Exceptional Dental Practice Management

Crazy Week

...or, more accurately, a week of crazies.  Did you ever have a week where at least once a day you had to deal with a seriously "off the wall" patient?  Well this was that week, but you know what?  It was just fine.  

Now, I didn't always come through a week of cray cray's with a smile, but a funny thing happened on the way to being 54...I grew up.  Happily, there are some benefits to getting older, and I dare say one of them is wisdom, at least once in a while. Don't get me wrong, I still have plenty of foolish moments, but I find more often that I am able to find the path to serenity.

What I found out is this: you don't have to be crazy just because someone else is.  You can deal with someone who is rude, insulting, weird, strange, unpleasant or mean, with compassion.  A lot of the time, when faced with someone who is offensive, we automatically feel like we need to respond defensively.  If you do that, you are basically allowing them to make you into a mirror.  It is so much more satisfying to not only remain calm, but to stay happy.  Yesterday we had a patient that seemed to be compulsively insulting and snide.  After the first 5 minutes around her I found myself praying to be able to shake off the aggravation I was feeling.  Every word out of this woman's mouth was sarcastic and caustic.  Suddenly I realized that she thought she was funny.  She had no idea that she was so offensive.  I challenged myself to try to find some common ground with her.  I finally found that we had both spent time living in New Jersey.  that got us talking like normal people and by the time she left, we had had a few laughs and I had maintained my good mood.  

I can tell you, that's better than feeling totally annoyed and put upon.  It's the best for everyone if you can do it.  This is something that we rarely explore with our staff, but we should.  The knee-jerk reaction is to feel put upon and abused when faced with someone like the above, and the only thing that gets us through it is knowing that we will regale our co-workers with the details of all we've been through.  Instead, talk to them about how to not only cope, but how to find the dignity in finding something good in an annoying person.  Ask them to talk about their successes with this at staff meetings so they can encourage each other.  The benefits to the atmosphere in the office will be well worth it and crazy weeks won't make life miserable anymore.

The Energized Practice - Idea #4

Develop a Passion for Problems

Sounds a little strange, doesn't it?  That's ok, a little strangeness won't kill you.  But it makes you think, doesn't it?  And that's the point.  If everything is always easy, you don't have to think, and you begin doing things by rote.  And that's when things get boring, you get boring, your staff gets boring and your patients get bored.  When patients get bored, and their friends tell them something interesting about the new dental practice they've found, your patients go away and then they're not bored anymore, but they're also not your patients anymore either.  Now you're not so bored anymore, you're panicked!  That's a problem you didn't need to have if only you'd kept things interesting.

Which brings me to the point; develop a passion for problems.  Maybe I should say, problem-solving.  Problems can make you think outside the box.  If you remember that problems can be opportunities to create something better, you can consciously decide that you will try to not only solve problems, but to develop interesting solutions to problems so that you end up with something better than whatever you had before the problem arose.  

Get your staff on board whenever possible to help solve problems.  Nothing brings a team together, or builds morale more solidly, than coming together in response to a problem.  Before you know it, not only will people automatically team to respond to whatever pops up, they will begin to look for ways to improve what is, before it becomes what's bad.  I don't know about you, but even thinking about that kind of team dynamic just energizes me.

Keep coming back for more.

Grow Your Own

How do you get an amazing staff?  You grow it yourself.  I think it's very unusual for a great staff to just assemble in one practice without a concentrated effort that starts with the dentist and manager and grows with each staff member as they are initiated into the integrity of the culture of the practice.

You are the starting point because you have the knowledge of your vision for the practice.  To initiate your staff, you have to share your vision with them.  You must explain your ideals and values and ask them to accept them as their own regarding the practice. 

If you think about anything that you care about and want to see thrive, you realize that you make sure that you create the proper environment to give it the best possible chance.  If you are expecting a new baby, you get the room ready, buy baby clothes and toys and read up on all the best parenting information.  You want your baby to have the best possible start in life.

Try to think about your employees in the same way, whether they're brand new to the practice, or they've been with you a while.  Think of it and explain it this way:  You want to go in a new direction, so everyone's starting at the beginning with this vision for your practice.  There will be some stumbles, maybe some tears, maybe some laughter, but you'll all learn to ride this new bike.  

Some staff members may offer resistance, but with patience and time proven results, they'll learn that doing things in a new way doesn't have to be painful or stressful, and it can be so much better.  Some might not make it if they refuse to let go of what no longer works.  That will become so apparent to everyone that it will be almost a natural falling away.  

As time goes by and the value of working in this new way becomes clear, those that work with the changes will begin to take ownership of the new culture they've helped to create. They will become less dependent and accept more responsibility and continue to grow in confidence and loyalty.  They will uphold the standards and practices with new staff members because they want to protect what they helped grow.  As new staff members enter the team, they too will soon value and appreciate the healthy and positive atmosphere you've created.  

What began as something that you had to grow and tend with little help, will become a thriving co-op that benefits everyone involved.  As you consider the vision you started with and look at what you've grown, you'll experience the satisfaction that comes from working with determination and belief in yourself and those who you've asked to work with you.

Unity

"What we must decide is perhaps how we are valuable rather than how valuable we are."   ~Edgar Z. Friedenberg~

The days of an employee in a dental practice being more valuable than another, just because they have certain credentials are coming to an end.  In this new, challenging economy, it becomes ever more clear that how and what we contribute is just as important, maybe even more important, than the credentials we insert after our name.  Every person in every position has worth and the way they perform, the way they interact and treat others determines their value to the practice.

The fact that I can use CDA/CDPMA after my name doesn't mean that I'm better than someone who doesn't have the letters.  It doesn't make me work harder, behave better, or think smarter than someone who doesn't have it.  It only means that I went through a course and then  took and passed a test.  The real test is in what I do with what I know.  If I use it to help my co-workers, serve my patients and boost our practice, I'm doing something good.  It's the same with the DDS and the RDH.  They are letters that stand for the education required to earn the right to use them.  They represent long hours, dedication and some amount of personal sacrifice.  The value they represent is in the potential to serve that they allow the bearer.  To be of value, the bearer must serve and create unity between those they work with.

When a person stands on their credentials and believe that it somehow makes them more valuable than others, they are at cross-purposes with the thing they desire; to feel important.  When they take their accomplishment as see it as a means to increase the level of the work they do with others, there is true value and importance in that.  Sharing knowledge and teaching skills never diminishes what we already have, no one can take that from you.  Rather, it increases your own value and that of the person you share with.  Knowledge shared is knowledge squared.  When you share and increase the value of another to the practice and the patients, you create unity.  It is the best use of your knowledge and skill and by using those in that way, you have found the way to be of value.

Total Medical Compliance Rocks

 You know me, when I like something I let you know.  Our staff and I just spent the day in training and it flew by.  Never thought I'd say that about OSHA and HIPPA training.  Casey Morris from Total Medical Compliance (TMC)did a fantastic job making what can be a boring subject, interesting.  She worked with our staff to make sure everyone understood, in everyday terms, everything we need to know to keep our staff, patients and practice safe. 

People tend to groan when they think about OSHA, but to be realistic, it's good to be safe.  We owe it to our staff to keep them healthy and injury-free.  Staff owes it to the practice to practice good work safety habits.  That is much more likely to happen with education and enforcement.  Our patients need to know that we are doing everything we can to safeguard their personal and medical information.  Again, education and enforcement makes it much more likely that it will happen.

What was so great about Casey in particular?  She's down to earth and doesn't come off as if she's here to shove your shortcomings in your face.  She's not a know it all, but she truly seems to know everything.  We've had in office training before and felt like we'd been told off by the time the person left.  Not with Casey, she was professional, yet personable and she welcomed questions and scenarios.  That helped our staff feel that they could understand how to apply what they learned in a normal working day. 

If you need training, I'd check them out.  We are now the happy owners of both a very concise and easily usable HIPPA and OSHA handbook.  There were things that came up that I never thought we needed, but that will make responding in emergencies and unusual situations easier and less stressful. Who ever thought anyone could make these subjects something to write a blog about? 

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.

Good Intentions - Who Paved the Road to Hell?

"No matter how full a reservoir of maxims one may possess, and no matter how good one's sentiments may be, if one has not taken advantage of every concrete opportunity to act, one's character may retain entirely unaffected for the better. With mere good intentions, hell is proverbially paved."

                                                        ~William James~

I was talking to a friend the other day who is an office manager in another practice in town.  When I asked her how things were going, she was clearly frustrated.  Everything is running smoothly in the practice, the staff is nice, the patients are satisfied, everyone gets along, and she's about to go crazy.  Well, of course my next questions was, "Why?", but I thought I knew the answer.  It's all a balancing act, and it's a tower of stuff that feels like it's perched on a tea cup on top of her head.  If she lets her shoulders relax for a minute it will all come tumbling down. ( I knew the answer because we office managers tend to take on all the responsibility in our practice.  It happens gradually because we may have tried to delegate something and it didn't work out so we decide it's easier to do it ourself.  The problem is that if it grows out of control, we soon find that we think we're the only ones that will do anything right and we build our own tower of stuff.)

She likes her staff and thinks they're all great people, but they don't think for themselves.  She is constantly running interference and jumping in to rescue everyone.  They don't accept accountability for anything out of the norm.  If something comes up that is unusual in any way, they immediately run to her rather than trying to come up with a good response.  On the other hand, when they have made decisions on their own, they haven't always been so great.  She always ends up having to step in and rescue the situation.  The doctor sees that everyone seems happy and they all get along, production is good, and that makes him feel satisfied with the way things are.  He doesn't seem to understand why she's so stressed.  At this point, not only can I see her stress, I can feel it, it's palpable.  She said that when she tried to explain her frustration to him his reply was, "I think that they are all coming from a place of good intention."  He doesn't understand why, with everything that's going well, she feels so on edge.

I do understand what she's worried about.  Sooner or later, she's going to need to let her shoulders relax and all the stuff will come tumbling down.  The problem is with the foundation, it's like an inverted pyramid, there's too much empty space on either side of the tip for it to be stable.  Starting out with good intentions is fine, but good intentions have to be fortified by determination.  That would build a solid base.  Think about a hygienist who sells her patients lot's of high fluoride toothpaste, but forgets to charge for it over and over again.  When she comes to you about it she says, "I always forget to charge for the toothpaste, I wish I could remember."  Well, her intention is good, she wants her patients to have less decay, and she would like to remember to charge, but those good intentions are not solving the problem.  The problem is she is giving away toothpaste and costing the practice money.  Her intention is not solving the problem because she has not taken every opportunity available to act differently.  She could make herself a little reminder note that she'd see before she lets the patient go, "Did you remember to charge for toothpaste?"  Or she could make a rule for herself that she cannot let go of the box until she enters the fee into the ledger.  It's not hard, it just takes determination.  It's the same with any other performance issue in the practice, if the staff member is determined to improve, she will find a way.  If she hopes to survive on good intentions, sooner or later it won't be enough.

Now, let's get back to my friend.  How much of her problem is of her own making?  Her good intention is to make the practice and team successful, I know that about her.  You can even say she's determined to make it happen, even if she has to do it herself.  Aha, maybe that's where her good intention has led her down the nicely paved path to hell?  Maybe her intention needs a few building blocks along the way.  If we return to the idea of a pyramid, a proper pyramid sits on a broad base that eventually reaches it's pinnacle.  Maybe she needs to build her base a little more by holding her team accountable for what they do and helping them find ways to improve.  She was slightly annoyed by that suggestion, after all, she is constantly trying to get them to do things the way she wants them done.  Well, what if we try to bring them into the process of solution rather then just prescribing the reactions and actions we want to see?  Maybe that's the reason they can't think for themselves, they've become accustomed to her having all the right answers.  If she asks them what they think when it comes to finding solutions, they may feel more accountable, rather than just feeling that they are carrying out orders. 

