Exceptional Dental Practice Management

Hiring...Oy Vay!

    One of the biggest dilemmas for me as a practice manager has to be hiring new team members.  I'm a sucker.  They get me at hello.  I'm talking about the interview.  A candidate comes in, she's dressed professionally, she says all the right things.  I'm excited, I think she might be who we've been looking for.  OK, we move to the next step; the working interview.  Sometimes I catch on here.  Someone says they have years of experience, yet when you ask them to place topical for # 3 and they spread it all over the lower left quadrant, something's fishy.  But, sometimes they shine at the working interview and I'm happy to add this wonderful new person to our staff. 
    Now we have a three month probationary period.  Usually I can ferret out poor employees here.  When I remove a temporary that they've cemented and the sulcus is full of cement I have them take a look.  If it bothers them, I know we can work together to improve on it.  If they shrug and say "Oh well", I know I've made a mistake.  More episodes of increasing carelessness lead to the end of this relationship. 
    I have tried hiring for character and teaching skills.  That has worked beautifully for our front desk and lab assistant.  They are both conscientious and happy to have been given the opportunity.  I haven't had much luck with the chairside assistant though.  First of all, there aren't many experienced ones out there.  Wonder why.  Well, I kind of think I know why but, that's another topic for another day.  Teaching chairside assisting on the job is time consuming and if it doesn't work out, very frustrating. 
    I've talked to other office managers in medical and dental offices.  They all say the same thing.  It's tough to find good employees with a good work ethic.  What's going on?  It seems that for every five people I hire, one works out well and stays on long term.  The team we have is fantastic so I refuse to keep someone who won't or can't strive for personal excellence.  I don't think I'm wrong in that.  A friend told me that everyone will fall to the lowest common denominator to keep peace.  I want my lowest to be pretty high then. 
    I think the answer is to keep searching until you find the person who is right for your practice.  Don't hire in haste.  The other day, I had a doctor's appointment.  My doctor has a fantastic assistant.  No...I didn't try to hire her away, tempting as it was.  I asked her if she had any friends who were like her that wanted a job.  Birds of a feather usually do flock together.  She's going to ask around.  The office manager almost died, thinking I was trying to lure her away.  She said it took her three years to find her most recent employee.  Tomorrow I'm going to interview someone who sounded really good on the phone.  I'm an optimist.  She sounds like she really wants the job and wants to work hard and learn.  So far, I believe her, but I'm going to interview the heck out of her.  I hope I don't get disappointed. 
    Most office managers want to do a good job.  You usually get to this position because you care about the practice.  It feels bad to choose the wrong person to hire.  I feel responsible to our staff.  When I choose the wrong person they go through all the stress of trying to accept them into the team, getting attached and then having them leave and starting all over again.  I feel responsible to my boss to have a complete team in place so that everyone can function well and not be over-worked and aggravated. 
    It's difficult to identify and hire a good employee, but, when you do, it is very satisfying to watch all the pieces fall into place.  So keep at it, don't get discouraged, don't give up and don't give in.  A happy, well-functioning team is your reward at the end of the process.

End Of Discussion

     Sometimes enough is enough.  This may sound like flip-flopping.  After all, my last post was all about having an open mind.  Well, sometimes you just have to say "That's it for right now".  When a problem or issue is being debated to death and the conversation is running in circles, the best next step may be to close the case for the day.
      What does that accomplish?  It ends futility for one thing.  Once people have reached a point where the only thing they want to hear is their own point of view the discussion is going nowhere.  It also allows cooling off time.  Things that seem so important in the heat of the moment can lose a lot of substance once rational thought is allowed to return.  I say allowed because once emotion enters the picture rationality can begin to recede.  If you find yourself on the edge of your seat, just raring to get your two cents worth in, it's probably time to wind it up for the day and allow your more rational mind to review the information.
    There's nothing wrong with spirited conversation.  It's great to be passionate about your ideas and what you do.  Problems require a level head and reason.  When tempers flare and words are being spoken rashly, it is wise to retreat, regroup, rethink, prepare and come back later refreshed and ready to reach a solution that works.  Words spoken under duress may sound so foreign to the speaker later that they can't believe they really said such things.  Then it may be too late.  All it requires is for one person to have the presence of mind to bring the fact that the conversation is disintegrating to the attention of the others and to suggest the topic be tabled for a while.  It is hard to walk away when you think you can still say the thing that will make everyone realize how right you are.  It's a maturity issue.  You may even decide later that you were saved from making a drastic mistake.  What sounds so great at one moment may sound ridiculous, even to your own ear, later, after the urgency is past.  One way to tell if the conversation has ended and a fight has begun is to look at the other person's face.  Do they look furious?  Stunned?  Disgusted?  Appalled?  Then slow down, admit that things are snowballing out of control and ask for a time out.  Admit that you are too stressed or emotional to continue the discussion right then and set a time to return to the topic.  That's just smart.  It may save the relationship and even promote the progress of the resolution of the problem rather than delay it. 
     So remember, there will always be time later to make your case, if you still feel the need to.  You may not always get a chance to unmake your case if you speak and act in haste.  Control your emotions and counsel yourself before you speak too strongly.  The listener may not be as willing to excuse you as you are to make an excuse.  Save yourself the grovelling later by letting wisdom and evenness be your guide.

Open Wide... Your Mind Not Your Mouth

    The definition of insanity:  Doing the same thing, the same way, and expecting a different result.  Bet you've heard that before.  Lots of people do that, don't they.  Are they all insane?  I hope not, I'm often in that category.  But, there's hope for me and hope for you, too.  It's not easy, but it's possible to change this habit.  All you have to do is open your mind.  I told you it's not easy, if it was, we'd all have done it already and there would be no war, no poverty, no discrimination, no school bullies, just peace, love and happiness. 
    Where do you start?  Everywhere, if you can.  Let's start with awareness.  That's the first step.  You have to be aware that you don't have an open mind and you have to be able to own that.  Now, think actively.  By that I mean, don't just react to whatever comes your way.  Question, challenge and analyze your thoughts and feelings.  I know, it seems so exhausting and unnatural, but it will become more natural and in the end you'll be energized because you should have less problems to deal with and more time for people and things you enjoy.  Whenever information enters your awareness and you feel a reaction that is above or below the midrange, question it.  Is your  natural response something that will make the next thing that happens positive or negative.  And then what, and then what, and then what?  All the way to the conclusion.  Now you know what to do and what not to do. 
    Someone came to me today and wanted to warn me about a patient's mood.  Good intention, but likely to be a negative influence on my next move.  Why?  Because, with that information I'd approach the patient differently than without it.  I'm a big girl, I can figure out if someone's grouchy or not.  If I am employing open-minded thinking, I can decide whether or not to let it influence my interaction with that patient.  I don't need to have my pump primed. 
    If a staff member comes to me and is upset with something that happened on the job I can decide to think of her as a complainer and approach her that way or...I can think that she really cares about what's happening and I can help guide her thinking to resolution.  While I'm doing that I am helping her to have an open mind. 
    If a patient is upset about an extensive treatment plan I can give up and decide that nothing I can say will change their mind.   Or I can be patient and educate them about what they need and why they need it until they "want" the treatment. 
    If my boss is grouchy I can worry that I've done something to displease him and even carry it out to a scenario so extreme that I can convince myself I'm unappreciated and maligned or I can do a quick mental scan and know that I haven't done anything wrong and he's likely upset that the dog jumped up on his clean shirt with muddy paws just as he was walking out the door. 
    If something isn't working for you as a leader or in any area of your life, open your mind and find a new approach.  Admitting you need to change is painless and may even help eliminate future pain.  It takes nothing away from you, it makes you bigger and better.  The only regret you'll have is that you didn't start sooner.

