Restructure your team to share management responsibilities

Jan. 1, 1997
Are you frustrated by inefficient office procedures? Maybe it`s time to re-evaluate your management style.

Are you frustrated by inefficient office procedures? Maybe it`s time to re-evaluate your management style.

Here`s one system that really works.

Susan Smallegan Holtrop, DDS, MSBA

Imagine yourself, as the owner of a dental practice, sitting in a corporate board meeting, quietly taking notes, while six or seven executives give you a thorough description of every aspect of your business, from finances to inventory to marketing. A problem is introduced by one of the board members. Suddenly, the board initiates a lively and creative brainstorming session. The board collectively decides to make a change in the system—one that everyone will stand behind and re-evaluate in a month.

Now imagine transferring this scenario to your practice. Imagine the kind of positive growth your practice could achieve. Think of how this could help you lose the "boss stigma" and, instead, you could become respected as an involved, fully-supportive leader.

This may be the ideal time to restructure your dental team to share the responsibilities of management. In addition to his or her selected clinical or business role, each team member will manage one particular system within the practice and will be expected to lead the team to achieve growth in that area. In essence, each becomes a systems manager for that particular area.

For example, each system manager will study and organize the system to accomplish measurable goals. The idea of measurable accountability allows the system manager to track and report progress. The team then can make decisions regarding each system, with input from the leader (either the dentist or office manager).

When the dental team is restructured to share the responsibilities of management, life gets easier. You`ll see more organization, more profit, more free time and bright, more responsible attitudes at work. The synergy and enthusiasm that unfold among the team is truly awe-inspiring. Individuals will develop the kind of emotional ownership that you have been trying for years to instill. Your team-meeting time will "fly" and everyone will walk away energized. Team members will seek and embrace changes.

Good Reasons, Great Results

Three strong reasons support the expansion of management responsibilities to members of your team. The most compelling reason is profit. For example, in most dental practices, real-live, hands-on, wet-gloved dentistry—by the dentist—comprises the practice profit center. If the dentist declares his or her ideal work week to be 30 hours per week, 95 percent of the doctor`s hours should be focused in the profit center, not on management. Let me further suggest that the remaining 5 percent of time be spent in leadership, not management activities.

Remember, leadership is the organization of people and management is the organization of things. There is a big difference! Dentists should only manage if they are so attached to handling systems details that they cannot relinquish control or if they take personal pleasure in managing a particular system. The second reason to expand management responsibility is to position your practice for growth. The team attends to the important systems and the dentist is free to focus on clinical dentistry.

Consider the alternative. If the size of the practice grows with its "house" not in order, chaos will result, due to disorganization and systems breakdowns. Conversely, if the dentist is consumed with the details of keeping his "house" in order, the growth of the practice naturally will be limited. Without change and growth of some kind—whether in size, in quality or in culture—lack of available energy and resources will stifle your practice. Frequent staff turnover will be the likely result.

The third and best reason for expanded management in- volves empowering the entire team. People who develop a shared responsibility for managing their workplace work harder and smarter. Perform-ing routine tasks on a day-to-day basis, with little attachment to measurable growth, ultimately will result in boredom and burnout. Employees who are challenged to use their intelligence and creativity to improve systems within the practice will develop a stronger sense of value and long-term dedication. Team spirit and cooperation develop from facilitating each other`s goals. The entire practice benefits when innovative solutions flow freely from the staff. After all, they`re the ones who know the problems best.

As the board-meeting example given at the beginning of this article suggests, the team structure works beautifully without an office manager. Authority truly is shared, because no staff member is another`s superior—all are managers. Employing a single office manager who assumes most of the management task can limit your practice.

For example, even the most competent office manager will become a detriment to the practice, if he or she leaves the practice without a fully-trained replacement. However, you may wish to try a "shared" management structure and, at the same time, preserve the existing office manager.

The new role might be redefined as "team leader." Or, he or she could assume a substantial system-management role, such as becoming your financial coordinator, overseeing the financial health (the numbers) of your practice.

