1) A call from a dentist wanting help with performance reviews. It’s time for raises and the staff is pressuring the dentist for a review. Or the dentist is panicked because she promised reviews six weeks ago, but has been avoiding it because it takes so much time. Or the dentist feels reviews and raises just create trouble and is tempted to just give everyone an across-the-board raise to get it over with.
2) A call from a team member wanting to know how to get her (or his) dentist to do performance reviews. She might complain that he keeps rescheduling them, and she needs some valuable feedback. She may feel she is entitled to earn more money because she believes she’s carrying a big load. Or the dentist promised a review after six months but she’s been working there ump-teen years without any feedback.
Here are some thoughts from Sandy Roth about this timely topic:
I’ve written several essays on the issue of compensation and performance evaluations. By now you know that we encourage our clients to compensate staff based on merit and work performance, not length of service or time of the year. For that reason, it is essential to establish a system of reviewing the performance of every member of the team at regular intervals. But how do you structure such an evaluation? And how can these evaluations be done without becoming a huge burden for the
The process can be made simple if the preliminary work has been done. We can’t talk about evaluations without mentioning that a Statement of Performance Expectations must be in place for each employee. A Statement of Performance Expectations is quite different from a traditional job description.The job description was a union invention which outlined exactly what the employee was expected to do and thus guarding her from having to do anything more. This mentality makes no sense in dentistry, where each person is expected to grow and change as the needs of the client and practice change.
Whereas a job description outlines the employee’s tasks and limits the scope of her influence, a Statement of Performance Expectation widens her sphere of influence by suggesting ways she might have a greater impact on the success of the practice. When a Statement of Performance Expectations is appropriately in place for each employee, performance evaluations are a breeze.
The next step is to involve each employee in her (or his) own evaluation. The process is amazingly simple and wonderfully healthy. The employee begins by evaluating her own performance, using the Statement of Performance Expectations as a guide. Simultaneously, the dentist (and in more sophisticated teams, other team members) evaluate the team member’s performance, using the same guide. The employee, dentist and other relevant team members all participate in the Performance Review meeting, during which each of the participants contributes his or her perspective on the employee’s impact on the success of the practice. This meeting is held discussion style and everyone gets an opportunity to contribute.
At the conclusion of the meeting, new goals are set, new expectations are identified, new training and learning opportunities are planned, and supportive commitments are made to the employee. Finally, the next Performance Review meeting date is set.
The following structure outlines some of the categories of expectations which you might want to consider. Use this list as a starting point and add your own ideas. For each area, identify first the expectation then the actual level of performance or mastery.
Evaluation of Clinical Effectiveness or Administrative Accuracy/Efficiency
Clinical Acumen – Diagnostic Skills – Clinical Intervention Skills – Clinical Information Skills – Clinical Strategy Skills – Clinical Collaboration – Information Transfer – Administrative Efficiency and Accuracy – Record-keeping and Tracking
Evaluation of Client Relationship Effectiveness
Listening Skills – Questioning and Learning Skills – Other Communications Skills – Ability to focus on the patient – Sensitivity to patients and their issues – Ability to develop and advance healthy relationships – Ability to transfer information to the team – Ability to handle difficult patients – Social skills – Feedback from patients
Evaluation of Team Participation
Listening Skills – Questioning and Learning Skills – Other Communications Skills – Collaborative Skills – Conflict resolution skills – Respect for others – Finesse
Evaluation of Practice Alignment
Alignment with practice vision – Problem-solving skills – Willingness to commit to the success of others – Planning and strategizing skills – Ability to spot trends and stay aware of changes – Growth patterns/Personal commitment to learning
Please note that some evaluation points are duplicated under more than one evaluation category. It is not unusual for a team member to be extremely effective with patients and out of whack with the rest of the team. These differences are worthy of notation.
Obviously, the expectations will be different for each member of the team, depending on her (or his) role and level of responsibility, and, of course, not all team members will have clinical responsibilities. So, you must individualize the Performance Evaluation categories and items to reflect the expectations of the individual team member.
