by Sandy Roth
The day had not gone well. Danielle was a master at planning the perfect schedule, vividly able to envision how each patient would be greeted, seated, and cared for. But somehow, the picture in her mind was rarely what occurred. Looking back on the series of events, it became clear that her perfect days were often doomed from the start.
Today, for example, everyone got off on the wrong foot. Marcia, Dr.Morgan's chairside assistant, arrived 10 minutes late, and in a sour frame of mind. Whatever caused her delay accompanied her into the morning review session; her mood alternated between snippy and silent the rest of the day. The morning scheduling plan called for the clinical staff to move things along quickly; Danielle worried that Marcia's bad mood would overflow to others. One patient, Dennis Jackson, followed six patients who were scheduled for short procedures. Dr. Morgan required three full hours of uninterrupted time for Dennis's treatment. This wouldn't work if Marcia dragged her feet all morning.
Danielle crossed her fingers and hoped for the best.The plan began to crumble with the first patients. One seemed unaware of her exact appointment time and arrived 20 minutes late. Another came in place of her husband, thinking the appointments would be interchangeable.
These events made it difficult for Dr. Morgan to respond quickly when the hygienists were ready for patient exams. Both hygienists ran late for the rest of the morning. Justine was particularly annoyed when the assistants didn't help her catch up. They must be aware that she needed help charting and running x-rays through the processor. It was obvious that she was behind - while they merely chitchatted with patients.
Kerry, the newest clinical assistant, quickly got the message that Justine was upset about something - her glares spoke volumes. But what was the problem? Kerry assumed she had done something wrong. She had only been on the job for seven weeks and still made many mistakes. In the past month, she had received lots of nonverbal feedback from the rest of the staff. These signals often left her discouraged and unsure about what she had missed and what to do differently. She was less experienced than Marcia and needed training; but no one had been designated for that responsibility. Marcia was the logical person, but she often seemed annoyed or put out when Kerry asked for help. Kerry assumed that it was her responsibility to figure most of this out on her own.
What Kerry didn't know was that Marcia's moods were largely due to the burdensome responsibility she felt for training Kerry, in addition to doing her own job. It had gone on for almost two months, and she was beginning to dread going to work each day. More work, same money!
Meanwhile, Dr. Morgan was 30 minutes behind when he joined Stephanie, his part-time hygienist, and her patient. He silently prayed that Stephanie would summarize the highlights of the appointment so he could quickly do the exam and return to his operative procedure. However, Stephanie's antenna wasn't working. After a longer than desired discussion about the recent windstorm damage to the patient's garden, Dr. Morgan completed the exam. He had hoped to spend a few moments discussing a new alternative for the patient's sensitivity, but didn't know if Stephanie had introduced the concept. If she had, his contribution would be short. But if she hadn't, he would be further delayed. He opted to skip the topic entirely, making a mental note to address it later.
Danielle wasn't having the best of luck either. Payroll and the federal tax deposit were due tomorrow, and she had hoped for substantial collections today. Several patients told her to send them a bill; another forgot her checkbook. The big blow came when Dennis Jackson exploded at the end of his appointment. Granted, he was kept waiting 45 minutes while Dr. Morgan got caught up, but everyone had apologized, and he seemed calm when he left the chair. Danielle bore the the brunt of his anger. When she told Dennis the fees; he seemed totally unaware of what the charges would be. He was so angry she didn't have the nerve to ask him to pay any of the balance today. By the time the last morning patient left, everyone was carping at everyone else. How could things have become such a mess?
Events like these too often occur when expectations are held but aren't conveyed, discussed, or agreed to. The staff is full of good intentions; they are all convinced of the righteousness of their positions, yet fail to convey those thoughts to others. Let's dissect the components:
- Danielle expected everyone to have the same vision she had of the day and to behave accordingly.
- Dr. Morgan expected Marcia to train Kerry in addition to her normal duties.
- Marcia expected that Dr. Morgan would see why she was out of sorts and remove the burden of training Kerry - or at least compensate her for the extra work.
