8 management mistakes

Oct. 1, 2000
If you`re guilty of any of these eight menacing management mistakes, take the bull by the horns and correct them!

If you`re guilty of any of these eight menacing management mistakes, take the bull by the horns and correct them!

Sally McKenzie, CMC

In the endless pursuit of a magic bullet, dentists go ahead and make management changes without necessarily considering costs or damages, long-range implications, or alternatives. If they get hurt, they`ll know better next time. What a concept! I shudder to think of the disservice being done to so many practices in the name of "progress."

To make it in dentistry - to really make it - you`d better be as good at avoiding mistakes in practice management as you are at avoiding them in your art and science. To that end, I have culled eight of the most menacing management mistakes a practice can make from thousands of dental practices I have consulted with across the country.

Here, for the first time, is this ominous octet:

Changing systems or protocol without a means of measuring effectiveness.

While on the golf course, a colleague mentions that calling patients to confirm appointments is a big waste of time and manpower. Back at the office, you direct front-desk Fran to stop making the calls immediately. Most happily, Fran gives up this tedious task that she always claimed she didn`t have time to do anyway.

After four months, however, you and your staff notice a marked increase in no-shows and a commensurate slowdown in production and revenues. Some coincidence!

Why did you make this mistake? You made it because your golfing buddy has a very successful practice, and he made it sound really credible. Besides, you think it might make Fran`s job easier, which, in effect, would make your life easier.

Before making any change in a practice system or protocol, it`s critical that measurements be used wherever possible to anticipate what kind of impact the change will have on the practice. In the above instance, if no-shows had been tracked and were holding at 5 percent with reminder calls, it wouldn`t have taken all those months to figure out that the no-show rate had quadrupled since the calls were stopped. Without such tracking, too much damage can occur before anyone realizes the negative effects of the change.

Speaking of tracking and measurement, consider this: Dentists call me all the time, asking if they should renew their Yellow Pages ads. "Well," I ask, "how many new patients did you get from your ad last year and how much production was generated as a result?" No response. If this information is not being tracked, doctor, your guess is as good as mine about the potency and performance of your advertising dollar. Why are you considering pulling the ad? Is it because it might save you money? But if you don`t know what amount of business your ad is bringing (or not bringing) in, there`s no way to know whether it`s going to save you or cost you money!

Purchasing a new computer program, you take advantage of the training offered with purchase, but you do not contract for additional training.

Dental practices frequently are being run on a day-to-day basis by a staff member we`ll call Barb. She received only the training-with-purchase provided by a software manufacturer, or, worse yet, some watered-down software basics by a third- or fourth-generation business staffer. Why did you make this mistake? Because you believed you were saving money by not contracting for additional training.

Or, maybe you didn`t think you could afford the time it would have taken for Barb to be trained. Finally, it`s also possible that Barb didn`t want you to think she needed training, so she faked it - and you bought it!

Having rather limited skills in this software program, though, creates still another problem. Barb frequently resorts to using her old, slow-as-sludge manual systems, and then she doesn`t have enough time to get everything done. So, a business helper is hired and payroll costs jump up another 2-3 percent of practice income.

Besides the added expense, there are productivity problems. This category includes treatment plans not being entered into the computer, which gives you no way to track and schedule outstanding dentistry. This, alone, packs a far greater financial wallop than the moderate price tag you would have paid for additional software training.

Waiting until year-end to see how you did.

Oops! Production last year was $742,000, and this year it`s $740,976. Not to worry; it`s close enough, right? What about the fact that you raised fees by 5 percent back in April? Somehow, that doesn`t compute. Why did you make this mistake?

It happened because you don`t like looking at the numbers. If they`re down, you don`t know why or how to reverse the tide. So, it`s more comfortable to do the ostrich thing - stick your head in the sand.

Or, let`s say that you are a numbers person. Then your mistake might have been not making sure that one of your staff members received training on how to generate the information you need on a monthly basis. As a result, she keeps putting it off - and you allow it!

