8.24.18 Issue #859 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

3 Reasons Staff Conflict Leads to Turnover
By Sally McKenzie, CEO

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When there’s staff conflict in a dental practice, it doesn’t just affect the people directly involved – it impacts everyone in the office. Other team members are well aware of what’s going on, and have to deal with the negativity, tension and efficiency issues that conflict brings.

If it gets bad enough, some team members might decide it’s time to find another job, leaving you with another problem. Not only is conflict holding your practice back, now you have to go through the hiring process to fill open positions. This leads to extra stress and frustration, only making the situation worse.

The possibility of turnover is one of the many reasons you simply can’t ignore staff conflict. As soon as you notice an issue among team members, take them aside to find out what’s going on and work with them to find a solution to the problem. Don’t place blame; focus on resolving the conflict so everyone can move on.

If left unresolved, staff conflict can cause a lot of damage – and that includes prompting team members to look elsewhere for employment. Here are three reasons staff conflict can lead to turnover, and advice on how to keep issues among team members from getting out of control.

1. Conflict Creates A Toxic Environment
No one wants to work in an office full of gossip and tension, but that’s exactly what your employees are exposed to when conflict takes over. Team members spend more time complaining about each other than actually doing their jobs, which brings the rest of the staff down. They start to dread coming to work each day, and that impacts their performance.

Instead of gossiping and making snide remarks at every opportunity, your team members should work together toward achieving the same goals. They should support each other and do their part to move the practice forward. Holding daily morning huddles can help ensure everyone is on the same page and that any brewing conflict is resolved before it becomes a major problem. Team members should feel comfortable bringing up any issues they’ve seen, allowing everyone to work on finding solutions and resolving problems before they cause turnover and other damage.

2. Conflict Hurts Practice Efficiencies
When team members are focused on conflict, their productivity suffers and other team members are often left to pick up the slack. This is frustrating and leads to resentment and even more problems among team members, which could prompt employees to start a job search.

To avoid this, I suggest you deal with any issues you see as soon as possible and make it clear that gossip will not be tolerated in your practice. Let employees know they should only talk about team members who are in the same room. If another team member breaks that rule, they shouldn’t engage in the conversation – it’s best to just walk away. Bottom line: Gossip wastes time and shouldn’t be part of any dental practice.

3. The Patient Experience is Anything but Exceptional
Your team members want to provide your patients with the best care possible, but that can be difficult if they’re dealing with conflict day in and day out. Patients can feel the tension, making them uncomfortable during their appointments. It also affects the level of care team members provide. If employees are focused on being angry at each other, they’re not focused on your patients – and that could hurt retention numbers as even your most loyal patients decide to make their next appointment at the practice down the street.

When patient retention numbers drop, so does team morale and job satisfaction. If team members know patients are leaving because they’re not happy with the experience, some of those team members are going to start looking for a new job at a practice that puts the patient first.

While you might think creating an excellent experience is a priority in your practice, the focus on serving patients gets lost when there’s conflict. After you sit down with team members to resolve issues, remind them how important it is to provide a positive patient experience. Patients should be greeted with a friendly smile the moment they walk through the door, and team members should do whatever they can to help them relax throughout the appointment. Exceptional experiences keep patients coming back, leading to job satisfaction that also helps keep team members loyal.

If left unresolved, staff conflict can do a lot of damage to your practice. That includes costing you money, patients and, yes, team members. As much as you might want to avoid it, you really have to help your employees work out any problems that come up. You might think they can handle it on their own, but it doesn’t work that way. They’ll just let it fester until the conflict boils over and ends up hurting your practice.

Still not comfortable dealing with staff conflict? Not to worry. I’m happy to help. Feel free to reach out for guidance.

Next week: Staff conflict damaging your practice? Here’s how to handle it

For additional information on this topic and more, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
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Belle DuCharme, CDPMA
Instructor/Consultant
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The Difference Between Clinical Chart Notes and Written Narratives for Insurance Companies
By Belle DuCharme, CDPMA

There is much confusion over how to chart clinical observations, diagnosis and treatment and then edit it into a narrative for the insurance company. Narratives need to be short (about 80 characters) but clinical notes can be as long and detailed as the doctor wants. A narrative that is longer than 80 words (including punctuation) should be attached to the claim on a separate document. It is recommended that the dentist use the SOAP format - Subjective, Objective, Assessment, Plan - to organize their observations, diagnosis and treatment plans. Insurance companies often ask for clinical notes instead of narratives.

