McKenzie Newsletter 470

Tackling Termination
by Sally McKenzie CEO
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Many dentists will do everything they can to help a problem employee become an effective member of the team, only to be forced to eventually terminate the individual. Oftentimes, the primary reason is a poor attitude - the problem employee is so negative that she/he drags down the entire team. It is poison for any practice and must be dealt with swiftly.

In other cases, the employee’s skills are weak and could be improved, but they won’t take the necessary steps to become a more effective member of the team. They repeatedly fail to perform up to the practice’s standards. Or perhaps the employee makes a half-hearted effort to improve for a while, but eventually slips right back into their old ways.

With a progressive discipline procedure, the penalties become stronger if the employee misconduct or poor performance is repeated. For example, it may start with a verbal reprimand, proceed to a written reprimand, then suspension, and ultimately termination. When the employee sees the documentation and when they understand the progressive discipline policies, they cannot deny that they are responsible for their actions and the consequences. The dentist doesn’t just decide to terminate the employee on a whim, rather the employee chooses not to correct the problems and the doctor simply takes the next and final step in the progressive discipline plan - termination.

It all sounds neat and tidy, but what happens when you actually have to sit down and tell the employee? Yes, you have the documentation. Yes, you are confident in your decision. Yes, you have a contingency plan for how the individual’s duties will be handled until a replacement is hired. But you hate conflict. You fear the worst. You know what you have to do, but you are paralyzed and can’t seem to take the final actions. Now what? Press on. Take these measures in handling the final step:

Meet with the employee in private but have a witness present such as your attorney, office manager, or spouse. Patients should not be in the office or expected in the office when an employee is being terminated.
Tell the employee that the purpose of the meeting is to release them from their position.
Be clear. Make sure the employee knows s/he is being dismissed from employment in your practice. This is not the time for vague generalities, but be respectful.
Don’t go into the details of the performance problems. Through the progressive discipline procedures, the employee has been provided numerous opportunities over the past 60-90 days to understand and address the performance issues. One of the most common mistakes employers make in terminating staff is talking too much during this final step. Script or outline your words and stay on point.
Don’t assess blame or make apologies for the action. It’s not necessary to blame the employee, the practice, the team, the patients or anyone else for the termination.
Don’t talk about yourself - “I know how you feel.” “I don’t want to do this.”
Let the employee speak, but do not become argumentative or try to defend yourself or the practice. You can tell the employee that you appreciate their candor but do not get into a discussion and do not admit to any wrongdoing. Don’t defend yourself or your actions. You should be calm and controlled at all times even if they tell you that you are a lousy boss.
Give the employee a check on the spot for earned salary and benefits or tell them to expect payment within a certain number of days.
The person then should be escorted to collect their personal belongings and hand over the office key.
Shake their hand and wish them luck. You might tell them “This could be the best thing that happened to you.” They may find an opportunity better suited to their talents. End on a positive note, but avoid getting drawn into any kind of discussion. It’s time for the employee to leave the premises.

When they are gone, call the team together and inform them that the employee is no longer with the practice. Do not get into any details regarding the dismissal. It’s important that the team hear from the doctor as soon as possible to avoid speculation and gossip. Although firing an employee is extraordinarily difficult, once the step is taken most dentists find that it was the best thing they could have done, and, typically, it was long overdue.

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

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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Frustrated with HIRING the WRONG people? Remove the guesswork. Employee Testing On-Line

Carol Tekavec, CDA RDH

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Help - My Dentist Gets Mad when I Call Him for a Recall Exam!
Carol Tekavec RDH

A hygienist recently sent me this email:

My name is Jenni and I have been working as a hygienist for Dr. G. for two years. Every morning we have a team huddle and look at the schedule for the day. I mention which of my patients will need recall exams, and Dr. G. sees where they occur on the schedule. But then during the day, when I notify him that the patient is ready to be seen, Dr. G. makes us wait, or worse, acts upset when he comes to my room. What’s going on?

At first glance, it is hard to find an answer for this hygienist’s dilemma. It appears that the dentist is at best, unreasonable, or at worst, rude! But, like many problems, there may be more going on here than meets the eye.

