Exceptional Dental Practice Management

Leading Through Disappointment

I think the biggest challenge in managing a dental practice is hiring, training and keeping good staff.  It's as precarious a task as building a house of cards.  Pull one card out and the whole thing comes tumbling down.  Losing a staff member that I thought would be with us for a long time is a big disappointment for me.I thought we were there with a really strong staff that was on it's way toward being long term.  This morning, our roving assistant e-mailed me to tell me that she'd accepted a job as a scrub tech because she'd get better medical benefits.  I'd like to say my first thought was that I was happy for her to have that opportunity, but I'd be lying.  I was annoyed because I'd put time into her, believed her at her interview when she told me she didn't want to work in a hospital and could see herself with us for years, and know my effort was in vain because I'd have to start all over with someone new.  I'm disappointed because she was the best person we've had in that position and she didn't even give us a chance to counter with an offer of higher salary. 

I called and talked to my boss about it and his pragmatism helped me to see that although this is a huge inconvenience and disappointment, it's just the way it goes.  People will, and probably should do what is best for them.I know our staff will be disappointed and even a little annoyed, just like I was.  This always affects everyone.  We all have to chip in more, help guide a new employee and get used to whatever their new personality will bring to us as a team.  As a leader, I'll have to keep them focused on positive aspects of this situation.  Who knows who we'll find to take this position and what special benefits and side effects they'll bring with them.  I was reading this article about interviewing on Dave Rendalls Freak Factor blog and liked what he had to say about the side effects that people have  on a workplace.  He also says that we all have weaknesses in addition to our strengths and I'll admit, my initial despairing gut reaction to an employee quitting is probably my Achille's heel.  I immediately get flooded with negative thoughts in response to reading, "I'm sorry to say I'll be leaving."  Luckily, I have Dr. Morgan to counter that with his eternal optimism.  That's not to say he wasn't disappointed, as well, he just seems to have a resevoir of "pull your socks up and keep moving-ness" to draw from.  Knowing he'll back me up and support me in the challenges to come will help keep my socks up, too.

This employee was thoughtful enough to give us two weeks notice.  Now, I have often heard dentists say they won't accept the offer and want the employee out immediately.  I once had an employer try to force me to refuse the notice, but I talked him into letting her stay.  If an employee bears no ill will to the practice, they can be a major asset in helping train someone new, or at least keep things moving for two more weeks.  It will be odd to go in next week and tell the team that she is leaving while she's still there, but I hope that I will have the wisdom wo find a way to make it comfortable for everyone. 

It's always stressful to work with an incomplete staff, so I'll be working hard to find someone to take her place.  In the meanwhile, I'll be trying to find ways to keep our staff optimistic, knowing that while they may have to work a little harder for a while, it won't be forever.  We all have to realize that some employees will come and stay a long time and become a part of who we are as a practice.  Others will drop in, add a little flavor and move on.  It's not about who we are, it's about what they need and we'll wish them well.  We'll all keep our socks pulled up and if we have to, we're not above bending over and pulling up someone else's when they just can't do it themself at the moment.  And it's good to know we're stronger than a house of cards.  Pull one out and we may lean a little, but we keep standing.  Disappointment happens, and that's all it really is.

Are You Holding Back?

Disclaimer: This is a totally gratuitous, possibly a little boastful post.  I have it made, as do my co-workers.  We have an amazingly kind, fun, optimistic, totally wonderful boss. 
In these worrisome days of a dismal economic outlook, it seems that most people are focused on how bad things are.  Sometimes we have to take time to look around at the people we are with every day and realize we have a lot to feel good about.  For the past two days I kept getting the overwhelming feeling that I just needed to tell my boss how great it is to work with him.  I didn't want to come off as a kiss up, but when I thought about it I realized that we often have no qualms about criticizing or complaining, but we can feel squeamish giving a heartfelt compliment.  Maybe we just need more practice with it.  Why do we feel so awkward telling someone else how much we value them?  Why do we brush off the urge to say something nice?  We worry more that someone will think we're odd when we give a compliment than we worry about what they'll think when we say something negative.
I'm sure I looked completely goofy when I told Dr. Morgan that we have it made, but I'm glad I did it.  He looked so pleased and he immediately responded that he has it made, as well.  That sure feels better than complaining or blaming.  So, maybe it would be a good idea to make a habit out of giving truly felt compliments.  I say truly felt, because I don't want you to go around giving smarmy, insincere comments.  People see through insincerity and it makes them feel weird about you, so make sure you mean it.

