Exceptional Dental Practice Management

Criticize This

"Asking a working writer what he thinks about critics is like asking a lamppost how it feels about dogs."      ~Christopher Hampton~

"People ask for criticism, but they only want praise."
                                             ~W. Somerset Maugham~

    As a manager or owner, when you see a staff member doing something wrong that you've corrected them on a few times already, what is the first thing you think?   Maybe it's, "I showed her how to do that 10 times, what's the problem?"  Maybe it's, "Oh no, how many times do I have to show her the same thing, over and over and over...?"  It gets frustrating, doesn't it?
    I'd like to suggest that when you find yourself thinking something like that, you use it as a reminder to stop and review.  What's going on here?  Is the task very complicated?  Are you confident in your ability to explain it in a way that someone who has no experience can understand?  Have you looked at it from the employees experience?  Have you asked her why she's struggling?  That question alone could open a floodgate of insecurity and pent up frustration.
    I believe that most people want to do well.  I'm also aware that there are people out there that feel entitled to come to work, do a lousy job, and have that job protected just because we made the mistake of hiring them in the first place.  But, for this, let's pretend we've already weeded them out and are dealing with someone who wants to do it right. So, let's say you just watched your employee do something wrong for the umpteenth time.  You've shown her how to do it correctly just as many times.  You've typed it out step by step and made a nice book of guidelines for her that is sitting right there next to her.  Ok, be honest now, what are you feeling?  Frustration, disbelief, impatience, aggravation, helplessness, hopelessness?  Yeah, well, to be honest, that's your problem.  Your job is to help her "get it."  When her job gets hard for her, your job gets hard for you.  The only way to make it get better for both of you is to find a way to help her "get it."  Sorry, and it's hard for me to do this, too, but you have to put how you feel about it aside and think about them.  I imagine that the person is feeling awkward, embarrassed, frustrated, aggravated, helpless and even a little disbelieving herself.  So, you already have a few things in common. 
    What if someone was going to critique your handling of this situation?  What would you want to show them?  A patient, understanding manager who worked kindly with the employee to discover a way to help them understand the correct execution of the task?  Of course you do.  So, everytime you face this situation in the future, imagine you are being critiqued on your critique.  Treat the person as you would if you knew your handling of the situation would be on the front page of the newspaper tomorrow.  If you wanted to impress him, how would you behave? 
    Now, get down to the nitty gritty.  Really see the person and work with them to get them where they need to be.  This is what you want to have happen.  You want to help them learn to do the task correctly.  In the process, you have the opportunity to create a mutually respectful relationship and to develop influence with them.  They will have an additional reason to learn.  They want to make you proud of them.  They want to show you that they have the ability that you've shown them you believe they have.  In the process, their confidence is increased, you've accomplished what you set out to do and everyone feels good about the outcome.  So, remember, no one really needs to be criticized.  They need to be lead and taught. 

Get Away To Gain Perspective

"During  periods of relaxation after concentrated intellectual activity, the intuitive mind seems to take over and can produce the sudden clarifying insights which give so much joy and delight."  ~Fritjop Capra

"Stress is an ignorant state.  It believes everything is an emergency.  Nothing is that important."   ~Natalie Goldberg~

"Acquire inner peace and a multitude will find their salvation near you."

~Catherine Du Hueck Doherty

"There is no need to go to India or anywhere else to find peace. You will find that deep place of silence right in your room, your garden or even your bathtub."  ~Elisabeth Kubler-Ross

 You may have figured it out.  I've been on vacation.  I always find that when I'm away from work, I'm almost as productive, and maybe in a more meaningful way, as I am when I'm actually at work.  Here's why; when something, or someone is not right in front of your face, in the midst of a million thoughts, questions, decisions and problems, you can actually appreciate it all with some clarity.

    I don't know about you, but in my role of manager, I often feel a lot of pressure (probably self-imposed) to make a lot of improvement.  So, I'm always looking for weaknesses to improve, ways to make our service, ourselves and our practice better.  When I'm away, I can reflect with some realistic thinking about where and who we are.  I always realize this:  We're pretty darn great! 

