Finding Some Keepers

Aug. 1, 1999
Why do some offices have contented, long-term staff members, while others can`t seem to retain good employees? The answers may surprise you!

Why do some offices have contented, long-term staff members, while others can`t seem to retain good employees? The answers may surprise you!

Dianne Glasscoe, BS, RDH

One of the most challenging aspects of practice management for many clinicians is staff management. Why do some offices have contented, long-term staff members, while others seem to have a permanent ad in the newspaper seeking new employees? In this article, we`ll examine three factors that affect staff satisfaction and longevity and give you a peek into the psyche of a staff member.

It`s five o`clock on Thursday afternoon. You have just completed another tough week, and you are looking forward to having Friday off to do the things you want to do. Just as you are preparing to leave, one of your staff members appears in your doorway.

"Doctor, could I speak with you for just a moment?"

Uh oh!! This feels like trouble. This better not be a request for a raise! Then you notice the staff member is visibly nervous and appears to be on the verge of tears.

"I`m here to give you my resignation. I will stay for two more weeks to give you time to find a replacement. I`ve ... accepted a position in another office."

By this time, you feel a knot tightening in your stomach. In fact, you feel as though you`ve just been punched in the gut. You finally stammer, "But why do you want to leave? I wasn`t aware there was a problem."

"It`s not you, doctor," the staff member replies, "but lots of things that have been building up. Please don`t take this personally. I feel I need a change." With that, the staff member turns and quickly leaves.

So much for a great weekend!

What happened? Why didn`t you realize that this valuable staff member was unhappy? Were there subtle clues along the way that you should have been sensitive to, things that would have alerted you to the fact that something unpleasant was brewing? Was this preventable?

If you are like most doctors I know, you deserve to have a loyal, dedicated group of staff members who wouldn`t think of leaving you for another job. The good news is you can have this! However, you must earn it!

During my last 27 years in dentistry, I have learned some of what it takes to develop a loyal team. I have in my possession a letter that was written by a staff member to her doctor. It, among other things, is a letter of appreciation. Many of the comments made in this letter about what a staff member looks for in a practice reflect the same values that other staff members have told me they appreciate in their offices. I want to share the contents of this letter with you.

The staff member speaks

You probably do not remember our first meeting, but I certainly do. I remember being so nervous at the job interview that my voice actually was trembling. But your warm personality and friendly way helped me to relax. You asked questions that caused me to talk about myself, and you really seemed interested. Little did I realize that when I answered the employment ad in the newspaper, my entire life would be changed for the better.

When I first came into your employment, I felt a little frightened and disoriented in my new surroundings. However, you seemed to sense my insecurity. I somehow got the feeling that you remembered what it felt like to adjust to a new job. Trying to stay on schedule, remembering where things were, learning the routine, interfacing with coworkers, becoming acquainted with patients - these were just a few of the things I had to adjust to. But you were very patient with me, even when I was clumsy and slow. Because of your patience, I grew and flourished in my job.

Over the years of working day after day with you, I have amassed a great deal of respect for you. I have placed you on a pedestal because you have earned that position. Let me tell you a few of the reasons why.

First of all, you treat all of your patients with the same level of respect, whether the patient is a school janitor or the mayor. That`s a trait not often seen with professional people. You see, I openly identify with the blue-collar working people because that`s what I am.

You also treat your staff with a high level of respect. We all work together as a team and each team member plays a vital role in the smooth functioning of the practice. Even though as staff members we do not possess the same educational background as you, you always have made us feel as if you could not survive without us. Many days, you have ended the workday by saying, "Thank you. See ya tomorrow!" We have a great "family" feeling here in this practice.

Compliments go a long way

I nearly burst with pride every time you compliment me in front of a patient. I know in my heart that your praise is not just empty flattery, but sincere expressions of gratitude. This always makes me want to work even harder to be worthy of your praise.

You accept the role of coach and chief cheerleader heartily. Your expressions of concern for other staff members and me make me feel as though you really care for me, both as a person and an employee. You`ll never know how much I appreciated the balloon bouquet you sent when I was out sick with the flu. When my child was in the hospital, you came to visit. When my mother died, you closed the office and came to the funeral.