This is the way I see it.  There are positives and negatives that come along with every staff member.  If the negatives are outweighing the positives, and you've addressed it and nothing changes, the staff member won't work out.  If you have a staff that are nice, treat your patients well, are caring and get along with each other, you're way ahead of the game already.  That's the foundation you build on, that's your concrete.  Now you decide if you are going to put in the determination to take that cement and build up to a pinnacle of success, or if you are going to let good intentions build a long and winding road straight to...well, you know where that's going to end up by now, don't you?

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.

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.

Sheep Herding?

I'm noticing a disturbing trend in people lately.  They don't seem to think for themselves anymore.  Being in a leadership position makes me feel a strong responsibility to empower the people I manage.  I have found that many people seem to be apathetic about assuming responsibility.  It's like throwing a beach ball to a person who refuses to lift their arms and catch it.  It just bounces off their chest and dribbles to a stop.  It's disappointing to try to give an employee an opportunity for autonomy in an area of responsibility and watch them ignore that empowerment.

It's not just added responsibility that people don't seem to want to accept, it's personal responsibility in very small things, as well, and that might be the most worrisome.  A friend, let's call her Diane, told me she hired a new office assistant who seemed very excited to get the job.  On the second day, she came to work 5 minutes late and proceeded to spend the next ten minutes in the bathroom fixing her hair.  Meanwhile, Diane had been waiting to show her how to open the operatories in the morning since that would be her responsibility.  Since staff meeting in their office starts at 7:45 the employees have 15 minutes to do this.  The new employee had used all the time by being late and doing her hair.  Diane opened the ops herself and then went to the new employee who had finally emerged from the bathroom.  She said, "You need to be here at 7:30 ready to begin work.  I was waiting to teach you how to open the ops, and had to finally do it myself."  The reply?  "You need to tell me that."  Diane couldn't believe her ears since she had verbally told her that at hiring and given her an office manual that also stated the start time. She said she felt her great hope that she'd finally found an employee who would have some self-motivation, crashing and burning.

I told her that if she plans to keep this employee she will have to herd her.  She will need to make very specific training sheets and follow them to the letter.  She will have to hold her accountable for everything and keep insisting on getting it right.  In other words, she will have to be strict and she may need to be stern, and she will not be able to worry about whether this employee thinks she's nice.  She will need to give instant feedback as well as weekly reviews.  She will have to be relentless and it will be exhausting and stressful but in the end, she may develop this person into a good assistant. 

Sometimes with more seasoned staff, you need to herd, as well.  I have noticed that people become complacent if you let them.  After a certain amount of time, many people feel like they've reached the stage of "good enough" and they're satisfied with that.  Now, if you feel the same way about your practice, then you can all go along being good enough for as long as you can stand it.  The problem is, good enough becomes monotonous for you and your patients. Before long, good enough isn't cutting it anymore, and the practice down the street who is dedicated to continual growth is welcoming the patients that used to think you were "good enough."  People talk, and when they find something great, they tell their friends and it's intriguing.  They think, "Why not see what this new practice is all about?  After all, my dentist and his staff don't seem to care anymore." 

Now you're stuck with herding these employees who thought everything was good enough into action.  It's not going to be easy.  I remember hiking with my family when my son was about 5.  He stepped into some mud and it sucked the shoe right off his foot.  Pulling that shoe out of the mud took some strength and determination.  It's going to take the same to pull those employees out of their complacency.  Better never to let it happen at all. 

You can be righteous or you can be realistic.  You can say, "They're adults, they shouldn't have to be told everything", or you can realize you're going to have to ride herd over them to get them where you want them to be.  If you've ever watched a herding competition, you've seen that the herding dog never takes his eyes off the sheep, and he never lets up.  He gets that sheep where she needs to be.  That's his job.  He doesn't complain, he doesn't give up, he doesn't feel sorry for himself. He doesn't resent the sheep, either. Without her, he'd just be a dog with nothing to do. He keeps on going till he gets the result he wants.

Now, lucky for us, human beings have a lot more going for them than sheep.  Yes, you may need to ride herd diligently for a while, but at some point you will see that your employees will start to do things without your constant guidance.  That doesn't mean you can forget the herding though, you just don't have to be constantly herding.  You will need to nudge from time to time, and now and then you'll get a good herding workout, but in the end, you'll be the practice that is accepting patients from the good enough practice down the street.

People Are Strange?

    Is it just me or are people stranger than they used to be?  I have never had more bizarre experiences hiring people than I have in the last few years.  I hear that since the economy is so bad, we should have a great pool of people to choose from when hiring.  Where are they? 

    From what I've seen, most people are expecting us to impress them, rather than trying to knock our socks off.  Hiring is a nightmare anymore.  Everyone knows what an employer is looking for, and they can wow you at the interview.  Ok, so knowing that, we are going to call references, have multiple interviews, ask open-ended questions, and do everything we can think of to weed out any insincere candidates.  They can still get through, though.

    I recently interviewed someone in her 40's who never took her coat off, kept her sunglasses on top of her head through the interview, and texted on her cell phone every second we left her alone.  She made it easy to decide not to hire her, but somehow, she thinks we made a big mistake.  She has emailed me every week to ask when I'm going to hire her.  Glad to miss that bullet.

    The way people answer their phone speaks volumes. Some barely grunt, others sound like they hate whoever has the nerve to bother them.  Then there's the waiting music that makes you so happy that you called and dodged yet another bullet. 

    People don't appreciate opportunity anymore, they don't even recognize it when they are getting one.  I've seen young women with no training come in, throw out attitude, text, disappear into the breakroom, leave messes behind and show up late and leave early.  If you dare to voice displeasure, you're the unreasonable one in their eyes. 

    When someone who really stands out comes along, I feel irrationally lucky.  I just found a person who really wants to be part of a great team, who realizes she's getting a wonderful opportunity, and who is not strange, thank goodness.  I've had all the strange I can stand for a while and our team needs stability.  Whenever we lose a staff member I feel a sense of dread because I know how difficult it will be to find someone of the caliber we want. It's pretty easy, be real.  Don't play games, don't manipulate, you will be found out and it won't last.  The best thing anyone can do when starting a new job is work hard, have a good attitude, and appreciate the opportunities you get.  That's so rare these days that you will be worth gold.  Not so strange, is it?

Where Are All The Normal People Hiding?

If you've ever interviewed for an opening in your practice, I'm sure this thought has entered your mind.  I am currently interviewing for a roving office assistant and I am disheartened by the attitudes of the applicants I've been interviewing. 

To begin with, I can remember interviewing for positions when I wanted a job.  I tried to present my skills, abilities and willingness to be an integral part of a team.  I never asked what the position benefits were until we were clearly negotiating my employment.  Once I was hired, I understood that if I wanted my salary to increase, my skills and value to the practice would have to increase first.  I didn't expect to be paid more for being nice, or funny, or for just existing.  I knew that I'd have to take on more responsibility, find ways to improve what we were doing, and be an overall asset in terms of my physical, personal and psychological presence in the practice.

Let's break it down.  When I say my physical presence, I mean I have to work.  If a patient cancels and I'm an assistant, I have to find other things to do, even if it's just wiping down shelves or straightening the supply closet.  I have to offer my help to others in the office.  It doesn't mean sitting in the break-room with a cup of coffee and the newspaper.  The dentist is already losing money because of the cancellation, I'm not going to rub in the fact that he's paying me to read Ann Landers.  This holds true for any position in the office. 

When I talk about personal presence, I'm referring to the mood you create around you.  I try to be upbeat and optimistic, try to help my co-workers and look for ways to help them stay on time and relieve stress for them.  I don't wait to be asked, I don't act like a request is an imposition and I don't feel like they owe me something if I help them.  It's all work, it all needs to be done, and I'm getting paid to work; seems like a no-brainer.  Everyone knows they can come to me for help and I like that. 

Finally, having a healthy psychological presence in the practice is so important.  We've all worked with people who bring their baggage to work with them.  They seem to define themselves by their quirks and expect others to find it endearing.  It's not, it's usually annoying.  They seem to think that it's their God-given, legally protected right to be weird, and if we are unlucky enough not to catch it in the interview, we're stuck with them. If we really can't take it and we let them go, we're going to end up paying unemployment while they sit home watching The Price Is Right.  They may even manage to seem fantastic during the interview process, only to unleash their poor work ethic, entitlement attitude and generally unacceptable personality flaws soon after beginning to work. All of which would have been huge red warning flags slapping you in the head if they hadn't so carefully hidden them while they were sitting in your office convincing you that if you just gave them the chance they'd be a dynamic part of your hard-working team.

What I am finding, despite the poor economy, are people who want to spend the interview time telling me what I'll need to do to make them feel cherished and happy.  They are applying for an entry level position, but want to tell me what responsibilities they will assume, rather than show a willingness to progress by learning what we want to teach them in the time-line we have developed.  I'm sitting there listening to what they apparently consider the thoughts of a genius, and thinking, "Where are all the normal people hiding?"  Sometimes I even wonder if my boss has set up a hidden camera somewhere in my office, but I think Candid Camera has gone off the air.  I have developed an interview system that usually saves us from making hiring mistakes, but it's arduous and time consuming. 

I've heard that this is a great time to be hiring because there are a lot of talented people available due to cut-backs and lay-offs.  What I'm really seeing are people who are willing to take a job outside their area of interest until something they really want becomes available.  During the interview, if you ask them why they want to work in a dental office after attending nursing school, they'll tell you that they realized they don't like working in a hospital, but really love the dental environment.  Two months later, they may tearfully hand you their resignation when a nursing job is offered.  I understand that people need to do what is best for them, but it's made me harder to convince when the next person comes along.

I want to interview someone who will show an interest in becoming a hard-working member of a fantastic team.  I want someone who will not damage the culture of our practice with bizarre behavior and unreasonable attitudes.  In other words, someone with a great work ethic, a desire to serve our patients, and a pleasant and caring personality.  Anyone like that out there?  If so, click on comment, I'd like to interview you.

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?

Oh, Trust Me

Really listening and suspending one's own judgment is necessary in order to understand other people on their own terms... This is a process that requires trust and builds trust.                    ~Mary Field Belenky~

    How many times have you been in a relationship in which you felt like you'd developed a firm feeling of trust in the other person, only to find yourself feeling betrayed by them?  So many relationships in life seem to be based on a high degree of trust.  Your relationship with your spouse, your parents, your children, your friends, your co-workers, your boss...the list goes on and on.  You feel so sure you know the other person and that they understand what's important to you. 

    The problem is, a lot of what builds trust for you may seem perfectly reasonable and obvious, but the other person may not have a clue of how strongly you feel about it.  A lot of times when we are doing something, we just aren't clearly thinking about how someone else may be affected by it or feel about it.  We are full of expectations and beliefs that are as different from person to person as one snowflake from another.  What seems crucial to you, might seem inconsequential to the next person.  Can we really say which person is more right or rational?

    Trouble begins when we react immediately to what we perceive to be a callous disregard of our feelings, when it may really truly be a lack of awareness of the magnitude of importance a matter has for you.  More time is wasted, and problems instigated, by a rush to judgment, rather than a desire to understand.  When we immediately react with anger or hurt feelings we wipe out an opportunity to gain greater understanding, or to resolve a difference of style.  Rather we can rapidly escalate what may be a poor decision into an evil act of betrayal or careless inconsideration.