Think about it, are you holding back?  Why?  Do you worry about how the other person will receive your compliment?  Do it anyway.  Even if they act uncomfortable, inside they love it.  Keep it up, you might get everyone else started.  Our staff really likes and supports each other and we don't mind letting each other know that.  We probably don't do it often enough though, so I'll need to expand it out to them.  We should never take having it good for granted.  If we don't have it so great, we should try to find ways to change that.  It has to start somewhere.  Why not with you?

What Are You Going To Do Tomorrow?

Are you going to do the same old thing, or are you going to dare to do one thing differently?  I say dare, because making any change comes with baggage.  First, you have to be brave enough to actually let the words come out of your mouth.  Then you have to let them sink in and wait for a reaction.  Most of the time, any mention of change brings an initial, knee-jerk resistance.  Eyes roll, moans escape lips, and sometimes the most assertive staff members will actually string a sentence or two together to let you know why things are fine just the way they are.

So, how brave are you?  Once you get past the initial reaction, if you really want change to happen, you'll probably have to go first.  Then you have to keep encouragement coming and momentum moving forward.  When the results come in you have to share the victory or take the blame if it's not so good.  Still want to do it?  Yes?  Then it's a good idea, go for it!

I once had a boss who told me that life is full of peaks and valleys, but he preferred to live in the ruts.  I drove him nuts.  Truth be told, he drove me a little nuts, too.  I like to rest in a plateau now and then, but that next peak is just waiting to be reached and you only get there by taking the first step.  It may be easy to just keep on doing what you've always done, but it's boring.  Change keeps people on their toes.  I'm not suggesting you have a constantly morphing practice, just one that is always looking for tweaks.  Never say never.  New technology can be exciting or it can be frivolous, you have to check it out to see what will work for you.  New ways of doing things can make work more fun, or just complicate things.  You'll never know if you never investigate. 

Going to work tomorrow and making just one change you've been wishing would happen, could lead to more good changes.  Before you know it, you might start feeling excited about going to work.  In this economy, many are so focused on worrying and watching their practices decline.  What one change could become an action that answers some of those concerns? 

What are you going to do tomorrow?  Let us know.

Joy Rising

How cool is that? I can't watch this video without smiling and wishing I had been there. I'm probably the world's worst, yet most persistent dancer. I would have loved it. I was watching Oprah (love her or hate her, she's pretty impressive) and some of the people who danced in the video were talking about how great it felt. These were all amateurs who were strangers to each other. One person said it was like joy rising. Another talked about how amazing and unifying it was. They were talking about how fantastic it felt for so many people to work together like that, at one point each person had their hand on another person's back, and how much fun it was. They said it was shared joy for the Black Eyed Peas and the crowd. It was something neither group could have done without the other. Now, if a huge crowd can make something that takes so much cooperation happen, and have a great time doing it, it should be easy for us to create synergy and shared enthusiasm in our practices. Believe me, when a dental team works happily together, the patients feel it, and love it. Our staff went out to dinner together the other night after attending an OSHA meeting and had a wonderful time. Our waitress commented on what a happy group we were. That's joy rising. It came right off of us and floated onto her. She felt it and appreciated it. It happens in our office, too. Our patients comment on it all the time. My son worked with us this summer and I asked him what he thought the feeling in the office was. He said, "Happiness. Everyone always seems to enjoy what they're doing, they like each other, and you can always hear someone laughing." That's joy rising and floating up and down the hall and in and out of the rooms. You may be thinking I'm exaggerating or that it's a fluke, nobody's that happy all the time, right? So, what's our secret? It's simple, anyone can do it. We decided to make it happen. we made a conscious decision to make the atmosphere in the office happy. We decided to like each other despite the things we may not like 'about' each other. It's a minute to minute choice that we make daily. Oh, sometimes we get off track, but then we want the joy to rise again. Joy rising. It's addictive. Is joy rising in your office?

I'm So Happy To See You!

