Exceptional Dental Practice Management

Lesson From Randy Pausch - Part 3

"It’s very important to know when you’re in a pissing match. And it’s very important to get out of it as quickly as possible."   ~Randy Pausch~

We've all been in one of these pissing matches that Randy talked about.   You never feel yourself getting there, you become vaguely aware that you're in it once you are, and it's tricky to drag yourself out.  It's the patient who starts out by wanting you to do something for free.  This is always so affronting and it's hard not to get emotionally involved.  But, once you engage in back and forth, nobody walks away feeling very good.

Think about getting into a pissing match with a staff member.  I saw an attempt at one the other day when a staff member was contacted about a show of impatience that was unnecessary and rude.  Her response was that others had done it, so she thought it was ok.  When that explanation was deflected, she went on the give other reasons which were dismissed as soon as they were given.  Finally, she was told that she needed to take responsibility for her actions and just apologize.  Think of how much worse it could have been if the other person had gotten drawn into a debate.  By deflecting the excuses the problem was handled quickly and without drama.

When you feel like things are taking on a life of their own between you and another person, that's the time to look at what's happening and take control of yourself. 

Lessons From Randy Pausch - Part 2

"When you see yourself doing something badly and nobody’s bothering to tell you anymore, that’s a very bad place to be. Your critics are your ones telling you they still love you and care."  ~Randy Pausch~

We've all been there.  A staff member just isn't cutting it and you have to find a way to teach, lead and motivate them into better performance.  One thing that I find quite often is that people don't want to hear that they need to improve.  People react in all sorts of ways, too.  It almost always starts with defensiveness.  People love to hear what they're good at, so it makes sense to start with a few positive comments.  That opens them to listening to you.  Unfortunately, the door often starts to slam shut when the critical feedback starts, and that's what they need to hear the most.  I find it frustrating and unnecessary to have to deflect all that so we can get to the topic that really needs to be discussed.

When I read the quote above by Randy Pausch, it was the magic phrase that kept the door open.  When I was faced with an employee who wanted to tell me why I was wrong about her performance, I stopped her with that quote.  After a moment of uncertainty I could see that she realized the truth in that statement.  That's when we began to get somewhere. 

When someone has the courage to take the time to give critical feedback, it is a sign of caring.  It means that they believe in your potential.  It's not easy to give this kind of feedback.  No one enjoys telling someone else that they are lacking in their performance.  Having this quote to back you up can work wonders and pave the way for communication and improvement.

Lessons From Randy Pausch - Part 1

I wrote about the passing of Randy Pausch a few days ago.  There are many great lessons in his Last Lecture and I urge you to buy the book or watch the video, preferably both.  I want to take some of my favorite quotes from the last lecture and apply them to managing a dental practice.  Let's start with this:

"Have something to bring to the table, it will make you more welcome."

There are so many ways to apply that suggestion.  When you interview candidates for a position in the practice do you try to find out what they will bring to the table, or do you just try to seat them?  Just having earned a hygiene license or dental assisting certification isn't enough, they must bring something that will add to the team.  When you have a team meeting does everyone just show up, or do they bring something that will challenge, inspire or integrate the team? 

As a manager, do you just go about making sure that reports are run, people show up on time and patients are seen or do you bring something more.  Something that serves everyone and makes it easier for everyone to perform to their fullest capacity.

As a dentist, do you just examine, diagnose and treatment plan, or do you conduct a co-discovery with your patient and staff and educate the patient so that they can make an informed decision about their care?

There is a difference between just showing up and showing up with something more to offer.  When you show up wanting to give more than is expected, there will always be room for you at the table.

Inspiring Leadership

It's a question I've heard and read about.  Can people be taught leadership?  If leadership requires self-confidence, strength, dedication and insight, can we give those positive character traits to others?  I believe we can inspire those traits in others.  I think that we all have the possibility of leadership, but sometimes the necessary traits are lying dormant inside of us.  An insightful, caring leader may be able to draw them out.

I'm reading The Glass Castle by Jeanette Walls.  She has written about her life growing up in an extremely dysfunctional family.  My son was assigned this book for summer reading for college.  After he read it he urged me to read it as well.  I'm only part way through it, but he's anxious to discuss it.  I pointed out that it's amazing that children in dysfunctional families accept their circumstances as normal.  He said, "Yes, but as they grow up and become more aware of the world, they start to see that it should be better." 

What if the same is true with adults in their careers?  What if a caring leader could show their staff that things can be better.  What if they could dig in there and awaken those dormant leadership traits in others?  Wouldn't everyone benefit, both the leader and the team, and everyone they touch? 

