Exceptional Dental Practice Management

Passing The Buck On Kids?

    I'm interrupting my alphabet thing to tell you about something that really bothered me today.  My boss does a great thing for kids.  He takes children from one of the local elementary schools and cares for them at no fee.  They get the same treatment as anyone else.  Prophies, x-rays, restorations, you name it.  The problem is we are also doing extractions of permanent teeth and root canals on 10 year olds.  It's heartbreaking.
    Today we devoted the entire morning to eight of these kids.  Every panorex told a similar story of neglect and pain.  One little 10 year old had two bombed out molars.  My boss asked her if her teeth ever hurt so much that she couldn't sleep.  She said they did.  Not too long ago we saw a little 6 year old whose teeth were so decayed we had to refer her to a pedodontist.  He was forced to extract most of them.  When I talked to the resource person who brought them she said that these kid's health wasn't a priority with their parents.  She said the parents were more than happy to let the school do anything they would for the kids, as long as the parents didn't have to do anything.  So, who's responsibility is it now?
    It frustrates me that we are willing to help, but by the time we get them they are in terrible shape.  The school nurse happened to stop in and I told her we needed to do something different.  Our county health department is focused on prevention but the public health hygienist screens the kids in kindergarten and fifth grade.  A lot can happen in the intervening years.  Even when she diagnoses decay, the only thing that happens is a note gets sent home to the parents.  We've already established that these parents aren't too concerned with their kids health so we might as well ball up the note a toss it in the trash. 
    After talking to the school nurse we decided that I would come into the school and try to educate the kids about home care and nutrition.  I will also come to the PTO meetings, but I may be preaching to the choir there.  Most of the parents of these kids probably don't go to PTO meetings.  I'm frustrated and upset that kids in this country can't sleep at night because their teeth hurt.  I hate that a 6 year old can't really eat solid food because she hardly has any teeth.  So what's the answer?  I'm proud of my boss for what he's doing, but I'm afraid that it's a drop in the bucket.  What works in your community?  Whose problem is it?  If you have any answers, I'm all ears.

Burned Up

Do you ever feel like this?   Running from room to room, spinning in a circle until one of your staff members grabs you and points you toward a patient?  Do you look at tomorrow's schedule and think about just forgetting to set the alarm so that you don't have to face another day of taking two steps forward and one step back?  Then you may think that you're burned out.  I hate to tell you this, it's worse than that, you're burning up.

     I have to give my boss, Jeff Price credit for coining that phrase.  Oy!  We've had a week!  Emergencies out the whazoo!  Combine that with a scheduler with a soft heart who's still learning the ropes and a shiny, brand new assistant and it starts getting a little too hot.  When things get hot people get burned and if they get too hot, people get burned up.  So, rather than running around putting out fires, it's imperative to prevent them from ever igniting.

     The way to do this is to have scheduling guidelines and follow them.  This is where the Mars/Venus thing can get you.  Mars says, "Here are scheduling guidelines.  Follow them and we will not have any fires."  Venus says, "Ok, Mars, you're the boss.  I'll do whatever you say."  And Venus means it...until someone calls with a problem.  And Venus starts to melt.  After all, "Aren't we here to relieve pain and suffering?"  or  "They were really insistent, I had to get them in."  Sometimes that's true, and Mars knows that.  But, when someone hasn't been in for two years and they call with a broken molar and get put on the schedule next to 3 units of crown and bridge that's already been short-changed about 20 minutes to make it fit into the time slot, things are going to get hot.  There are a million other scenarios that drive dentists crazy, just pick you favorite one.  Think about it this way.  You have a stick of dynamite with a really long fuse.  The fuse is not endless though.  At some point you're going to run out of fuse and hit the gunpowder.  Once the explosion happens, it's too late.  You've missed your chance to get it right. Day after day of coming to work and just making it through is burning that fuse, little by little.  You see it sizzling, but, oh come on, there's plenty of fuse left, right?  Maybe not.  After days and days, weeks and weeks, months and months, years and years, it's going to be a magnificent explosion.  DO SOMETHING!!  Make it work.  Walk the walk.  You are not at the mercy of anyone but yourself.  Good intentions do not snuff out the fuse. Everyone has their limit and everyone eventually runs out of gas if they're driven too long.  Whenever an staff member looks at a dentist, often they only see him in the context that applies to them.  Hygienists may think he's got it easy because he just steps into the room, pokes around the mouth, chats the patient up and walks away.  Assistants may decide that he's got it made.  They set up and clean up the rooms.  They take care of everything.  He just has to saunter in and run that bur around the tooth.  How tough is that?  The front desk assistant sees him as a never ending source of dentistry.  Have patient will drill.  One more won't hurt.  Heck, that assistant's doing all the work anyway.  Get real.  If he has two hygienists and they each see ten patients, and he has about fifteen on his schedule, that's thirty-five mouths to explore, names to remember, stories to listen to, problems to solve, never mind the actual dentistry.  Get the picture? 

