Exceptional Dental Practice Management

Be The Change

"You must be the change you want to see in the world."

                                    ~Mahatma Ghandi~

What are things like in your world these days?  Are you and your family feeling an economic pinch?  I read an article the other day that said if you're hurting because of the economy now, you'll still be hurting in a year, but if you're doing ok, you'll still be doing ok in a year.  Seems pretty random, doesn't it?  Why do some hardly feel any effect while others are truly suffering?

It seems to be the same in dental practices.  While some dentists are laying off staff, shortening hours and even cutting back on days, others can't find enough hours in the day to see all their patients.  Some of it has to do with demographics.  In areas where many patients have been laid off and lost their insurance, practices are feeling it, too. 

Some of it has to do with attitudes.  If a dentist and his staff are constantly bemoaning the economy it can affect the way they present treatment and even the treatment the dentist recommends.  It's easy to allow discomfort or fear to guide your thoughts, but be careful not to let your concerns keep you from giving patients all their options. 

Finally, sometimes we just forget to think outside the box.  In this case, the box becomes the economy.  The in the box thinking might be: "The economy stinks so patients won't want treatment.  If I tell them they need a crown, they'll think I'm just trying to help myself and that I don't care about how they're doing.  They'll get mad and go somewhere else."  Outside the box thinking goes like this: "Mrs. Jones would really benefit from a crown, but she might need to just do a composite right now.  I'll let her know that the composite can take the place of the build-up I'd have to do and have my office manager talk to her about a payment plan so that she can get the treatment she needs as soon as possible and pay in a way that doesn't stress her too much."

Some dentists are seeing a slow down in their hygiene schedules.  A lot of them might be cutting hygiene hours or doing their own hygiene.  When they do this they not only do their hygienists suffer, they hurt themselves, as well.  If you don't have patients in your hygiene chair, you don't have patients to examine and schedule treatment for. 

Oh, I can hear you now.  You think I've lost my mind.  Why are you going to let a hygienist keep her hours if she has nothing to do?  Yes, that would be crazy, so don't let that happen.  Here's the inside the box thinking: "If my hygienist isn't cleaning teeth, I'm just paying her to sit there and do nothing."  Here's the out of the box mentality:  "Julie's schedule has been really open lately.  How can we use her open time in a way that will help our patients and the practice?"  Your hygienist can help out with some assisting duties and enable you to move more easily from patient to patient by cleaning temporary cement, taking impressions, or assisting chairside.  She can get on the phone and try to find patients who've fallen through the cracks. 

Now, here's the change you can be in your world.  Think of the many patients who have been in your practice for years, that may now be struggling financially.  Ask your front desk assistant if patients have been declining recall appointments because they just can't afford it right now.  Make a list of the long term, "good" patients who fall into this category.  Have your most diplomatic, well-spoken employee, maybe that hygienist with downtime, call the patient and offer a recall free of charge.  Just remember, you have to do it in a way that allows the patient to keep their dignity.  Here's a suggestion: "Mr. Davis, Cindy told me that when she called you the other day to schedule your recall, you said you couldn't afford it now because your business is really struggling.  I'm sorry to hear that you are having difficulty, but we don't want to see dental problems added to your worries.  You've been a wonderful patient for years and we'd like to schedule a recall for you at no fee in gratitude for your loyalty all these years.  Dr. Jones wants to play a part in making things better for our patients.  We ask that you pay it forward by helping someone else in whatever way you can.  If we all help each other, we'll all be better off."  This is a good thing to do because it's a humanitarian thing to do.  It's also a good business decision because it keeps patients involved in their dental care and keeps it a routine part of their life.   When things get better it's much easier to continue treatment with a patient who has been seen regularly, then it is to reactivate patients who've drifted off.  The savings in staff time spent trying to reactivate patients may alone make up the cost of those prophies provided at no fee.

We have choices, we can sit and bemoan our fate or situation or we can do something positive.  It costs little in materials to provide a prophy.  It creates a lasting impression when we reach out to care in this way.  People don't forget it when someone helps them when they are down.  They tell other people, too.  Your staff sees your goodness and it cements them in their loyalty to you.  You are truly being a caring provider and walking your talk.  When you do good, you feel good.  Generous acts beget good feelings and positive results.  You become a positive influence in the lives of others.  You become the change you want to see in the world.

