A time to share good ideas

Dec. 1, 1997
The suggestion to host staff meetings is enough to make many of us groan loudly. But routine meetings do improve productivity. Goals are met, and there`s even time for lunch.

The suggestion to host staff meetings is enough to make many of us groan loudly. But routine meetings do improve productivity. Goals are met, and there`s even time for lunch.

James Pride, DDS

It`s not news to any of us - dentistry is an industry in transition. The good news is that dentists have more leeway than most other entrepreneurs. And more good news is that guidelines are being developed on an ongoing basis to help steer dental practices through these times.

Fortunately, we have a commodity that will never cease to be viable. People around the world are increasingly more health-conscious. People expect to have normal, pain-free function. Cosmetically, people want their mouths to look attractive. In other words, dentistry is not just some fad that will dry up and blow away. Dentists will never become obsolete, unlike so many other commodities that are here today and gone tomorrow. How would you like to be an entrepreneur in the every-changing computer industry?

If we have any challenge, it is to run our practices like bonafide businesses. By that, I mean following those time-proven principles that all successful companies espouse to: listening to customers, communicating within the ranks, analyzing financials, training employees, and monitoring the results. These business activities are part of a necessary cycle. There is no such thing as "finishing" any of them. They may overlap each other. They change as daily and monthly priorities dictate, but they are always with us.

Dentistry`s unique challenge is how to find time in the day to perform the business side of the business. After all, how can dentists possibly have time for critical business tasks when they are delivering the commodity of clinical excellence?

In a word, meetings. Before you stop reading and throw up your hands, read on. The jury`s in on whether or not meetings are a productive use of time in the dental office. Practices that conduct regular business meetings experience as much as a 30 percent increase in production. Consider that hefty statistic, and then consider the fact that these practices are conducting their meetings during time that would otherwise be available to patients - yet the net result is a gain in production.

Business meetings can be a tremendous waste of time in any industry, if poorly conducted. The trick is to master the art of conducting meetings, as well as to have some basic practice management principles in place in your office to support the process.

Successful businesses around the world operate on meeting power, and no business has just one type of meeting. Boards of directors` meetings, financial meetings, managers` meetings, staff meetings, planning meetings, marketing meetings, training meetings, budget meetings ... the list goes on and on.

Consider yourself fortunate, then, that there are just four types of meetings which enable the dental practice to function as a successful business. They are the morning huddle, the trend indicator meeting, the implementation (or training) meeting, and the open agenda meeting. Let`s look at each in some detail.

The team meets daily for the morning huddle. The morning huddle is a brief meeting to set strategy for the day, just like its counterpart in football. The "plays" are studied beforehand, and each team member is prepared to share important information during this 10- to 20-minute meeting.

During administrative time at the end of the previous day, team members complete the huddle preparation form pertinent to their position. Completion of these forms takes 15 minutes or less each day. This time is more than recouped in better organization the following day due to enhanced communication between the front and back, better patient service and the overall improved production of the dental practice.

Armed with the specific information each team member has gathered, the team follows a consistent huddle agenda to discuss:

- Specifics about the previous day. How could the schedule have been tighter? How were cancellations and no-shows addressed? What can be avoided next time, and how will it be done differently?

- Specifics about today`s schedule. Who are the new patients and what do we know about them? Are there openings that we can still fill? How will this be done, either by accommodating additional, necessary dentistry in today`s patients, or by contacting future-scheduled patients and moving them forward?

- Emergency and catch-up time. What are the flexible procedures that are scheduled which will allow for any adjustments to the schedule? How much time can be utilized and when is the time available?

- Production pre-blocks. Are they filled? When is the next available pre-block?

- Financial information about today`s patients. Is anybody in arrears with payment? What is the plan to address this with the patient? Coordinate to assure the team member in charge of patient payment has the opportunity to talk to such patients using the proper verbal skills.

- Dentist/hygienist hand-off. What is the best time for any hygiene checks that need to occur? What verbal skills need to be used with hygiene patients who have previously diagnosed, but not yet accepted dentistry in their charts? What "silent" communication mechanism will the hygienist use with the dentist to communicate specific findings prior to and during the hygiene exam?

- Marketing. Were any of today`s new patients referred by existing patients and if so, who? Which of today`s patients will be asked for a referral and does the team understand the correct, effortless, fun way to ask for referrals?

The effective use of the morning huddle assumes that proper appointment scheduling techniques are employed by the dental team. For starters, this means that a day-at-a-glance book or computer system is used with a 10-minute page (five minutes for pedodontists and orthodontists) and that:

- Each column on the page represents an operatory, with a separate column dedicated to each hygiene room.

