Exceptional Dental Practice Management

Negatives and Positives

We've been addressing an issue we're having with handling phone calls in our practice lately.  A staff member is having a difficult time thinking on her feet when a patient poses a question that isn't covered in the scripts in our front desk manual.  You can try all you want, but you'll never cover every possible scenario that patients can present you with, now matter how many scripts you write.  Our staff member wants to do a good job, but she freezes when presented with the need to ad lib.  We've been doing role-playing to try to help her see where she gets stuck and to try to teach her how to respond to what the patient is saying.  She's pretty stressed over the whole thing, even though we are willing to work with her on it.  Today, when I asked her how she felt it was coming along, she told me she'd rather leave than be a negative in the practice.

I told her that we are all negatives in the practice in some way.  Each one of us has something about us that would be better if it were different.  I tend to be impatient at times, I don't like it and I'm sure that whoever I'm feeling impatient with doesn't like it either, but I try to control myself.  Most of the time I do, but every now and then, I'm a negative, and I know it.  We all have something.  On the other hand, we all have lots of positives.  I told her that the important thing is to make sure the positives outweigh the negatives, and that they're more important.  You can also try to use your positives to help you work around or make up for your negatives.  For instance, that staff member may not do well with ad-libbing, but she can learn techniques to help with that.  She can take advantage of our team's generous spirits and allow them to work with her on it.  Finally, she can decide that she's going to focus on learning how to overcome her negative and stop being self-involved about it.  You see, when you keep thinking about how bad you feel about having a negative, you become kind of self-involved about it.  Open up and let yourself be helped so everyone can move on.

Success is largely supported by the desire to succeed.  Desire is born within.  You can't teach desire, you can't force it either.  People desire that which is important to them.  Team members with a desire to succeed are a positive.  Team members who don't really care about the success of the practice, their co-workers or their own success are a negative.  Successfully dealing with negatives takes commitment and sincerity.  Positives overcoming negatives, that's what it's all about.

It's Deja Vu All Over Again

Let's face it, we leaders love to lead, as long as people keep following.  But...once we look behind us and see that everyone is just doing their own thing, which as far as we're concerned is the wrong thing, then we don't love leading so much anymore.  Well, maybe we still love the idea of leading, but we really don't like that they don't seem to get that they're supposed to do what we say they should do.  That's when the complaining begins.

First, we may start in our own heads.  "What's up with these people? They're like children and they want us to be their parents.  They won't think for themselves, but worse they won't do what we want them to do either.  Sooner or later it bubbles up and we complain to our boss, or we go home and bore our families or friends with it, and believe me it's pretty boring to everyone, but you.  Eventually, we'll probably get so frustrated that we'll spew it all out to the offending staff members in a tirade that sounds anything but professional or intelligent.  Now we're just seen as unreasonable and very, very Type A.  When that happens, you've lost any influence you may have, or may have hoped to have with your staff.  Or...maybe you didn't realize that developing influence with your staff is what it's all about.  If that's the case, let me suggest a great book for you, The World's Most Powerful Leadership Principle, How to Become a Servant Leader, by James C. Hunter.

Here's the thing, most adults don't like to be told what to do.  They like to feel that they play a part in their own actions and decisions.  So, maybe your job as a manager is to help them develop some good thinking and decision making skills.  Maybe they already are capable of coming up with some good ideas, but you didn't notice because you're so in love with your own ideas.  Oh, come on, admit it, we love our own ideas.  Let me be the first,  I love my own ideas!  And yes, sometimes I don't think that anyone could possibly come up with anything better.  There, I've said it.  I also know that when I give our staff a chance to brainstorm, we all come around to an idea we all like and can agree to implement.  Even though I may have been very comfortable with my idea, and I may have even liked the glory of being "the one with the good ideas", there is so much more satisfaction is seeing our team work together and talk things out. 

Another reason to stop dictating and start listening is this: you may learn something.  I talked about scripting yesterday.  It's something we've been struggling with a team member about.  I finally realized, she doesn't think like I think, so she's not going to do or say what I'd do or say.  My boss and I have gone round and round trying to figure out how to make her my clone, and what we really need to do is work with the person she is, or not.  She's not going to be me, so we have to decide if she can use her strengths to work around her weaknesses.  Can she learn some new skills that will help her represent our practice in the way we want?  If she can't, is there another place for her in the practice in which her strengths can be used?  The only way to really know is to be up front with her and make her part of the process.  She will need to take some responsibility for succeeding in her position and will have to commit to trying to grow.  She may even be able to give us some insight into why she's having a problem and how she thinks she can improve. 

The definition of crazy is doing the same thing over and over and hoping for a different result.  Well, just saying the same thing over and over and hoping someone will respond differently is kinda nuts, too.  At least it will drive you nuts if you keep doing it long enough.  When you see a problem that persists, step back, look at how you're dealing with it and be willing to admit that it's not working.  Ask for input for anyone involved in the problem or anyone who might care.  Or you can just go on with Deja Vu, over and over again.