     Of course, there's always that employee, often the office manager, who is going to ride in to the rescue.  She'll direct the action better than a midtown traffic cop and everyone will do what she says to 'git 'er done'.  She's as pleased as punch with herself because she just saved the day.  Wow, is Mars going to be happy with her.  Oh yes, she can just see it now, he may even decide to make today the official "Amazing Office Manager Day."  You think you know what hot is?  Nah, just wait.  Wait until Mars isn't so impressed.  As a matter of fact, just the opposite.  He's disgusted. Here's a fictional example of how that might go:  Venus: "Well, we got it all done.  Nothing is too much for us to handle."  Mars: " If everything had been managed correctly, heroics would not have been necessary."  Venus:  "What?!  That ingrate!"  Now, it gets even better.  Having gotten that off his chest, Mars goes on with whatever he's going to do next.  Venus, on the other hand is furious.  Oh, the wrath of a woman who feels unappreciated and dismissed.  That comment is going to burn her up.  She is just sure he is unaware of just how special she is.  Uh, not really.  When you think about it he's right.  Good management can handle problems, great management never lets them happen to begin with.  The shame of it all is, nobody was slacking off, no one was being uncaring.  Everyone may be chipping in and working their tails off.  But, how can someone appreciate all that when they never wanted it in the first place?  What they wanted was a properly scheduled day and a staff that was working at a normal pace.  They want to enjoy what they do, not just survive it.  If a dentist spends his whole career like a hamster in a wheel because no one can figure out how to make the day run well, sooner or later he's going to decide to just stop running, and there will be nothing left for anyone.  Or, he may run himself into an early grave or a miserable disposition.  Either way, no one's going to be happy and no one will ever figure out why.

     So, decide how you want your schedule and your working day to be.  When a schedule is overbooked, patients become crown preps and denture try-ins, not nice Mr. Smith or sweet Mrs. Jones.  Conversations are limited to "Tell me if this hurts", not "So, how are the kids?"or "Where did you go on vacation?"  Get the picture?  Stress kills and at the very least makes what you're doing less rewarding and quite miserable.  Sitting down and establishing a pleasant rapport with a patient is satisfying and feels good.  It's a no-brainer.  Get your schedule working with you, not against you.  If you work all day and have nothing worthwhile to show for it, you'll just burn up.  Have you ever smelled burning dentist?  It's a pungent aroma that you can never quite get rid of.

 I'll dedicate this to Jeff Price, who survived this week and didn't really burn up enough to emit any toxic fumes, at least not that we could smell.  Don't worry JP, next week will be better.  You even get Monday off.                                  

I'm A Mess!

   

"The problem with people who have no vices is that generally you can be pretty sure they're going to have some pretty annoying virtues."

Elizabeth Taylor

   