- Danielle expected the clinical staff to hustle through the first patients and be ready for Dennis Jackson.
- Danielle expected patients to remember appointment information and arrive on time.
- One patient expected to substitute herself for her husband at an appointment.
- The hygienists expected Dr. Morgan to arrive at a certain time to examine their patients.
- Justine expected the assistants to leave their patients to help her with ancillary tasks.
- Kerry expected a formal training program and proper support.
- Staff members expected Kerry to read, understand, and respond to their facial messages.
- Dr. Morgan expected his hygienists to initiate discussions with patients about treatment and integrate him into discussions in progress.
- Danielle held expectations about how patients handled their accounts.
- Danielle also expected that others had discussed fees and made financial arrangements with patients.
In each case, one person envisioned a scenario that required the conscious agreement or involvement of others. But because these expectations were both unexpressed and not specifically agreed to, the plan went awry.
Expectations are reasonable only when they are clearly conveyed, discussed, and agreed to by all relevant parties. Until this happens, they are merely wishes or assumptions. In this second installment of Communications Skills for Successful Relationships, we focus on how to establish clarified expectations. First, I'll help you look at how easily assumptions and unexpressed expectations can destroy the finest plans. Then, I will introduce some important skills to begin using in place of those you may have adopted.
Relationship damager No. 4 (see the February issue of Dental Economics for 1-3): Failing to clearly state your expectations. Expectations cannot be fulfilled if they are not conveyed. I remember a conversation where a dentist complained about a particular employee's mode of dress. "I think it is highly inappropriate for her to come to work in skin-tight animal print fabrics or short patent-leather skirts like the one she is wearing today," he said. I asked if he had outlined a dress code when she was hired; he sheepishly acknowledged that he had not. "Don't you think she should be able to figure that out for herself?" he asked. Apparently not.
Because this dentist failed to outline a dress code, he could not presume anyone would be able to divine his wishes. Moreover, when she "tested" the dress code by wearing leopard skin, she received no direct feedback that indicated she had overstepped a boundary. The dentist conveyed neither his expectations nor his disapproval of her choices. In the absence of information to the contrary, why would she not believe that her choices were perfectly acceptable? I am amazed by how often employment relationships end due to unmet expectations at this level. I am convinced it happens every day.
As dentists become more sophisticated and promise more to their patients, the standards for employee performance increase. In many practices, however, these standards are merely hinted at, never defined. Dentists strive to impart their practice vision or philosophy to their employees, yet their language is often so vague that team members are forced to rely upon their own interpretations. Concepts like "strive for excellence" and "demonstrate a spirit of caring" are too general to have any real meaning. Dentists must therefore provide more precise direction and guidance.
Not only can employer-staff relationships be damaged by unexpressed expectations, but patient relationships also suffer, particularly when expectations change. In many practices, ideas about fee payments, insurance, and appointment responsibilities have radically evolved. Once patients are accustomed to a set of working agreements, unilateral and dramatic changes can easily jar their sense of security, especially when not clearly outlined in advance. Every practice has the right to change for philosophical or business reasons. Failing to convey new expectations to the population you serve, however, is public relations suicide.
Relationship damager No.5: Failing to understand what others expect. The other side of the coin is equally important. While we may hope others will routinely share their expectations with us, it is foolish to presume so. We each are fully responsible for our relationships; we are equally responsible for their breakdown. It is therefore incumbent upon each of you to ensure that expectations are clearly outlined.
Many people try to guess, surmise, or decode others expectations. They take their cues from informal conversations or third parties rather than the person in question. Perhaps that is because they feel obligated to live up to expectations once they are known. In some cases, we may simply not want to know the answer. Our parents, friends, and colleagues may try to wield influence over our lives, but they are successful only to the extent that we allow them to do so. Remaining uninformed is not the answer.
Relationship damager No. 6: Failing to agree about expectations. Conveying expectations is only the first step. What must follow is a discussion of those expectations leading either to an agreement of mutual accountability or a decision to abandon the expectations. Anyone has the right to ask you to meet a specific standard, but unless you agree, they do not have the right to hold you accountable.