What You Would Do...And Other Fantasies

How many times have you been frustrated with a staff member and thought, "If it were me I'd _________."  And you wonder why you're frustrated?  I hate to tell you this but, she's not you.  That's why she's not doing what you'd do.  Ok, it's a big drop from that high horse, but brush yourself off look at the world the way she does.  She can't do what you'd do because she doesn't think the way you do.  It's that simple, so you have to figure out how to create the tools she needs to do things the way you want them done.

Scripts are really popular in dental offices these days, and they're great, as long as the patient has the same script.  When you make a person dependent on a script to answer the phone, you doom them to fail as soon as the caller diverges from the expected questions.  What happens is usually stunned silence while the hapless team member first thinks, "Hey, that's not in the script!", and then desperately tries to ad lib.  Not everyone can do it.  It's the same for the hygienist who tries to recite a canned presentation about why her patient needs scaling and root planing, or the assistant who is discussing a tooth that needs a crown.  If they assume that every patient will be satisfied with a generic explanation, they will be in for a surprise.

The answer is to start with basics.  The first and most important basic is the vision of the dentist and team for the practice;  Why do we exist?  Next is the mission of the practice; How do we treat our patients?  Finally, each staff member must develop a personal interest in each patient, and must strive to seem them as people who need something from them.  People who trust them to help them and provide them with what they need.  People who need them to care about them. 

Let's look at the vision of the practice:  Why do we exist?  We exist to meet the needs of the patients.  We want to educate patients, help them prevent dental disease, and treat them in a way that can achieve dental comfort and the cosmetic result they desire. 

Now, the mission:  How do we treat our patients?  We treat them with respect, dignity, empathy and a desire to understand their needs, wants, fears, concerns, and we strive to see them as individuals.

Once the staff members understands those two aspects, she must learn to develop a personal interest in each patient.  The best way to do this is to listen, wanting to hear and understand everything the patient is presenting to us.  This includes their personal concerns as well as their dental needs.  Any encounter with any patient can be successful if they know we care about them.  One way to do this is to respond, as opposed to reacting.  Be inquisitive.  Every sentence a patient says is an opportunity to show interest in the patient.  Use the 4 W's and an H.  Where, what, when, why and how.  Here are some examples:

Staff: "When were you last seen by a dentist?"

Patient:  "Five years ago."

Staff:  "Oh, I'm glad you've decided to begin your dental care again.  Do you mind me asking, what kept you from regular care?"

Patient:  "I had a bad experience with a root canal and I developed a terrible fear of the dentist."

Staff:  "Then I'm glad you chose Dr. Morgan to be your new dentist.  He's wonderful and caring, and our whole staff is, too.  We will work with him to help you regain your confidence and lose your fear of dentistry."

Now you've gained the opportunity to develop a relationship with your new patient, you've learned something that will help you and the rest of the team in your first, in-person encounter with the patient, and the entire contact was more satisfying for both you and your patient.

Scripts are good and have their place, but since you can't be right by each staff members side at every moment of the day, building a foundation of understanding is an essential step in creating a great team.

Optimism - Catch It

"Perpetual optimism is a force multiplier."    ~Colin Powell~

I think that one of the most predictable common denominators for a successful practice is optimism.  I'm not talking about Pollyanna-ish, naive, "build it and they will come" optimism. You have to pair optimism with hard work, desire and a willingness to find and use whatever is available to help you succeed. There's a joke I heard once: 

It was raining very hard and flooding was predicted.  As the water rose, a very religious man watched the water rise from his window.  Someone knocked on the door and offered him a ride to higher ground.  The man refused, "No, the Lord will provide."  As the water rose higher he watched from the porch of his house.  Another man in a rowboat came along and offered to take him to higher ground.  The man said, "No, the Lord will provide."  The water continued to rise even higher, forcing the man to climb to his roof.  A helicopter came overhead and a man with a bullhorn begged the man to accept transport to higher ground.  The man shouted, "No, the Lord will provide."  The man drowned and when he got to heaven and encountered God he said, "I believed that you would save me and you didn't."  God said, "I sent a car, a boat and a helicopter!  What more did you want?"

