Part 4 of 4The many HATS of dentistry — The operations-management hat

Sept. 1, 2003
Does your office fall short of the ideal practice you desire? Do efforts to improve the practice fail to capture your team's interest or fizzle out after a short time?

by James R. Pride, DDS, and Amy Morgan with Victoria Farr, DDS, and Reza Moezi, DDS

Does your office fall short of the ideal practice you desire? Do efforts to improve the practice fail to capture your team's interest or fizzle out after a short time? To transform your professional aspirations into tangible, lasting improvements, you need the skill of operations management.

In our "Hats of Dentistry" series, we've explained how you need to juggle different hats to be successful as an entrepreneur and clinician. The advanced clinical hat requires that all of your practice-management hats be firmly in place to support clinical advances. The statistical-management hat measures the performance of you and your team, pinpointing successes as well as areas needing improvement. The leadership hat is the one you wear to set the vision and direction for your practice and to inspire your team to achieve goals. While leadership sets the vision and statistical management measures the results, yet another hat is needed to get you from your vision to the results — the operations-management hat.

To illustrate this concept, we chose a husband and wife team who wears the hat well. Less than 15 years in practice, they stand a few short years away from financial independence, when they can choose to retire or to continue practicing dentistry for the love of it. They not only practice the full-mouth dentistry that they enjoy and spend time managing their practice, but they accomplish all of this in a three-and-a-half-day workweek with 10 weeks of vacation each year. They are Reza Moezi, DDS, and Victoria Farr, DDS, general dentists who work together at Creekside Family Dentistry in Vacaville, Calif.

Drs. Moezi and Farr joined Pride Institute shortly after starting their joint practice. "Dental school gave us the clinical information, but we also needed the business skills so things wouldn't happen haphazardly," recalls Dr. Moezi. "If we had a good or bad month, we wanted to know why so we could repeat our successes and correct our failures. Pride taught us the management side of dentistry." A hallmark of this practice is seeing a few patients in long appointments for comprehensive-care dentistry in an exceptionally caring, friendly, and comfortable environment.

"When we began practicing, Reza said that his goal was to open any chart and be able to say three things about a patient that were nondental," says Dr. Farr. "Now, thanks to the time we spend getting to know our patients, we can do that. Because we build strong relationships, our patients are more apt to accept the kind of treatment they need and we want to provide."

Let's look at some of the management skills that have helped these two doctors practice their dream.

Hiring

"We purchased a wonderful practice from a great dentist. However, as new leaders wanting to make changes, we were met with resistance from a team that had its own way of doing things," Dr. Farr recalls. "Within the first 18 months, we lost everyone except one team member. We had to learn how to hire people who were eager to learn the new systems we wanted to have."

Drs. Farr and Moezi developed a key skill of operations management — hiring suitable people. Here are the elements of their effective hiring method:

• Develop written criteria and a questionnaire. "Before we hire anyone, Reza and I figure out exactly the criteria we are looking for, and this can change with every position," explains Dr. Farr. For example, in an appointment coordinator, they look for "lots of self-confidence, because they're met with no's and resistance from patients, and they can't take it personally." In a financial administrator they look for someone "super-organized and extremely honest." They place more emphasis on values, goals, and interpersonal skills than on dental experience. "Although clinical skills, like how to use a saliva evacuator, are very important, we can teach these things fairly easily. We look more for someone who will be attentive to the patients and enjoy dealing with them," says Dr. Moezi.

The two dentists design a list of probing questions to reveal applicants' clinical skills, as well as their character and attributes. Here are some examples: What do you feel are your greatest strengths? What was the worst mistake you ever made in a job, and how did you handle it? Describe a recent situation in which you had a dissatisfied customer and tell us what you did to remedy the situation. If you could create the ideal job for yourself, what would it be like? What do you think patient service in a dental office consists of? Where do you see yourself career-wise in three to five years?