- Procedure codes are used for each patient.

- Chair time is indicated along with a completed doctor tracking column.

- "Significant" appointment pre-blocks exist each day and that the team knows the verbal skills for filling them.

- The team can differentiate between "flexible" and "captive" appointments.

This information is critical because the properly documented appointment page is what the team members will use together in the meeting to set the strategy for the day.

The end result of properly conducted morning huddles is reduced stress, higher productivity, better communication, enhanced-quality clinical experiences for patients, improved patient marketing, and an overall reduction in wasted time for both patients and staff. It`s proven fast, efficient and effective. Period.

The three remaining types of meetings necessary in the successful dental practice (the trend indicator meeting, the implementation meeting, and the open agenda meeting) are conducted monthly, resulting in a total of one staff meeting each week. All three types of meetings are pre-blocked into regularly scheduled office hours. Plan on 90 minutes for each meeting. For ease in illustrating these meetings, they are described per the following monthly schedule, but schedule them according to the best time for your particular office. The point is to have them.

During the first week of the month, conduct the trend indicator meeting. The purpose of this meeting is to review the previous month`s production and expenses. Numbers tell the story and numbers don`t lie. The only way to ascertain if your practice is succeeding or failing is by the numbers.

The trend indicator meeting is the only one of the four meetings facilitated by the dentist. The staff, though, are an integral part of the trend indicator meeting. Their help is needed to gather the information to complete the basic trend indicator worksheet and the monthly operating statement (the two forms used to track the practice`s performance each month, based on the practice`s goals as determined by the annual plan). The staff must also be aware of production and expense goals, because they help ensure that these goals are met. It takes total teamwork and open communication to make these goals a reality.

Initially, some dentists may balk at the thought of sharing their numbers with team members. They feel the staff will learn individual employees` compensation amounts. Because only the major and minor expenses are shared with the team, it is important to note that the dentist`s (owner`s) cash and non-cash compensation is left out of the picture. And team salaries are lumped together in one figure in the major expense category, so no one can differentiate who receives what for salaries.

Besides, you can bet your team thinks they`ve figured out your take-home pay. After all, they know they collected $38,000 on the desk last month. Instead of letting them think that most of that goes directly into your personal checking account, wouldn`t it be better to help them understand the costs involved in running the dental business? Rent, insurance, lab, employee benefits, employment taxes - it all adds up and fast. In fact, teams who are familiar with the numbers of their practices are less likely to ask for raises and other perks once they understand that the practice isn`t hitting production or expense goals. Instead, these teams are extremely motivated to learn the necessary skills and systems to assure that goals are hit.

For example, if the goal for case acceptance for the month was 85 percent of the amount diagnosed for patients of record, but the actual was just 76 percent, the team would identify the need to research and practice skills for:

- Debriefing the patient at the end of the appointment to recap what was done at the appointment, and why, plus subsequent recommendations for treatment if necessary (an auxiliary skill).

- Providing a quality hand-off from back to front office for the patient`s reappointment, supported with a reiteration of the dentistry to be performed in front of the patient (an auxiliary skill).

- Specific utilization of the patient`s motivators and concerns and documentation of same in the chart for future interactions with that patient (all team members).

- Case presentation and diagnostic techniques (dentist`s skill, with active support from all team members).

The team will add these training items to the agenda for the following week`s implementation (training) meeting. Then, they will research specifics about each of these skills from a knowledgeable practice management source, and discuss and role play each of these areas during their next several training meetings.

Remember, the numbers tell the story. Reviewing the numbers together as a team allows for buy-in and understanding from all employees on the importance of top-job performance and implementation of new skills and systems. The trend indicator meeting also prevents you from wasting time on issues which you may "feel" are problems, but which, in reality, are not the problem at all. Pinpointing the true problem is the first step in correcting it, and the numbers allow you to focus your energy in a timely way on the real issues needing to be addressed.

The next type of meeting necessary to your practice`s success may be the most instrumental in assuring that your team is properly trained and that positive changes are made in the office on an ongoing basis. This is the implementation meeting.

The purpose of the implementation meeting is to brainstorm improvement to practice systems and the team`s management skills, discuss strategies for how implementation will occur, and rehearse new skills to assure team training is complete.

The implementation meeting is typically held during the second and third weeks during the month, again for 90 minutes minimum, and all staff are required to attend.

A blank agenda for the implementation meeting is posted in a spot where all team members can add topics to be discussed and trained at the next meeting. Training topics will reveal themselves automatically during morning huddles and the monthly trend indicator meeting, as well as during the course of day-to-day business.