    What's the solution?  Wait a minute.  Really, 60 seconds can give you the chance to slow your heart rate and allow a few generous thoughts to germinate.  Wait 60 seconds more and those thoughts may take root and allow you to approach the situation from a more positive place.  You usually get what you're looking for in a conflict.  If you want to have a fight, you'll probably find one.  If you want peace, you will approach the other person amiably and usually find a peaceful solution.  You can let someone know where you're coming from, allow them to understand why would have liked to see a situation handled differently, without making them wrong or bad.  When you do that, it's likely that when that situation arises again, the other person will go out of their way to make it turn out right. 

    When you listen, rather than accuse you also save yourself from making yourself look silly.  How many times have you been absolutely certain someone deliberately disregarded your feelings, only to find out they really meant no harm at all.  If you had just asked, really wanting to hear what they were thinking, you could have saved both of you so much stress and hurt feelings.  Someone has to trust first, and by trusting, they increase trust for everyone involved.  When trust is consistently developed in a dental team, the culture of the practice becomes peaceful, supportive and caring.  Each aspect grows from the initial trust and the benefit is felt by the team and the patients.  How much trust do you have in your practice?  Can you begin to increase the level of trust between the members of your team?  What would you do to make that happen?

                                   

Successful Interviewing

  

  We've finally got our interview technique perfected, or at least we're getting really good at it.  We used to interview in a kind of rush.  Usually we'd be in a hurry because we were responding to a sudden need due to a poor decision made during a previous messy interview.  I used to feel like as long as the person had a good personality and seemed to have a good character, we could train the rest.  It's a popular thought right now.  It's wrong in some ways.
    Many times job candidates put their best foot forward in an interview and we are so happy to see how nice they look and how pleasant they are and we believe it on the spot.  We have to test them for depth.  Can the initial impression hold up when tested?
    As you know by now, I am blown away by the service at 131 Main, and the manager was nice enough to spend some time talking to me about how they develop such great staff.  The key is the interview process and the lock is the training process. 
    I took Jon's advice and used when I was interviewing for a new front desk assistant.  Recently I had two candidates for the position.  The first one was recommended to me by a dentist's wife.  She had been her husband's primary da for 15 years.  Something had happened that had caused her to leave and the wife still thought she was wonderful.  The other candidate was a woman who hand-delivered her resume.  She had no dental experience, but as I glanced at her resume I saw a strong letter of reference, so I decided I'd interview her.
    When the person arrives at the office I hand them a pad of paper and ask them to write 3 paragraphs; one telling me about themself, one telling me why they want to work in a dental office and one telling me what they'll bring to our practice if I hire them. 
    The person with experience laughed at me when I gave it to her.  Not a good start.  I started to imagine working with her and realized she was going to have to do something great to wipe away the initial cynicism.  The other person sat right down and started writing.  Once that task is finished I interview the person to try to understand their work ethic, attitude toward patients and other staff, and personality type.  The person with experience had no chance after a few sentences.  I predict she will have a very difficult time adjusting to any office she is hired in.  The other person, however, was starting to seem like a diamond in the rough.  She'd need some polishing, but she was going to shine.
    I brought her back for a second interview.  This interview is with my boss and myself.  It is a more in-depth interview and we ask a lot of questions.  The purpose is to see how the person handles themselves under pressure, to see if they are consistent, and to draw out information about past work experiences and expectations in this position.  Cathy, our new employee, handled all the questions with sincerity that you could sense was real and showed a calmness and warmth that we were looking for. 
    The third step in the process is a working interview.  This gives us a chance to see how the staff and some of the patients respond to her, and how quickly she learns basic tasks.  At the end of the day, we hired her, based not on emotion, but on information that we gathered throughout these three interviews. 
    We had to put our own work, time and effort into the hiring process to get what we wanted.  I will never hire on the spot because someone feels like they'd be great again.  Subjective impressions are just feelings.  To succeed in hiring, you needs the facts.

The Most Important Job, Oh Really?

   

I didn't forget about this topic, I just haven't been feeling well, so please excuse my absence.  So, did all of you assistants and hygienists think, "Hmmph, how can she think the front desk assistant has the most important job?  At least she gets to sit in one place and answer phones all day.  It's almost a glamour position."  Well, we won't go there because we can all acknowledge that there's a lot more to it than that.  But, you're right, what about the clinical team?
    Think about it.  The assistants and hygienists have to put on a happy face all day no matter how they are actually feeling.  I will tell you this, the hygienists in our practice are a case study in grace.  They each have personal challenges that they have been dealing with for an extended period.  Both come to work everyday and behave in a professional manner.  Not only that, they are both warm and caring to their patients and considerate and helpful to other staff.  They leave their troubles at the door and focus on what they are doing.  Absolutely inspirational.  To me, that makes them irreplaceable.  Oh sure, if one of them left I could find someone else to take the position.  But, I'd be hard pressed to find someone to be who they are to our practice and our patients.  So, doesn't that mean that they have the most important job?  Nope.
    Now, since I'm the only assistant in our practice right now, I won't use myself as the example of the da.  Any hard working da can make the case for being extremely valuable and maybe even most important.  They work side by side with the dentist all day.  They learn his way of working and his preferences, and a good one can read his mind in the operatory.  They figure out ways to make the impossible schedule, possible.  She works hard and just keeps going until every patient is seen.  She can explain treatment, calm fears and present treatment plans.  She works with the other staff to see that everyone is getting what they need.  She's the smiling face and has the encouraging word to help the dentist keep going through the crazy days when it seems that every patient in the practice has a broken, abcessed central incisor that must be taken care of immediately because their daughter is getting married in the morning.  She is sanity and he needs her there to keep him from going crazy.  But, she's not the most important one either.  Hmmm. 

The Most Important Job

The most important job in the dental office is the front desk, of course.  She is the face of the practice.  Everyone gets their first impression from the way she answers the phone and greets them when they arrive. 
She is the general giving everyone their marching orders.  The order of the day is determined by her scheduling.  It will also set the tone for the staff.  They will be running around like lunatics, working productively at a comfortable pace, or sitting around staring at a schedule full of holes.  It's all up to how she does her job.
Your hygienists depend on her to keep their schedule full.  If she allows a lot of cancellations to go unscheduled the hygienist will be in the uncomfortable position of sitting there with nothing to do. 
The dentist relies on her to make every day satisfying with a mix of procedures that will guarantee steady production.  Nothing worse than running like crazy through a day filled with crown cements and denture adjustments and looking at an anemic deposit in the evening.
The patients count on her to get them in when they have a problem.  They want her to remember them by name and even remember a little bit about their last vacation, their kids, their hobbies and what sports they play and what kind of dog they have.  They want her to make their insurance pay and to understand when they come for their crown prep unprepared to pay.
So, it stands to reason that she has the most important job in the practice...but, wait a minute.  Look down the hall, there's those hard-working hygienists and assistants.  The dentist just poked his head out of his office, he's kinda important, too.  Stay tuned, we'll talk about them tomorrow.  Who do you think is most important?

Culture Of Trust

    

If you've ever dealt with a competitive or pushy staff member, this post is for you.  People like this frustrate everyone else and can quickly damage the culture of a practice.  The first thing to do is to try to understand them.  What is driving their behavior?  Are they trying to prove themselves, are they insecure, are they control freaks who only feel comfortable when they are guiding the action, do they need to be the center of attention, be the best, do they have very little consideration for the desires and sensibilities of others, and most of all, can they change? 
    An aggressive staff member will drive healthily assertive staff members nuts and will intimidate less assertive staff members. They are generally showboats who are constantly showing the boss and patients how wonderful they are.  What the boss and patients aren't seeing is the fact that they are pushing everyone else to the side to show just how great they are.  They become a distraction and a source of constant irritation for everyone. 
    A major effect of people like this is that they discourage and anger good staff and eventually cause them to become disengaged if they see that no one is going to stop the aggressive person.  The longer you wait to react, the harder it will be.  These people are masters of deception and spin and can make it very difficult to stop them.  They will defend every offensive action as an attempt to help.  They will tell you they just want to help the "team" when what they are doing is damaging team morale.  The best way to deal with a pushy team member is to push back immediately and firmly.  Let them know that it's not ok.  Then help them find ways to redirect their efforts so that they can integrate better with the flow of the team.
I read an essay that quoted the following excerpt from an article.  I think it could be a good thing to incorporate into daily practice life.

We live in a competitive culture. Most of the time it takes the form of harmless fun—we enjoy sporting events, board games, and other contests that pit one against another. But when a competitive spirit invades our daily lives and our relationships with others, it can lead to feelings of jealousy, resentment, and self-doubt.

Those who have found true peace have learned to step off the merry-go-round of competition. It’s not easy—quick fixes seldom work. But there are a few things we can do, a few truths we can remember, that can make a difference in our life and in our heart.

Not long ago, a learned professor needed to have some plumbing work done in his home. He was amazed at how much the plumber knew about pipes—and how little he, with all his academic training, knew about the subject. No one knows everything about every topic; it’s not possible—or even necessary, if we’re willing to work with instead of against each other. We each have areas of strength and expertise. Search for yours, and then build on them.

Be committed to lifelong learning. Instead of competing with others, learn from them, appreciate them. You can always expand your knowledge, develop a skill, and share a talent. This can open your heart to others and create a sense of humility, as you learn that everyone you meet can teach you something you didn’t know.

When we’re tempted to compare ourselves to others, it helps to remember that we never know the whole story of anyone’s life. All we can do is love, be patient, and be kind. We’re all in this together, and we need each other.

In sports, there can be only one winner, and in order for one to win, everyone else has to lose. But life doesn’t have to be that way. Truly, we can all win when we open our hearts in abundance to others.

Finding the way to bring this non-competitive spirit into your practice will take patience and work.  I think it is worth it to work in a practice culture of unity and peace.  When all see that the greatest impact is ofter made in a spirit of cooperation, collaboration and trust, that's when you have the right culture in your practice.

Office Managers Need Love, Too

   

Office managers often have it tougher than you think they do.  I can only speak for myself, but I 'd like to spend most of my time thinking about ways to improve service to our patients.  The rest of the time I'd like to be paying attention to how everything is functioning.  That includes paying attention to staff matters.  When a staff member or members cause me to spend most of my time focusing on them, that's when problems seem to arise.  The reason for that is; as adults I would like to be able to count on them to reinforce my efforts toward patient care and practice success, not to divert my attention to petty issues or insubordination. 
    Doctors, if you have a good office manager, you might not realize just how much she is dealing with.  She needs your support.  I consider myself very lucky because my boss supports me completely.  Let's start there, because it's a two-way street.  Managers, you have to prove yourself worthy of that kind of trust.  You have to think and act in ways that make you step outside of the box and really see what is going on with everyone.  Then you must respond in a way that offers a win-win solution.  Doctor, when you see that happening you must also realize that there are so many intricate little dramas at work beyond what you actually see, that your manager is dealing with, dissecting and evaluating.  It is mentally exhausting at times.  If you have a good manager, I guarantee that many times when you think she is being too quiet, or even moody, she is actually in her own head trying out solutions to whatever problem she is currently solving.  Give her time, understanding and support her and she will repay you with even more dedication and loyalty.
    Finally, managers often spend most of their time supporting and encouraging everyone else.  They promote the practice and the dentist and take on a lot of the awkward, difficult and unpleasant tasks.  They are often the bad cop and the one to deliver difficult messages.  Remember that every now and then, they need you to sit them down and list a few of the attributes that make them outstanding and make you thankful that they work for you.  For a really good manager, a few minutes of praise and thanks is all the fuel they need to get them through months of trials, tribulations, triumphs and successes.  It will inspire and encourage and you will find that a small investment of time and self on your part will be paid back many times over in effort and renewed energy.

...And Then What?

