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Why do some practices succeed and others struggle?

July 1, 2008
Reality shows are all the rage on television today. Why are they so popular? If you can get past all the commercials and hype, there is human drama that is true to life for all of us — the need for basics.
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For more on this topic, go to and search using the following key words: teamwork, unity, communication, team, Rhonda Savage, SCN.

Reality shows are all the rage on television today. Why are they so popular? If you can get past all the commercials and hype, there is human drama that is true to life for all of us — the need for basics. Food, water, clothing, and sleep are essentials. The ultimate survivor is the one who listens, is supportive, caring, and pays attention to the business of surviving. As a team, though, to survive, participants need good communication skills.

We have similar drama in our practices. Our offices struggle with communication issues, lack of teamwork, and training issues, plus the staff and doctors often feel unappreciated. One of the most dramatic issues dentists face is, "Why can't we all just get along?" I spoke with an office administrator recently who asked this very question. Just as the basics are necessary in the survival of reality shows, so are the basics necessary in private practice.

The three basics of a successful practice, one that has minimal struggles, are: excellent clinical skills, effective business systems, and communication. The most important of these three is communication. If we're looking for harmony, growth, cash flow, improvement in our business systems, and want to provide excellent clinical care to our patients, we need great communication skills. At Linda Miles and Associates, we believe team meetings are critical to the communication process. When I asked the above mentioned office administrator about the effectiveness of their team meetings, she said, "Oh, we don't do team meetings well!" Unfortunately, most offices don't! Why don't doctors like team meetings? Many feel that the meetings are a waste of time, unproductive, and often turn into gripe sessions.

Rather than having an unproductive gripe session, consider letting your team know you're interested in long-term harmony. Get to the root of your issues. Talk about what it takes to have a successful practice. Explain how the whole business runs, get a better understanding of what each team member does, and how important it is for each of them to be harmonious with one another. To begin, let them know it's OK to talk about what's wrong in the practice. Talk about what is going well, but also discuss what could be better and what changes are necessary for success.

Begin by talking about how teams usually interact. A psychologist named Bruce Tuckman did interesting research in this area in 1965. He discussed how groups interact and the stages that groups go through. The interesting part of all this is that all groups go through these stages. The stages are normal to group dynamics, even if it's just a group of two. You can think about these stages as they apply to marriage, friendships, or work relationships. He called these stages "Forming, Storming, Norming, and Performing."

The forming stage is the "honeymoon" period. We're on our best behavior and we're also on our guard. We're very polite to each other — it's an English tea party! Could you please pass the Grey Poupon? This stage happens whenever something changes – new goals, new skills, or new staff. Team members are getting to know each other and make new friends. They're also learning how each of the members work as an individual and how they respond to pressure. If you're implementing change, even a new computer software system, your team will move into the forming stage. People are tentative during this time, because the "safety" of the situation has not yet been established.

Then starts the storming phase where people turn into mud wrestlers! Your team members will start to test the systems, stepping on each other's toes. This can be the stage where your staff wants to kill each other (figuratively speaking, of course!). When this happens, things are about to change. Sometimes, the staff will have a meeting after the meeting — about you! Different ideas will compete for consideration. The team will address issues about the problems they're supposed to solve, and how they will function independently and together. They open up to each other and confront each other's ideas and perspectives.

In some cases, storming can be resolved quickly. In others, teams never leave this stage. The maturity level of team members usually determines whether the team will leave this stage, which is crucially important to the growth of the team. It can be contentious, unpleasant, and even painful for those who are adverse to conflict. Without tolerance and patience at this stage, motivation will drop and the team will fail.

Most doctors are not experts at dealing with confrontation. We tend to avoid staff issues; in fact, some doctors will take a vacation and hope it all "just goes away." One thing I know to be true is that issues with women do not go away. In fact, if we have a problem, we worry it to death until it's resolved. Our problems keep us up at night, become magnified … we turn a molehill into a mountain! The important part of all this is that we can't avoid the storming phase. If we avoid it, we can't improve.