The Ups and Downs of Being a Patient Care Coordinator

    Being a patient care coordinator (pcc) can be a very fulfilling job.  You get to spend a lot of time getting to know your patients and can make a real difference in their attitude toward their oral health and dentistry.  You can promote your dentist and team to the patient so that they are excited to be in a place where everyone is so great and works so well together.  You get to have a lot of independence in your job as well and have many opportunities for personal growth.  Sounds great, doesn't it? 
    So what is the hard part?  Well, I think for most people it is presenting treatment plans and discussing financing.  Everything can be going along great and then you have to tell a patient they need a lot more work than they thought they did and it's going to cost a lot too.  This is where the rubber meets the road and you have to be able to think on your feet.  Maybe you need to break down the treatment plan into smaller bites.   Maybe even spoon feed it a little at a time, all the while explaining why the treatment will benefit the patient.  Don't get anxious and don't get defensive or apologetic.  The patient came to your practice for care and that is what you are proposing to them.  You may need to explain that they have a choice between optimal and adequate treatment.  All the while you must be educating the patient so that they know the benefits or consequences of their choices.  It is your responsibility to make sure you are prepared to answer their questions.  Go over the treatment plan with the dentist before the consult if there is anything you are not sure of.
    How about payment?  That's probably the biggest hurdle.  Again, approach it as a business matter.  You can only tell them the fee and help them decide on the best method of financing.  Don't hesitate to offer Dental Fee Plan, Care Credit or any other financing source you work with.  You may lose a percentage up front, but the payment is in your hands at the beginning of treatment and it is better to give up a small percentage than to lose the case altogether because the patient didn't have this option. 
    Do you get nervous or feel funny talking about these things?  Then learn to act.  Think about it, actresses in plays are paid to be someone they are not in their normal lives.  That's how they get their job done.  Acting like you're not nervous about talking to patients about treatment or fees is no different.  You are getting your job done.  If you have a really bad case of nerves try using positive visualization.  Picture yourself in the consult with the patient calmly going over all the information.  You can even picture the patient getting upset and picture yourself calmly answering their questions and helping them calm down.  It works, try it.
    Being a pcc is something you grow with.  You will be a much different pcc a year after you start then you were when you began.  You will learn different ways to problem solve and you learn how to interact effectively with many different types of people.  I was speaking to a friend recently about challenges in life and he told me to be happy for big challenges because that's how you learn to handle big problems.  Now, that's a great way to look at it.  Remember, you can choose to put a positive spin on any situation and come out a winner.  Whenever you face a situation that feels uncomfortable or uncertain that is the time to ask yourself what all your possible responses are and what the outcome of each will be.  Then choose positively.

How To Be A Greased Pig

    In the South we have a day called Farm/City day.  There are all kinds of fun events, but the funniest one is the greased pig catching contest.  A bunch of good ole boys and gals chase a greased pig but it's just about impossible to get a grip on it.  The pig usually wins.
    Every dental practice needs at least one greased pig.  Not the kind the Board of Health will object to...one that mans the front desk.  We need someone up there that everything slides right off of.  Everybody in the practice has a story to tell about how a patient was rude or mean but, the front desk person deals with every single person that calls or comes in.  So the opportunities for insults or crankiness tip the scale against her.  She has to be a slippery little one.  She can't let anything stick and she can't take it personally.  Because...it really isn't personal.  She has to be able to deal with whatever is said to her, shake it off and move on, leaving it behind her.  There are two reasons that this is important: 1- the next patient needs her to be her best and 2 - she needs to be happy in her job.  It's that simple. 
    Letting patient's moods or comments get under your skin is an exercise in futility.  They get over it or don't even register it at all within moments.  If you sit and stew too long you'll be a soggy mess.  If you share the experience with the rest of the staff you leave behind your purpose of serving each patient the best you can.  All you can do is call upon your own integrity and inner brilliance.  You know that in the long run, this really doesn't matter.  See it for the momentary irritation it is and brush it off.  Better yet, be a greased pig and never let it get stuck to you to begin with.  Remember, the greased pig usually wins.

Patient Care Coordinator Wanted

    The patient care coordinator (pcc) can really pull customer service together.  Before that can happen, the concept has to be accepted by the patients.  A lot of this depends on the attitude of the pcc.  First of all, she has to believe in the job.  She must approach it with the firm belief that every patient's experience in the practice will be better because of what she does.  Some of it is role playing, but most of it is commitment to the position. 
    Ask yourself this question: Is dentistry a calling or a business for me?  If you want to be successful as a pcc, I believe your answer must be that dentistry is your calling.  You must love it and have a strong interest in the profession to be effective.  You must enjoy educating your patients and helping them understand what is going on in their mouth and what they can do to help improve or maintain their oral health.  You have to be patient and have a thick skin. 
    You are the person who will be presenting treatment options and fees.  Patients who came to the initial consult saying they want to really improve their smiles can sometimes be downright angry when they find out how much that will cost.  They want to find a place to dump the anger and the disappointment that the treatment they wanted might be more than they can afford.  You're sitting right there across from them so you're the likely dumping ground.  Can you take it?  You can if you put it into perspective and don't take it personally.  That part is just business.  Let them blow and let it flow right past you.  Commiserate but don't suck it in and hold on to it.  They're not mad at you, they're just mad.
     I learned this from a mistake I made.  Sometimes, discussions about a large cosmetic case can be like a fencing match.  In a fencing match the opponents approach, put forth an effort, retreat, and come back and try again till someone dominates.  When discussing fees and treatment patients can sometimes be unreasonable, emotional, aggressively assertive and even desperate.  It's important to see it for what it is and not become emotionally attached to the maneuverings or the outcome.  Remember that the goal is for the patient to be served.  Your personal feelings must be put into perspective.  It's not about you.  That can be extremely difficult.  Some consults can be exhausting and you can feel like you've taken a beating.  Patients may decide that if they are going to pay such a high fee that they want to talk to the dentist, not his "flunkie".  Yes, they might actually say that.  And you can't let it get to you, it's really not personal.  You could put great effort and much time into a case presentation only to have that happen and then the patient may accept the case after talking to the dentist for five minutes.  He may say exactly what you said, too.  You know what?  They just want to hear it from him.  They want him to "earn" their money.  Now here's the hard part.  You have to choose whether to feel resentful or whether to just be happy that the patient will be served and the practice will benefit as well.  Choose to be happy, I know, resentful doesn't work.
    The position of pcc has more rewards than heartaches.  When you think of the difference you can make by having the right attitude and commitment you will love coming to work every day.  One of the most important abilities you must develop is the ability to hold your own counsel.  You must be able to perform rapid and accurate self-examination and discipline yourself to always do the right thing.  Self indulgence doesn't work if you want to be in this position.  This attitude can be developed.  The work is hard but the rewards are great.  Do you have what it takes?  It's not a job for people who can't think on their feet.  You must be able to field questions but you must also be able to admit what you don't know and make it your business to get the needed information.  It's all about comittment, care and the desire to serve.  Leave your ego at the door, it's all about the patient.