The Do's and Don'ts of Interviewing

The internet has had an impact on just about everyone's life by now and on every business in some way or another.  I kept thinking that jobs in our town must be really scarce due to the economy and then I realized that just because there are no jobs in the paper, doesn't mean there are no jobs.  They're posted on-line on Craig's List, Dental Finders, or other sites.  I post job openings on Craigs List and the response is usually immediate and enormous.  So, here's your first do and don't:

Don't depend solely on your local newspaper when searching for a job, you'll miss out.

Do search the listings on Craig's List and post your own ad for work wanted, as well.

Just because you're replying to an on-line ad, it doesn't mean you can loosen up on protocol.  The response that gets my attention is still professional and well written, and that means correct grammar.  I would strongly suggest spell checker and having someone else read your reply to check for mistakes.  You wouldn't believe how many grammatical mistakes I see in replies.  That usually weeds out that applicant right from the start.

Don't reply as if you're e-mailing a friend.  Don't start out with: Hey, I want to apply for the job you have on Craig's List.

Don't copy and paste your resume to the body of the e-mail, add it as an attachment.  If you don't know how to attach documents, get someone to teach you. It's good to  show that you have computer processing experience.  Better yet, format it as a PDF file and attach it.  It's easy to make PDF documents.  Just download CuteWriter, it's free. 

Don't sign the letter too casually.  Don't write, "Thanks, Mindy" or Have a Blessed Day.  It's too casual.  I'm not your buddy, I'm your potential boss.

Don't reply to a position for a receptionist and tell me that you hope to be a practice manager someday.  I'm the practice manager, I'm not trying to hire my replacement.  I want to hire someone who wants the job that I've described.

Do reply graciously and respectfully: Dear Sir or Madam, I would like to apply for the position of Front Desk Assistant.  I have attached a cover letter and resume.  I hope that my experience will meet your requirements and I look forward to hearing from you.  You can reach me at 555-555-5555.  Thank you for your time.

Sincerely,_______________

Do write a professional, yet engaging cover letter, just as you would do if you were going to print it out and mail it.  A cover letter gets points from me and makes me feel like the applicant really cares about getting the position.  It shows effort and let's me see how well you express yourself.  In the cover letter, explain why you would like the position, why you are qualified for the position, and what benefits the employer will receive by hiring you.  Do sign the letter professional with either Sincerely or Best Regards.

Do write a concise, yet thorough resume that lists your past positions starting with the most recent, the responsibilities you had and the skills you acquired.  For each position, list your supervisor and their phone number.  Give the years (at least I hope it's years) you worked there and the reason you left.  If the reason involved conflict, don't get down and dirty about it, just say it was not a compatible fit . 

Do list references with phone numbers.  Do list supervisors, I don't want to talk to a bunch of your friends and relatives who will tell me how wonderful you are and that they can't think of a single negative thing about you.  I want to talk to someone who won't be sitting at the same table with you at Christmas.  I want to hear your strong points and the areas that you struggle with.  If you want to be a step ahead of the rest, give your supervisors permission to be candid when I call.  No one's perfect and I don't expect our employees to be either, I just want them to strive for excellence.  I need to know if you will.

If you've followed the do's and don'ts so far, I'd probably be calling to talk to you on the phone.  I want to hear how you sound and you'd be surprised at how people sound when they answer their phone.  About 90% of the time the person sounds bored, annoyed, or lazy when they answer.  I think it's got something to do with the fact that most list their mobile number and often the call is interrupting them. Once they hear it's me, calling them about the position listing they replied to, they brighten up and sound the way I was hoping they'd sound.  A surprising amount of people end up really bashing their former bosses or co-workers, or getting too casual with me.  That's the second group to weed themselves out.  Be positive and pleasant throughout the call.  Think of it as a pre-interview because it's your ticket to the real, in-person interview.  I also hate to sit through your choice of music while I wait for you to answer.  Your friends may not tell you that they're sick of listening to Kenny Roger's sing Lucille, but I'm telling you, get rid of it.