 

Yeah, Yeah, you're probably wondering just what's so great about our little dental team and practice.  When I think about the people I work with I know, without a doubt, that they all care.  They all have a heart for the practice and the patients.  If we hear sad news about any of our patients, we all suffer the news.  We don't just pay lip service, we feel it.  If one of us is dealing with sadness, the others hurt for her.  I had a phone call from my son the other day about some news he was struggling with and when I looked up I saw the two concerned (truly caring) faces of our hygienists in my doorway.  They are on vacation too, but have emailed me to see how things are going. 

    I hate to admit it, but there are times I don't give them the credit, in my mind, that they deserve.  Sure, I encourage, persuade, influence and cajole, but sometimes I forget to take stock and give thanks on a regular basis.  When I'm on vacation, I can really review it all with a relaxed mind and I always find myself amazed by how lucky we are.  So, I think it would be a good idea to take regular vacations from the busyness of business and be realistic about reality.  If you can do it, I highly recommend it, and I suggest that you can do it.  Maybe a good hot soak will give you some perspective.  Maybe a walk in the forest.  Whatever relaxes you, do that as a way to gain perspective on the reality of your good fortune.  An appreciative heart and mind pave the way to a peaceful soul and a pleasant demeanor.  Can't go wrong there.

Recoginition Demands Innovation

   

Ok, so if we need goals to inspire great performance, and we need recognition to acknowledge and reinforce achievement of those goals, we may, hopefully, find ourselves giving a lot of positive feedback pretty soon.  After a while, the same old thing, gets to be, well, old.  We need to be innovative in the ways in which we recognize outstanding performance, that is, if we want a lot of the performance in our practice to be outstanding.  And who doesn't want that?
    That means we have to think differently about reward.  A reward should be a concrete symbol of pleasure and appreciation in return for good service or behavior.  So, what should we reward?  Anything that enhances the quality of life in the practice and anything that promotes good word of mouth about the practice.  What should a reward be?  Individual and suited to each person, or it can be something that benefits the group.  For instance, all clinical staff wash their hands a few dozen times a day.  Make some really good hand lotion available to them.  The best I've found is Aveeno Intense Relief Repair Cream, by the way.  A patient told me about it and it really works, and I should know because I've dealt with cracking, sore hands for years and I've found immense relief with this.  It's a little hard to find, but Walmart seems to carry it.  Or, if one staff member has gone out of her way to help everyone else, maybe a gift certificate for a manicure may be just the right thing.  But, you have to know she'd enjoy that and that's why you have to really know your staff.  Giving her a manicure that she'll just pass on to someone else won't make her feel appreciated.  She may even be annoyed that you didn't know her better than that. 
    If a staff member always talks about the new movie she's been to see, she just made it easy for you to reward her.  A set of movie tickets will make her day.  Your front desk assistant loves to knit?  Give her a gift certificate to a yarn store, she'll love it.  Keep that in mind.  You want to think, "She'll love that!" after you choose a reward.  You are asking your staff to serve others, so why not serve them in a special way?  Once a year or so I have a party or dinner for the staff and their families.  I call it Italian Night and go all out with making lots of different dishes for them.  I make sure to make a few meatless dishes for our vegetarian staff member.  Think that makes her feel special and welcome?  You can bet she appreciates it, and the fact that I don't call attention to it, I just serve enough for everyone and don't single it out as "her food."  She always thanks me.  These dinners are a lot of work, but so worth it for the chance to see each other as friends and not just co-workers, the opportunity to see our co-workers as mothers and wives, fathers and husbands and the goodwill that lasts way beyond that one night.  It's a labor of love that boomerangs back to me and the practice.
    So, in reality, if you want exceptional performance and effort, you have to recognize it in both big and small ways.  After a while it becomes a part of what you do and how you work.  You'll even find you enjoy thinking up fun and interesting new ways to reward your staff.  The best part is, they are always delighted.  Now, who doesn't want to work with a group of delighted people.  Oh, and don't forget to compliment and reward the dentist, as well.  Next week, pick a day and thank him/her for a really great day at work.  I guarantee, he/she will look shocked and then very pleased.