The truth is, if you had kept tabs on the numbers throughout the year, you would have figured out some time ago that your new business-office assistant, Sue, isn`t scheduling to production needs. You also would have known that patient retention had fallen off by almost 10 percent. Or, you would have known that no one was following up on the unscheduled treatment that adds up to a hefty six-figure "loss."

At the end of each month, have your business-staff member give you year-to-date production and collection figures compared to the same time last year. You`ll find that practicing preventive management is as prudent as performing preventive dentistry.

Giving patients interest-free loans.

Go ahead and run your accounts receivable report. Now, take a look at the account history of patients who have owed you money for more than 90 days. There`s the classic story of the patient who "forgot" to bring her checkbook the day you took impressions for her crown and forgot it again on the day you seated it. Not to worry. She promised to mail in her payment. However, months later, her insurance company has paid its portion, but the patient has never paid her share. Why did you make this mistake? You made it because the patient is a friend of a friend of your cousin`s sister-in-law.

Then there`s Mr. and Mrs. Delinquent and their five kids. Nice family, but when family members came in for their recall visits more than six months ago, four of the kids needed fillings and Dad needed a root canal. They paid $100 on the day of service ... and have been sending a check for $10 each month since then - $10!

Why did you make this mistake? This occurred because you`ve had more than one business assistant in the past several months, and nobody has followed up on past-due accounts. Or, maybe it`s because Lynn, your long-term business assistant, sees this family at church every Sunday, and she just can`t muster up the guts to make a delinquent-account call.

You`re very aware of the fact that you can`t allow a patient to pay nothing upfront and nothing again on delivery of an $800 crown. For the same reason, you can`t allow a family to pay $10 a month on an account in excess of $1,000. So why did you make this mistake? You made it because you haven`t given. Tracy, your business assistant, the responsibility and accountability to follow up on delinquent accounts. What`s more, mild-mannered Tracy has received neither the training nor the uninterrupted time to do justice to this difficult, but vital, task.

Hiring without testing. Employees not meeting the expectations of the job - it`s a sad, old story, coming back to haunt you when you least expect it. Like Lisa, the dental assistant who consistently professes to be too busy to take X-rays, forcing the other assistant into a compromising cover-up. Or Karyn, the business administrator who can`t report the percentage of revenues collected, because she`s no good at math and doesn`t know how to maneuver the software to generate the data. Or the recently hired Ms. Prophy, whose perio production hasn`t scratched the surface of the 33 percent that perio should play in your practice. Finally, there`s Tammy, the patient coordinator, who writes a thanks-for-the-referral letter to the oral surgeon, but misspells the words "appreciate" and "generosity."

Why did you make these mistake? You made them because you never thought about asking Lisa to takes an FMX before you hired her. You assumed that everybody knew how to figure what percentage 43,236 is of 48,612. You also assumed that a hygienist with Ms. Prophy`s years of experience would not only have great perio skills, but also the mindset to secure her job and her department`s profitability with perio. Finally, even if Tammy wasn`t a good speller, you expected her to have the smarts to use a spell-checker, right?

By testing prospective employees for specific job skills - plus some general abilities needed for each job, such as verbal, dexterity, math, or grammar skills - you`re taking the hit upfront, perhaps in the number of candidates you need to interview or the amount of time it takes to hire a new employee. But that sure beats finding out you have an unqualified employee after the fact!

Hiring another clinical assistant instead of a business administrator.

Did you hire a dental assistant to get instruments done more efficiently? Or to develop X-rays for a hygienist? Or to get rooms cleaned up quicker? Why did you make this mistake? First of all, what you know is clinical dentistry.

You get frustrated when you can`t find Lola, your assistant, because she`s always in the sterilization area scrubbing instruments. Another reason for this hiring mistake is that Lola was pleading for help - and you depend so much on her that you would quit dentistry if she ever left you. So, invariably, whatever Lola wants, Lola gets - whether it`s appropriate for your practice or not!

A number of factors should be considered here. First, hiring an additional clinical assistant usually doesn`t cause production and collections automatically to increase. But the additional salary may well put your payroll costs beyond the industry standard of 19-22 percent. Please, doctor, don`t think that just because you`re booking another column in the schedule that you need another assistant. The fact is, each assistant should be able to handle up to 13 patients per day.

