Integrated teamwork

Sept. 1, 2007
Doctors routinely note a lack of teamwork as their number one challenge in the practice. A lack of teamwork clearly causes stress...

by Jenn Robertson

Doctors routinely note a lack of teamwork as their number one challenge in the practice. A lack of teamwork clearly causes stress, and results in inefficient patient care and business systems that negatively affect the bottom line. Doctors feel the burden of being alone to bear the weight of producing great results. Their stomach acid burns while their belts tighten.

Yet we’ve all experienced the success of integrated teamwork. Picture any Cirque du Soliel performance, a Harlem Globetrotters game, or the 1972 Miami Dolphins season. These are ordinary people doing extraordinary things. To the viewer, these performances are poetic in precision and flawless in execution. Integrated teamwork in a dental practice is no different. Imagine the fluid movements of your team members as they seamlessly care for patients, incorporating technology, utilizing their influence, and managing the business while creating an environment where patients thrive. Utopia, you say? A magical combination of people? I argue that it can be achieved with an effective strategy!

Strategies for integrated teamwork

Attacking the challenge of teamwork begins by determining that the team you have is the one you want. You are not looking for extraordinary people; you are looking for ordinary people willing to do extraordinary things. Your assessment begins with a declaration from the leader (that’s you) stating, “I’m ready to play our game differently. Who’s ready for excellence?”

For a radical impact on your team, it must be a memorable moment. Wear a wig, wave a flag, use a noisemaker, play a song. Make it an outrageous, unforgettable moment that you can refer to as you begin your journey. Then you must provide a clear and decisive explanation for your team that you are investing in teamwork and focusing on outstanding patient care. The team you want will follow.

This article outlines the successful mantra used in many process-related industries: plan, do, debrief, and act.

Step 1: plan

To achieve true team integration (Globetrotter style), you must be willing to spend time planning what your version of teamwork looks like - how your day will flow, what your patients will say about you, what your reputation will be, how you will feel, and what it will take to make that happen. This essential plan starts with a one-hour team meeting to discuss these items, and continues with a committed daily strategy of planned communication.

➢ Plan to communicate - The players (your dental team) interact infrequently. Rarely are the doctor, hygiene team, administrative team, and clinical team together at the same time, making meaningful communication challenging. The few minutes that are spared in the hallway between patients or after work hardly provide a cohesive line of communication. True “integration” is a challenge. You must commit to daily communication that includes a 10-minute prepatient huddle, a five-minute postpatient debrief, and ideally a one-hour weekly team meeting.

The prepatient huddle is a basic principle that is a constant challenge for most dental practices. If your huddle is simply a review of the day, it is boring and lacks inspiration. To develop integrated teamwork, the huddle should focus on how you will deliver care. Here are some examples of areas to discuss in that vital 10 minutes:

❍Ideal times for hygiene exams - Doctors tend to wait until the end of a hygiene appointment to do their patient exams, which causes delays between hygiene patients and creates stress for the next patient by reducing his or her personalized time. In an effort to get back on schedule, hygienists often eliminate discussion on elective services and products such as Sonicare, rinses, home fluoride, bleaching, night guards, NTIs, and other ancillary services. By agreeing on the best time for each patient to be seen, team communication can actually increase production and efficiency in the hygiene department.

❍Patients with delayed treatment - Have the best influencer on the team determine why treatment is not being completed, then talk to the patient about how the team can assist in the completion of care.

❍Patient preferences - By identifying how each patient filters information, team members can adapt their style of communication to each patient. Team members may have input on how to best connect with individual patients based on their previous interaction. A notation of patient preferences allows team members who have not treated a patient to relate to him or her more easily.

❍Elective opportunities - Don’t make patients ask what types of services you provide. If you offer a service they may benefit from, make sure they know about it. The most effective team member to suggest elective treatment is the one with the best relationship with the patient!

❍Emergency appointments - Deciding ahead of time when to treat emergencies allows the team to control the schedule, thereby creating the best experience for both emergency patients and scheduled patients. Often clinical teams creatively turn emergency visits into possible treatment, thereby eliminating unproductive visits and maximizing patient contact time.

❍Care items - Do you need preop or postop photos? Who is due for FMX or pano? Does anyone need to be appointed for a comprehensive exam? Is there anyone with anesthetic concerns, latex allergies, or flags on their health history? Is there an opportunity for additional treatment on any of the scheduled restorative patients? Are all of the patient’s family members scheduled for their recare visits?