Set Goals To Inspire Your Team

   

One frustration of training new people seems to be getting them to learn things the way we want them to do them.  Often a new set of eyes sees a different way to do things.  That's ok, but later.  First master what is being taught, then we'll talking about making changes.  To help employees master the work we must set clear standards for them to follow.  We must give them goals to measure their progress against.  We must encourage them.  We must explain the values and principles that are important to us in the practice.
    It's the same with the rest of the staff.  Just because someone has been at it for years, doesn't mean they don't need to hear that they're doing a great job.  Praise and recognition are the antidote for burn-out.  It's surprising how easy it is to forget to praise a great employee because we've begun to take their effort for granted.  "Oh, Kathy, sure she's really good, I never even have to think about her, she's on auto-pilot."  Nice for you maybe, but I bet Kathy is starting to feel taken for granted or invisible.  Giving Kathy some new goals will inspire her and keep her interested. 
    How do you know which goals to set?  Think about what you need from your staff.  Teamwork, attention to detail, service to patients, efficiency, partnership in treatment, patient education, and so on.  Now, expand on each area so that they have no doubt about your expectations for these goals.  What does supporting teamwork in your practice mean?  How will you know they are paying attention to detail?  What does great service to your patients look like?  Be specific and ask them for input.  Write it down and keep it where it's easy to see.  Go over it at staff meetings and morning huddles.  Recognize those who meet those goals and uphold those standards.
    Goals will help everyone concentrate on what's important.  It will help them focus on what they're doing.  Recognition for meeting goals will inspire attention to quality and excellence will be the result.  Goals add more meaning to our work and give us a sense of purpose.
    Meeting goals and expectations and getting honest feedback about how we are doing will keep staff interested.  A lot of the work in a dental practice may seem pretty routine.  Every day we come in and do the same set-up tasks.  We sit for morning huddle and often staff members may go through their patients in a monotone.  Then we all disperse to get through the day.  What would happen if the manager came to morning huddle with some muffins to thank everyone for having everything set-up so consistently every day?  Imagine going through the list of patients and commenting on how well the hygienist educated Mrs. Edwards the last time she was in, or on how kind the assistant was to an older, lonely man who just lost his wife.  Maybe the front desk assistant worked really hard to get a patient in who had a tough schedule to deal with.  You've commented on all that in front of the group and now everyone is sitting a little taller with a smile on their face.  You cap it off by saying, "You're all doing a great job of maintaining the values in this practice and meeting your goals.  I'm proud of you and grateful to have you in our practice."  Wow, wouldn't that be a great way to start the day?
    What if someone isn't performing so well?  It's just as important to encourage that staff member.  Just make sure your feedback is designed to encourage her to do better.  Talk to her and find out why she's struggling.  Work with her to find a way to improve her performance.  In the end she'll trust you and see feedback from you as a positive thing, even when there's a problem.
    Encouragement costs nothing except a little bit of yourself.  You have to take the time to see your staff as people who need encouragement.  You have to get past any personal likes and dislikes and find out what encourages them.  You have to be interested in them.  People need to feel that they are making a difference.  Get your staff to understand that without any one of them, things wouldn't be as good.  Once they see that there is a deeper meaning to what they are doing and to their place in the staff, they will be more committed.  Then their focus will shift to working for the common good of all, rather than what's in it for me.
    To get started, ask yourself these questions:

1. What are the values and principles that matter in this practice?
2. How do I explain those values and principles to the staff?
3. Do they share those values and principles?
   
4. Do I instill meaning in what we do every day and in what I ask the staff to do?
5. Do I let them know what I expect by setting goals and do they understand the goals and expectations?
6. How do I recognize success and achievement?
7. How do I give feedback?
8. How do I get feedback on how I'm doing?
9. Is the feedback you give designed to help others improve, or is it just telling them what they're doing wrong?
10. How can you improve the feedback you are giving others?

