By Jack D. Griffin Jr., DMD
Take care of your staff; they are the reality of your vision.
I'm tired of dentists telling me how to have a million-dollar practice. They give advice like it's as easy to have a seven-figure practice as it is to bake a cake. Let me stress this right off the top - I don't have all the answers! It's like every guy I knew who had an Internet stock the last two years and thought he was a great stock-picker. Guess what happened on the way to the bank? The market went down and suddenly we weren't the Peter Lynches we thought we were.
In dentistry, I have learned what works for me from my successes and failures. Sometimes my brain even goes into vapor lock, and I repeat the same stupid mistake over and over, expecting a different result each time.
I am lucky enough to have one of those offices that has reached the magic seven-figure production barrier. You have heard this before: "If I can do it, you can too!"
The questions are:
- Do you really need to produce that much?
- Since when did bigger mean better?
Unless Regis is around, what's so magical about $1,000,000? I know how we all can get there. We can find a few patients who will sit still for 20 crowns a year at $50,000 apiece. We hear that we should ig nore that UCR fee stuff anyway. Or maybe we can sell 100 soft-tissue-management cases at $10,000 each - the hygienists should do more of their share. Or maybe we can see patients from 7 a.m. until midnight.
It's important to accept the fact that income does not equal happiness, success, or peace of mind.
The reality is that I practice in Hillbilly, USA, and a crown goes for around $550 and a four-surface posterior composite for $150. Full-mouth rehabs come in the office about as often as the Hale Bopp Comet flies by. There are four full-time dentists in this suburban town of 5,000, and many people are so tight they squeak when they get up out of the dental chair. I kind of enjoy my family, so I only work 27 hours a week.
My formula may not work for you or anyone else. Frankly, most practice-management seminars we go to (and articles we read) are useless to us, not because of the content or the instructor; it's just that we have become comfortable in our own inefficiencies and are unwilling to change. I may practice the wrong way, but it's my way! So, after a few days of trying new stuff, we migrate right back into our old routines.
The most successful practices have:
- a definite, clear plan for the practice philosophy
- a confident dentist who is not afraid to actively manage the practice
- a motivated, dedicated staff
The first two are more of a personal decision by the dentist and vary greatly from practice to practice. Proper staff is the key to efficiency in any practice. Woe to any dentist who thinks he or she is God's gift to the staff and who treats them like they ought to be thankful just to have a job. We all have a staff - that is one of the few things we all have in common. What I would like to do in this article is to discuss what has worked for me in regard to my staff.
Patients like to see familiar faces. They don't like turnover. It's like the Cheers theme song: Everyone wants to go where people know their name. Patients will have a much harder time thinking of reasons to leave your practice if they are friends with your staff. If they can personally relate to the staff, patients will find reasons to stay instead of searching for excuses to find another dentist. Not only does the staff make patients feel comfortable, they also help put out the fires that occur in everyday practice. They take care of many things like: "Why did I get charged for that?" or "Why is my filling still so sensitive?" or "Why does he drive that BMW when we all have Pintos?"
As the old saying goes, "If Mama ain't happy, ain't nobody happy." If you are surrounded by unhappy, bickering, incompetent staff, you also will become that way. Your character will gravitate toward the level of those around you. If you become bitter and angry as a dentist, go sell vacuum cleaners. Our attitude goes up and down proportionately to the attitudes of those around us. We must make it a priority to surround ourselves with content, dedicated people.
Allow your staff to help hire the new ones
The staff must get along with you, of course, but just as important is that they get along with each other. Some of the ladies in my office occasionally get on one another's nerves (there's some news). That's why it's very important that you allow your staff to interview potential employees. Let the staff help you choose. Not only will they hopefully choose those whom they will get along best with, but you will be involving them in critical office decisions.
Involving your staff members makes them feel more valuable, which is a key to retaining them as dedicated employees. Most staff members are female, and they seem to be more perceptive than some of us males. They tend to focus on things we often overlook. Besides, what good is it to walk into a dental meeting with your staff of Pamela Anderson look-alikes if your practice is in shambles?
The staff can be critical in building a cohesive team. These are the steps that work for us: Once we accept applications, we get together for a few minutes and narrow it down to a few people we want to interview. Then the applicants we've chosen come in at a time when we are treating patients to meet the staff and see how the office operates. Each staff member makes notes on a copy of the applicant's re sume. After interviewing is finished, we get together to discuss our notes and decide who we want to hire.
Some times dentists feel that they are above the task of hiring or too busy to be involved. But look, your practice is the largest potential asset in your life. Why not take an active role in selecting the part of it that potentially can give you the most stress? I also think it's a big mistake for any office to allow only one other staff member to hire people. A hidden agenda could influence that person's decision. The more people involved in the process, the greater the chance of hiring the right person.
Have clearly written job descriptions
You don't have the right to get all over staff members for not doing their job if they aren't sure what to do. And how can we expect them to know what to do if we don't tell them? The reason we write out a list of tasks expected is that we forget to tell our staff members things. As I get older, my neurons aren't firing as well as they used to; I think I've burned up too many synapses.
