Exceptional Dental Practice Management

Normalizing The Abnormal

I'm on vacation at the beach in Florida, and it's raining.  I've already worked out, had breakfast,read; and it's only 11:00.  That's after sleeping till 8:00.  So, being me, I started thinking about what to write for this blog.  Hmm, I started thinking, "What's the next thing I need to do to move our team forward?"  That's when it hit me.  We have an abnormal (for us) situation at work right now and it's causing a certain amount of tension.  Left to it's own devices, that tension could cause someone (probably me) to snap. 

Here's the deal.  We have a delightful, but currently unreliable new employee.  She has a lot of personal issues to get straightened out, but they are not seemingly insurmountable.  Things like arranging daycare, getting reliable transportation, etc.  She just moved here so that's why she's somewhat unsettled, and that's why I say currently unreliable.  I expect that to change and normalize. 

In the meanwhile, we are left in a state of abnormality.  When she's present, everyone is trying to help her learn her job.  When she's not there, everyone is trying to do parts of her job.  The result is pretty stressful, either way.  What is happening is this:  I'm expecting everyone to see what needs to be done, and do it.  They in turn are doing what they are used to doing, and while willing to do something if asked, just don't see it all as easily as I do.  Now...that seems obvious to me right now, on vacation, but in the heat of the moment, it's frustrating to have to be on alert for everything. 

I am reading a book titled ChiRunning.  I want to be a good runner, but I apparently have terrible form, I'm too tense, and I get frustrated with my slowness, lack of aerobic fitness and the screaming from the muscles in my legs.  I hope ChiRunning will be the answer, we'll see, but in reading, I may have found the answer to normalizing the abnormal situations that come up fairly frequently in a dental office.  Think about it, when was the last time you actually worked the schedule you began the day with.  Patients cancel, emergencies come up and procedures change in midstream.  One of the foundations of ChiRunning is focus.  Focus on your core, and your legs become a different story altogether.  Focus on breathing correctly, and what do you know, you master that. 

Think about bringing focus into your work.  Something unusual pops up and you learn to focus on the next most important thing to do.  What if your team could do that, too.  It takes work, it takes mistakes (which are the best learning tools I've found) and it takes commitment, but I think the payoff could be big.  Next, how about bringing relaxation into the day?  Relaxing at work?  Don't we want less of that?  Well, yes if we're talking about relaxing and reading People during patient care hours, but if we're talking about working in a relaxed manner and atmosphere, I'm all for it.  Think about posture.  How often do you catch yourself with hunched shoulders and tension in your neck.  What if you learned to notice that tension sooner and to quickly release it?  Being focused on your body can help with that.  If you regularly scan your body for tension and release it, you'll be more at ease while you work.  I think that if teams could master focusing, they would work more relaxed because there would be less nagging worries. 

Talk to your team about normalizing abnormality in your practice.  What daily stresses get to them?  You might be surprised.  What would be a response to normalize those stresses.  Think about starting the day with a few easy stresses, or at least encourage team members to stretch between patients.  Yoga is a helpful practice for dental professionals.  Specialists, next time you want to send a thank you to your referring dentists, send them an in-office session with a yoga instructor, and skip the basket of cakes or candies.  We work in abnormal positions most of the day, normalize that as much as possible by being aware of each others posture and gently pointing it out.  One of our rdh's always worked with her elbow at a 90 degree angle, and she complained of shoulder pain.  I noticed it as I walked by her room one day and told her.  She tries to pay attention to it and if we see her doing it we give her a signal.  She hasn't complained of shoulder pain lately. 

It's pretty normal to get used to things that are abnormal, so pay attention.  Very often, it's easy to normalize abnormality.  It just takes awareness and a desire for normality.

Drop The PPO, Keep The Patients!

My good friend, Sandi Hudson, has started a business that will be an invaluable aid to dentists.  Whether you are just starting out and feeling completely lost about what plans to participate in, been in practice for years and ready to opt out of plans, or somewhere in the middle, Sandi can give you the guidance you need.  The following interview should give you a better idea of what services Sandi can offer to help you.