Training New Staff (or old ones for that matter)

    One of the things I enjoy is training a new staff member and seeing her "get it."  One of the things I struggle with is training any staff member and not being able to get through.  It's frustrating for them and me.  That's why when I read Steve Roesler's post Don't Let Your Knowledge Confuse People on his All Things Workplace blog something rang true for me. 
    Many times anything I'm trying to teach someone else at work is something I could practically do in my sleep.  "It's so easy, why don't they get it?" is a question that's often floating around in my head.  "Well, genius, you know it so well because you've been doing it for years" is often the answer.  And, according to Steve, that may be exactly where we're getting stuck.  I may be having as hard a time teaching it as they are, learning it.  And it may just be because I know it so well.
    My solution has been to stop talking and start listening for the questions to my answers.  You see, I may have been so sure I had all the answers that I really didn't listen to the questions well enough to tell me what was missing.  Every question actually holds some hidden information about how the learning process is going.  For instance, if I'm telling the staff member about how to take a payment and she asks me how she'll know if the patient is supposed to pay the full amount, that tells me we also need to talk about the guarantor notes and payment agreement icons and what they are used for (Dentrix). 
    Watch your language, too.  No, not the kind that got your mouth washed out with soap, I'm talking about dental terminology.  If you have an employee that hasn't had dental experience, don't expect them to know what caries, gingiva or  lateral incisors are right off the bat.  They may smile and nod, but in their head there thinking, "What the heck is she talking about?"  By all means use the correct terminology, but don't forget to translate.  I encourage new staff to write down words they didn't understand and ask, especially during meetings.  It gives everyone an opportunity to participate in teaching and that builds stronger relationships.
    Give the new staff member permission and encouragement to say "Stop."  I know I'm a fast talker.  I know I'm talking too fast when I see a certain look come over someone's face that practically screams, "What in the world did she just say?!"  I'll stop and tell them that if I'm going too fast, they have a responsibility to themselves to tell me that.  Otherwise, everything I've just said is wasted. 
    When I don't think a new person is getting it, I ask them if there is a way that they learn best.  Some people do best with written guidelines.  Some have to watch me do something a few times so they can take notes.  Others need to do it themselves while I watch.  I like to combine all 3 so I don't miss any opportunity to get it in there. 
    Finally, give timely feedback.  Don't wait, if you see the staff member doing something the wrong way, tell them as soon as possible, before it becomes a habit they have to break.  Ask them how they think it's going.  That will give you insight into how much they understand.  If you think they're struggling in an area that they feel they've mastered, it may be time to review that area. 
    Stick in there with the staff member and keep working on it.  Sometimes the hardest things to learn, are the things that really stick once they've got it.  Remember, you started somewhere too, and you depended on the patience and good will of someone else.  One of the most rewarding things about training a staff member is eventually overhearing her tell the next new staff member, "This is how insert your name taught me to do it."

I See You

   

Think about it.  How does your day in the office start out?  Maybe you're sitting at your computer, or maybe you're setting up rooms, checking the answering machine or drinking coffee.  How attentive are you to the people entering the office after you?  How much do you recognize the people that are already there?  Even in our own practice, I often noticed that sometimes people would come in, put their coat away, say hello to those they passed, but never come to greet those of us who were at the other end of the hall.  The hall's not that long so it's not a big excursion, it just never entered anyone's mind to do so.  Often I'm sitting by myself at the front of the office and it was odd to hear people come in and say nothing.  So I said something and it was obvious that no one realized they were doing that.  Now they at least shout a hello my way.
    If you're the dentist, how much of a greeting do you give your staff as you or they arrive?  Do you even look up from your computer and smile or do you just wave your fingers as you keep on with what you're doing?  I know you are probably doing something very important, but think about it.  Your staff is very important to your success.  They might get used to your unenthusiastic greeting, but it won't inspire them. 
    If you're a team member, how do you greet your co-workers?  Someone is going to set the tone for the practice.  It is usually the person with the most persuasive, assertive personality.  Many times it's a bully.  They can make everyone believe that nothing is fair or that every day is a chore.  Are you going to stand there and let it happen, or are you going to assert yourself and recognize everyone with a smile that let's them know they count with you?
    Think about how you react when someone you really like that you haven't seen in a while, walks into a room.  Your whole body reacts.  You sit up straighter, lean forward, you don't just smile, you beam and they have no doubt that you're happy to see them.  That's how I react when when of my children comes home from college.  I can't hide my delight in their presence. 
    How would your boss, staff or co-workers feel if you showed your delight in their presence when they walked into the office every day?  I'm not suggesting you overdo it.  Not at all.  What I want you to do is to think about how much these people really do mean to you.  What they bring to your day and your work.  How you would like them to feel as they go about their day.  How you would like to feel in their presence.  How you would like to go about your day.  Do you think you have any influence in that?  You can do your part.  You can let them know you actually see them, for starters.  Really see them for who they are and what they do.  That will make it easier to enjoy them because they will react positively to your recognition.  From there it becomes ridiculously easy to just build better and better relationships and a better practice culture.
    I see you.  You're sitting there reading this and wondering if you resemble the guy sitting at the computer barely grunting a hello. Or maybe you're the one drinking coffee and dreading the 10:00 patient who always complains and won't let you lean her back.  But, do you really see her?  See how it goes?  If I see you, you might see me, too.  Before you know it you'll be seeing everyone in a different way.  Maybe they'll be less dreading and more enjoyment.  Can you see how much better that might be?