Do you make your staff feel like that when they arrive in the morning?  Chances are you don't.  I don't think I really do, consistently.  This is what usually happens:  I'm usually the first to arrive by at least 30 minutes and I'm usually deep into something by the time they get there.  Cathy usually gets the best greeting because she comes in the front door and we say hello and often have something to discuss from the day before.  Julie and Annette come in about 20 minutes after her and shout up the hall.  I don't know if they even hear me grunt my reply, which is usually something like, "Uh, huh" or just "Huh" if I'm really into something.  Harris flies by with barely a nod and passes by so fast that I could easily miss her. My boss yells hello down the hall and heads straight to his office. I often feel a little miffed at the abruptness of it all.  Why don't they walk the extra few steps down the hall to make visual contact with me? Why doesn't she slow down and say "Hello?" Well, why don't I go to them?    When we all finally get into the breakroom for morning huddle, we give each other a more considerate greeting.
I started wondering today, what would it be like if I broke away from whatever "important" thing I'm working on and was waiting to give them a really great greeting.  What if they felt that I was really happy to see them.  Because honestly, I am.  The day is always better when everyone shows up.  When I start to realize that it's 10 minutes past the time anyone would normally get there, I start to worry like the mother hen that I am.  So, how can I start the day by letting them know how happy I am that they've arrived?  I already have the coffee brewing when they get there, and to be honest, they take it for granted.  If I forgot, they'd just make it themselves, so that's not such a big deal.  I think I'll try just getting up from my desk and going to them and asking how they are today and really listening to the answer.  What if I made greeting them the important thing.  Now, they might think I've finally cracked, but they might also realize just how appreciated they are.  People like to be noticed.  Often, they'll do whatever it takes to be noticed, even if it means they have to cause some trouble before anyone pays attention to them.  They love it though, when you notice them for who they are.  Don't group them into "the hygienists", "the assistants", or the "front office".  See them as individuals who each add something valuable and unique to the practice.  Ask them how they feel and what they think about what you're doing together.  Really listen to understand.  When people see that you notice their contributions, they tend to contribute more.  When they see that you acknowledge change that you've requested, they are more willing to comply with your requests in the future.  Best of all, when you show them that you're happy to see them, they tend to be happy to see you, too.

Do You Really Know How To Lead? Really??

Leadership is an interesting concept.  I call it a concept because there are really no set rules about how to lead.  There are no real leadership schools, because it's something you learn along the path of life.  I think that very few of us are ever finished, we've never learned all we can about leading others. 
I remember when I started managing our practice.  I felt like someone threw me into the middle of the ocean and said "Swim" without also teaching me how to tread water, or at least tossing a life preserver in after me.  So I did what anyone who wants to survive would do, I desperately paddled and waded, went under a few times, (felt like staying under a few times) and finally started making some productive progress.  It wasn't too long before I thought I knew all there was to know about swimming leading.  I'd soon find out that all I really knew was just enough to keep me from drowning. 
I have found that just when I think I'm really a good leader, reality smacks me in the face and I realize that I have a lot to learn.  Here's a little of what I now know:

1. Leadership lends you no power.  If you are accepting a leadership position, don't do it for the power you think you'll have.  If you try to lead by might, you'll find out how weak you can be.  You will realize that you are dependant on those you lead, not vice versa.  If they don't like you, don't agree with you, don't like your methods of leading, you will be as effective in getting things done as a bird with no beak or wings.  The power is in the relationships you build with your team.  It is in the example you set.  The power is in the character you unfailingly display.  It is in your consistency.  The power is in the trust you build.
2. Speaking of trust, in case you didn't know, you build it with every word, every response, every facial expression, every nuance and every action you take, every conversation you have, the way you handle good times and the way you react in harder times.  When you are doing it right, your staff will look to you for reassurance, they will base their response on the way you seem to feel about a situation, and they will mirror your attitude toward others. If you want to test this, walk into a meeting and just be quiet and don't display your usual upbeat personality.  You will see the mood deflate and become flat.  They trust you to set the tone for the day.  If you think it's a downer, it must be.  So if you want to have people who are working together in harmony for a common goal, you better make sure you do it first.  Make sure you're happy doing it, too if you want to work with happy people.
   
3. You don't get a bye when you are in a leadership position.  It doesn't matter if the boss is grumpy, the patients are nuts or the staff seems like they just hopped off a party boat, you have to be consistent.  You get to have a bad day now and then, hey, you're only human, you just really shouldn't show that you're having a bad day.  I guarantee you, if you do, and if you do it too often, you'll lose credibility.  I'm speaking from experience, so believe that I know what I'm talking about.  And if you think it was hard to establish credibility to begin with, it's much harder to regain it.   Control yourself in the short term to make your own life easier in the long run.  It's a choice and you know you're making it when you decide to give in to a bad mood or other negative attitude, so dig in really deep and pull out that strength of character and save the meltdown for the car ride home.  Or, instead of melting down in the Honda, congratulate yourself keeping it together instead.  Don't worry that no one would have known that you were upset about something.  It's not wasted, be proud of yourself for dealing with it and not letting anyone see you sweat.  Let it be over and move on.  (Note to self, let it be over and move on).
   