What exactly is Drop The PPO?

 

"Drop The PPO is a web site and consulting service for dentists who are looking for guidance in how to manage their insurance participation.  We offer advice and tips on how to negotiate fee schedules, how to analyze what each PPO is costing the practice and which plans, if any, to consider dropping."

 

How did you get started in such a specific niche in the area of dentistry?

 

"As a manager of my husband’s dental practice I was able to apply my business degree and background specifically in the area of insurance participation.  By creating my own system for analyzing insurance for our practice I have been able to help our practice grow the way we want to as opposed to running frantically for low insurance fees.  Because I also work directly with patients on a daily basis I have developed our systems to be sensitive to patient feedback and can clearly see what works and what doesn’t."

 

What is the most common problem you see with insurance participation in a dental office?

 

"Often it’s a matter of a dentist wanting to gradually reduce their PPO participation but being too busy with dentistry to analyze where to start.  When a dentists has spent years building their practice and finds themselves with a full schedule, they start realizing that the PPO write offs are potentially not necessary any longer.  A plan can be created to systematically determine which insurance plans are costing the most and how many patients are associated with each plan.  By dropping a plan strategically with a system in place to keep patient retention when transitioning to an out-of-network provider, dentists see an increase in profits while continuing to keep happy patients.  Most dentists are working towards this as an end result but often seek out our help in mapping out the process."

 

Do you recommend every dentist drop PPOs?

 

"No.  I do not believe PPOs are necessarily a poor choice.  Unless a dentist is practicing in an underserved area he or she must spend money to attract patients.  They either pay in the form of marketing dollars to get patients in the door or they pay with a discounted rate to an insurance company.  I believe in creating a mix of the two that helps reach the practice goals as defined by the dentist as opposed to a one-size-fits-all approach.  The key is that the control must be in the hands of the dentist in terms of making sure the insurance plan pays at amount allowing the dentist to provide quality care in a profitable manner."

 

Isn’t it easy to just pick the lowest fee schedule and choose that one to drop?

 

"Obviously the lowest fee schedules are the ones to look at first but there are several factors to take into consideration.  Going out-of-network for the first time means your staff must have a clear understanding of patient benefits and, more importantly, must know how to communicate the changes to patients so they understand they can still see you as a provider.  Front desk skills are critical which is why our consulting packages include working with staff for high retention rates.  Front desk staff can make or break the process of dropping a PPO. There are also many lifestyle factors that play into choices as well.  A new dentist with a high debt level will be in a different stage than a dentist who is in the middle of their career and looking for more vacation time or adding an associate.  We take individual factors into account as well as looking at hard numbers to make the best decision for each practice."

 

How do I get started looking at my office’s insurance participation?

 

"Visit our website at www.DropThePPO.com for some great tips and my regularly updated blog.  We offer very affordable consulting packages designed to quickly analyze your office situation and offer solutions that put you in charge of your growth.  Whether you choose to add or drop PPOs, our goal is to maximize your profit while providing quality patient care.  There are many routes to that path, we can help you find the best one for you."

Visit Sandi's website and I know you'll find the answers you've been looking for. 

The Drive

"Greatness is more than potential. It is the execution of that potential. Beyond the raw talent. You need the appropriate training. You need the discipline. You need the inspiration. You need the drive."       

                                                                            ~Eric A. Burns~

I've been talking lately about what I want to see in an employee.  Let's talk about potential.  I can see potential in so many people that I hire, that's why I hire them.  I can speak to their potential, teach to their potential, and implore them to fulfill their potential, but I can't make them live up to it.  I can show them their possibilities, but they have to want to go there. 

Many people have raw talent; the ones that become effective, and even great at what they do are the ones that use talent as a starting place and develop themselves.  They have to move beyond comfort levels and take a chance of messing up.  They have to want more for themselves and to give more to the practice.  They have to realize that getting more and giving more go hand in hand.