Who Cares?

  

  Hopefully, you do.  Whether you're an owner or a staff member, if you don't care about what you're doing and how you're doing it, you'll just be wasting your time and languishing in mediocrity.  You can be smart, you can have a beautiful office, great looking staff and fantastic skills, but if you don't care, your patients will think you're just ok. 
    Here's the thing, and it's a good thing, it's not hard to show you care.  It takes a little bit of thought, insight and oh yeah, caring.  Think about it, your patient comes to your office, sits in your chair with their mouth open for an hour and a half while you introduce sharp, spinning, whining instruments that sometimes hurt and at the least make them bleed or drool.  They trust you with that.  So, isn't it a good idea to take three minutes at the end of the day to call them to see how they're feeling?  Believe me, that small investment of your time will pay big dividends in loyalty and word of mouth advertising.  You are always making impressions on your patients.  You are guaranteed to make a good one when you call to see how they're feeling.  Even if they are having discomfort, they'll still think you're great for caring about that.
    Show you care in any way that you can think of.  Send flowers to a patient who's had surgery, a card to a patient who misses an appointment because of the flu, a plant to a patient who's lost a spouse.  Make them feel your caring and you'll have a loyal patient.  The bonus to all this caring is that you'll likely find that you really do care and that will make what you do very satisfying. 
    I see lots of dentists trying to be the best, or trying to win patients by adding spa amenities and running glossy ads.  I remember going to a new dentist and being handed a rose on the way out.  The problem was that from the word go, I had a very negative feeling from the staff and dentist.  No one seemed to enjoy what they were doing and there was absolutely no connection.  The rose almost seemed like an insult to my ability to discern whether or not I'd received caring treatment.  I'd have been much more impressed to have been treated warmly.  As it was the beauty of the rose could not wipe out the thorny indifference of the staff and dentist. 
    I'll leave you with a compliment we received from a patient today.  Yes, I know it's Saturday, but this patient had called yesterday to ask about some pain he'd experienced after biting on something hard with an implant crown.  I called to see if he had experienced any more problems.  He was fine, but his comment made my day.  He said, "Dr. Morgan and all of you are outstanding because you understand that you are dealing with human beings.  You can have all the skill in the world but it doesn't matter if you can't figure that out.  You consistently show me that you care."  There's the secret formula for successs.  CARE.  Even if you don't really feel it, fake it at first.  Before you know it you'll find yourself hooked on caring.  Who cares?  You must, after all you're reading this aren't you?

Turbyfill Seminars at NuCraft Dental Arts

    Ok, so by now you must surely realize that I really enjoyed my time at Dr. Turbyfill's seminar at NuCraft Dental Arts.  Dr. Turbyfill is 76 years old now and full of energy.  He's part of an old guard of teaching dentists and he's a treasure.  If you want to take a removable prosthetic course, this is the one to take and NuCraft is the place to take it.  Click on the following link to check out the schedule for the next seminar. Download Schedule 2009

    As you can see from the group picture, this was a nice, happy group of people who had a wonderful time learning from a one of a kind instructor who has spent the last 50 years immersed in a career that he loves.

