If your staff meetings are "on the blink," it`s time to take out the troubleshooting guide and fix them. A practice that wants to improve needs to conduct regular meetings.
James R. Pride, DDS
Doctor, are your staff meetings on the blink? Have you given up holding regular meetings because you just can`t get them to work? When a computer crashes, we don`t toss it in the trash heap and conclude, "Computers are a waste of time!" Instead, we take out the troubleshooting guide and fix the problem. We know that we must use our equipment and tools properly or they will malfunction.
However, we often give little thought to properly using one of our most valuable tools, staff meetings. Then, when one or two meetings malfunction, we abandon them altogether. I`ve heard all the excuses why you shouldn`t hold staff meetings. In fact, I even used to make some of them in my own practice. The most common excuses are:
- "We don`t have time for meetings."
- "Our meetings always turn into gripe sessions."
- "Our meetings never accomplish anything."
- "Pat has exercise class at eight, Terry picks up the kids at four, Kelly only works part-time, and I have golf on Wednesdays. It`s just impossible to get us all together at the same time."
I understand the inconvenience of trying to institute meetings suddenly, when you have not been holding them in the past. However, not having effective meetings is more than just inconvenient; it means that your practice is not operating up to par.
Professional athletes must work on improving their performance during practice sessions, not while a game is in progress. Dental-team members, too, cannot be both "in play" and trying to improve their game at the same time.
The dental team that does not have pre- and post-game time to identify its "batting average" (i.e, its production, collections, case-acceptance rate, etc.), to pinpoint weak areas and brainstorm strategies for improvement is like the batter who goes up to the plate and swings at the same bad pitches every time. These practice and strategy sessions are your meetings. The good news is that after you and your staff begin holding effective meetings and seeing their stunning effects, you won`t ever want to live without them again!
Types of meetings essential to the dental practice are:
1) The huddle, which, like its counterpart in football, is brief and focused on the upcoming play (or, for the dental team, the upcoming day), and
2) the lengthier staff meeting, which focuses on comprehensive skill-building and problem-solving.
For example, asking Mrs. Smith to see the financial administrator when she comes in that day is a topic for the morning huddle. Improving cash flow through better accounts-receivable policies is a topic for a staff meeting. Practices have achieved outstanding improvements - including production increases of 30 percent or more - by instituting a 10- to 20-minute huddle at the start of each day and a 60- to 90-minute staff meeting once a week. These practices conduct three types of staff meetings:
a) The business meeting, held the first week of the month;
b) the implementation meeting, held twice during the month; and
c) the open-agenda meeting, held once a month.
During administrative time at the end of the previous day, each team member takes 10 minutes to complete a huddle agenda unique to his or her job, then brings this form to the next morning`s huddle. The huddle covers:
1) A recap of the prior day with an eye to pinpointing problems and avoiding their recurrence;
2) a review of the upcoming day`s schedule, with comments about new patients and discussion of any holes in the schedule and plans to fill them;
3) a plan for accommodating emergencies;
4) An alert on any patients needing to see the financial administrator;
5) the coordination between doctor and hygienist on exams for hygiene patients and strategies for broaching those needing restorative treatment that was diagnosed previously, but has not yet been performed; and
6) the targeting of one patient per team member to ask for a referral.
In the business meeting, doctor and staff discuss the previous month`s key practice statistics, comparing actual figures to goals. The staff examines and rates the office`s performance in key areas, including production, collections, new-patient counts, case-acceptance rates, and expenses. (We employ "trend indicators" to reveal powerful data indispensable to decision-making. Ten indicators are utilized for practices just beginning to measure their performance, with more added as entrepreneurial skills advance.)
The implementation meetings are held later in the month. They provide the forum needed to improve the state of the business by developing strategies and building skills in weak areas revealed by the practice statistics.
For example, if the number of new patients is low, the dentist and team can use the implementation meeting to practice asking patients for referrals, to review external marketing efforts, and to develop or revise marketing plans. (They also can use the huddle to target specific patients to ask for referrals.)
The open-agenda meeting, held monthly, presents an opportunity for the staff to discuss any personnel issues in a forthright manner. These meetings teach staff members that airing their suggestions or grievances constructively, in an open forum, is a far better way to resolve problems than gossiping or complaining among themselves. Areas covered by open-agenda meetings include: uniforms, work schedules, job responsibilities, housekeeping duties, and staff morale. If there are no pressing personnel matters, the practice uses the time reserved for the open-agenda meeting to hold another implementation session.
