Building a master practice team

Teams that are truly teams recognize the power of their collective and integrated work as a harmonious and productive synergy.

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Th 184739
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Teams that are truly teams recognize the power of their collective and integrated work as a harmonious and productive synergy.

Many years ago, the dental profession was something that could be conceptualized as a two-story house. In this upstairs-downstairs scheme, the dentist occupied the upstairs. From this lofty position, he or she created and coordinated the practice design, hired and fired, and directed the activities of the team. As the sole architect of practice productivity and profitability, the dentist controlled the placement of the nuts and bolts and screws and nails of practice economics. Team members performed their respective functions, generally without a clue about how things in the practice as a whole were going.

The dental team was composed of individuals hired for skills that supported this upstairs-downstairs conceptualization. There was usually a hygienist who cleaned teeth, a receptionist who scheduled appointments, a dental assistant who seated the patient in the operatory and then stood by the dentist in the operatory, handing over instruments, mopping up excess saliva, or cooing over the patient. In this two-story house, members of the dental team lived downstairs, often occupying individual rooms with no connecting doors. Some rooms were bigger or more comfortable than others, but no one on the team thought much about questioning the hierarchical structure or infringing on the rights of the person upstairs.

The business of dentistry was solely and exclusively the province of the dentist, and everyone subscribed to the premise that the traditional upstairs-downstairs infrastructure was workable. As long as team members did what they were expected to do in the roles assigned to them, things went smoothly. At the end of the week or the month, each team member would be handed a paycheck (with little or no idea of the economic hocus-pocus that made that paycheck possible), deposit it or spend it as personal or family finances required ... and that was that.

Team meetings - if they were held at all - were usuallychaired and conducted by the dentist. The information shared at such meetings was generally focused on issues that concerned what was occurring downstairs. If things were going well, praise was directed at the individual(s) who had made them go well. If things were going badly, the perpetrator(s) might be summoned to an audience for a private tongue-lashing. Rarely were the positive or negative effects of team activities viewed as something that affected the entire practice. It goes without saying that the meetings seldom, if ever, touched upon the entire house. What occurred upstairs stayed upstairs; the team was not privy to that information and it was universally assumed that there was no reason for them to know about such matters.

Moving to a split level

Somewhere along the way, the dental profession began to change. The upstairs-downstairs practice construct was abandoned and replaced by something that resembled a split-level. The general business environment had begun to recognize the value of teamwork, and the dental profession adopted some of the premises of the business community at large. Dentists began to see that team members who were more aware, more engaged, and more involved with general practice operations could contribute something that went beyond their respective duties in the operatory or the reception area.

For many team members, this was like a breath of fresh air. It was a paradigm shift that acknowledged what they had already suspected, but seldom had the nerve to mention. That unmentionable thought was really quite simple: What team members do in their respective jobs carries over into the practice as a whole. For example, many hygienists intuitively recognized that things they did or didn’t do with patients had a ripple effect. If something went right, the appointment went well, the patient was happy and made a new appointment. If something went badly, the patient reacted in a way that cost the practice money, caused a problem for the person doing the scheduling, or otherwise interfered with the way the practice as a whole functioned. Other team members were also seeing this phenomenon, and this led to some serious rethinking about the nature of teamwork and team dynamics.

Some things began to change, but underlying assumptions and misconceptions were preventing truly meaningful changes. The practice as a split-level home was more conducive to teamwork, but there were still flaws. Often, these flaws had to do with expectations. The dentist expected the team to know certain things and the team expected the dentist to know certain things ... yet, frequently, one side or the other was clueless. Individual practice systems remained, by and large, a function of individuals.

Never was I more conscious of this than when I made my own paradigm shift from hygienist to practice-management consultant. What I saw in most practices was an infrastructure that was fragmented instead of cohesive. Teamwork was more pep rally than substance. The infrastructure continued to focus on the parts, rather than the whole.

Teams, though working more closely and communicating better, were still working without a full understanding of the global systems of the practice. Dentists, though more open to suggestions and observations from the team, remained distinct from the team. Global practice systems and how they impacted one another remained a mystery. As a result, most of my consulting work centered on demystifying systems integration, connectivity, and interdependence.

Somewhere along the way, I began to think that the ideas I was sharing with individual dental practices were good ideas that would benefit teams beyond the teams I worked with. I began to write articles on the subject. Because I had started my professional life in dentistry as a dental hygienist, most of the articles were directed at a new design for the hygiene department and at new roles for the hygienist. The underlying premise was that the hygienist could be a viable business partner within the business of the practice, one that could have a significant impact on practice productivity and profitability.

