Th 94942

Communications workshop: Tools every dentist needs

June 1, 2002
In part three of her series, the author emphasizes the importance of clarity of purpose when conveying expectations to your staff.

by Sandy Roth

In part three of her series, the author emphasizes the importance of clarity of purpose when conveying expectations to your staff.

Most dentists agree that success is impossible without a strong team. Your staff essentially has a greater impact on the health and success of your practice than you do. Of course, the sword cuts both ways. A well-functioning team can lead the way. A dysfunctional team, on the other hand, can great damage.

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Almost everyone has an idea of what "team" means, but too often that idea emphasizes getting along over high-caliber functioning. Staff members often define "team" as merely a group of people who help each other. But this is common courtesy, not teamwork. A team has a significantly higher level of authority, obligation, and accountability. Let's turn our attention to the concept of team to lay the foundation for conveying expectations.

My definition of a team is a group of people, each of whom brings who each bring valuable skills and perspective. I emphasize common purpose, for it determines the expectations that must be conveyed to your staff. Resist the urge to turn the page as I revisit what many people call "vision," "mission," or "philosophy." My approach is different. Many of you have been through the exercise of creating a philosophy statement. Instead of spending precious time creating erudite statements that are of little practical use, I ask you to view the following as an exercise in building purpose within the team.

Staff members relate to practice purpose in one of four ways:

•Congruent. Individuals who are clear about their own purpose look for opportunities to pursue that purpose in all relationships both personal and professional. They want their work to be congruent with the rest of their lives. These people often will accept less than perfect circumstances for work that is meaningful to them. On the other hand, they will rarely agree to work in pursuit of a purpose they don't value - no matter how attractive the working conditions. The dentist's goal is to build a team of employees who are in alignment with his or her practice's purpose.

•Unclear. Some team members are not yet clear about their own purpose and can work almost anywhere as long as the pay and hours are right. This often is the case with very young people who have not had enough life experiences to shape their thinking. Employees who are unclear about their purpose may have the skills to perform tasks competently, but they will not bring passion to their work.

The impact from those who are unclear about their purpose will be minimal, and, because they may be unsettled, there is a potential for negative impact if they grow in a divergent direction. These individuals require more supervision, and they often fail to recognize the value of congruency. Turnover is likely to be high.

•Incongruent and incendiary. Employees whose life purposes are inconsistent with your practice's purpose will bring that difference to their work. If their personal purpose is dramatically incongruent with yours, they will work at cross-purposes; they also will undermine the impact of others. It may not always be intentional, but it is inevitable. They may fully understand what your purpose is, yet they disagree, which means greater conflict. The impact of their efforts frequently will be negative and disruptive. Turnover is almost always the outcome, although it may take longer to occur.

•Incongruent, yet benign. Employees with an incongruent, yet benign purpose understand your perspective but fail to get excited about it. Their impact will be minimal. Turnover may be rare because there is little trouble associated with these staff members, and their cooperative spirit can be endearing. Their apathy, however, can seriously shortchange the practice.

The demands of an extraordinary team

These four conditions illustrate how important a common purpose is to your team. When two people share a purpose, they are more likely to put their energies into achieving it. When they do not share a purpose, their energies are dissipated. When appropriate skills are added to shared purpose, the mix is powerful.

Ordinary practices can function with ordinary skills, attitudes, and staffing approaches. Extraordinary practices, however, have very different requirements. Hiring, training, and staff development greatly impact the high-caliber practice; therefore, they require at least as much attention as financial planning and analysis - perhaps even more. Yet, dentists often fail to give these issues the proper focus. People are hired and plugged into positions only to fail for reasons that might have been avoided. Dentists become cynical about staff. Staffs become disenchanted with their employer and often the profession as a whole.


