Hiring and Retaining Good Employees

by Michael Kurtz, MS, MBA

The single most important task that contributes to practice success is getting the employment process right. Doing so will give you a competitive edge.

French philosopher and political commentator Jean Baudrillard used the term postmodernism to reflect the dramatic changes and turmoil we see in life today. Globalism, an increase in consumerism, mobility of workers, increased diversity, the decline of the nuclear family, and increasing access to information shape today’s postmodern world.

Under the onslaught of postmodernism, boundaries and distinctions have become blurred. Some of the losses associated with the collapse of traditional distinctions have been trivial, but others have been earthshaking, and there’s no way to distinguish between the two. As a result, people no longer know where the lines fall.

Employees in this environment are much more likely to question authority. They will move to another job for a higher salary or at the first sign of conflict or dissatisfaction with working conditions. Given this, the human resource component of managing a dental practice can be daunting. If handled poorly, it can create chaos that results in a negative impact on the bottom line.

Consider this. A recent Gallup survey found that 71 percent of American workers are not engaged in their work. According to Martha Irvine, in an article in the St. Louis Post-Dispatch, today’s generation has the reputation of expecting a high salary and flexibility, yet has little willingness to take on grunt work or remain loyal. Simply put, yesterday’s rules - where ability plus motivation plus environment equaled performance - do not apply.

In fact, many management gurus now believe it’s a myth that people are the greatest asset of an organization. The right people are the greatest asset of an organization. So the challenge is to get the wrong people off the bus and the right people on it. This article is a primer for hiring and retaining good employees, and hopefully it will provide you with the tools necessary to build a winning staff.

Begin by taking a T-inventory of your current staff. Divide them into the three T’s: terrorists, transmitters of the status quo, and transformers.

Terrorists are easy to identify. They are the negative types who consistently perform poorly and drag down the rest of the staff. They convey a simple message to patients: go somewhere else! These staff members are like termites. By the time you realize they are terrorists, they have already done considerable damage.

Transmitters of the status quo are the ultimate average employees. More often than not, transmitters do what they are told and nothing more. These employees show up for work every day and make few mistakes. However, alongside a terrorist, they can be easily swayed to the dark side. Most employees fall into this category.

Transformers are those rare employees who are always positive and go out of their way to exceed patient expectations. They see themselves as stakeholders in your practice. Transformers exhibit what Daniel Goleman calls emotional intelligence (EQ). Emotionally intelligent employees recognize feelings, are better at mood management, and are self-motivated and able to direct themselves toward a goal. They recognize feelings in others and are good at tuning in to verbal and nonverbal cues. Cooperation is their hallmark. People with high EQs understand the importance of managing relationships, handling interpersonal interaction, resolving conflict, and negotiating. Most hiring managers today agree that a high EQ supersedes a high IQ.

Most dental practices that go through this exercise realize that the single most important task that contributes to practice success is getting the employment process right. Taking an inventory of team members makes dentists aware of the need to rid their practices of the toxic drip of the terrorist and to transform the practice by attracting transforming staff members. Transformers pull up the transmitters, which leads to increased patient satisfaction and profit growth. Like taking inventory in a retail business, the T-inventory plays a significant part in assessing the performance and condition of your staff.

It is absolutely essential to develop accurate job descriptions. This includes a brief list of principal job responsibilities, a list of the knowledge skills and abilities required, education or licensure required, pay range for the position, and a summary of the working conditions. Most practices use job descriptions as a prequel to hiring.

But developing a job description is where most practices stop. To hire and retain emotionally intelligent employees who expect more from their employers, another step is necessary. Job enrichment motivates employees by giving them a career track that includes higher pay, increased responsibility, and variety. As the job becomes more interesting, employees become more energized. This has a positive impact on attitude and productivity and allows employees to have more control planning their work and deciding how it should be accomplished.

This taps into the natural desire most employees have to do a good job, to be appreciated for their contributions, and to become stakeholders. Consequently, it may be beneficial to review your job descriptions to ensure that your practice is maximizing all of the available energy. An example of this would be to have different job descriptions for a specific category - such as dental assistant I, dental assistant II, and dental assistant III - with tiered responsibilities and tasks.

The next step is to develop a job application form. Many practices simply ask for a curriculum vitae or resume. However, it’s important to remember this is the candidate’s marketing material. The goal of the job application is to find out things the candidate is unwilling to tell upfront but that you need to know to decide whether or not to bring him or her in for an interview. It also avoids wasting time interviewing candidates with no chance of getting hired.

Appropriate items for a job application include a work history, salary history, reason for leaving previous employment, and at least three professional references. Include a check box to allow the candidate to consent to a criminal record check and drug screening along with permission to check references.

With the job descriptions and applications developed, it’s time to get down and dirty with recruitment. Advertising in local newspapers or dental society publications is often very effective. Depending on the position offered and the job market in your community, it may be necessary to engage the services of a recruitment firm. Having a larger pool of applicants improves your chances of finding the one who will transform your practice. A very important but often violated rule is that no one should be hired out of desperation to put a warm body chairside. The cost of using a temporary agency pales in comparison to the damage that can result from hiring the wrong person.