That guy was optimistic and a believer, but he didn't use everything available to aid in his success.  In that case it cost him his life, in your case the life of your practice may depend on your use of optimism, desire, and whatever else is available to ensure your success.  Some dentists are giving in to despair, and I can understand that in these times it can be easy to do that.  I know a specialist who is have some tough personal and professional challenges.  It has to be hard to be optimistic.  But, on the other hand, what will pessimism get him?  His personal situation won't get worse if he tries to believe that things will improve.  They surely won't get better if he is pessimistic about it.  Optimism may not prevent a decline, but it may make the days better in the meantime.  In his practice, there is a sense of giving up.  His staff feels it, and maybe worse, those that refer to him sense it.  People steer away from pessimism because it makes them uncomfortable.  It's like pushing their own worst case scenario in their face.  Optimism is uplifting.  When you're worried about your own problems, you welcome anyone who will shine a ray of hope on the situation.  In this doctor's case, he would be better off focusing on ways to make it easier for patients to accept treatment, rather than telling everyone how bad things are.  Pessimism often comes off as a result of failure to others, no one wants to let it seep into their own life. 

So, what positive things can you do to keep yourself, your staff and your patients optimistic?  Address the economy in a positive way by letting everyone know what steps you are taking to make things easier for your patients.  Maybe you're freezing your fees for the time being.  Patients notice it when you raise fees almost immediately, but rarely notice that you haven't raised them in two years.  Talk about it in your newsletter.  Offer in-house payment plans to patients who have a good payment history with you and let them know that you're doing it because they've been such faithful patients.  They will live up to your trust.  Have team meetings and share your values and focus for your practice with your team.  Make sure you understand each other.  What's important to them?  Do they know what's important to you?  Dr. Marc Cooper addresses this in his book Valuocity. 

So many times we fall into complacency and figure, well this is the best we can do.  We accept team members who don't give us what we need in terms of attitude or effort and think that the devil we know is better than the devil we don't know.  What we really need is optimistic, hard-working angels who are aligned with our values and want to work to have a positive impact on the practice, patients and each other. 

Why is that so scary for some us?  We are afraid of what patients will think if they see too much turnover.  Granted, patients often start to think that something is wrong, but we can be open and let them know that we are working to find the right people to serve them well.  Get comfortable talking to patients about how dedicated you are to keeping the culture of the practice healthy and that means finding people with the best values and strong work ethics who are passionate about patient care, and those people are in short supply.  Talk about the high quality of the team members that work in the practice and how proud you are of them.  Likewise, employees, talk to patients about how much you believe in your dentist and brag about his qualities.  Patients love to know that their favorite staff member feels great about their dentist.  

When you find yourself thinking pessimistically, try to think of a positive counter-thought.  You notice a decrease in new patients?  Use that as an opportunity to look at how you are treating your current patients.  How can you increase your service to them?  Do you have a patient who is having her anterior composites replaced and notice that her smile would really benefit from bleaching?  Offer to make bleaching trays at no fee and only charge a little over your cost for the bleach.  Her gleaming smile might make her friends ask who her dentist is.  She may be so thrilled that she'll spread the word without being asked.  Take a look at your fees.  So many times we just set them and forget them, but often, fees like bleaching or bite splint can be lowered because the actual cost isn't that high.  Greater acceptance may offset the reduction in fee and add more service to your patients.  Finding positive answers turns problems into opportunities.  Optimism and pessimism are equally contagious.  Which will you catch?

More Fun Than A Root Canal?

Well, just about everything is more fun than a root canal.  Just ask me, I tried to have one today.  My saga with tooth #18 started 4 weeks ago while we were on vacation.  It hadn't bothered me too much since I started on an antibiotic so I didn't worry too much about today's procedure.  I've had quite a few root canals in the past and only one had been uncomfortable so I figured that once the injection was over, I'd be fine.  That blissful ignorance ended pretty soon into the procedure as this was obviously going to be the second troublesome root canal in my life.  I felt numb, until she started opening the tooth.  Then the party started.  The tooth was apparently very inflamed and basically laughed at Dr. Madison and her anesthetic. 

While I can't say I enjoyed the discomfort, I can say that Dr. Madison and her assistant Amanda kept me entertained.  They were completely compassionate, but kept a great, natural flow of conversation going.  It was obvious that they were comfortable with each other and the other people working in the office.  Even in the midst of my worrisome predicament, their great working relationship and compatibility cut through my anxiety.  Everyone in the office had a warm welcoming attitude that was noticeable immediately.

Why is this good?  It kept me from really focusing on anticipating more pain, and maybe even from becoming overwhelmed by stress.  They couldn't finish and had to just medicate and send me on my way until Wednesday.  As I drove home I thought about patients that we saw just that week that had been fearful and anxious.  Experiencing those feelings myself made me realize I probably hadn't really empathized with them as much as I should have. I was sympathetic and tried to reassure them, but I could have empathized more.   Sitting in their seat today made me determined to take more time to try to help patients when they are stressed or frightened rather than just write them off as over-reacting.  I realized today that being in the patient's seat can be a vulnerable and nerve-wracking experience.  True compassion and empathy can ease that anxiety.  Sure, most things are more fun than a root canal, but caring professionals like Dr. Madison and Amanda can make an unpleasant situation a lot easier to take.