Meetings Are Critical

A systems report meeting, held at least once a month, is crucial. Say goodbye to crabby, top-down idle meetings. Say hello to positive energy. Very much like the board meeting described earlier, each manager will have a chance to lead the meeting for a few minutes. Meetings begin with a report (both oral and written) that includes some measurable(s) that the team is interested in tracking. Managers introduce any particular successes or snags, and they invite other team members to share ideas that might "dehassle," outperform or stimulate the system.

All meetings should have a predetermined beginning and ending time, preferably during the slowest time of the day. Meeting at least monthly, the team begins to feel safe making changes, knowing that if an idea fails, it can be revisited next time. Monthly meetings also allow for a comparative report.

For example, when the scheduling coordinator reports on last month`s 22 broken appointments, eight cancellations and 31 no-shows, the news sounds dismal. However, the team may want to celebrate, instead, when she declares that broken appointments were decreased by 50 percent over last month`s 43. Noting that improvement, she can ask for further ideas about improving the no-show rate.

Keep in mind that each system runs in parallel; patients experience a cross-section of systems as they flow through each aspect of the practice. Meetings are crucial in achieving harmony among all the systems.

What systems need managing? The list could be endless—if you had 30 employees, you probably could think of 30 systems that run simultaneously. What follows are some suggested systems. Rank them in terms of priority and assign as many of them as you have staff members. Always be sure an individual has a genuine interest in the system you will be assigning. Listed next to each system are some examples of measurables that the manager/team may be interested in reporting.

Financial System: The financial system indicates the practice`s financial health. This is critical in developing a practice that shares management responsibility. Some measurables include total collections, collections percentage, total production, doctor production, hygiene production, payroll percentage, total overhead percentage, number of insurance claims processed, etc. Quarterly goals (or productivity indicators) might be tracked, such as total production, collections, doctor hours worked, production per hour, hygiene hours and hygiene production per month.

In our office, the financial coordinator has cultivated enthusiasm in many areas. The team actually has worked toward decreasing the payroll percentage, by increasing collections to 100 percent and decreasing slack time on either end of scheduled shifts. Furthermore, the financial coordinator has motivated our team to achieve monthly and quarterly goals which are not attached to a predetermined bonus structure.

Scheduling System: This system tracks patient-appointment activity, including hours or "units" of time lost to: (1) broken appointments of 24 hours or less notice; (2) cancellations of 24 hours to three days` notice; or (3) no-shows. Appointment activity may be measured for the doctor and hygiene department or by individual provider. Our scheduling coordinator has decreased all "dis-appointments," by working with the team to develop skills that will reinforce our need for patients to keep their scheduled appointments.

Recall System: This system tracks recall activity, such as appointments filled after a no-show, cancellation or broken appointment; unscheduled hygiene hours at the beginning and end of the month; number of recall cards sent with scheduled appointments and without scheduled appointments; number of recall phone calls made; number of recall appointments successfully scheduled; and number of hygiene patient visits. An example of a goal in this area might be reaching 80 percent of active patients returning for prophys twice a year. That number is easy to calculate if you track the number of active patients.

Our recall coordinator not-iced that the cancellation rate was much higher than the broken appointment or no-show rate for prophys. With the team`s input, we solved the problem. Appointments were scheduled six months in advance and were confirmed one day prior to the appointment. When the recall coordinator began to confirm hygiene appointments three days before the appointment, she gave the patient two more days to plan for a forgotten appointment. In the event that a patient did cancel, she had three days to fill the opening.

Inventory and Ordering System: This system requires organizing a user-friendly method for the whole team to track supplies on hand. The goal can be simple month-end and year-to-date clinic and office-supply overhead percentages. In our office, the inventory/ordering coordinator decreased our clinic-supply percentages from 8 percent to 5 1/2 percent in one year. She price-shops in catalogs and records the best deal on top-quality products. She uses this data to negotiate prices during her biweekly meetings with supply representatives. At team meetings, she periodically hosts a contest (with a prize) for the best money-saving idea. Applause determines the winner. The best idea wins the prize, but all the good ideas can be implemented!