❍Practice items - When is your next restorative and hygiene appointment available? Who is asking for referrals? Are there any financial concerns or balances that need to be addressed? Have all laboratory cases and implant parts arrived? What is your scheduled production and how close are you to goal?

❍Hygiene support - Identifying specific use of a provider’s time can develop a better integration of teamwork. For instance, it may be advantageous for the hygienist to administer anesthetic to a restorative patient, while a clinical assistant sets up the hygiene room. Or, an administrator could assist the hygienist with periodontal charting. Establishing these assignments during a dynamic morning huddle creates certainty for the doctor, team members, and patients. This reduces stress and creates a smooth day of integrated teamwork and seamless transitions for outstanding patient care.

The key is eliminating the “my patient, your patient” mentality on the team. With an all-team approach, the needs of the patient are met, and five-star service and financial vitality of the practice are also accomplished.

Step 2: do

Executing your morning huddle plan is a matter of follow-through. Most doctors are happy to play receiver while their clinical coordinator plays quarterback. Reducing the stress of “having to do it all” empowers a team to do what they plan and a doctor to let them. If we consider that there are roles on the team rather than assignments, then doing what’s best for the patient comes naturally.

It’s critical to commit to the actions you agree upon in the huddle. The seamless performance of the team relies on everyone knowing his or her role and the impact it has on other team members and patients. Expectations are developed in the huddle that must be met during the day. Most importantly, doing what you say you will is the basis for establishing trust in the practice.

➢ Allow people to fail without repercussion - Team members with guaranteed slam-dunk success never take risks. If they never take risks, they will never achieve more. You must foster a culture that rewards team members who stretch, even if they aren’t successful the first time. While it is necessary to remember that real failures have real costs, a practice that wants team members to innovate needs to provide an environment that encourages people to be innovative.

Recognize what’s been done well and what could improve. This leads to the next important process in Step 3.

Step 3: debrief

Debriefing is essential to understanding what went well and what could have been improved about the day. It is similar to reviewing a play-by-play of a game. This end-of-day, five-minute review is less common than the morning huddle because providers complete their tasks at different times. Select a time when everyone can meet and commit to it. The purpose of debriefing is to close out the day, make adjustments, and follow up on deliverables and tasks.

Use a facilitator to direct the debriefing session. This is generally the clinical assistant or treatment coordinator. Use this checklist to guide the day’s debrief:

❏ Review day’s performance - Is there anything that could have been done differently for a better outcome? What was fun, satisfying, or great about today?

❏ Follow-up phone calls - Are there any postop treatment phone calls that need to be made? Any calls required to specialists or patients?

❏ Special recognition - In an effort to develop a winning environment, take time to recognize any team members who made an above-and-beyond effort, created a great experience, or had a compliment from a patient.

❏ Future agenda items - This is an ideal time to add items to your weekly team meeting agenda that can’t be solved in this five-minute time block.

Step 4: act

Step four is the most crucial step in stimulating change ... act! Change comes in developing an action plan based on outstanding patient care and systems that improve your planning, execution, and debriefing. Strong strategies are developed during your one-hour weekly team meeting.

The focus is on resolving problems, improving what’s already been developed, and creating methods that achieve your desired outcomes. When the team contributes to the agenda, it solidifies their sense of team membership.

By collaborating on a desired outcome, the team owns it and it is not solely the doctor’s desire. Addressing concerns weekly also allows for behavior modifications to take root and improved systems to develop. With seven days between team meetings, follow-up and reporting is more timely, which creates faster results.

While the nonproducing hour may initially appear costly in labor expense, when it’s implemented properly, most doctors report that this is the most valuable hour of the week!

The environment of an integrated team is unmatched in talent. Achieve this level by implementing four simple steps - plan, do, debrief, and act. This strategy inspires your team to excellence and ensures the success of your business by adding to the bottom line. The stress of the day will dissolve as team members unify in their approach. Systems will be refined to the precision of the Cirque acrobat. Most of all, you will be assured of being rewarded for your efforts with a sold-out show.

Jenn Robertson is the COO and director of professional development for the Hornbrook Group Center for Clinical Education. With a rich background in practice coaching and management for some of the top producing dentists in the United States, Jenn is able to fulfill her passion by touching hundreds of practices who desire excellence through the Hornbrook Group course curriculum, with a focus on enhanced business systems, elegant communication, customer service, and practice profitability. After earning honorable distinction in business development for large corporations, she has incorporated those skills and strategies into the fundamental success of any dental team. For more information, call (866) 467-6276 or visit

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