Doctor's training for successful team performance

by Anil K. Agarwal, DDS, MS

The human desire to control people could be considered the Curse of Earth through the ages. After many hours of studying business models, professional coaches, and even the millionaire mindset, I now realize that the key to success in dentistry lies in controlling ourselves while giving freedom to others.

I contend that no one has built an optimum practice single-handedly. It takes a team, loaded with powerful followers who recognize that the patients are their actual employer because, without their contentment and trust, the practice cannot thrive. A well-run team considers it “our practice,” a place where they belong rather than it being the doctor’s property or problem. The doctor is just the middleman, distributing the money that the team has earned.

However, in my travels around the country, I find that many dentists view their staff as something to manage and control. They seem to have lost sight of the basic principles of success — enthusiasm, customer service, respect, and a happy frame of mind. They are tangled up in high staff turnover, animosity, and negative energy that perpetuate poor productivity. I also contend that a well-cultivated team of happy, enthusiastic people who are allowed the freedom to grow will do more for practice performance than all the bar charts and worksheets one can create. It’s time to leave behind current bad habits and develop a better model for successful team performance. I offer nine challenges for change that have served me well.

Hiring the best

Building a team starts with the hiring process. The typical practice evaluates a candidate’s level of dental experience and length of time at previous employers. I believe personality, desire to learn, and specific behavioral attributes should be weighed more heavily than the technical dental knowledge of a candidate. When someone has the desire to learn, he or she is easier to train than someone who is satisfied with the rut of life. Challenge No. 1 is that in the hiring process, priority should be given to people exhibiting these eight qualities:

Listening and understanding skills
A focus on patient satisfaction
The ability to anticipate a situation
The ability to identify needs and find solutions
A willingness to make and keep commitments
Concern for fairness without bias
Good interpersonal skills
The ability to be a leader and create other leaders

One cannot make snap judgments when hiring. I use a five-step process that begins with a 10-minute phone screening by a current team member. The team member evaluates the interviewee’s tone and use of language, then calls the references provided if the candidate is qualified to advance to the next step. During the second step, a team member spends a maximum of one hour, face-to-face time with the candidate to discuss his or her former position and interest in employment. They then meet with me for role-playing, during which I specifically look for the eight attributes listed above. I also suggest a paid working interview to evaluate the candidate’s commitment to shifting his or her personal schedule. This is an excellent way to assess the individual’s flexibility. The potential candidate spends a half-day in each of my two offices and has lunch with all the team members, except me, afterwards. I’ve found that this opens discussion and allows a nonthreatening exchange of questions and answers. I completely trust my team members to properly assess whether the candidate belongs in our practice.

Challenge No. 2 is to give a personality report prior to extending an employment offer. My team has constructed customized questions that identify 23 characteristics which are evaluated in a 40-minute home test. The results are reflected in a bar graph that provides a great composite for strengths and weaknesses. In administering this test, I check whether the candidate tests well in the areas needed for the position, and I see how that person feels rewarded in his or her personal life.

The categories we have chosen include job attributes, reward and culture, and behavior. The job attributes section encompasses seven characteristics that include empathy, diplomacy, and self-management. The reward and culture section examines the variety of ways people feel rewarded. For example, some value creative self-expression, others value practical accomplishments, and social people value opportunities to be of service. The behavior section determines whether people can maintain an optimistic attitude, deal with frequent changes, and enjoy interacting with others.

I’ve found that this level of analysis and team involvement affords the practice very little turnover and shortens training time. When we hire someone with the correct personality and values for the position, and that person has a sincere desire to learn and be a leader, he or she fits seamlessly into place. I consider someone a leader if he or she is a powerful follower who is capable of these four significant behaviors:

Able to take instruction
Not argumentative
Willing to take initiative
Has intentions to improve a situation, not self-serving

Training for success

During training, new hires are often thrown off guard because they have never been viewed as leaders. They are used to training that requires reading manuals or following around existing employees. They fear their first mistake and view the dentist as unapproachable. This doesn’t work, hence, Challenge No. 3. I have very few written training materials because they don’t get read, and I don’t expect existing team members to hover over anyone. Rather, new team members are told what must be done, shown the location of critical materials, and allowed to complete the procedure in the method they choose. If they make a mistake, they figure it out or seek assistance.

