8.27.10 Issue #442 Forward This Newsletter To A Colleague

Feel Like Pulling the Escape Slide on Your Practice?
by Sally McKenzie CEO
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When JetBlue flight attendant Steven Slater grabbed his bag, his beer, and slid down the escape slide in a defiant display of “take this job and …” many cheered. In an industry where employees are literally shoulder-to-shoulder and face-to-face with tired, frustrated, and downright rude passengers day-in-and-day-out, you can understand how someone might just say “Enough!”

But it isn’t just those in the airline industry who identify with Slater’s frustration. I believe it’s safe to say that all of us have had at least one, and probably multiple occasions where we simply wanted to walk away from the frustration and never look back. In the dental practice, no doubt, there are patients you would happily send out the emergency shoot - if only you had thought to build that into your office design. And there are days when you just might think that Mr. Slater’s way of dealing with the heat of the moment wasn’t so bad – finding the quickest, shortest route to the nearest exit.

Certainly, we all have bad days, bad weeks, even bad years. The stress of work and family can pile up to the point where you feel your only option is to release the emergency shoot and jump. I’d like to suggest a different approach, one that will keep your practice intact and your dental license in good standing.

First, ask yourself two fundamental questions: Does your practice give you the financial resources and time to enjoy your work, your life, and your family? Second, and perhaps the most important question: If you could do it all again, would you choose this same career path? If you answered “no” to either or both of the questions above, it’s time for change.

Consider what you want. If it is a more successful practice that will provide you with the resources to achieve greater enjoyment from both your work and your personal life, I can assure you that you have the power to make that happen. If you are questioning your career choice, I would venture to guess that it is because you pursued dentistry to be the dentist in your practice, not the VP of Human Resources, not the collections police, not the office counselor, not the rule maker, and so on.

We consistently find that dentists who are the least satisfied professionally and personally have the weakest practice systems. They resign themselves to unhappiness and dissatisfaction because they either don’t realize that they have choices or, in some cases, are afraid to make different choices. Let’s look at the areas that tend to be the chief misery makers for most dentists and what you can do to address them.

  1. Employee Headaches - Many dentists would love going to work if it weren’t for the staff.
  2. Scheduling / Production Inconsistencies - You are crazy busy one day and pacing the halls the next.
  3. Collections Concerns - Sometimes patients pay, sometimes they don’t.

Those three areas affect multiple systems and can be the source of seemingly endless frustrations and perpetual dissatisfaction. Consider number three: collections concerns. This is an issue that is resurfacing for many practices that had seen highly successful collections rates, but once again are experiencing increasing accounts receivables. Why? With the economic worries facing many, some dentists are afraid that patients will respond negatively to strict payment policies. Consequently, they, along with their business teams, are making assumptions about patient finances and bending or disregarding policies. Certainly flexibility and options are important, but you don’t want a return to the problems dental practices had 20 years ago with accounts receivables well over one month’s production.

Revisit your financial policy and ensure that everyone on your team who is discussing payment policies with patients understands clearly how patient financial arrangements will be handled. Yes, be sensitive to the economics of your area; provide reasonable financial options that do not compromise the fiscal stability of your business. If you haven’t already, establish a relationship with a patient financing company, such as CareCredit. Consider allowing patients to build a credit balance on their accounts before major work is started or allowing them to make three large payments. Another option is to offer a 5% reduction on the cost of treatment for patients who pay in full.

Next week, rid your practice of the top two “Misery Makers.”

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 Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Coaching Employees for Success
By Nancy Haller, P.h.D., Leadership Coach McKenzie Management

We will be celebrating Labor Day in another week, the holiday dedicated to the achievements of the American workforce. It was first intended to honor workers and give them a day of rest. In truth, President Cleveland declared it a national holiday to appeal to unions.

It’s unlikely that you have to contend with unions, but you are likely to have some labor struggles in your practice from time to time. If you are concerned about creating adversarial, 1930’s style labor vs. management problems, you probably avoid talking with your employees about their performance. Dentists are not trained to deal with the sensitive interpersonal dynamics involved in changing unacceptable employee behavior. Naturally there’s a desire to steer clear of conflict.

But your success is measured in terms of the way your employees perform. You need them to take responsibility and to make a commitment if they are going to serve you well. Face it – a poor employee isn't going to get better unless he or she is made aware that there is a need to improve. Don’t wait until there’s a threat of a walk-out before you address deficiencies in an employee’s performance. The challenge is to use mistakes to impart knowledge, to expand skills, and to develop heightened awareness.

Whether you are dealing with a new employee or a seasoned veteran, the goal is to concentrate on the desired results rather than the person’s shortcomings. Feedback tells people whether they are “on course” - keep doing what you’re doing - or redirects them. The problem is that most people associate the term “feedback” with criticism rather than information. What if you were to think of your intervention with an employee as collaborating with them and helping them succeed? Instead of using feedback to punish employees, try coaching them. A coaching approach to performance problems enables you to inspire and support your employees while giving them the direction and clarity they need and deserve. 

A large percentage of the problems related to employee performance are due to inadequate data. Much of this can be traced back to inadequate direction and guidance as well as inadequate feedback. The reality is that we don’t get much feedback generally. In the absence of feedback, most people tend to think they’re doing well - even when they are not. Feedback is essential for learning. Consistent feedback to your employees enables them to do things better. 

The problem with “negative” feedback is that it focuses on the past, on what has or has not occurred. The emphasis is on what’s gone wrong. On the other hand, coaching employees about their performance focuses on the future. This difference has a profound effect on how the conversation might go, and therefore on the motivation and engagement of your employees.

