by Greg Psaltis, DDS
Constructing a cohesive staff is crucial to your practice's success.
Some argue that team-building is just a popular buzzword in today's business world. However, the time and effort (which can be enormous) required to develop a well-informed, clearly communicating group of co-workers will pay off in ways that are hard to imagine until you've done it. Once a group of individuals comes together with a common goal and vision, it can formulate plans for systems, support the doctor in innovative ways, and take a large step toward creating a workplace that everyone can enjoy.
The process requires a commitment of time for meetings with the help of a facilitator. During these meetings, the group can work together on issues such as communication skills, mission statement, and learning how to be a cohesive entity working for the common good of the practice. This can't happen by itself, nor will it occur without some bumps along the way. It won't happen merely because the doctor dictates it either. Building a dream team requires both guidance and trust by the owner/doctor. Jumping into that unknown realm will be an adventure, but one that can pleasantly surprise even the most skeptical. Assistance from an outside facilitator is invaluable to the process of team-building. Let's examine the steps involved in this process and how the outcome will benefit the practice.
Using a facilitator
Dentists often surprise parents by inviting their children into the operatory, where they cooperate fully with the doctor's directions. While the parents are amazed, the dentist recognizes something universal in human behavior - children usually manipulate their parents and misbehave with them far more than with anyone else.
Likewise, many of us maintain an air of bravado behind the wheel of a car until we get pulled over by a policeman. Suddenly, our demeanor shifts from road demon to deferential, polite, and attentive citizens. Is it any surprise, then, that employees have difficulty approaching "the boss" - no matter how good the relationship - when they have difficulties, suggestions, or problems? This is not about the doctor; it is about human nature. Once the practice leader makes the decision to build a genuine team, a facilitator will prove invaluable. He or she can provide the safety net for employees to open up. In my opinion, this can only be done with an outside person initially, and with the explicit approval, if not encouragement, of the doctor. We have been working with a facilitator for 10 years, and continue to learn from her still.
It's a long-term project
It is unrealistic to assume that an undertaking as grand as building a team can be done in a short time. Any doctor embarking on this journey should assume the goal is months, if not years, away. In our society of instant gratification and easy access, this may provide one of the biggest challenges to pursuing this worthy end. Dentists are primarily task-oriented and are used to seeing a tangible result in a 30-minute appointment. A project of lengthy duration requires great mental discipline from the dentist. Not only will it require time, but the progression of the process will not always be linear. There will be ups and downs and possibly even moments when the doctor will feel like "chucking it all." If the doctor understands the value of a team - with a capital "T" - and has a clear vision about its role in the practice, it becomes easier to stay the course during frustrating times. Our practice was functioning as a cohesive team after a couple of years, but attaining the goals I envisioned required almost 10 years!
Regular meetings are critical to the evolution of a team. These are not the basic, short, end-of-morning meetings, but rather ones that are scheduled ahead of time so that everyone can attend. They should last at least half a day. Holding the meeting at a neutral site is more effective than trying to squeeze everyone into the lounge or in the waiting room, which is rarely configured for a discussion or to accommodate a group. We rent a meeting room in a church down the street from the office for our meetings. It is inexpensive, clean, roomy, and has tables and chairs that we can set up in any layout we prefer. In spite of "losing productive time," I suggest scheduling these meetings on a regular workday. This will ensure attendance and will send the message that meetings are genuinely important.
Arranging these meetings can be an exercise in creativity. In our practice, we have two full-day meetings and two retreats (of two days' duration) each year. The retreats are overnight, and attendance is mandatory. We see it as not only as an opportunity to learn, but also a chance for everyone to spend time together outside of the daily work schedule. This raises morale and enhances our appreciation of each other as human beings. As time goes on and the team evolves, the full-day meetings may be supplanted by your own internally run monthly meetings. In our practice, we hold monthly, half-day meetings that include material formally saved for facilitated sessions.
Some individuals may choose to leave the practice once they recognize that they are being required to step up to a higher level of personal responsibility. This is to be expected. At these moments, it is of great importance that the doctor be clear about his vision. The employer may be surprised when some of his "best" employees leave. However, the "best" employees are team players who will both support and embrace the team concept.