Through these four, key meetings, members are poised to: 1) handle the day-to-day activities (the huddle); 2) assess the state of the practice (business meeting); 3) build skills and solve problems (implementation meeting); and 4) resolve conflicts among themselves and improve working conditions in the office (open-agenda meeting). In other words, the dental team is ready to play ball - i.e., to deliver the all-star standard of patient care and practice profitability.
What follows is an example of the irreplaceable role of meetings in improving the dental practice. This case study examines addressing excessive hygiene cancellations with, and without, meetings:
Y Without meetings - Doctor tells hygienist (or appointment coordinator) that the hygiene cancellations have to stop. Staff member assures doctor that everything possible is being done, but patients just don`t care about their prophys. The doctor, getting a little testy, repeats the need to reduce the cancellations, and the staff member, also getting testy, reaffirms that everything possible is being done. Just then, Mr. Jones arrives for his crown seat and the doctor drops the conversation to perform treatment. Each party feels that he or she is right, each feels frustrated, and each is interrupted by the work at hand before the issue can be considered properly and resolved. Continual frustrations like this cause low morale, stress, and burnout.
Y With meetings - The business meeting shows that hygiene production per day is short of the practice goal, while the number of unfilled hours on the hygiene schedule is excessive. A review of the records shows that one out of every seven hygiene patients is canceling. Everyone agrees this is unacceptable. The doctor expresses concern about patients who cancel not receiving quality care, and the team sets an immediate goal to reduce cancellations to one every other day and a longer-range goal of no more than one cancellation per week.
The team devotes an implementation meeting to develop strategies to achieving its goal. As part of the preplanning for the implementation meeting, one person distributes practice-management guidelines for an effective recall program, such as those found in Pride Institute`s volume, Continuing Care. The team members compare their program to the guidelines and brainstorm ways to improve, while one person writes ideas on a flip chart.
In our example, the staff members decide on the following action plan and person(s) responsible for each step:
1) Hygienist - Instead of only verbally telling patients about their periodontal condition, the hygienist also might use a "Continuing Care Slip," which pinpoints problem areas on a tooth diagram, briefly explains home-care procedures, and establishes the next hygiene visit. The information on this slip will better educate the patient and reinforce the need to return. For example, the hygienist might circle Tooth 16 and write "5 mm pocket" on the diagram. She then might write under home-care procedures, "Floss behind tooth and use tufted brush." The hygienist then would give the Continuing Care Slip to the patient and keep a copy in the chart.
2) Front-office staff - Instead of asking if the patient would like to schedule his or her next continuing-care visit, the team member will find a similar time and day for the next hygiene visit and present it to the patient more positively. For example, "Mr. Harris, to save you the time of calling to schedule your next appointment, I can reserve your next continuing-care visit now and secure for you the same time and day as this one. How does 7:30 on Thursday, November 4, sound?"
3) Front-office staff - Instead of accepting cancellation calls without question, the appointment coordinator will pull the patient`s chart, examine the Continuing Care Slip, refer to the patient`s specific condition and need for re-evaluation, and then ask if there is any way the patient can keep the appointment. For example, "I see that Terry found a gum infection and bleeding on the upper left side. It`s important that your condition be re-evaluated at this time, Ms. Gibbons. Is there any way you can make your appointment?"
4) Doctor and assistant - When debriefing the doctor`s patients at the completion of the restorative work, the dental assistant should reinforce the need for the patients to return for continuing care and insure that the appointments are scheduled. The doctor also should mention the need for continuing care when patients complete restorative treatment.
5) Financial administrator - This team member will help educate patients about the great benefits of pro-active hygiene care, which can be accomplished with relatively little cost and a minimal investment of time. The team in our example feels unsure of the needed verbal skills, so the facilitator suggests practicing how to handle cancellation calls and debriefing the patients as topics for the next business meeting. The next month`s business meeting will show whether hygiene production has increased, and another implementation meeting in one month will be set to review progress on reducing hygiene cancellations.
Problems do get solved, and both the team and the practice rise to a new level of excellence with the invaluable aid of properly conducted meetings. Consult our Troubleshooting Guide (read the various examples scattered throughout this article) to fix the glitches, so that your office can achieve its full potential and become a satisfying and rewarding place for your patients, your staff, and you.
"We ramble on at our meetings, often going off on tangents, and never really accomplishing anything."
Possible cause: No agenda, so topics and time frames remain undefined and people just say whatever they feel like saying.
