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The mediocrity Trap

March 1, 2004
It's like lugging around an extra 200 pounds. You're not yourself anymore. Where's the enthusiasm? Being a dentist was supposed to be fun, rewarding, and enriching in every sense of the word.

by Sally McKenzie

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It's like lugging around an extra 200 pounds. You're not yourself anymore. Where's the enthusiasm? Being a dentist was supposed to be fun, rewarding, and enriching in every sense of the word. But these days, going to the office is like going to prison. There's too much pressure, and too little return.

This isn't what you wanted for your dental practice. You are an excellent dentist, but you are painfully aware that your practice doesn't reflect it — revolving patients, employee turnover, holes in the schedule, and low treatment acceptance. Your vision of establishing the highest standards and building the very best practice is trapped somewhere beneath the daily squabbles, system breakdowns, and staff complacency. Like concrete blocks around your ankles, your practice is bearing the weight of mediocrity. You and your team have become shackled to the minimalist mindset.

How does it happen? As familiarity breeds contempt, complacency breeds mediocrity. Teams get comfortable. They are not challenged. They don't question what they do or why they do it. They shun change, and actively avoid accountability. Most importantly, leadership, which is central to success of the practice, is nonexistent. Ralph Sardell, an executive coach for McKenzie Management, finds that mediocrity, complacency, and leadership are all intimately related.

It takes leadership to examine systems, processes, and staff and change those that don't work. Teams mirror the leadership of the practice. Look carefully at your team: do they reflect your commitment to excellence? Are they open to change? Are you willing to challenge them to make changes? Or do you shun better, more efficient systems, and procedures because Mary Jane has been there since the beginning of time and you decided long ago that it's not worth it to challenge her negative attitude and poor performance. You rationalize your fear of addressing the problem by telling yourself that she handles all the insurance, or she knows all the patients, or whatever the excuse. If you've chosen to ignore the problem, you've abdicated your responsibility as the leader. You can count Mary Jane as one of your concrete blocks — dead weight tethering your practice to mediocrity.

Meanwhile, Mary Jane is the shining example for the rest of the team. Employees are expert "boss watchers." They are quietly watching as you take zero action to address this obvious employee issue. The irony is that virtually every time a problem employee is dismissed, the entire team breathes a sigh of relief and becomes more effective. Most employees want to excel, and they want to be challenged. But they look to the dentist to be the leader and address bad attitudes and poor performance.

Reluctant leaders

Dentists are leaders, but it's often an uncomfortable fit. They frequently lack leadership experience and/or training. Dentists are trained to be excellent clinicians, but they seldom possess the skills needed to lead teams and avoid complacency. However, dramatic leadership improvement can occur under the right circumstances — if the dentist truly wants a practice that reflects the level of excellent dentistry he or she provides.

To improve leadership skills and avoid mediocrity and, ultimately, a loss of control over the practice, dentists must take three essential steps:

• Change your definition of leadership.
• Change your behaviors as leaders.
• Change your expectations of the desired outcomes.

The leadership definition for small businesses is different than for large companies. The vision is to make a good living. The plan is to work hard every day and deliver the best service and quality to patients. The required communication skills consist of knowing what you want your staff to do and telling them.

Mediocrity and the routine patient

Strike the words "routine check-up" from your vocabulary and change that routine mindset. Let me share with you this true example of how the "routine" approach binds the practice to complacency. "Diane" is a long-term patient in "Dr. Gary's" office. When the six-month appointment rolls around, Diane feels like she might as well be going in for the 3,000-mile routine oil change. It's scrape and skate, floss and fly. Get her in. Get her money. Get her out. The staff is on autopilot, and it is abundantly clear to this patient.

Before her most recent visit, Diane had been having some trouble with a tooth and decided that if the doctor asked about any problems she'd mention it. Like many patients, Diane is a bit anxious about going to the dentist, and since the pain was only sporadic, she didn't want to make a big deal out of it. In addition, she had been having some sensitivity with some other teeth, which the hygienist noticed during treatment.

Dr. Gary came in, greeted Diane, politely asked about her family, looked in her mouth, checked a few old X-rays, and said, "Looks good — see you in six months." Dr. Gary never asked Diane if she was having any problems. What's more, although the hygienist noticed the sensitivity, she did not mention it to the doctor, nor did she recommend any special products or homecare regimens to address it. During the appointment, Diane casually asked the hygienist a few questions about whitening. Although this practice wants to emphasize cosmetic dentistry, the hygienist suggested the procedures she thought would be best for Diane would be "pretty pricey!"

So, if you were Diane, what would you be thinking when you walked out? "This place is so unbelievably average they can't even figure out when they have a patient in the chair who wants to spend some money on her smile!"

It's easy to assume that long-term patients will return, and it's also easy to fall into the trap of thinking that they will raise concerns and inquire about treatment options without prompting. Here again, if there is no defined process and no training, it's too easy for teams to fall into the minimalist mindset trap. Mediocrity strikes again!

Instead of cruising on autopilot, find out about what's on your patients' minds. Do they have questions about new treatments ? How do they feel about the condition of their teeth? If you and your team have recently participated in continuing-education programs that will benefit your patient, tell them! Educate them about new services. Wow them with your information, your time, your consideration, your care, and your questions. Your practice must be involved in a continual cycle of patient education. As you share information with them, you also gather information from them.