Sometimes managers worry that encouraging team members to be leaders will eventually make the manager lose their own importance or even make them unnecessary.  Inspiring leadership in those we lead doesn't work us out of a job or position.  Rather, it improves morale and the effectiveness of everyone and highlights the impact the leader has on the team. 

I really think that Linda Miles has a lot of great information and she has a great attitude toward dental teams.  She has an article in the July Dental Economics that talks about recognition for dental assistants that have gone through assisting school.  Let me just relay a small segment of her article.  A dentist asked his assistant to train another assistant who had no dental experience.  The assistant was upset because she felt she had invested time and money in her education and now was being asked to give it away for free.  Linda asked her the following 3 questions:

1. 
   Will it benefit the patients for assistant #2 to be very well trained in clinical and communication skills just like you?

2. Will it benefit the practice as a business for your doctor to have two exceptional assistants?
3. Will it benefit you personally to have skilled help everyday?

If the answer is yes then it actually is a good thing to be a mentor and trainer for others on the team.  Linda explained that our world would be terrible if every teacher felt the way she did, and that as you teach, you also learn.  That assistant finally came to embrace that understanding and has since continued to thank Linda whenever she sees her.

Good leaders guide others, they do not command them.  I remember a rather abrasive person once telling me this, "I don't earn respect, I command respect."  She was fooling herself.  Not only did she get very little respect from others, she was disliked. She spent her time frustrated and blaming others for what she say as their inadequacies, when it was actually she who was lacking humility and empathy. 

I believe that we inspire others and as a result they respect us.  When we guide others into leadership we inspire them.  Is is so satisfying to hear someone that you've taught or guided, teaching someone else the same thing.  If you really think about it, that lesson being taught could very well go on to be repeated long after you are gone. When you continually teach others and inspire them to pass it on, you give yourself more time to learn, as well.  It's a continuous journey leading to greater success and satisfaction.  In the process, you may leave a legacy of teaching, learning and inspiring. Not a bad way to be remembered, is it?

Randy Pausch Died Today

If you haven't heard of Randy Pausch yet, he was a professor at Carnegie Mellon University and the author of The Last Lecture.  He was a devoted husband and loving father of three and he died today of pancreatic cancer. What made Randy special wasn't the fact that he had pancreatic cancer, it was the way he took the time with what time he had left, to try to make us aware that it is important to respect the time we have and use every minute of it.

Professors at Carnegie Mellon are asked to give a lecture that would be what they would say if they knew it would be their last one.  Shortly after Randy agreed to give a last lecture, he received his diagnosis and with it, the knowledge that in all likelihood, it would be his last.  He fought and endured every treatment that offered hope, but he did the lecture to leave something of himself for his children.  In the process he touched the world and changed the way many think about how they use their time. 

Randy's message held up a mirror to anyone who heard or read it.  How do we think, what do we value, how aware are we of the fleeting nature of our time on earth with those who we love?  Randy talks about his childhood dreams and how many of them he achieved.   He talks about a coach who pushed him hard.  When the assistant coach talked to him about it he told Randy, "That's a good thing, when you're screwing up and nobody says anything to you anymore, that means they've given up on you."  Randy realized that "our critics are often the ones telling us they still love us and care about us, and want to make us better."  Can you see how pointing that out to a staff member you are trying to help improve could make a difference?  Randy would have liked to think that he inspired that difference.

Randy talked about running up against obstacles.  "Brick walls are there for a reason.  They give us a chance to show how badly we want something."  I've come up against brick walls many times in my life.  I remember thinking that it was unfair and that I was tested more than others.  I'll never think that way again.  I'll see brick walls as a chance to verify the honesty of my desires. 

I could go on about the lessons Randy gives us.  I don't want to take away your chance to watch the lecture or read Randy's book.  I suggest you do both.  Visit Randy's site and you can watch the video or order the book.  Knowing he was dying, Randy could have fallen into self-pity, he could have spent every moment of his last days with his family, he could have complained and railed at God and fate.  He chose to use his time making the world aware of our precious moments of time.  He reminded us of the precariousness of our existence.  He left his children a legacy that embraced all people.  He showed us that now is the time to live.