Don't Tell Me Your Problems

     Today we were done a little early so we were able to have a longer lunch break than usual.  We decided to go to a new pizza place and have a nice relaxing meal.  When we placed our orders we mentioned that we were on our lunch hour.  We were told our food would be ready in fifteen minutes.  Twenty-five minutes later we still didn't have our salads.  After asking a different waitress to help move things along, our original waitress came and told us that someone else had gotten most of our order and they would have to start all over.  We couldn't wait so we all shared one small pizza. 

     Mistakes happen, the situation could have been saved with an apology.  That didn't happen.  Instead the waitress continually dumped her problems and excuses on us.  Even though we were visibly annoyed her demeanor remained the same, unconcerned.  I finally asked for the manager and told her about our experience.  Her remark was that she was giving us the meal for free so could we at least be happy about that.  Not really.  We went in fully  expecting to pay for our food. We just wanted to get it in time to eat it. When we finally got some, it was delicious. But, the service was horrible and the food just can't make up for that.  It is aggravating to feel that the person responsible for your needs doesn't care about the outcome of your encounter. 

     You can relate this experience to your interactions with you patients.  Be sure to listen and hear what they are saying they need from you.  Then do your best to make it happen.  Don't make excuses, don't blame the receptionist, don't complain and don't lose your cool. If something goes wrong apologize and do what you can to correct it or make up for it.   Sometimes you have to put more effort into something but make sure they know it is your pleasure to do it.  You have two choices, you can give outstanding customer service or you can't.  Anything in between is poor to average.  Who wants to be poor to average?  You don't or you wouldn't bother reading a dental weblog.

     When you have a tough patient or a procedure that is difficult be sure to maintain a pleasant disposition.  We had a patient who was extremely nervous today.  She needed two root canals in teeth that were very inflamed and difficult to anesthetize.  My boss was the picture of patience and perseverance.  I'm sure he was getting frustrated and wishing the patient would just stop squirming and that the canal was easier to access.  He never let her (or me) see him sweat.  That is what makes him stand out among his colleagues.  Sure, after the procedure was completed we commented about how tough it was but the patient never had to worry about it.  That is the key to outstanding service.  Keep the problems to yourself and make it all seem effortless and as if the pleasure is all yours.  That will set you apart from the crowd.

Motivate and Empower To Succeed

      

One of the most difficult challenges a leader faces in motivating team members is getting them to believe in their own potential.  If you get them to believe in themselves they can base their actions on their belief.  If they see it in themself to achieve more they will then work toward that goal.  When they don't have faith in the growth they can aspire to, they tend to stay in their safety zone. 
    Why would someone want to stay still and stagnate?  Because it is a known entity.  It's a sure thing. It's safe, or so they think.  That feeling of safety is an illusion because in a workplace continued improvement is the true safeguard.  When you immobilize yourself you sabotage what you and the team could become.  You are like a deer in the headlights, frozen and unable to move in any direction.
    Sometimes people do take a chance and try to move forward.  If it works out, they become braver and inspired to take another step forward.  If they fail, it can be a different story.  When a baby is learning to walk. she doesn't let a few falls keep her from her goal.  She gets up and tries again and before long her parents are running all over trying to keep up with her.  Adults are not always like that.  They've learned that mistakes and stumbles can have big consequences.  They don't just fall and get up and keep going.  They analyze their next move.  Some people decide that good enough is better than taking the chance of attempting the next challenge.  They can become paralyzed by fear and indecision.  They forget to be persistent.  They try and are satisfied with the fact that they tried whether they achieve the goal or not.  They don't finish and move forward.
    What can leaders do to help their teams keep achieving and resetting their potential?  They can keep things in perspective.  They can keep everyone focused on what is really important.  They can take stock of the staff every single day and identify the needs and opportunities that present themselves.  The leader must model what they want to see in the team.  Don't just tell others how to do things, do things that way yourself so they can see it in action.  Back up your words with your deeds.  Give them the tools and information they need to succeed and then catch them doing it and applaud them when they do.  You succeed when you help them achieve and reach their goals.  When you help others feel good about themselves you will see a slow, sustained improvement in behavior and attitude and that will generate positive results.  Encourage people to be creative and to rely on their intelligence.  Just as the job of a parent is to prepare their children to become self-sufficient, the job of a manager is to empower their team to believe in themselves enough to work without constant direction or supervision. 
    You are never finished.  There will always be the next problem to solve, fire to put out or crisis to manage. Be happy about that.   As a manager, that's called job security.

A Solid Foundation

   

What do you want from your staff?  I think that is one of the most frustrating things for staff and dentists.  So many times I see people going about their business thinking everything is OK while their boss is silently wishing things were very different.  Why does this happen? 
    I think many times fear of confrontation is the problem.  I also think that fear comes from past experience.  Many people do not take critical feedback well.  They may feel that they are being treated harshly or unfairly.  Most of the times it actually means that their supervisor sees untapped potential or they wouldn't be bothering.  It can be difficult to try to give information about how something should be done if the person getting the instruction is more intent on defending themselves than listening.  Often, they go right back to doing things the same way they always did.  It's even worse if they become hostile and grudging.  Dentists and managers don't enjoy telling an employee that they need to improve, they'd rather compliment than criticize.  It's more fun for everyone.  And yes, we get butterflies sometimes, right before the words leave our mouths.
    The answer is to be forthcoming when the need to do something different is first recognized.  Don't wait too long or the staff member will wonder what else they're doing wrong that you haven't told them. Say it in a way that builds up rather than deflates the ego.  Staff, be receptive and welcoming to the suggestions and information that come your way.  Understand that the person giving the feedback is trying to help you and believes in you. If they fumble in the telling realize that it is awkward for them, too. It all really starts with trust and good communication.  If you have that then the rest should go smoothly.  Take the time to lay the foundation and then build your team on that.