I've had it with myself!  I'm a mess.  My desk is a wreck.  Actually, my entire office is a pigsty.  I don't know why.  I've always been that way.  When I was a teenager most of my wardrobe was on a couch in my bedroom.  My mother often wondered how I knew where anything was.  When I got married, I did a pretty good job of suppressing my inner slob.  Well, she's back, and she's sick of being neat.  I have a couch in my bedroom again.  Guess what.  That's right, a good percentage of my wardrobe is on it, but I know where everything is.  I will give myself a little pat on the back and tell you that at least it's all in season.  Well, except for the sweatpants.  Hey, sometimes my husband turns the air conditioning way down.  You wouldn't want me to freeze, would you?
    So, if I'm not hurting anyone with my sloth, why am I worried?  Well, there's a quote that says a messy desk reflects a messy mind, and it keeps popping up when I look at my desk.  It makes me feel a little guilty or undisciplined or something. I kind of know where everything is...I think.  The only problem is, I spend a lot of time remarking on the mess and vowing to put it all in order.  I try.  I put a dent in it today.  My problem is that I get started and then I unearth something and I get an idea that takes me off on a tangent and before you know it another pile appears.  Maybe that messy desk, messy mind saying has some truth in it.  Anyway, I think if I could get it under control I could find something better to obsess over. 
    I hate it when I have to do a consult and my office is cluttered.  On a bad day I have to take a pile of stuff off the visitor's chair and balance it on top of a pile that seems to be more out of their line of vision.  I place it and slowly let go to see if it seems like it can safely teeter there for about 30 minutes.  As I usher the patient into my frat room, oops! I mean office, it never fails;  I apologize for the mess that only moments ago I was hoping they wouldn't notice.  It's the Catholic in me, I have to confess my sins.  Sloth is right up there, too.  I'm convinced that if I don't change my ways I'll be on the hot tamale train straight into hell.  Not really, it just sounded good.  My boss is a mess, too, but it doesn't seem as bad since he's a guy.  Janis at the front desk is very neat and organized.  She peers at me with an equal measure of amusement, amazement, and disgust on my worst days.  I wonder what she really thinks. 
    I guess in the end, it would be nice to get more organized so that I could stop moving things from one pile to the other.  But how?  I'm up for ideas here.  Click on comment and give us your best ideas for being organized and staying that way once you get there.  I can get organized very nicely.  My office looks like a neat freak's palace when I set my mind to it.  It lasts for about 2 hours and then I begin my decline back into slovenliness.  OK, I'm waiting, give me your ideas.  What should I do? 

Who Let That Wife In?

    I have a few friends that are married to dentists.  I've been talking about what it's like for them because I'm getting ready to write the next installment of my Other Side of the Chair series for Dental Office magazine.  So, I go to the source and luckily I have some very good ones.  I also think about Ben, who writes the dmdstudent blog.  He wants to be prepared for the real world when he starts out.  What would they tell him about having his wife work in his practice? 
    It sounds to me like it's just like everything else.  It depends in part on what you bring to the situation and part on who you surround yourself with.  It also has a lot to do with communication.  Let's break it down and look at it. 

    A dentist and spouse start a practice from nothing.  They need to identify a location, buy equipment and furnishings and hire staff.  It's tough going at first.  They probably hire a minimal staff, they spouse may work in the practice and little by little the practice grows.  More staff members are added, better equipment is purchased and maybe now the spouse backs out for a while to raise a family. 

    In the meantime the spouse may do things from home or come in on a limited basis.  Let's assume it's a wife so I can use a gender here.  Maybe she starts to sense the staff would rather she stay away.  Why?  Whenever there is an issue with a person feeling unwanted I always think it's best to take a good look at yourself first.  Have you done something to put the others off?  You have to be honest here, you know if you've been acting like a jerk.  If the answer is "no", look at them.  Are they worried about you because they are somehow lacking and they are worried you'll see it?  If the answer seems to be "no" again, ask for a staff meeting.

    Am I crazy?  Well, you could get conflicting answers on that, but that's a different concern altogether.  It's not crazy to call a staff meeting and get that burning question on the table.  It's very honest and straightforward.  It saves time and anxiety.  Of course, you have to establish trust and you must be willing to listen and hear what is being said.  You can't punish anyone for their honesty either.  If they let you know that they just resent the fact that you are the boss's wife and they don't want you there, you have to let them know that you will be a fact of their life.  You should state the purpose that you will serve and ask them to support you.  Your husband should then ask them to commit to working with you in peace and with a shared vision. 

    As the wife, you may feel that the staff expects you to shower them with appreciation.  Not necessary if you have the right staff.  Sometimes dentists train their staff to expect too much or, by denying them any appreciation, make them crave it.  A reasonable dentist/staff relationship involves mutual respect and regard.  A reasonable spouse should be able to enter into that culture and move with the flow.  It is all easy to achieve by having patient care and service as the desired end result.  That may be where the relationship between the staff and wife goes bad.  If the staff perceives that the wife is only concerned with the bottom line it will feel wrong.  They will wonder why they listen to so many discussions about patient service if the wife is going to come in and ask why overhead is high or why collections are low.  Yes, those things are important and if they are not controlled the service to patients will suffer.  They can't be the only thing that she is about though.  So, as in everything, the balance must be right.  The balance of what she shows interest in, the balance of how she uses her authority and the balance of how friendly she is with the staff.  It is a difficult juggling act at first, but once you get it right, It is very rewarding for everyone.