Let’s take a corrective feedback conversation. It might go something like this:

Doctor: (assertively) “Here’s what I noticed. Why did you do that?”
Employee: (defensively) “These are my excuses – blah-blah-blah.”
Doctor: (authoritatively) “Well it’s not good enough. Here’s what you should have done. From now on I expect you to do A-B-and-C.”

If you put yourself in that employee’s shoes, what might you be thinking and feeling? How useful would that conversation be to you? What would happen to your commitment to that manager and to the job? My hunch is that you wouldn’t be inspired.

Let’s take the same situation with a focus on the future. It may go something like this:

Doctor: (assertively) “Here’s what I noticed. Let’s talk about why it will be important for us to get this right in the future.”
Employee: (objectively) “Well, for this reason and for that reason.”
Doctor: (curiously) “So what could you do differently when you face a similar situation in the future to be sure you get it right?”
Employee: (without emotion) “Well, I could do this or that.”
Doctor: (supportively) “I think that the first of those ideas is especially useful because X-Y-and-Z. Let me also suggest something that’s worked for me (provides example). How would that be for you?”
Employee: (smiling) “That’s a great idea. I think that’s something I could use. Thanks.”
Doctor: (establishing agreement) “So, can I get your commitment to put that into effect the next time this situation occurs?”
Employee: (accepting the positive pressure to change) “Yes, I will do that.”
Doctor: (supportively) “Great. Let’s get together again next week to see how it’s working for you.”

If you put yourself in the employee’s shoes again, I would bet that the level of engagement and desire to improve would be much better. Rather than an interrogation (no wonder employees get defensive), a supportive coaching discussion emphasizes creative problem solving. You and the employee are working together in a collaborative vs. accusatory manner. By supportively talking about solutions, you show respect and caring for the employee which builds trust and commitment. And that creates a strong labor force.

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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Imprive your hygiene performance one day... in your office

Carol Tekavec, RDH
Hygiene Consultant
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Converting Prophies to Periodontal Maintenance -
Not So Simple Is It?

By Carol Tekavec, RDH Hygiene Consultant

It is known that almost 80% of adults have some form of periodontal disease, yet 90% of our patients are coming in for prophies. We know that this doesn’t make sense, but finding our way toward proper diagnosis, accurate treatment plans, and most importantly, helping patients understand why they now need periodontal treatment after being patients of record for many years, is not so simple.

As a working hygienist and consultant, I know that there is a lot more to increasing our percentages of periodontal treatment to prophies than announcing at a staff meeting it will be done. If your answer is “no” to any of the below questions, converting prophies to periodontal maintenance in any meaningful way is going to be extremely difficult.

1. Is the practice committed to appropriate patient care and treatment?
Things are constantly changing in the world of dentistry. Doing something one way just because “that’s the way we always do it” is not a reasonable approach to taking care of patients. Dentists and staff must be willing to keep up-to-date on all aspects of patient care. Just because our patients have “always” come in for prophies every six months, does not mean that is necessarily appropriate for them. And where did the idea of six month recalls come from in the first place? Some credit old Pepsodent toothpaste commercials that said, “Brush your teeth twice a day and see your dentist twice a year.” Not exactly scientific! Recall time intervals need to be based on what the patient actually needs.

2. Are the hygienists open-minded about evidence supporting more identification and treatment of beginning stages of periodontal disease?
Hygienists need to be open-minded about new recommendations concerning identification and treatment of periodontal disease. Not long ago it was considered inappropriate for 4mm pockets to be treated with periodontal scaling. Now, under the guidance of the American Academy of Periodontology, we understand that beginning stages of periodontal disease need to be addressed! Arming ourselves with knowledge such as that which is available in the AAP Parameters of Care can help us overcome any reluctance to make necessary changes, as well as back up our suggestions to our patients. Remember that patients cannot be converted to periodontal maintenance without receiving scaling and root planing or periodontal surgery first.  Periodontal maintenance is not considered to be appropriate unless previous treatment has been performed to control the disease process. After initial therapy, periodontal maintenance is correct and according to the ADA Current Dental Terminology may be continued for the “life of the dentition or any implant replacements,” as ultimately determined by the dentist.

3. Can the staff work together to support a “new way of doing things?”
Once a different philosophy of treatment is identified, can the staff work together to support changes? If the office manager is the only person supporting the “new ways,” changes will never get off the ground. The assistants, hygienists and the dentist can sabotage making changes effective, even if this is done unconsciously. Patients will often ask a dental assistant, “Do I really need this treatment?” If she cannot answer “yes” confidently, the patients will know it.

4. Is there enough time during a typical hygiene “recall” for both identification of periodontal disease and discussion with a patient about treatment?
Appropriate time must be scheduled into the hygiene appointment to allow for identification of periodontal disease, and patient education about the situation. Rushed appointments do not lend themselves to patient comprehension and acceptance of periodontal treatment recommendations. Should hygiene appointments at the office be lengthened? Discussion of scheduling needs to be a part of a staff meeting prior to instituting changes in patient care. It is not possible to be successful if identification and education is just “crammed in” to an already overloaded appointment.

5. Can the clerical staff support the hygiene department in discussion of treatment, discussion of fees and insurance, and scheduling for patients who are being moved to the periodontal “track?”
Once a patient has been identified as requiring scaling and root planing, the clerical staff can further streamline patient acceptance by being well versed in office fees and possible insurance parameters for patients who are being scheduled for periodontal care. Many insurance contracts provide for a certain amount of benefits for periodontal treatment. However, patients will typically find themselves facing higher co-pays or responsibility for more of their bill (for example - most contracts provide for only two periodontal maintenance procedures annually rather than the four visits which are typically recommended). It is usually up to the business staff to help patients understand their financial obligations.

Offering more appropriate care for patients can be good for patients and good for office production. Careful consideration of how changes are implemented can be vital for success.

Carol Tekavec CDA RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com

Carol is also a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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