Communication is the key

April 1, 2000
How can you hit a bull`s eye with your staff and avoid burnout? By learning and implementing effective communication skills.

How can you hit a bull`s eye with your staff and avoid burnout? By learning and implementing effective communication skills.

Cathy Jameson, PhD

As the president of a consulting firm that has served more than 1,700 dental practices throughout the world - and as a lecturer to thousands of dental professionals every year - I am aware of the many challenges facing the industry today.

As a dental professional, you must attend to a patient`s physical needs through careful diagnosis and treatment. You must be able to educate a patient about the value of recommended therapy for the oral cavity. You must be able to communicate effectively and deal with a patient`s psychological issues involving his or her oral health-care needs.

To provide care for your patients, as well as run a successful business, you need to attract and keep quality personnel. Your office team needs to function in a dynamic mode before the intricacies of practice success can be achieved.

However, one of dentistry`s greatest challenges is personnel management and team development. Turnover and replacement of quality team members are among the major trials that a dentist and his or her team must handle. During 1990, 41.6 percent of all practicing dentists attempted to fill the position of a team member. In surveys taken throughout the country, challenges related to team interaction and team communication rose to the top of the "stressors" list for dental professionals.

Purpose of this study

The purpose of my doctoral study was to assess the impact of communication-skills training on dental professionals. Prior to any training, baseline data on stress-related symptoms were gathered. Members of a volunteer group were evaluated through a questionnaire prior to participating in a two-day training course in communication skills. Re-evaluation of all participants was handled by administering the same questionnaire to determine if, in fact, communication skills training could have an impact on reducing stress for the dental professional.

For my doctoral research, I hypothesized that improved communication on the part of team members would reduce burnout and dropout, improve job satisfaction, improve team relationships, aid in the control of stress for the doctor and team members, and improve practice productivity.

In this series of four articles commissioned by Dental Economics, I will give a synopsis of this study and the results. Eight years of research, study, and analysis comprise this project. The results have proven to be statistically significant. It is my intention that the results of the study and of the course on communication skills will have a statistically significant impact on you and on the productivity of your practice. I not only believe, but also have now proven, that great communication does equal great production.

The impact of communication

Without question, burnout, dropout, and job satisfaction are related. Unless a person is experiencing satisfaction in his or her place of employment, burnout and dropout are likely to occur. The "turnover" in dentistry among auxiliaries is an issue of concern for the industry and for individuals. According to the American Dental Association`s 1995 surveys, performed by the Gallup poll, only 50 percent of all newly hired dental employees last longer than six months.

This high turnover is emotionally and financially painful for the parties involved. According to Karen Greenhouse of Karen Greenhouse Associates, "The estimated cost for each staff turnover is approximately $15,000, with the loss coming from the time-consuming and expensive task of replacement."

Burnout and dropouts

According to studies of health and social science professionals by T.L. Albrecht, A.V. Irey, and T.K. Mundy, office communication patterns affect anxiety and exhaustion among workers in the field. These researchers determined that exhaustion caused by inadequate support and communication systems makes health-care workers particularly vulnerable to mental and physical strain and job tedium because they care for troubled people day after day.

Health-care professionals often leave a position because of "burnout," which can be defined as a syndrome of progressive emotional, attitudinal, and physical exhaustion. This is a critical occupational hazard for people in a wide range of healing professions. Those who are afflicted find themselves plagued by chronic fatigue, low energy, irritability, and a negative attitude toward themselves and their jobs. Not only do they find themselves personally depleted, but burnout victims also are a drain on their organization and the clients they serve.

Many factors in dentistry lead to career burnout, both for the dentist and the dental auxiliary. These include the constant need to take care of patients; the tiny environment in which the clinical staff must perform intricate procedures; the constant demand on the part of all staff members to deal with a patient`s fears and anxieties; repetition of similar procedures over a long period of time; and rejection on the part of patients to accept a recommended treatment. All of these factors result in mental, emotional, and physical fatigue, which can lead to burnout.

Building a strong, open, and communicative team of professionals is a forward step in dealing with stresses and potential burnout. Dental professionals who realize the humanness of each other and are honest and open are better prepared to deal with the burnout syndrome than those who have not worked at building a connected team.

Research Question #1: Will a training course in communication skills for the dental professional reduce burnout and dropout?

Thirty-one percent of the participants in the communication skill-training course said that they had left a dental office due to poor communication or uncontrolled stress.

What causes such stress? In the nationwide surveys that I conducted, conflict among team members evolved as the most significant cause of negative stress in the practice. The analysis of the data preceding and following the training course indicated statistically significant change for the better. Fourteen of the 24 questions dealing specifically with communication skills indicated a statistically significant change for the better following the training. This means that 58.3 percent of the areas studied showed marked improvement. There was positive change in all 24 questions being studied, taught, and analyzed.

In the area of "conflict resolution," two statements dealt specifically with burnout and dropout: "There is so much conflict in our office that I don`t want to come to work" and "The communication is so poor among team members that the stress level is extreme. I get so tired and frustrated that I sometimes want to quit."

The first question showed a 38 percent improvement and the second question showed a 32 percent improvement following the training course. The responses by the participants indicated that their improved communicative abilities had a positive and constructive impact on burnout and dropout.

B. Sher and A. Gottlieb and The Group at Cox both determined in their research on dropout, burnout, and teamwork that quality of environment was a critical factor in determining both satisfaction and longevity in the workplace. One aspect of a "quality environment" was an environment that nurtured good communication.

M. Erez and A. Somech`s research determined that communication among group members reduced social loafing. In a separate study, J.E. Dunlap determined that boredom and stress were two of the major factors leading to burnout and dropout. Dunlap`s research found that paring down boredom in the workplace would reduce burnout and dropout. One might deduce, then, that if communication skills and networks are developed within a team of workers, that boredom will be minimized and burnout and dropout will be decreased.

