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February 14, 2009

By Lynne H. Slim, RDH, MS, and Fran Pangakis, RDH

It was a typical Monday afternoon in Dr. King's general dental practice. As a young doc, he had holes in his schedule but his hygienist, Mary, had a pretty busy schedule. Mrs. Brown was bringing in all five of her "Rugrats" for hygiene care and she was also scheduled for periodontal maintenance.

When Mrs. Brown arrived, she was concerned. Her youngest child, Kevin, hadn't slept well the night before because he had a broken primary molar and it was painful to the touch. His cheek was swollen and he wasn't interested in eating. She suggested to the receptionist that Kevin be seen by the doctor ASAP, and she was also concerned that he wouldn't be cooperative in the hygiene operatory that day.

Dr. King, who had plenty of open time on his schedule that afternoon, e-mailed the receptionist from his office and told her that he would evaluate Kevin in the hygiene operatory after Mary had taken a periapical radiograph and had completed the preventive services. When it was Kevin's turn to visit with Mary, he wouldn't sit in the dental chair. Mary, feeling very frustrated, called in Dr. King who became agitated at seeing the child in tears. He was able to see the tooth in question and then abruptly left the operatory.

Mary, not knowing what to do at this point, went about her business and decided to introduce Kevin to a spin brush. As she was showing the screaming child how to use it, Mrs. Brown decided to walk in and check on Kevin (who was now crying uncontrollably). She, too, ended up in tears and asked Mary to dismiss Kevin immediately. Kevin and his mother hugged and left the hygiene operatory. After Mrs. Brown checked out and took her children home, she called the office and asked that the family's dental records be sent to another dentist in the local community.

What on earth went wrong here, and how could this situation have been handled differently? When does trying to do the right thing go wrong? Is this scenario common in dental practices today, and is it a communication issue or something more?

The aforementioned scenario and many others just like it are good examples of underestimating the power of feelings, and it's a very common problem in any workplace. From the 1990s to the present, a new appreciation for an aspect of intelligence called emotional/social intelligence has emerged. Unlike other behavioral profiles that focus only on personality assessment, psychological assessment tools exist that include emotional intelligence (EQ).

What is EQ and from where did it originate?

Over the past century, measures of general intelligence have focused mostly on mental abilities such as verbal, spatial, and related logical information processing.(1) From the 1990s to present, researchers have further explored the possibility that measured intelligences are more diverse and include an understanding of human relationships along with other life outcomes including work performance, social relationships, and the attainment of psychological well-being.(1)

EQ is now considered to be a powerful predictor of important life outcomes, but it's tough to define. Simply stated, it's the mental ability to reason about emotions and to use emotions to enhance thoughts.(2) In other words, if we are emotionally intelligent, we let our emotions inform us but we are not ruled by them in our day-to-day decision making. Daniel Goleman, who started writing about emotional intelligence in the 1990s and who has authored several books and numerous articles on the subject, refers to EQ as "just another way of being smart."

In reviewing a Web site from the University of New Hampshire on EQ, John Mayer, his research partner Peter Salovey, and others developed the concept of emotional intelligence and worked on understanding what it predicts.(2) Their predictions can be summarized as follows: "People with higher emotional intelligence are likely to have better social support, and fewer problematic interactions with others."(2) They also discovered that people with higher EQ tend to demonstrate the following:

1. They are less likely to abuse drugs and alcohol.

2. They are more satisfied with their social networks and appear to receive more social support.

3. They are better able to successfully avoid interpersonal arguments and fights. It is also possible that groups that possess higher average EQ may behave in a more peaceful manner.(2)

EQ and the dental practice environment

In tough economic times, leaders and individual team members can be taught to manage emotions for the good of the practice. If a leader drives emotions in the wrong direction, all the money spent on practice management, consulting/coaching, and continuing education will be wasted and changes will not stick.(5) Let's look at Table 1 and discuss the four domains (skills) that make up EQ.

Many dental teams around the United States receive some type of training from practice-management consultants using the DISC® classic personality assessment tool. The DISC® classic assessment focuses on communication styles, personality, and behaviors. Besides these psychological attributes, it's also important to recognize the role of emotions in the workplace, especially in the following areas:

1. Being aware of one's own emotions and how they impact others

2. Being able to manage one's own emotions, especially in front of patients

3. Being sensitive to the emotions of others

4. Being able to respond to and negotiate with other people emotionally

5. Being able to use one's own emotions to motivate oneself or others

For whatever reason, people who are skilled in EQ seem to recognize and respond more appropriately to their own emotions and they can better express their feelings to others. They also tend to be more talented at recognizing other people's emotional responses and can respond with the appropriate degree of empathy.(3)

Have you ever met someone who seems to be able to gauge someone else's response to a crisis and can respond to that person in just the right way? They oftentimes respond with a personal touch and are perceived as warm and genuine. This is a good example of someone with high EQ.