• Run an unusual, eye-catching ad. The dentists do not give logistics such as hours, days, or salary in their ads. "We want the reader to be curious and to know that our office is different," says Dr. Farr.

One of their ads reads like this: Our progressive, unique dental team is waiting for a friendly, experienced, fun-loving RDA looking for a new frontier. Please fax your resume ...

• Conduct a series of interviews. First comes the office manager's well-orchestrated phone-screening of candidates from chosen resumes. This is followed by an in-person interview with one of the dentists to select the short list of final candidates. The dentists ask the finalists to work half a day with the group from the morning huddle through lunch to determine if there is a good match. "We intentionally don't offer to pay candidates for the working interview, because the job requires off-hours reading of training materials. If they don't want to invest time in the interview, it suggests to us there is a mismatch," says Dr. Farr. The working interview greatly impresses the candidates. "We usually hear remarks like, 'I've never seen anything like this. You guys are very organized, and you have so much fun with the patients.' "

• Tell applicants about the job. Drs. Farr and Moezi make their practice philosophy and job expectations very clear immediately, thereby avoiding misunderstandings later. The philosophy includes taking extra care of patients beyond the average dental experience. Requirements include attendance at morning huddles, team meetings, and ongoing training programs, which involve travel, seminars, role-playing exercises, and off-hours reading. "We always ask what the applicant thinks of these expectations so we can see if there is a good match," says Dr. Farr.

With this carefully crafted hiring program, it is no wonder that the practice has acquired an exceptionally enthusiastic, motivated, and professional team with whom the patients and dentists love dealing.

Training

After hiring the right person, the dentists begin a rigorous training process. Two qualifications are critical for the trainee's success: willingness and capability. The program provides an opportunity for the qualified person to flourish. Here are some elements of the process:

• Training manuals — Years ago, when their veteran financial administrator retired, the dentists were jolted. "We had no way to train a replacement. Instead of freaking out, we wrote a detailed training manual for the position. It's 60 pages of information on how to turn on the computer; ring up charges; process insurance; close the day, month, and year; post notes in the computer; send monthly statements; etc. It was so helpful that we wrote a manual for every position. If we didn't have these manuals, things would be done haphazardly and inaccurately," says Dr. Farr. The manuals have made it possible for the dentists to standardize the proper way of performing tasks, readily bring new hires up to speed, and cross-train team members, thereby enhancing patient service in a smoothly run office. A case of cross-training shows how invaluable the manuals have become: "We had an employee who could no longer perform her job for a medical reason," explains Dr. Moezi. "She was such a phenomenal person that we didn't want to lose her. Our manual made it easy to groom her for another position that she could perform."

• Training charts — The dentists complete a training chart for every new team member, listing initial tasks to be learned. "We try not to overwhelm the person, so we concentrate on only a handful of things at a time, usually three things that will make the biggest impact," says Dr. Farr. For a new hygienist, the training chart will include clinical, verbal, and diagnostic skills. Under these three broad categories, the dentists list specific tasks for the trainee to master. After this, the dentists introduce more items to complete and refine the person's skills. Progress is monitored by the dentists and their office manager. Drs. Farr and Moezi also meet with the new hire regularly to discuss progress, to get the employee's input on how the process is going, and to revise the training chart. In the meantime, the trainee is working. This training is supplemented with a wealth of resources and feedback for guidance:

Regular team meetings with ample role-playing to hone critical skills

Required readings from Pride Institute's volumes on Appointment Scheduling, Financial Arrangements, The New Patient Examination and Consultation, or Continuing Care, depending on the job position

Patients' feedback on the new team member, elicited by the doctors

A basic skills workshop to familiarize new hires with the systems

• Continuous professional growth — "Everyone has a training chart, even Reza and me," says Dr. Farr. The dentists revise everyone's chart at annual — or more frequently if necessary — performance evaluations called growth conferences. "Our basic training program takes a year or longer to complete, after which we extend the training beyond basic tasks to interpersonal and leadership skills. For example, our office manager is broadening her skills by learning to be the trainer for the practice." The entire team attends a yearly advanced-skills workshop to hone higher level skills.