Stop Talking So You Can Learn

    One of my biggest frustrations is trying to give feedback and being met with defensiveness and excuses.  Of course, there's often a little blaming going on, too.  My frustration is that I have to wait through all that before I can even hope to get my message across.  It's human nature to enjoy hearing good things about ourselves.  We all love that.  It's also very human to want to jump in with explanations or deflections when the feedback is critical.
    The problem is that it wastes time and doesn't produce anything.  Rather than explaining or blaming, you can learn to be better by working toward a solution.Talking about problems doesn't have to become another problem in itself.  First, remember that the person who is giving the feedback is probably overcoming some anxiety to approach you to begin with.  No one likes to tell another person that they are not performing satisfactorily because we know all about human nature.  Then realize that if no one told you about what you could do better, it would take a lot longer for you to progress.  We often cannot see problems that lie within ourselves. 
    When someone approaches you with an issue that needs to be addressed, be all ears.  Ask for suggestions for improvement.  Put some ideas of your own out there.  Be a part of the solution.  Don't argue, you'll just be spinning your wheels.  It's the same with patients.  I've said it before, you can't win an argument with a patient.  You'll have more success if you listen empathetically, ask the patient what would make the situation better and let them know you want to work it out.
    So give your vocal cords a break and stop talking and start listening.  It's a compliment to be given critical feedback.  It means that the person talking to you has faith in your ability to improve.  It's when you're doing something wrong and they stop mentioning it, that you have to start worrying.

Keep A Good Thing Going

    I think it's human nature to notice problems.  Have you ever noticed that when you have to give an employee a review that both you and the employee worry more about the criticism, than anticipate the praise?  Think about the performance of your staff during  the day.  It seems like we are always noticing what's wrong and spending a lot of time figuring out how to fix it. 
    Is there really that much more wrong than right?  If there was, would you still be in practice?  I wonder what we'd find if we spent some time looking for what's right?  What if we walked through our offices complimenting staff and praising their efforts?  I bet we'd all feel better and so would they.  Shoulders might just slide down from hunched positions, spirits would rise and the atmosphere would lighten. 
    We can drive employees into despair with constant demands and criticisms.  Unfortunately, we tend to take good performance for granted.  We even tend to need more and better performance to remain satisfied with a high performer.  We can forget that our employees have lives outside the office and demand more of them than we have a right to expect. 
    Hard workers thrive on appreciation.  They are the ones who don't need promises of bonuses to perform and deliver their best.  We tend to get so accustomed to their great performance that we take it for granted.  It's disheartening for someone like this to be treated indifferently. 
    Take a look around at your staff today.  Think about what each of them bring to the practice.  Let them know you noticed.It's the best way to make a good thing better and to keep it going. 

The One Thing

    What is the one thing, that if you could change it in your practice this week, would make a big improvement in your day to day life?  It may be something you would take away or something you would add.  It's something that bugs you on a regular basis, but for some reason, you haven't done anything yet.  It may be something you find yourself wishing you had, or didn't have.  You're going to have to help me here, by commenting.  It may be worth it, you may find yourself with suggestions that can make your wishes a reality.  So, what would that one thing be?

The No Blame Game

    Did you ever notice that when something goes wrong, people seem to spend more time trying to figure out who to blame than they spend trying to make it right?  It's as if making someone else wrong makes us feel better and somehow vindicated.  It doesn't have to be that way.  Situations can be fixed without finding a fall guy.

    We had a patient who I felt was being pretty unreasonable.  He wanted to blame his hygienist for the fact that one of his teeth under a stainless steel crown had developed decay and needed a new crown.  He felt that we owed him a new crown.  My first inclination was to talk to him about accepting responsibility for his own oral health, but I knew that if I did, I'd only make him mad and probably lose him and his wife as patients.  I decided to listen to him and then asked him what we he felt the hygienist did wrong.  He said she should have seen the decay. I told him that an x-ray wouldn't have shown it and that there was no decay at the gumline.  Basically, I led him through a co-discovery of the whole scenario.  By the end of the conversation he came to realize it was a blameless, though unfortunate, situation.  We went on to talk about ways to avoid further decay problems and by the time we hung up he was satisfied and pleasant.  He lost his desire to blame once he understood that I cared enough to listen to him.

    It's the same with staff members.  People don't make mistakes on purpose.  Nobody wants to do a bad job.  So, when things go wrong, aim for solutions, not blame.  When people see that you will work with them to fix things rather than against them to affix blame, they respond.  They remember.  You've got them working with you then. 

    If you've been playing the blame game, switch things up.  Pay attention and you'll enjoy seeing the look of surprise on the faces of the people you interact with.  The atmosphere will lighten up and and people work better in that environment.  And after all, that's what you really want, isn't it?

Your Venting Place

     Office managers and dentists, this is for you.  How can you keep yourself feeling thankful for being in, what quite often feels like, a thankless job?  Let's face it, if you're doing it right, the buck stops here.  The ultimate responsibility for everything and everyone lands on your shoulders.  And does anyone appreciate it?  Sometimes it doesn't feel like it, does it?  Can you tell I've had one of those weeks?  Heck, I'm only human and sometimes I need a place to vent, or rant, whatever you want to call it. 