   

Chomping At The Bit?

    Last week I wrote an article titled, This Old Pair Of Jeans.  An office manager had asked me about a problem she was having at work that seemed to have no easy way out or possibility for a happy ending.  I don't know how that turned out because I haven't heard from her again. 
    Today another office manager e-mailed me and said that she has had it.  It seems that her boss is stuck in neutral and she wants to be in overdrive.  In an attempt to put the brakes on her she (her boss) seems to be belittling her and finding fault with everything she says and does.  She has been offered a job with another dentist, but feels torn between loyalty to her current boss and the promise of new horizons with the one who would like to hire her.  She read my article and now she wants to know what she should do.
    I don't know, I'm not her.  So, to try to be of some help, I would advise her to weigh the positives and negatives.  Actually make a list and look at it.  If she  finds herself excited by the positives about her current job and making excuses for the negatives, then she still has some investment there and she should try another approach to solve the problem.  Going to her boss and saying, "Doctor, this dentist wants to hire me and let me do everything I want to do, so if you want me to stay here, you better shape up." is not the right way to find a solution.  Asking to sit down and talk about what she would like to do more of and how she can do that in a way that her boss is comfortable with would be better.  She should also consider that when her boss says no to an idea, it might not mean no forever, it might mean not right now.  Her boss could just need a breather from the pace the manager might be setting.  Her approach in presenting her ideas may be making her boss feel pressured and she may be responding in frustration and desperation.
    On the other hand, if she is writing fast and furious with a sense of fury about the negatives in her current position, can't think of too many positives and gets pumped up just thinking about handing in her notice and moving on, then that's her answer. If that is the case there are probably other issues that contribute to her unhappiness.  Listening to your inner voice will tell you how you really feel. 
    Everyone is different.  Some people feel that there is a way to work out any problem if you just persevere, and they may be right.  People with perseverance tend to be able to look up, down, in, at and all around a problem until they find the right answer.  Others don't want to invest that much in a job.  They tend to move on faster and that's fine for them. 
    One of the things she told me is that she likes her boss as a person, but doesn't want to come to resent her for limiting her to her boss's scope of possibilities.   It's difficult when two people can not come together and find a way to support each other.  On the one hand, it is the dentist's practice and she has the right to have everything the way she wants it.  On the other hand, she needs people to help her and has asked this person to invest something of herself in the success of the practice.  At some point she has to give her some of what will make her feel a sense of purpose and satisfaction if she wants to keep her.
     One final thing to consider is the fact that the other dentist is trying to hire her away from her current position.  I always have a problem with someone approaching a staff member who is working for someone else.  It justs seems inconsiderate to the current employer.  It will have an effect on that dentist's practice, possibly for a long time.  I think that would make me wonder about his character and really think twice about working for someone who would do that.
    I hope that they can get together and work it out.  The feeling I got from the e-mail was that this is what the manager would like.  Sometimes people really don't know how good they've got it till it's gone.  I hope these two will consider that before it's too late.  What would you tell her to do?

It Hurts When I Do That!

     Why do people insist on doing things that hurt them?  In the process they manage to spread that hurt around to everyone they come in contact with.  Their unhappiness becomes viral; infecting others who were feeling pretty good until the telltale symptoms of infection started  to manifest themselves.  Just like you take feeling well for granted until you feel lousy, you can take feeling carefree and happy as a given until you are dragged into someone's emotional misery.   
    Maybe misery really does love company.  After all, how miserable can you be by yourself?  It's a much more intense feeling if you can embroil your friends, family or co-workers in it with you.  If you don't watch out you can become addicted to the drama.  It can be difficult to let down the defenses you build in your unhappiness to let the sun shine through.  Once you start involving others, you may build an ally or two, but you will be more likely to isolate and alienate yourself.  Most people try to steer clear of unpleasant viruses.
    We had a situation recently in which one person was being a real curmudgeon.  She was dragging others into problems she was creating.  It could have been a real epidemic if it wasn't stopped in it's tracks.  What's a manager to do?  Serve, that's what.  Here's your opportunity.  When a child is sick, Mom serves.  She soothes, she sees to it that the child follows the proper protocol for recovery and she medicates as she deems necessary.  That's what a manager should do.  First, recognize the symptoms.  Next, a reasonable dose of empathy.  Finally, help the sufferer find the way to recovery.  There is always a way.  Recognize that the person is hurting and let them know you will help if they will accept it. Accept them as they are and help them understand their value.  Medicate with love and understanding and repeat as needed. 