It's too much to expect, but it doesn't hurt to ask
It's too much to expect, but it's not too much to ask
Mary Chapin Carpenter/Don Schlitz

Dentists not only have the right but also the obligation to outline expectations to their staff. But expectations are reasonable only when they are clearly conveyed and agreed to by all parties. Until this happens, expectations are merely wishes, hopes, or assumptions.

Failing to convey your expectations increases the likelihood that they will be unmet. I remember a conversation where a dentist complained about an employee's mode of dress. He stated that short skirts and skin-tight, animal print fabrics were unsuitable for his office. When I asked if he had instigated dress code for the office, he sheepishly admitted that he had not. "Don't you think she should be able to figure that out for herself?" he asked. Apparently not! And it was unfair of him to presume that his employees knew his opinions on the matter. Moreover, when the employee in question "tested" the unwritten dress code, she received no feedback that she had overstepped a boundary. The dentist failed to convey both his initial expectations and his unfavorable reaction to her choices. In the absence of information to the contrary, why would she not believe that her choices were perfectly acceptable? I am amazed at how often employment relationships end because of unconveyed expectations, yet I am convinced it happens every day.

Expectations for employee performance increase as dentists become more sophisticated and practices promise more to their patients. Some dentists never communicate these expectations, while others merely hint at them, like the scent of perfume from an atomizer. In many cases, dentists strive to paint a picture of their practice's vision, but use language so vague that their employees misinterpret the message. For example, many dentists instruct their employees to "talk" to patients with the hope that they will engage in meaningful conversation relevant to the patient's care. However, employees may interpret "talk to the patients" as a green light for more superficial, social conversation. Likewise, concepts like "strive for excellence" and "demonstrate a spirit of caring" are far too general to have any real meaning. Dentists must provide precise direction and guidance.

The other side of the coin is equally important. We may hope that others will routinely share their expectations, but such is seldom the case. We are fully responsible for our part in a relationship and for its breakdown should you fail to outline our expectations.

Many people try to guess, surmise, or decode the expectations of others. They take cues from informal conversation or ask third parties rather than the person in question. Perhaps it is because they feel obligated to live up to expectations once they understand what they are. In some cases, you simply may not want to know the answer. Parents, friends, and colleagues may try to wield influence over your life, but they are successful only to the extent that you allow them. However, remaining uninformed is not the answer.

Conveying expectations is only the first step, however. What must follow is a discussion about those expectations and either an agreement to mutual accountability or a decision to abandon the expectations. Anyone has the right to ask you to meet a certain standard, but you are accountable only if you agree to it. It's easy to justify avoiding this discussion. It takes time, and it is potentially conflict-ridden. The other party may demand clarification when you feel least prepared. Nonetheless, discussion must ensue, and both parties must outline what they agree on as well as what they do not.

I see examples of this frequently when dentists attempt to outline expectations with their staff members. Clearly outlining standards of performance and procedures is a great start, but if there is no opportunity for further clarification and agreement, it is incomplete. "Marian, I want to outline the concepts and principles for discussing the first appointment with all new patients. These are ..." conveys the expectation. "What questions do you have about this?" extends an invitation to dialogue. And, "Is that something you can be accountable for?" finalizes the process.

Your staff members have a right to learn about your expectations right away. Do not wait until after the fact. If an employee's expectations about time off or compensation go unmet, for example, you will likely bear the brunt of their disappointment, even if you were unaware of their expectations. Protect yourself by initiating these conversations when you have any reason to believe the employee's expectations and yours are not in alignment. If you expect staff members to stay in the office until every patient has left, tell them so, and ask for their agreement on the matter. If you believe continuing education is a necessary part of staff development, yet your employees consider weekends entirely their own, you have a potentially serious problem that can be avoided by addressing the issue directly and in advance.

Most working relationships deteriorate over matters like these. This is a shame when they might so easily be avoided. It is well worth the time and effort to clarify expectations and reach agreement before relationship breakdown occurs. It is almost impossible to recover after the fact - at least without a few scars.

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