4. Leadership is all about impact.  What do you teach the others around you?  Do you model patience, or are you often exasperated?  Do you persevere, or are you always on the verge of throwing your hands up and the towel in?  Do you have faith, because in this economy you really need to be positively realistic and realistically positive.  You have to find ways to keep your practice afloat and even thriving, but you should not promise the impossible and then fail to deliver.  You inspire faith when you set achievable goals and have a plan for reaching them.  Then you lead the way.  You inspire faith when you do what you say you will do.  Do you really believe in your boss and his/her skills and character or do you roll your eyes and complain behind their back?  The staff will do what you do, so I hope you have faith in the person who trusts you to lead their practice.  If you have faith, the staff will have faith.  If you all have faith, the patients will, too and that's the impact you want.  If you have a hard time with this, better to leave your work then to work in  bitterness.  (Someone else said that first, I can't remember who it was). Remember always, it's an honor to be asked to run someone else's practice.  It really is, so respect that and leave it if you cannot fully support the dentist.
   
5. Leadership is about dedication.  Do you dedicate yourself to the staff?  That means caring more about them looking good, then looking good yourself.  It means giving them wings and teaching them what they need to know to succeed.  It means helping them before you help yourself.  Stopping to show them how to do something, rather than attending to your own work.  Then later, you don't suffer because you have to stay a little late to finish the task you postponed to help, you just do what needs to be done.  Do you dedicate yourself to your patients?  Do you spend time helping them understand why they need treatment, and what their condition means?  Do you maintain your composure with them, even when they seemed determined to make you lose it?  Do you continue to be respectful to them despite the fact that they may be  behaving rudely to you?  Do you dedicate yourself to your boss?  Do you know what his vision for the practice is?  Do you listen to him and give him suggestions when he needs them?  Do you partner with him in making the practice and staff successful?  Do you dedicate yourself to yourself?  Do you have balance in your life or is your job your life?  Make time for the things you enjoy away from work.  Save attention for the people you love and the things you like to do.  Don't be boring and if you are only interested in work, guess what?  You're boring.  Dedication doesn't end as you lock the door behind you. You're always watching what others do in their business that makes you feel good, and then incorporating that into the practice.  It's talking up the practice, dentist and staff whenever the opportunity arises (without being annoying, use common sense here).  It's not about doing it all yourself because it's easier, it's about sharing what you know and being confident that you'll still be needed.
6. Leadership is about perseverance.  "Never, ever, give up."  Winston Churchill said it succinctly.  So did Thomas Edison, "Most of life's failures are people who didn't realize how close they were to success when they gave up."  Don't give up on your doctor, your team or your patients.  Don't write people off.  Invest in them.  Spend time trying to understand who they are, how they are, what interests them, what motivates them, and what their talents are.  Then take that and use it to help them get where they need to be.  Realize that not everyone will be ready to be where you think they need to be when you think they need to be there.  Also realize that even if they aren't, and it doesn't work out that you'll continue a relationship with them, you still never have to give up on them.  You can accept that it is what it is, and separate with goodwill.  It will always serve you well.  Persevere when things seem hard, it won't kill you.  Be aware of your emotions during difficulty and try to call on an emotion or attitude that will aid you in difficulty rather than pull you down.  When you feel frustrated try to figure out what is frustrating you.  Maybe it's a team member who has a bad attitude.  Will frustration on your part make a dent in her attitude?  It may actually increase it and take away from your credibility.  You can't control her attitude, you can only address the problem, discuss the change you expect to see, and let her know the consequences of staying the same.  No need for frustration when honest, open communication is available, and it always is, you just have to be brave enough to use it.
7. And the last one for today.  Leadership is about courage.  It's not easy to tell someone else they have to change.  It's not easy to keep going back over mistakes or bad attitudes.  It's hard to be the one who has to give feedback and face the fury of a staff member who doesn't want to hear it.  You get tired, you get hurt, and sometimes you wonder, "Who cares about me, who worries about me, who tells me I'm doing ok?"  The honest answer?  You do.  You are your own mentor, you are your own cheerleader.  You supervise yourself.  And you have the courage to believe in what you are doing.  You know that you want the best for everyone and for the practice.  You have the courage to put yourself in front of everyone and make mistakes.  You have the courage to put yourself behind everyone and push them to success, even though there may be mistakes along the way.  And when success happens, you place yourself beside everyone else and share the victory equally, knowing that it really is equal, because without them allowing themselves to be led, you wouldn't get anywhere.  Knowing that you did what it took, gave what you had to give, to develop the influence that made them choose to follow you is enough satisfaction for you.  You lead.
   

Everything's Amazing and Nobody's Happy

Something to think about?

Valuocity

I just finished reading Valuocity by Dr's. Marc Cooper and Mark Silberg.  I will be published soon and I'll include ordering info at the end of this review because I think you'll want a copy.

Valuocity

Marc Cooper

Mark Silberg

Let’s start with the acknowledgements.  We get a real sense of where the authors are coming from and who they are as people.  I like to know I’m about to read something written by someone with healthy priorities and values. The story opens with a recognizable figure.  Carl is a dentist who wants to keep moving forward, but who feels the unrelenting suction of a bleak economy trying to pull him into decline along with many of his peers.  His thoughts, feelings and responses will be familiar to anyone connected with a dental practice. 