    In my last post I quoted Dr. Henry Cloud from his book, Integrity.
"Character = the ability to meet the demands of reality."
Let's talk about what we need to meet the demands of reality.  I've thought about our most recent group of new employees a lot in the last week.  The major lack was that they could not or would not pull anything out of themselves to give to the practice.  My real feeling is that the reason for that is that there was no depth of character.  Everything was superficial.  One of my main frustrations in hiring, especially in the last few years, has to do with the fact that the person who presents for the interview often seems to be an entirely different person than the one who shows up for the job.  It truly amazes me, even though I have come to accept it.  I finally realize it's a lack of depth on a few levels. 
    First of all, do they think I'm stupid?  Don't they realize that I get the fact that they obviously know and understand what traits and responses are desirable in an employee.  That's why they interview so well.  Now, don't they realize that when they show me that they understand what I desire, I'm going to expect that when they are an employee?  So, that tells me that they lack a certain depth in thinking things through.  One thing I tell new dental assistants to think is "...and then what?"  Whenever you're assisting, don't just sit there and watch and wait for the dentist to tell you what he needs, always think for yourself and anticipate what he'll need.  When people interview well and get hired they should also think, "...and then what?"  If they would only do that maybe they'd think, "The first step was getting the job, the next step is learning the job."  ...And then what?  "The next step is working hard."  "Seeing what needs to be done and doing it."  "Retaining what I've been taught and putting it to use."  "Becoming proficient and efficient in my job."  "Becoming a valued member of this team."  Developing an ownership mentality."  "Becoming indispensable."  ...and then what?  "Receiving recognition and praise."  "Job security."  "Being trusted with more and varied responsibilities."   "Developing influence."  "Being rewarded." 
    The problem is that often, new employees don't want to do their ...and then what?, but they expect the employer and manager to give them the ...and then what? that would have followed great performance.  That's when things get messy and the drama starts.  When the employee fulfills their ...and then what, and the employer answers with their corresponding ...and then this, there won't be any drama.  There will be a happy team working together productively.
    Do we as managers and employers have a right to expect to see results before we reward?  You bet we do.  Do we have a responsibility to try to understand our employees psyches and challenges?  Only to the point that the understanding helps us encourage the employee, and allows us to understand how to help the employee develop the skills and thought processes that will help them succeed in the job.  The danger in getting too deep into all that is that it can distract us from the real reason the employee is there.  If we change our expectations (..and then whats?) because of an employees insecurities or weaknesses, we may take away challenges, and therefore, growth opportunities for the employee.  Growth is the ...and then what?, that follows challenge.  We create weak employees and weak teams when we stop developing our employees and expecting them to meet new challenges.   ...And then what? 

The Lack

   

As you've surely surmised by now, we've been having a bit of trouble identifying good team members to fill some positions in our office.  Given the state of the economy, you'd think people would be camping out on the steps.  You'd think they'd be happy to have a job once they were hired.  Stop thinking, you'll just hurt your brain, today's workforce doesn't think the way we think they do. 
    A reader, who happens to be a dentist commented on my Bad Company post yesterday.  I had said that if a staff member has a bad attitude, it won't work out.  She says she has a staff member who has a good attitude, but this person is needy and constantly breaking and losing things.  She finds herself avoiding this staff member for the last 7 months.  That makes her staff member bad company.  Any consistent, persistent, negative feeling about a staff member makes them bad company for you.  I'm not saying you shouldn't try to talk to them, you should.  The mistake we make is that we talk to them, and when nothing changes we blame ourselves.  We take the responsibility for the problem and wonder how we should have stated the issue in a way that they could understand.  We keep re-approaching the same problem in different ways and getting the same response from the employee.  That's the definition of insanity, and while we're all going insane, the rest of the staff and our patients are waiting, watching and feeling the strain.
    One thing that drives me almost to despair is the fact that the person I interviewed and hired, rarely shows up for the job.  Oh, they are actually the same person, but the good employee disguise is off.  The thing that is really disturbing about this is the deceptive factor involved.  The applicant obviously knows what employers are looking for because that is what they present themselves to be at the interview.  One thing I've learned: don't, as the interviewer, state what kind of employee you are looking for, ask them for examples of past performance that they feel will make them the kind of employee you want.  I tend to talk about teamwork, and of course they say they want to be part of a strong team.  I talk about character and of course, they become junior philosophers because in the course of talking to them about character, I've given them insight into what I want.  It's a shame it has to be so psychological, but that's what I'm finding.  There's even a dentist I've heard of that pays a clinical psychologist to do personality tests on himself and his team and then he does one on new prospects and decides if they will be a good fit.  It's that important, because, as I can attest to, a bad fit is misery.
    We keep hearing, hire for character, not skills; you can train skills, but you can't train character.  How about the total package?  Can't we hire that?  Is it too much to expect that someone will be trained and adept and also possess a good set of character traits?  Are we too worried about what our patients will think, so we keep bad company around too long,  just so they won't think it's us?  I face that head on and write about our trials and tribulations in our newsletter.  I let our patients know that we are willing to go through it all to identify the best people to take care of our patients.  Most are very understanding and say that as long as our core team is there, they feel fine about it.
    So, where's the lack?  The lack is character.  The lack is having the right attitude, skills and character in the same person.  The lack is integrity which allows a person to have good skills and maintain a good attitude about having great skills so that they are not constantly wanting more or dropping subtle hints about better opportunities.  It's finding people who want to be part of a culture, not just a name on a paycheck. 
    In his book, Integrity, Dr. Henry Cloud has this to say about character ~"Character=the ability to meet the demands of reality.  The demands that reality brings are many and varied."  In my next post I'm going to begin to explore the variety of demands that reality places on our character.  Don't get me wrong, I'm sure I didn't handle everything perfectly with this situation either.  The difference is I wanted to and I tried to.  I was open to discussion and had the offer thrown back at me.  That is a major sign of a lack of integrity.  Integrity in a team means making it all work together despite differences.  It only works if everyone wants it to work.  One break in the chain, makes a broken team.  Stay tuned and keep sending in those comments. 

Bad Company

    Have you ever had house guests that seemed like they had come straight from hell?  I think we all have, and I think we can all relate to the feeling of absolute relief that accompanies their departure.  Not only do you experience the well-being of getting your house back, it makes you appreciate how great you've got it. 

    You've probably experienced the same feeling when you've hired the wrong person to work in your practice.  Just like we tolerate the bad house guest, we often tolerate the poor employee long past the time that we should have asked them to leave. 

    How can you tell you have some bad company in your practice?  If you find yourself avoiding the person or if you just feel uncomfortable in your own practice, you've got bad company.  Invite them to leave.  It won't get better.  It's one thing to observe behaviors or misconceptions that need to be changed.  Often you can talk about that and make it work.  Bad attitudes only change when it hurts too much to continue in the same way.  If you have an employee with a bad attitude, I'm sorry to tell you, you're probably one of the lessons they have to learn from.  Look at it this way, by letting them go, you are the first step in helping them learn how to get along in the workplace.

    Does that sound harsh?  I'm sure it might.  I'm a person who likes to work things out, but you have to protect the culture of your practice.  It takes a lot of work and commitment to achieve a great practice culture.  As leaders, we owe it to our teams and our patients to do what we can to keep our culture healthy. 

    Just like it feels absolutely freeing to wave goodbye to bad company as they drive away from your home, you will realize the same feeling as you watch the door close behind bad company in your practice. If you find yourself walking down the halls with your shoulders hunched hoping you won't have to interact with someone on your staff, you know what to do.  Wave goodbye to your bad company.

Aha! They Might Love Work

    Do you have a staff member that seems blah?  Well, if she's just not going to be an enthusiastic team member, you'll have to let her go.  That's what the consultants and experts say, right?  Well, think again, she might be in the wrong position.  If you like her in general, but just don't get her attitude, talk to her.  We recently hired three new employees due to unexpected staff disintegration because of retirement and health issues.  I know the old adage hire slow, fire fast.  Well, I guess I reversed that this time around.  I didn't have time to hire slow because there's only so much of me to go around.  I can't do all the jobs in the office.  Here's how it went:
    I put an ad on Craigslist.  This is the only way I'll place an ad in the future.  I received about 30 replys.  Of those thirty I interviewed about ten people in person.  Of those ten I hired three. Of those three, I like them all, they all have great hearts and kind, caring personalities.  You've heard it before, those are the things you can't train.  None of them have dental experience, so they're blank slates. 

    Starting out I felt that one would be perfect for the assistant position, one would be great at the front desk and the third would do well as a cross-trained assistant, helping wherever she's needed. Well, you know what they say, "We plan, God laughs."  The person who I thought would be great at the front desk was deflating before my eyes.  My first thought was, "Oh boy, did I misjudge her, she's going to be a disappointment."  The only thing was, when she was away from the front desk, I saw the person I hired.  The cross-trained assistant was excellent whenever she helped at the front desk.  I wanted these three positions and I didn't want to fire the unhappy front desk assistant and start over.  I finally asked her if she'd like to try working in the back as the cross-trained assistant.  She jumped at the chance.

    Within one day I knew I'd found my solution.  By the end of the day she'd organized the lab.  All models that weren't needed soon were catalogued and put away.  I went over our lab storage system with her and she got everything placed where it needed to be.  She began trying to pour models and make matrices after watching me do it, and did very well.  She checked with the front desk assistant periodically to see if she needed help, and helped out when she did.  Best of all, she and the other assistant worked pleasantly and companionably together all day.  They made sure the patients were seated on time and made them comfortable.  I've decided to train both to share the cross-trained duties and chairside assisting equally. 

    We had been about to let this employee go.  She wasn't what we wanted in a front desk assistant.  I'm glad I thought outside the box and pictured her doing something else.  In the end, we all win.  Don't be too fast to let go of an employee that has good attributes, but who doesn't seem to fit her position.  See if you can plug her in another capacity.  Maybe someone else would like a change and could switch positions with her.  In our case, it worked.  We get to keep someone we like and avoid launching a search for a new employee.  She gets to keep a job.  In the end, she didn't like the work she started with, but it looks like she loves the work she's got now.

Have A Heart

I finally figured out how to define the elusive quality I'm looking for when hiring new staff members.  I want them to have a heart for the practice.  When I say practice, that encompasses the dentist, the patients, and the team.  For the first time, I've noticed that overwhelmingly, candidates are asking about pay, benefits and "what's in it for me", on the phone when I'm trying to set up an interview.  They are coming to the interview and telling me that they expect certain things and want a time line for pay increases.  One person actually told me that she so enjoyed working at her last practice that we'd have "a high bar to meet" if we wanted to make her happy to work with us.  Huh?  Did someone flip things around when I wasn't looking?  Isn't she supposed to try to meet our expectations?
   
    Now, I guess you could say that they have what we're looking for, skills, experience, the willingness to get out of bed in the morning and grace us with their presence.  Realistically, it's a two-way street, we have the position available and the paycheck that goes with it.  We could go back and forth for days over who has the upper hand, but if we did, I don't want you here.  Plain and simple.  I don't want someone in our practice who doesn't have a heart for the practice.  I don't want someone who is sitting there going through the motions until it is time to go.  I don't want someone who distracts herself from what she may consider boredom in her job,  by reading magazines that she shoves into a drawer when someone is coming.  I don't want someone who chats on the phone,  surfs the internet or texts her significant other and thinks she got away with something.  I don't want someone who is more concerned with her next pay increase than with what she can do to make the next patient who walks in the door feel special.