In 2002, PennWell Books published “Dental Hygiene: The Pulse of the Practice.” It was a book I had written as a tribute to dental hygienists and as a nudge to the dental profession as a whole to recognize that empowering the hygienist to become a bigger player in practice systems and economics was the wave of the future. Chapter after chapter was devoted to explaining in copious detail how the hygiene operatory could be converted from the place where a nice young lady cleaned teeth to the place where a well-educated and business-savvy hygienist could serve the practice in many other ways. The picture I painted was of a hygienist who could be - and who should be - a master at education, case presentation, marketing, scheduling, and customer service.

It was while writing the book that I began to see that the hygienist, like the dentist, did not operate in a vacuum and the “dental economic” paradigm had to be expanded to include all team members. As each chapter in the book evolved, the book about hygiene and hygienists was peppered with cross references to other team members and other departments, and how their respective functions and responsibilities served to support hygiene and the practice as a whole. One of the lessons I learned from this was that the true nature of teamwork was multilateral - every team member had something important and exquisite to contribute. These composite contributions formed the foundation for successful practice economics.

A one-story practice design

It became clear that a new practice design was needed. The split-level had to become a one-story structure in which communication about systems and philosophy - and all of the other components of the business of dentistry - could flow easily from room to room and not be impeded or distracted by staircases or elevators.

My efforts became more and more directed at instilling in all team members - including the dentist and the hygienist - the idea that dentistry is a business that succeeds or fails in direct proportion to the validity of its individual parts and the way they function together. Everyone had to be on the same page and everyone had to participate in practice economics. This meant opening all the doors and windows and allowing everyone in the practice to see what was happening, why it was happening, how it was happening, and what should be happening.

Several things emerged from this new construct ... or rather, they re-emerged in a different form. In my capacity as a management consultant, I had spent thousands of hours working with dentists, hygienists, front-desk administrators, dental assistants, billing clerks, and all other practice personnel. Part of this work entailed coaching and training individuals, departments, and entire teams to improve practice productivity and profitability. Invariably, this meant restructuring and reformulating the dynamics among team members and between the team and management. In each case, focusing on the individual parts was never as gratifying or successful as focusing on the whole.

Teams that were truly teams recognized the power of their collective and integrated work as a harmonious and productive synergy. A win for one was a win for all, and the end result was personal satisfaction grounded in professional satisfaction, grounded in practice solidarity.

It is with this idea in mind that I decided to approach the editors of Dental Economics® with a proposal for a regular column that would be directed to the dental team. I had been reading Dental Economics® for many years, culling from its pages ideas that could be shared with the dentists who had retained the services of my firm. But although the articles I read were well-written and informative, most were directed exclusively to dentists. With few exceptions, they were not directed at dental teams or individual dental team members.

For me, “dental economics” had become a concept to be shared and understood by every member of the dental team, not just the dental team leader. Thus, my vision for this column was to supply the missing link.

During subsequent communication with DE’s editor, Dr. Joe Blaes, exactly what I wanted to do and how I wanted to do it began to crystallize, and the column design evolved into a series of systems articles, each approximately one page in length, and all related to practice economics, productivity, and profitability. The range of specific themes for these articles will include clinical excellence, supplies and products, technology, managerial and administrative strategies, internal marketing, case acceptance, time management and scheduling strategies, collections, patient education, ethics, communication skills, quality control, and related topics, all geared to team members rather than team management.

The global emphasis for the series will focus on how individual skills and strategies relate to teamwork within a practice, and how they can be used as a bridge between preventive and restorative dentistry, between management and team, and between one team member and another. The articles also will focus on how individual systems and processes relate to a business design for individual departments which dovetail with the business concerns of the practice as a whole. Each article will be presented as a tear-out unit that dental team members can use to create a systems portfolio which might evolve over time into an SOP manual for the practice.

My vision for this column has evolved from experience and lessons learned over the years as a teammate, consultant, educator, and author. It is a response to the situations where I have seen unrealized potential and also when I have witnessed miraculous transformations in practices ... transformations that have allowed full team participation in the business of dentistry and which have encouraged a full understanding of dental economics.

I hope that I have inspired the dentists reading this article to invite their team members to embark on a journey in which they can participate as informed and active partners in the business of dentistry and the dental economics of the practice.

My message to the team members who are reading this article today is, “This one and those to come are for you.”

Cynthia McKane-Wagester, RDH, MBA, a practicing hygienist, is president of McKane & Associates, a full-service management consulting firm. She is the author of “Dental Hygiene: The Pulse of the Practice,” a book on the business of hygiene. McKane-Wagester is co-founder and director of the Chesapeake Institute for Dental Studies, an educational enterprise that promotes teamwork through the integration of clinical excellence with business principles. She can be reached at or at (800) 341-1244.

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