Emotionally intelligent individuals are also adept at regulating emotion and moods. Moody office managers or dentists who bark at employees on Monday and Wednesday but who are more even-keeled on Tuesday and Thursday confuse their teams and patients as well. Emotional variations in mood lead to tremendous stress and are demotivating. Individuals with negative or fluctuating moods are also known to affect creative thinking negatively, and it's hard to solve problems when emotions are not in check.(3)

Goleman has written extensively on EQ in the workplace and he proposes ways that individuals can be more effective and cooperative team members, and he even talks about improving technical skills at all job levels.(3) One of his hypotheses is that EQ can be learned and it improves with age. That's good news for many of the baby boomer practitioners out there!

In one study of 450 boys who were raised in Massachusetts, IQ was found to have little impact on success later in life.(3) (These boys were followed for 40 years.) Instead, abilities like being able to handle frustration, control emotion, and get along with others were demonstrated to be more influential for later success.(3) In another study of nurse leaders, high-scoring nurses appeared to demonstrate heightened emotional awareness of both themselves and others, and the researcher identified emotional awareness of self and others to be the underlying cornerstone of EQ. Nurse leaders with high EQ were able to manage their own emotions while tending to the emotions of staff, patients, and family.(3)

It's time to ratchet up behavioral profiles in dentistry to include EQ testing because it's an important piece in the competitive workplace.

Let's take another look at the introductory scenario between Dr. King, his hygienist, Mary, Mrs. Brown, and her son, Kevin. Dr. King and Mary may not have understood themselves well enough to be able to reach out to their young patient, Kevin, who was in obvious pain. Here were some of the reasons why both Dr. King and Mary failed their patient:

1. In an emotionally charged atmosphere, it's not the time to conduct business as usual. Mrs. Brown's concerns about her youngest son were dismissed even before Kevin was seen by Mary. This is a good example of good intentions by all team members that went terribly wrong.

2. Dr. King distanced himself from the situation when he entered the operatory and walked out on his patient and hygienist who both needed him at the time.

3. Neither Dr. King nor Mary displayed empathy toward a child with a broken primary molar that was causing him pain.

4. Mary was going through the motions of being the conscientious dental hygienist and she was teaching a crying child how to brush his teeth. What good would that do?

5. What was Mrs. Brown thinking when she walked to the back and saw Mary attempting to teach Kevin to use a spin brush? She was probably thinking of nothing else but her son's fear and discomfort and she was probably feeling confused and angry herself. This was an emotionally charged situation that was handled poorly by everyone concerned.

Emotionally intelligent dental teams and leaders

Everyone wants to take his or her team to the next level but there are very few dental practices that have learned how to apply "collective" emotional intelligence. Let's try to learn from this team's disastrous monthly staff meeting: The entire team of Happy Tooth Dental Care (with the exception of one employee) is gathered together for the usual one-hour monthly meeting which is scheduled before lunch. Even before the meeting begins, the office manager and two of the practice's dental assistants want to discuss something that happened which involved the third dental assistant who is absent from the meeting that day and cannot defend herself. The two assistants accuse the third absent dental assistant of not performing adequate infection control and the discussion goes on for about 45 minutes. The owner of the practice telephones the dental assistant after the meeting is over and he lets her know that she was the sole topic of discussion at the monthly meeting. He then tells her that she is going to have to fix the problem by taking an infection-control course because the entire team is upset. When the third assistant returns to work, she is given the cold shoulder by the entire team and she fights back tears the entire day. She wasn't able to defend herself and feels that she was treated unfairly. In the end, she resigns because she feels disrespected and moves on. It's fairly obvious here that the dentist and office manager, as leaders of the practice, displayed poor judgment by allowing this discussion to take place. Dental teams need to learn to discuss emotions openly at staff meetings but obviously the absent employee was being picked on and she wasn't even there to explain her actions to the group.