    What do I mean when I say I want someone who has a heart for the practice?  I want someone whose service comes from inside.  Someone who can do no less than her best because of how it makes her feel.  A person who sees a patient and thinks, "What can I do to make her time in our office even better?"  Someone whose face lights up with delight when I tell her how much I appreciate the effort she puts into the personal side of her service to our patients.  Someone who feels as lucky to be a part of our team and practice as we feel to have her.  I want people who don't think it's nerdy to care, or even if they do, don't care if they're nerdy.  I want people who inspire our patients to refer the people they care about because they want the best for them and believe that in our practice, that's what they get.  I want people who understand what our boss risks every day just by owning a dental practice and asking people to come there and work on our patients.  There's a huge amount of trust, reliance and hope involved in that.  I want people who do the best they can because they don't know any other way to be. I want people who say "Our practice", who pick up lint on the floor rather than step on it.   I want to see sincerity shine from their faces and compassion apparent in their words and deeds.  I want to work with those people.  People who have a heart for the practice.

 

Toughing It Out

    So, sometimes the going gets tough like it did for our practice last week.  There are times, when it just seems like everything you work so hard to build up can just evaporate.  The temptation is there to just toss in the towel.  It would be so much easier for the moment to just admit to being beaten.  But, then where would you be?
    People who care enough to develop great teams, do it because that's what they believe in and that's how they want to work.  We may be tempted to give up but, we won't. I was really surprised and dismayed when our hygienist gave her resignation last Thursday.  It felt like a disaster in the midst of everything else that was happening.  A week later she has changed her mind and asked to stay.  Part of me wondered how this could ever work but, then I remembered this quote:

Just because something doesn't do what you planned it to do doesn't mean it's useless"

                                                                                        ~Thomas Edison~

    That hygienist didn't do what I'd planned, but she's not useless.  We probably have to look at what didn't work for her, and also, what didn't work for us.  Sometimes the employee that's welcomed back can become you're most loyal team member. 

    In the meantime our new receptionist is proving to be a quick study, a hard worker and a great team member.  Next week we'll welcome a new assistant to our team.  We'll all work together to get her trained feeling good about her job.  We are all toughing it out in our own way.  Some have added to the stress, but in the end, they just gave others a chance to shine and show their loyalty to the practice. 

    Nothing worth having ever comes easy.  Even once you're there, you have to keep calibrating and tweaking to keep a good thing going.  You know things are going well when hard times come as a surprise.  Just keep looking up and you'll be back on top before you know it.

When The Going Gets Tough

    One thing I've been really proud of in our practice is the strength of our staff.  We've worked together very well, we supported and liked each other, and we worked hard to get it that way.  We went through a practice transition without a blip and things were going great; until the last month or so.  First our receptionist retired.  Then our dental assistant decided she doesn't like assisting after all.  Now our hygienist has decided she wants a change.  We're down to myself and the other hygienist as the only remaining original staff.  To say I'm disappointed and disheartened would be an understatement.  I put so much into staff development that this comes as a blow to me.
   But, now I realize as I write, that I'm full of it.  Here I am, feeling ready to throw in the towel and ignoring my own advice.  That is: You can't control what other people do, you can only control your own reaction and that will determine the outcome.  That didn't come back to me a moment too soon.  Throughout the day I found myself thinking I didn't have the energy to start over with a new group.  I felt that I'd let my boss down.  I wondered if he thought less of me.  I wondered if I was even fit to lead a team.
    So, let's put my own advice to the test. 1. Our receptionist retired and after a few false starts I've hired a new young lady to take her place and she started today. 2. The dental assistant decided she didn't like assisting.  I know that I tried my hardest to help her succeed, but no one can make someone enjoy a career if they don't. I've hired a very nice new person to teach dental assisting and I think she'll do very well. 3.The rdh wants a change.  Everyone has to do what's best for them.  All I can do is wish her well and search for a new hygienist. 4. I don't have the energy to start over.  I do, if I take it one step at a time.  I owe it to this group to lead them with enthusiasm and dedication.  Of course I can do that. 5. I thought that I'd let my boss down.  My boss sees what I do for the practice, our patients and our staff.  He understands that these events are out of our control. 6. I wondered if he thought less of me.  I asked him and he assured me that he doesn't.  I choose to believe him so I can move forward productively. 7. I wondered if I was fit to lead a team.  I've done it successfully for the last 5 years.  It's these difficult times that make us see what we're made of.  I'm hoping I'm made of some good stuff.
    I know this: nothing is guaranteed.  I also know this:  the higher you build something, the further it will fall when and if it does, and the crash will be more devastating and awesome than something average.  I hope this:  that the memory of something special that is lost will be dear enough to cause the desire for re-building.  That the trust and confidence my boss has placed in me will be the impetus for giving it my all in developing a new team.  That now that the going has gotten tough, I'll be tough enough to keep going.
    I've always said that a big part of why I write this blog is to help others learn from my mistakes, trials, success and triumphs.  It's not easy to write about my failures, but if someone who's going through the same thing reads this and feels less alone, I can deal with the discomfort.  A friend told me I'll look back on all this a year from now and recognize it as an opportunity.  I plan to prove her right.  Hey, if we always win we forget about the excitement of standing up after a sucker punch.  If Rocky can keep coming back for more, so can I.  I guess I'll go another round after all.

What Gets Rewarded, Gets Repeated

    I notice that there are a lot of conflicting feelings about staff bonuses and salaries.  Some people feel that bonuses motivate staff.  Some think that it just backfires and creates an entitlement mentality. 
    I have always been the kind of person who works hard and does the best job I can because it's the right thing to do.  It satisfies me.  I've also believed that a staff that has to have a bonus in front of them to accomplish good work, is a staff that being encouraged to focus on what's in it for them. It also deteriorates into everyone watching what the other person is doing.  Since a lot of people think they work harder than the next person, that can cause problems.  I do believe that everyone appreciates money and will continue to work harder when they are fairly compensated.  I also believe that if you choose a healthcare profession, you should find value in working for the benefit of the patient.  That should come before worrying if the goal is met or if Mary is pulling her weight to get us there.
    I also think that bonuses that don't recognize the differences between efforts can reinforce a weak team member in mediocrity and discourage a strong team member with the anonymity of not recognizing their extra effort. It just won't feel fair to the employee who gives more. It can become a well meaning snowball that ends up in an avalanche of demotivation, entitlement and resentment.
    I find that what gets rewarded, gets repeated.  If a hard working staff member looks at the less inclined co-worker next to her and feels that her efforts didn't matter, you may be lowering the bar with what you hoped would raise it.  If you can't differentiate between the amount of reward the two should receive, soon enough you may find you can't differentiate between the way they work anymore either.  I believe in rewarding individual and group effort, but show me the work before you ask me to show you the money.  If someone is not contributing, they should not share in the reward.  Maybe they shouldn't even be there.
    People who work hard count on those who benefit to recognize that and be fair to them.  So many times we hear employers bemoaning the fact that it's hard to find good employees.  Maybe a good work ethic can't be trained, but it can be beaten into submission by disregard and disillusionment.  Reward what you want repeated; good or bad, either way you'll get it.

Hurry, Hurry, Hurry!!!

"He felt that his whole life was some kind of dream and he sometimes wondered whose it was and whether they were enjoying it."          ~Douglas Adams~

     Time is money and no one feels like they have enough of either these days.  I recently corresponded with a hygienist who is worried because she can't seem to get her patients finished in under an hour.  She was wondering if it was ok to leave stain and plaque on the teeth if she got sub-gingival calculus off.  Where are we in our thinking if we have a dedicated hygienist thinking that she has to weigh the least offensive way to leave a prophy uncompleted in the effort to finish in under 60 minutes? 
     We've gotten to the point in some dental practices where we look at our staff members and patients as production numbers.  One hygienist times ten prophies a day, equals the hygienists worth to the practice?  Is it worth it to hire another assistant?  Will she make up for her salary in production?  Never mind that the sole assistant is working herself into early burn out and going home and collapsing on the couch with no energy left to live a normal life.  As a dentist, do you feel an urgency to beat your productions numbers from the year before every year and do you run yourself into the ground, or raise your fees to a point that patients are leaving, to do it?  What kind of life is that? Who's enjoying it? Remember, in the end, we all end.  It's what happens in the middle that counts.  It's your life, and you have the ability to make it enjoyable.

     That hygienist got me thinking about what her day must be like.  I thought about how her concern about fitting her work into a time period that doesn't fit her, may affect her interactions with her patients.  Speed doesn't always equal efficiency because it doesn't allow for the personal aspect.  I'd rather have a hygienist take a little longer because she is inspecting every surface and groove on every tooth rather than writing her grocery list in her head as she works.  In other words, I'd rather have a hygienist who works with intention and takes a little longer, than one who skims over every tooth with a hit or miss approach and then shrugs when the dentist pulls a hunk of chicken out of an interproximal and pointedly wipes it onto the patient napkin.  I want the hygienist with a mission, not the hygienist whose only mission is to get done and out on time.  I'll give the first hygienist more time because in the end she's going to educate our patients and be a partner in co-discovery with the dentist, bringing the patient into the process.  

     Hurrying makes an impact on the atmosphere of the office.  I'm not saying that you should act as if you and your patients have all day either.  Efficiency, according to Webster, means being productive of desired effects.  When you look at yourself and your staff, decide what the effect is that you desire from yourself and them.  Look at each individual and decide if they can do what you need them to do.  Then see what they need to be able to perform well and weigh that against the value you and your patients will receive from them having that.  If you have to expect a hygienist to see nine patients instead of ten, the production lost from that one appointment may be more than made up for in the quality of her work, the satisfaction of the patient from the experience, the treatment she may help the patient understand and want, and the word of mouth advertising that nine pleased patients a day will produce.  Production numbers can't always be written down on paper.  A smart person knows that there's more to it than ink on paper.  It's the feelings that are generated, the good will that's created and the satisfaction in doing a worthy thing well, without angst that let's you close the door quietly behind you at the end of the day.  It's having energy and spirit to enjoy the life that waits on the other side of that door that is the biggest benefit.

Stop Talking So You Can Learn

    One of my biggest frustrations is trying to give feedback and being met with defensiveness and excuses.  Of course, there's often a little blaming going on, too.  My frustration is that I have to wait through all that before I can even hope to get my message across.  It's human nature to enjoy hearing good things about ourselves.  We all love that.  It's also very human to want to jump in with explanations or deflections when the feedback is critical.
    The problem is that it wastes time and doesn't produce anything.  Rather than explaining or blaming, you can learn to be better by working toward a solution.Talking about problems doesn't have to become another problem in itself.  First, remember that the person who is giving the feedback is probably overcoming some anxiety to approach you to begin with.  No one likes to tell another person that they are not performing satisfactorily because we know all about human nature.  Then realize that if no one told you about what you could do better, it would take a lot longer for you to progress.  We often cannot see problems that lie within ourselves. 
    When someone approaches you with an issue that needs to be addressed, be all ears.  Ask for suggestions for improvement.  Put some ideas of your own out there.  Be a part of the solution.  Don't argue, you'll just be spinning your wheels.  It's the same with patients.  I've said it before, you can't win an argument with a patient.  You'll have more success if you listen empathetically, ask the patient what would make the situation better and let them know you want to work it out.
    So give your vocal cords a break and stop talking and start listening.  It's a compliment to be given critical feedback.  It means that the person talking to you has faith in your ability to improve.  It's when you're doing something wrong and they stop mentioning it, that you have to start worrying.

