Doc, I Want a Raise!

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Brush them!A recent poll conducted by Real Money magazine reveals that 71% of the respondents want a raise this year. The clients we work with will often give us two perspectives;

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
dentist?

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.

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We Need More Help at the Front Desk!

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We Need More Help at the Front Desk!

Why is it that team members in the non-clinical roles, often referred to as the “front desk staff”, complain about the amount of work they have to do and always seem to be stressed out? Here are a few of the comments we hear all the time:

The people in the back don’t understand all the stuff we have to do”.
“How can I do the insurance when I keep having to answer the phone?”
“We never get caught up.”
“I’m constantly having to stop what I’m doing to take care of a patient. Then when I come back to it, I forget where I am.”

We have a couple of theories about the traditional front desk configuration and why it sets most teams up for failure.
THEORY 1: The front desk isn’t the area in which the dentist works. He or she doesn’t fully understand the challenges the staff is faced with and is less likely to know how the systems work against them, not to mention the outdated equipment and software challenges. For instance, many practices have only made a partial transition to paperless charts, making the practice dependent on two systems (paper and  computer), which makes locating information more difficult, causing duplication and increasing the chance of error. The dentist rarely understands the challenges this poses for the team. (This is a subject in itself!)DISCONNECTED

THEORY 2: People who work in this arena often develop tunnel vision and have difficulty
seeing new ways to structure their work. The result is that the front desk staff keeps doing the same old things in the same old ways, and not doing any of them at optimal level.

THEORY 3: When the non-clinical staff complains long enough, the dentist usually breaks down and adds another person to the team to do the same things the other team members are doing, creating more confusion, more errors and even less efficiency and effectiveness – not to mention more overhead!

So, what’s the answer? Consider separating the tasks into two areas of specialty and assign the responsibilities to the individual who has the right skill sets. Let’s look at the responsibilities of the non-clinical staff and how those duties break down.

There are three distinct areas of focus in every practice – what we call the A-B-Cs :

A – Administrative:
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Responsibilities that support the business of the business. They are related to paper and tasks – not patients. They can occur “behind the    scenes” and in most cases, are not ones that must be addressed in the moment.
The key in this role: to be EFFICIENT with THINGS.

Just some of the responsibilities that might fall under this heading are:
– review chart entries at dayʼs end to balance against deposits
-insurance pre-authorization, submissions, review and followup
-opening and sorting mail with distribution to appropriate person
-entering payments from mail and over the counter
-printing receipts for patients
-monthly statements
-daily deposit
-monthly and annual closing and archiving
-organizing invoices and packing slips before matching to statements for payment
-payables entry in accounting system
-preparation of a/p report for dentist review and approval
-preparation of checks for dentistʼs signature
-mailing signed checks
-inventory of office supplies
-purchase of office supplies and patient amenities
-errands as assigned
-correspondence
-maintenance of office equipment and machinery
-computer system oversight and IT
-maintaining patient amenities (ie: coffee station, water, etc)
-hourly upkeep of patient washroom and reception area
-implementation of marketing, promotion
-communication and follow up with the lab
-communication and follow up with vendors
-planning continuing education
-planning meetings

These responsibilities require focus, attention, detail, someone with self-direction and organizational skills -an analytical thinker.  This same concept can also be applied in the clinical area of the practice – responsibilities associated with sterilization, operatory preparation, inventory and lab duties. They are all essential to providing patient care but occur independently of patient care.

B – Behavioral:
Depositphotos_24330021_mThis arena has to do solely with the business of our patient’s business and is often the most overlooked area. These responsibilities often occur with patients and are focused on patient care, connection and communication. While some of the duties require planning and preparation, events often occur in the moment, can not be predicted and must be responded to in real time. This job requires an individual with big picture thinking. The best people are those with sensibility, grace, maturity, empathy, curiosity, good listening skills, confidence, good command of language, and the ability to think on their feet.
The key in this role: to be effective with PEOPLE.