Do answer your phone pleasantly and politely.  You should do this anyway just to be nice, but at least do it while you have your resume out there.  Do maintain a pleasant, yet professional demeanor throughout the call, remain positive, and if offered an interview, thank the caller for the opportunity.

Don't answer your phone like a grouch, it makes a terrible first impression.  It's one that I write down immediately on my notebook under your name, so it stays there and when I'm comparing candidates I consider it. 

Don't say: "Now which job was that?  I answered so many of them."  Just listen and you'll figure it out from what the caller is saying.  It's fine to ask the name of the practice if they don't offer it from the start. 

Don't complain or speak negatively about any past employer.  Be gracious and discreet.  If a job was just plain hell, say that while you appreciated the opportunity, you felt you would like to work in a position that allowed you to contribute more to the growth of the practice.

I'll say it again, don't make callers listen to your favorite music while they wait for you to answer.  To me it seems a little immature and slightly self-indulgent.  It may be your signature song, but I may not want to hire someone who relates that closely to Lady Gaga.  I have nothing against Gaga, but I sure don't have her blaring on the radio at work.  

So, if all has gone well so far, I'll probably ask to set up an interview in the office.  Try to be available for any time I offer, or at least for the second time I offer.  If you're too hard to schedule, that will make me wonder if you'll be able to work the hours we need you to work.  Get to the interview about 5-10 minutes early.  Any earlier and you'll seem obsessive and I'll feel rushed to get to you. If you're late, I won't be interested unless you were caught behind an accident.  Don't tell me you were caught behind an accident if you weren't, I'll check.  Be prepared to answer questions intelligently.  I ask candidates to answer a list of questions about themselves that will give me an idea of who and how they are.  If you are handed something like this, give good information, but don't take overly long doing it.  Don't try  to make yourself sound like a saint, I won't believe you.  If I ask what your least favorite task in the position it, it's ok to say you don't like to take out the garbage, but fully intend to do it whenever needed.

Don't dress like a slob.  Sorry to be so blunt, but you wouldn't believe how people show up.  I had one lady show up in a black sweatsuit that was covered in cat hair.  She wanted to know how long the interview would take because she had to get home to feed her cats.  How this lady didn't weed herself out to begin with, I'll never know, but she sounded great on the phone.  Needless to say, she was quickly on her way home to feed those kitties. 

Don't slouch, look bored, or put your feet up on the seat of the chair you're sitting in.  Don't call me sweetie, honey, or darling.  Believe it or not, one woman did all the above during her interview.  My boss witnessed some of it and was horrified, literally, you should have seen his face.  It was worth sitting through it.

Don't be scary, creepy or weird.  Don't be crazy.  Don't be too familiar.  Don't be gross.  I've seen it all and I don't want to see it again.

Do dress professionally.  Wear conservative make-up and style your hair neatly.  This isn't the time to break out your green-gold glitter eyeliner.  Wear neutral colors.  Black and white or beige and black are classic for a reason. 

Do speak politely and shake my hand when I introduce myself to you.  Make eye contact.  I can't tell you how important this is.  If you can't look me in the eye, I wonder about you, so will the patients.  It's uncomfortable and distracting to speak to someone who never looks at your face. 

Give me the information I ask for, but don't give me every last detail of the bad stuff.  If you didn't like your last supervisor, I understand, but don't bash her.  Don't try to bs me.  Tell me what you're good at and what you'd like to improve in.  Don't tell me that you're the best assistant, receptionist, etc., that ever lived.  I won't believe you and I won't like that you are so conceited.

Be someone I'll want to spend my days around.  Show me that you'll work hard, get along with our staff and treat our patients well.  Be prepared to give me examples of how you've done that in the past.  Then, be determined to live up to it if you get the job. 

When you're leaving smile, shake my hand and thank me for the interview.  Tell me you feel that you'd really love working with us and that you'd work hard to make me happy that I made the decision to hire you.  When you get home, send me an e-mail thanking me for the opportunity to interview and tell me a reason you feel you be a good fit for the position and why you'd enjoy working with us.  Hint: make sure you send it to the right person.  I received one today thanking me for the interview and telling me that she just knows she'd love working for our office.  The problem was that the office she referred to in her e-mail wasn't our's.  Ouch.