Discipline is something that can be developed.  No one is born disciplined.  We all start out crying for what we want and having others meet our needs.  As we grow, some of us are lucky enough to have people in our lives who teach us that we can can and should work for what we want.  We learn the sense of satisfaction that can be derived from achieving goals. 

If we are really fortunate, we've been inspired by someone.  I remember having a boss that inspired me when I was 19.  She always held herself in a place of integrity.  She didn't ask for it, but I was awed by her.  I sensed something in her character that  bore no foolishness.  She let me know that she saw my potential and expected me to live up to it.  I didn't stay in that field, but I carried her vision of me and her expectations with me.  My former boss inspired me to learn all I could about dentistry because he was generous with his knowledge.  My current boss inspires me to see the best in others because he so obviously does and I see the benefit for him and them. 

The drive comes from within.  If you don't feel it, study yourself.  Why not?  Are you in the right occupation?  Have you become complacent?  Are you in the right practice?  Figure it out, or you not only hold greatness from yourself, you hold back others you work with.  Take any chance presented to you to get more training.  We are never finished when it comes to learning.  Learning something new just gives you more capacity to learn even more.  With understanding comes the new void that must be filled. Look for inspiring traits in others.  If you find yourself impressed with someone, figure out what it is that makes you take notice and absorb it.  Set goals for yourself and drive yourself toward them, even when you're tired or discouraged.  Make your intention greater than you are right now.  Want something.  Want more.  Want to keep getting better.  If you do this you will find that you are in demand because so few have a desire to drive themselves to fulfill their potential.  Work for something bigger than yourself, work for the greater good of those you affect.  Only then will you begin to reach for true greatness.

Devotion to Growth

"Life is a process of becoming, a combination of states we have to go through. Where people fail is that they wish to elect a state and remain in it. This is a kind of death."            ~Anais Nin~

This quote makes me believe I'm on the right track with my "six month rule" theory.  I find that most new employees seem to do well and progress until they hit six months.  Then many of them seem to skid to a stop.  No matter what you say or do, they seem to want to stay right where they are. 

I can remember my mother saying that she hated change, it always made her sad to lose what she had.  So many times she just could not see that she would be receiving anything to take the place of the loss.  She just anticipated the pain of losing.  My husband always reminds me to "enjoy the rut" because a lot of the time, even though the ups are great, the downs can be terrible.  Philosophers remind us to live in the moment, and that nothing that happens is either bad or good, it's all in how we think about it.

So, with all that in mind, I still don't get the six month phenomenon that I seem to witness in the workplace.  We, and many other practices have a 90 day probationary period.  I think of it as the honeymoon period.  If you have problems during the honeymoon, it's unlikely that this marriage is going to work.  But, often, people really are showing their best selves during this time.  Also, this is still new and exciting so they are energized and engaged.  But, then it all seems to become ordinary, and the great new job that they were so happy to get, is just a job.  They settle into a rut and would be happy to remain as they are, unless someone comes along to pry them out. 

That someone is you.  Why not you?  You're the one reading this, so now that you know something must be done, why shouldn't you be the one to do it?  Unless, of course, you're in a rut of your own.  Believe me, I understand it if you are.  Not too long ago, I felt like I was just going to accept whatever I got out of employees.  It seemed too difficult and disappointing to keep trying to inspire the uninspired new employees that seemed to come our way.  I had found the state of "Whatever" and was planning to try living there for a while.  Here's why.  Once an employee is in the practice for six months she becomes someone the patients and staff consider part of the practice.  They feel they know her and are comfortable with her.  The fact that they've elected to remain where they are in their development is not evident to staff and patients.  They just know that this person is nice and they like her.  The manager or doctor know that they want more from a person in this position.  They may like her, too, but they can separate their feelings for the person from their expectations of the employee. 