The responsibilities that most often fall under this heading are:

-working with new patients from initial telephone call through treatment planning
discussion
-supporting patients in the moment whether on the telephone or in person
-urgency triage and establishing clear expectations with urgency patients
-maintaining oversight of patients in process – those for whom treatment has been
recommended but not yet completed
-organizing and managing the “lost souls” project – those for whom treatment has been
recommended and have dropped out of sight
-handling fees and financial arrangement discussions that are not properly handled
elsewhere
-addressing patient complaints and issues in a timely manner
-ensuring that patient interests and concerns are clearly understood by all
-supporting patients by helping them price-test their treatment options
-ensuring that all patient-contact staff are prepared behaviorally for patients before they
arrive
-identifying patterns and trends with patients as they occur
-maintaining oversight of the schedule and making appointments as necessary
-managing patient correspondence and followup
-coordinating non-clinical aspects of care with specialists and referrals
-internal training on communications and patient relations
-connecting with referral sources, public relations, networking

C – Clinical:
Depositphotos_24330067_mEvents related to the delivery of care. Commands most of the focus of the practice and is often the most up-to-date area. Requires the attention and oversight of the dentist/business owner. Removes the dentist/owner from constant oversight of the two other areas, making it even more important that self-directed, well-matched, highly-effective people are placed in the non-clinical roles.

As you can see, the non-clinical staff is responsible for two of the three critical areas of the practice. These staff members are often asked to perform both Administrative and Behavioral roles simultaneously while the responsibilities are very different from one another and require different skill sets.  It becomes clear that when we ask them to assume both roles, they are split between two very different responsibilities, making them choose in the moment which is more important. This usually creates more problems, and sets them up for failure, making them less effective or efficient in either of these areas.

It is our opinion that when you separate the Administrative from Behavioral roles and hire/assign responsibilities based upon strength in one of these two areas, you encourage deep competency, similar to your competency in the area of dentistry. Each person performs at a higher level when they are focused on only one arena and they become more successful than if they were asked to do everything with less effectiveness.

This is not to say that a person who is assigned administrative responsibilities can’t support the one who is responsible for patient connection by answering the phone, welcoming patients or checking patients out when necessary. There are always exceptions. Some practices opt for a third person to act as a greeter or to handle phone triage and appointment scheduling. Remember, the goal is to encourage deep competency in their skill set and prevent team members from performing in areas where they are not as skilled.

This concept may require you to think differently about the individuals, skill sets and responsibilities in your practice. A good exercise for each of your non-clinical team members is to have them make a list of their duties and determine whether it is administrative or behavioral (we hope you aren’t asking them to also perform clinical roles too!). Ask them to assess how much of their work load is in each of these arenas and discuss how roles might be shifted to better serve this new model.

Take home message: You most likely don’t need more people serving in a non-clinical role – you just need the right people, with the right skill sets, in the right positions, which creates a better, more efficient and effective systems.

A caveat here – you may discover that you have team members who share similar skill sets leaving you with no one to serve an administrative or behavioral role. This may be the eureka moment that explains why certain problems keep occurring in your practice.  This process may also cause you to consider restructuring your non-clinical staff altogether. We can help you consider your options and sort through the implications of making changes to better serve the practice and your patients.

My Prediction for 2013

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Good news!  U. S. News and World Report has announced their list of the top jobs (those in greatest demand) for 2013 and topping the list at number one is dentist!  Following in the number ten position is dental hygienist! At the risk of angering some of you, I’m going to say it. No more whining! You can position your practice and seize the market. But you must decide to take a good hard look at your practice and make some improvements.  Look at these FIVE ELEMENTS and ask whether you are making the most of each opportunity:

1) Your Physical plant

Patients have very little in which to judge your expertise or competence and some will assess you by the appearance of your practice. From the exterior and signage to the decor, wall art and clutter, look at your practice with new eyes or ask a third party or professional to give you their honest opinion. And while you must like and be comfortable in your surroundings, the more important issue is who you are targeting and what will appeal to them.

2) How are patients welcomed?

The best investment you can make is to train the team members entrusted with answering the phone and welcoming new AND existing patients. NO AMOUNT OF ADVERTISING OR EXTERNAL MARKETING WILL BENEFIT YOU until your team members learn how to connect with people in the most effective way. The challenge is that you rarely know how your team members are engaging people because you are focused on doing dentistry. Enlist the help of a professional to both assess and train your team appropriately.