Professional, Career Dental Assistants

   

How do you help make your dental assistant a professional, career assistant?  How do you make sure she spends that career with you?  I think that any dentist who is lucky enough to have a great assistant will be interested in the answer to those questions.
     Like I said, I was at the Turbyfill denture course at NuCraft Dental Arts in Athens, GA the past few days.  What a great experience!  At one point, I was talking to a very nice young dentist and he said that his assistant was kind of jealous that she wasn't going with him to the course.  Ah Ha, I thought, he has an interested dental assistant.  That's the first step to having a professional career dental assistant (PCDA, from now on)...identify the interest.  He then went on to say that he thought she was going to leave assisting to go to hygiene school.  I asked him if he knew why and he said he thought she wanted more responsibility, respect and more earning power.  I asked him if he could try to find a way to give her that as an assistant.  Now, I'm not saying to throw money at her, I'm saying to find ways to give her more responsibility in the office so that she can be more productive and earn a higher salary.
    Most assistants really like assisting and only leave for hygiene because they percieve it to be more respected and more lucrative.  We can change that and keep more assistants where we need them, in dental assisting.  It's a two-way street though.  Dental assistants have to be serious about making assisting a respected position.  I would like to see mandatory certification to begin with.  I'd like to see that certification require a two year accredited program.  I'd like to see more self-policing and mentoring by experienced assistants.  We have to take responsibility for bringing more respect, responsibility and value to what we do.
    Dentists will need to be willing to look at assisting as a profession.  Most dentists who have a PCDA in their practice will tell you how valuable they are to them.  They are willing to pay them according to the value they bring to the practice.  Practices with PCDA's don't find as much immaturity and in-fighting among their staff, because the PCDA is doing what she enjoys and is committed to, and is appreciated by her boss and team members. 
    Whenever I hear or read about dysfunctional practices I wonder what happened.  Why would any member of the dental team be permitted to cause dysfunction?  Why wouldn't a dentist protect his or her investment and livlihood by insisting on professional staff members?  I think it's because there are few to be found sometimes.  When I hear about dental assistants who stir up trouble and try to avoid work, I wish they would just find something else to do.  They hold the rest of us back from being seen as PCDA's.  That keeps more serious minded people from considering dental assisting as a profession.   I think that years are spent, or wasted, dealing with nonsense and putting up with poor performance because, "that's the best I can find."  Developing PCDA's can have an enormous impact on making things better.
    In the end, the dentist I was talking to agreed that he might be able to make his assistant see the value in staying in the profession.  He is sending her to my course at the Florida National Convention in June to hear me talk about how assistants can function as Patient Care Coordinators.  He's opening his mind to other ways that she can bring more production to the practice.  He's probably going to bring her to the Turbyfill course the next time he goes.  He probably going to be working with her for a long time to come if he does all that.

A Gift

    My boss and I are attending a Turbyfill prosthetic course and if you ever have the chance to attend, do it.  Dr. T. is 76 years old and absolutely delightful.  He brings a patient in who is having problems with a denture and remakes the denture during the three day course.  It's really something to see.
    The patient today was a very sweet 68 year old woman named Mary.  Her full upper and lower dentures fit so poorly that she said she takes them out to eat.  Now, where's the logic in that?  When she started talking about how it affects her, it was an eye-opener. 
    She is very mild mannered, but when she began talking about her journey with these dentures she became agitated, upset and somehow seemed almost ashamed because she had gone to a "discount" denture clinic since she couldn't afford her dentist's fee.  Her general dentist was there and had been asked if he could supply a patient for the course.  He was obviously very grateful to have her getting some help.  As she told us about her denture I realized that denture patients may often feel like a lesser class of denture patient.
    As Dr. Turbyfill stated, we need to be very compassionate and caring with our denture patients and make them feel good about what we are doing for them.  So often these days, we are classifying dental IQ's and feeling that patients who accept implants must have high IQ's because they are choosing optimal treatment.  Being able to afford something better doesn't make a patient smarter than someone who has to choose within the limits of their budget. 
    After listening to Mary, I gained new insight into the feelings and experiences of a denture patient.  Thanks to her, I think I have more empathy for what our denture patients may experience.  Dr. T. has assured us that Mary will not only join us for lunch tommorrow, she'll keep her dentures in her mouth to eat it.  I can't wait.  What a gift for her and what a satisfaction it must be for Dr. Turbyfill to be able to give that gift.