Experience. The Most Brutal Teacher

    But you learn, by God, you learn.  Yes, there's a quote that goes like that, I didn't think it up myself.  But...it's true.  Yes, even those of us who think we are smart enough to write weblogs can, and need to, learn a thing or two.  And, if our egos allow it, we might just share what we learned, through trial by fire, with you.  And hopefully, you'll be smart enough to sit up and take notice.  So, what is this monumental thing I've learned?
     Don't keep bringing up the past.  Let it go already.  What's done is done.  No sense beating a dead horse.  Let the past be in the past.  MOVE ON.  Where did I learn this?  In this great article by Michael McKinney on the leadership blog.  In his article Case Closed, Michael discusses all the misconceptions about discussing a wrongful situation and achieving forgiveness or resolution.  It rarely happens.  Instead he suggests dismissing the matter once there is nothing more to say.  No more talking about it or referring back to it.  Move ahead and move on.  Sometimes, if we're lucky, we learn our lessons before a situation becomes irreparable.  I hope reading Michael's message will help someone else learn what I have learned.  There is nothing to be gained by rehashing past grievances. You won't find the magical phrase to make it all make sense or make everyone feel all warm and understood.  Sometimes, you have to face the fact that you just can't fix it.  As a leader you have to determine whether you will see others as doing the best they can at any given time or if you see them trying to get one over on everyone.  The mature thing to do is decide that enough is enough and to move around and past the boulder in the road.  If you don't, you might as well dig a little space under the boulder and hunker down and live there.  Because you are not allowing yourself the opportunity to see what may be waiting further along the way.  And you'll have only yourself to blame.  In this, as in all other situations in life, you had the power all along.  That is, you have the power to decide how you will react to the rocks and potholes that you find in your path.  And that is all the power you really need.

Control Yourself

        Self-discipline.  It sounds so simple and understandable.  What could be so hard about it, right?  Well, if it's so easy, why don't more people use it?  Let's break it down.  The dictionary defines self-discipline as the act of controlling your impulses.  Impulse is defined as the sudden wish or urge that prompts unpremeditated acts or feelings.  So where do you start?
    Can you prevent a sudden wish or urge?  Probably not.  You can only prevent your response to those wishes and urges.  Giving in to a wish or urge to murder someone is criminal and has severe consequences.  Giving in to a wish or urge to speak when you shouldn't, to complain hastily, to gossip or to pick a fight are much less onerous but also destructive in their own ways. 
    But, it's so hard to change.  You can have wonderful intentions, but they can be as insubstantial as smoke in the wind.  You can play the blame game and say "If she hadn't done that, I wouldn't have acted that way.  It's her fault for making me do this."  Tell it to someone who cares. You are your responsibility.  And sometimes, your own worst enemy.  It only makes sense to you that you allowed someone else's behavior to control your response.  You respond freely.  You choose whether to employ self-discipline or not.
    It is a conscious act at first.  It must be honed into a natural response.  I think that if you keep at it, after a while it becomes part of your character.  Think about it,is it worth it to diminish yourself for the momentary satisfaction of being a hero in your own mind?  Because remember, the person you're responding to might just think you're a schmuck. 
    I know it's hard.  Most things worth doing are.  Things that cause improvement come with their own form of growing pains.  No pain, no gain.  But at the end of the pain can come rebirth.  You are pushing forth a new and improved person of the world.  You might get a little banged up in the process, but you'll get over it.  And then you can start all over again.

                               "The first and best victory is to conquer self."
                                                                                                  — Plato

The Blame Game

   

Dental offices are full of personality.  It's all over the place, in more ways than one.  First of all, there are a lot of people, between the staff and the patients coming and going all day.  Then there are the differences in all those personalities.  Now, all those different people with their individual personalities must interact with each other and make it all work.  That's a lot to ask of mere mortals.  How do you do it?
   I'm definitely not an expert, I have my own personality issues to work on, but you know what they say...those who can do, those who can't teach.  So let me take a crack at it.  I think the answer is to take responsibility for your own personality.  Identify the good traits that you have and while you're at it, take a look at what can be changed, improved, eliminated, or enhanced.  Then look at the people that you interact with.  Do the same, identify their strengths and weaknesses, without judging them, of course.  Now, how can you best play your personality off of their's?  I'm not suggesting you behave in a phony way, not at all.  Just decide which of your traits are acceptable to them and which aren't and use that as your guide.  If someone doesn't like to joke around, then have your serious discussions with them, save the funny stuff for the person that likes that.  Respect who they are and their boundaries. 
    I once worked with someone who did not like to be teased and I'm kind of a joker.  Every day we would get into it and I would walk away wounded.  I thought "I'm just trying to have fun with her, she's such a pill".  Then I finally realized that my idea of fun and her's were worlds apart.  I was just annoying her.  It didn't matter that I thought she was grouchy.  If I wanted a better relationship with her, then I would have to change what I was doing.  I had to stop blaming her.  It worked.  She's still not a lot of fun, but that's OK, that's who she is.  There are other people to have fun with and she and I get along better now that I understand and respect her boundaries. 
    It's hard to find out that there are things about you that people you enjoy don't like.  But, if you think about it, it's better to know so you can make adjustments rather than ruin a relationship forever.  There is something to be appreciated in the fact that they will risk the consequences of their honesty.  It doesn't mean that they don't like you, it just means that that part of your personality doesn't work for them.  So now you have a decision to make.  Are they important enough to you?  Will you to make some concessions,  or not? In a work situation, you probably should and it really takes nothing but self-discipline.  I just made that sound easy and I know (believe me) that it's not.  Let me think about that a little and I'm sure I'll have something to say on that subject soon.

She Drives Me Crazy!!!