Has Dentistry Created An Abnormal Normal?

    I was reading a post this week on Dentaltown from an assistant.  She considers herself to be amazing.  It sounds like she is committed and probably highly skilled.  She wonders why dentists don't appreciate assistants more.  I have to wonder, "What would enough appreciation be?  What would it sound like, look like, or feel like?"  How could the average dentist know he had hit the mark with his assistant?  How much time and effort should either of them put into worrying or thinking about this?  Shouldn't both be most concerned about the welfare of the patient? 
    It seems that dentistry is unique in the way it shows appreciation.  From what I hear, it's feast or famine.  Some dentists take their staff on cruises, give elaborate gifts and bonuses or over the top dinners complete with limo to and from the restaurant. Others do little more than give a paycheck.   A dental practice is a small business whose focus should be on providing excellent service to it's patients. That should be the main concern.  The hours are good; most offices work 4-4.5 days, with major holidays off.  Salaries seem to be where the abnormal stuff starts.  Some dentists seem to be totally confused about what constitutes a fair salary.  Different positions vary greatly in compensation causing a kind of watch dog effect.  "What are they doing that is more important than what I'm doing?" may be the thought.  Trying to keep the revolving door from spinning, dentists may give in to demands from employees that want higher salaries without giving better service.  They look at other practices and envy the extras that are provided there.  They don't take into consideration the differences in the circumstances of the dentists.  One may be in the midst of paying college tuition and looking ahead at graduations and weddings, while the other may have been there, done that, and now has a little extra to spend on his staff.  Either way the expectations seem to have become abnormal.
    It is normal to expect fair pay for a day's work.  It's normal to expect recognition for work that is above and beyond routine.  Thanks should be a two-way street.  The dentist should be grateful to a dedicated staff and the employee should be appreciative of a nice, clean place to work and a kind, considerate person to work for.  Anything beyond that is a gift.  Way beyond that begets abnormal.  That is what starts the jealousy and dissatisfaction ball in motion.  Recognize the difference and be happy and satisfied with what is normal and don't wish for what is not.  Remember, also, that everything is not always what it seems.  That super generous dentist may have to be exorbitant in his perks to make up for a bad temper.  Look at the positives that you have and find satisfaction there.  The need for bigger and better perks can become insatiable.  Find your reward in the service you offer and in the expressions of gratitude that you receive.

CELL PHONES AT WORK

   

Or let me put it this way.  CELL PHONES AT WORK!  They can create a huge distraction in a dental office.  I have actually seen a hygiene patient answer his cell phone as the hapless hygienist was about to proceed with his prophy, talk for 20 minutes while shooing the hygienist away as she beseeched him to hang up, and then fully expect to have his appointment continue.  When he was done, of course.  When I explained that we would have to reschedule he was incensed.  He couldn't believe it.  It didn't matter that he inconvenienced the hygienist and that we would have inconvenienced our next, and hopefully more considerate, patient.  Oh, well. 

    It's not just patients though.  Sometimes staff can get out of line with the darn things.  Our staff is so dedicated to patient care that I don't even have to say anything about this, they use their common sense and make calls on their own time.  Thanks, ladies.  But, I hear about it all the time.  Staff members going up the hall with buzzing, humming pockets.  Assistants peeking at text messages with one hand and suctioning with the other.  The heck with infection control, huh? 
    I, personally, would resent the intrusion into my concentration.  I think the interruption into the workday takes us away from a different aspect of our lives and holds us hostage to those who think nothing of butting in to our professional life.  I have to wonder how much respect they have for what we do for a living.  How much respect do you have for your work if you will let yourself be so distracted from what you are doing?  Maybe you need to find new ways to stimulate your interest in your career.  It may just be about prioritizing.  It's easy to get caught up in the soap opera of the minute to minute details of friend's lives. Maybe you think you'll miss something or don't want to be left out. Take control of your time and have respect for your employer and patients.  As I related a few weeks ago from personal experience; you are telling your patient they are not important when you talk on your cell phone when you should be caring for them.  Period.  No doubt about it.  Is that the message you want to give them? 
    Employers, how do you handle cell phone usage at work?  Employees, what do you think is reasonable?  I started thinking about this after reading Ellen Weber's article here.   If you leave an answer for me, copy it and pop on over to her site and paste it there.  We're both curious about this.

