by Cathy Jameson, PhD
We hear this comment from practices throughout the country: "Finding good people in my area is almost impossible. There is so much competition that we just don't get good applicants any more. Then, when we do get someone who shows promise, he or she just doesn't stay."
First of all, let me say that there is not a single city, state, or area of the country that is different from any other. There is no area that is not in need of quality team members. Don't think you have a problem unique to you alone. That's simply not true! With low unemployment nationwide, increasing corporate benefits, and newly evolving job types, dentistry maintains its challenge to stay competitive for top employee candidates.
Certainly, stimulating an interest in your practice is step one. Candidates must be motivated to respond to your ad, "word of mouth," or any of the other ways in which you get the word out that a position is available. Then, your method of interviewing and hiring must not only comply with all human resources mandates, but also be exceptional so that even if a candidate is interviewing with several different offices, yours is the one selected. You see, it's a two-way street. A candidate must sell you on the benefits of hiring him or her ... and you must sell the candidate on the benefits of your practice and the position you are offering.
Hiring quality team members is one of the most important and challenging aspects of your business. If you are trying to elevate your practice, you must start with a dynamic group of professionals. If you are replacing a team member, finding a person who not only will perform the responsibilities excellently, but who also will "fit in" with the other team members, may be challenging. A team takes on its own personality, and adding a new person changes the dynamics of the group. This can be motivating, but also challenging.
Enrollment and orientation: a moment of truth
Once you invite a candidate to accept a position on your team, do yourself and your new employee a favor and do a terrific job of enrolling him or her into your practice. Most dentists, when asked, will admit that they do a poor job of training new employees. (New employees will tell you the same thing!) Devoting quality time and attention to this early phase of a person's employment with you may make the difference in whether or not he or she stays with you, and it will certainly make a difference in whether or not this employee is productive, confident, and committed to the practice.
Dental professionals in all phases of the profession certainly agree that training new employees is important. Then why is this not a carefully developed and administered part of the practice? Some reasons given are:
- "We don't have time. We are short an employee (thus the need to hire!), and so we just have to throw new employees into the fire and hope for the best."
- "I hate to train. I just want them to figure things out by watching."
- "I want someone who is sharp enough to think this through and see what needs to be done - and, then, just do it!"
- "I have to do the dentistry. I can't afford to take time away from patients to train, and I certainly don't want to come in on my day off!"
- "I have so much to do anyway. Now the doctor thinks I am supposed to train the new person. I can't put one more thing on my plate!"
- "I am sick of this constant turnover. I am always the one who has to do the training. I don't get anything else done, because I'm always training a new person. If this doesn't stop, I'm leaving."
And so on.
It will cost you a great deal more - in time, money, and stress - to have an open position in the practice or to have a constant turnover in staff than to invest quality time and attention in training your new team member effectively. You want a person to be successful in his or her new position; you want this new person to be productive as quickly as possible; you want this person to feel respected; and you want this person to stay with you. So, great training is a must!
Make training a priority
Training must be an established "system" within your practice. There are three essential steps of a great training system ...
1. Define the job description or position responsibilities. Some doctors are leery of written job descriptions. Please rethink this if you fit into that category. A written job description details the responsibilities of the position. Job descriptions become an essential part of your operating manual. Of course, these job descriptions are not static, but are, rather, dynamic. They may change as the practice, the position, or the person changes. Be willing and ready to evaluate these descriptions from time to time (certainly when you are hiring) to make sure that they still are accurate.
The job description not only lists the responsibilities, but also details how those responsibilities are to be administered. The better the detail, the more likely the success. If you don't describe how you want a task to be administered, you are giving the new employee the liberty to administer the task however he or she may wish. System confusion and deterioration may result.
Your practice is made up of a conglomerate of "systems." Each one should be so carefully developed and documented that a new employee can almost step into the shoes of the previous employee and continue to administer the system at a high level. The last thing in the world you want is for one person to be the only person in the practice who knows how to do a particular task or tasks. If this happens and the person leaves (heaven forbid), you are up a creek without a paddle! Don't risk the health and well-being of your practice in such a way. Make sure that each job has a written description of the requirements of the position and that each system has a written description of how it is to be set up and administered.
2. Establish priorities for the position and for the training scenario. Once you have made sure the job description is clear and accurate, prioritize the responsibilities. Prioritize in two distinct ways:
- What are the major priorities of the position? What should be done first, second, etc.? What must be done even if nothing else gets done that day? Establish a precedent for the day-to-day activities of the team member and of the position.
- What needs to be taught first, second, etc.? Spend a bit of time figuring this out. There are many responsibilities that are built one on top of the other. For example, a person will need to understand the strategies and protocols of your scheduling system before he or she will be able to tackle hygiene retention.
3. Define who is going to provide the training for each aspect of the job description. Certainly, there are different people on the team who will be best suited to teach the new person specific tasks. Once you have outlined and prioritized the job description, and you know how the training is going to progress, decide which person will provide training on each part of the job. As you prepare to hire a new person, include the team in discussions of not only characteristics and skills desired for the new team member, but also a review of the job descriptions and the development of the training protocol. Write out the entire training scenario. As you discuss each part of the training, discuss who would be the best and most appropriate trainer. Including your team members in this decision will help them buy into the participation much easier than just telling them that they have to do it.
Make sure that the person designated to train understands what to do, how to do it, and why each step of a procedure is important.
4. Establish time frames for each phase of the training. How soon do you want your new employee up and running independently? Once you know this, start working backwards. Determine the time frames for training that will take place for each aspect of the job. Do your best to figure out how long it will take to complete the full training so that the new person will be able to take over the task. To do this calculation, you will need to know a bit about adult learning and adult education.