   

We all know someone like that.  Sometimes it's someone we work with.  That can be a big problem.  On one of my previous posts, Elizabeth talked about a co-worker that she has some real problems with.  It's easy to give advice and say that she should rise above it and find a way to carry on professionally.  It's hard to put that advice into practice when you're in the middle of it, though.  All good intentions can be forgotten in the middle of an antagonistic encounter.  So, what can you do? 
    This is a real dilemma.  If both people don't want to fix the problem, it may remain and simmer into a final show down.  Other staff members can get drawn into it and sides will probably be taken.  A once healthy environment can succumb to the misery.  Once that happens, recovery is difficult and sometimes impossible.
    What will change the situation?  You know the old saying, "It takes two to tango".  I know, making it sound simple is really annoying.  And you're right, it's hard to act like every thing's OK when it's not.  It's torture to watch someone who's driving you crazy get away with it.  But, what are they getting away with?  Being immature, vindictive, destructive or petty?  Let them have it.  They must be pretty unhappy if they try so hard to get others to join in their wretchedness.  Try to think of that the next time you're in a situation like that.  You have the freedom to choose how to respond to every situation.  It's no fun to mud wrestle alone.  So don't jump in the pit.  Deny them the win.  Go on your way and get on with your life.  It's not easy, it's hard, but it's the right thing to do.
    Feel free to share your solutions to this dilemma by clicking on comment.

What Is A Patient?

    My boss has this essay hanging on the bulletin board at the office.  We pass it every day and don't notice it.  It's been there a long time and looks pretty worse for wear.  It's as timeless and pertinent now as it was whenever he first hung it there.  You might want to share it with your staff, too.

 

What Is A Patient?

 

A patient is the most important person ever in this office, either in person or otherwise.

 A patient is not dependent on us. We are dependent on him.

 A patient is not an interruption of our work; he is the purpose of it. We are not doing him a favor by serving him; he is doing us a favor by giving us the opportunity to do so.

 A patient is not an outsider to our practice; he is part of it.

 A patient is not a cold statistic – a name on a chart or ledger. He is a flesh and blood human being, with biases, prejudices, feelings and emotions like our own.

 A patient is not someone to argue with – nobody ever won an argument with a patient.

 A patient is a person who brings us his needs. It’s our job to fill them with tender loving care and to do so profitably – to him and to ourselves.

 

                                  Author Unknown

Any questions?

   

 

Start Small For Big Results

    I'm reading "Leadership" by Rudolph Giuliani right now.  I like the way he writes, you can almost hear him speaking.  In the book he talks about something he did when he first became mayor of NYC.  New York really was a mess then and he wanted to do something right away to make a noticeable improvement.  He decided to start small.  He would pick one small thing that was attainable, that would make an impact quickly and would get people's attention.
    He decided to get rid of the squeegee men.  If you ever visited NYC prior to Giuiliani becoming mayor you know what I'm talking about.  These guys would come over to your car when you were stopped at a light,  spray your window and swirl the resulting mess around with a filthy rag. Your window was definately better off before they "cleaned" it.  Then they expected you to pay them.  If you didn't they were likely to spit on your window or kick your car.  Kinda scary for a wimp like me.
    At first the police said they couldn't do anything because they weren't breaking any laws.  So Giuiliani decided to ticket them for jay-walking.  Then they could do a background check and many had outstanding warrants.  He got it done.  Why did he pick the squeegee men to focus on first?  They hung out around the bridges and tunnels and they were the first and last impression made on visitors to the city.  He didn't want squeegee men to be the lasting impression that people left NYC with.
    What small change could you make in your practice that would delight patients upon entering and make them leave with a satisfied sigh of appreciation?  Even a more enthusiastic greeting at the front desk can make a big difference.  Offer something to drink if they are going to have a few minutes to wait.  Before they leave the operatory make sure they are put back together.  You know what I mean, ...no alginate on the face, give them a mirror to reapply lipstick and fluff up their headrest flattened hair.  Give them good home care instructions orally and written.  Call patients who've had surgical procedures at the end of the day to see how they are doing. What can you think of that would make a noticeable improvement in your practice?  Figure it out and do it. Your patients will love it.  Little things really do mean a lot.

Nobility and Humility

   

Since I've started this weblog, I've gotten a few e-mails from other practice managers that convey a feeling of "Why am I doing this, what do I get out of it?"  That's a familiar feeling and there's nothing wrong with feeling it.  You are in a position that requires giving.  You must give encouragement, guidance, education and most of the time, you must give other's the credit for anything good that happens.  That can get frustrating if you only think of it that way.
    In case you haven't noticed from my favorite book list, I really like the books that Tom Morris  writes.  "If Aristotle Ran General Motors" was my textbook on how to become a practice manager.  There is a quote in that book that can show you how to think in a different way about the frustrations you may face in managing a practice.  Here it is:
    A man should always wear a garment with two pockets.  In one pocket, there should be a note which reads, "I am but dust and ashes."  In the other pocket, there should be a paper which says, "For me, the world was created."
    Tom goes on to explain that "people are inspired by a sense of nobility in who they are and what they are doing.  If you can convey a sense of nobility to the people around you, you can unlock their deepest potential." 
    Not everyone is aware they are capable of more.  You can only show them by modeling the actions and behaviors you expect from them.   Let them see that you believe it is within them to do the same.  The satisfaction comes in watching the awareness overtake them.  When you see the dawning realization that they are more than they thought were, then you will understand humility.  You will know that it truly is better to give than to receive when you see someone develop a belief in them self that they didn't have before.  It is an awesome thing to be a part of.  You will wonder who receives the greater gift and you will know that by lifting, you are also lifted.
    To be humble is to be dignified, reserved and respectful.  It doesn't mean that you think lowly of yourself.  It means that you value your capabilities and accomplishments but also realize that they are given to you so that you can join them with others to create something that goes way beyond anything we could accomplish alone.   
    This is the way to deal with the frustrations of managing.  Look at the people you work with and see the wonderful qualities and potential in them.  They are your canvas, but always remember, they are also the brush and the paint. You are the hand that guides them.  Without them, you would accomplish nothing in this endeavor. 

It's All About The Patient

   