The Exceptional Dental Practice- Why Good Enough Isn't Good Enough

    Just because you have a good team, doesn't mean your work with them is done.  Even if your staff has been with you for years or have been in the profession for a long time, it doesn't mean they can't improve or enhance what they do.  One of the most dismaying things I've ever heard a staff member say was, "I'm as good as I'm going to get."  My heart sank because I knew that her time with us was coming to an end.  A great team is full of people who ask, "What more can I do?"  rather than say, "That's good enough."
    I'm reading a very good book by M. William Lockard, Jr., DDS titled The Exceptional Dental Practice-Why Good Enough Isn't Good Enough.  Well, of course the title appealed to me immediately, I like exceptional things and people.  Dr. Lockard is a Pankey trained dentist and he has very thoughtful and well-defined systems in his book.  Having systems is not an attempt to be overly controlling with staff or to create automatons.  Rather, having systems gives staff a road map to success.  Dr. Lockard very clearly and succinctly sets up job descriptions and expectations.  I found that while reading this book new ideas are popping up regarding ways we can serve our patients better and make our working experience more gratifying. 
    He has a chapter on personality styles which lends so much insight into how patients and staff members think and suggests appropriate responses to their personality style.  You could have a great staff meeting on that chapter alone.  If you think about it, a mindful approach to interacting with patients and staff could save time, minimize stress and rescue relationships.
    Sometimes we present a new approach to staff and then assume it is being done.  Or maybe they adopt a new protocol, but as time goes by, they may slip up now and then until the new way of doing things disappears altogether.  That's when a manager may be tempted to just think "Oh well, I guess this is good enough."  If you find yourself thinking that, it's a clear indicator that you need to brush aside complacency and address the issue.  For instance, I want all our clinical personnel to escort their patient to the front desk at the end of their appointment, even the hygienist whose room is 10 feet from the front desk.  Why?  Because it's like walking a visitor to the front door of your home when they are leaving.  It's polite and it completes the patient's experience with you.  You wouldn't sit on the couch and wave a visitor off would you?  Also, the staff member can make sure that any necessary arrangements for a next appointment are clear to the receptionist.  It helps avoid the feeling of "I'm done with you, now go bother her."
    Managing a great team makes your job a little trickier.  The areas for improvement are harder to find.  You need to really watch for areas to tweak.  Small sentences can make a big difference.  Dr. Lockard suggests that the assistant tell the patient at the beginning of treatment, "We want to make sure that you have a comfortable experience today.  Please tell us if you are experiencing any discomfort, of if you need a rest."  That may feel awkward to the assistant at first, but she will soon see the effect it has on the patient and it will make sense.  She should feel free to vary the statement to keep it from sounding mechanical. 
    One thing that occurs to me while reading the book and considering the suggestions.  It is important to have enough staff and to have staff cross-trained so that they can help each other.  The assistant should not be listening to the patient with half an ear, just waiting until she can jump up to empty the autoclave.  The time reserved for the patient should be considered time reserved for the doctor and assistant to be uninterrupted, as well. 
    Every practice is different and when you read any book that is meant to help you improve, you should read it with an intention to discover ideas that will work for you.  You can take the basic idea and use it as is, or mold it to fit your preferences.  The important thing is that the book has it's basis in service to patients and The Exceptional Dental Practice is solidly based in patient care and in optimizing the patient's experience. I've given you just a few gems, but I've only scratched the surface.  I have it listed on my sidebar if you'd like to learn more about it, or contact Dr. Lockard at bill.lockard@sbcglobal.net

If you'd like to order the book you can go to Dr. Lockard's website at billlockarddds.com

Champion of Mediocrity

    What does it mean to be mediocre?   According to Dictionary.com it is the state of being, "of only ordinary or moderate quality; neither good nor bad; barely adequate."  Is that what you want to be?  Of course not.  But, if that's what you accept from your team, it's what you will be.  When you accept good enough, you champion mediocrity. 

    Why are people willing to settle for mediocrity from themselves?  Well, I can only assume that either they are lazy, don't understand the personal satisfaction to be gotten from doing a thing as well as you can, don't care about what they are doing, don't care about who they are doing it for, don't feel appreciated, don't understand what a difference great would make as opposed to good enough, or they don't know what's expected of them.  The list could go on and on, but that's quite a run-on sentence I've got already.  My daughter would be appalled. (She has a Master's degree in creative writing, don't tell her about that sentence).

    Now, why are people willing to accept mediocrity from the people they lead?  I can tell you from personal experience that it is mainly fear and weariness.  We are afraid that if we push staff too hard, they will leave.  We are so weary of finding and training new staff that we let the fear take over.  I tend to fight the fear and deal with the consequences.  I can't tolerate watching a staff member bring down the level of performance of the whole staff.  That is what most people don't realize.  It is rare that the staff can drag a reluctant or lazy performer up to their level.  They will be dragged down because they can't keep up their own level of performance and cover for someone else at the same time.  That is when the problem escalates because you now have good performers exhausting themselves and resenting you for championing mediocrity.

    So, what can an owner or manager do?  Obviously there is a lot to figure out.  You can have one, many, or all of the above that you need to address.  I think one of the first things to do is explain your expectations.  This puts everyone on the same playing field and they start with the same opportunity to excel.  Then let them know what the result of failing or succeeding will be.  Then do it.  Push the fear aside and be real about it.  Give instruction where needed, but hold their feet to the fire.  Let them feel the heat when they are not living up to your expectations.  Compliment and reward whenever it is deserved.  By the way a reward can be something as simple as calling a staff member into your office and praising them and letting them know how much you appreciate and admire their work.  Appreciation and admiration go a long way toward job satisfaction.  Pay fairly and give little treats or bonuses when deserved.  A gift certificate for a manicure is not very expensive but makes a staff member feel special.  Everyone has their own style as far as bonuses and rewards go, just make sure yours is consistent. 

    Championing mediocrity?  You don't have to, unless being barely adequate is good enough for you.  But, remember if it is, that makes you mediocre, too.  It's not easy to push for the best from people, but it's worth it to get a great team.

Stalled Again

  

Have you ever had a team member that is just amazing in the first 6 months, and then they stop?  It's like they've run out of gas.  You're astonished, confused and finally dismayed because you thought that this was the one you'd always be able to count on, and now look what's happening!  Maybe it's just me, but I've seen it happen quite often.
    Since no one exists in a vacuum, let's examine this a little and see if we, as managers or supervisors have any role in this.  (Of course we do or I wouldn't be writing about it, would I?)  So, you are brilliant enough to recognize and hire a superstar.  She starts out great and you keep telling her how wonderful she is.  (and she believes you, so it's going to bite you in the butt later)  Every now and then you see a little laziness here, a little inconsistency there, but hey, no one's perfect and you don't want to upset this mega star.   About 3 months in you start to see her for a normal human being who has a great work ethic, but a few rough edges.  When you attempt to correct, she smiles and says she'll get right on it and you relax and think, "See, that was easy, it will all be perfect again."  Well, there is no perfect and if you think people can be perfect, you're setting yourself up for disappointment.
    In reality, you have a good employee who may be able to be motivated to strive for excellence, but you have  a responsibility to be clear about your expectations, to be consistent in your feedback and in control of your own responses to her performance.  Even if you're jumping for joy inside, you have to be reasonable in your responses to her. 
    If you gush to her about how wonderful she is, she will feel that there is no room for growth or improvement.  Once the honeymoon period is over and day to day life ensues, that's when the imperfections that you'll want to address will become obvious.  If you've created an employee who thinks she's amazing just as she is, you'll have a struggle. 
    Does that mean you can't give a new employee high praise?  No, you should definitely let them know that they're doing a great job, but at the same time continue to put goals in front of them.  Goals are a great equilibrator.   They tell an employee that you believe in their potential, but at the same time, there's room for growth.  Give reasonable praise and encouragement consistently and you won't find yourself stalled again.

Excuses Don't Solve The Issue

    We're in a recession, right? That's why our schedule is open, right? Or maybe that's what your telling yourself or your staff is using as an excuse for a light schedule. Look around, people are still driving SUV's, they're still filling the restaurants in the evening rather than eating home. Jason and Jennifer are still being bought the latest video game and attending dance, karate and getting private one on one skills coaching for soccer. Yes, we're in a recession, but that only makes people re-evaluate their priorities.

    Make sure that they see dental care as the priority that it is. People tend to see a problem and look for an excuse, rather than a solution. If the schedule is light and you ask your staff what they think can be done, wait a few minutes. They'll come up with some impressive excuses, but rarely a solution. The reason is that people tend to react to a discussion of a problem defensively, rather than seeing that this is an opportunity to dive in and come up with solutions. Even if we can define the reason that a problem exists, without a solution we still have a problem.

    Many times you'll see holes in the hygiene schedule 6 months after a week of vacation. The hygienists weren't seeing patients that week so the corresponding 6 month recall didn't happen. We recognized that and our solution was to spread appointments out more the week before and to double up on new patients in the two weeks prior to vacation. Then when scheduling their 6 month recall, we scheduled them 6 months and a week.

     Now, we are having a recession, I'll admit that. I won't use it as an excuse though. It is more important now, more than ever to educate patients about the importance of their oral health. Let them know that prevention now can prevent expensive treatment later. Placing a crown on a compromised molar may prevent the need for a root canal or extraction a year from now. Don't invent treatment, meet the patient where they are, and recognize their ability to pay a fair fee and work with them. Dental care doesn't have to be expensive if care is accepted and provided before small concerns become big issues.

Teach Thinking

    Have you ever noticed what a thinking rut people can get into?  Some people seem to have a natural ability to see solutions and ways that will make everything work better.  They usually end up managing something or someone.  That's good, it uses that natural talent in a productive way.  What about the people who don't think outside the box very easily?  Is it something that can be learned, or are there two groups, the leaders and the led? 
    Do leaders encourage those they lead to be dependent on them so that they feel more secure?  Do they give up and just see it as their cross to bear?  Maybe those that are led like having the burden of seeking solution placed squarely on someone else's shoulders.  Sometimes people worry so much about making the wrong choice in an unusual situation that it paralyzes them in indecision.  Maybe they've tried to do something out of the ordinary in a pinch and got reprimanded when it didn't work out.
    So how can you get staff members to stretch outside their comfort zone?  I've even seen people squirm when a suggestion takes them into unfamiliar territory, even though any possible negative consequences are pretty benign.  We want what we know and we resist what is different.  Maybe the answer is to lead them through some possible dilemmas and see what suggestions they come up with.  Encourage them to think wildly outside the box.  Come up with some exaggerated worst case scenarios and let them figure out how they'd deal with those consequences. 
    If staff members can believe that it's safe to try to come up with solutions on their own, you may see the confidence they develop show up in other ways during the workday.  You may have to bite your tongue sometimes if you do this.  The thing about leaders is that we like to come up with answers.  We like to feel needed.  We have to be careful not to send mixed messages.  We can't make the staff feel like we want them to come up with solutions, but only if it's exactly what we would do.  If, as a leader, we can see growth in this area as a win-win for all of us, we might have just learned a new way of thinking ourselves.