I believe that Challenge No. 4 is never to call attention to the mistakes made by anyone on the team. I simply try to guide the team member toward improvement. I believe this approach creates continuous growth, develops confidence, and encourages initiative. In fact, if several weeks pass and someone hasn’t made a mistake, I playfully harass my team, because if there are no mistakes, I believe they aren’t taking enough initiative!

New team members also meet with me during lunch two or three times per week so we can figure out problems and find solutions. I find problems arise when they don’t know what is expected of them or they haven’t been adequately trained. When we discuss issues as they arise, no one develops a negative perspective.

All of my team members become cross-trained in every position, except for clinical dental hygiene. Even the most challenging positions such as office manager and director of clinics (head dental assistant) can be run by others should it become necessary. More importantly, cross training allows everyone to understand the impact of their actions on others in the office.

The value of developing leaders

My goal for each person, each day, is to be more aware of good customer service, be more flexible, and engage in excellent interaction with the entire team. I consider them pivotal performers if their number one quality is leadership, the discernment of a powerful follower who makes decisions that grow our practice. I subscribe to Michael Gerber’s philosophy as presented in his book, E-Myth Mastery, in which he explains the need to create leaders to manage for you. He claims we only have a “job” if we have to monitor people, but we have a “business” when the work gets done even in the leader’s absence. We operate by the principles of open book management, which builds trust. Team members generate reports that help us track our progress, and this information is shared in our weekly recharge meetings.

Challenge No. 5 is to require a one-hour meeting every Monday, apart from the daily huddle, to prepare for a successful week. We start with a nondental “insight of the day,” followed by relevant statistics reported by each team member, and then we read our purpose aloud. It is written down and framed for all to see, serving as a reminder throughout the day. Then I present a message relating to important matters about life, not dentistry, and address questions that have come up. This meeting proves well worth the effort.

Many dental practices find my approach to negativity unusual, yet successful, and this leads to Challenge No. 6. Should a team member raise an issue in a negative tone, or cite reasons why something isn’t possible, I have the team practice the 333T game, which is based on the story of a company that fulfilled its goal to raise $3 million in three days, working three hours each day, to recoup from a disaster. They set a lofty challenge, and maintained the attitude that they would succeed, even though the odds were against them. They each asked, “What can I do to make this work?” rather than wasting time evaluating why it wouldn’t. So when we encounter doomed-to-fail thinking in our office, a staff member intercepts it with the word “next,” which indicates it’s time to either drop the topic or find a solution.

In addition to daily huddles and weekly recharge meetings, both of the offices and all of the team members gather monthly off-site to listen to special speakers, enjoy exotic food, and participate in team-building games that often require unanimous decisions during a time limit. These games mirror the daily group dynamics at the dental office and help everyone understand the decision-making approaches of others.

Performance on track

How to approach performance reviews represents Challenge No. 7. I schedule performance reviews quarterly and do not link them to salary increases. I evaluate the office managers, the director of clinics, and the head of dental hygiene. They are then responsible for the reviews of the team members they oversee. My team feels that their needs are being met because they make higher-than-standard salary, receive benefits, and often receive an optional bonus each month, so I believe that they consider salary irrelevant. I reward them with an hourly increase when I see consistent initiative, enthusiastic customer service, and personal growth — three things that make our practice grow. But I caution dentists against reminding a team member about a recent raise because he or she will resent this. I contend that a team member should never have to ask for a raise if he or she is doing appropriate communicating and rewarding.

From time to time, a team member must be told that he or she is not performing to expectations. I always approach this situation with love and compassion, beginning with the statement, “It has to be my fault. How can I help you?” That starts a dialogue about their position, what they like and what they do not like. Not surprisingly, they don’t like the things that ranked low in their personality composite test, or that don’t present clear expectations. We then make adjustments. However, if a person continues to perform poorly, he or she is terminated.

Challenge No. 8 requires that an employee should be terminated in 30 seconds or less, otherwise I have talked too long. When receiving this type of news, people are instantly in turmoil and stop listening to critique and sage wisdom. It is best to assure them of severance and offer a subsequent phone conversation for a more thorough explanation, should they care to learn from their mistakes.