How well do you serve your patients?  In a busy dental practice sometimes the purpose for being there at all can be forgotten or at least undermined.  We are there to serve the patient.  Numero uno reason.  If you don't do that, you might as well learn to do something else, because sooner or later that's what you'll be doing. 
    Why do we forget about serving the patient?  Other concerns get in the way.  It's difficult to put concerns for ourselves and what we want to do aside sometimes.  If you can resist self-interest in the short term, you will benefit in the long term.  In that respect, it's a character and integrity issue.  You must integrate all the reasons for any action you can take until they steer you toward what most benefits the patient. 
    Sometimes dedication to the practice itself becomes the problem.  It can be aggravating to deal with patients who don't seem to value their scheduled appointment time and who don't seem to respect the doctor's time.  It can be hard to remember that they just really don't understand what a cancellation costs the practice or that sometimes a demand in their life seems more urgent to them. They're not usually inconsiderate people, they just don't know what you know.  You can help them by treating each patient individually.  Get a handle on their previous track record and work around it.  If they're always late, confirm 10 minutes earlier than appointed.  If they forget a lot of appointments, find out what confirming method is best for them.  E-mail, call two days before, whatever it takes.  Dedication to the practice is great so show that by making the patients happy and don't take what they do personally.
    Some patients want more special treatment than others.  Provide what you can without detriment to other patients.  Make unusual requests sound like a piece of cake.  Act like you're thrilled they asked.  If you can't provide something at the current appointment, try to be sure you can at subsequent appointments. Remember what they like and have it ready next time.  Anticipate needs.  If they are rubbing their neck, bring out the neck pillow.  If you've noticed that their lips are dry, offer some lip balm.  That's what makes you stand out.  Susan Bird posted a good article on her website  .  Most of her articles are great for dental professionals to take a look at.  I recently discovered her website and I am now an avid visitor. 
    Just always keep in mind, the reason we all go to work everyday is to serve the patient.  The practice and the doctor deserve our best effort too, but without the patient there is nothing to go to work for. 

Balancing Acts

    I just watched a wonderful tribute to the women who gave birth after losing their husbands in the 9/11 catastrophe.  Every year since it happened, I know I get an uncomfortable awareness that a terrible anniversary is approaching.  I guess this is the new normal for September from now on.  I watched those women with their children as images of the men they lost were shown and I was filled with admiration for them.  I'm amazed by the strength that people can find to rise out of their sadness and despair and live again. 
    There was also a tribute to Steve Irwin tonight.  They showed him full of life.  His children and wife really loved him and now will go on to a life without him.  How will they do it?  He was such a big part of their lives.
    My brother was in the World Trade Center on 9/11.  He was lucky, he got out 5 minutes before it fell.  Do you think he must thank God for saving him?  He still doesn't believe in God.  I asked him if he prayed.  He didn't.  We never hear from him unless we call him.  He's not able to go on with the life he had in some ways.  He's different, of course he would be.  He never talks about it.  There's something appalling in his head that we will never know or understand.
    One thing I always notice when something horrible happens is that people need to talk and keep talking as if they will say something sooner or later that will make the outrageous make sense.  Patients come into the office and everyone feels basically the same and says basically the same thing and you just keep listening over and over until one day nobody talks about it anymore.  Until the anniversary comes around. 
    My husband asked me why I remember the anniversary of bad or sad things.  He says he only remembers good anniversaries like weddings and births.  Not me.  I'll always be melancholy in July because that's when my mother died.  But I have happy memories in February, October and November because that's when my children were born.  Different people find their balance in different ways.  It's important to let them do it their way.
    I hope someday my brother can find a way to balance what happened to him that day with some good things in his life.  My husband may not remember the dates of his sad days but he remembers the thing that made it sad.  He's a great balancer, he gets over disappointment and gets back in the game.  I take longer but I am who I am and I do my best.  My daughter just lost a much loved pet.  She's very upset.  She lives four hours away and I want her to feel better.  She will in her own time.  She'll get through the way she does.  We can be there for others but we can't make them do what we'd do.  It's their balancing act. 
    Hopefully, most of our lives weigh heavier on the happiness side of the scale, but not everyone's does.  It's important to remember that when you come across someone who's behavior you don't understand. They may be balancing as best as they can.  It may take all their effort. Don't make it harder. Don't judge or tell them what you'd do.  Don't take it personally if you can help it.  It may be the best thing you could do for them.  No matter how well you know someone, there's the life that happens inside their heart and mind and soul that is known only to them.  Just be there to help in case they lose their balance.

What Am I Anyway?

    Lately it seems like there are a lot of people working in dental offices that don't know who they are.  By that I mean specifically, they don't know if they are a receptionist, a scheduling assistant or a practice manager.  Sometimes it sounds to me as if they like the way the title practice manager sounds so they decide that's what they'll be.  It doesn't sound like their bosses are being too clear about it either, so that doesn't help.
    Let's clear this up.  A practice manager runs the business in accordance with the dentist's wishes.  She keeps the dentist informed, hopefully they meet regularly and discuss issues and decisions, and she handles it all.  She supervises the staff and that includes hiring, dismissing, training, staff meetings,  discussing problems, mediating, and performance reviews.  She makes sure the office manual is kept up to date and followed.  She tracks the business stats and follows up on account receivable and scheduling.  In some offices she may handle financial arrangements and treatment presentation.  She makes sure service people are called when needed and keeps track of ordering and production.  It may vary from office to office.  In some offices the dentist's wife may handle payroll and payables or the office manager may do that, too. 
    Answering the phones, scheduling appointments and taking payments are handled by the receptionist.  In addition there may be a scheduling secretary or someone to handle insurance.  Those jobs take a lot of poise and concentration on the patient. If one person is trying to do all that and manage the practice, something or someone will probably suffer.
    A great practice manager can set the dentist free to concentrate on dentistry and keep the staff operating smoothly and the patients happy and well-served. 
    If you're not sure what your job description or title is, it may be a good idea to ask your boss if you can talk to him or her.  They may be surprised to realize that you've grown into a leadership role and may want to encourage you to continue. 
    If you own a practice that has an employee that shows leadership ability, why not consider appointing her manager.  It could be such a great thing for you that you may wonder why you didn't think of it before.  As long as everyone gets on the same bus, you might really find yourself going somewhere fantastic.

You Say You Want A Revolution

     What should you expect if you accept a leadership position in the dental practice you work in?  Nothing.  That's right, you heard me, nothing.  Zilch, nada, not a thing.  Sounds bad?  Then leadership may not be for you, it ain't for sissies.  Why would I say something like that?  It sounds terrible, doesn't it?  Do you think maybe I just had a bad day?  Well, parts of it were great, parts of it were fun, some were frustrating but all in all a pretty good day.  I guess that's not it.  So what am I talking about?
     When you choose to become a leader, you choose to serve.  When you choose to serve you choose to provide, supply and attend to.  No whining, you had a choice.  When you became a leader, you became a harbinger of all things good and bad, you are the maestro of the schedule, the pacesetter of the day and the supporter of the team.
      Why should that all be the manager's responsibility?  Because, you chose it, you agreed to it, you probably wanted it.  Right?  So, sure, you have a receptionist, but it's your responsibility to make sure the schedule is as it should be.  You know what the dentist wants and likes, you have to make it happen.  If she gets it wrong, you have to make it right.  Why should you have to set the pace for the day?  Somebody has to, you raised your hand so do it.  People generally like to move at a relaxed pace, that doesn't make them bad or lazy.  Sometimes you have to take it up a notch, so get moving and put the pressure on.  Throughout the day, every day, somebody's going to need help and encouragement.  You supply that. Your boss saw something in you and trusted you to guide his practice through whatever comes your way.  He knows you have it in you, or at least he's pretty sure you do, so if you don't have it, get it or give it up.
     Maybe you're confused.  Maybe you just wanted to be a manager.  OK, do that.  You get to tell people what to do and tell them off if they don't do it.  You're the head honcho, the big kahuna, the BOSS.  Yeah, you're not going to last long, either, so enjoy it now.  On the other hand,  maybe you really want to serve as a leader.  Now, that's a different thing altogether.  A leader leads by example.  You influence people into working hard, too.  You show them how you treat the patients and how you treat others.  You make it something they want to do, also.  Then you make leaders out of all of them.  That is your reward.
     A few people have told me that being a leader is lonely.  Sometimes it is.  Sometimes it would be nice to be the person being encouraged and complimented.  It would be a break to leave at the end of the day without any cares about the next day, week or month.  To shrug off responsibility, to take a hiatus from constantly trying to improve so you can lead better.  But, that wouldn't be you, would it? 
     How do you know you're ready for it?  Here are three questions from James C. Hunters book The World's Most Powerful Leadership Principle - How To Become a Servant Leader. 

