of litigating employment claims. I’ve distilled the most effective procedures from hundreds of corporate manuals and policies – and I’ve created unique methods for the doctor to deal with problem employees in a manner that is neither confrontational nor disruptive. In doing so, the doctor creates a paper trail that effectively immunizes the practice against employment claims.

Here are the key elements of an effective policy:

  • The policy must be only as detailed as necessary, and must be understandable and useable by anyone. A multi-volume policy, or one written in legalese, will simply end up in the drawer.
  • The policy covers every contingency that you can conceive of – use of computers, dress, provision for ongoing education or certification, leaves of absence, reimbursement for dental work on staff and family members, etc.
  • Because it is concise, every employee gets a copy of the provisions and signs that it has been received and read. The receipt acknowledges that she was paid to read it.
  • The policy guides you in effectively hiring staff.
  • The policy provides employees with an anonymous means of bringing issues of concern to the doctor’s attention – simply stating that you have an “open door” doesn’t get it.
  • “Discipline” in the form of warnings and suspensions do not exist. You definitely counsel, and you document counseling. The policy provides for the employee to be the first to take responsibility for her own behavior by, among other things, providing the employee with a “decision day” to consider her situation if there have been ongoing issues.
  • Exit procedures are clearly set forth, and your protection is in the “exit evaluation” that every separating employee is asked to fill out upon leaving. This applies to everyone – including those who are terminated.

The key to effective management of staff performance is that – insofar as foreseeable – every contingency affecting an employee is known. It doesn’t require hundreds of pages, but it is the first critical step. Second, you consistently follow the policy. In most cases, there is no undo hardship for the doctor in this. Third, by following the policy, you – and the employee – create the documentation to establish that all employees are treated with fairness, consideration and respect.

Remember – queen bees and cliques didn’t work in high school, and they won’t work in a professional office. The consequences for the doctor if they go unchecked can be more costly than you can possibly imagine. So take action, institute a policy, and follow it. You will sleep better every night.

Mike Moore is ranked among the best in employment law and has been named one of the top 10 lawyers in Ohio. As Director of McKenzie's HR Solutions, Mike is the creator of the Employment Policy and Handbook, geared to providing dentists who are unsophisticated in the legal arena with a step-by-step policy manual.

Click here to hear Mike present “7 Elements of an Effective Employment Policy.” Email Mike at mike@thedentistsnetwork.net.

Interested in having Mike 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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Say What - Another Hygiene Exam?
By Jean Gallienne

So you’re working on your scheduled patient and you look up and see the hygienist pacing outside your operatory. You know what she wants. The hygienist is looking for you to break away from your patient in order for you to perform yet another periodic exam in hygiene. What about your own schedule and staying on time yourself? Not only do you have to be conscientious of your own schedule, but you also need to be conscientious of the hygienist’s schedule. Not because the hygienist will get behind and have to work late. It is because of the patient and respecting their time. If you want patients to respect your time and the hygienist’s time, you need to respect their time.

Having the time to do periodic exams in hygiene has been a problem for many dentists. It is a talent and a very conscientious effort to be capable of doing periodic exams in hygiene while staying on time with your own patients. Patients are very aware of underlying stresses in the office. They may not know what they are, but if you or the staff appears to be put out or rushed because of the scheduling demands, this is not the way to maintain patients.

The key is to be flexible – and this goes for both the hygienist and the dentist. Doing the periodic exam on the scheduled patient in hygiene during a time that works into your scheduled patients is what will make the difference. Many doctors want to hold off until the end of the hygiene appointment, not taking into account what will be happening in their own schedule at that time.

One way to help is to have the hygienist come prepared to the morning business meeting, allowing you and the entire staff to be aware of when you will need to do exams. This will give the hygienist a chance to tell you who will need exams because of x-rays being taken, or if there are past clinical notes that have indicated a specific need for you to come into the hygiene room. Once you have been made aware of the needs of the patients in hygiene for the day, it is important that you use that information in the right way.

If your office is paperless, the practice needs to determine a way to have the patients that need exams in hygiene stand out from the rest of the hygiene schedule. Even if you are a paperless office, you may want to have a paper schedule at the morning meeting so you or the assistant can highlight the schedule, making the hygiene exams stand out.

Now, the key to the entire procedure is for you to perform the periodic exam in the hygiene room when you have time to break away from your patient. Let’s say you just got your patient numb and you are getting ready to go into a long procedure on your current patient. This would be a great time to go check the hygiene patients. Another good time would be when you have been working on your scheduled patient for a bit and your patient is starting to fidget or the assistant may need to take an impression or x-ray before you go further.

When you have a lot of little procedures and you know that you are going to be pushed, you may want to do the periodic exams before you start all of the little procedures. As you go from one room to another, go into hygiene before you go to your next patient. The assistant will want to make sure the patients are always brought back to the operatory on time. If there is only one assistant, the front office person may want to seat your patient for you.  

Remember - the less you have to excuse yourself from your patient, the better. Patients have schedules of their own to maintain and you must be respectful of their scheduling/timing needs. The hygiene exams are what help to keep your schedule full, rushing them or making the patient stay longer than they anticipated is not a good business builder.

All of these logistics can be covered at the morning meeting. This is the one time of the day the entire staff can get together and make the schedule work as a team. This time is priceless! Start looking at your schedule and how much treatment is being diagnosed out of your hygiene department. This may be a much bigger motivator for you and your dental team to be more aware of the need for periodic exams in hygiene.

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1 day Hygiene Training Program.

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