Why would a dentist be “mad” at being called to the hygiene room to see a patient? After all, the recall exam is an important time for identifying necessary restorative treatment - a vital function in a successful practice. If a patient-of-record’s needed treatment is not identified and subsequently scheduled during the recall appointment-when will this happen?

The answer may lie in the fact that the dentist is frustrated at being constantly interrupted during his day. Just when he is ready to finally find that last stubborn canal during an endo, or is in the middle of a difficult prep, the call comes for an exam. He may feel pressured to stop what he is doing and jump up for the exam. Or he may feel resentful of these repeated interruptions, and decide to finish up a procedure, making the hygienist wait. Either way, it is not hard to see how he might become stressed, therefore making the hygienist feel that she is making him “mad.”

Performing dentistry requires concentration, skill, care, and judgment. It is difficult to drop everything, switch gears, and take the time to deal with the required conversation and mental challenge of another patient, when one is intent on providing a service for the patient already in the chair.

What to do? One solution might be for the hygienist and the dentist to come up with a recall format and “hand-off” script that makes dealing with the recall patient a little easier.

For example: Jenni and Dr. G. can agree that during the first 15 minutes of the recall appointment, Jenni will inspect the patient for plaque and calculus, talk briefly about her home care routine, expose necessary radiographs, (as previously ordered and agreed upon at the last recall), perform an oral cancer screening, inspect the patient for possible restorative needs, take photos, discuss possible restorative needs with the patient, and then put in the call for the dentist’s exam. She can then proceed with the prophy. When the call comes in, Dr. G. knows that Jenni and the patient are ready for his exam, but he also knows that he can respond to the call any time during the next 30 minutes. When he is at a stopping point with the patient he is working on in his own chair, he can go to the hygiene room for the exam.

When he arrives at the hygiene treatment room, he utilizes a “hand-off” script that he and Jenni have agreed upon. He might say, “Hi Mrs. Patient, it’s so nice to see you again” and then address his next remarks to the hygienist, “Jenni, what have the two of you been talking about?”

Jenni can give her report - “Mrs. Patient and I have been going over her home care routine, and she is doing well with the new electric toothbrush she purchased after our last appointment. I also think that she may be doing a little better with flossing. However, I found a tooth on the lower left that I think may have a crack in it, and I took a photo for you to look at. Although Mrs. Patient has not noticed any discomfort with this tooth yet, she has a very large amalgam filling and two distinct cracks that appear to be undermining an entire cusp of that tooth. I explained to her about the possible need for a crown for that tooth and wondered what, if anything, you might recommend.”

Dr. G. can get right to business. He can examine Mrs. Patient’s mouth, give his opinion on the tooth that Jenni has identified, affirm (or not) Jenni’s suspicion that the tooth in question needs a crown, and then go on to complete his exam. Once the dental portion of the exam is complete, he can go on to the niceties that patients value in a caring dentist. He can ask about her family or her job, talk about the soccer team, her son and then politely (and quickly) exit the room. Jenni can enter a treatment plan for identified treatment and send the plan to the printer up front, to be ready for the treatment coordinator to go over with Mrs. Patient when Jenni brings her to the front desk area. She then goes on to finish the prophy.

Using this recall format, the hygiene schedule stays on track, necessary treatment is identified, the dentist is more in control of his time, and the hygienist and the patient are not kept waiting,

While this example does not take into consideration every aspect of every hygiene recall appointment, for instance, how many times a year a complete periodontal probing is accomplished, it shows how a recall appointment format can help dentists and hygienists work together. When a dentist doesn’t feel pressured to “drop everything” when the call comes for an exam, he can arrange for a smoother transition from one patient to the next. When the “hand-off” script allows the dentist to address dentistry first, and pleasantries second, less time is spent in non-dental conversation, allowing for him to get back to the other patient in his treatment room in a more timely manner. And, when the hygienist knows that the dentist will be arriving during the prophy time in good humor and on schedule, her day also goes more smoothly.

