Conflict: Itís Not the Personalities, Itís the Process
Conflicts among employees within the dental practice are common. However, the much bigger issue is the tendency to avoid conflict. Dental leaders typically see these team dynamics as distracting “drama.” They bury their heads and hope that conflict will just go away. However, by virtue of their position, practice owners are the practice leaders and whether they like it or not, staff look to the leaders to address problems, concerns, and yes, conflict.
Take the case of “Ellen” in “Dr. Mike’s” office. She has been with the practice for 12 years and has held various positions. Her current role is “floater.” She floats from the front to the back and the back to the front “helping” where she’s needed. Ellen does not have a defined job description because, well, she’s just always been a fixture in Dr. Mike’s office. She was his first employee and has achieved the status of “practically family.” Staff see her as untouchable.
She means well. The patients love her. But the team is always doing clean-up after her. If she helps with the schedule, she disregards the daily and weekly goals and just gives patients any appointment time they want. If she is turning over the treatment rooms, she invariably will “forget” this or that key detail. On the surface, it appears these are simple workplace misunderstandings. In actuality, these have become major obstacles to efficiency and productivity. Tensions are rising. The fact that the doctor refuses to give clear direction to Ellen as well as the rest of the staff has created a free-for-all mentality. Dr. Mike cannot figure out why “the ladies” can’t seem to get along.
He doesn’t know how to address the problems, so he continues to ignore them. Tensions surrounding Ellen are spilling over into other areas. The employees take their cue from the doctor and rather than dealing with the issues head on, they try to ignore the problems. But the frustration is manifesting itself in passive aggressive behaviors. They “vent” as they like to call it with one another, engaging in gossip and whisper campaigns instead. Nasty comments and accusations quietly abound.
Eventually, the lid will blow and the damage caused can, in some cases, be irreparable. All the while Dr. Mike is blissfully ignoring that his team is readying for war. He won’t wake up from his delusion until he is in the throes of a serious financial crisis. And he’s well on his way.
In the typical workplace, managers spend anywhere from 25-40% of their time managing conflict. Additionally, employees spend at least three hours a week dealing with conflict. Conflict is extremely expensive and commonly a symptom of dysfunctional practice management systems. Disagreements and misunderstandings are a reality of living and working. Tackling conflict head-on will save you countless headaches, problems, stress, and staff turnover during the course of your career. It will also clue you in to specific management system issues that are directly affecting your productivity and profitability. As the dental leader, your goal is not to make employees like one another, but to be able to work together. You need to help them reduce the emotions and get to a resolution.
Follow these strategies for dealing with conflict effectively:
1. Set aside time to directly address matters that are causing conflict. Focus on the issue, not the people. Do not allow gossip or personal attacks. These are a profoundly destructive force in any workplace, but especially in small offices.
2. Establish clear standards for professional office behavior and specific office policies. If the scheduling coordinator is routinely slotting emergency patients incorrectly, assume she/he doesn’t know what you expect. Educate your staff and help them to become more effective.
3. Deal with the issues that cause conflict. Do not make excuses so that you can continue to look the other way. She’s too nice. He’s too argumentative. They’ve been doing it that way forever. They’ll never change.
4. Choose to be positive. Anyone can criticize others and be negative in difficult situations. It’s the leaders and problem solvers who choose to remain positive and constructive.
Pay attention to what the discussions tell you about your systems. Almost without exception, at the root of team conflict is ineffective management systems.
For more information on this topic, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
New Patients in Hygiene
There are some patients who insist on scheduling an appointment for a cleaning, even though they are new to the practice. In some states, it is illegal for the hygienist to see the patient first, and the doctor has to do an exam in order to determine what the patient’s needs are. However, many offices will schedule the new patient in the hygiene chair first, because that is what the patient wants - a cleaning. I am not here to tell you if this is right or wrong. This article is to help you through some of the hurdles that hygienists may encounter when a new patient is scheduled in their operatory first.
“Mary” the hygienist seats “John” the patient and reviews his health history. Mary determines that according to the office protocol created by the doctor, the patient needs a full mouth series of x-rays. She takes the x-rays and sees visible calculus, or she glances at the x-rays and does not see visible calculus, but sees that the patient has vertical bone loss. This practice also has a protocol that every patient will have a 6-point probing done on every existing tooth, and recession will be entered into the chart as a baseline. Mary goes over probings with the patient.
“John, I will be doing a procedure on you today that is called probing. This is where I go around the gums and measure the level of the attachment of the gum to the tooth. Measurements of 1, 2 or 3 are all considered within normal limits. I would like it if you count all of the 4’s and above on your fingers as I am calling the measurements out. When you have 4’s and above, this usually indicates a more extensive and aggressive procedure than a cleaning, because you have gum disease.”Reminding the patient to count all of the 4 millimeter and above probings on his fingers enables John to co-diagnose his periodontal disease. The probings are done, and Mary determines that the patient needs 4 quadrants of root planing. She now goes into even further description of root planing and what it involves with the patient.
Up until now, the appointment has been all of the fact-finding and standard protocol that the office has put into policy. What happens next? The patient is expecting a cleaning and needs four quadrants of root planing. If the hygienist does not do the cleaning the patient is expecting, the patient may not return.