1.  Are you truly committed to personal continuous improvement and being a more effective leader?  If your answer is yes, then you must understand that personal change will be required in order to accomplish this.
2. Can your ego handle receiving feedback, even emotionally painful feedback, from others, including subordinates, to better determine the gaps between where you are now as a leader versus where you need to be?
3. Are you willing to do the necessary work, take the necessary risks, and suffer the necessary pain in order to close the gaps between where you are now and where you need to be as a leader?   

    If your answer is yes, I suggest you read this book.  Over and over again.  I'll probably read mine till the pages wear out and I still won't close the gap all the way.  Because the more I can change and improve, the more I'll be required to.  And the gap will widen again.   I'm working on handling frustration better right now.  I've got a long list of things to work on.  That's one of the things I like about this job...the opportunity for the revolution of my character.  That's the bonus.

         

Don't Judge a Book By It's Cover

     You've heard that before.  Well, don't judge a patient by their age or appearance, either.  How many times do you look at a patient who needs teeth replaced and think "she's a removable partial?"  Why?  Well, she's not dressed so great, she's missing a lot of teeth and the rest aren't in great shape, she's over 65, etc. 

     Well, think again, she may just be interested in multiple implants to replace those missing teeth.  Or a crown instead of patching up an old, huge amalgam.  She might just agree to scaling and root planing and placing Arestin.  You just never know.  Just because someone doesn't look the way you think someone interested in optimal treatment would look doesn't mean they aren't. 

     Learn to lose those preconceived ideas and you will do yourself and your patients a big favor.  My boss has a great approach.  He thinks about what he would want for himself or his family and at least offers that option.  If he feels that is the only viable option, he's not afraid to say it.  Patients have the right to know and understand all their choices.  It's up to us to educate them and help them.  There will always be patients that will leave your practice to find a dentist that will do what they want, even if it's not in their best interest.  That's also their right.  At least you won't be the one providing sub-standard care. 

     Make sure you offer all your patients all the choices that are right for them.  There is so much information available from many different sources now.  Patients that a few years ago may not have heard of many dental procedures are now much more well-informed.  Keep that in mind and don't underestimate them.  They may just surprise you!

Just Friends

                "I get by with a little help from my friends"  John Lennon
    So, did you go read Ed's post about the fragility of friendship ?  If you didn't you're missing out.  Are the people you work with your friends?  I don't mean your only friends or even your best friends.  Are they just your friends?
    Do you do your part to help it happen?  It takes commitment, tolerance, nurturing, openness and work.  You spend most of your waking hours during the week with each other.  Hopefully, you spend years together.  Do you bother to dig in and get to know each other or do you just stay on the surface and brush past each other's lives  barely breaking the surface? 
    I know I work with friends.  We care about each other, hope for each other, cheer for each other, scold and lecture one another.  We get mad and fight and that shows we care because fighting is such a hassle why would you bother otherwise?  We cry for each other, cry with each other, laugh together till we cry and do what it takes to help each other through our hard times.  We grow together because we watch each other grow and we learn from that.  We tell the hard truths and lend a hand, an ear, a shoulder and anything else any of us could possibly ask for.  As individuals, we've been through a lot, maybe more than most, but we're tough and we get through without becoming hard.  That is because we can land so softly on each other. 
    It's not always perfect.  We bicker, we give the cold shoulder, the icy glare and go home some days thinking we've had it, enough!  But we know that Ed is right.  Friendship is fragile and we don't dare break it.  It is something we treasure and take care of like all fragile things.  We may resent the effort at times and wonder if the having is worth the price, but of course it is.  It's been built on tears and laughter, on work and play, on happiness and sorrow.  There's history here and we know it.
    Does working with friends make work easier, better, more productive?  I think so.  It does for me.  It's all embracing.  Sometimes it's like the hug from the childless aunt who wears too much perfume.  A little desperate and a little cloying and not always welcome.  But, you'd miss it if it went away.  Most times it's like a beloved child who wants to brush your hair.  Comforting, soothing, validating and now and then a little painful.  It says I'm glad you're who you are, even though if I had my way I'd change one or two things,  I'll still take you.  Working with friends makes it easier to leave the comfy bed and the familiar home and venture out into whatever lies in wait.  I'll take a fragile friendship and the work that goes along with it because in the end, it makes me happy.

You Gotta Read This

    I just read Ed Brenegar's new post "The Fragility of Friendship. and I think it's a real wake up call.  It also happens to be 5:30 am so I kind of mean that literally, too.  Go read it and think about it.  I will too and I'm sure I'll have more to say about it later.  In the meantime, duty calls, go out and have some fun, be productive and do some good things today.  Make today count on the plus side.

The Fourth Question

   " What problems have we created?"  That's the fourth and final question in "The Four Questions Every Leader Must Ask" .  What an interesting question!  I thought we were trying to make things better, so how can we have created problems? 
    Every yin has it's yang.  For every action there is an equal and opposite reaction.  You go two steps forward and one step back.  There are enough cliches that relate to this so there must be something to it.
    What it amounts to is periodically sitting back and evaluating what we are doing.  Not everything is going to be perfect.  Some good things can still be good even if they expose a problem to be dealt with.  I encourage you to see problems as opportunities to learn and increase in strength.  Learn to see problems as separate from you as a person so that you can stop defending them (yourself) and start solving them.  Depersonalizing problems automatically makes them smaller and less threatening.
    So what problems could we create in a dental practice by looking at our impact and opportunities?  We could realize that we are understaffed.  We could see that we have some character issues that need to be worked on.  Maybe we see that some things we routinely do are not productive and need to be changed.  There are many possibilities.  Possibility is the key word.  Possibilities are opportunities for increase and opening.  That brings more interest and enthusiasm. 
    Problems challenge us to expand our thinking and that could result in new ideas that we wouldn't have come up with if we didn't have a problem.  So, problems bring growth.  Problems challenge our minds, hearts and souls to action.  They are the bugle call to wake up and get moving in the right direction.  Without problems, you can see where you could stagnate.  Problems, who needs 'em?  Anybody who wants to keep on improving and increasing their potential, that's who!