When we put things in writing, we have a greater chance of getting our message across consistently, and it holds me accountable for things I really did tell the staff that I would do.
These task lists should be specific. Let assistants know how long to sterilize instruments; let them know when and how to lubricate handpieces; explain to them how you want the charts written up. Write down for the front office the date billing is to be sent out; let them know the only payment options accepted; explain exactly what to do with the invoices. Clearly write down the criteria for a soft-tissue-management patient for the hygienists; make it clear when to take a full-mouth series vs. a panorex. Your employees will appreciate these clear descriptions, because they will know exactly what you expect of them.
Make these task lists different for different employees. For instance, I have two full-time assistants. One of them has an "Organization Assistant Task List," because she is in charge of inventory, ordering supplies, and making sure OSHA stuff is in order. Her list also has all of the normal assistant duties listed: suck spit, don't whack my drill with your suction, and be able to read my mind. The other assistant has our "Maintenance Assistant Task List." She is in charge of equipment lubrication, taking care of the developer, keeping the lab in order, and all of that other assistant-oriented stuff. There definitely is some overlap of duties, and that is stressed. However, one person ultimately has to be responsible for getting what's important done correctly, so these customized tasks lists are invaluable.
Have a clear office policy and benefits manual
It is management suicide for an office to have no written benefits manual. This should explain clearly what your salary plans are, your benefits, which employees are eligible for each benefit, and generally what is expected as far as appearance and attitude in the office. There are computer programs to help you with this, or you can plagiarize from another dentist or small business near you.
You're asking for trouble if you tell employees that you will do something for them on a certain date and then don't do it. If you have things written down, then you will be held more accountable and you will forget less. You always will have an employee or two who will memorize the office policy and make sure you follow it, so proofread everything carefully and plan to carry out what you have written. If you change anything in the policy, make sure you give employees a copy of those changes, explain why you made them, and give your staff a few months before the changes go into effect.
Be consistent in your decisions
If you have different rules for different employees, you will die an early dental death. Consistency is critical. If an employee asks you for something, make sure that you would do the same for all other employees before you say "yes." Don't cause staff friction by helping your employees to isolate someone as a teacher's pet. If you decide an employee needs correcting, make sure that when others mess up, you correct them in the same way. Don't be a chump; there's a least one staff member who already thinks you favor someone more than her. Don't make it worse.
Sometimes two different employees will do the same thing wrong. For some reason, when one of them does it, I blow it off; but when the other one does it, I want to zap her with a cattle prod. But that isn't fair. We must keep continuity in our management and discipline, and we must always ask ourselves if we are creating staff friction by showing favoritism.
Praise often for a good job or excellent work
This is a no-brainer, right? So, how often do you actually give your staff members a compliment? If you never praise them, you have no right to criticize them. They must know when they've done well so that they can contrast it with when they have failed. Thank your staff regularly for being dedicated, or for being loyal, or for assisting with a great-looking temporary, or for not stabbing you with a Bard Parker when you change your mind for the 20th time.
Thanks can be oral or written, a bonus, a paid trip to the mall, or a paid day off. There are countless ways to praise people, but none of them replaces just saying it frequently.
This sounds a bit mushy for some of us. Our nature as managers and dentists is to focus on the bad instead of the good. I think we learn this in dental school. There, you never heard, "Hey, nice margins and tertiary anatomy." Instead, you heard, "That waxing doesn't look like any part found on a human. Start over!"
Remember, it never hurts to give a compliment; it only can do good.
Reward staff fairly
Your staff members could be flipping burgers instead of sucking spit. Compensate them well because of all the garbage they put up with from patients, other staff members, and you. As the old saying goes, "If you pay peanuts, you get monkeys." Pay your staff well.
If you want them to act like they work at McDonald's, pay them that way. If you want them to act like professionals, pay them like professionals. If your staff members are happy, you will, in turn, have more patients and make more money because of it. Your income will suffer if your staff members' attitudes suffer.
Just how much should staff members be paid? Hire unexperienced people at a minimum of $2 per hour more than they would get working in a fast-food restaurant. If $5.50 is the starting salary at Taco Bell, start them at $7.50 in your office. If they are fulfilling their new roles in your office well, give them a raise of at least 50¢ an hour after three months. This will motivate them to stick it out through the rough early-training period.
Experienced and trained employees should be paid the average for that position in your area to start with. Again, after three months, give them a raise in proportion to their expended effort and ability to fit your practice's needs. Remember, the goal in management is to have as little turnover as possible. It costs you way too much to hire and train new people all the time. You might try the ultimate gift by giving good employees a raise when they least expect it. You'll be amazed at how happy they will be.
Bonus systems are great if they have a specific purpose. The problem is they often turn out to be just another expected form of income, like a paycheck. You will see what I mean if you try to change an established bonus system in any way. I still have bruises and bite marks from the last time I changed our system. Keep the system very simple and target a specific practice need. Stress that a bonus is not part of a salary, but an extra reward for doing something above and beyond the call of duty.