Handling patient objections

Just as negativity is destructive within the team, it is also crippling for patients. We cannot influence patients’ behavior as easily, but we have found a successful method of confrontation. First of all, the practice has a mandatory policy to explain all treatment and financial responsibility to patients before scheduling in order to avoid ambiguity or confusion. But sometimes a discontented patient calls and his or her situation must be handled appropriately.

First the team member will apologize, and then ask what the office can do to resolve the issue. The patient usually just wants someone to listen, and so someone does, without interruption. We even ask the patient to elaborate. Eventually, the confusion is cleared up. But if the patient is still not satisfied, my team schedules an appointment for a discussion with me. I cannot be unapproachable and expect my team to tolerate anger.

Keeping the team motivated

People are motivated by recognition, money, flexibility, respect, and concern. That’s it. Different people are motivated in different ways. I really like Warren Buffett’s answer when he was asked for his job description. He stated that he has five to six main business managers, each a billionaire. He sees it as his responsibility to keep each one motivated, because none of them have a monetary reason to work. In some ways, I see myself as a motivator. I have had the pleasure of retaining four team members for more than 11 years, and five for more than three years, because they see their efforts rewarded. In fact, the only reason I have had turnover is because of personal life changes!

Like many dental practices, I maintain performance-based incentives, paid monthly as I choose, that reflect a percentage of the profit. I look at the average monthly collection, averaged over three months, minus expenses, to establish a baseline. I exclude expenses related to my car, travel, entertainment, and salaries. I have a formula that I review periodically that allocates a percentage of the baseline among all the team members except the hygienists. This bonus reflects their individual performances, relative to their titles, and has nothing to do with seniority.

I calculate the dental hygienists’ bonuses differently because I feel that they are directly in control of their production, and are decision makers for disease management in my practice. They are not “teeth cleaners.” I add up their monthly production for all procedures except my patient exams, subtract their monthly salary, and reward them with 33 percent of the remainder.

But what about those people who are not as motivated by money? I run the practice with an “open your heart” attitude, which I consider Challenge No. 9. I thank my team members daily for their efforts, and keep movie and dinner tickets handy for on-the-spot recognition when someone goes well beyond the call of duty. I credit Bob Nelson’s book, 1001 Ways To Reward Employees, for helping me develop an inner spirit for genuine rewards. I encourage and reimburse for training courses, and pay their salaries while they attend, because I know they do this to continue growing and I would be foolish to interfere.

Training never stops in the practice and, in fact, I require a minimum of two CE courses annually to maintain employment for those team members not mandated CE by law. Finally, I am attentive to the personal needs and stressful issues of team members. I notice performance drops when someone is overwhelmed by a problem and know that a solution is in everyone’s best interest. At times, I have provided an interest-free loan for a down payment on a reliable vehicle or covered the cost of car repairs. Once I coordinated the purchase of a mother-of-the-bride dress for a single mom and found myself sitting at the family’s table during the wedding reception! These small gestures foster a happy, successful team that remains loyal throughout the years.

To truly achieve successful team performance, one must learn an important distinction. Controlling a team with micromanaging tactics because your name is on the door causes productivity to suffer. However, if you encourage their growth potential and performance, your practice can grow exponentially. Do the front-end work to create a team of enthusiastic people who like to learn. Develop them into leaders, train them well, and then give them freedom and room to grow. They will make effective decisions, contribute to the productivity of the practice, and remain committed to team success.

Dr. Anil Agarwal is a practicing prosthodontist with two multimillion-dollar practices in the Chicago suburbs. As president of WIN Practice Performance, he consults with individual practices and lectures upon invitation. His recently published book, Extreme Dental Practice Makeover, is available at www.winpracticeperformance.com/freebook. He can be reached at www.winpracticeperformance.com or 1-800-WIN-8566.

9 Challenges To Create Successful Team Performance

In the hiring process, give priority to people who exhibit eight important qualities.
Present a personality test prior to an offer of employment.
Don’t bother with written training materials.
Never call attention to mistakes by team members.
Set a one-hour meeting each Monday to prepare for a successful week.
Should negativity arise, challenge the team to the 333T game.
Schedule performance reviews quarterly and do not link them to salary increases.
Terminate an employee in 30 seconds or less instead of talking too long.
Keep an “open heart” attitude.