Ask Dr. Christensen
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensen, please send an e-mail to firstname.lastname@example.org.
I graduated from dental school five years ago. I had no experience working with dental assistants, dental hygienists, front desk personnel, or laboratory technicians. During the past five years, my clinical skills have matured and my practice speed has increased. However, I am having difficulty with my staff members taking responsibility for their assignments in the office. It seems that I am always having to finish up tasks that they should have been doing.
You are not alone! Currently, most dental students graduate from school without any experience in “team building.” Students have to do all their clinical tasks alone, an arrangement that would bankrupt a real-world practice. Additionally, learning how to communicate and work as a team with laboratory technicians is absent in most schools. To complicate matters more, many new dentists have almost no experience in developing and leading a dental team. What can you do about it? Here are some of my own views on team building that will provide some resources for you to help you build a true team.
Do your employees work for you orwith you?
What does that question mean? You must have had “jobs” before you went to dental school. Most of these jobs usually have a supervisor who provides you with a list of tasks. You need only to do those tasks, and you will collect your check at the end of the pay period and carry on with your life. You are not required to think about the list, critique it, or be creative and try to change it. In my opinion, this is a typical description of a “job.”
You went to dental school to become a professional. You are now the boss of a small business. You make decisions about almost everything in the practice. You hire, you fire, set work schedules, set salaries, and you determine what and how clinical procedures will be done in your practice—or do you?
Delegation of responsibilities
Some bosses delegate tasks to their employees, provide lists for their employees to master, and supervise the employees to do the tasks. They assign or delegate tasks, but the boss still oversees the accomplishment of the tasks. This type of boss hopes that the tasks are accomplished and is always worried that the employees will be responsible. This is the manner of delegation in many dental offices. The final responsibility is still maintained with the boss—the dentist.
Conversely, other bosses delegate with responsibility. How does that work? As an example, let’s say you want to assign making provisional restorations to a qualified dental assistant. If you previously have been doing this task by yourself, a typical delegation-with-responsibility conversation could proceed as follows:
Dentist (D): I have been making the temporary restorations in the practice, but I want to change that to having staff persons do the temporaries. How would you like to be the person in charge of and responsible for making the provisional restorations in our practice?
Dental assistant (A): I would like the responsibility. What does it include?
D: You have had some experience with that task in other offices, but I am asking you to take over responsibility for provisional restorations for all of our staff. I have great confidence in you, and I know you can do it. What do you think you will need to do to be the overall person in charge of temporaries for crowns, onlays, and other fixed restorations?
DA: I will need to upgrade my clinical skills in those areas.
D: How will you do that?
DA: I know of a couple of courses in that area that have been recommended by my friends.
D: Can you make full-arch temporaries?
DA: No, I know relatively well how to make single-crown temporaries, but I will need to learn the full-mouth procedure, since we do some of those cases.
D: What else do you suggest?
DA: I will need to know the best and least expensive materials for temporaries. I know sources where I can find that information. Our local distributor can help, and I know product evaluation companies that can help also.
D: When can we start?
DA: I will work on it. I need to find course dates and locations, supply sources, appropriate materials and devices, and patients who will tolerate my initial slowness as I adjust to the learning curve. All of this should require about two months. I want to start with simple single units and work up until I can do full-mouth provisionals.
D: I am very pleased that you will accept this responsibility. You tell me what you need, and we will provide whatever it is. I want you to be creative in this assignment. If there are new techniques, materials, or devices for provisionals that you want the team to consider, bring them up to us in our staff meeting next week. You know that this responsibility will require time and energy on your part, since you will be the expert boss in this area. Your salary will be adjusted to compensate you for the extra effort. I look forward to working with you on this project when you need my suggestions, but you are in charge of it, not me. I have great confidence from our experience working together. I know you will do a great job.
Figure 1: Employees of Clinicians Report Foundation, Practical Clinical Courses, and TRAC Research, who all have individually assigned areas of activity
What is different about delegation with responsibility?
As you noted from this make-believe conversation, the dentist did not dictate how the assistant should go about assuming this leadership role. The assistant tentatively planned it out and suggested the sequence of events to the dentist. Assuming that the assistant has the personality characteristics necessary for leadership, as judged by the dentist, the dentist can now step back and assist this transition and not have to supervise it to completion. The assistant has the leadership role, and the dentist is the consultant.
Expand this concept into every area of your practice, and you will see what happens. Assuming you have hired staff members who are self-starters, creative, and good leaders, they will eagerly accept leadership roles.
You do not need to have your mind on all the activities in your dental practice, wondering if they are being done. When you delegate with responsibility, every person on your staff is thinking about her or his specific personal area of responsibility, and your mind can concentrate on what you do best—treating patients.
Unfortunately, because one of the known characteristics of dentists is a controlling personality, the antithesis of delegation, some dentists have great difficulty delegating tasks fully. There is a feeling among some dentists that only they can do whatever task or assume whatever responsibility, and that staff are incapable of doing the task.
After many years of working with employees and having them assume responsibilities in the manner described, I can confidently state that team members become highly competent and dependable when tasks are fully delegated with responsibility. And of course, you must hire competent employees and pay them well.
An example of delegation with responsibility is shown in Figure 1. The many employees of Clinicians Report Foundation, Practical Clinical Courses, and TRAC Research have individually assigned areas of activity for which they are responsible. They have professional positions and the ability to consult with others in the organizations when needed. They work with organization leaders, not for them. Seldom are there challenges with carrying out their specific roles or working together for the advancement of the organizations.
Staff who are allowed to take on ownership of given areas of the dental practice soon take on the responsibility well, grow in their knowledge, improve their skills, and enjoy their position in the practice. In contrast, staff who are assigned a list of things to do soon become bored, lack the ability to exercise their creative skills, and find a more positive role elsewhere.
Author’s note: Additional educational resources and product evaluations, some of them relating directly to this article, are available from Practical Clinical Courses:
Two-day courses in Utah
• Faster, Easier, Higher Quality Dentistry with Dr. Gordon Christensen on March 2–3, 2018
• Foolproof, Fast Single-Crown Procedure (Item No. V1980)
• Top Insurance Coding Strategies (Item No. V4783)
• Avoiding Common Administrative Errors (Item No.V4784)
Gordon J. Christensen, DDS, MSD, PhD, is a practicing prosthodontist in Provo, Utah. He is the founder and CEO of Practical Clinical Courses, an international continuing education organization founded in 1981 for dental professionals. Dr. Christensen is cofounder (with his wife, Dr. Rella Christensen) and CEO of Clinicians Report.