It's competitive out there and for every position listed, there are at least 50 applicants or more.  You have to take every opportunity to stand out in a positive way.  Here's a little secret:  It's not hard to do because there are so many people out there who have no idea how to do it.  I'm telling you here.  Use my do's and don'ts properly and you'll make a better impression.

Good Luck With That Pal!

If you watched the video above, you see what can happen when people say no instead of yes. You can be sure that anyone from United Airlines that was involved in this case, wishes that they had chosen a different path. Some mistakes can't be fixed and the repercussions can be relentless. I'm sure you can think of times when you, or someone else in your practice, made a poor choice when interacting with a patient, or with each other. Sometimes people get too caught up in protocols, rules and guidelines and forget to use their imagination and be creative in solving problems. As we've been working with a staff member to help her develop a better manner of handling phone calls, we've realized that many times people react, rather than respond to what others are saying. On Monday morning, an older woman came into the office and told our front desk assistant that she was here for the summer from Florida and had lost a crown from her front tooth. She said she had gone into an office down the street and they had said they were too booked to see her, and suggested that she try our office. I came up front and looked at her and saw that she was missing crown #9. Now, I don't know about you, but if I was in that condition I'd hope that someone would have compassion for me and help me out. We were also fully scheduled and didn't have an open room right then, but I asked if she'd mind coming back in a few hours. She happily agreed and returned at the agreed upon time. Upon examination she told my boss that her dentist in Florida had told her she needed to replace an adjacent bridge, so she wanted us to do that and incorporate #9 into a new 4 unit bridge. As it happened, a patient that was scheduled for Wednesday had to postpone her treatment and we appointed this lady for that time. We prepped the bridge yesterday and found her to be a wonderful patient. I had to wonder if the dentist in the other office even knew that his front desk assistant had sent away a patient in need, who ended up needing and accepting a bridge, and who happily paid the fee. If only she had thought yes, rather than no. Patients are happier with staff who say yes. Sometimes it seems like it is impossible to say yes, and sometimes there are things you just can't do. You still don't have to say no. If you can find a way to align yourself with the patient, you can still do what you need to do, without a resounding no. For example, a patient came into the office one day very irate because his insurance told him they wouldn't cover perio maintenance for him. He was demanding that we change the code and file for a prophy instead. Our front desk assistant at the time immediately said, "I'm sorry, we can't do that." The patient was now angry, not only at the insurance company, but at our staff member, as well. She wouldn't back down and his face progressed from irritated to ready to blow. I got there before the impending explosion and told him I had overheard and could see why he was annoyed. His anger began to fade and you could see he felt he'd found someone who he might just get somewhere with. Now, I was not going to change the code either, but I was going to help him see that it wasn't the answer. Rather than tell him what I couldn't do, I told him what I would do. I told him I would call his insurance and ask them what we could do to help the patient get coverage for perio maintenace. I then pointed out to him that he had a lot of treatment scheduled. In the end, even if they didn't pay for the perio maintenance, he'd still hit his maximum with the rest of his treatment. By the time he left he was satisfied that his insurance would be handled correctly and that we were on his side. I didn't say yes, but I didn't say no, either. Always look for the yes that is available every time you start thinking you'll have to say no. Be as flexible as you can, and when you do have to enforce rules, you do it as positively as possible. Still determined to stick to your rules, scripts and regulations? Good luck with that, pal!

It Takes Two

"It takes two to speak the truth – one to speak and another to hear. "

                                                                            –Henry David Thoreau

How many times have you been in a conversation with someone and realized that they weren't really listening to what you were saying, they were just waiting for you to take a breath so that they could start talking.  Let's face it, we all love to hear ourselves talk.  The problem is this, if we only talk and never listen, we never learn anything new.  We only know our own truth, and it's not always the real truth. 