First Reaction

    When there is a crisis in your practice, what is your first reaction?  Do you panic or think clearly?  How about your staff, do they run in circles in response to a critical situation or do they become a well-functioning group of responders?  If you've been lucky enough not to have faced a crisis yet, don't rest too easily.  Sooner or later you probably will.  If you've already dealt with an extremely stressful situation, you know how unexpected these things are and how people react if they've had no preparation for facing something out of the ordinary and frightening.
    Let's talk about an unruly person in the practice.  I've had this experience with a patient and also with a staff member's boyfriend.  In both instances the angered person did not feel that they were getting what they wanted and did not want to accept the fact that they wouldn't.  In both cases the other person became somewhat threatening.  I found it was best to remain in control of the situation, to keep other staff members within sight and aware of what was happening, and finally, to be willing to call the police if the situation did not resolve within a reasonable time.  Once the situation gets disruptive, repetitive or unreasonable, it's time to end it by escorting the offending person to the door or by calling the police.  To do less is to expose the patients and staff to undue stress and unreasonable risk.  Hopefully, most practice won't deal with this type of situation, but it does seem like many people put less restrictions on their behavior so the odds are higher that you will.
    Another dreaded experience is a patient or staff member with a health crisis.  I think most people's first reaction is to take themselves out of the situation, especially if they feel unprepared to deal with it.  People tend to react fearfully and are likely to panic which can turn normally pragmatic people into helpless, not to mention unhelpful individuals.  I have seen normally reasonable, intelligent people scatter and become almost incoherent in this situation.  Kind of a deer in the headlights scenario.  The way to avoid this is with preparation.  If this hasn't happened in your office yet, you're lucky, chances are it will to some degree.  Prepare your staff by spending time discussing the types of emergencies that may occur.  Figure out which staff members would be best able to help with CPR and which just wouldn't be able to stay calm enough.  Some of the less composed staff members should be assigned to call EMS, clear the reception area and wait for the responders.  Everyone can take part in helping, just make sure they know what their part is and feel comfortable with it.  Don't always count on the dentist to be the one to administer CPR, he could be the one who needs it.  Have at least two other staff members who are comfortable with and capable of administering life support until EMS arrives.
    Being prepared in advance takes away the unknown to some degree.  Remind the staff that their first reaction may be to panic, but encourage them to recognize it as a response that can be challenged and overcome.  It's easier if they have had a chance to practice and know what is expected of them.  Hopefully you'll never face this kind of stressful situation, but don't count on it.  It's better to practice and never need it, than to face a crisis a wish you did.

Pot Stirrers Not Welcome

    There is nothing more detrimental to a happy work environment than a pot stirrer.  You know, the kind of employee that makes little digs intended to start some drama.  Once the trouble starts, she is the first one running around trying to see how everyone feels about it.  In the event that she is confronted, she will cry to the boss about how mean everyone is to her when she only wants to help.
    I've seen more workplaces ruined by this kind of behavior.  Even the happiest, healthiest office can not survive intact if this is tolerated.  The best employees will either leave or become frustrated and resentful.  The tension will destroy the culture of the practice and the reverberations will be felt by anyone walking in the door.  Faces that were once open and pleasant will become stressed and drawn.  Laughter will turn into exasperated sighs.  Harmony will melt into discord.
    Employees should  be urged to confront this behavior and let the pot stirrer know that their antics are not appreciated and will not be entertained.  They should understand their responsibility for maintaining the healthy relationships and should not be drawn into this drama inciting behavior.
    Managers and dentists have a responsibility to the team and patients to recognize a pot stirrer for who they are and the damage they are capable of.  The only response to this behavior is a serious confrontation with the promise of dismissal if the behavior continues.  Pot stirrers tend to be manipulators and can turn the situation every which way to try to continue their behavior as well as their employment.  For the sake of the team and the health of the practice it is imperative to recognize the behavior, confront it and follow through with dismissal if it continues.  Anything less is detrimental to the team, the patients and ultimately the health of the practice. 

Shine On

    We all know how great it is to find a star among our staff members.  First let's define what makes a staff member qualify as a star.  She is the one who sets up rooms at night so they're ready in the morning.  She thinks ahead whether she is assisting chairside, handling inventory, scheduling patients or anticipating the needs of a nervous patient.  She is always aware of what is best for the patients, best for the practice, and best for the team.  She really cares and is always trying to find better ways to do things and always open to learning more and improving her skills.  She gets along with others, helps her teammates and celebrates their victories.  She's self-motivated and doesn't need constant prodding or monitoring.  She's a pleasure to have around.  She's not conceited or petty and she is loved by the patients and staff.
    How do you keep her shining on?  You let her know how great you think she is and every now and then, you thank her for what she does for your practice.  She doesn't need that to make her keep doing what she does.  That's in her, she can't be any other way.  She needs it to shine.  You can have an employee with all the above attributes, but if you never acknowledge or appreciate it, she'll become discouraged and dismayed.  She'll lose her shine and before you know it, you'll have a martyr with a lot of great attributes.  She'll feel like her efforts don't matter in your practice and she'll become unhappy.  It doesn't have to be that way.  It takes so little to make an employee like this shine.  A kind word of thanks, noticing the special things she does, and just telling her she makes the day better will do it. 
    It often takes so little to encourage our team members, yet we often neglect or avoid giving thanks and encouragement.  We lose nothing when we give to others.  We build a bank account of good will and set up a savings fund of tolerance and understanding that we can draw from on those days when we are not our best selves.   We have choices in everything we do and making the choice to appreciate those who come to work every day and give it their best is always a good idea.

Building A Great Hygienist

    You know what you have to do, make your list.  Ok, got it?  Now this might be the tricky one.  You might have a hygienist who has many years of experience.  Or, you may feel that she is not going to welcome your ideas about what you need her to be.  In many practices, hygienists are looked at as somewhat separate from the rest of the team.  If that's the way it is, get ready for change.  If you set your hygienist, or she sets herself, apart from the team, on a different level, you will never really have a complete team.  You will have a team and a hygienist.  It may be good, but it won't ever be great.

    We have two hygienists with 17 and 19 years experience.  They were already pretty good team players.  When we decided to make our team exceptional, they came right along with us.  We've all heard the stereotypical prima dona description that seems to be velcroed to hygienists because of the actions and attitudes of a few.  If you entered our office at the end of a workday, you would not be able to single out the hygienists from the rest of the staff.  One might be cleaning up the lab, while the other might be in the kitchen washing dishes.  They get done sooner than the assistant because they only have one room to clean, but when they're done there, they go and help the assistant finish her rooms.  When they have downtime in their schedule, they help with other things in the office.

    How'd we build them?  We talked about what we wanted our practice to be like.  We took ownership and we want the culture of the practice to feel good for our patients and ourselves.  We all work happier because we work together.  Our hygienists know that no one is feeling resentful towards them because they work together with the rest of the team.  Expect this from your hygienist and you will build a great one, too.

Buiding A Great Dental Assistant

     Ok, get out your pen and paper.  Make your list of all the things that you would want to have in a dental assistant.  This position often has the most untapped potential of all.  Here is what my list would look like and why:

1.  Loves assisting - I don't want to put a lot of work into someone who is going to leave and go to hygiene school.  I want someone who wants to keep learning and improving and who really enjoys coming to work every day.  That spreads out into everything she does.

2.  Enjoys serving others - I don't want someone who sees service as servitude.  I don't want someone who resents what is asked of them.  I want someone who looks for ways to give the extra that makes us special. 

3.  Compassion and Empathy - I want someone who will look past a patient's bad mood and find a reason to like them.  I want her to be able to care about how people feel and who wants to make it a little better.

4.  Intelligence - I like to hear an assistant who is able to answer patient's questions and who can speak with proper grammar.  We all reflect on the practice and on our boss's judgement so I want everyone to be shining examples of good taste and character.

5.  Integrity - Speaking of character, integrity ties the whole picture together.  It's the Australian Sheep Dog of all the character traits.  If you have integrity, you probably have many of the others.  Integrity means that you do the right thing.

6. Good Chairside Skills - Or the desire and capacity to improve.  A good chairside assistant makes the worklife of a dentist much easier and impresses the patients.

7.  Honest Communication - I've seen some employees in other offices who feel that they have great communication skills, but they come off as phony.  There is one office that has a young woman that calls me babydoll every time I talk to her, it drives me crazy.  I don't want anyone to drive our patients crazy.  I want our staff to be warm and welcoming as well as professional. 

8.  Sense of Humor - Dealing with patients can be stressful.  I don't want an assistant who will walk around feeling put upon or grouchy.  I want someone who can laugh and be easy with everyone and help keep tension under control.

9.  Team Player - I want someone who realizes that her best success comes when she joins her effort with the rest of the team.  She worries more about getting the job done well, than about who gets the credit.  She shares what she knows with others because she realizes that knowledge shared is knowledge squared.

10. Someone Who Lives Up To Their Potential -In the book, The 7 Habits of Exceptional People, Steven Covey talks about P/PC.  That is Production vs. Production Capability.  I want someone whose production matches her capability to produce.  I want someone who is encouraged and excited about the fact that when they meet their goals, their potential expands to make room for new growth and new goals. 

     I'm sure there are others, but those are big to me.  How do you build an assistant like that?  You tell her what you want and then you expect to get it.  If you don't get it, you let her know and reinforce your expectations.  You show appreciation when she lives up to it and you cheer her on.  You let her know that she makes things better.  Make sure her salary is a reflection of her abilities and of what she brings to the office.  Building and keeping a great assistant will make your practice a place you enjoy going to every day.

Building A Great Front Desk

    This will be the first line of every part of this series:  Sit down and make a list of what's important to you about this position.  What character traits should the person who fills this position possess? 
    This is the person who will be the first and last impression every patient gets of your practice at every visit.  What will make that impression not only good, but good enough to make them tell other people about it.  Since the first contact is usually made by phone, it would be desirable to have a warm, sincere manner on the phone.  She must be able to make decisions based on what the patient is telling her and must be able to ask questions that give her a clear idea of whatthe patient needs. 
    While she's on the phone, other patients may be arriving at the office while others are coming to the desk to check out.  So she must be able to keep her cool and not get flustered.  She must have the patience to deal with insurance claims and the tenacity to follow up when there are delays.  She has to have the nerve to ask patients to pay their fee, tempered by graciousness. 
    How do you build this person?  Start out with someone with the promise of having or developing these traits.  Ask questions at the interview that will let you see if they exist in the candidate.  Develop a basic job description that can grow as the staff member grows.  State expectations and set goals.  Recognize and celebrate achievements.  Guide the employee in her development and be consistent.  As a manager, the success of teams members is your success, too.

How Will You Build A Great Team?

    Think back to when you set up your dental practice, or think forward if you're just starting out.  You didn't take anything for granted, you researched the equipment you needed to buy and bought the best you could afford, right?  These decisions were important.  These are the tools you use to make your practice successful.  You have to use them everyday, so you want to be sure that they are suited to you.
    Shouldn't you put the same effort into building a great staff?  These are the people you will work with every day.   Shouldn't they be well-suited to you as well?  When you were thinking about buying your equipment you probably asked yourself what you expected from each item and how important it would be to you in your practice.  You should do the same with the employees you hire.  Don't just think, "I need a new assistant."  That would be fine if all assistants were generic and identical.  When one left, you could just pull another one in and sit her across from you and pick up where you left off. Define the person that will suit you and then look for her in the people you interview. What do you expect from your office manager?  Do you even know what to expect?  Do you even really know what an office manager is supposed to do?  Same thing for the front desk assistant.  Do you see your hygienist as a part of the team, or is she someone who comes in, cleans teeth and goes home?  When you hire the wrong people you hurt not only yourself.  A bad hiring decision boomerangs all over the place.  It can affect your other employees and your patients, too.  The stress from a really bad hire can ripple out to your family and your team's family if it's something that everyone takes home with them.
    You can build a great team.  You have to be willing to decide that you want to put the work into asking yourself what you want, you have to do your homework, and then you have to begin to build.  I'll help you.  I'm going to start a series here that will take us through each position so that you can have a better idea of what you should look for to build your great team.  The good news is, some of those people may already be on your team, you may just need to develop them in a new way.  Haven't you waited long enough?

Guiding a Great Team

    Sounds like it should be easy, doesn't it?  If you have a great team, they're basically on auto-pilot, right?  If you assume that, sooner or later, you're going to have to pull them back to the path you want them to continue on.  If you don't, one day, you won't have a great team anymore.

