The Long Haul

April 1, 1999
Why do some employees remain loyal to the same boss for years? Let`s let them tell us. "I respect the doctor`s professionalism, integrity, and outstanding quality of care," says Sheila Bell, employed for 21 years by orthodontist Charles Wear of Santa Rosa, Calif. "I also value our emphasis on interpersonal communications at staff meetings and, especially, at our annual retreat. In addition, I appreciate the opportunity I`m given for personal and professional growth by attending seminars and conv

James R. Pride, DDS

Why do some employees remain loyal to the same boss for years? Let`s let them tell us. "I respect the doctor`s professionalism, integrity, and outstanding quality of care," says Sheila Bell, employed for 21 years by orthodontist Charles Wear of Santa Rosa, Calif. "I also value our emphasis on interpersonal communications at staff meetings and, especially, at our annual retreat. In addition, I appreciate the opportunity I`m given for personal and professional growth by attending seminars and conventions. This turns a job into a career."

Dawn Briarton, employed for four years by general dentist Gregory Stump of Schaumburg, Ill., adds, "Dr. Stump is supportive and makes me feel appreciated. When I have a problem, he`s very approachable. Having a team atmosphere really helps, too. At other jobs I had, the people just didn`t work together; here, we all work toward the same goals."

Keeping contented, competent employees for years - not to mention decades - can be challenging. However, the rewards of increased productivity, reduced costs, improved customer service, and lowered stress can reap dividends for your practice.

We hear countless complaints from some dentists that their veteran employees are set in their ways, suffer from bad habits, spread bad attitudes, and, in effect, do as they please. Shortcomings in the dentist`s leadership can transform long-term employees into a nightmare, rather than a dream-come-true. The question here becomes: Why is the staff running the practice counter to the doctor`s goals, and how will hiring a new staff change things? If leadership is lacking, then the new staff also will develop poor performance patterns. In order to benefit from long-term employees, the dentist needs the leadership skills to communicate goals, inspire the staff to achieve them, instill good work habits, and resolve conflicts. Doctor, if you need leadership training, please do yourself - and your staff - a favor by honing the skills that are the precondition not only of retaining staff, but of creating a productive, organized, low-stress, and high-profit practice that fulfills your professional and personal goals.

Keeping staff for the long term

Let`s review the statements of the employees at the beginning of this article. Notice that money, while it may be an important issue, could not have been the only motivator, because the employees did not even mention it. Early researcher Dr. Lawrence Lindahl found that the number-one staff motivator was the full appreciation for one`s work, followed by: 2) feeling "in" on things, 3) sympathy for personal problems, 4) job security, 5) good wages, and 6) interesting work. Later, researchers Ken Kovach and Bob Nelson corroborated these findings.

Notice the reasons given by our two dental employees for their longevity: respecting the dentist, communicating effectively, working as a team, improving oneself and the practice, having an approachable boss, being appreciated, etc. Their thoughts are reinforced by researcher Gerald Graham from Wichita State University, who found the following top five incentives missing when employees quit their jobs:

1) 58 percent never received any personal thank you from the manager;

2) 76 percent never received any written thank you;

3) 78 percent never got a promotion for good performance;

4) 81 percent never received praise in front of others;

5) 92 percent never attended morale-building meetings.

Let`s examine in more detail the things that experts and valued employees are telling us about how to keep the staff happy on the job.

1. Education - To maintain interest in their jobs, employees need to grow personally and professionally. No one can maintain enthusiasm when stagnating in a job. If the work becomes dull and tedious, with no new challenges to arouse interest, the staff and the practice plateaus. When this occurs, the staff`s effectiveness diminishes. To keep employees excited about their work, the dentist needs to provide opportunities for growth. This can be achieved through meetings that educate employees on how to enhance personal growth and improve the practice.

The Retreat - The most important educational meeting is the retreat, held once or twice a year, in which the dentist takes the staff to an off-premise location for an overnight stay. The purpose of the retreat is for the dentist and staff to discuss how they can improve themselves and their job performance. Ideally, these meetings are facilitated by someone outside the practice who serves as a communication specialist and an impartial third party. Lacking an outside facilitator, this meeting may be conducted by the team itself, with segments of the agenda facilitated by various staff members.