Dental teams can learn to function better by being coached in team emotional intelligence. Training in EQ intelligence skills benefits the entire group and is a learned skill in which there is an awareness of emotional interactions that harm the team's performance. Individuals in the team seek to understand each other so they can focus on the bigger picture.(4)

Imagine what you would hear if you sat in a staff meeting where participants were discussing ideal traits that a leader should possess. In asking the questions below, responses include issues that have nothing to do with intellect or skill level. See Table 2 to view ideal leadership traits. Effective leaders typically demonstrate strong emotional intelligence traits such as self- and social awareness, good communication skills, empathy, and the ability to manage team conflicts.

EQ assessment

Table 3 is an example of an assessment tool that was developed to assess the emotional intelligence of a group of registered dental hygienists.

During this self-assessment, the emotionally intelligent person would circle all 3's. Do we live in a world in which we are "mindful" of our emotions or are we living and working "mindlessly"? In the world of mindless living, individuals go about their business without listening to their bodies and feelings or recognizing the feelings of others. Think of the complexity of the human psyche as being like one of those Russian nested dolls: most of the time we only see the outer persona, but as you look below the surface, there are many hidden complexities and it's important to study all of the layers. Emotional intelligence requires a unique form of intelligence and one in which a range of emotions in various domains are managed effectively.

Team behavioral profiles that focus exclusively on personality traits are incomplete without consideration of EQ. Leaders and individual team members can learn how to adapt their own emotional intelligence skills and discover the secret behind exceptionally productive and compassionate performance.

Emotional intelligence matters and it influences virtually everything that a person does and says. In our present understanding of EQ, we have learned that modifying one small action, on a daily basis, has a positive ripple effect in daily interactions with people. EQ is a powerful force in many aspects of the business environment, and a dental practice — like any corporation or other small business — can realize improved business results and morale as a result of EQ coaching.

Lynne Slim, RDH, MS, is the perio therapy columnist for RDH magazine and an award-winning dental author who has published extensively in dental/dental hygiene journals. Lynne is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of evidence-based periodontal therapy into the hygiene department of the general dental practice. She coaches dental hygienists and dentists in advanced hygiene initiatives, which includes emotional intelligence testing. Lynne is also the owner and moderator of the periotherapist yahoo group: www.yahoogroups.com/group/periotherapist. She welcomes speaking engagements on the topic of conservative periodontal therapy and other dental hygiene-related topics. Lynne can be reached at: periocdent@mindspring.com or www.periocdent.com.

Fran Pangakis, RDH, brings more than 30 years' experience in dentistry to her consulting business, with career experience as a dental hygienist, assistant and business manager. For the past seven years she has been working toward blending her clinical and coaching skills to provide transformational solutions. As a practicing dental hygienist, Fran's passion was creating relationships with her patients by understanding their wants and needs, and supporting them in achieving their oral health goals. During her clinical career she was very lucky to be part of a dynamic dental team that supported her desire to become a consultant/coach, and who remain a valued client to this day. Fran is a certified training and development professional with extensive skills in facilitation, communications, training, coaching, and professional development. One area of expertise is working with leaders and their teams by using performance management assessments to unlock talent by tapping into Emotional Intelligence factors and behavioral traits. She is a certified consultant with the human resource and personnel policy firm Bent Ericksen & Associates, as well as being their lead certified consultant for Integrated Performance Management (IPM). IPM is a tool that is used for hiring, team building, leadership development, and employee motivation. Fran proudly serves on the board of directors for Career Fusion as well as being one of their coaches. Career Fusion is the leading retreat for dental professionals who are looking to create possibilities for their futures through exploring opportunities. The Career Fusion coaches are dedicated to exploring, creating, and transforming opportunities. Fran also coaches other consultants on how to achieve their goals and "make the impossible possible." She is also a member of the Academy of Dental Management Consultants since 2004. You may contact her by e-mail at PangakisF@aol.com.

References

1. Mayer JD, Caruso D, Salovey P. Emotional intelligence meets traditional standards for an intelligence. Intelligence 1999; 27:267-298.
2. http://www.unh.edu/emotional_intelligence
3. Dorset Research and Development Group. http://www.emotionalprocessing.org.uk/Sundry files/Contributions.htm. Accessed: 9/15/08.
4. Bradberry T, Greaves J. The emotional intelligence QuickBook. New York: Fireside. 2005.
5. Goleman D, Boyatzis R, McKee A. Primal leadership. Massachusetts: Harvard Business School Press. 2002.

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