If the bonus becomes expected, then it doesn't work —so get rid of it! Don't make life hard by having complex formulas to figure out who gets what. If it takes more than 30 seconds to figure it out, scrap the system. If you want staff members to collect more, choose a monthly collection goal and only give a bonus when your goal is met. If you want them to focus on new patients, give a bonus when they meet your goal for new patients in a month. If you want fewer weeds in the yard, give them money when they pull extra dandelions. A bonus should only be a way for the staff to share in the prosperity of the office when goals you set are exceeded.
Have staff meetings at least monthly
It's surprising how many dentists don't meet regularly with the entire staff. How many brains do you have? I'm assuming one or less. Now, if you have three other staff members, you have 75 percent more neurons attacking the problems that you have in your office. Believe me, your staff members know your office as well as you do. It just makes sense, then, to review practice production, collections, new patients, patients lost, and accounts receivable at a monthly meeting. Ask your staff to pay attention to practice trends and potential problem areas.
The focus of these meetings is to evaluate the practice, be a think tank for the business, and teach staff new ideas and techniques. It is time set aside to build up the staff, which will make the practice grow. Meetings should be positive, so make them rewarding. We meet at a local restaurant for two hours once a month for a lunch where I pick up the tab. You can't believe the honest, quality answers you get from the office staff when you involve them more. Listen to them and talk less.
One of the reasons I hear that staff meetings don't work is that they can become complaint sessions. Hello! That is one of the very reasons you should have them; they become a time to iron out problems. It makes for an unhappy staff if problems are allowed to fester. Staff meetings that regularly turn out to be "whine-fests" can be a sign of leadership problems - the dentist isn't doing his or her job. If your staff members are afraid to come to you with problems when they occur, they will save them in a basket and dump them on you at the meeting. Don't let that happen. Make sure your employees have such rapport with you that they aren't chicken to come to you with problems. Sure, you're a doctor, but don't let that be intimidating to them. Plus, it's good therapy to vent once in awhile; just pick a restaurant with no sharp knives when you do stupid things like changing the bonus system.
I choose to have my staff members refer to me as "Jack," and I consider them to be my friends. I spend more of my waking hours with them than almost anyone else in my life. There are many ways to look at this, and the name your staff members call you may or may not make a difference in that relationship. The important part is your attitude. If staff members sense that you are so stinking important that you can't waste your time on their petty problems, you only will get to deal with those problems when they become giant issues. The belief that staff members are just hormonal and that the problems will pass is absolute CEO suicide!
Have a yearly practice review
The big meeting of the year for us is in January - the "State of the Office Address." This is where we go over practice numbers for the year and compare them to the history of the practice. It is interesting for staff to compare - in chart form - how many endos we did last year compared to four years ago, how many units of crown and bridge we did, how many sealants we've done over the years, and how many prophys we performed. The reasons for comparing these numbers are many.
First, we identify areas of the practice that are lacking or are being overlooked. For instance, if accounts receivable is higher than in previous years, we discuss how we can improve this area. If we have fallen down on our panorexes despite an increase in new-patient exams, we need to address this. We look at broken or missed appointments and try to figure out why these numbers are too high. We then set realistic goals in these areas for the upcoming year. Staff members like to see just how much work they are doing.
Secondly, the annual review gives the staff a chance to be included in the "guts" of the practice. Just like we discussed before, your employees absolutely need to feel involved in the day-to-day operations of the practice. They need to feel important. They actually will come up with things you were too analytical to see. Give them some room. Ask questions and then just listen - ears learn more than tongues!
Review staff at least yearly
We normally do staff reviews twice a year. One is a "Quick Review," which is a little form on which I just list strengths and things I would like for each employee to work on. Our second review is a more formal one. This review - I think I stole it from a practice-management person - is more detailed and often accompanies a salary change as well.
Don't think a review is just negative stuff. If the employee does a great job the majority of the time, then the majority of the review should be positive. If you think meetings are just to "straighten them out," then you are again missing the point. Of course you must correct mistakes; but, you also must encourage their good qualities. You actually can have staff members who look forward to their review.
It's true that the reviews become predictable. After having reviewed the same staff members for eight to 10 years, the employee analyses look almost the same every year. That doesn't matter. Reviews are a chance to get together and talk privately with each employee for 10 or 15 minutes; it won't kill you. Focus on the good things they do and offer suggestions on ways they can improve their office skills. Have the staff review themselves every year. It's amazing how similar their review is to mine. Remember, the main goal is to increase communication with employees and provide a private time for them to vent if they need to. But be sure to keep their trust. Don't blab what they tell you to the rest of the office.
Once a year, I ask the staff to review me as well as the overall function of the office. We usually do this at a staff meeting. I ask staff members for a list of things we need to improve on and things I can do to make their jobs easier. They know what patients like and don't like, because while the dentist is trying to negotiate curved MB roots, they are talking and listening to patients. Let your staff help you manage; you'll be amazed at how good they are.
Give some of this a try. Like I said earlier, I only know what works for me. You may have ideas that are better than what I've suggested here. The dumb thing we do is refuse to listen and change. Look at what other offices do and try something new. Above all, take care of your staff; they are the reality of your vision.