The success of the retreat hinges on how it is held. The dentist should not posture himself as the authority figure, dictating policy. On the contrary, these gatherings are discovery meetings in which the staff members identify for themselves their good points and areas that need improvement. The retreat refreshes the staff and renews enthusiasm. It is a "refueling" event, as essential for the health of the practice as the refueling of your car is for its proper function.

And, doctor, please spend the money to take your staff to an upscale, rural, resort-like setting away from the office, with outdoor areas for meeting and relaxing. In the evening of the first day, treat your team members to dinner, so that everyone can bond again after what may have been an intense day of problem-solving and conflict resolution. Staff members look forward to a properly run retreat, returning to work recharged to improve themselves and the practice.

The Staff Meeting - This weekly or bimonthly meeting is held in the office to address specific topics for growth, such as how to improve customer service, efficiency, front-office operations, marketing, or any other aspect of the business. This meeting also is not dictatorial, but participative, resulting in a greater contribution of ideas and acceptance of them by the staff. (For more details, see my article on how to hold staff meetings in the January issue of Dental Economics.)

2. A chance to contribute - The retreat and staff meeting offer employees a chance to contribute ideas to improve the practice. Every business must continue to grow until terminated through its sale or liquidation. When an employee suggests an idea that can improve profits - and the doctor agrees with the idea - then he or she must help the staff implement it when appropriate. We find most dentists resist change. However, for the staff and the practice to flourish, the dentist cannot impede appropriate change. Such a policy will frustrate the best employees, who will seek outlets for their talents elsewhere. The dentist needs to allow the staff to discover solutions to problems and then implement them.

3. Compensation - Motivating the staff to remain with the practice means offering appropriate compensation. Although money is just one of several motivating factors, it is important. If the practice is improving financially, employees rightfully feel that they should share in the rewards. This should not scare the dentist, because all salary increases must come from increased profits. (Pride Institute does not recommend that a percentage of profits be given to employees, but rather that increases in compensation be based on increases in productivity.)

Conscientious employees understand this concept; they do not expect a raise for just showing up. They know that they must accomplish something to earn their pay, and that doing an excellent job leads to personal fulfillment, as well as financial reward. Some dentists keep a short-term staff, fearing that escalating salaries for veteran employees will become unaffordable. This problem vanishes when salary increases are tied to increased profit, rather than to arbitrary, yearly, automatic raises.

But what if the dentist no longer wishes to grow the practice, such as in the case of an approaching retirement? Long-term employees need to grow, and compensation is a part of their development.

The best thing to do in this type of situation is to share the employee with an associate or to pay the employee the same compensation for reduced hours. When reducing hours for the same pay, productivity per hour must increase. For example, a dentist studying with us pays her staff for the five-day week they once worked, although they now work only three-and-one-half days a week.

By practicing comprehensive, quadrant dentistry, production per hour has increased to the point where the practice can earn more in three-and-one-half days than it formerly earned in five, so the staff compensation for five days makes sense, based on the increased productivity per hour.

Employees also need to count on their paychecks. If you decide to attend a continuing education course, leave the office open and pay the staff (there always are things to do, such as filing, purging charts, and re-activating delayed treatment cases).

4. Praise and recognition - Employees need to know that the boss appreciates their work. Earned praise is motivating. Productive employees deserve to hear frequent, genuine compliments for their work. The Robert Half Interna-tional Corp., a foremost staffing specialist, pinpoints the number one reason for employees quitting as "limited recognition and praise." At Pride Institute, we have found that when employees constantly complain about compensation, the underlying issue often is a lack of feeling appreciated, which is harder to verbalize. An important part of recognition is acknowledging the staff member`s employment anniversary. Like birthdays, such dates warrant celebration because the staff member is valued; verbal appreciation is appropriate, and you might want to consider small gifts.

5. Performance evaluations - If we feel we`re going nowhere, then chances are we`re going nowhere. By recognizing outstanding achievement and identifying areas for growth, performance evaluations are the vehicles that drive us somewhere. Without these evaluations, employees worry about whether or not they are doing a good job. Performance evaluations allay their fears and tell them where they stand. These meetings should be constructive, honest, nonblameful and allow "give and take," with both the doctor and employee contributing ideas.