His fears, concerns and worries are palpable and really drive home the reality of what many dentists are carrying in their hearts and minds these days.  He wants what we all want…to be ok and to keep what he’s got.

As I read, I got a real sense of the overwhelming nature of his concerns.  He can think of nothing but his present problems and the possibility of a dismal future for himself and his family, to the extent that all pleasant and positive stimuli are blocked by these worrisome and dismaying thoughts.  Seem familiar? 

Carl had been pulled into a tornado of negative thinking that made even attempts at positive solutions seem like formerly valuable possessions that were now reduced to rubble because of the force and ferocity of the destructive nature of the power of the wind.  In his despair, he’d allowed his thinking to spiral into a pit of negativity where one desperate thought feed another, and even the arrival of a stranger who wants to cast some hope into the situation, seems like just another burden to cast into the wind tunnel.  Even though he initially snubs his offer of help, he can’t get him off his mind.  The man, Sidney, is a fellow dentist, who has a consulting business and he assures Carl that he’s helped other dentists in his position.  Carl just can’t see how he can ask a stranger to help save his practice.  After all, he built this practice; shouldn’t he be the one to save it?

We then see that Carl has another problem.  His wife has no idea of the trouble the practice is in.  She helped him build the practice, but once they were certain of success, her involvement had dwindled and she fell out of the daily loop concerning the health of the practice.  They’d begun to take success for granted and now Carl didn’t know how to let her know the truth.  He was loathe to pull her into his misery and out of her safe, secure, happy life.  How would this situation affect them and their marriage?   Rather than find out, he’d been avoiding the discussion altogether and now he had another problem.  His unwillingness to be open with her in the beginning was making it seem impossible to tell her the real truth now that it had gotten bigger and harder, and their relationship was suffering the same decline as his practice.  One problem was causing and adding to another until everywhere he turns, there’s another thing he’s too overwhelmed to face.  Finally, Carl realizes that the problems are just building on each other and nothing is getting better.  He is ready to reach out for help, even to a stranger, even though it feels odd and discomforting.

  As he talks he starts to feel his burden lifting as he shares his worries and burdens with Sidney. As we listen to Carl struggle to decide whether to share the entire truth about the severity of the problem’s with his practice, we realize that Carl’s feeling about himself as a dentist, husband, father and man are defined by the success or failure of his practice.  If he’s honest about his practice, what will Sidney think of him as a man?  What will anyone think?  What does he think of himself?  Is he really ready to face that?

At this point let me say, I found it hard to miss the undeniable coincidence that the author is a dentist who is a consultant, and so is Sidney.  I started to fear that this whole fable would begin to seem like a glorified marketing technique, and then I started to understand that just as I’ve always found with Dr. Cooper, the focus is on helping dentists learn how to help themselves.  This isn’t a cookie cutter program designed to fit one and all. It isn't even something for which success is dependent on hiring Dr. Cooper.  He's giving you the information you need so that you can depend on yourself. This becomes a probing foray into what makes you tick; a co-discovery that will allow you to help yourself and help your practice.  Dr. Cooper or Sidney facilitates that means to a successful end.  The one being served is the reader, who will then go on to put these lessons into play, thereby improving the lives of everyone involved with their practice.

How do you see your situation?  That’s the question that defines the problem and helps point you toward the solution.  It’s easy to fall into patterns of thinking.  You have to become aware of them before you can start to create new patterns.  Carl starts to understand the negative momentum he’s creating by living in dread and denial.  He starts to see that his perceptions were determining his actions.  He also began to see that his perceptions were inaccurate.  He realizes that he underestimated his wife’s ability to handle bad news and her willingness to partner with him for a solution.  He begins to see everyone and everything as they really are.  He sees the possibilities.  A new way of thinking is opening up for him.

As Carl agrees to let Sidney help him, the first step is to spend a weekend at Sidney’s ranch.  The first advice he gets is to surrender to the journey.  Think about it, don’t we all have to surrender what we think is the only reality in order to find possibilities?  Aren’t we so sure we’re right, even when we’re sure things are hopeless?  How can you go anywhere better, without first surrendering your despair?  As Carl finds out, you have to transform yourself before you can transform your practice.  You have to see yourself and your abilities differently before you can make positive changes in your practice.  Only when you question the reality that you think exists, can you see the possibilities that are all around you in your environment and the people you share it with.