My hypothesis was that improved communication skills would reduce both burnout and dropout. Through the creation of workable communication networks, the development of open and honest lines of communication to identify and address problems, and through minimized stress which comes with improved communication skills, I believed - and the study affirmed - that turnover of team members could be reduced.

Job satisfaction

Maximizing the performance levels of team members within a dental practice serves the employer and the employee. Maximizing performance is relative to the task, the challenge, the regard, the profile of the individual, and the work environment.

According to F. Herzberg, two sets of factors affect an employee`s performance. The first set relates to the work environment itself: company policy and administration; supervision; interpersonal relations with peers, supervisors, and subordinates; working conditions; salary; status; and job security.

The second set of factors, according to Herzberg, are motivators that deal with the issues of job satisfaction and fulfillment found from work: achievement; recognition; the work itself (interesting and challenging); advancement; and responsibility.

Herzberg found that workers might function in an environment with only the first set of factors in existence, but these workers experienced reduced job satisfaction, resulting in lowered productivity. Unless motivation factors such as challenge, interest, and recognition were introduced, performance did not excel. Employees who receive a great deal of challenge and motivation must be rewarded commensurate with their work and the success of the organization. These two sets of factors go hand-in-hand to establish satisfied workers. There is a need for reward, motivation, and challenge in order for a person`s skills and talents to be maximized in the workplace.

The desire to do something often requires change. In business - and in dentistry - motivation is a necessity if progressive change is to take place. When the doctor or any team member believes that a member of the team is a "passive recipient," frustration often results because the same people who often are seeking change become resistant to external controls or outside recommendations. In reality, you can "assist another person toward effective, independent functioning by helping them to help themselves," according to F.H. Kanfer and A.P. Goldstein. Communicating effectively is required if this is to be accomplished.

Buck Rodgers, former corporate vice president of marketing for IBM, said, "Like it or not, much of our success depends on the skills and motivation of other people. So, unless you`re an artist, a craftsman, or a professional who operates independently, you had better understand and develop strong people-management skills." He goes on to say, "The most successful motivators often become the most successful leaders. They are the people who make things happen. They move others to action with their ability to influence, inspire, and nurture. They stimulate others, spark them, move them, and arouse them, through encouragement, nourishment, and inducement."

What do successful businesspersons see as the keys to motivating their employees? Rodgers believes it is the ability to think clearly, the ability to make themselves understood, being a skilled listener, being a good conversationalist, and being skilled at written communication.

Before specific management skills relating to the day-to-day operation of the practice can be successfully incorporated into a practice, the leader of the team must understand the intricacies of managing people. The communication system at work in the practice is the bottom line to success in all areas of practice and personal development.

Research Question #2: Will a training course in communication skills for the dental professional improve job satisfaction?

Job satisfaction is rated as one of the most desired characteristics of fulfillment in the workplace. Albrecht, Irey, and Mundy focused their research project on the impact of communication networks and job satisfaction. They determined that the value of excellent communication and communication networks was measurable for both job satisfaction and stress control. People in management positions were under greater stress and were more interested in good communication than people who were not in management positions. These managers felt a sense of co-ownership and knew that the clarity of communication would have a positive impact on the practice. They also felt stressed when those communication lines were not clear, honest, and open.

Herzberg discovered that job satisfaction was one of the most prominent motivators in the workplace. A person who was not satisfied with the work itself did not stay or was not productive in his or her position.

People in the workforce today are interested in fulfillment in their careers. C. Katz said in response to his research, "Lack of opportunity for development and stimulation can be a major source of stress for the bright, creative, growth-oriented staff member." When an environment for change and improvement is established, enhanced learning can take place. Team members are encouraged to take the necessary steps to implement the desired and necessary changes for goal-accomplishment.

Openness of communication leads to motivation of employees. If people in the workplace are to accept change - which is an ongoing part of any workplace - and if they are to be enthusiastic about that change, communication is a must. B. Kay and D.M. Christophel determined in their extensive studies that managers who provide open communication in the workplace produce and maintain a motivational environment.

In the present study, several areas were evaluated that dealt specifically with job satisfaction: respect in the workplace for employee opinions; wanting or not wanting to go to work because of conflict among team members; and self-esteem. Each of these areas showed marked improvement following the course.

Three statements in the area of conflict resolution that impact job satisfaction showed statistically significant improvement: "There is so much conflict in our office that I don`t want to come to work"; "Poor communication among team members has a negative effect on patients and on our ability to produce"; and "The communication is so poor among team members that the stress level is extreme. I get so tired and frustrated that I sometimes want to quit." Question 1 showed a 37 percent improvement, while Question 2 showed a 34 percent positive improvement and Question 3 showed a 36 percent improvement following training.

Throughout the course, the development of mutual respect among participants was encouraged. A basic premise of good communication is that there must be a mutual respect for each party. Even though the two parties may not agree with each other, learning to respect each other`s opinions enhances relationships that will improve job satisfaction.

Team members who feel that they have no influence on what goes on within the practice often approach us. They believe that the doctor or other members of the team do not care about their opinion. These team members stop speaking during team meetings, because they don`t think their opinions matter. In this type of disrespectful environment, people leave or become less productive. In the analysis of the data, not only did this question show a high percentage of positive change after the training course, but it also indicated statistically significant improvement.

Dropout or low productivity can have a profoundly negative impact on the dental practice and on the dental profession as a whole. "Will a training course in communication skills for the dental professional improve job satisfaction?" was and is a relevant question.

For more information about this article, contact the author at (580) 369-5555.

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