Resistance may come in many forms. Some employees may attempt to sabotage the process by dominating the meetings with personal issues that reflect their unwillingness to deal with other employees effectively. Others will prefer the more traditional power structure where the boss is the "king" who holds court and makes, monitors, and enforces all the rules. This is an easier path for many employees, but one that fails under most circumstances. Our office has had retreats where an entire morning was spent dealing with an inconsequential issue that had become a "big deal" between two employees. It was a stressful and fruitless session. Both employees eventually left the practice.
Topics to discuss in these meetings range from tangible issues, such as effective scheduling, to more general ones, such as communication skills. A blend of topics usually will provide the most comfortable and effective format. Exclusively tackling conflict resolution is too exhausting. In our meetings, we spend time learning about active listening, giving feedback, and goal setting, as well as discussing numerous topics that are task-oriented, such as how to fit general anesthetic cases into our schedule. Here are some specific examples of topics we have covered:
- How to invite parents into the operatory to be with their children during appointments
- What to say when a child asks if she is "getting a shot"
- When and how to approach a team member with whom you have a conflict
- How to fit emergencies into the schedule
- Which information is important when a new patient calls for an appointment
- Why we do one procedure (e.g., stainless-steel crown) over another (a filling) in some cases
- Where the parents should be during restorative visits and how to coach them to be helpful
- How to listen to negative feedback without getting defensive
- How to understand parents' styles to provide proper guidance at initial visits
This is not the entire list, but it does provide some idea as to the breadth of topics covered. As you can see, some topics are obviously related to actual patient care. The more effectively the entire team works together on a similar agenda, the more effectively the patients will be served and the better their experience will be.
Values and vision
The basis for much of this training must first come from the owner/dentist. Prior to beginning a team process, it is vital that the doctor has a clear vision. This is the blueprint and the foundation on which the practice and the team will be built. The meetings provide the time and organization to clarify the doctor's values and vision, as well as the means to implement them. The facilitator and the doctor must agree on a plan to be effective in moving the practice toward those goals. When the values have been clearly defined, the team can embrace them and work together to create systems that support them. Team members will have a greater sense of ownership of the systems and will be more likely to support them enthusiastically if they are involved in the process.
Each doctor will realize different benefits. For some, it may be the relief from "having to figure everything out." For others, it may be the satisfaction of seeing a group of people that he cares about learning valuable new skills that are applicable both in the office and in the home. For still others, it may be the ability to let go of the roles of sheriff, judge, and jury. In my own experience, it is all of the above. Perhaps the greatest source of satisfaction to me is the realization that my team is very nearly an autonomous group that requires only encouragement and occasional guidance from me. I still need to make some decisions, such as capital outlays or choices of appropriate materials, but establishing my "Dream Team" has freed me to "just be a dentist." Earlier in my career, when I still maintained a more traditional power structure in my practice, I was generally far more exhausted by the nondental issues of the day than anything I was doing in anyone's mouth. I hold it as a satisfying achievement that I have become an interchangeable part in my practice. This was frightening to me at one point, but it isn't any longer. In fact, as I write this article, my practice is literally at work, providing the same high-quality care that I would expect, in spite of my absence.
My partner is a skilled and able practitioner, but it is my team that provides the continuity of care, given our partnership arrangement. That is to say, the two of us alternate weeks of work and the practice continues to provide a level of care with continuity I believe could only have been done through the creation of this team. These are my two principle benefits from the lengthy process to which I committed - 26 weeks off each year without concern for the quality of treatment and level of care for the patients in our practice. This is a rich reward for me and is a payoff far beyond my expectations.
Your goals may be different; your path may take a shorter course. No matter what your vision, the chances of making it a reality are tremendously enhanced with a genuine team in place. Some doctors are familiar with the concept, but apply it only casually to their staff. I hope this article provides some insight into the differences between "staff," which requires constant attention and guidance, vs. a team, which is a group of people who have heard, understood, and embraced a vision - and then works together to make it happen.
When I look back on the time, money, effort, and, sometimes, emotions I have invested in this process, I can say without hesitation that it was worth it. I write this while listening to the pounding Pacific surf from the veranda of a time-share in Cabo San Lucas, Mexico. I can fully relax and enjoy this moment because I know that the children and parents in our practice are receiving the same care right now that they would receive if I were treating them in Olympia. My own "Dream Team" has been central in creating my own dream life. You can do it too!