Financials need to be reviewed before the root planing is started. Some patients are compliant and will be ready to go ahead with the root planing immediately, and some patients will only want the cleaning they were told they would get. How this is handled is crucial, as it is a huge part of the trust relationship you are building with the patient. It becomes very important for the hygienist to read the non-verbal clues and communicate what is going on before mobbing forward. Once the financial coordinator has gone over the details, the hygienist will then be told if the patient is prepared to move forward. If the patient is not ready and is still asking about the cleaning they came in for, then the hygienist had better do the cleaning. This may involve doing all of the healthy teeth and leaving everything else that needs to be root planed for future appointments. This gives the hygienist time to talk to the patient some more about periodontal disease.
The patient may try to appoint again in six months without having the root planing done. If this happens, go ahead and make the appointment, and the hygienist can continue to educate the patient about periodontal disease and the need for more advanced treatment. To dismiss the patient immediately without having another time scheduled for further education would be a loss of a potentially good patient. However, at a certain point if the patient is non-compliant about everything you recommend doing, you may have to dismiss them from the practice. Sometimes this is a wake-up call to the patient, and they start getting work done. The doctor has to determine protocol for when it is appropriate to dismiss a patient, as it may be based on the individual patient and their needs.
It is important for the doctor and hygienist’s time to be as productive as possible. However, with some patients it is more productive to step back, pay attention to their wants and needs, and make sure treatment is presented in a non-confrontational, safe, and compassionate environment. It is always very important for the entire team to be tuned-in to what type of personality the patient has, and be observant of ALL non-verbal and verbal communication the patient shares. We want to keep the patients that walk in the front door and not chase them out the back door because of a hard sale attitude.
Interested in improving your hygiene department? Email email@example.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151
Get Buy-In from Your Team
Here’s a question I recently received from a doctor. His dilemma seems to have a great deal of applicability to many readers so I thought I’d share it with you.
“How do you best recommend approaching staff with changes you want to make that you do not feel will make them happy? I want to have staff take turns answering the phone over lunch hours and on days we come in late. I feel we are missing out a lot. I know they like spending their lunch hours together, but I feel running a business requires the phone to be answered more than the hours we are seeing patients. Any help on this matter would be appreciated.”
Change in and of itself is difficult. People’s preference for and reactions to change are so different. Therefore the first step is do nothing until you have a careful plan of action. Telling someone that you are going to disrupt their life needs to be given serious thought in order to have maximum buy-in. Unless there is a life-threatening issue, take time for planning what you will say and how you will deliver the message of change.
The most logical approach is to bring up the issue at a staff meeting with everyone present. Share your concerns about missed calls at lunch. Talk about it from the perspective of your feelings and the impact this has on the practice, including on them. Frame it in a positive manner. Speak slowing and softly. Have an inquisitive tone, one of curiosity. Pause between sentences. Here's a possible script to build on:
"I have been thinking about our office policy and the fact that we only answer the phones when we are seeing patients – during office hours. During the lunch hour and on those days when we don't start until late morning, new patients are likely calling us. And we are missing those calls. We can schedule more appointments by expanding our phone coverage. New patients mean more business…which means more money for all of you (or whatever benefit they will gain). I need your help to make this happen. What ideas do you have?"
The bottom line is don't “announce” a change. No one likes to have a bomb dropped on them. Instead, frame the problem as moving TOWARD something better, for patient care and especially for employee satisfaction. Invite them to participate, especially early on in the process. You can always institute a command, but that is not the place to start. The goal is to build excitement and good will. Or, at the very least, you need to have foresight to minimize as much resistance as possible. Remember to be patient and avoid the potential to rush to a solution. If it’s not a fire, flood or earthquake take your time up front to plant the seed and see what grows. This is not a waste but an efficient use of time because it will give you a sense of their willingness (or not) to engage with you in covering the phones.
I assume that the person who stays at lunch or comes in early will be paid for these additional hours. Have you considered that there may be a staff member (or more) who might want to add more money to their paycheck? It reminds me of one of the dilemmas in The Adventures of Tom Sawyer. Tom was tasked with painting a fence on a beautiful summer day when he would have preferred to be out fishing. When his buddies started teasing that he had to work while they played, he portrayed the painting as something very few could do. He built up the task as a privilege. He initially resisted letting any of his friends try it. Then, with the appearance of great reluctance and worry, he let go. In the end, the fence had 3 coats of paint while he idled in the shade.
OK, let's say no one volunteers. Again, be patient. Tell them you understand they don't want to give up their lunches…that they like spending time together…that you are happy about their camaraderie. Empathy is powerful and the fact that your employees like each other is a plus. Acknowledge that then pause. The key is to be thoughtful and deliberate. In a calm, slow voice tell them once more “we really do need to expand the phone coverage" and "please think about what we can do to make that happen.” Wait a few days and ask again. This can be at the end of the morning huddle so you don't need to call a formal staff meeting.
I think by now you have the drift of my thinking. This is a step-by-step process that is carefully planned and executed. You can always "announce" a change. But that should be your last step. Good luck. Keep me posted.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at firstname.lastname@example.org
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