Candidates who make the cut should be invited to a personal interview. Always have more than one person interview candidates because they can often pinpoint strengths and weaknesses you may have missed. Preselect questions for the interview and ask the same questions of all applicants to avoid bias. Questions might include: Why are you applying for this position? What made you choose this field of employment? How might you calm a nervous or angry patient? Why are you leaving your current position? Why do you feel you are the best candidate for this position?

After you have narrowed your candidates to one or two finalists, conduct a second interview. This often gives you a clearer definition of the candidate. It does not matter if you think you’ve found the diamond in the rough or may lose the candidate to competing job offers. Always take the extra time to check references and perform a criminal record check and a substance abuse screening. There are a number of companies that provide these services to small businesses for a nominal fee with a short turn-around time.

Even though we said that the most important thing practice managers do is hire, it in no way implies that this is the end of the staffing process. A well-designed orientation program can make a new employee productive from the first day. This first day should be a celebration, with either a breakfast or lunch period where the new employee can be introduced to everyone in the practice.

Assign a preceptor to the new employee. This is a staff member who is responsible for making sure the newbie is welcomed and who will serve as both trainer and mentor throughout the orientation period.

To ensure the orientation is complete, create a new employee orientation checklist and start a personnel file that includes the job application, interview records, reference check information, and verifications of any credentials or certifications. Complete any necessary paperwork such as INS Form I-9, employment eligibility verification, employment agreement, receipt of your employee handbook, W-4 form for payroll withholding, personal data sheet for emergency contacts, home address and telephone number, Social Security number, benefit coverage election, and beneficiary designation forms.

In the first few days, the preceptor should explain the following practices and procedures of your organization, which should also be carefully addressed in your employee handbook: work hours and attendance/tardiness policy, payroll periods, when paychecks are delivered and when first check will arrive, rates of pay, overtime rules, parking arrangements, dress code, and training or introductory employment periods. The handbook should also contain all employee benefits for which the new employee is or may become eligible including medical insurance, sick leave, vacation, personal leave, jury duty, holidays, pension programs, savings programs and/or stock plans, and life, disability, and accident insurance.

Also provide the new employee with copies of the following documents: employee handbook, safety plan, letter explaining COBRA (Consolidated Omnibus Budget Reconciliation Act of 1988) governing continuation of benefits following payroll separation, and an employee benefit booklet explaining each offered benefit. Show the employee any marketing or informational materials used with your patients. Play any video or audiotapes you have prepared for employees or patients that explain your practice’s offerings. Explain your practice’s mission and philosophy.

Orientation should continue with in-depth training of technical and clinical aspects related to the employee’s specific job. The preceptor and new staff member are accountable for the training’s success. The orientation period ends with a formal evaluation of performance during this time.

Before you can accurately evaluate an employee’s performance, you must establish a system to measure that performance. This entails the development of performance standards and goals appropriate to each position. Performance standards describe what workers in a particular job should accomplish and how you want the job done. These standards apply to every employee who holds the same position.

For example, a standard for a practice manager might be to maintain accounts receivable at no more than 45 days’ unadjusted production. Make sure your standards are achievable and directly related to the employee’s job.

Unlike performance standards, tailor goals to each employee and keep in mind the individual’s strengths and weaknesses. For example, a goal for a dental assistant might be to become certified with expanded function. Your staff can help you figure out what reasonable goals should be.

The first performance review should take place immediately after the 90-day orientation period. This period is designed to make sure that the employee is a good fit for the practice. If for any reason you believe the person is not a good fit, then both parties can engage in a “no-fault divorce,” and the employee can be released. This serves as a fail-safe for mistakes or misperceptions. Schedule other performance reviews at six months and one year. Subsequent reviews are done annually unless performance lags.

Deal with poor performance issues immediately and follow up with a performance improvement plan that documents the areas of performance that need improvement, what the employee needs to do to correct the poor performance, and the consequences of not making the improvements up to and including termination. Termination of a poor performer should never come as a surprise to an employee. A record of poor performance should be well documented. If done correctly, litigation will never be an issue. On the other hand, a practice should never use fear or threat of litigation to keep a poorly performing employee.

Michael Kurtz, MS, MBA, is manager of laboratory outreach for St. John’s Mercy Medical Center in St. Louis, Mo., and president of Provident Practice Group, a practice-management consulting firm assisting physicians and dentists. E-mail Kurtz at [email protected].

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How To Hire Good Employees

• Take an inventory of your current team members.
• Develop accurate job descriptions.
• Develop a job application form.
• Employ effective advertising techniques.
• Conduct personal interviews using preselected questions.
• Conduct second interviews with the finalists.
• Check references and perform criminal record checks and substance abuse screening.
• Use a well-designed orientation program.
• Establish a system to measure performance periodically.
• Deal with poor performance issues immediately and follow up on areas that need improvement.