Growth conferences and salary reviews

How do Drs. Farr and Moezi make the training "stick"? An important method they use is that of growth conferences, which are yearly meetings that either Dr. Moezi or Dr. Farr hold with each team member individually to discuss and acknowledge the person's successes and strengths and to define areas for improvement. Both doctor and team member prepare a written list of strengths and areas for further growth prior to the meeting. "I let them talk first," explains Dr. Moezi. "They mention the positive things happening in their department that they feel great about. Then I ask them to name some things they would like to see improved. Most of the time their lists match mine identically. I emphasize the positive things to encourage them to continue their good behavior. Then I ask them for ideas on how they can grow in their jobs, and we come up with items to go on the training chart." Rather than provoking anger or defensiveness, the approach is collaborative and problem-solving.

For example, there was a case in which patient care was being compromised. Instead of saying, "You know, you didn't take care of the patient very well," Dr. Farr broached the matter at a growth conference with the nonthreatening question, "How do you feel our patient care has been recently?" The team member replied, "I know exactly what you're going to say." The method of having the team member identify the shortcomings makes the person more receptive to acknowledging and changing them. Dr. Farr continued with these questions: "If you were the patient in the chair, how would you feel if ..." and "Can we agree that this needs to be changed?" The team member came up with solutions to the problem, and Dr. Farr scheduled follow-up meetings. This is how problems are identified and solved without tension or blame.

The salary review, which is separate from the growth conference, is easy when team members know where they stand. If they have failed to meet expectations defined in the growth conference, they will not expect a raise, since yearly increases are not automatic in this practice. When team members meet expectations, they get raises based on a percentage of increased production.

Conflict resolution

"Conflict resolution is super-important!" says Dr. Farr. "At one of our meetings, Reza and I contracted with the entire team to address all problems that arise. This contract is between all of them individually and also between us and them. It acknowledges that there are going to be issues and conflicts that need to be addressed, so no one should feel upset about that." Both the doctors and team wrote down individually how they want to be approached if someone has an issue to discuss with them. One person prefers a written note. Most want to be told immediately, but "just be kind about it." Some want to be approached during a slow time in the practice. The team members use verbal skills they learned to approach each other respectfully and positively.

Sometimes employees resolve conflicts by themselves; other times one of the dentists gets involved. One recent example occurred when Team Member "Alice" corrected Team Member "Bee" within hearing range of a patient, thereby causing Bee embarrassment. Because of the contract, the incident was brought up. Dr. Farr helped resolve the conflict by asking Alice, "Can you see how the patient's hearing you would be an issue for Bee?" Alice agreed, but explained that she did not see the patient, so the overhearing was unintentional. Like many disputes, this one was a simple misunderstanding. Once aired, the matter was quickly resolved.

How much time do Drs. Farr and Moezi spend on operations management? "A lot," says Dr. Farr. "But it pays for itself a million-fold. We have team members who show patients the value of dentistry, make them feel comfortable, and educate them ... and patients say 'yes' to the treatment they need." Through their mastery of the business side of dentistry, Drs. Farr and Moezi have molded the practice of their dreams. They not only enjoy their profession, but have ample time to pursue their other passion — big mountain skiing in off-resort, unchartered areas. Their three-and-a-half-day workweek and 10 weeks of vacation are made possible by their high-production practice and skilled team, which, in turn, are made possible through their mastery of the business side of dentistry. As we have shown in this series, the good life awaits those dentists who can wear the many hats of the successful entrepreneur and clinician.

Meet Drs. Farr and Moezi as they teach operations management; learn what they have learned in developing their ideal practice. They are two of the instructors who conduct Pride Institute's "Team Strategies: Skills, Training, and Motivation for the Team" seminar. For more information on cities and dates, call (800) 925-2600.

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