Think about a time when you've tried to give critical feedback.  As a manager, you know that a lot happens before you actually utter the words.  You've already spent lots of time thinking about the problem, documenting the behavior, and figuring out how to approach the person in a positive, yet firm manner.  You've put all that effort into this and now you're finally started the discussion.  Unfortunately, you find yourself face to face with someone who doesn't want to hear a word you're saying.  You see the shades come down as they go inside their head to prepare their defense.  There's not a chance that they will even consider the validity of what you're trying to say.  Many times, a staff member would rather quit than admit you're right and try to change.

Who's to blame?  Well, maybe both of you.  How are you bringing up the issue?  Are you being positive and reinforcing their good points, or are you jumping right in and slamming them with the bad news without any finesse?  I'm not suggesting that you baby adults, but I am saying that you set the stage for success.  When you give a staff member the opportunity to feel good about themself, they can accept that a few things need work.  Defensiveness is usually in response to an attack.  People who are being attacked react by shutting down, it's a self protective mechanism.  People let in what they can handle.  Most people can handle critical feedback, as long as the delivery is respectful and considerate.

It's the same with patients.  You have to talk to them in a way that makes them willing to listen.  You also have to listen, wanting to understand so that you can find out what they want for themselves.  If you want them to listen to you, you have to appeal to their hopes and dreams, and to what's important to them.  When you listen attentively, you can then speak in a way that shows them that you heard them and understand them.  

It all comes down to respect and honesty.  It's respectful to listen when someone is talking and it's the only way to really achieve true honesty between people.  Show that you'll do your part and you may find that others will do the same.

So What?

"When I start to be too impressed with myself, I think, "So what?"  When I start to be too impressed with someone else, I think, "So What?"  ~Father Nick~

I was in church the other day and those were the sentences Father Nick started his sermon with.  What he was saying was, "What's the importance?"  I recalled when I first became the office manager in our practice.  I have to admit, I was somewhat impressed with myself.  So what?  What did it really mean?  In actuality, office manager is just two words, a title.  Just being told I was becoming the office manager didn't make me a good one.  Seven years later I can tell you what the so what is; it's the whole thing.  If the whole team didn't work with me, I wouldn't be successful at what I do.  I would just be an office manager with a chaotic team.  Actually, if that was the truth, I probably wouldn't be an office manager anymore, would I?

I thought about how "So what?" could be applied to just about anything to bring clarity and to give direction.  Let's think about our staff member that's having difficulty with phone calls.  So what?  Well, if she doesn't get better at it, she may need to be reassigned.  If we let her keep going as she is, we may have dissatisfied patients.  So, that brings a very specific consequence to this situation.

How about a staff member who wants a pay increase.  She goes to the dentist or manager with her request.  "Why do you think you deserve a raise?"  I work hard, I'm never late, and I never complain."  "So what?"  If she is prepared to answer that question, she'll be much more likely to get a raise.  "I've developed a recall system that works and as a result the hygiene department production increased 30% last year.  Staying on time keeps my patients happy and satisfied. I have time to educate my patients about their conditions and I believe that's why they are more receptive to treatment recommendations.  I researched it and 95% of my patients schedule recommended treatment at their recall appointment.  Not only do I refrain from complaining, I try to help others when I can and I believe I play my part in helping keep a positive atmosphere in the office, which patients frequently notice." 

Maybe you have a patient that needs a good deal of dental work, but nothing is hurting...yet.  "You have five large old fillings that are leaking and need crowns."   "So what?"  "Well, you're right, you can just keep going on as you are until something breaks or the decay progresses, but then you may need to have root canals or, depending on the severity of the damage, you may lose teeth.  That could double the cost of the treatment you need.  We always try to catch problems when they are less expensive to fix.  Bacteria can seep into leaking fillings and cause decay.  Once the tooth starts to hurt, your problem will be bigger than it is now."  Ok, now I see what you mean, I'd rather take care of it before we get to that stage."

"So what?" is a great question.  It's a grounding question.  It can show you something about yourself, and it can help others understand where you're coming from and vice versa.  "So what?" is a preparatory question.  It helps you to be ready for whatever may come up.  It's like doing your homework before the teacher actually assigns it.  Don't be afraid to look, it's a question that gives you a chance to make things right before they go wrong.  "So what?"  I don't know about you, but I like getting things right.

