Scared silly!

July 1, 1999
Case Profile: In this wild west practice, our dentist is one lonesome cowboy clashing with a bunch of renegade homesteaders.

Sally McKenzie, CMC

Case Profile: In this wild west practice, our dentist is one lonesome cowboy clashing with a bunch of renegade homesteaders.

Symptoms: Communication and interpersonal dynamics between staff and doctor are out of control; practice systems are up for grabs; and the bottom line looks like it`s been through a hangman`s noose.

Observations: We`ve got several parallel, yet opposing, patterns at play here. First, our doctor is so petrified of staff turnover that he usually stays silent on matters of employee performance. Next, because the doctor`s so intimidated and vulnerable, the staff resorts to calling the shots, unaware that business is slipping. Finally, when the doctor does speak up now and again, the staff becomes insubordinate, even hostile. And, so, for a short time, to "show" his staff, Dr. Panic will start doing things himself, such as financial arrangements, insurance forms, recording due dates on recall, etc. This behavior makes the staff feel that he doesn`t trust them, making them all the more hostile ... and the situation all the more touch-and-go.

Discussion: Looking objectively, it`s easy to see the chaos caused by the doctor dropping in and out of the management role like a cameo actor on Walker, Texas Ranger. Make up your mind, fella! Control is not something you can dabble in, if and when the mood strikes. And make no mistake, once you`ve dropped those reins, there`ll be hell to pay when you try to re-establish your hold. Watching the doctor`s approach-avoidance behavior, I`m struck by the singular nature of the problem this doctor shares with countless doctors across the land. He is scared silly of staff turnover.

Treatment Plan: If only he had training protocol in place - written manuals, audiotapes, or videos - he wouldn`t need to be so dreadfully afraid. Putting such protocol in place, therefore, is my first recommendation. These materials will be invaluable throughout the life of the practice. They will help put an end to leaving employees in positions they`re not suited for or who are not up to the task. But training is only the first park of the plan. Second is the design of results-oriented job descriptions/ expectations for all business and clinical staff. Lastly is the objective measurement of employee performance with regard to specific job performance, productivity, innovation, work ethics, cooperation, initiative, time management, attitude, attendance, and following instructions. Each employee is given a set of parameters in which they have to perform. For example: The financial coordinator measures and reports to the doctor the amount of production for the month and year to date; collection ratio; accounts receivable; percentage of accounts receivable over 90 days; and over-the-counter collections. She also is reviewed on skill statements such as "I review the next day`s patient balances," and "I make delinquent account calls at 31 days past due." Dental assistants` performance is measured strictly by skill statements such as: "The contacts on my X-rays are open and never overlap," and "The models I pour never have defects." To these skill statements, the employee must answer: Always, Most of the Time, Sometimes, Seldom, Never. For convenience, I suggested that a step-by-step guide to all of the above was provided in my Performance Measurements book and tapes.

Sally Says: If you don`t take control, you lose control. If you`re afraid to replace an insubordinate, a mutineer, or a fool, you might find yourself surrounded by them. Be fair always; but, take the reins and ride `em, cowboy!

Sally McKenzie is a Certified Management Consultant, nationally known lecturer, and author with more than 32 years in the dental profession. Her sole proprietorship, McKenzie Management and Associates, provides in-office systems` analysis of the business, clinical, and hygiene department; staff training; and offers a full line of educational-management books, audiotapes, and videos. McKenzie`s dental clients span 40 states over 20 years. She is a consultant to the Council on Dental Practice of the ADA. Call Sally at (877) 777-6151, e-mail to [email protected] or check out her Web site at