Here comes the push.  Will this person be willing to leave the state they have become comfortable in and grow?  The pain in growing comes from the risk of failing and the fear of embarrassment, loss of pride, and loss of the esteem from others.  How can we make the risk, more appealing than the safety of the known state?

"And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom."            ~Anais Nin~

I think feedback and encouragement are the answer.  Communication is to the soul, like water to the bud.  Hear their thoughts and worries and share yours with them.  I believe that employees benefit from hearing how they're doing much more frequently.  I like to correct or congratulate quickly.  I like to let the employee know I'm anticipating their progress and success, just like we anticipate the beauty of the fully open flower.  There is promise in the tightly closed bud, just as there is promise in every person.  If we don't nurture the bud, it will wither and die before it ever has a chance to show us what it could become.  It's the same with any person.  Unless they are really missing something fundamental, that promise is there.  We have to turn the risk of blossoming into an opportunity to come into being.  We have to let them know that we are expecting something, that we will help them become what they can be and that they have to take part in the process.

"Life shrinks or expands in proportion to one's courage."    ~Anais Nin~

Isn't this really what it all comes down to?  Courage.  Yours and theirs.  Yours because it takes courage to push someone.  It takes courage to know that you may push them into frustration, anger and maybe even end up without them.  It takes courage to be strict with someone while those watching may judge your methods or intentions.  It takes courage to know that you may reveal that you were wrong to begin with in hiring this person and may bring that to a head  by pushing them to meet your expectations.  It takes courage to know that if they don't make it you may have to start all over, with another unknown, but you do it anyway.  Theirs because it takes courage to leave a comfort zone.  It takes courage to try something knowing you may fail.  It takes courage to risk revealing a weakness or ineptitude.  It takes courage to succeed, knowing that more will then be expected in the future.  It takes courage to commit to a lifetime of growth rather than a future of predictable routine. 

To me the answer lies in the expansion of life.  If you can remember to stop, measure and demonstrate the expansion of your employee, you may find that you have created a sense of devotion to growth in them.  Once that takes hold, you will also find that you can release them to themselves a little more.  You don't have to be a constant catalyst.  You've given them the gift of expansion.  You've done your job for the moment.

How To Be Good

The other day I received a comment from a reader named Jennifer asking me if she would be a good dental assistant.  She said she'd had mediocre grades in assisting school, but she seemed to do well in practical work.  She also said she was shy and introverted.  Overall, she was worried about making mistakes and being yelled at, a nightmare for a shy, introverted person.

I've been reading Marcus Buckingham's book, The Truth About You.  I've just started it, but one thing stands out already.  When it comes down to it, the only thing your business cares about from you is your performance.  In the end, that's what counts.  We are all hired to perform certain duties.  When we show up for an interview, it's often our personality and ability to sell our strengths that get us the job.  Very quickly though, it comes down to performance.  Can you do the job?  Can you do it well?  Do you show up ready to perform consistently?  

Here's what frequently happens.  A candidate;s personality can act as a smokescreen to cover weaknesses.  No one is going to come to an interview and say, "I tend to be late frequently, I sneak peeks at my cell phone to check for new texts, but I'm so good at it you'll hardly ever notice.  I like to form little girl gangs and pick on people who perform better than me, and by the way, if you're ever wondering where I am, I'm probably going to be in the break room reading People.  Hey, I have to have something to talk to your patients about."  Nope, nobody ever says that, even though some, or all of it often applies.  People tend to come to an interview prepared to tell you what you want to hear.  People want to have a job to pay their bills, but they often don't care about being good at their job.

Jennifer, the commenter I mentioned, wants to be good at her job, and that's an important first step.  She cares even before she has a job.  So, here's how to be good.  Always be on time.  When an employee is frequently a few minutes late, I don't care why they are late, I just know they're late... again.  I don't want to hear the reasons: " I got behind a school bus, my road was icy, my child didn't want to go to daycare..."  I want to know that you will anticipate these problems and figure out what steps you need to take to deal with it and show up on time.  That's all I care about.  If you're someone who's rarely late, that's a different story.

