by James R. Pride, DDS; Amy Morgan; and Mary Lynn Wheaton
This series chronicles the true story of a young dentist whom we're calling Dr. Mary Thompson. In two years, she transformed her $255,000-a-year start-up practice into an $812,099-a-year, high-quality office. Our previous articles in Dental Economics described how Dr. Thompson, just three years out of school, began her program of management improvement with the dream of buying the practice next door and doubling her patient base of 1,200. Pride Institute consultants helped her develop a plan to purchase the second practice and raise production incrementally - not only to meet the greater overhead, but to substantially improve earnings for both doctor and staff. Eight months into the program, production was 24 percent higher than the entire previous year and 12 percent over the year-to-date goal. Despite this success, collections were running at 87 percent, far short of Dr. Thompson's 98 percent goal. Where was the money?
Dr. Thompson could not seem to solve her problem of low collections. She confronted her appointment coordinator - whom we'll call Sarah - the same employee who previously had not performed up to expectations in scheduling patients. Sarah, however, didn't have a definite answer as to where the money was. "It's in insurance," she would say, but she was unable to substantiate her claim.
All of this was part of a larger problem. Dr. Thompson noticed that Sarah did not make follow-up calls for delinquent payments. "I don't have time," she would say, yet she refused the doctor's offer to add a person to help at the front desk. She also refused to make written financial arrangements with patients, insisting, "The patients don't want to sign the papers." Dr. Thompson asked Sarah to make confirmation calls two days in advance - instead of one day - in an effort to reduce cancellations and no-shows. But Sarah did so only briefly, because patients began appearing a day early for their appointments.
"The patients just don't listen," said Sarah. Her other excuses were "I'm doing the best I can," "I couldn't help it," and "It's not my fault."
An even greater problem was Sarah's uncooperative attitude, which affected her team members and her relationship with patients.
At her consultant's urging, Dr. Thompson finally agreed that achieving her goals required Sarah's departure. But there was another problem: Dr. Thompson believed she could not fire anyone! Typical of many dentists, she is fair and gives employees the benefit of the doubt. And she feared confrontation - also typical of dentists. Together, Dr. Thompson and her consultant developed a plan to give Sarah an opportunity to improve through the proper training and a system of accountability and feedback designed to make confrontation easier.
A team judges a dentist by the way he or she handles the weakest link. Failure to confront an employee who is not carrying her weight or personifying the business philosophy hurts everyone - the practice, the staff, the patients, and the dentist.
Dr. Thompson set written expectations for Sarah and reviewed them regularly with her to determine if they were being met. When pressured to change her behavior, Sarah improved, but only for a short time, then reverted to her old ways. The clear expectations Dr. Thompson set made it obvious that Sarah's job performance was incompatible with the goals.
Through coaching, Dr. Thompson learned how to calmly dismiss Sarah in a nonthreatening way. When Dr. Thompson had done all she could to help, with no change on Sarah's part, the doctor finally said, "I think it's best if this were your last day." She offered a week of severance pay and added that Sarah could take her time gathering her personal effects. But, to Dr. Thompson's surprise, Sarah had already removed her belongings!
When the leader sets clear expectations, communicates them effectively, and measures performance against them, the employees know where they stand ... sometimes even before the doctor realizes it. Establishing clear expectations and accountability allows the employee to choose whether she can and will do the job. Getting fired came as no surprise to Sarah, and it was an enormous relief to Dr. Thompson. She recalls, "It was as if a weight pulling me down for so long was suddenly lifted."
That evening, Dr. Thompson telephoned each of her staff members to explain what she had done, focusing on her philosophy and asking for feedback. She emphasized that Sarah was dismissed because she didn't do what was required of her job. The employees judged the doctor's action as fair and respected her for maintaining her high standards; however, the one staff member who was Sarah's friend asked if she would be next. Dr. Thompson assured her that if she did what was required in her job, the same thing would not happen to her. The dentist thanked the employee for being open about her concerns. Soon after Sarah's departure, it was this worried employee who commented that the office was so much more pleasant without Sarah around to cause stress!
Dr. Thompson asked her staff for their cooperation in filling in for Sarah and promised she would hire a replacement as soon as possible. The doctor gained the support of her staff through openness and honest communication.
The doctor's consultant trained the team in hiring a replacement. This included testing the candidate's abilities and involving the staff in the interviewing process by allowing them to take the candidate out to lunch and giving their input. The consultant encouraged Dr. Thompson to hire someone with a good attitude and to train for skills. An employee's basic attitude is deeply ingrained and far more difficult to instill than job techniques.
Dr. Thompson found an excellent candidate who was a clerk in a local store (with no experience in dentistry). The result was a remarkable success! Collections soared to 98 percent almost immediately. All financial arrangements were put in writing. A 48-hour confirmation call decreased cancellations and no-shows, and tension in the office was markedly reduced. The tools used to train the new employee included instructional cards for teaching proper verbal skills, forms for making financial arrangements, and scripts and timelines for collection calls.
Dr. Thompson finished her first year of the management-improvement program with $549,169 in production - 20 percent over goal and 115 percent over the previous year.
"My life is different now," reflects Dr. Thompson. "I'm much more confident about the direction I'm headed and my ability to get where I want to go. I feel free to make choices and to change things I don't like about my practice. I have definitely grown as a leader, and I have a sense of financial stability."
Dr. Thompson attended a workshop on how to reward staff for excellent performance, and she gives them a share of the increased profits that they help to create.
It is important for the staff to see a link between their compensation and the practice's profitability. They should participate in the annual planning process, because their input in setting practice goals strengthens their commitment to realizing them.
The staff finished the year with a greater sense of personal accomplishment and clarity regarding practice goals. It was a highly successful year, yet there were more challenges ahead and an untapped potential for even greater achievement. How much could Dr. Thompson and her staff improve in their second year? More than they ever imagined! We'll discuss this in our next article.
Pride Concepts
- Set expectations, then inspect what you expect.
- Confront often when employees fail to meet expectations.
- Be a leader who makes personnel decisions with honesty and fairness.
- Retain only those employees who share your practice vision and are committed to helping you achieve it.
For details on educational materials, seminars, and management programs, call Pride Institute at (800) 925-2600.