I know that absences by any staff member present a hardship. Please believe me when I say that I do not enjoy causing undue hardship on you and the other team members by being absent. However, there are times of illness and other special circumstances that dictate my absence from the office. I appreciate being allowed to be sick. I am so grateful that you have been understanding and graceful about those times.

Another thing that I always have wanted to tell you is how wonderful I think you are for helping a few struggling families in the practice. I`ll never forget your kindness to the Smith family, who was experiencing a catastrophic illness. I`ve told many, many people what a wonderful person you are and some of these people have become patients in the practice because of my praise of you.

How fortunate I am to have a boss who has such a good attitude about work! You come in the door each morning with a cheery smile and a hearty greeting to all the staff members. Now, I know there must be days when everything is not so cheery in your life. But, somehow, you have learned to leave all the extra baggage outside the office and focus your attention on the patients who are scheduled for that day. Your good mood rubs off on all your staff members and sets the tone for a great day!

The consistently excellent quality dentistry that you do makes me proud to be a member of your team. It is obvious to all the team members and patients that you value quality over quantity. Even though your fees are above average, patients appreciate how hard you work to provide them with the best dental care. I`ve seen how you have labored with the shade of a crown to get it "perfect," often sending it back to the lab for revisions. I`ve seen you remake a denture case up to three times to make the patient happy. You always work very hard to please your patients by being gentle, caring, and thorough. Maybe that`s why our practice literally is "bulging at the seams" with satisfied patients who refer their family and friends here.

My friend, Jane

My friend, Jane, is a staff member in another dental office. She has told me some things about her dentist/employer that makes me glad I do not work there. For example, Jane says that her boss usually is grumpy, especially in the mornings, and often ill-tempered. No one dares to speak to him when he first comes in for fear of being rebuffed. He has been known to sling instruments when procedures do not got well. He becomes agitated when patients do not get numb on the first attempt at anesthesia. Often, his injections bring tears.

Another thing she told me is that the doctor often goes in his private office, closes the door, and talks on the telephone for long periods of time. He doesn`t seem to care that patients are waiting to see him. He often runs behind, which means staff members must work into their lunch hour or after 5 p.m. She feels his disregard for patients` and staff members` time shows a lack of respect for the very people who have helped him have a viable practice in the first place.

Even though the doctor puts on a smiling face for his patients (especially the executives and influential people), his poor attitude about his work is quite evident to all the staff members. Jane says she wonders why a person would stay in a profession that seems to make him so unhappy. In addition, the doctor`s unhappiness seems to rub off on the staff members. This probably is one reason why this doctor has such a high staff-turnover rate.

Another problem Jane related to me is that on the rare occasions when she has missed work due to illness, the doctor gives her the "cold shoulder" or the "silent treatment" when she comes back. It is as if she is not allowed to be sick. The doctor does not seem to care that she was ill, but only that he was inconvenienced by her absence. He seems to take it as a personal insult when any staff member has to miss work.

On a few occasions, patients have called Jane at home to complain about the doctor or his work. It seems that some people are intimidated by his abruptness or rudeness and would rather talk to a staff member than the doctor. Jane says she often has made excuses for the doctor in an effort to salvage patient relationships. When she has brought these occurrences to the doctor`s attention, he casually brushes the matter aside instead of taking positive or corrective action. Jane is certain they have lost many good patients because of the doctor`s inattention to patient-satisfaction issues.

Jane says she cannot even remember being complimented by her employer. She feels very unappreciated and taken for granted. This is just one of the many reasons she is looking for a new position.

Now it`s my turn

Hiring and maintaining a top-notch staff is one of the most difficult aspects of practice management that many doctors face. Doctors have lamented to me that their life would be so much easier if they did not have to deal with staff issues and turnover. When I hear this lament, I immediately know that something is amiss with the doctor`s hiring practices, attitude, or practice atmosphere. Let`s look at each of these issues more closely.