Don’t fall into the trap of believing that every team member should have the same expectations and evaluation criteria. Although they are entitled to equal respect and attention, no two team members are the same, nor will they ever be. For that reason, the Statement of Performance Expectations as well as the evaluations for two team members who occupy essentially the same position will necessarily be different in some significant ways. The important thing is to set a time for evaluations and involve everyone in the process.
If you haven’t yet created Performance Expectation Statements for your employees, it is not too late. ProSynergy’s Hiring Kit is packed with information to help you learn how to create, even remedially, great relationships with your staff.
This has been a topic of conversation lately. And while it may be fun to watch on Survivor, the gossip, taking sides, stirring of s@#$%t that takes place in a practice can be toxic and damaging. I dug up an article that Sandy Roth wrote a while back and with her permission, pass it on to you:
Triangulation and Forming Alliances: How to eliminate it
Why can’t we just get along? I suspect one of the reasons is that we don’t know how. First, the fancy definition: Triangulation occurs when one person, having an issue with a second person, takes that issue to a third person. Now for the street version: Triangulation is talking about people behind their backs.
Triangulation is a serious problem for many teams, and it can often get a group in big trouble. Although triangulation is a behaviorally immature approach to disagreement, many adults engage in it without understanding the full implications of this choice. When I observe this behavior, I ask about it. Often, team members are simply unaware of what they are doing. They have learned to gripe but not to address their problems directly; so they simply do what they have always done.
• Triangulation solves no problems
The only route to solving inter-team conflict is a full, honest and open discussion of the issues with every person’s active participation. All problems ultimately belong to the group and not a secret subset of team members. Here’s why. Let’s say Jeanne and Jane have a difference of opinion. When their individual efforts fail to resolve this difference and either party secretly takes her frustration or anger to a third person, that third person is now involved in a clandestine discussion. This unhealthy dynamic now “infects” the entire team. People always know who is mad at whom and who is part of a faction.
• Triangulation creates new problems.
Triangulation fractures the group by putting a greater emphasis on differences than on understandings. It almost forces people to focus on the negative aspects of their culture. Moreover, this strategy creates an environment of distrust and disrespect, which tends to undermine healthy aspects of relationships. Practice attention must then be shifted from patient care to team dynamics. What a waste.
• Triangulation creates false alliances.
Jane is angry with Maggie and goes to Susie to dump. “Have you noticed Maggie doing such-and-such?” Jane asks Susie. Now, Susie hasn’t noticed this, and initially she has no beef with Maggie herself. “No,” she answers. “Well, I have,” adds Jane. At this very point, Susie will most likely make a choice between aligning herself with Jane or standing in defense of Maggie. Susie will find it difficult to disagree with Jane. After all, Jane has come to confide in her — an act of “friendship.” And just because Susie hasn’t seen something doesn’t mean it hasn’t really happened. Human nature will more often result in a secret alliance between Jane and Susie against Maggie which is based on incomplete information and a pact to tell no one else. If she tells Maggie, she has violated Jane’s “confidence.”
The confidential information Jane has shared is now almost impossible to ignore. (Don’t think of an elephant.) Even if Jane drops the conversation at this point, Susie is now predisposed to seeing Maggie in the negative light of Jane’s characterization. She is now more likely see those things which confirm Jane’s picture of Maggie and selectively ignore information to the contrary.
• Triangulation encourages factions
Under the guise of “checking it out,” a team member triangulates with a third party (Sometimes this person is the dentist). First, let’s agree that this is tattling. If the initiator really wants to check things out, he or she can go to the only person who can answer the questions. The real purpose of this behavior is to gain allies. The more people who agree that you are right and the other is wrong, the stronger you feel and the more righteous you become. Once the number of allies begins to grow, the opposition is forced to counter. Before you know it, the practice is split and there is a full-scale civil war.