Working with patients in a dental office can be stressful. The constant pressure to stay on time can take its toll on the entire team. However, a recall format and “hand-off” script can provide a method for reducing these problems, making the work-day more pleasant for everyone.

Carol Tekavec 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 hygiene efficiency and profitability for McKenzie Management. Interested in having Carol 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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Are You Leading Your Team Fairly?
Nancy Haller, Ph.D., Leadership Coach McKenzie Management

The instincts about fairness that emerged on the playground when you were a child also apply to how you lead your team today. On one level, fairness is just common sense. You need to be guided by objective standards, not because you like the employee or conversely because you feel sorry for him or her. At the same time, when you try to make things fair for everyone you run into another danger because employees often interpret “fair” as what is best for them and only them.

Several years ago, a scientist at Emory University introduced female capuchin monkeys to money. She gave them granite pebbles and taught them that if they surrendered a rock back to her she would trade it for a piece of cucumber. Capuchins like cucumbers and if that were the only deal available, they would trade rocks for cucumber slices almost every time.

The researcher then placed two monkeys in cages next to each other so they could see the bargain made by the capuchin next door. The primatologist approached one monkey and made the standard trade: a pebble for a piece of cucumber. Next, the scientist approached the second monkey and exchanged the pebble not for a cucumber slice, but for a grape. Capuchins like grapes more than they like cucumber slices.

As logical as the need for fairness may be, feelings of being used are often at the heart of what destroys working relationships. Seeing another monkey get a better reward for the same action, the first capuchin often got upset. She might "go on strike," refusing to make the exchange in future rounds. She might refuse to eat the cucumber piece even though she paid a pebble to acquire it, and if she hadn't seen the grape trade, she would certainly have eaten it. In extreme cases, she might throw a small fit, such as tossing the token or reward out of the test chamber.

Behaving this way is certainly irrational - we might even conclude that it is emotional. The aggrieved monkey didn't hurt anyone but herself by refusing to trade rocks for food or by throwing away cucumbers she otherwise would have eaten. So why did she do it?
The authors of the study wrote that "Capuchin monkeys seem to measure reward in relative terms, comparing their own rewards with those available, and their own efforts with those of others.”They respond negatively if a partner “gets a better deal." Academics call this phenomenon "inequality aversion" or "distributive justice." You might call it evenhandedness, doing right by the other person, or just plain fairness. If fairness is essential for a capuchin monkey, fairness is even more important and more basic to humans than we realize.

Gallup research didn’t involve cucumbers, grapes, or side-by-side enclosures. Nonetheless, similar discoveries emerged in interviews with people comparing their best and worst work situations. Several statements about fairness proved crucial for successful collaboration. They asked respondents how strongly they agreed or disagreed with each of these statements:

We share the workload fairly between us.
We do not have to keep track of who does what and who gets credit for what.
We see each other as equals - one is not better than the other.

Collaboration has little chance of succeeding unless all parties believe it is fair. On a scale from 1 ("strongly disagree") to 5 ("strongly agree"), it takes an average above 3.6 on these statements to reach the range considered "good." Only respondents who strongly agree to all three statements have excellent alliances.

Don’t focus on keeping things “even” between employees, but strive on being fair. Keep in mind that employees need some help understanding how any decisions that you make for them also affects their coworkers. If they get to leave early, it leaves more work for someone else. If everyone always gets the same raise, the people who work harder, are never late to work, go the extra mile, etc. feel that their initiative is not appreciated. More and more it’s essential to explain to employees the impact of their behavior, on you and the practice.

It’s also crucial to have an Employee Handbook that clearly states the policies and procedures of your practice. This information helps employees to know what is expected. Follow those basic guidelines consistently as you deal with common situations such as family illness, personal “emergencies”, etc.

Explain why you are willing to do certain things for some employees, but are hesitant to do them for another one. Encourage employees to talk with you so they have an outlet for their emotions. Provide appropriate but professional support to employees but don’t be swayed by high drama. The ultimate goal is to maintain a positive work environment where you are seen as a fair leader.

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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