The next phase is called norming. Norming is when we adjust to each other's behaviors, and develop work habits that seem more natural and fluid. Team members work through this stage by agreeing on rules, values, professional behavior, and shared methods. During this phase, they begin to trust each other. Motivation increases. Teams in this phase, however, can lose their creativity if the norming behaviors become too strong and stifle healthy dissent. If we're not careful here, we begin to have "group-speak."

In the performing stage, the team functions as a unit, getting the job done smoothly and effectively. Conflict is minimal and there is little need for supervision. Team members become interdependent. If we're lucky in the dental practice, we'll reach this stage … maybe for six minutes! I liken this stage to the perfect golf stroke. In this stage, the doctor is leading the staff, and the staff leads the systems. Then something hits – a change in staff, a divorce, a marriage — and the team cycles through the stages again. This is all normal!

Talk with your team about these stages. About 50% of the population is resistant to change. Twenty-five percent of the population is sensitive to confrontation. That pretty much makes up your entire team, including the doctor. When you know that these group dynamics are normal and that we need to move through the stages, it will be easier to talk about the difficult issues. Now it's time to share with your team your vision and how you want your business to run. These are common elements of a successful dental practice:

1) Great people: Everyone is a self-starter. Everyone is an excellent worker with a positive attitude. We have our patients' best interests at heart. You will only be as strong as the weakest link of your team.

2) Harmony: You may not like everyone on your team, but you must respect each other. Team building exercises help. Discuss behavior styles, conflict resolution techniques, and deal with issues immediately.

3) Continuous flow of ideas: Take your team to CE meetings (your entire team). Ask them to write down two or three of the best ideas to bring back to your next team meeting. Hopefully, that meeting is scheduled on the Monday of your return. Watch educational programs for an hour, again noting the best ideas. Then talk about them for an hour, including how to best implement the change into your practice. Bring specialists into your office for a lunch-'n'-learn, or consider bringing in Sonicare or an implant representative for a lunch session. Avoid "group-speak" by allowing open discussion of new ideas. Avoid saying, "But we've always done it this way!"

4) Team training: If you think about the phases of communication in a dental practice, there are eight phases for a new patient, beginning with:

  1. The phone, a critical instrument. Phone skills will be addressed in a future article.
  2. The greeting and patient registration forms
  3. Seating by the assistant or hygienist
  4. Data gathering: health history screening; blood pressure screening; necessary X-rays; charting of existing restorations; asking two important questions; tour of the mouth with an intraoral camera; comprehensive, extensive needs, e.g., photographs, models; examination by the doctor
  5. Post-treatment explanations
  6. Financial and benefit plan arrangements; next appointment
  7. Dismissal
  8. Of these eight steps, your staff is responsible for seven of them! If you don't invest time and money in training your team, you will not have a successful practice!

5) Leadership challenges: Does your team have a well-liked and respected leader? Can you say: "I am the leader. I lead by example"? Are you passionate, cheerful, and love what you do? Or are you marking time? Do you need a "shot in the arm"? Consulting and coaching can help! One final element of success: Do you earn the loyalty of your team and your patients? Loyalty means stability, growth, and profit. Loyalty must be earned! For a copy of my suggested reading and audio leadership list, send me an e-mail at [email protected].

The beauty of being in business for yourself is that you write your history, create your destiny, and write your paycheck. You'll never be all you can be, though, without your team on board, behind you, backing up everything you believe in. Stages of team development are important for your practice growth. Just as in a marriage, if we can survive the tough times, we grow and become stronger. If you can move through the stages of development, your team and practice will be stronger. If you open up about what you want and lead your team forward with this method, you will have a harmonious, successful practice.

Editor's Note: View a video of Dr. Savage speaking at a recent meeting on the video link of As one of the key players behind the Speaking Consulting Network, Dental Economics® is pleased to announce a partnership with SCN in which various members will be featured on the DE® video page in the coming weeks and months. Keep watching for the newest videos from influential speakers in the industry.

Dr. Rhonda Savage has been in private practice for 16 years, has authored many published peer- reviewed articles, and has lectured internationally. She is active in organized dentistry and is the immediate past president of the Washington State Dental Association. She is an affiliate faculty member of the University of Washington School of Dentistry. She is the chief executive officer for Linda L. Miles and Associates, a practice management and consulting business. Dr. Savage can be reached by e-mail at [email protected].

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