First Carl must give up his habit of making others and himself wrong.  He is told that most people make others wrong so that they can be right.  As I read along I realized that I had stopped seeing the story as just a fable, I was beginning to look for my own answers, too.  Revelations were taking place that hit close to home and I found myself cringing at the recognition of my own tendencies to make assumptions, but at the same time, I was excited by the anticipation of changing that pattern.  I found myself thinking, “ Hey, I read this to give my opinion, not to find my own story in the pages!”  I don’t have a failing practice and I work in a pretty successful one, but I still saw myself in the tale.  I didn’t hate what I saw; I just recognized the need for more awareness and a different way of seeing things. 

Dr. Cooper makes Carl a very identifiable figure; one in whom any of us can see something of ourselves. Carl finds that he has to figure out who he is.  How does he view the world around him?  What is at the center of his practice?  What are his assumptions?  What does he stand for?  What does his practice stand on?  Does it have a foundation at all?  Think your practice is based on excellence?  You may need to redefine excellence and you may find that you have a bit of work to do if you want excellence in your practice to become a reality. What are your core values for your practice?  It’s what you base your decisions and actions on. 

Carl learns how to determine what his core values are, and how to apply them daily.  He has to define the way he and his staff would demonstrate their core values in their behavior.  He begins to visualize how that would look in practice.  As Carl finds out, defining values, describing behavior that would express those values, and measuring behavior to see if the values are being lived in the practice is a process that requires an initial contribution of time and consideration and an ongoing investment of attention and monitoring.

Carl will also find that he needs to put more effort into his staff if he wants his staff to choose to uphold the core values in the practice.  Do you have job descriptions in your practice?  Get ready to put them on the shelf.  Valuocity will teach you how to lead your staff to responsibility.  They will begin doing what should be done because they are part of the process and choose to work for success, rather than just working for a paycheck.   They will become accountable for their actions.  Carl will learn how to develop performance reviews that are individual to his practice, based on his values for his practice.  He will use those reviews to steer staff in the right direction.  He’ll learn that performance reviews set the stage for salary reviews. .  Carl learns how to create a meaningful salary review and how to assign points for performance. When the practice does better, the staff does better. 

Carl vacillates between optimism and anxiety about how much work it will take to make changes and how the staff will resist his efforts.  We’ve all been to CE that had us excited and enthusiastic, only to experience that slow deflation as the work week goes by.  Soon enough, that CE that had us hopeful and excited is just a vague memory, like all the others.  Why would this be any different?  It’s different because it involves a process that has values at its core.  It’s not the same for everyone; it’s based on individual values and commitments and depends on accountability   The dawning of a new way of leading and managing give Carl the promise of a better way of living his life and managing his practice, and he sees that he can still have the practice of his dreams.  He understands that he’ll need a coach to hold him accountable for doing the things that are uncomfortable for the good of the practice.    He goes from the person who is lost in despair at the beginning of the story to a man who has a vision for the future and a renewed sense of optimism and purpose. 

Valuocity 2 will take off where Valuocity leaves off.  It will follow Carl as he returns to his practice and finds the hard work is putting these lessons into practical use.  The feeling I had after reading Valuocity was this: Someone had reminded me that I had the power all along.  I had to stop wishing for the changes I’d like to see in the practice I manage.  My boss and I need to sit down and design his dream practice and then we need to pull our staff into in with us and build it from the core.  Even though our practice is already very good, we still can, and should, continue to grow and evolve.  So can you.

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Disclaimer:  I will not receive any gratuity or any form of reimbursement for this review.  These are my personal opinions and thoughts on this book, provided purely as a guide for the readers of this weblog.  I am involved in Dr. Cooper's Mastery of Office Management program, but that in no way influenced my review.  My participation is not contingent on any reviews or testimonials for Dr. Cooper's work.

Mom, Dad, and the Kids

Do you ever feel like that in your practice?  Mom and Dad are the dentist and office manager and everyone else waits for them to tell them where they're going next.  The problem is, the staff aren't kids and pulling them along isn't as productive or enjoyable as driving your kids to a day at the beach. 

It's easy to fall into that type of pattern though, because it often seems more efficient to just "do it yourself."  If you do that, you may save time in the short term, but you'll lose growth in the long run.  It takes time to train staff and  monitor them, and it takes a certain amount of trust and generosity to set them loose, but it's the right thing to do.

Why generosity?  Because we managers like to be the go-to person.  We often like to be depended upon.  Sometimes we may feel powerful, in charge, all-knowing, whatever, we have to realize that the real power and impact is in giving knowledge away and letting go of responsibilities.  First of all giving knowledge away, doesn't lessen your own knowledge.  I like to tell the staff that knowledge shared is knowledge squared.  It not only helps another team member, it increases their appreciation of you as a person. 