Next, I want you to arrive ready to start.  Don't walk in in a flurry of stress and confusion and start putting on makeup, fixing your hair, and telling your co-workers about your crazy morning.  Come in and get moving.  Don't create havoc in the beginning of the day and stress everyone out, or draw everyone into the drama of your life.  I want calm and pleasant.  Come to morning huddle ready to contribute something.  I'm looking about information that will help us look amazing to a patient, or ideas to make the day flow smoothly.  I don't want you to walk in late, rummage through the fridge and proceed to fix your coffee and eat your breakfast.  This is a business meeting, not a meal. 

When the meeting is ended, it's time to concentrate on patient care and caring.  That means work to stay on time, but also show the patients you care in the way you speak to them, the way you work on them, and they way you end the appointment.  Each step is important and should never be rushed.  When you walk up and down the hall, remember that patients see you and pick up your vibe.  If you're mad, they'll know it, if you're rushed they'll feel it, if you don't care, they'll sense it.

If you work in a support capacity, sterilization, room set-up/clean-up, lab work, etc., take pride in doing everything excellently.  The people who are benefiting from your work will notice it.  When you set up a room, try to be exact.  When you put things away, put them in the right place.  If you don't know, ask.  When you are told, remember.  It is your responsibility to ask, remember and perform.  Take yourself and your performance seriously.  Your supervisor does not want to spend extraordinary amounts of time figuring out how to help you remember and learn.  You must know yourself, your strengths and weaknesses and make them work for you in your job.  If you have a hard time remembering what you are told, take notes.  Write down the steps and post them somewhere that you can access them when you need them.  Figure out ways to work around your weaknesses by incorporating your strengths.

Finally, I want to address the personality aspect of Jennifer's comment.  In dentistry we work with many different personalities all day long, both in our patients and our co-workers.  We can never figure anyone else out completely, but we can give everyone a chance.  We can call on the strengths in our own personality to help us work with the challenges presented by others.  An abrasive co-worker may make us want to snap at her, but we can just decide we have no idea what makes her say the things she says and get on with our own day.  We don't have to spar with her.  An unpleasant patient may just need us to quietly accept them in the moment.  They may actually be sick with apprehension.  We don't know, so we can choose to assume on the side of generosity and kindness.  What if you are the one with a personality trait that presents a challenge?  Jennifer's shyness may be something that she needs to work around.  Often, a lot of what we do involves performance.  We can't bring all our worries, stresses and frustrations to work with us.  We have to leave them at the door and perform for patients as if they are the most important thing on our mind.  Figure out how you can do that.  I work with someone who has a great deal of worries in her life.  I asked her how she stays so positive and pleasant every day.  She said that she sees the hours she is at work as a break from her worries.  That works for her.  I'd say she has a strength for compartmentalization and she's using it in this way.    I have a strength for perseverance, not matter how difficult a matter is, I am going to keep going until the end.  My boss has a strength for positivity.    He can always find the good in everyone. 

In the end, you must be able to perform well if you want to keep your job.  You can be good at what you do if you are willing to focus.  Not just until you get your supervisor off your back, focus every day until what was hard becomes routine and then focus on the next new thing.  Some of it will be hard and some will be easy.  Get what's easy done and then hunker down and figure out how to become good at what is hard.  Don't be needy, be self-motivated.  At the same time, don't be afraid to admit you need help, but then take that help and work with it until you can be confident that you've got it.  If you have to ask for help again, do so, but be able to show that you've learned something in the previous lesson. Take feedback calmly and thoughtfully and then use it to do better.   Keep trying, don't make excuses for yourself and face challenges with determination.  Don't hide mistakes, don't avoid difficult tasks and don't depend on the sympathy or good-will of others.  Pull your own weight and help others.  That's the way to be good.