4 frameworks to reduce staff turnover and boost practice performance

The term organization refers to a group of individuals organized together to accomplish a common set of goals.¹ A shared mission, vision, and core values all employees are passionate about communicate a positive image to customers, if they are embedded in every operation of the practice.² Lack of structure, support, compensation, accountability, and healthy communication can lead to low morale, poor performance, low productivity, negative workplace culture, and high turnover.³

Employee turnover negatively affects profitability due to costs of recruitment, training, and new hires.^3,4 Challenges and impediments to change in the office can include culture—accepted values and norms; groupthink—faulty decision-making; uncertainty or insecurity—fear of a role change or job loss; and habits—difficulty breaking them.

Too often, leaders misplace the blame because they don’t understand the underlying causes, and “targeting individuals while ignoring large system failures oversimplifies the problem and does little to prevent its recurrence.”⁵ Leaders need to zoom out and see from a new lens to really understand what’s going on.

As leaders, dentists should create a SWOT (strengths, weaknesses, opportunities, and threats) analysis to become fully aware of all the factors involved in making a business decision.⁶ They should “discover recommendations and strategies, with a focus on leveraging strengths and opportunities to overcome weaknesses and threats.”⁶

Leaders should also assess the state of their organization from four frameworks and make appropriate changes in each frame for successful outcomes for the practice, employees, and the patients. These frameworks offer perspectives and ideas that work and “define the questions we ask and solutions we consider.”⁵

The structural framework

The concepts from this framework are drawn from sociology, economics, and management science.⁵ It “depicts a rational world and emphasizes organizational architecture, including planning, strategy, goals, structure, technology, specialized roles, coordination, formal relationships, metrics, and rubrics.”⁵

Organizations using this framework create rules, policies, procedures, and systems, and allocate responsibilities to employees by division of labor.⁵ Indicators are used to measure progress, and when performance suffers, often the structure within the organization needs to be redesigned to remedy the problems.⁵ Organizations using the structural framework focus on tasks, facts, and logic, and by redesigning processes, because they believe problems arise from structural flaws rather than individuals.⁵

The human resource framework

This framework involves viewing an organization as an extended family and a place where people feel good about themselves and their work.⁵ This perspective is rooted in psychology, and focuses on peoples’ needs, feelings, skills, prejudices, and limitations.⁵

Organizations working from this framework tailor organization to their people because “when basic needs for security and trust are unfulfilled, people withdraw from an organization, join unions, go on strike, sabotage, or quit.”⁵ Leaders should ensure employees are adequately compensated, supported, and possess the skills and resources to do their jobs.⁵

People are the heart and center of organizations, and if their needs are met, they are more likely to be committed and loyal.^3,5 Communication, empathy, and seeking the best interests of people as well as the organization is the focus of those leading from a human resource perspective.⁵

The political framework

This framework is rooted in the work of political scientists and focuses on competition of power and resources in the workplace.⁵ Those using this framework believe negotiation, bargaining, coercion, and compromise are a normal part of life, and that conflicts arise as a result of individual and group differences.⁵

Power may be concentrated in the wrong places or widely dispersed, so leaders must manage conflict productively, use power wisely and with caution, and make reasonable compromises.⁵ Organizational harmony and collaboration are key to progress and success for those built on a political frame.⁵

The symbolic framework

The symbolic framework emphasizes culture, symbols, and spirit as the keys to organizational success, draws on social and cultural anthropology, “treats organizations as temples, tribes, theaters, or carnivals,” and “depicts organizations as cultures, propelled by rituals, ceremonies, stories, heroes, history, and myths rather than by rules, policies, and managerial authority.”⁵

From this perspective, the symbol, myth, and magic help organizations be successful.⁵ Leaders inspire their followers to loyalty and commitment and use dramatic and visible symbols to communicate organizational mission such as creative slogans, storytelling, rallies, and awards.⁵ Traditions and values are used as a base for culture-building to provide cohesiveness, meaning, and a shared vision.⁵

Dental leaders should do a SWOT analysis and use these four frameworks to assess and manage their practice. Successful leaders should focus on tasks, facts, and logic and redesign processes if needed. They should value their people by investing in them because they’re the heart of the practice. They need to exert authority but use their power cautiously without insinuating conflict.

It’s important to ensure harmony and collaboration because fighting together for one cause is much more productive than fighting each another. Lastly, tradition, shared values, and a culture of meaning and cohesion to inspire employees to loyalty and commitment are important for team leaders to incorporate. 

Editor's note: This article appeared in the February 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Ekene C. Organizational behavior and human resource management in Nigeria: problems and prospects. Int J Sci Res. 2015:4(12):505-511.
2. Etchison P. Practice management: fostering engagement and retention in the new labor market. J Calif Dent Assoc. 2023;51(1).
3. Soundarapandiyan K, Ganesh M. Employee retention strategy with reference to Chennai based ITES industry–an empirical study. Global Mgmt Rev. 2015;9(2):1-13.
4. Frye L. The cost of a bad hire can be astronomical. EHS /Careers. May 17, 2017. Accessed July 19, 2025. https://resources.ehscareers.com/directory/the-cost-of-a-bad-hire-can-be-astronomical-article-741.aspx
5. Bolman LG, Deal TE. Reframing Organizations: Artistry, Choice, and Leadership. 6th ed. Jossey-Bass; 2017.
6. Schooley S. SWOT analysis: what it is and when to use it. Updated September 16, 2025. Accessed July 19, 2025. https://www.businessnewsdaily.com/4245-swot-analysis.html