Such discussions are easy to avoid. They are potentially conflict-ridden, and take a great deal of time. You may be challenged to be more specific or clear, yet feel unprepared to do so. The discussion must ensue, regardless. Both parties must outline what they agree upon, and what they don't.
I see examples of this frequently when team members discuss fees and financial arrangements with patients. Clearly outlining the fee and the method of payment is a great first start; however, if there is no opportunity for clarification and mutual agreement, the process will be ineffective. A statement such as, "Marian, the fee for Dr. Neuhester's services is $$$. We prefer that the fee be paid in full at the first appointment," fully conveys the expectation. Following it with, "What questions do you have?" extends an invitation for dialogue. And finally, asking, "Is that payment arrangement agreeable to you?" closes the process.
Relationship enhancing skill No.3: Formalize your expectations and ask for agreement. The most effective juncture to begin establishing expectations is at the beginning of a relationship. When expectations are clear at this point, it increases the likelihood that the relationship will not only survive, but thrive. A major part of hiring, for example, is constructing a written understanding of the employer's expectations and vice-versa. This is an important area frequently overlooked in many practices. Each position comes with specific expectations, as well as attitudes, work ethic, performance, code of conduct, and (yes) dress code. In return, employees have a right to identify expectations they have about performance reviews, compensation, fair play, and how their contributions will be acknowledged. Create a template to include each aspect of interest to the employer as well as the employee. Be specific, be detailed - and put it in writing.
Patients likewise have a right to learn about expectations early in their relationship with the practice. Don't wait until after the fact. For example, if a patient expects coverage for a procedure from his insurance carrier, and you fail to convey otherwise, you will likely receive the brunt of the patient's disappointment. Most patient relationships deteriorate over nonclinical matters, which is particularly unfortunate when they are so easily avoided. Protect yourself by initiating the discussion, especially when it appears that the patient's expectations and yours are not in alignment. If you count on patients to treat your time with respect, tell them so, and ask for their agreement. If you consider appointments confirmed when they are made, but the patient believes they can cancel up to 24 hours before, you have a potentially serious conflict. Avoid this and other problems by addressing them directly and in advance. It is well worth the time and effort
Relationship enhancing skill no.4: Reveal expectations as they develop. Developing a practice involves continuous clarification of expectations, both from yourself as well as from your staff and your patients. One thing can be counted on: expectations will change. Just as the expectations you have about dental materials, equipment, and procedures will change, so will your working and serving relationships. The changes won't always be dramatic; more likely they will evolve over time.
It is particularly important to reveal new thoughts and expectations as you consider them. Not only will this better prepare your staff or patients for your final decision, it will also help you strengthen your purpose. The questions your staff and patients ask will force you to clarify the details. A mature person often experiments with an idea, takes it out for a spin, and turns it in for a new model when it doesn't suit his purpose. In other words, you can always change your mind with further clarification or new information.
Guided personal exercise
This month, I invite you to engage in an Expectation Inventory. In preparation for your team meeting, each member including the dentist should respond to the following questions:
Section One: Relationships within the team
- What expectations have been specifically conveyed to you by your employer and by each individual team member?
- What expectations do you suspect team members have that have not been specifically conveyed?
- What expectations do you have of others that you have specifically conveyed?
- What expectations have you failed to directly convey?
Section Two: Relationships with our patients
- What expectations do you have of your patients?
- How and when do you convey them?
- What crucial areas have yet to be addressed with your patients?
- How do you handle patients who do not agree to your expectations?
- How do you discover the expectations our patients have from you?
- How do you handle expectations that you do not agree with?
Begin the meeting by sharing your answers individually. Each team member must listen attentively as others share. Afterwards, the group can discuss what they have learned from one another. The goal is to reach agreement on expectations and establish a process by which patient relationships are enhanced.
Best wishes as you take on this very important project.
To learn more about how you can develop your communications skills, call Sandy Roth at (800) 848-8326 or send her an e-mail at email@example.com for a catalogue of learning resources.