Reality Check

We were doing an amalgam for a physician today and the conversation turned to just what it's like to be a doctor these days.  This patient is also a friend of mine and I've known him for years.  I've watched him become more stressed with each passing year.  He started talking about how managed care is affecting physicians and just how tough it's getting.  He said he's seeing more and more emails advertising for doctors, which he said he hadn't seen in the past.  He talked about the feeling that patients and staff look at him and think he's got it made.  He said, "They don't think about the fortune that it costs to go to medical school or the hours and years of studying and hard work."

I started thinking that it's the same for dentists.  They also spend a lot of time and money preparing for their career.  A lot of people look at them and think they take home a lot more money than they actually do.  Don't get me wrong, dentists make a decent living, but it's not what some patients and staff think it is.  And, it's not a snap to make it happen.  Here's the reality.  First of all, the dentist assumes all the risk.  If an assistant drops an instrument in a patients eye, the dentist pays.  If a hygienist messes up, she may have to defend her license, but the dentist will bear the ultimate responsibility.  If a patient keels over with a heart attack, everyone gets upset and stressed, but imagine being the owner.  Think about how it feels to tell a patient who just needed a crown at her last recall, that she needs another one.  The dentist knows he's telling the truth, but that skeptical look from the patient could make anyone squirm.  Some even go a step further and ask him if they're funding his trip to Europe or a new boat.  How would you like it if your boss asked those kinds of questions every payday?  Staff sees a patient accept a $40,000 treatment plan and start thinking that they should get a bonus since he just got that big case.  What they don't realize is that those big cases end up costing more than expected and the dentist just eats the difference.  That doesn't take into account the time spent planning the best treatment and trying to anticipate any problems that may arise.  They still end up waking up at night worrying about something they may be missing.

I'm not trying to make you feel sorry for dentists, and they wouldn't want you to either.  They'd just want you to understand that they have their own share of worries, pressures, and demands on their time and resources.  They also went into dentistry because they want to help people and make a difference.  They're interested in their work and want to feel respected and appreciated, just like the rest of us.  They depend on their staff to work with them to achieve their vision for their practice, but  they end up being in a weird place with their staff, too.  They own the practice, but they can't really be friends with their co-workers, they have to keep a little distance, so it can be lonely for them in their own office. They want their patients to take responsibility for their oral health and to care about it as much as they do.    We need to realize, that everything isn't always what it seems.  Health care professionals dedicate themselves to helping others. Where would people be without doctors, dentists, nurses, hygienists, and assistants?  We all work together and have the same focus and vision.  We need to look at each other fairly, realizing that we're more alike than we are different, and give each other the respect and appreciation that everyone wants.

Time To Put On Your Big Girl Pants

I don't know about you, but I find giving critical feedback to staff members to be one of the most anxiety producing aspects of management.  When I think back to my beginnings in dentistry, I remember getting some pretty harsh critical feedback from a dentist.  I thought I'd been doing ok, but he thought otherwise.  He let me know that if I didn't improve by the end of the next week, I'd be outta there.  I was stunned and asked him what I was doing wrong and he listed everything he was dissatisfied with.  I had only been working there for a week and I was horrified to see how much he didn't like about what I'd been doing.  I was 19 years old.  I made up my mind to take every point he'd complained about and improve it.  At the end of the week he handed me a $10 bonus.  That was more than 10% of my take home back then, so a very big deal to me.  More important, I had overcome my shortcomings and given him what he wanted.  I was thrilled.

Notice, my boss didn't sit and plan out how he was going to tell me that he was dissatisfied, he didn't worry about my psyche, he didn't cushion his complaints with compliments about my personality or anything else.  He cut to the point and told me what he thought.  He didn't attack me personally either, and I didn't take it that way.  I understood that he didn't like my performance that week and if I could improve it, I could stay.  If I couldn't, or wouldn't, I would be let go.  Simple, easy to understand, and all the onus where it should have been, on me.