So what are the alternatives?
• Always go to the source
The cleanest way to handle any problem is to go to the source. Yes, this can be tough, but eventually the problem will have to be aired anyway and it won’t get any easier under the unhealthy circumstances triangulation creates. Forget about rehearsing, making sure you are “right” before you raise an issue or gaining evidence. None of these excuses justify triangulation.
• Never agree to keep triangulation confidential
If someone asks you to enter into unhealthy alliance by sharing secret information with you, simply refuse to keep it secret. The proper answer to “If I tell you something, will you promise not to tell anyone else? “ is “NO.” For what honorable reason would someone call your attention to a problem if she didn’t want some help actually solving it? If the real reason is to get your support in the civil war, refuse to be drafted. You can agree to help the person raise an issue, but you must never agree to be a secret-agent.
• Ask for facilitation if you need help
If a co-worker tells you about an issue she has with a team member ask the following: “How did you raise that issue and what happened as a result of your discussion?” Too often, you will hear that there was no discussion. At this point, encourage your friend to raise the issue immediately and offer to facilitate the process. Facilitate does not mean gang up. Facilitate means to insure that each party is heard and understood.
• Return the problem to the group if necessary
Of course the team needn’t handle every issue. But when reasonable attempts to resolve disputes prove unsuccessful, it is time to ask for support from the entire team before the relationship deteriorates needlessly. Be sure to ask team members to listen to the issues and avoid taking sides. The only side which matters is the onein the best interest of the practice as a whole and the patients whom you serve. Principles, core values and promises to patients matter. Egos must get out of the way.
Help! My Staff is Holding Me Hostage!
The voicemail message sounded desperate. “Call me back as soon as you can. I need your help right away!”
What caused such distress? What made the situation so urgent? As it turned out, the dentist was having difficulty keeping a chairside assistant and was faced with hiring for the third time in less than one year. His receptionist had left but he wasn’t happy with the performance of her replacement. Each day brought another drama with the hygienist whose personal life was in total disarray. The practice was totally unstable and he feared losing another employee every day. What would his patients think when every time they came in there were different staff members?
After a short discussion, it was quickly clear his staff was calling the shots:
“My hygienist didn’t show up for our meeting yesterday and didn’t even offer an explanation. We are constantly bailing her out of personal situations. I know it’s hard for her – she’s a single mother and doing the best she can. Then, my chairside assistant refuses to do things that are part of her job. I end up having to pick up the slack at the end of the day before I leave. I overheard them complaining in the lab today about a continuing ed program I was paying for them to go to on their day off. They joked that they would just sit in the back and text on their phones. I’m afraid to lose them because our patients seem to love them and I’d have to spend time breaking in new staff but I don’t know how much longer I can go on. I feel like a doormat”.
While this scenario may vary from one specific practice to another, the problem is basically the same in many: dentists who neither know nor enforce their boundaries and expectations because they are afraid they may lose staff. Indeed, their staff is holding them hostage. How does it get to this point?
Let’s examine the factors that contribute to this phenomenon:
1) The dentist’s personal relationship with staff makes it awkward to set and maintain standards and/or fire a low-performing employee
While we all have busy, challenging lives that can effect our professional lives, these issues should never dictate office policy. This is an area in which many dentists confuse their personal relationship with their work relationship. It stands to reason that because you work together closely all week, you might easily develop a strong bond with one another. You may find yourself identifying with your staffs’ personal problems, like managing a home and family and trying to make ends meet. Express your empathy, of course, when appropriate, but as an employer you must establish clear boundaries. Do not advance paychecks, pay rent, loan cars, or pick up kids. Do not make concessions for days off outside a very rare and unavoidable situation. By doing this you will set a very dangerous precedent. Other employees will consider it favoritism and they will expect you to afford them the same concessions.