Hanging On

    I've been writing a lot lately about what managers can do to help motivate employees and wondering aloud about how to proceed when it becomes apparent that an employee just doesn't want to, or can't keep progressing. 
    What if you're the employee who just isn't cutting it?  What can you do to save your job?  Well, first, decide if this is really where you want to be.  If the answer is yes, go all out for it.  You have some making up to do.  Don't just come in and do the same thing that wasn't working the day before.  Give a little extra effort.  Come in a little early, leave a little late.  Be more productive in any way you can until you figure out how to give them what they want.  Ask this question:  "What can I do better this week to make you believe that I can do this job?"  Then, do that and a little more.  Next week, ask the same question.  Keep asking.  Don't blame anyone else.  Make up your mind to find inspiration inside yourself.  Ask your supervisor to meet with you for 10 minutes at the end of every week to tell you what you did better and what you need to shoot for next week.  Just seeing that you care and are willing to put forth some effort can go a long way in making your manager pick up the towel she might have thrown in.  It's easier for her if you make it work, she won't have to hire and train someone else.  Don't be belligerent or try to blame others or whine that you're being asked to do too much.  There's someone coming up the street that can and will do what you won't.  Maintain your dignity.  Don't start a campaign to make everyone feel sorry for you and don't try to turn them against your manager or boss.  You will make yourself an untouchable.  Most people need their jobs so don't ask them to risk it by  commiserating with you. 
    Focus.  Identify what you need to do and do it.  Ask for help, guidance, information and support.  That's smart and your manager really does want you to succeed.  Here's a secret for you.  Manager's want the staff to do well.  If nothing else, it is a reflection on how well they are doing that part of their job.  Most managers will work hard to help an employee who is struggling but wants to do better.  The worm turns when the employee makes excuses, blames anyone but themself, feels victimized, pouts, sulks or doesn't try.  There is a point when a manager will have to look at the situation as a whole and gauge the effect the individual is having on the group, on the level of service to the patients and on the health of the practice.  When that time comes, the manager's sensibilities will shift away from concern for the welfare of the employee, and  to the responsibility they have accepted to do what is right for the practice as a whole.  Don't fall one step behind that process.  It is difficult for a manager to give up the belief they have in an employee, and once they do it is hard to regain.  Make life easier for everyone and don't let it get that far.  If you love your job and for some reason find that you've gotten yourself into a situation that demands you change if you want to hang on, then face it, find out how to fix it, and make it happen.  Hang on and be determined to make each day better than the one before.  You can do it if you want to.

Letting Go?

    I'm putting this out there to see what you think.  Many times managers face a dilemma about what to do when an employee just can't or won't perform satisfactorily.  For some reason, it seems to become the manager's failing as well as, or as opposed to, the employee's.  This may be only in the manager's mind, or it may be that some of the other people on the staff and the employee themself want to lay the blame at the manager's feet.  Should the manager pick it up and shroud themself in it?  It depends.  I believe that people that have reached the age of reason are responsible for themselves.  If you accept a position, it is ultimately up to you to make yourself fit for it.  The manager has their own responsibility to live up to the requirements of their position and hopefully will aid you in learning what you need to perform your duties well.  If it doesn't happen, you must figure out a way to acquire the tools to do your job; if you want to keep your job. 
    So many people want to look outside themselves for the reason for their failures.  Many times it all comes down to a refusal to face reality.  The reality is, if you want to stay valuable, current, employable; you must progress.  You must keep learning and acquiring the latest knowledge and master new concepts. You must continue to maintain a good attitude, even when things are challenging.  As a manager, I see my responsibility as being a conduit for the staff members.  I direct resources to them and direct them to resources.  Sometimes I am one of their resources and then I do my best to impart to them the information they need or to guide them in learning new skills.  It is a pleasure and a privilege to mentor a person who is eager and grateful to learn.  That is a gift.  It is frustrating and dismaying to repeat the same instruction over and over to someone who is resistant or rebellious about accepting new responsibilities or who refuses to believe in their capacity or ability to grow. 
    My question to you is, at what point do you know that you've done all you can and decide to help the employee accept the fact that they may be more comfortable elsewhere.  I believe that when it becomes a daily struggle and there is no acceptance of or desire for help, it is time to take a hard look at the viability of the situation.  In this case, dispositions begin to sour and the atmosphere of the office can take on the pall of the sickroom.  Something is unwell and frail here and it can be contagious. 
    Who is to blame?  Maybe no one.  Maybe it's just a situation that can't work for the combination of people involved and the abilities needed.  Maybe it's OK to say enough.  Maybe it will prevent further erosion of the spirit and self-confidence for both the manager and the employee.  Is there a way to make the transition less painful and disheartening?  What do you think?  What do you do? How have you felt if you've been in either position?   I'd love to hear some thoughts on this. 