     Let me make this clear, I love my job, I think my boss it great, I admire my staff and am committed to our patients.  Overall, I see it as an honor to be asked to do this.  But....sometimes it's a pain in the tush.  Grumpy patients, staff that seems to need hand-holding, schedules that self-destruct, decisions to be made, complaining and blaming to be absorbed, mediating to be done, not enough time in the day and late hours are all a part of the pressure that builds.  Add to that the fact that very often we're the coach, cheerleader and water boy and you could really get yourself into a snit.  It never ends, or so it seems.

     But...think about the trust everyone places in you.  The dentist trusts you to run his practice.  The patients know you'll make sure they're taken care of.  The staff counts on you to guide them.  They all believe in you. Think about how great it feels when a patient says that your practice is special or when a staff member thanks you for your help and patience.  When your boss thanks you for all you do, you forget about all the negatives.   That's a pretty good swap.  So, you're only human, even though you may feel like you need special powers, you're all you've got to work with.  Being a manager can be a little isolating, too. Sometimes you just need to talk to someone else who knows what it's like. 

     So, this is your ranting place.  Come here a tell us when you've had a bad day and we can brainstorm a solution, or at least commisserate.  Just click on comment and you'll have my ear and anyone else's who has some advice or tea and sympathy.  All in all, we love what we do, but sometimes we just need a place to vent.

How Do We Treat Our People?

We had a very productive staff meeting today.  It began with a discussion about a patient who we had messed up with.  It was one of those things where everything that could go wrong does go wrong and the patient was very annoyed with us.  What I wanted the staff to remember is that our patients are people whose lives do not revolve around dental appointments.  I used the following questions to help get a conversation going that made everyone a little more conscious of how we affect our patients.  Feel free to use it with your staff.  Our staff really came up with some great thoughts.  Let me know how it works for you if you try it. 

HOW TO TREAT OUR PEOPLE

 

First, and most important, realize that our patient’s are people first.  They only become our patient’s when we earn their trust.  Where does that begin?

 

What is the first step we can take to make people trust us enough to become our patients?

 

Who can do this?

What can we learn about a new patient on the first phone call?

 

How can we help them begin to trust us on that call?

 

What can we do to make the patient continue to trust us and feel welcome when they arrive at the office?  Who can do this?

 

What can we learn about them while they are waiting to be seen?

 

Why should we walk to the patient in the reception area to invite them to accompany us to the treatment room?

 

Once in the room, what should we say and do to make the patient see that we are going to treat them exceptionally?

 

Do you have what you need to make this happen?

 

At the end of the appointment, what can we do to make them leave feeling well cared for?

 

Do you have what you need to make this happen?

