by Dr. James R. Pride and Amy Tuttle-Morgan
The second quarter is a critical time for many practices undergoing management improvement. The doctor and staff have experienced an initial success and have become excited about change. The doctor has had a taste of forecasting expenses, often for the first time, and is feeling more in control. The staff has enjoyed the challenge of having a goal and hitting it. If the practice doesn't continue its conscious efforts at improvement, the brief breath of celebration will expire as the initial excitement wanes, old habits return, and underlying issues remain unresolved. One such troubling issue emerged in Dr. Johnson's practice shortly after the initial success.
Knowing that the employees need to be won over to the improvement process, Dr. Johnson's consultant polled them on the things they wanted to see handled better in the practice. Through the staff's feedback, the consultant discovered a major "hot button," which she selected from several other issues to address first. The staff felt that the doctor was extremely poor at time management, causing them to have to work through lunch periods and stay late. The dentist loved to "visit," especially with patients who were his friends, and then he would lose control of the schedule. For example, the doctor would appear for a hygiene check and end up in a lengthy conversation with a patient about a mutual interest, throwing his own, as well as the hygienist's, schedule off track. The staff members wanted Dr. Johnson to honor the patients and their time to promote efficiency and enable the practice to achieve its production goals. The consultant told Dr. Johnson that if he wanted his staff to change, he would have to show a willingness to change too. The dentist agreed to work at achieving a balance between socializing and maintaining the office schedule.
He did improve - but since old habits are hard to break - the negative behavior persisted, with the staff's frustration mounting. The matter came to a head at a staff meeting. The team wanted to take the practice to the next level and meet the progressively higher production goals of the annual plan, but felt the doctor was the major obstacle. Having become more openly communicative with the dentist in the newly instituted morning huddles and staff meetings, they overstepped their bounds. The doctor had been picking up on the staff members' rolling eyes, irritation, and snide remarks that made him feel backed into a corner. Typical of dentists we've worked with, Dr. Johnson's leadership was undermined by an inability to confront his staff. He would accept poor behavior without addressing it when the issue was still small. Then he would reach a point at which the issue became too big to contain any longer, and he would blow up. He had been getting definite signals of the staff's annoyance that he suppressed until, finally, at a morning huddle, when an employee remarked disapprovingly on how he always falls behind in the schedule, he became angry.
This was a crisis for Dr. Johnson. He was afraid his temper outburst would destroy the team's cooperation and, with it, their hard-earned gains. While he was distressed by his blowup, his Pride consultant was happy. She saw the team stretching against the old boundaries. The frustration that was occurring, she be lieved, indicated their struggle to attain the next level, which was only possible with a more significant de gree of change. This initial stage of change she defined as the group's experiencing a period of frustration during which they were working to build trust in each other, but had not yet attained it. The consultant guided Dr. Johnson in addressing the issue with his staff, because a leader needs to feel comfortable modeling failure and accepting responsibility for it. Dr. Johnson also needed to confront the issue with the employee who was the primary recipient of his anger. He did an excellent job at both tasks.
Dr. Johnson invoked his mission statement to resolve the matter. He explained to the staff that having visiting time with patients was an important part of the vision he had of his dental practice. Therefore, the chatting never would be completely eliminated. But, it could be planned for, scheduled, and controlled so they could still run on time. He also explained that his behavior at the morning huddle was not in line with his vision. He expressed his concerns and allowed the staff to communicate theirs. He acknowledged their concerns about staying on schedule, while asking them to accept his vision as well. They decided to work on a compromise that would allow greater productivity and also some degree of free time with friendly patients.
Dr. Johnson and his staff were pleased with the way they handled this problem. They created a set of rules that would support their continued growth through better communication. These rules could be followed on any issue confronting them:
- We all agree to confront problems as soon as possible, so we don't let them fester.
- We'll communicate our concerns without "attitude" or blame.
- We'll attempt to be open-minded and listen first to others before we disagree.
- We'll be as flexible as possible, since not all situations are black and white.
- We won't interrupt when another person is talking.
- We'll respect each other's strengths and challenges and create an environment in which everyone can grow without fear of failure.
The doctor also resolved matters with the employee who was the target of his anger. While he apologized for his behavior, he also addressed underlying issues that had prompted his reaction.
"I had to handle a somewhat defiant employee who could get bossy and order others around sometimes," said Dr. Johnson. "I had to let her know that this wasn't OK. My consultant walked me through it, and the team member's behavior improved. From time to time she'll bounce back to that behavior, but I don't have to do too much to let her know I see it, and she changes."
Because there had been a lot of venting to the consultant without talking to the parties involved and solving the issue, the consultant also established a rule: The dentist and team members could communicate their problems to her, but they must also address the issues with each other.
Production at this time - the fifth and sixth months of the year-long program - was $48,322 for the fifth month (goal was $48,320) and $59,774 for the sixth month, a new record for the practice (goal was $55,880).
Pride Concept: Great successes often occur when a team is in the initial phase of development.
This was the time when the group was stretching the limits and seeing more of what is possible. The performance of Dr. Johnson and his team during their initial period was a vast improvement over the average office production for the year prior to beginning management improvement. Average office production that year was $40,501. It is important to note that whether the doctor is increasing production from $40,000 to $60,000 per month or from $80,000 to $95,000, the same issues tend to arise. The behavior of doctor and staff is not tied to any specific production figure; it is tied explicitly to any form of change, regardless of the magnitude.
Emerging from Dr. Johnson's crisis in leadership are these Pride Concepts:
1. The leader should never be afraid to model failure. When the leader openly acknowledges mistakes and a willingness to change, the team will be supportive. This is very hard for dentists to accept, since they tend to be perfectionists, which makes it difficult to admit failure.
2. When team members show frustration at meeting higher goals because of their increased awareness of underlying problems, it's a good thing. Awareness is the first step toward resolution and further growth. This is another difficult concept for many dentists and other leaders to accept, because they neither understand nor like to deal with any form of conflict. Learning this concept is the first step to a successful career of any kind.
3. The dentist wanting to socialize with patients should not have to stifle this facet of his or her personality, yet the staff and other patients should not have to suffer for an office running late. The dentist's behavior just needs to be planned for and controlled.
"It's nice to be able to speak more openly with my teammates and the doctor," says one employee. "Everyone's more receptive now. Because we have common goals, I can speak up when we're not meeting them, and it doesn't seem as if I'm whining or complaining. We all try to meet the goals."
Next time, we'll look at another problem that arose at this juncture. While the office production was setting record highs, imagine Dr. Johnson's distress when his collections dropped from 98 percent to 75 percent!
For more information on improving your practice using the methods described in this article, call Pride Institute at (800) 925-2600.