Now, let`s look at what tasks can be done by the business staff to increase production or collections. For starters, there`s the follow-up on unpaid insurance claims, calling past-due recall patients, trying to get patients with unscheduled treatment on the books, and rescheduling patients who have cancelled or failed an appointment.

Hiring a person who directly solicits business should have a direct, positive impact on your bottom line. So, after considering which new hire the practice needs most, ask yourself how much more money per month you`ll need to produce and collect in order to keep staff salaries to the industry standard.

Hiring and not training new staff.

Just because you hired Marianne, who has had years of previous experience, doesn`t mean she knows what to do. In fact, Marianne might need as much training as another person with little or no experience. If, for example, the practice doesn`t have set systems in place, then Marianne might incorporate whatever "system" she`s comfortable with in your practice. That might be detrimental to the practice.

Even if you have systems in place, if Marianne isn`t trained in those systems, she might resort to her own, which may be in conflict with yours. Some of the most widespread problems we see are: hygienists not having the verbal skills to sell perio; business employees not knowing how to schedule both doctor and hygienist to production goals; how to handle patients who don`t pay; or how to get hundreds of thousands of dollars in unscheduled treatment on the books. And the list goes on!

Why did you make this mistake? You didn`t want the expense of professional training or the downtime training would require for the new hire. Nor did you want to attempt the training yourself. Just think of all the downtime that would require! Besides which, although you might be comfortable with teaching the making of a temporary crown or the taking of X-rays, teaching business procedures is just not your forte.

Another reason you might not be providing training is that you don`t want to insult Marianne, who considers herself a veteran. Lastly, since your practice doesn`t have effective systems and procedures in place, training seems pointless, since it`s always "jump ball."

Having no method of measuring employee performance.

Your employees come to you and ask for a raise, fully expecting to get one because it`s been a year since their last raise. After all, their raises have never been contingent upon anything but enough of a time span between one raise and the next.

They`ve got you over a barrel and they know it. Why did you make this mistake? You made it because you didn`t have a game plan or formula for measuring employee performance against job specifications and expectations. Another reason was that you would do most anything to avoid a confrontation. Lastly, you again hoped that by sticking your head in the sand, the request for raises would go away.

The first rule of thumb that you need to get comfortable with - and make clear to your staff - is that from this day forward, raises always will be tied to performance.

Frankly, business assistants` skills are easy to measure because they deal with money. Hygienists` skills are easy to measure as well, because they have to produce X amount of dollars in production per day. The performance of a dental assistant, however, is not so easy to measure. The only way to rate a dental assistant is through the use of skill statements.

For example, you might have a statement that says: "You can see the distal of the cuspid on every bitewing X-ray I take." The assistant then checks one of four answers: 1) Always, 2) Often, 3) Sometimes, or 4) Never. Performance measurements are not only essential for employee management, but they also ensure the success of practice systems.

So that, as they say, is the short list - eight mistakes that wreak enough havoc to induce terror in the hearts and minds of those in the know. Now that you`ve been given a map of these practice potholes and the best routes around them, let`s hope that forewarned turns out to be forearmed!

Sally McKenzie, a certified management consultant, is a nationally-known lecturer, author, and consultant to the Council on Dental Practice of the American Dental Association. She is president of McKenzie Management and Associates, providing in-office analysis of the business, clinical, and hygiene departments; conducting on-site staff training; and offering a full line of educational management books, audio tapes, and videos. Since opening McKenzie Management in 1979, she has developed expedient practice systems, methods, and technologies - as well as effective management approaches - for the dental practice. Her 34 years of experience and expertise now are available as on-tap resources for her new ventures, The Center for Dental Career Development, in La Jolla, Calif., and Practice Management Online. For information on her companies and what they can do for your practice, call McKenzie toll-free at (877) 777-6151. You also can visit her Web sites at www.mcken ziemgmt.com, www.dentalcareer develop.com, and www.practicemgmt online.com.