Dental Economics year-long "Quality Management" series.

July 1, 1998
3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

Initiate the transition to...

...`Your opinion counts`

3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

Deming believed leaders should relinquish control to staff members.

Dr. Bruce Waterman

Joan Forrest Eleazer is executive director of Dr. Peter Dawson`s Center for Advanced Dental Study in St. Petersburg, Fla. Before joining Dr. Dawson, Joan was president of her own training and consulting company, specializing in the development of self-directed work teams. She consulted with Fortune 500 companies throughout the United States, Mexico, and Puerto Rico. In a conversation with the author, Joan discusses how building effective teams can improve a dental practice.

Waterman: As we have discussed in previous articles in Dental Economics, teams are an essential part of the Deming philosophy. Why is it important to build a team in a dental practice?

Eleazer: First, I think it would be helpful to define team. It is common practice to refer to the staff of every dental practice as a team. But more often than not, it is merely a group of people working in the same physical location.

My preferred definition of a team comes from Katzenback and Smith`s book, The Wisdom of Teams. They define a team as "a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable." The key point is that the team is a unit focused on performance. I like to add that the team is focused on the continuous improvement of all aspects of performance.

Waterman: So if your staff is truly a team, everyone is working together to continuously improve the patient`s experience. Is that right?

Eleazer: Yes. And this idea of working together is very important in the dental practice. When I visit dental offices, it is quite common to hear references made to "the front" and "the back." These comments reflect a conflict or animosity between the two components of the team and often are accompanied by finger-pointing and blame.

I call this "silo thinking." When the staff members see their function or department as standing alone - like a silo in a field. Silos are tall, independent, vertical structures.

We must remember, however, that the patient`s experience is horizontal. The patient`s experience cuts right through those silos. Everyone on the staff must develop this horizontal perspective and work together to ensure smooth hand-offs, so that departmental areas of responsibility are transparent to the patient.

Waterman: Doctors are used to the traditional management mindset where they command and control all decisions. How can teamwork help us evolve from "when I want your opinion I`ll ask for it" to "your opinion counts?"

Eleazer: Dentists are not alone in using the traditional command-and-control style of leadership. This approach has been the accepted standard of leadership for decades. Management experts have finally realized, however, that such practices are not the most effective approach. "Your opinion counts" is a cornerstone of the quality management philosophy.

Dr. W. Edwards Deming taught that those closest to the job know it the best. This holds true in the dental practice. In order to strive for continuous improvement, every person on the team must constantly and purposefully look for ways to do things better. No one individual has the total picture of everything that happens throughout the day - including the doctor. Therefore, everyone must be involved in contributing to change and improvement.

I think this is really good news for dentists because the doctor cannot be a full-time manager or leader. He must spend the majority of his time producing. By encouraging participation, giving responsibility to staff and allowing everyone to fully apply their talents to the continuous growth and improvement of the practice, the doctor can concentrate more fully on dentistry.

Waterman: I have heard you discuss that, when you consulted in industry, you observed the same problems with management and teamwork that we see in dentistry. What insights can we gain from the team-building process you implemented in the industrial sector?

Eleazer: You`re right, Bruce. I have found that dentistry is just like any industry or profession when it comes to the challenges of management, leadership, and people.

Six years ago, I consulted with an international manufacturing company that makes spark plug ignition sets. The factory was structured as the typical autocratic organization. The plant manager ruled, and employees checked their brains at the door. Because of pressure from foreign competition, the company had to reduce costs, increase productivity, and improve quality if it was going to survive. In dentistry, the same pressures exist - not due to foreign competition, but due to managed care.

Last year, I had the opportunity to return to the plant and observe the changes over the last five years. An entire level of management - first-line supervisors - had been removed. The production-level workers were organized into teams. They monitored and evaluated their own results. They made design changes in their work systems in order to be more productive. The team members interacted directly with their customers to obtain feedback. The changes were dramatic and quite remarkable.

Those significant changes did not just happen, though. One of the most significant factors in the successful transition was training. The company committed resources to extensive training in the technical aspects of the job as well as in interpersonal skills.

There are many lessons for dentistry in this amazing transformation.

The first is training. Time must be set aside weekly for clinical, managerial, and interpersonal training. It takes a leadership commitment to do this.

Secondly, accountability. Most people want to be responsible and accountable for their efforts. People want to have meaningful work - this is a classic human need. As leaders, we must be willing to relinquish some control and allow our team members to assume responsibilities. They can`t be accountable for their results without first having the responsibility.

Lastly, time. The transformation did not happen overnight and is not yet complete.

The new plant manager, more of a facilitator than a dictator, noted that they had been on the journey for six years and would continue to move forward. No one - not managers, production workers, engineers, or customers - wanted to return to the old way.

Waterman: What specific actions can a practice take to begin to develop into a true team?

Eleazer: Bruce, I like your phrase "begin to develop," because becoming a team is a process. I would recommend the following three steps as a means to getting started.

The first step is to get a focus. All members must have a clear and common picture of what the doctor envisions for his practice. In other words, the team members must develop a shared vision. From this vision, develop specific goals, the accomplishment of which will move you forward toward the vision.

The second step is to develop measures to evaluate the team`s effectiveness in achieving the goals. Measures should be regarded as feedback. Just like taking your temperature provides feedback regarding the status of your body, measures provide feedback regarding the status of the organization.

The third step is to spend time discussing how to improve. The mindset of continuous improvement has to be developed in each team member.

The doctor, as leader, must constantly direct the team toward improvement of performance.

A good way to do this is to focus frequently on two questions. What do we like about what we`re doing? What can we do better?

Building an effective team is more than improving interpersonal skills and communications. Those are components of the process, but unless they are used to enhance the team`s ability to focus on goals and continuously improve, the impact on the practice will be minimal.

I believe that the major strides that have been made in industry as a result of building effective teams are available to the dental practice.

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