    Since teams are made up of individuals coming together for a shared purpose, all of those personalities need to be funneled into the vision that has been conceived by the dentist and shared with the team.  The job of the manager is to take everyone's ideas, strengths and abilities and use it all in a constructive way.  Strength crashing against other strength is ultimately discordant and destructive.  Strength flowing alongside strength creates a powerful current that flows in the same direction. 

    How do you respond when a great team gets off track?  Hopefully, not by reacting without thinking.  When you ask a lot of your team and generally receive it, you must be gracious when you are disappointed in them.  The best thing you can do is wait for your "feelings" to pass and determine what went wrong and what needs to happen to make things right again.  Of course, you must let them know that the team is going off course, but that you fully trust they will be able to pull back together again.  Letting them keep their dignity in the face of your disapproval will benefit everyone and get you the results you desire faster. 

    It's not always easy to wait for calm and reason to return when you're in the midst of problems, but there's nothing worse than reflecting on how you acted and wishing you could grab it back.  You may feel powerful or vindicated in that few minutes that you gave your good team a piece of your mind, but repenting is definately a leisurely and lonely experience.  On the other hand, walking away, confident that you've expressed the problem with class and control, and clarified the correction, is a great feeling.  Everyone can move forward and no one is left smarting from a careless release of frustration.  It's worth it to take the time you need to cool down and consider the best way to proceed to get the outcome you want.

Trust

"Trust men and they will be true to you; treat them greatly, and they will show themselves great."
                                                                                                                   ~Ralph Waldo Emerson~

    The secret to effective management is trust.  Trust comes into play on so many levels.  First and foremost, the manager must be someone that the staff can trust.  They have to know that you will do the right thing.  They have to have confidence in your commitment to be fair and to respect them.  Therefore you must fill your team with people you respect and have confidence in.  Then you must let the team know that you trust them.  Make it a theme in your dealings with them and they will value that trust, protect it and live up to it. 
    Being human, there will be times that they don't.   When that happens, address it.  That adds value to your trust.  The other person will see that you are basing it on something and will fight for another chance.  Once that chance is given, they will protect the trust you have given them. 
    When team members feel trusted they develop greater confidence.  The patients sense that and they, in turn, trust the staff and dentist all the more.  People like entering an environment in which the staff gets along well, is happy, and genuinely likes what they're doing.  Trust makes all that more likely to happen.  When staff trusts each other, gossip is virtually eliminated.  It opens the door for teamwork and cooperation.  Trust means never having to say, "What is she up to?"
    If you have a team member that you just don't trust, you probably need to let her go.  Keeping an untrustworthy employee destroys the culture of your practice.  Before you know it the team will start discussing this employee amongst themselves and the entire network of trust that has been established can be broken.  You cannot make the team believe that you value trust if you make them work with someone who can't be trusted.  Believe me, any problem that you see with a team member has already been noticed quite a while ago by the rest of the team.  You're just catching up. 
    Trust encourages happy teams, healthy practices and satisfied patients.  When patients trust their dental team, they tell others about it.  That makes them want to share in the experience and causes a steady stream of new patients to your front door with little to no outside marketing.  When your patients let others know that you are someone to be trusted, you build a practice on that solid foundation.  What's the word on the street about your practice?

So, Let's Get Going!

    We talked about taking a look back, looking forward and seeing the changes you want to make, and personal change.  Now let's make something happen.  Don't let this new energy dissipate like the average New Year's resolution.  I dread going to the gym on January 1 because I know it will be packed.  I also know I only have to wait a few weeks for the wishers to fall away, leaving only the ones with determination behind.  Be determined, this is your everyday life.  Don't spend it wishing, make it happen.

    I know you're wondering where to start.  Sure, it's easy for me to give advice, I'm not the one who has to stand in front of your staff and tell them about all your new ideas.  Let me assure you, I've been there.  I've seen the eye rolls and skeptical stares.  I've heard the weary sighs and listened to the sarcastic remarks.  You'll be ok, I lived through it.  You have to grab their interest.  You have to believe so much in what you're telling them, that they sit up and take notice. 

    You have to have what I call rational passion.  Rational passion is something that they can relate to.  You're not on a soapbox.  You just have an attitude that's positive, hopeful and just excited enough that they want to get a little of that for themselves.  Rational passion is contagious, not off-putting.  So, you don't want to be a fanatic.  You don't want to turn anyone's world upside down.  That's why I had you rate the changes you want to make.  Start with the overall vision, but then select the top three things that you want to focus on first.  Help the staff see how making these changes will make their jobs more satisfying and enjoyable.  Sometimes you have to remind people that personal satisfaction in a job well done can be just as gratifying as financial rewards.

    Start with a staff meeting.  Begin by telling them that this staff meeting will be the beginning of a new culture in your practice and that you want them to help you create that culture.  Tell them about the vision you developed when you were listing all the things that are important for you to have in your practice.  Let them make objections if they need to and then ask them for solutions to their objections.  Let them see that they have the power to make it work. 

    The most important thing is to keep re-directing your staff in the way you want to go.  Everything's not going to magically change because of one staff meeting.  When you do see positive changes, mention it a morning huddle.  Give reminders at morning huddle, too.  New habits and behaviors take a while to become incorporated into everyday practice so be patient and persistent.  The payoff is the practice of your dreams.

The 15 Minutes Of Fame Review

     Everyone hates performance reviews, those that give them and those that get them.  Dentists and managers dread sitting down with staff members and telling them about their performance.  Sure, it's all nice while you're telling them the good stuff, but sooner or later the problems have to be laid out on the table and dissected.  For their part, staff members dread reviews.  They worry, they get nervous and spend a lot of the days leading up to the review thinking back over the year and trying to figure out what will be remembered and what will be forgotten.  A lot of times, the really worried ones will give the best service of the year in that week. 

     It doesn't have to be that way, and I think it really shouldn't.  A good manager will let team members know immediately what they are doing wrong and how they need to fix it.  They don't wait all year to dump it on them in one fell swoop.  Why would you keep watching someone perform poorly without telling them that things need to change.  It should be discussed, corrections should be recommended and followed through on, and a follow-up discussion should be scheduled.  If the problem still exists, maybe this person isn't right for the team.  It really is that simple.  Managers complicate the process when they become emotionally invested in the team members performance.  It's important to care about team members and their performance, but the team member needs to take responsibility for their own performance.  If you've been attentive to this all year long you should not have many performance problems.  Then you don't have all the anxiety and stress of a bad performance review.

     That brings me to the 15 minutes of fame review.  I do it once a year and we all look forward to it.  I spend about 15 minutes with each team member recalling moments of greatness on their part, improvements they have made, goals they have reached and goals yet to come.  I let them know that they are appreciated and needed in our practice.  The look of pleasure and satisfaction on their faces is enough for me to know that everyone deserves their 15 minutes of fame.

What Will Make Her Stay?

     Ok, so you did your homework, hired a great prospect for your team and she's trained and everything's going well.  She's one of the gang.  How do you keep it that way? 

     Make no mistake, I'm not going to suggest that you pamper a staff member or set yourself up to be at the mercy of someone who will make constant demands.  What I am saying is much more basic and simple than that.  Make her a part of your vision.  See her as an integral part of your practice and help her see herself that way.  Let her know that you're better with her than without her.

     One of the basic things employees want is appreciation.  I don't think that you have to constantly tell them how wonderful they are, just let them know that having them there makes life easier.  At the end of a tough procedure the words, "Well done!" will ring in your assistant's ears for days.  When the front desk assistant fills a huge gap in the schedule, let her know how nice it is to be able to count on her.  When your hygienist discusses treatment that is needed with her patient, let her know that you appreciate her efforts.

     Be consistent.  Set standards and expectations.  If things change, discuss it with your team.  Don't just keep them on edge all the time wondering when you'll change your mind again.  It's fine to change it, just clue them in. 

     Treat them at least as good as you want them to treat your patients.  You've heard the old saying, "Treat your family like friends and your friends like family."  What I've noticed is that if you treat your staff well, they'll be your biggest fans. 

     I don't think you have to give your staff the moon to earn their dedication.  As a matter of fact, that usually backfires in the end and leaves you with a group that can't ever be satisfied.  Keep seeing them as the wind beneath your wings and they'll keep you flying high.

Now That You've Got Her

    Ok, you've hired someone for whom you've got great expectations.  First and foremost, share those expectations with her.  Every office is different, every dentist wants specific things from their staff and each staff member has had a unique experience prior to joining you.  Start right away, don't wait a week to let them "get settled in."  You'll only let them get settled into bad habits or things that just don't work well in your practice.
    Get your team involved.  Let them know that it's in everyone's best interest for this new team member to be trained efficiently and correctly.  Once she's got it down, you will all be operating like a well-oiled machine again.  Make sure they know that it's ok to step in and give constructive advice to the newcomer.  Tell  them to treat her the way they'd want to be treated as a new employee.  No one likes to find out that everyone watched them repeat a task incorrectly, but no one told them the correct way to do it.
    Touch base often.  Set aside five minutes a week to talk about how it's going and to let the new staff member ask questions and express any concerns.  Remember not to focus so much on the new person that you forget to notice what the others are doing well.  It won't help the new person if you sing her praises so much while neglecting your existing staff, that you build a wall of resentment around her.  Find ways for her to have one on one time with other staff members doing projects or completing tasks so that she gets to develop relationships with them faster.  If she mentions something nice or helpful that another employee did for her, pass it on, it will encourage more of the same.
    At the end of her probation period, if she's been successful and will be a permanent part of the team, take everyone out to lunch to celebrate.  You've asked everyone to be a part of making this new situation work, so now it's time to enjoy your success and welcome the new team member on board.  That's the first step in the next part of the adventure; keeping this great new team member for a long time.

Hiring And Keeping Great Dental Staff

    It's not easy when it comes to building a great staff.  First you have to identify them, then you have to develop them, and finally you want to keep them.  It's an all or nothing proposition, all the steps need to be there.   So, let's start with how to find great staff members.
    Listen to your instincts.  Be ready to wait for the right person.  Don't bring someone on board that you think you can change.  Change doesn't come easy, so don't start out a working relationship hoping for  something elusive.  Be very clear about your expectations for this person and spell out the responsibilities that their position will include.  Listen to them.  Ask open-ended questions and listen to their answers.  This will let you know if they are articulate, if they have good grammar and it will also give you an insight into their character and what's important to them.  The following are a few questions that I like to ask at interviews:

1. Tell me about the best teammate you ever worked with, and what made her so impressive?
2. Tell me about the worst teammate you ever worked with and why you felt that way.
3. What will you bring to our practice?  How will you make us better?
4. What will make you feel satisfied in this position?
5. What is your definition of a good work ethic?

   

Watch their reactions and listen for sincerity.  If the answer sounds too good to be true, it is.  You'll feel it, but you have to listen to yourself.  I once hired someone who gave the perfect answers and I knew that she was trying to impress.  When she told me that if I hired her I'd be hiring the best assistant in the state, my initial reaction was that she was conceited, but I convinced myself that she was just confident.  She was conceited and made life miserable.  She was so sure of her own perfection that I could not help her see that her behavior was not appropriate, because in her eyes, she was perfect.  Had I listened to my gut, I'd never have had to deal with her. 
    If a candidate has poor grammar, you may think it won't bother you, but it probably will eventually.  The way they talk to you in the interview is the way they will talk to your patients.  If they do not connect well or don't sound intelligent, that's what your patients will experience.  They are the people your other staff members will have to interact with.  Hiring a staff member who is a poor fit with the rest of the staff can cost you a good staff member in a few months.  It's in everyone's best interest to be careful and responsible when hiring.  Next, I'll talk about how to develop a great staff member once you've hired them.