Dr. Gary and his staff missed the opportunity to involve Diane in more comprehensive dental treatment. In other cases, patients are simply uninformed about the benefits of comprehensive dentistry. Communicating and taking the time to understand your patients' needs, desires, and questions will set your practice apart. Involve patients in "co-diagnosing" their dental wants and needs. You will motivate them to seek the best your practice offers.

Schedule – the master or the servant?

Too often teams act as if their days are dictated by the whims of some unseen scheduling force intent on keeping them running like crazed maniacs through half the day, only to bring patient activity to a standstill mid-afternoon. Controlling the schedule is not only possible; it's critical to move beyond mediocre production and income. It requires vigilence and a few key elements:

Identify your practice's financial demands and objectives. This enables doctor and team to understand the importance of scheduling to meet daily production goals. Each day has a purpose that goes well beyond making it through without collapsing. What's more, the scheduling coordinator has clear objectives, and the doctor turns greater attention to diagnosing the best dentistry for patients.

Clearly communicate the specific time needed for every treatment to the scheduling coordinator. This ensures the fates aren't controlling your day – you are.

Avoid over-scheduling. Booking an entire treatment plan does not guarantee that the patient won't change or cancel appointments. However, it does make your schedule appear overwhelming and often forces loyal patients to wait several weeks for routine procedures – sending them a dubious message that their dental care is so completely unimportant they can just wait U and wait some more. The doctor should never be scheduled out more than three weeks.

Review the schedule as a team first thing during the a.m. huddle. The clinical staff advises the scheduling coordinator where to place any emergency patients. The dental assistant reviews specifically what procedures are scheduled and sets up the treatment rooms accordingly.

Delegate responsibility for the recall system to a patient coordinator. This person is accountable for its success and should be expected to:

• Make a specific number of patient phone calls each day.
• Schedule a definite number of appointments.
• Ensure that a specific number of patients complete treatment.
• Schedule to ensure the hygienist achieves a daily or monthly financial goal.
• Manage a precise number of unscheduled time units in the hygiene schedule per day.
• Establish clear production and scheduling goals and monitor the system at least every 30 days.

Breaking out of the cycle of mediocrity and complacency all comes down to embracing your role as the leader of your practice. Retake control of your career, your business, and your professional and personal satisfaction.

Establish a clear vision for the team and implement systems and expectations. Ultimately, you will have real results — not gut feelings — to measure. In the end, the doctor, the team, and the patients reap the rewards of true practice excellence. And you are at last freed from the cage of mediocrity.

A leader must explain to the staff what is expected of them, how their performance will be measured, and how that performance will be rewarded. In exchange, the followers will get paid and appropriately recognized. Rather than allowing your practice to sink under the weight of mediocre minions, choose to build and lead a team of star players. Focus initially on following manageable steps. You will see improvement almost immediately. Those who are valuable to the future success of the practice will emerge, as will those who aren't.

• Get the right people into the right jobs. Some employees are perfectly at ease asking for payment, while others feel as if they were making some extraordinarily difficult demand of the patient. I highly recommend personality testing to place your team members in positions in which they can excel – not just get by. The Keirsey Temperament Sorter Test found at is an excellent tool to use for this process.

• Tell it like it is. Develop job descriptions for each position. Specify the skills necessary for the position. Outline the specific duties and responsibilities. Include the job title, summary of the position and its responsibilities, and a list of duties. This is an ideal tool to explain to employees exactly what is expected of them.

• Train. I've watched this mind-boggling scene hundreds of times — dentists allowing untrained team members to handle tens of thousands of dollars in practice revenues. Would you hand them the instrument tray, a couple of handpieces, and say, "Have at it, let's see what you can do." Of course not! Team members must be given the training to succeed and meet specific performance standards.

• Encourage the best. Performance measurements and a credible system for employee review consistently yield a more effective and higher performing team member. They also increase that person's personal job satisfaction. Face it, when we understand the rules of the game and how we can win, life and work are a lot more fun and rewarding.

• Celebrate! Inspire the team with a practice vision and goals and recognize the progress you make in achieving those goals. Break out of the same ol' way of doing things that has yielded the same ol' mediocre results and professional dissatisfaction. Create the incentives for staff to use their skills and training to develop plans to continuously improve patient services, boost treatment acceptance, and build a better practice.

If you create a structured environment with clear expectations and a plan for total team success, Mary Jane may actually rise to the occasion. If not, it's time to cut her loose.

The Hygiene Question

If you are tolerating average performance from your hygiene department, you're slogging through more concrete. Rise above mediocrity by measuring outcomes and insisting on accountability. Take these steps and build a hygiene department that fully contributes to the success of the practice. If hygienists receive guaranteed salaries regardless of production, the expectation must be that they produce 3x their pay.

• Schedule the hygienists to produce at 3x their daily wages.
• Consider paying hygienists a commission for achieving additional production.
• Evaluate fees and determine if they are too low. Look at the procedures to determine the production per hour costs. If the hygienist is paid $25 per hour and the cost for the prophy, not including the dentist's exam, is $50, the hygienist is making .50 cents on the dollar. Hygiene salaries should be less than 33 percent of their production, not including the doctor's exam fee.
• Insist on periodontal assessment. One-third of hygiene production should be in interceptive periodontal therapy. Require the hygienist to measure the total number of dollars produced in the 4000 code and divide it by their total production.
• Review hygiene production each month.
• Customize the time per patient based on patient needs, not on a standard, one-hour allocation for each patient.
• Provide hygiene hours in the evening if patients request late appointments.

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