She Drives Me Crazy!!!

   

We all know someone like that.  Sometimes it's someone we work with.  That can be a big problem.  On one of my previous posts, Elizabeth talked about a co-worker that she has some real problems with.  It's easy to give advice and say that she should rise above it and find a way to carry on professionally.  It's hard to put that advice into practice when you're in the middle of it, though.  All good intentions can be forgotten in the middle of an antagonistic encounter.  So, what can you do? 
    This is a real dilemma.  If both people don't want to fix the problem, it may remain and simmer into a final show down.  Other staff members can get drawn into it and sides will probably be taken.  A once healthy environment can succumb to the misery.  Once that happens, recovery is difficult and sometimes impossible.
    What will change the situation?  You know the old saying, "It takes two to tango".  I know, making it sound simple is really annoying.  And you're right, it's hard to act like every thing's OK when it's not.  It's torture to watch someone who's driving you crazy get away with it.  But, what are they getting away with?  Being immature, vindictive, destructive or petty?  Let them have it.  They must be pretty unhappy if they try so hard to get others to join in their wretchedness.  Try to think of that the next time you're in a situation like that.  You have the freedom to choose how to respond to every situation.  It's no fun to mud wrestle alone.  So don't jump in the pit.  Deny them the win.  Go on your way and get on with your life.  It's not easy, it's hard, but it's the right thing to do.
    Feel free to share your solutions to this dilemma by clicking on comment.

What Am I Anyway?

    Lately it seems like there are a lot of people working in dental offices that don't know who they are.  By that I mean specifically, they don't know if they are a receptionist, a scheduling assistant or a practice manager.  Sometimes it sounds to me as if they like the way the title practice manager sounds so they decide that's what they'll be.  It doesn't sound like their bosses are being too clear about it either, so that doesn't help.
    Let's clear this up.  A practice manager runs the business in accordance with the dentist's wishes.  She keeps the dentist informed, hopefully they meet regularly and discuss issues and decisions, and she handles it all.  She supervises the staff and that includes hiring, dismissing, training, staff meetings,  discussing problems, mediating, and performance reviews.  She makes sure the office manual is kept up to date and followed.  She tracks the business stats and follows up on account receivable and scheduling.  In some offices she may handle financial arrangements and treatment presentation.  She makes sure service people are called when needed and keeps track of ordering and production.  It may vary from office to office.  In some offices the dentist's wife may handle payroll and payables or the office manager may do that, too. 
    Answering the phones, scheduling appointments and taking payments are handled by the receptionist.  In addition there may be a scheduling secretary or someone to handle insurance.  Those jobs take a lot of poise and concentration on the patient. If one person is trying to do all that and manage the practice, something or someone will probably suffer.
    A great practice manager can set the dentist free to concentrate on dentistry and keep the staff operating smoothly and the patients happy and well-served. 
    If you're not sure what your job description or title is, it may be a good idea to ask your boss if you can talk to him or her.  They may be surprised to realize that you've grown into a leadership role and may want to encourage you to continue. 
    If you own a practice that has an employee that shows leadership ability, why not consider appointing her manager.  It could be such a great thing for you that you may wonder why you didn't think of it before.  As long as everyone gets on the same bus, you might really find yourself going somewhere fantastic.