Attitude toward staff

Sometimes doctors are their own worst enemies. Why do I say that? Because if the doctor has a negative attitude about his or her staff, it will negatively affect the working relationship.

I have a dentist-friend who has a bad attitude. He has been through more staff people than you would believe in his 10-year career. Because of his inability to communicate on an effective personal level, he winds up offending every person who comes to work for him. His turnover problem has caused him to mistrust his staff members, and he refuses to admit that his staffing woes are of his own making.

What is your attitude toward your staff members as a whole? Do you view your staff as a vital support system that permits you to operate your practice effectively and smoothly? Do you see your staff members as the eyes, ears, mouth, hands, and feet of the practice, while you are the soul and the brain? Are they valuable components in your practice machinery without which you could not function?

Or, do you view your staff as a necessary nuisance, similar to insurance that you know you need, but wish you didn`t need? Do you view your employees as liabilities? Are you more concerned about what these people can do for you and your practice than about them as human beings? Do you write their paychecks with reluctance? Do you expect them to be perfect?

Indeed, the relationship we have with our staff members is similar to that of a parent-child relationship. Children thrive on recognition and praise, and so do staff members. If we understand this concept, then why don`t we act on it more? Those old perfectionist attitudes we hold as professionals often prevent us from praising our staff as often as we should. However, we should never underestimate the power of praise!

Honestly evaluating your general attitude about your staff as a whole can be the first step in determining turnover problems. Staff members are quite sensitive to your attitude about them as people and as employees. If your attitude toward your staff is negative, you will have a very difficult time expressing appreciation to them, verbally or nonverbally.

Generally, when people do not feel appreciated, they tend to seek a position where they will be appreciated. If you appreciate your staff, you will express that appreciation verbally, financially, and emotionally.

Attitude toward work

What is your attitude about your work? Do you wake up each working day with sense of excitement and anticipation of the challenges that wait you? Do you love dentistry? Are you interested in the latest technological advances and do you try to stay abreast of the tides of change? Are you proud to be a member of the dental profession? Are you enthusiastic about helping your patients have beautiful smiles and good masticatory ability?

Or, do you carry a sense of dread at the thought of going to the office? Are you just biding your time until your children graduate from college so you can retire? Are you often grumpy and ill-tempered? Does the thought of trying anything new intimidate you? Would you rather be anywhere than at work?

If you find that your work attitude has deteriorated, an introspection is in order. Determine why you feel this way and what can be done to bring back the joy you once had in performing dentistry.

Doctors who have a poor work attitude cannot hide the fact from their staff members. A poor attitude reveals itself in a multitude of actions that are detrimental to staff morale and the practice in general.

Practice atmosphere

The practice atmosphere refers to the level of doctor and staff interaction with each other and with patients. It is related to the "feeling" that one gets while in the office. It is the office personality.

Just as people have varied personalities, so do the offices where they work. However, the doctor`s personality is strongly influential in determining the office personality.

If the doctor is friendly and caring, the feeling created there will be one of friendliness and caring. If the doctor is subdued and unemotional, the office atmosphere usually will be quiet. If the doctor loves hearty laughter and having fun, the atmosphere will be jolly. If the doctor is an "off the chart" perfectionist, the atmosphere may be one of "walking on eggshells." If the doctor is stressed out, the practice atmosphere will be tense.

To quote Jim McCann, the CEO of 1-800-FLOWERS, "The boss who sees the workplace as an opportunity to have a good time, as opposed to doing time, will command more loyalty and be at the helm of a more efficient organization."

A staff member who loves to laugh and possesses a good sense of humor can be an invaluable asset to a quiet, introverted doctor who would like to have a lively, happy atmosphere.

Also keep in mind that one disgruntled staff member can poison the practice atmosphere. I`ve seen situations in which a new staff member was negatively influenced by a domineering or gossiping coworker. When a staff member is determined to be a negative force in the practice atmosphere, termination is the best answer. Refuse to pay someone to make you miserable!