When we let go of responsibility, I don't mean we shirk our responsibility or throw it to the wind.  I mean that we take the opportuntiy to pass on the task to someone that we have given knowledge to and can now trust with the responsibility.  Then we allow growth for ourselves as well, by freeing us up to learn something new and tackle new challenges.  When was the last time you asked your staff what they thought about how the practice is doing, what they think works and what could be better?  In tough economic times, the thoughts that may be languishing inside your teams brains may be the thing to pull you out of a slump. 

Many times staff have ideas, but nobody bothered to ask.  Ask away!  Set aside time for a brainstorming staff meeting and give them at least a weeks notice.  Ask them to come prepared with ideas and issues to talk over.  Have small, fun prized for things like best idea, most ideas, most unusual, but useful idea, etc.  Ask them what they are willing to do to be a part of the success of the practice.  Ask what motivates them and what keeps them excited and interested in their job. Then remind them that they don't have to wait for the next meeting to share their ideas, encourage them to come to you regularly with their thoughts.  Let them know that you see their ideas as a gift and not a burden.

Most of the time, the kids don't have much say about which direction the family car is going to be pointed in.  Does your staff?  Remember the Flintstones foot powered cars?  Well, wouldn't they go faster and be more efficient if everyone's feet were moving?  Think of your practice like that and you'll get where you want to be a lot faster and you'll share the work, too.

Hygiene Anxiety

   It seems like the economy is really starting to have an impact on hygienists in some practices.  More and more resumes come in for hygienists and I see more posts on DentalTown by hygienists looking for work.  It seems that patients are looking to cut expenses wherever they can, and sometimes they see their hygiene visit as a luxury along the lines of having their nails or hair done.  We can do something about that.  Dentists also sometimes look at the hygiene department as their loss leader and feel that they can cut their hygienist's hours and do some prophy's themselves and save money.  We can do something about that as well.  There are probably other reasons for hygiene anxiety, but let's concentrate on those two because I think they're the main problems.

    Ok, so your patients are looking at their hygiene visit in the same category as their more optional grooming appointments.  That may be a sign that you need to educate your patients more about the importance of regular hygiene visits.  If you can make them understand that oral health is directly related to overall health and well-being, you will take yourself out of the manicure, waxing, hair coloring loop, and put yourself back into the necessity category.  I think it's great for hygienists to develop a good rapport with their patients, but you have to remember to guide the appointment and include patient education in the conversation.  If you go through the entire hour and the patient has learned nothing more than your dog's name and the adorable thing your six year old said, they may think you're just wonderful, but not necessarily the vital part of their health care team that you truly are. 
    Make every visit a co-discovery of their oral health.  Talk as you examine their soft tissues so that they know what you're doing.  Discuss your probing results and when you do find deeper pockets, describe the reason it's important to disrupt the bacteria that is colonizing under their gums.  Help them understand so that they can help themselves.  Treat each tooth as an individual and discuss it's health or disease with the patient.  Talk about the overall condition of the tooth - does it have a large fracture line, an old amalgam with breaking down margins, etc.?  Let them know that acting preventively can help avoid more costly treatment that postponing or ignoring the problem could cause them to need.  When you're done, sit them up and review your findings before the doctor comes in.  Then go and brief him/her on what you discussed with the patient.  Your patient and your doctor will see you in a new light.    When a dentist thinks that he can save money by cutting hygiene hours, I often wonder if he is seeing the whole picture.  When anyone sees hygienists as loss leaders, I know they are only looking at part of the equation.  It tells me that they are saying, "My hygienist charge for the appt is $75 and she gets an hour to do her work.  I pay her $xx per hour.  I have to pay for her supplies, the front desk person to schedule her appointment, the room..., hey, I'm barely breaking even on her!"  And then they stop thinking.  If they continued to think realistically, and they have a hygienist that does what I've described above, they'd realize that a hygienist who educates her patients plays a big part in treatment acceptance and that keeps both the patient and the practice healthy.  A dentist doing his own prophies should be a last gasp effort. 

    "But my hygienist is sitting around with hours of open time on her schedule!", you might say.  First, you have to see if you really have hired her for more hours than you need.  Multiply the number of patients in the practice times two and that's how many hours of hygiene time you need to have available.  For instance, a practice with 2,000 patients will usually see those patients twice a year for recall, so they will need to have 4,000 hours of hygiene appointments available for the year.  If that all adds up, then maybe patients are falling through the cracks.  This is what the hygienist should be working on during her open appointment time.  Don't call it downtime because it sounds like time when she is shutting down.  This is time that can be as vital to the health of the patients and practice because she can get on the phone and get patients motivated to come in and continue their good oral health regimine.   