Hygiene Holes

    This seems to be a pretty common problem.  People just don't value their hygiene appointment; or so it seems.  You start out the day with a fairly full schedule and they just don't show up.  Or, you go through phases were nobody wants to schedule.  How do you fix it?
    We had a big problem a year ago.  We had 2 full-time hygienists whose schedules were 75% full.  That seemed to say that we didn't have enough work for 2 full-time hygienists.  We look at the personal aspect of our team members.  We couldn't just tell one that she would have to forfeit her full-time status and lose pay and benefits and feel OK about it.  So we had to fill those schedules.
    We started a soft tissue management program.  That almost immediately did the trick. For a while. About 6 months to be exact.  Now that all of those people have had their initial treatment, things are slowing down a little.  Many times we get the schedule filled only to watch it disintegrate.  So now what?
    Confirming is key.  Personally confirming.  Patients will blow off a voice on the machine as if it never really was there to begin with.  They will call after hours to cancel to avoid the broken appointment fee.  I have let our receptionist know that she is responsible for the schedule.  Period.  She must confirm.  If she can't get them during working hours, I am willing to take a list of unconfirmed patients home and call them.  If we have patients that habitually break appointments, we ask for the best number to reach them.  We charge starting at the second broken appointment.  After 3 broken appointments they are only given same day appointments.  If they call and we have an opening that day we will put them in it.  We don't give patients who habitually cancel another appointment in the same week.  That de-values the appointment.  They think we have plenty of openings so if they cancel today they can always come in tomorrow.
    The hygienists also take responsibility.  They don't read magazines during downtime.  They work the continuing care and unscheduled lists.  They do chart audits and make re-activation calls.  They know they need to keep their schedules healthy and they want to. 
    You can see it's a team effort with the emphasis on success.  When everybody takes a part in fixing a problem, everybody has the right to celebrate it's resolution.  And we love to celebrate!

What's Up With That??

    Have you ever tried to tell a staff member about an aspect of their performance that needed improvement only to be met with defensiveness and maybe even a touch of hostility?  You tried to be empathetic and approached the employee with a solution and let them know that most of what they are doing is just fine and rather than accepting the feedback they responded by getting angry or acting hurt and pouting.  Now if this was an employee who had numerous unattractive characteristics, you could decide that they might be happier working elsewhere.  But if the staff member is otherwise a good employee, you may have a dilemma. 
    When this happens, I tell employees that the fact that I am discussing the solution with them is telling them that I believe that they can make the necessary changes and succeed.  If I didn't believe that, we'd be having a different discussion.  Sometimes that is all it takes but other times there is still a show of hurt feelings and if it doesn't end in a reasonable time then we have another problem and solution to discuss.
    So, what do you do?  Do you think it's an issue with the delivery of the problem and solution or could it be a lack of confidence or self-esteem on the part of the staff member?  Is it up to the manager to help build up the staff member, does the staff member need to find a way to help themselves or should it be a joint project?  I love to see people flourish and grow in confidence but I have little patience for mediocrity.  How do you approach this reaction to constructive criticism?

Yo! Knock It Off!

    Can't say that, now can you?  What can you say when a patient is exhibiting behavior that bugs you?  For example, today I had a patient who was obviously staring at my chest.  I don't like that.  He finally said "Do you know you breathe fast?".  I said "Is that why you are staring at my chest, are you counting my respirations?"  He replied he was and began to resume the offensive staring and counting.  I asked him to stop and he smiled a lecherous smile and continued.  I informed him that I was leaving the room and would come back in when he was ready to focus on something else.  He finally gave in and I returned.  He commented that I was no fun.
    So, was there a better way to handle this?  This is a guy who bullies the staff and would like to bully the dentist if he could (and sometimes does).  It's hard to keep a sense of humor around him but would probably go a long way toward not giving him the satisfaction of knowing he got to me.  I also want to maintain my professionalism even if he is begging me to abandon it and give him a big noogie.
    He's coming back for his crown cement in 3 weeks and will probably take that opportunity to check my pulmonary function again.  Should I stuff my scrub top with Charmin, wear a catcher's chest protector, or how about a sign across my chest that says staring at this sign will cause blindness?  What would you do or say?  Click comment and give me some good ideas!

GRUMPY OLD MEN(and women and kids and other 2-legged creatures with teeth)

You know them.  You can see them coming.  They walk through the door, you smile and say "Good Morning Mr. Sourpuss" and he glares at you and says "What's good about it, I'm at the dentist, aren't I?". 
What do you do?  You can't tell him not to let the door smack him in the butt on the way out(even though you may fantasize about it).  No, you must put on your psychologist cap and make a quick decision on how to react.  Having a few tried and true stock reactions can help.  What other tactics are successful for you?  Share your ideas here and feel free to add your dilemma for discussion.