Whoosh ... whoosh ... whoosh

Case Profile: A small midwestern town with a population of 20,000 is the backdrop for this general practitioner whose six operatories yield a yearly production of $972,000. There are five days a week of hygiene, three chairside assistants, two business staff, and since last year, an associate dentist. Picture perfect, right?

Sally McKenzie, CMC

Case Profile: A small midwestern town with a population of 20,000 is the backdrop for this general practitioner whose six operatories yield a yearly production of $972,000. There are five days a week of hygiene, three chairside assistants, two business staff, and since last year, an associate dentist. Picture perfect, right?

Symptoms: Whoosh ... whoosh ... whoosh. That`s the sound of the revolving door as patients and staff leave this practice. Think I`m kidding? Most staff are in and out within a year, and now that patient retention has plummetted to 37 percent, the practice is losing 39 patients a month! Did somebody yell, "Fire?" Holy cow, it`s a stampede! And if a mass exodus isn`t enough to worry about, accounts receivable are running at two times monthly production and accounts over 90 days past due ... a whopping 28 percent.

Observations: The doctor wants everything perfect. Who doesn`t? Seriously, I`m talking here about a compulsive perfectionist who`s never satisfied with the way anything is done in his practice. A continuing education junky, he subscribes to every dental newsletter in the industry. Following each seminar he attends or article he reads, he storms into the office and starts changing everything ... again. Fueled by change because it promises perfection, he doesn`t mind shooting from the hip. But never satisfied that his staff is putting forth ample effort to help him reach the perfect practice he lives for, he`s always stressed out and is becoming disillusioned with dentistry. Staff perspective is: "We`re not doing good enough." "How can he empower people he doesn`t trust?" "There`s unending change here." "The lack of confidence he has in my abilities to get the job done on time, correct and as directed is frustrating." "He needs to better appreciate his office and its staff."

Apart from the observations just mentioned, there`s another glaring problem in this practice. Thanks to the revolving door, the practice has engaged two business employees who`d like to succeed but don`t have the benefit of knowing how a dental office should be managed. Adding to the confusion, these ladies shy away from the computer as if it would unleash a bolt of lightning at first touch.

Discussion: Like other `isms` that are more recognizable, perfectionism can be a highly destructive force not only to the individual who`s obsessed by it, but to those surrounding him. In the all-or-nothing world of the perfectionist, there`s no such thing as pretty darn good. And that`s a situation fated for failure.

As for the two ladies trying to hold down the business part of the practice, rather than pointing an accusatory finger, I`d like to note that when the computer system in question was converted from an even worse system, these poor gals received only three hours of training. Small wonder there`s no recall system and accounts receivable are such a mess!

Treatment Plan: This will be a two-part plan. Part one - and I say this with all due respect - is for the doctor to get some professional counseling. The aim here is for him to overcome his obsession for perfection, his constant need for approval, his own overachieving, as well as his tireless elbowing of employees to do more/better/faster.

In addition, he needs to overcome his fear of rejection and resolve his trust issues. He must come to recognize that his drive for "perfection" is the source of his own stress, as well as the force that pushes his staff through the revolving door. This recognition is critical to the counseling process, for without it, the doctor forever will be stressed because nobody around him can live up to his expectations.

Coupled with counseling, the doctor ought to stop reading all those newsletters for one year and stick with the professional recommendations outlined here. Furthermore, he must make a commitment not to make any other changes during that year without the input and agreement of the entire team. Finally, he needs to modify the management of the practice from autocratic to participatory.

Part two of the plan requires that definitive systems be put into place; that employees become accountable for those systems; and that measurements are deployed to monitor their performance. Let`s use collections as an example. As mentioned earlier, accounts receivable are two times monthly production and over 90 days past due is 28 percent.

One of the two business employees will become the financial coordinator who will be accountable for: having no more than 18 percent of total accounts over 90 days; achieving a 45 percent over-the-counter collection rate; reducing accounts receivable to one times the monthly production or less; and achieving an over 100 percent collection ratio for the next few months as the over 90 days` due accounts are actively pursued.

A recall system must be implemented right away. Rather than a `silly` postcard that may send the wrong message, professionally printed notices (in envelopes) will be used to make the impression that this is important. As the patient self-addresses the envelope, the hygienist will explain how the system works and what is expected from the patient.

Before each notice is sent out, the hygienist will jot down the clinical need for the patient to return. While this recall system is being implemented, the second business employee will become the patient coordinator whose job will include accountability for retaining the 468 patients who presently are inactive as of the past 12 months.

For part two of the treatment plan to work, the doctor will need to invest monies in training these employees to effectively fulfill their job descriptions. Meticulous training on computer and verbal skills will help empower staff and make them accountable. That`s about as perfect as necessary.

Sally McKenzie is a Certified Management Consultant and president of McKenzie Management, Inc., a full-service, in-office dental management consulting company with clients across the U.S. and Canada. She can be reached at (800) 288-1877; e-mail McKenzie@earthlink.net; or visit her web site at www.mckenzie-mgmt.com.

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