3) Work on building relationships

This may sound like a no-brainer but there is more to building a relationship than learning where your patients work, their children’s names or where they went on their last vacation. Everyone who works in the practice must be capable and willing to learn communication skills that will carry your relationships beyond the superficial. This requires learning why patients come to you, what they are asking and expecting of you, and how you can connect with them in ways that help them get what they want. The end result is more patients authorizing more dentistry sooner!

4) Fostering referrals

It stands to reason that if you manage expectations and give patients what they want, they will be happy and continue to come to your practice. Far too often, we don’t ask our best, most satisfied patients for referrals. Do you and your team know the art of asking for referrals in a genuine way? Do you have a referral program that encourages people to voluntarily share their experience in direct and viral ways? Enlist the help of a professional to AMP UP this highly overlooked goldmine.

5) Marketing

For you old-school guys and gals, WAKE UP!  It’s 2013 and if you aren’t getting your business out into the community, you will be left behind. For those of you who have marketing plans in place, now is the time to re-assess their effectiveness.  Keep these three essential elements in mind as you craft your campaigns:

Reach – who you are targeting

Frequency  –  how often you are sending messages out

Top of the Mind Awareness/Familiarity  –  being in the consumer’s mind when they are in the market or have a need

I encourage you to consider more non-traditional means of promoting your practice with a heavy emphasis on education and good-will marketing. Think creatively and out of the box. Don’t rely on a team member to try to implement your marketing when they “have time”. Instead, hire someone who can focus on it.

I predict that if you tackle all five of these goals this year, your practice will SOAR. I would love to help you with each of these areas to make 2013 your greatest year ever and be poised for success for years to come.

Practice Perception Part II: What messages might your staff be sending?

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In the first installment of Practice Perception, I asked; Does your physical plant represent your practice mission? We looked at the elements that contribute to painting a fuller picture of what your practice is about and is often the primary way patients can assess who you are and your level of professionalism and expertise.

Of course, there are other factors that contribute to your practice image.  One of the most powerful influencers is your staff. They can be a primary reason why patients are attracted to or end up leaving your practice.

Inside the practice, you certainly would want your team to be on their best behavior and represent you in a positive light. However, you can’t assume they will behave or act appropriately without being specific about your expectations. Make sure your employee manual contains specific guidelines for things as basic as the following:

PERSONAL APPEARANCE – include specifics on what you will or will not tolerate regarding: jewelry, piercings, tattoos, hair, personal hygiene, oral health, cologne or perfume, or tobacco smoke or smell.  

CLOTHING – if you supply uniforms, this should not be an issue. If you don’t, you must be specific about what is and is not appropriate.

CHATTER – quite often, dentists complain that the staff banter gets in the way of patient care. Patients who hear staff talking amongst themselves while they sit idly waiting will feel ignored. The hard and fast rule should be that the content of staff conversations in places outside the staff break room should be focused exclusively on patient care. In addition, remind your staff there should be no bad-mouthing or negative comments to other staff members or patients at any time.

PRIVACY – and of course, any conversations relating to patient care should be private and discussed in a place where they would not risk being overheard by others.

TEXTING, CELL PHONES AND SOCIAL MEDIA – team members gripe all the time about patients who use their phones during their appointments. Imagine how patients feel when a staff member diverts their attention from patients to text or use their phone or check their Facebook. It is rude and inappropriate. Period. Patients should not see or hear a staff member’s personal phone – not even a buzz when it’s placed on silent.

You cannot stop team members from using Facebook or other social media outlets outside of the practice, but you can remind them that what they post about their job or the practice is up for scrutiny. Depending on the comment, it could present the practice in a bad light. Comments can also cross privacy boundaries.  In order to protect themselves and the practice, you should request that they refrain from commenting on anything related to the practice.