The roles of the facilitator and recorder are assigned at the previous week`s meeting. These roles are rotated regularly to assure all team members` participation in the meeting process.

Research is done prior to the meeting about the systems and skills which are to be improved. The old saw applies here, "garbage in ... garbage out." So be sure you are getting the skills and systems on which the staff will be trained from a reliable source. Use printed practice management manuals or textbooks. Photocopy small sections for team members to read in advance of the meeting, so that they will be ready to discuss and rehearse important specifics. Keep expectations realistic and don`t assign more than a few pages at a time.

Once in the meeting, ensure that at least 15 minutes is allotted for practice of a specific verbal skill. Have a flip chart handy for brainstorming and clarification of the group`s ideas. Be sure all team members take notes on areas specific to their positions and use action lists to plan implementation strategies and timelines for completion.

The dentist`s role in the meeting

Generally, the dentist`s role is to help the facilitator keep the meeting on track, if necessary, keep the team clear on the practice`s philosophy for doing business and for patient care and to follow-up on what is expected. It is important for dentists to give their input after hearing from the staff, because it is empowering for the staff to problem-solve on their own. There is an interesting dimension to power that says that those who have it dominate a meeting, while those who do not tend to contribute little or nothing. Admittedly, there are some days when the dentist may not feel "powerful." But if you can hire and fire, you`ve got power. If the dentist dominates the meeting, the staff will be less likely to contribute or even want to participate.

The consistent frustration I hear from dentists in my travels around the country is that there is no time to train staff members in the necessities of sound practice management. Even if there were time, the dentist wouldn`t know how or what to train staff on. Implementation meetings which present proper information and facilitation solve this complaint once and for all.

The bottom-line benefit for having implementation (or training) meetings is that it assures regular time is devoted to team training at least twice each month. Further, it assures that systems are analyzed, researched and reviewed on an ongoing basis for maximum organization and productivity. The implementation meeting enables problems to be identified and alleviated early on, due to team training on key systems. This, in turn, results in enhanced communication, reduced stress and, ultimately, in improved patient care.

The last meeting in our lineup is the open agenda meeting. The open agenda meeting allows the team to discuss basic "housekeeping" such as routine office issues, personnel policies, uniforms, maintenance, staff morale, and other business-related issues not related to systems, staff training, or the trend indicators of the practice. The open agenda meeting is not a gripe session, but a constructive discussion of any general issues that need attention. As with all the meetings, the open agenda meeting has an agenda, an assigned facilitator and recorder. Use an action list to assure follow-up. And, as always, the dentist as boss/owner/leader makes the final decision about policy issues and any other items that affect the operation of the practice.

Incorporating business meetings into your practice routine might seem daunting at first, especially if you`ve never had meetings, or if you haven`t been sure how to handle them properly in the past. But don`t let that deter you from reaping the benefits.

Remember, all successful businesses depend on efficient and effective meetings. Your meetings can be that way too, as long as the necessary practice management systems are in place to support your progress.

An agenda for conducting meetings

Follow these simple guidelines to assure effective business meetings in your dental practice:

- Pre-block meeting time. Meetings should be a regular part of your production schedule, and everyone is required to attend.

- Prepare an agenda with pre-planned time allotments to ensure that focus is maintained by the group, and to ensure that the meeting runs on time. Generally, all team members contribute to the agenda. The dentist and facilitator make the final determination about what will actually be covered. The dentist and facilitator consider the number of items placed on the agenda, the time element involved, and which items are of the highest priority based on business-need.

- Conduct meetings at a regular time and place. Start on time.

- Do not allow food in the meeting and don`t conduct meetings during the regular lunch break. Food, and the act of eating, are distractions, drawing attention away from the purpose of the meeting.

- Staff members, rather than the dentist, are to facilitate the meetings.

- Assign a facilitator who will be responsible for briefing the dentist in advance about the content of the agenda and who will conduct the meeting.

- Assign a recorder who will be responsible for taking short, concise minutes.

- Rotate facilitator and recorder responsibilities among all team members. This provides a growth opportunity for each team members` leadership skills. It also allows each team member to develop an appreciation for what it takes to be a positive force in the growth and management of the dental practice.

- Have a flip chart set up for brainstorming and clarifying ideas.

- All team members to use an action list to record items that need follow-up.

- Generally, the dentist`s role is to:

- Cast the deciding "vote" in the event the team is divided on an issue.

- Aid the facilitator in keeping the meeting on track, if necessary.

- Review progress of action items with each employee and lead staff with follow-up and recognition.