Adult learning/adult education: What works best?
Once you have established this four-step plan, become committed to being a good teacher. Training a new team member is a classic example of adult education. You are educating your new team member about you, your practice systems, your level of patient care, etc. How well you treat this (and every) member of your team will be reflected in how well your team members treat each other, you, and your patients.
Define what is to be done, how it is to be done, and why it is to be done.
Review the program that you have developed. Go over the schedule of training. Let the new person see the vision of where you are going. Let him or her know - right upfront - that the training program is carefully laid out so that one thing will build on another. Help new employees see that the goal of your training program is their success. It is so easy for a new person to become overwhelmed and confused. If this happens, you may lose someone before the training is completed. However, if the new employee can see the vision of the training program and can sense progress, he or she may be more likely to stick it out. Training is a tough task. Care must be given to both the trainer and the trainee.
Begin the training by explaining the system in full. Then, go over what you will be working on at that moment. Don't forget to explain why something is important - no matter how small the task. If a person understands why this aspect of the job is essential for successful administration, he or she will be more likely to do the task with commitment every time.
Demonstrate. Show the new person how the task is to be administered. As you are demonstrating, be especially explanatory. Don't worry that you may be explaining things the new employee already knows. That's OK if you do. You will be reinforcing this person's present knowledge. However, remember that no two dentists or dental practices are exactly alike. Therefore, even if someone has been in dentistry forever, he or she will need to learn the way you handle each situation and each system in your practice. People want to know how to do things correctly. People want to be successful. Don't worry about overteaching. That is rarely a problem. Underteaching is a far more devastating one.
Be sure to schedule some "nonpatient" time for training. If you are to fully explain and demonstrate a task, you will need time, focused attention, and freedom to speak without embarrassing the trainee or the patient. Most practices are extremely unwilling to schedule nonpatient time for training. If you feel that way, too, I encourage you to reconsider. I promise this will be time and money well-spent.
For example, if I am a clinical assistant and I am dying to have some help, then I need to be willing to pitch in and do a great job of training. Otherwise, I run the risk of losing this new help, having the new employee's performance be less than acceptable, or doing things over because they weren't done correctly in the first place. In essence, I hurt myself if I am not willing to train and train well. However, a bit of scheduled, quality time invested in the training process will save time, effort, stress, and headaches in the long run.
Shadow. Once you have demonstrated a task during nonpatient time, go to the chair and demonstrate with the patient. Prep the trainee before you perform the task, then debrief after the procedure has been completed. Questions that are asked as soon as the procedure is over won't soon be forgotten.
Observe. You have defined the task, demonstrated it, and "shadowed." Now, let the new person do whatever it is that you have been teaching. As he or she is performing the task, give careful and caring feedback. Acknowledge what that person does well. Give positive reinforcement whenever possible to solidify performance. And, identify areas where things could go better. Be careful not to accept less than the best during your training time. Slacking off during the training phase may lead to an even greater decrease in the quality of performance later on. If your commitment is to excellence, then demonstrate that.
Observe your new team member performing each task with and without patients. Continue your feedback. Make an effort to keep the lines of communication open so that questions can be asked without embarrassment. Good questions usually mean that the person is learning and learning well. I never get anxious about too many questions, but I do get anxious when there aren't enough questions.
It is important that the person not feel intimidated during the training period. If he or she is intimidated or is made to feel "stupid" asking questions, he or she won't ask them. Herein lies the greatest risk. The new employee may be unsure about something, but instead acts like he or she understands. Subsequently, that person may make big mistakes when "turned loose." Or the trainee may give an air of "Oh, I know how to do this!" to make himself or herself look good. The new staff member is vulnerable at this point in his or her position. He or she may be afraid of looking stupid, of getting released, or of not being respected by other teammates.
Help your new colleague establish confidence in his or her performance and in his or her place on your team. Do this by establishing comfortable, open communication. Your words are critical. Be careful not to put the person on the spot by asking, "Do you understand?" This question is intimidating in and of itself. You will usually get a "Yes, I understand" for the reasons listed above. Rather, as you are giving and receiving feedback, ask the person to explain the task back to you - what they are to do, how they are to do it, and why it is essential. Ask what your new staff member felt good about during his or her performance of the task and where more training would be beneficial.
A confident person usually will ask questions to make sure that he or she is on the right wavelength. The new employee will want to make sure he or she is learning things fully and properly. A person who lacks confidence sometimes will show artificial competence just to cover up insecurities.
Delegate. Once you have determined that a person has been well-trained and that he or she has demonstrated proficiency in a task, turn it over. Delegation may be the single-most difficult part of training. A person will never get faster, better, or more confident unless he or she is given a chance to perform new tasks on a regular basis.
Once you have delegated, continue to evaluate the employee's performance, but let it go. Turn it over. Step out of the way. Trust. Your regular performance reviews will help both you and your new team member by continuing his or her development and solidifying your trust.
Don't wait until your three-month "get acquainted" period is completed to give a performance review. Give one each evening before you leave the office. Ask the new team member what successes he or she had during the day; then ask what the day's challenges were. Once those challenges have been identified, ask how you can help make that area better. What additional instruction is needed?
Be an active, interested part of the successful training program. This doesn't mean that the doctor will do all the training. Remember, this process has been carefully laid out and carefully delegated. But, the doctor - or whoever supervises this new person - should make sure that each day of the training phase ends with a brief performance review.
Getting and keeping good people is a challenge to all dental teams. Once you have hired a qualified person, you must be prepared to start this person off on the right foot. Develop an effective training program that helps the new person become fully invested in the practice, become productive quickly, and become interested in being successful right there in your practice. The time and effort you put into a professional training program will come back to you multifold!