Contrast that to how we handle these problems today.  First, we have to document instances of poor performance and discuss them with the employee.  We have to make sure that we tell them that they are wonderful, and then back into the real issue.  By the time we finally get there, we will likely face an employee who wants to tell us why we're wrong, ungrateful, or too demanding.  We may find that we are facing an employee who refuses to let herself consider the validity of any criticism we may dare to put forth.  It's like bouncing a ball against a wall; everything you say bounces right off and just comes back to you.  You realize it never gets in and you're playing by yourself.  Since we're not psychologists, it's not our place to try to figure out what makes people do what they do.  Our job is to teach people how to do their jobs the way we want them done, work with them to find better ways to do things, and give feedback that will help them succeed.

In our practice, our staff understands that every critical feedback is given with the intention to help them excel in what they are doing.  They are open to it and look at it as information about what they are doing, not as a condemnation of them as people, or even about their overall ability or intent.  It is specific to whatever task they are struggling with or not performing satisfactorily.  They allow themselves to hear what I am telling them, to consider the problem, and to work with me to solve it.  In other words, they wear their big girl pants to work every day.

In a situation in which the dentist or manager is fair in their feedback, staff members who put up walls, turn the criticism back on the manager, or try to discourage feedback with tears or anger, are being immature, self-centered, and unfocused.  The reason I say self-centered is because they are looking at the situation as all about them, when it is really all about giving our patients the service that we are promising them. They are not looking at this as information meant to help them excel.  They become their own worst enemy and determine an unhappy future in their work life. 

There are times when the dentist or manager is unfair, unkind, or has taken a dislike to a staff member.  Even then, it is crucial for the staff member to pursue the problem and try to solve it.  It could be a misunderstanding, or it could be an unworkable situation.  There is no honor in staying in a situation that will never work.  In that case, putting on your big girl pants means being proactive about finding a position elsewhere that will allow you to thrive.  Everyone involved can only be responsible for their own actions and reactions, and the ones wearing the big girl pants will always do best.

Yadda, Yadda, Yadda...Not!

I've been talking about phone skills lately because it's something a staff member has been struggling with in our practice.  It's one of the crucial aspects of her job, so we have to get it right.  Funny thing is, I thought she was just fine with it.  When I'd walk by, or be in my office across from her desk, she sounded good, but every now and then I'd notice some uncertainty.  That uncertainty prompted me to ask a friend who's a consultant, to do a phantom call posing as a new patient.  That's when we realized we had cause for concern.  She became stiff and unwelcoming when an unexpected question was posed.  The scripts that were meant to help her, ended up stunting her conversation.  As a matter of fact, what should have been a congenial give and take conversation, became a stilted, mechanical, awkward monotone.  Now what do I do?

I think it's a great idea to use phantom phone calls with your staff.  Just be honest about it.  You're not the cop sitting in the bushes along the highway just waiting to catch someone doing something wrong.  You have to make it clear that the phone calls are a teaching tool.  That gives you the responsibility of presenting the results in a productive way.  If you go to the person and say, "You sounded horrible!", you're going to be faced with tears at the very least, or watching her walk out the door at the worst.  Tell her you've asked someone to analyze her phone style and that you've got some information that you'd like to go over with her so that you can help her increase her phone skill.  Be positive, it's hard to hear that you've been judged and found lacking. I also use a recorder that attaches to the phone.  That way she can either listen and judge herself and see what she likes and doesn't like, or we can review it together.  The point is to bring the responsibility back around to her.  People change and do better when they recognize that there truly is a problem and they know what they need to fix.

In our practice we are very open in staff meeting about our strengths and weaknesses.  Our long term staff are used to it and completely comfortable with discussing issues openly.  New staff need time to get used to it, but we don't let them off the hook, we just keep reminding them that we all want to help them grow.  So, back to the phone call.

Every phone call leaves an impression on the patient who is calling, and also on any patient within earshot.  Be welcoming and warm.  Avoid slang or lazy answers like Uh huh, Umhmm, and don't buy time with Ummm.  Start listening to staff talking on the phone this week and you'll notice it.  Just pointing it out to them will get them noticing how often they do it.  Always be polite.  I know I live in the South, but I'm born a Yankee and I've adopted "Yes, ma'am and No, sir, quite easily.  It sounds good and people like politeness.  Get involved in the call, don't just let it bounce off of you.  Sit up straight and don't prop your head up with your hand.  Remember, the caller can't see you, but patients in the office can.  I also think you speak differently when you sit alertly rather than when you sit slouchy.  Be professionally casual.  What I mean is, don't be so professional that you come off sounding stiff and cold, but don't be so casual that you sound rude or ignorant. 