Recommended action: To gain control of this area, post a blank agenda for team members and doctor(s) to suggest meeting topics. Then, the dentist and facilitator should make a final selection of the subjects to be discussed and the time to be allotted to each, based on the priorities and needs of the practice.
"My staff doesn`t take our meetings seriously."
Possible cause: Doctor may not be attending the meetings. Doctor may not be following up on the action plans to ensure they are being implemented.
Recommended action: The doctor must attend all meetings, on time, and for the duration. The doctor`s absence sends a strong message that the meeting is unimportant. Besides, issues will arise that require the doctor`s approval before the meeting can advance. The doctor needs to meet with individuals, as well as the team (at the next meeting), to review progress on action plans.
"My staff doesn`t say anything at our meetings.
I do all the talking."
Possible cause: Dentist is conducting every meeting. No facilitator is assigned, so the staff remains uninvolved. Dentist may not realize that his or her leadership can be strengthened by giving the staff more responsibility, rather than trying to do everything single-handedly.
Recommended action: Dentist conducts only the business meeting. A rotating staff member serves as the facilitator of the other meetings to: 1) discuss with the doctor the topics to be covered in advance of the meeting; 2) allot 15 minutes at implementation meetings for role-playing to build verbal skills; 3) stick to the topics on the agenda; 4) keep the team on track; and 5) elicit the views and participation of all members.
At these staff-facilitated meetings, the dentist`s role is to: 1) aid the facilitator, when necessary, in keeping the meeting on track; 2) provide a general direction based on practice goals; 3) cast the deciding vote when the team is divided on an issue; and 4) review progress on action items with each employee and lead the staff to achievement with follow-up and recognition.
"I don`t feel comfortable having a business meeting with the staff where we discuss the numbers of the practice."
Possible cause: The doctor may think that each person`s compensation needs to be divulged.
Recommended action: The staff needs to know the key trend indicators and expenses. However, the doctor`s compensation always is omitted and the staff`s salary appears only as a total sum, so no individual`s compensation is revealed. When staff members realize the cost of rent, supplies, payroll, taxes, etc., they usually conclude that the doctor must be making less than they had imagined, and they are less likely to ask for unrealistic or excessive raises.
"We talk about what we should do differently, but by the next day, all our plans are forgotten and nothing ever changes."
Possible cause: No recorder, minutes, action list, or follow-through, so plans for improvement remain unspecified and no one is held accountable for doing things differently.
Recommended action: Assign a rotating staff member to be the recorder. This person:
a) Takes brief, bullet-point notes of all points covered, actions decided upon, persons responsible for actions, and time lines for completion;
b) distributes a copy of these meeting minutes, along with any additional action plan completed by the team, to team members and doctor;
c) files a copy of the minutes and action plan in a special notebook for meeting minutes.
Using the minutes and action plan, the doctor follows through with individuals to ensure that changes are carried out.
"Our meetings always turn into gripe sessions."
Possible cause: Meetings are held so infrequently that conflicts go unresolved and frustrations build. An angry or accusatory tone by the doctor can raise defensiveness in the staff.
A minority of disgruntled employees can cause divisiveness among otherwise happy, cooperative team members.
Recommended action: Hold regular meetings. Allow time once a month for the open-agenda meeting to air staff problems. Confine complaints to that meeting, and focus the staff`s attention on business matters during the other meetings. Set a positive tone by focusing on "How will we solve this problem in the future?" rather than on "Who`s at fault?" The doctor must confront a divisive staff member privately to address the inappropriate behavior, the need for change, and the consequences (culminating in dismissal) of a failure to change.
"Because of our staggered hours, we can`t get together for the huddle or the staff meetings."
Possible cause: Doctor may be attempting to save payroll costs and benefits by excessive use of part-timers and by staggering schedules.
Recommended action: The savings achieved in payroll may be minuscule compared to the benefits of having all team members attend the huddle and staff meetings. (Practices with multiple doctors and shifts may need to schedule two sets of meetings or design a system for briefing late-shift staff on the missed huddle.)
"There always are employees who can`t attend the meeting. They complain about the time, the day, the inconvenience."
Possible cause: Staff meetings are being held during off-work hours or over lunch.
Recommended action: Do not ask the staff to meet during lunch, stay an extra hour, or come in on days off for meetings. Hold meetings during regularly scheduled production time. Establish a set day and time for meetings and preblock them on the schedule. Don`t worry about lost production! On average, production increases by a minimum of 25 percent due to improvements in the practice that directly result from staff meetings.