New Patient-Activity System: This system tracks all the sources from which new patients join the prac-tice—data that is vital to your practice`s marketing position. The coordinator may design an easy-to-use log to record information as each new patient arrives. The goal might be as simple as "zero patients from unknown sources." Other measurables include "dollars spent per new patient" from advertising sources, such as the Yellow Pages. This can be obtained by dividing the monthly expenditure by the number of patients attracted. Comparison of advertising investments then can be made. You also might want to track the type of new patient (i.e., emergency visit, new patient exam, etc.), the average dollars spent per new patient in a year, etc. Gifts or notes sent to individually-named referral sources can be tracked by the new patient coordinator or the internal marketing coordinator.

Using data generated by our new-patient coordinator, we began to understand how best to spend our advertising resources in our practice. We also learned that we spent $10 per new patient when we sent a thank-you gift to a referring patient. This may sound like an extravagance, but it isn`t when compared to the $26 per new patient obtained from the Yellow Pages or $53 per new patient from the local shopper`s paper. We noted that changing the sign on the building also attracted new patients. Investing in a new sign every three years was as effective as the Yellow Pages, in terms of dollars spent per new patient.

Internal Marketing System: This system tracks gifts and flowers sent to patients who are ill, the bereaved, newlyweds, new patients, etc., as well as gifts sent to referral sources. Other measurable items include dollars spent on special customer-service additions, magazine-subscription renewals, maintaining a library for patients, etc. For a specialty practice, this system might include tracking gifts or services to referring doctors or practices.

Continuing Education (CE) System: This system tracks continuing education for doctors and staff members. Keeping a log of each individual`s credits is one of the CE coordinator`s responsibilities. Disseminating information about upcoming courses and polling the team or individuals for their interest level might be others. The measurable items might include maintaining a budget and reporting on dollars spent for CE tuition, meals, travel or payroll, as well as the month-end and year-to-date overhead percentages.

By sharing this information with each individual, our scheduling coordinators draws attention to continuing education as a tangible and valued employment benefit. Before we had a CE coordinator, the doctor would select courses, based on a perceived need or the desire of the entire team. The CE coordinator was able to organize a system that attends to the needs and interest of each person. By monitoring an overall team budget and individual continuing education expense accounts, she has helped each team member achieve personal and professional goals in education.

Health and Hazard Commun- ication System: In our practice, this system involves monitoring and implementing any changes in the General Industry Standard for Safety, Michigan Bloodborne Infectious Disease Rules, Hazard Communication Standard and Michigan Medical Waste Regulatory Act. This system is the most difficult to determine measurables. Our HHC coordinator has gained several responsibilities, including tracking, coordinating and facilitating training schedules. She updates all written standards and organizes safety drills, such as simulated chemical spills or a fire drill. She measures regulatory laundry expenses, medical expenses (staff immunizations and post-exposure evaluations, etc.) and monitors all licensures, including CPR.

Other Systems: Once these systems are monitored, others will stand out, including laboratory-case coordination, equipment maintenance, office-facilities maintenance and computer-system coordination and training, to name a few.

Will your payroll expense, due to overtime, increase as managers take on more responsibility? It shouldn`t! Unless someone is completely overworked, even a part-time staff member will be able to oversee her system during regular working hours.

The role of systems manager may evolve slowly. A manager may at first introduce a very simple report, perhaps even handwritten. As the level of the manager`s responsibility in-creases, team reports will become more professional and detailed. During meetings, system managers can ask for input from other team members regarding the information that is most beneficial to report.

As your staff members feel more and more important to the practice, you will see them go that extra mile, putting the practice ahead of their personal agendas. In so doing, you and your office team will be able to use your innovative energies to build positive solutions and growth for the entire practice.

Restructuring your team to share management responsibilities works. Give it a try!

The author practices in Holt, MI, and is a member of Dental Economics` Editorial Board and past president of the Central District Dental Society. She is president of Contemporary Concepts in Dentistry, a teaching and consulting firm, focusing on dental-practice leadership and management. Dentists who wish to view a 13-minute video of excerpts from an actual team meeting, illustrating the management style discussed in this article, may call Dr. Holtrop`s office at 517-694-0353.

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