If you have already “let that horse out of the barn”, you can reverse this trend. Gather your group together and apologize. Explain that you care about each person on the staff and this has clouded your judgment. It has created a problem for you and others. You must now establish a new set of boundaries that are in the best interest of the practice and your patients. Then you must outline where you went wrong and what you are no longer willing to sponsor. They may not like it but they will understand.
If you believe your personal relationship with an employee has gone so far that the two of you can no longer be effective working together, give us a call. We can help you sort out what the appropriate next step should be.
2) Even if it’s written down in the manual, not every employee will know what’s expected and will follow through.
Your employee manual means nothing without two things. First, your staff needs to understand the bigger picture. It is your job to clearly convey to each person what your practice is there to accomplish and how their efforts are expected to help make that happen. The big picture is crucial. More than the step-by-step guide that a manual provides, your explanation of the practices’ purpose, as well as your beliefs and tangible examples of how this purpose is played out on a daily basis is vital. It will give them a guidepost to follow in their day-to-day challenge of making decisions about what is in the best interest of the practice and the patients.
Second, every employee must be on board with your purpose. Each must be in alignment with your belief system and share the same basic values. And you must have their agreement about their role and responsibility. This can best be accomplished as a group discussion where each staff person has an opportunity to ask questions and gain perspective. Time consuming? You bet. But without this clarity your staff will be working without a clear direction which often works at cross-purposes with the practice goals and will cause a great deal of frustration for everyone.
3) Hiring and training the right way often takes a back seat to retaining under-performing staff.
A good way to think about your problem employees is the bad girlfriend or boyfriend you may have had. You knew long before you broke it off that things weren’t working out but you avoided it hoping things would get better. They rarely do. Then, when you finally got up the nerve to end it, you thought to yourself, “I should have done this a long time ago”.
Your under-performing staff are robbing the practice. Pure and simple. You simply can’t afford to work with people who are inefficient, ineffective, and cost your practice time, money and resources. The focus and energy these employees sap from your patients and practice deprive you of much more. You can not be as effective in your job when you are worrying about staff doing their job. It stands to reason that the under-achievers aren’t dedicated to your practice purpose and patients are not receiving the same care and attention you strive to provide.
While hiring and training (and doing it right once) requires time and energy, doing it over an over again takes you away from focusing on dentistry. And it’s not a lot of fun. Cutting your losses and embarking on the hiring process can be an opportunity to make a course correction. If you approach this process correctly, you will avoid having to carry dead weight on your team. You will have a solid and stable group of individuals for a longer time. Approaching the hiring process correctly is essential.
You can bring your new hires on with a strategy for success that includes a thoughtful training plan designed to help them succeed. Equally important are periodic evaluations (for everyone) to keep your team performing at a high level, stay motivated and focused on the big picture.
There are way too many dentists “making do” with staff because they are afraid they won’t find a better replacement. While high-performing employees are more rare and difficult to find, they are out there. It is just a matter of knowing where to find them and how to attract them. They may be disenchanted with their current job or looking for a greater challenge or more responsibility. Perhaps they don’t feel they are appreciated or they deserve more compensation for what they do. Those are your candidates. It just requires more diligence on your part to find them. It takes a dedicated effort, creativity, and a solid plan to attract that exceptional staff member. It starts with an exceptional ad that is masterfully written and trying new and innovative strategies to distribute your ad. Most practices do a lousy job at this and dread the process. The pool of candidates often reflects the quality of the ad, which often misses the mark.
Are you being held hostage? Stop letting your staff dictate what happens in your practice and take control. If you believe it is a matter of establishing clear boundaries and re-establishing expectations, start the process today. You can no longer afford to allow this to go on. If you know in your heart that there are one or more staff people who would be better off somewhere else, start making plans today to embark on the hiring and training process.
Of course, we can help guide you through this. We can help you clarify where you need to make changes and develop a thoughtful process for implementation.
If you plan to hire, consider calling on us for support or using the tools in our hiring kit. You can learn more by clicking below or calling us at 800-848-8326.