Here's an example of a staff member that would sound too casual:

Staff member (SM)Dr. Morgan's office.

Patient (Pt) I'd like to make an appointment.

SM - What's your name?

Pt - Linda Zdanowicz

SM - Are you a patient?

Pt - Well, I've been coming there for 20 years!

SM - Well, it's hard to remember every patient.  What's your problem?

Pt - I have a toothache.

SM - Well, we're really booked up today, we can see you at the end of the week.

Pt - What will I do till then, it really bothers me?

SM - Well, maybe you could take some Motrin or something, that's all we've got open.

Ok, maybe that's extreme, but I've been the patient getting those kind of responses in healthcare offices before.

Here's an example of a staff member who is being too stiff:

SM - Good morning, you've reached Dr. Morgan's office.  This is Julie.

Pt - I'd like to make an appointment.

SM - Can I have your name please?

Pt - Linda Zdanowicz

SM - When were you last seen?

Pt - I was there in March.

SM - What can I do for you?

Pt - I have a toothache.

SM - Please answer the following questions:  The sm then rattles off a list of symptoms.

Pt - It started last night and it's killing me, can you get me in?

SM - I'm looking at our schedule and it's really tight.  Can you wait till tomorrow, we have some emergency time open at the end of the day?

Pt - I'd really prefer to be seen today.  I don't want to go through another night like last night.

SM - If you insist on coming in today, you can come by at 3, but I can't promise you that you won't wait a long time.  We'll be working you in between our scheduled patients.  You may have to sit in the waiting room a while.  I'd bring a book or something.

Pt - Well, I'll just have to wait then, because it's killing me.

Here's a better scenario:

SM - Good morning, Dr. Morgan's office.  This is Julie, how may I help you?

Pt - I'd like to make an appointment.

SM - Certainly, can I have your name, please?

Pt. - Linda Zdanowicz

SM - Hi, Mrs. Zdanowicz, when were you last seen in our office?

Pt -  Please call me Linda, I was there in March.

SM - Oh, yes, I see you were in for your recall appointment and everything was great.  I began working here in April, so I haven't met you yet, but I'm looking forward to it.  How can I help you today?

Pt - I am having a toothache.

SM - Oh, I'm sorry to hear that!  Let me ask you some questions?  When did it start to bother you and does it wake you up at night?

Pt - Oh, yes it does!  I woke up last night with a terrible toothache.

SM - Did you take anything for it, and did it help?

Pt - I took 4 Motrin and it did calm down after a while.

SM - Oh, good!  Have you noticed anything else?  Does it hurt when you chew or when you drink something hot or cold?

Pt - Yes, all three.  It's the worst toothache I've ever had.

SM - Oh, I'm so sorry Linda.  Well, let's get you in right away so we can get you out of pain.  Our schedule is tight today, but this is important.  We can see you at 10 am.  We'll do our best to get you right in, but please understand if you have to wait a few minutes.

Pt. - Oh, I'm just grateful to get in so fast.  The last time I had a toothache at my old office, they made me wait till the end of the week.  That's one of the reasons I left.

SM - Oh no, we always see a patient who is having pain the same day that they call.  We try to treat you the way we'd want our family to be treated.

You see the difference.  In the first call the patient was more of an intrusion than a person.  In the second, the staff member was using a script and a set of rules that she wasn't going to veer from.  She got the patient in, but she didn't seem to care about her problem.  In the last example,the staff member used empathy and concern to make the patient feel welcome and cared for.

Some staff members answer the phone and when the patient starts to speak, the staff member just hears, "Yadda, yadda, yadda."  It's all the same, they all call for the same reason.  They're always complaining or wanting something.  That attitude carries through the phone line.  What you want is a staff member who is responsive to what the patient is saying.  When a staff member asks a question, but doesn't comment on the patient's response, it leaves the patient feeling like she's being interviewed.  When the staff member responds appropriately, with concern and empathy, the patient feels like somebody cares.  And isn't that something that any of us really wants?