Professional Pride

    OK, this one is for dental assistants and practice administrators.  Get Certified!  That's right.  Take the time, spend the money and put in the effort and get certified by DANB.  Check out their website .  There are different paths to certification so don't think if you haven't attended an accredited program that you can't do it.  Even on the job trained assistants can be certified.
    Why become certified?  Professional pride for one.  Hygienists must be licensed and pass a very difficult board exam to achieve that.  I would like to see mandatory certification for assistants, as well.  Any assistant who values what she does should not mind being held to a standard.  Assistants will be taken more seriously and valued more if they are looked at as part of a profession.  That can translate into higher salaries and more respect.  Good reasons? 
     Practice managers...what's going on there?  It seems like everyone who sits at the front desk considers themselves a practice manager.  There is a lot more to it than answering phones and greeting patients.  A certified, true practice manager can and should run the practice, allowing the dentist to concentrate on dentistry.  Stand up and be counted, get certified!
    Dentists...what's in it for you to hire DANB certified staff members?  You get a team member who has shown she is committed to excellence by preparing for and passing a set of difficult exams.  This isn't just something she's trying to see if she likes it, she's a professional who will keep learning and developing her professional pride.  She needs you to recognize and value that.  If you do hire and train on the job, that's fine.  Just be sure to let the applicant know that you will be expecting her to prepare for and pass her DANB certification exams when she is eligible.  If she's not interested, should you be interested in her?
    Why do I feel it's so important?  I've been in dentistry for 15 years as an assistant and now as a practice administrator.  I've seen a lot and I see that team members that are certified stay with the practice longer, come to the practice ready to work, and understand dentistry better on entering the field.
     I've heard a lot of complaining by dental assistants about lack of respect and low pay.  This is how you stop complaining and affect a change.  Don't expect something to change because you're being a squeaky wheel.  Offer something more to get more.  It's that simple.

Positively Positive

   

    Have you ever listened to someone who was feeling bad about their life or themself talk?  No wonder they feel so bad, listen to what they think of themself!  As a manager, I think I am more in tune to it than I was when I was one of the staff.  I guess I care more about caring for the staff.  I'm asking them to give more than they might on their own and in turn I feel a responsibility to them.  I want them to be OK. 
    Negative talk about one's self is like bad gossip.  It paints a picture in the mind of the listener that doesn't make the them attracted to the subject of the gossip.  So, why would someone do that?  My theory, and remember it's a very amateur theory, is that they desperately want to have their negative view of themselves proved wrong.  They also need to see and hear about what other's believe them to be.  They are hoping they are wrong about themself and want someone to validate that hope.
    Can someone else really do that for a person?  Short-term, yes, to a degree.  But, it doesn't stick unless the person can find a different way to think.  Otherwise the first bit of evidence that their original opinion was right will dead drop them right back into negativity.
    So what can we as managers or bosses do to help?  Guide them to new ways to think.  There are many different ways to do this and sometimes just putting new opportunities in front of them is all is takes.  It depends on their self-motivation.  Creative visualization may be one way to approach the problem.  Steve Pavlina talks about this on his personal development blog.  Even if all the ideas there aren't right for you, he makes a lot of sense to me.  Norman Vincent Peale wrote "The Power of Positive Thinking".  Jack Canfield wrote "The Success Principles".  Both of those books have a powerful message of how to bing more positivity into your life.  I have a friend that I can actually see go into her "I'm no good" frame of mind.  I don't let up on her.  I won't sit there and let her away with bashing my friend.  That, I believe is key.  Hold the person accountable for what they are saying and what that is creating.  Show them tools that can help them change that.  Then step back and let them work on it.  Don't hover, don't mother, don't smother.  Believe in their capability to help themself.  Let them have the glory of success.  Be a gentle nudge, or if need be, a swift kick in the you know what.  Just don't be an enabler or a controller.  Then you'll just add to the problem.  Because if for some reason, you're not there anymore, the whole thing collapses.  With the subject being a person, nobody can afford to risk that.
    You serve your staff, the practice and the patients best when you help them see and believe in their own goodness and capability.  Mirror what you see in them until they know it's true.  Don't give up!  It's frustrating sometimes, especially when things seem to be better and then they nosedive.  Be patient, sometimes people have to go back and try on their old ways of thinking to be sure they don't want to go there again.  They come back to what feels better.  That is the reward of servant leadership.

Talk Amongst Yourselves

    Getting staff to say what's on their mind at staff meetings can be like pulling teeth, can't it?  Sorry, I know that was pitiful, I couldn't resist.  But it really can be tough to get people to speak up.  Why is that?  Are they afraid?  Insecure?  Don't want to say the wrong thing?  Worried they'll get the boss mad?  Who knows, maybe a little bit of all of the above.
    Think about the atmosphere created in a staff meeting, especially in a small group like most dental practices.  Usually, you're all sitting around the table in the break room or consult room.  The BOSS is there and he can hear everything you say!  Who knows what he's thinking?  Take a chance of saying the thing he doesn't want to hear and getting fired, why would you?  Share your feelings so that everyone knows the real you, no way!  Let somebody else start.  Let the office manager worry about the long silences.  Maybe they'll give up and we'll get a long lunch.
    That may be what's happening during your meetings.  Or they could be full of accusations and complaints.  Either way it's not productive.  I just read a great post by Susan Bird.  Check it out here .  She suggests banning the word meeting and having a conversation instead.  I know, it's sounds funny to say "It's time for our staff conversation", but so what?  I like funny.  It's more interesting and inviting.  Picture changing the layout of an area in the office and having some comfortable chairs and a sofa.  Now wouldn't that help get the conversational ball rolling. 
    Do something silly once in a while.  Have a guessing game and give prizes.  Our staff loves my prizes.  They don't have to cost a lot, just keep your eyes open for fun things.  Scratch off lottery tickets are a favorite. 
    Whatever you do, lighten it up a little.  It doesn't have to be grim.  You'll accomplish a lot more if you add a little levity.  Sometimes, boss, leave the room and let them talk amongst themselves, then come back in and ask for the lowdown.  You can find the thing that floats your staff's boat and then all you have to do is steer.