Many people think that hygiene is boring because they just do the same thing patient after patient, day after day.  Not so, if the hygienist is truly up to date with current practice modes.  The hygienist should be classifying patients by periodontal type from health to severe periodontitis.  If she isn't, your patients might not get the treatment they need and your practice could be falling short in that part of patient care.  Patients don't like to hear that they have periodontal disease, but let's face it, many of them do.  By educating them about their condition and helping them accept the fact that their disease literally lives in their mouth, the hygienist can help them attack the problem and, if not completely conquer it, at least improve and control it.  So many patients come in with problems that 1. they don't know they have, 2. they don't realize there's help for, and 3. they don't understand the consequences of.  Let's take a patient with xerostomia (dry mouth).  A dry mouth can wreak havoc with oral health.  Bad breath aside, it can cause food to stick to both hard and soft tissues leading to periodontal disease and rampant decay.  How often do we really have time to invest in discussing the causes, effects and treatments for xerostomia in the course of a routine hygiene visit?  Set up a protocol for a xerostomia visit and give the patient 30 minutes of the hygienists time to go over products and treatments that can help.  This patient may even benefit from a three month mini recall visit during which the hygienist can evaluate home care, plaque score, give a fluoride treatment and polish.  Keep the fee reasonable and keep in mind the preventive value and benefit of this appointment. Look at how you are using your hygienist's skill and knowledge and you may find that you are underutilizing talents that have been right there all along.  Hygienists, take a part in finding ways to put your talents to use for the good of the patients and practice.

    These are just a few thoughts about reducing hygiene anxiety.  Hygienists can look at what they can offer in a new way and help themselves while they help their patients and practices.  Hard times don't always mean we have to fall apart.  We are always so much stronger when we pull together and use adversity to gain strength.  Look for ways to build up, rather than ways to shut down and you may get what you're looking for.

Listening

    I'm involved in Marc Cooper's Mastery of Office Management Program and our homework for the last two weeks has been listening.  I am amazed at how hard it is for me to turn off my own thoughts so I can manage to actually really listen to others.  I'm not happy with this realization, but better to know it so I can try to do something about it.

    If I had a dime for every time someone told me I'm a great idea person, I'd have  a lot of dimes.  Ideas just come to me.  Sometimes I even wake up in the middle of the night with 2 or 3 ideas for something that would be just great to do in the practice.  People like to hear my ideas and think that I always know the right thing to say.  So, why should I listen more?  Maybe I meant to be talking more than listening.  After all, I'm so good at it, right? 
    Well, I got a lesson in the value of being listened to the other day.  There was a situation one morning that left me feeling hurt and upset.  At the moment, I didn't really know where to go with what I was feeling, my boss didn't know a lot of the background behind the reason for my distress and so he couldn't really appreciate or understand how I felt.  It was very real to me and all the more frustrating because it threatened to put us at odds with each other, which would have made the situation all the more dismaying for both of us. 
    We got through the day, talked a little, but I still felt like a solution was not reached.  The next day I got up and felt like I'd love to just turn off the alarm and sink back into the pillow and forget about that thing called work.  I pushed myself to get moving and made it through the day with less than my usual enthusiasm, but satisfactorily as far as I was concerned.  At the end of the day I was talking to my boss in his office and he told me that he didn't like seeing me feeling the way I was, and that seeing me frazzled would affect the way the staff looked at me as a leader.  He told me he wanted to help me find a way to breeze through stress like this without  letting them see me sweat.  Then he listened to what I was dealing with, how I felt about and we talked about how to handle the next situation like this.  As I talked I could see him listening to me.  He was really considering what I was saying looking at it from my point of view.  Finally, he said, "You sound like what happened makes you feel separate from everyone."  Exactly!  He put into words exactly what I was feeling.  I didn't even know the word for it myself until he said it.  I could see him replaying it all in his mind and seeing it how I saw it.  I don't know if he agreed with my point of view, but he saw it and accepted it for what it was.  And suddenly, the weight lifted and I felt better. 

    If he had sat there and talked and told me how I should have felt and how I should have handled the problem, I would still have felt isolated.  Instead, by really hearing me and considering my view of things, he stood with me as a mentor.  He showed me that listening is a performance art of wisdom and grace.  It is not passive, but a dynamic form of interaction.  Listening validates, it says, "You're worth the time it takes to hear you out."  Listening inspires.  It builds loyalty and gives you influence with others.  Listening is mature.  It means you can control yourself and your own impulses long enough to give someone else a chance to give you the information you may need to really know what is driving their reaction.  It allows you to be wise.  With all it has to offer, listening seems like a worthwhile endeavor.  I know I can talk, in the future I'll listen more.  I want to make someone else feel the way my boss made me feel.  That is something to aspire to.