The Exceptional Dental Practice- Why Good Enough Isn't Good Enough

    Just because you have a good team, doesn't mean your work with them is done.  Even if your staff has been with you for years or have been in the profession for a long time, it doesn't mean they can't improve or enhance what they do.  One of the most dismaying things I've ever heard a staff member say was, "I'm as good as I'm going to get."  My heart sank because I knew that her time with us was coming to an end.  A great team is full of people who ask, "What more can I do?"  rather than say, "That's good enough."
    I'm reading a very good book by M. William Lockard, Jr., DDS titled The Exceptional Dental Practice-Why Good Enough Isn't Good Enough.  Well, of course the title appealed to me immediately, I like exceptional things and people.  Dr. Lockard is a Pankey trained dentist and he has very thoughtful and well-defined systems in his book.  Having systems is not an attempt to be overly controlling with staff or to create automatons.  Rather, having systems gives staff a road map to success.  Dr. Lockard very clearly and succinctly sets up job descriptions and expectations.  I found that while reading this book new ideas are popping up regarding ways we can serve our patients better and make our working experience more gratifying. 
    He has a chapter on personality styles which lends so much insight into how patients and staff members think and suggests appropriate responses to their personality style.  You could have a great staff meeting on that chapter alone.  If you think about it, a mindful approach to interacting with patients and staff could save time, minimize stress and rescue relationships.
    Sometimes we present a new approach to staff and then assume it is being done.  Or maybe they adopt a new protocol, but as time goes by, they may slip up now and then until the new way of doing things disappears altogether.  That's when a manager may be tempted to just think "Oh well, I guess this is good enough."  If you find yourself thinking that, it's a clear indicator that you need to brush aside complacency and address the issue.  For instance, I want all our clinical personnel to escort their patient to the front desk at the end of their appointment, even the hygienist whose room is 10 feet from the front desk.  Why?  Because it's like walking a visitor to the front door of your home when they are leaving.  It's polite and it completes the patient's experience with you.  You wouldn't sit on the couch and wave a visitor off would you?  Also, the staff member can make sure that any necessary arrangements for a next appointment are clear to the receptionist.  It helps avoid the feeling of "I'm done with you, now go bother her."
    Managing a great team makes your job a little trickier.  The areas for improvement are harder to find.  You need to really watch for areas to tweak.  Small sentences can make a big difference.  Dr. Lockard suggests that the assistant tell the patient at the beginning of treatment, "We want to make sure that you have a comfortable experience today.  Please tell us if you are experiencing any discomfort, of if you need a rest."  That may feel awkward to the assistant at first, but she will soon see the effect it has on the patient and it will make sense.  She should feel free to vary the statement to keep it from sounding mechanical. 
    One thing that occurs to me while reading the book and considering the suggestions.  It is important to have enough staff and to have staff cross-trained so that they can help each other.  The assistant should not be listening to the patient with half an ear, just waiting until she can jump up to empty the autoclave.  The time reserved for the patient should be considered time reserved for the doctor and assistant to be uninterrupted, as well. 
    Every practice is different and when you read any book that is meant to help you improve, you should read it with an intention to discover ideas that will work for you.  You can take the basic idea and use it as is, or mold it to fit your preferences.  The important thing is that the book has it's basis in service to patients and The Exceptional Dental Practice is solidly based in patient care and in optimizing the patient's experience. I've given you just a few gems, but I've only scratched the surface.  I have it listed on my sidebar if you'd like to learn more about it, or contact Dr. Lockard at bill.lockard@sbcglobal.net

If you'd like to order the book you can go to Dr. Lockard's website at billlockarddds.com

You're Not Alone In There

There's more than one of us in each of us.  Bear with me, I'm not talking about multiple personalities, I'm talking about the internal struggle that we often deal with.  We all have an angel on one shoulder and a devil on the other.  Which one do you listen to more often?

Maybe you're a glass half empty person, but guess what?  You could just as easily be a glass half full type of person.  You just have to choose to listen to that part of you, it's in there.  We all have the power to be optimists rather than pessimists, kind rather than cruel, generous rather than stingy, accepting rather than judgmental, it goes on and on.  You have the choice and you make a choice every time you act.  It's the one you choose that determines your character.  It tells everyone who you are. 

Most people act without examining the reasons and evaluating the likely outcomes of their actions.  Then they feel like victims when things don't go well.  We are only victims of ourselves when we make the wrong choices.  At the end of the day, you're alone with yourself and you know if you made the right choices and you have the opportunity to evaluate what works and to avoid what doesn't.  No matter what you can get others to believe about your intentions and motives, you know the truth and you will either rest easy or squirm. 

You! Make It Happen

    That's right, I'm talking to you.  The manager.  Whatever it is you want to see happen in the practice, get going and get it started.  Now, I'm not saying don't delegate, but I am saying instigate.  Instigate the change or development you want to seeing by being the first one moving. 
    Sometimes we managers see ourselves as overseers.  We list what needs to be done and tell everyone else to do it.  Then when it doesn't happen we can feel like victims.  We're at the mercy of our team and they just won't do what we want.  Well, get in there with the team and get the ball rolling.  Then whatever is happening isn't happening to you, it''s happening because of you.  It's easy, but useless to stand by and criticize.  It's productive in so many ways to be a part of the process.
    Sometimes we're so busy critiquing our staff that we forget to evaluate our own performance.  We may have this vision of ourselves as being the leader of the pack, but if in that vision we are watchers, we're drawing the wrong picture for ourselves.  Just as we expect our team members to grow and evolve, so should we.  Make it happen by doing.  Your actions tell your team who you are.  Are you someone who stands over them and metes out criticism or praise or you someone who stands beside them and offers a helping or guiding hand?  The difference between a good leader and a poor manager is right there.  When you're right in there with them you have opportunities to discover strengths and weaknesses, to inspire, to teach, and to build a stronger team.  When they see that you are in it with them, you gain influence with them and they will do as you ask for the right reason.  They will follow you because they want to.
    Being a manager who makes things happen sets you apart from the crowd.  Being a cookie-cutter manager, that is just like all the rest, will get you mundane results.  Being a manager who inspires will get results that will launch your team to new heights.  Since your team's performance is a reflection of your performance, making good things happen will be good for everyone.