ATTITUDE – you have probably experienced your share of passive-aggressive behavior by your team. It manifests itself in ways in which you may not be aware until it is brought to your attention by another team member or a patient; being surly or short with someone, slamming doors or banging things, ignoring others, sarcasm and responding in an overly exaggerated sweetness that is “put on”. Patients pick up on these behaviors and it reflects poorly on the practice and you as their leader.

OUTSIDE THE PRACTICE:

How many times have you been in public and seen one of your patients?  Whether it’s at the grocery store, gas station, sporting event or the countless other places you might go, you are keenly aware of how you might be perceived by your patients outside the practice. Your staff?  Not so much.  

When they aren’t working, your staff are probably not thinking about patients seeing them in a less-than-flattering light. And there’s not a whole lot you can do about it. However, you can encourage them to be on their best behavior. Remind them that they can be a powerful influencer to encourage patients to stay active in their dental care by the warm greeting or response they give patients outside the practice.

Enforcing these expectations can be difficult but it is essential that your staff understand  how vitally important they are in influencing practice perception. They are a huge part of the equation.

Occupational Half Life – I don’t think we’re in Kansas anymore!

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Recently, regarding his book, The World is Flat, published in 2005, Tom Friedman said; “I looked in the index under F. Facebook wasn’t in it. Facebook didn’t exist. Twitter was a sound, the Cloud was in the sky, 4G was a parking place, LinkedIn was a prison, application is what you sent to college, and for most people Skype was a typo….”

Which brings us to our topic: the world is changing rapidly –  to the point where information, innovation and technology is evolving exponentially.  It’s a challenge to keep up and requires more time and effort than it did a mere 5 years ago.  Essentially, it’s like trying to out-run a tornado!

Photo credit: National Oceanic and Atmospheric Administration/Department of Commerce

Continuous change requires continuous learning. I don’t have to tell the doctors reading this. You get it. You know the importance of staying current in the clinical arena. But what about the team and the other areas of the practice?

Over 13 years ago, Jim Harris, PhD said something that caught Sandy Roth’s attention and it is just as relevant now as it was then:

“Another HR trend is the idea of occupational half-life, which asks the question, ‘How many years does it take for half of your work skills to become obsolete?’ In 1970, it took about 15 years. [That means] by 1985, half of your original skills were no longer useful. Today, the number is 2 1/2 to 3 years. That means in less than 30 months, half of what you’re doing will be obsolete.”

Whoa! This concept of occupational half-life is huge. It has major implications for anyone in almost any profession but it is especially true in the healthcare field.  What does this mean for your team? Well, for one thing, change is not an option. And to take that one step further, if one does not adopt a personal commitment to lifelong learning, they will quickly become irrelevant and obsolete.

Here is Sandy’s message to team members:

Learning cannot occur only within office hours. Academic and conceptual learning occurs outside of office hours. Practical application learning comes with the doing, where your practice is your learning laboratory. Indeed, there is a great deal that can be done during the hours of your employment, but it will never provide enough time to delve into the creative, the new and the innovative. And that is exactly where you must take yourself if you want to stay on the cutting edge and guard your future.

Your value to the practice will go down if your skills don’t go up. What is valuable to your practice right now will be less valuable in the future. Which half of your skills will be obsolete in three years and how will your diminished impact harm the success of the practice? You cannot expect your compensation to rise when your skill-base is stagnant.”

Did you get that last part team members?

So what role do you, the dentist, play in this? Certainly, you lead by example; taking continuing education courses, reading trade publications, learning how to implement new technology into the practice, networking with colleagues, learning from those smarter than yourself (that includes your team), involvement in professional organizations. While some of this may occur during practice hours, a lot of your learning and growth happens outside of the practice and at the expense of spending time with your family.  And why do you do it? While you know it will make you a better dentist and keep your practice growing, my guess is you have a curious mind and a strong commitment to lifelong learning.

Can the same be said for your team? Do they understand that their own growth and future potential lies in their own hands? Are they willing to invest in themselves by taking the initiative outside the practice? Are they spending their free time learning something new?  Do they have the mindset to “look it up” if they don’t know?

And are you encouraging and supporting them by providing opportunities for learning? Are you sponsoring independent learning, workshops, online courses or distance education?

I hope so.  That tornado is looming large in the distance.