Clinical Chart Notes
Clinical notes can be added through some computer software using templates that can be customized for each patient encounter. If you are still using paper charts, the SOAP format is easy to use. Using the same narratives for similar procedures on different patients is not recommended and can be a red flag to payors. Each charting must be unique to the situation of that patient.

SOAP format would identify:

Subjective: What is the patient telling you about their symptoms or “chief complaint”?  This should be recorded in detail to closely match the patients’ words.

Objective: What do the clinicians see when observing the patient? Write down symptoms and patient responses to questions, and record any diagnosis or observations the dentist makes.

Assessment:  From the subjective and the objective a diagnosis is completed with prognosis determined.

Plan: A written treatment plan is constructed to present to the patient with options and informed consent.

Patients’ clinical notes are a legal document. Dental clinical staff therefore have a responsibility to accurately chart all present teeth and past treatment, and make sure all treatment options are discussed. Update their medical history as well, keep correspondence with specialists, and keep consent forms and exact progress notes. Notes should always be recorded during and directly after the patient’s visit to support accuracy.  

Example of clinical notes: Patient presents broken tooth from biting down on nut shell, pain to cold--UL #14 fractured buccal/lingual cusp, and 50% of tooth left so recommended patient that a full crown is the best choice. Explained differences between gold and porcelain bonded crown, told patient that PFM was the most aesthetic option, but gold is slightly stronger and helps periodontal condition. Patient concerned about crown blending in with existing dental work, concerned about metal becoming visible due to gingival recession (past experience). Discussed choice of Lava crown (metal free), patient shown photographs of Lava crowns, patient wishes to go ahead with Lava crown.

Limited eval, 1 PA taken of UL1, PA shows bone to be stable no pathology. Prognosis: excellent, Pt. given verbal and written estimates and consent form to sign.

Who is accountable for creating clinical chart notes?
Although the dental assistant should record as much correct information as possible, the dentist is responsible for the content and must check that the notes are satisfactory and make any necessary additions or amendments.

Dental assistants (or front office) can then select CDT codes that reflect what was done on that date, to be entered on the patient’s ledger to create a dental claim.

Example of Narrative for Crown #14, D2740 Porcelain/Ceramic Substrate (Lava)    
Narrative: #14 (15 yrs) MODL comp fail / fx D/L cusp Dec undermg 50% rem #14 cold sens. Bne/no perio/Crn best

Checklist to create narratives:
1. EXISTING RESTORATION – size (large/small), restorative material (composite, amalgam, gold, ____)
2. SURFACE/SURFACES – modb, mif, or_____
3. CONDITION – fractured DB cusp, leaking M margin, hole in occlusal of crown, prior endo (and when endo was final), decay undermining
4. AGE OF RESTORATION OR DATE OF INITIAL PLACEMENT – this is also answered in box on claim
5. AMOUNT OF REMAINING TOOTH STRUCTURE – 1/3 natural tooth or ____
6. AMOUNT OF LOST TOOTH STRUCTURE – 2/3 natural tooth lost or _____
7. PATHOLOGY/SYMPTOMS – pain (hot, cold, biting, air night, day), decay (new or recurrent), location of decay (md, bl, _____)
8. OBSERVATIONS NOT VISIBLE IN THE X-RAY – take intraoral photos if possible or draw a picture, chart locations of fractures, cracks and how extensive they are
9. CRACKED TOOTH SYNDROME – note severe craze lines on anterior teeth and/or washed out existing composite restorations  
10. CHART PERIODONTAL FINDINGS – adequate bone support for crown/bridge
11. ABSENCE OF PERIAPICAL or PERIODONTAL PATHOLOGY IN X-RAY
12. BRUXISM – causing breakdown of periodontal system

If your practice demographics is mostly insurance patients, whether in or out of network, learning to chart and create good narratives will increase your revenue flow.

Need help with this? Call McKenzie Management for professional Front Office Training today.

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

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