The 24-hour rule

We've all heard it, haven't we? "Dr., my insurance company said you charge too much!" The typical dentist's response to this ranges from the almost socio-pathological, to the fetal-position fearful, to the nonprintable comic zingers.

Dr. Michael Gradeless

Being the boss is one of the most difficult challenges there is for dentists. Leading your practice effectively is complicated by several factors. The first problem is that we were never trained to be a boss. The second problem is that while you may be the boss, you are actually a co-worker with your staff. We work closely with them and know them personally. This leads to the third factor, which is that when it comes to confronting staff about job performance, most of us simply don't want to do it. Here are tips for effective confrontation.

The first and most important rule in effective confrontation is the 24-hour rule. The 24-hour rule is simple. If you are the type of doctor who would rather not confront the issues and simply hopes that problems will correct themselves, then you must confront issues within 24 hours of your first observation of the problem. If you are the kind of doctor who doesn't mind confrontation, you must wait at least 24 hours before discussing it with your employee. Dentists as employers tend to belong in one of two groups. We are either the spineless doctor who refuses to address issues, or we are the drive-by shooter who confronts every issue immediately, often confronting the wrong person at the wrong time.

The second tip is to always praise in public and confront in private. This seems straightforward, but it is also a timing issue. After you have a short meeting with an employee, you should understand that there will be meetings after the meeting where your employee will discuss what happened with the rest of the staff. The worst time to confront an employee is the end of day right before the weekend. By the time Monday morning rolls around, the entire staff may be outraged by your expectations. The best time for confrontation is the beginning of a day. The meeting after the meeting cannot happen until lunchtime. By this time, any feelings of anger or frustration will have decreased. Combine the 24-hour rule with optimum timing to keep the confrontation private.

The third and most important factor to remember is that we are confronting job performance, not the individual. Think very carefully about what you want to say. I have always found it helpful to rehearse what I will say to avoid an appearance of attacking the individual. Business experts recommend we use "I" messages. The "I" message follows a specific, three-step formula. The first step is to open with the behavior or action you saw without using the word "you." The second step is to let the other person know how you feel about this. Identify your emotion. This is important because if you have followed the 24-hour rule and rehearsed what you will say, you may not appear upset even if you really are. The third and final step is to identify how this particular action can affect the quality of patient care or service and how this fails to fit with your philosophy. Remember your mission and philosophy statement? This is the time to actually use it! When you put this all together, an I-message might look something like this. "Yesterday when we were preparing the crown for Mrs. Jones, there were several instruments that were not on the tray set-up. When our patients spend extra time in the chair because we are not properly prepared for their appointment, I get very upset. This doesn't fit with our philosophy of providing the highest quality customer service." The person receiving this message is certainly not going to be elated because you used an I-message, but when the message is about the care of our patients, they must be able to come around to our way of thinking.

There are many great employees who work in our profession of dentistry. We like them, enjoy working with them, and we prefer not to alienate them with an angry confrontation. When confrontation is necessary, use the 24-hour rule to defuse anger, keep the confrontation private, and focus on the quality of patient care. You can have a successful interaction that will improve your practice.

Dr. Michael Gradeless, a 1980 graduate of Indiana University, practices preventive dentistry in Indianapolis with an emphasis on cosmetics and implants. He is an adjunct faculty member at Indiana University where he teaches the Pride Institute university curriculum of dental management. He is also the editor for the Indiana Dental Association. Contact him at (317) 841-3130 or email to drmike44@aol.com.

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