Sleepy town is ideal setting ...

March 1, 1998
Case Profile: In practice since the late `70s, this general practitioner bought her practice nine years ago. The locale is a rural southwestern town of about 4,000. The doctor works a 32-hour week and keeps the following staff: two hygienists (one who`s been with the practice since the `60s and has outlasted three doctors); an office manager; a receptionist and two dental assistants.

Sally McKenzie, CMC

Case Profile: In practice since the late `70s, this general practitioner bought her practice nine years ago. The locale is a rural southwestern town of about 4,000. The doctor works a 32-hour week and keeps the following staff: two hygienists (one who`s been with the practice since the `60s and has outlasted three doctors); an office manager; a receptionist and two dental assistants.

Symptoms: This sleepy town is the ideal setting for a kicked-

back, relaxed kind of practice. But, according to both doctor and staff, it`s the site of an egg-tossing contest on most days. The doctor called us in to help resolve the following situations: staff incompatibility, a lack of teamwork, inefficient scheduling and a hygiene program that`s almost devoid of perio.

Observations: Staff not getting along ... that`s an understatement - like a heavily-traveled intersection with no traffic lights or stop signs! Common courtesy and yielding the right of way should be standard operating procedures, but instead, everyone here seems to be on a collision course.

Let`s start with staff talking behind each other`s backs. As you know, I always go to lunch with staff on the first day so I can gain some insight, seeing things from their perspective. During that lunch, staff talked openly about how the doctor tells her esteemed assistant what`s bothering her and that the assistant then disseminates the information to the rest of the staff ... no wonder the staff hates her guts! While it sounds like the doctor`s an introvert, the truth is that she`s an extrovert who likes to stay far away from confrontation.

Returning from lunch, one of the assistants came up to me, looked around the corner to make sure nobody saw her talking to me, and confided, "The doctor`s assistant just went in and told her everything we said." And so the gossip wheel turns.

Discussion: When staff members don`t get along, it usually is due to one or more of the following factors:

1. personality differences

2. poor leadership by the doctor

3. inefficient office systems or

4. lack of job descriptions

In this case, numbers 2, 3 and 4 were involved, with number 3 being the worst culprit. The office system at the root of much of this turmoil was scheduling. Typically, the doctor would utilize two operatories and her long-term assistant. Because of the way patients were scheduled, the second assistant always was struggling to find something to do. As a result, she felt unimportant and her low self-esteem caused her to be resentful of the number-one assistant. Intensifying the severity of this situation, the second assistant often would go to the front desk and chat with both the office manager and receptionist, causing them to run behind in their responsibilities and be resentful as well. Let`s look at how scheduling played a starring role in this mess.

The doctor was scheduling out of two columns using two chairs, and was on 10-minute units. Patients scheduled in column number 2 in the doctor`s schedule were emergencies, toothaches, walk-ins or extractions. The doctor had requested that the scheduling receptionist stagger denture deliveries, with partial deliveries in the second column. There were some days when an extraction would be put in opposite a filling. If the office manager "thought" that a scheduled filling would require a pin and build-up, she wouldn`t schedule anyone opposite that. She`d close her eyes and do this procedure from memory. Karnak, the magnificent ... what an ingenious way to schedule!

Let`s take a minute and address the perio - or I should say nonexistent perio - in this picture. The week I was there, hygiene-patient charts revealed no perio charting nor was there any indication of perio examinations. In the past 15 months, one hygienist produced a measly $1,555 in perio treatment out of almost $110,000 ... and the other produced $0 in perio treatment.

Treatment Plan: Of greatest importance: Procedures to be scheduled and amount of time needed must come from the doctor or assistant. This should not be decided by a scheduling receptionist or office manager, who do not have the training to know how much time is required. The only exception to this rule should be for an emergency patient. When the doctor is doing an exam in the hygiene-treatment room and tells the hygienist what needs to be done on a patient, the hygienist should ask the doctor how much time will be needed. The doctor must communicate this time in "assistant time/doctor time/assistant time," not as "three units."

Now, about the second assistant. If this employee and situation are ever to work out, the doctor needs to train - or provide training for - this second-string recruit. Raising the level of her skills should help free up both the doctor and her first assistant. Furthermore, once the second assistant is confident in her own skills, she will want to make more of a contribution to the practice.

To resolve other staff issues, the practice needs to have meetings at the beginning of the day, during which the doctor can express her concerns or compliments directly to her staff ... without relying on office chatter to spread the word. Monthly meetings also would help to keep the lines of communication open, and to actualize the one-year vision plan I helped them establish.

Finally, the lack of an interceptive periodontal-therapy program generally indicates that a hygienist doesn`t know how to assess periodontal disease or doesn`t know how to perform or "sell" periodontal therapy. In this case, the long-term hygienist was afraid that after seeing patients for years, the need for periodontal therapy would be a bad reflection on her previous work. The newer hygienist simply didn`t have the skills. Our hygiene consultants are now working with both hygienists to bring perio up to 33 percent of hygiene production, a very reachable goal.

Sally McKenzie is president and chief operating officer of Dental Partners, Inc., a full-service, in-office dental management and practice-acquisition company. She continues to serve as president of McKenzie Management, a division of Dental Partners, Inc. She can be reached at (800) 288-1877; e-mail [email protected]; or visit her web site at

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