The best practice atmosphere is one where a "family feeling" exists. In this scenario, each staff member truly likes and cares for each other and patients. To create this feeling, the doctor must first care for and like his/her staff members. Even in the best of families, disagreements arise from time to time. However, these disagreements are settled quickly so as not to allow resentment to build and cause more serious problems. Open communication is the key. Good office camaraderie makes coming to work enjoyable.

It is of utmost importance to hire congenial, caring people. These qualities in staff members cannot be learned from books nor can these qualities be valued in dollars.

The stress of adjusting to a new staff member is common to many practices. However, if you pay heed to the basic tenets of sound staff management, you should be able to hire and retain quality staff members.

Patricia Fripp, past president of NSA, says, "A team is not just a group of people who work at the same time in the same place. A real team is a group of very different individuals who share a commitment to working together to achieve common goals. Most likely, they are not all equal in experience, talent, or education, but they are equal in one vitally important way - their commitment to the good of the organization."

Three rules of thumb for interviewing

(1) Ask only for information that you intend to use to make hiring decisions.

(2) Know how you will use the information to make a decision.

(3) Recognize that it is difficult to defend the practice of seeking information that you do not use.

Suggestions for job-interview preparation

(1) Determine the competencies needed to fulfill the job requirements.

(2) Prepare a well-defined job description.

(3) Have the applicant complete a job application.

Hiring Practices

From the outset, it is important to place an ad that will attract the kind of person you wish to hire. For example, here`s an ad in the newspaper that simply says:

"Dental assistant needed. X-ray certification helpful. Call 123-4567."

Even though this ad is brief, it says (and does not say) several different things. First, it does not state whether this position is for a chairside assistant or business assistant. No mention is made of particular qualities that the employer feels are necessary to be successful at this position.

The ad also says that you would prefer someone who is X-ray certified. Have you been accustomed to having an assistant who can take X-rays? At this point in your career, are you willing to take a step backward in hiring someone who cannot expose X-rays? Also, no mention is made of when to call.

Do you want your business assistant to have to field these calls when she is trying to take care of patient business? This ad says that you do not feel formal education for an assistant is important and that you are willing to hire someone and train that person yourself. (While I personally know several wonderful assistants who have been trained in the office, it generally is easier on the doctor if an assistant has had some formal education.

Formal education tends to give a person a measure of self-esteem that cannot be earned by on-the-job training.) This ad does not "weed out" anybody. You may waste valuable time interviewing people who are totally unqualified and inappropriate for the position.

What follows are samples of ads that are intended to attract quality candidates:

- Dental Chairside Assistant - Our family dental practice needs one enthusiastic, experienced, and caring dental assistant to complete our dental team. If you are dependable, personally stable, and X-ray certified, call 123-4557 between 10 a.m. and 12 noon.

- Dental Assistant (noncertified) - Our dental office is seeking an enthusiastic, experienced dental assistant. If you are dependable, organized, and possess a caring manner, please send a resume to P.O. Box 1234 c/o this newspaper.

- Front-Desk Assistant Financial Coordinator - Our exceptional dental practice is looking for a person who has excellent communication skills in person and over the telephone. If you are enthusiastic, caring, dependable, and have experience with computer-scheduling, insurance, and collections, please send a resume and cover letter in your own handwriting to P.O. Box 1234 c/o this newspaper.

- Dental Hygienist - Our patient-centered practice is seeking a caring, dependable, and enthusiastic hygienist. If you possess these qualities, call 123-4567 between 10 a.m. and 12 noon only.

Be certain that your ad is worded correctly and that you have the correct phone number. By having the applicant fax a resume, this gives you time to review it before the interview. Don`t forget to check references. You might be surprised at what you learn!

Many doctors have had good success hiring office personnel and clinical assistants from among their patient base. Sometimes patients will ask if the doctor has a job opening. Even if you have no openings at the time, encourage interested patients to bring a resume that you can keep on file. This will give you a pool of potential future job candidates.

I have found that bank tellers and waitresses who have good work histories make good assistants. Also, be sure to ask your existing staff members if they have acquaintances who might be qualified. However, I do not recommend hiring a close relative of a staff member.

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