6. Displaying high standards of ethics and care - As employee Sheila Bell indicated at the beginning of this article, people are proud to work for a dentist with high standards of professionalism, honesty, honor, and integrity. The dentist`s good character means employees can trust his or her word and patients can expect quality care. High ethical standards set a personal and professional standard for the staff to respect and emulate.

Doctor, with all of these tools at your disposal, you can create a loyal, long-term staff invaluable to your practice. Imagine going to work every day without the annoyances, irritations, and conflicts caused by unresolved staff issues. Your office can be a rewarding work place for both you and your team. You owe it to yourself, your family, your patients, and your employees to create a nurturing atmosphere. If you don`t know how, consider getting professional advice. Begin grooming your staff now by expecting the best from them and by being the kind of boss who brings out the best they have to offer.

For proven methods that you and your outstanding staff can use to improve your practice, call Pride Institute toll-free at (800) 925-2600 and we`ll send you a free, 28-page booklet titled, "Taking Your Practice to a New Level."

Why retain long-term employees?

In my seminar on leadership, I ask the dentists in the audience how many have unresolved staff problems. Often, I see a majority of hands raised. Shortcomings in leadership can result in a long-term staff with performance problems (which we`ll address later in this article). When this occurs, dentists fail to see the immense value that veteran employees can be and ought to be. This section discusses the many benefits of long-term employees who are motivated to achieve practice goals.

() Long-term employees save money otherwise spent hiring and training new staff.

It takes three interviews to hire an employee properly and a minimum of 10 days of dedicated training to teach a properly documented job. In the misguided attempt to save time and money, some dentists cut corners when hiring and training, resulting in far more time and money wasted repeating the process when the improperly selected and poorly trained employee fails to work out. The practice also loses the staff trainer`s time and productivity while the new person receives instruction.

The real issue is that glitches in customer service, errors in scheduling, lost billings, increased office stress, etc., result from ill-prepared persons floundering at a new job. Thus, we have more wasted time and money, and antagonized patients as well. Some dentists think they can avoid paying some fringe benefits by hiring part-timers. This policy often leads to a transient staff with higher turnover, which is far more costly than the fringe benefits the doctor tried to avoid. Make no mistake: It can cost thousands of dollars to hire and train an employee, whether part-time or full-time, so invest for the long haul.

(1) Long-term employees are better able to implement change.

Those with the proper entrepreneurial mind-set, thanks to the doctor`s leadership, will welcome appropriate change. Because they understand your philosophy and purpose, they can propose and implement new ideas. For example, an established employee committed to your philosophy of quality care is more likely to accept, and even suggest, a new customer-service policy than is a new employee struggling to learn the office procedures. It is the long-standing employee who knows the systems well enough to recommend constructive changes. The new person typically (and rightfully) is focused on learning the systems, rather than on evaluating and improving them, and so initially will have little input toward positive change.

(2) Long-term employees bring consistency and reliability to the practice.

Established employees, following the agreed-upon procedures, provide consistent experiences that patients rely on. When one staff member asks the patient to pay at the time of the visit, while another one says "don`t worry, we`ll bill you," there is inconsistency, causing the patient to become confused and to lose confidence in the practice. The greater the staff turnover, the greater the inconsistency and confusion. Long-term employees also improve consistency by using their job know-how to train newcomers to meet performance standards. Experienced employees can better make decisions and deal with problems and crises without the dentist constantly having to intervene.

(3) Long-term employees better understand your patients and their needs.

Patients like dealing with the same helpful staff. They know that "Pat" makes them comfortable in the chair or "Terry" helps them complete their insurance forms. New staff members can create uncertainty, concern, and even anxiety in patients who are no longer sure of what to expect.

Although long-term employees can benefit the practice substantially, their longevity also may create difficulties. Familiarity with patients sometimes leads to the staff`s allowing some patients to manipulate the practice with expectations of favored appointment times, financial arrangements, or other special considerations that conflict with the practice guidelines.

Familiarity with the dentist`s preferences also can lead to problems. For example, if Sally knows that attitude problems among the staff upset the dentist, she may not inform the boss of such situations, to the detriment of the practice.

To keep long-term staff aligned with practice goals, performance evaluations and on-going communication are essential. Some dentists mistakenly assume that a long-standing employee no longer needs performance evaluations and regular feedback; however, just the opposite is true.