It is not hard to find dentists who love their profession. The work is challenging and rewarding, and rapid advances in materials and technology ensure that boredom is not a problem. The part of practice that most dentists do not enjoy is management. They often have high praise for their team, but they lament that they were only trained to do dentistry, not run a business. As one practice owner said, “In the dental practice, I’m the doctor who gets satisfaction from diagnosing and treatment planning, but managing the staff is a chore that I do not enjoy.”
Here are five management principles that take some of the mystery out of management.
1. Make sure that you couple responsibility with authority.
There are many examples of doctors giving someone responsibility without authority, with predictable negative consequences. Consider this scenario. A doctor decided that he needed a break from the intrigue, gossip, and petty dissatisfaction swirling around the office. He bestowed the title “office manager” on a trusted employee. However, that title was about all the hapless employee had going for her. Other team members did not respect her authority, because in reality, she had none. When the new office manager gave someone an answer that the other person did not like, the miffed employee went around the office manager and spoke directly to the doctor. His response was to inadvertently undermine his new office manager by saying, “It’s ok. The answer is yes. I will speak to the office manager.”
It did not take long for all the employees to grasp the new political situation in the office. All they had to do was ignore the office manager and go directly to the doctor. Bereft of any authority, the office manager soldiered on, trying to lead and manage, but only becoming more frustrated by the day.
Morale in the office sank to a new low. With the team openly defiant of the office manager’s directives, and the doctor acquiescing to team complaints that the office-manager-in-name-only was “unfair,” tensions that had been building beneath the surface erupted in the office, spewing a negative atmosphere that settled over everyone, including the patients. Eventually, the doctor fired the office manager because, he said, “she could not handle the job and the other team members did not respect her.”
At this point, to paraphrase Carly Simon, “you probably think this article is about you, don’t you?” In fact, this scenario is fairly common. The lesson here applies not to one office but to far too many dental practices.
The doctor belatedly realized his mistake. He hired a new officer manager and vowed to give authority commensurate with her responsibility. Everyone was told what to expect from day 1. When someone tried to go around the office manager and petition the doctor directly, he would have none of it. “The office manager is your immediate supervisor,” he said.
Some doctors are concerned that they will be ceding authority to an employee. Keep in mind that the doctor is still the ultimate boss and practice owner. It is the doctor’s job to supervise the office manager directly and allow that individual to do his or her job on a daily basis. In this way, the doctor can focus on patient care.
2. Build safety.
This concept is taken from Daniel Coyle’s book entitled The Culture Code (Bantam, 2018). The concept of building safety refers to running team meetings in an atmosphere of mutual trust. Here are my rules for running a team meeting, with a nod to Mr Coyle for inspiration and validation.
a. Set a definite start and stop time for the meeting. The first question everyone asks (usually in whispers) when a staff meeting starts is, “How long is this meeting going to last?”
b. It’s not all business. There is nothing wrong with starting the meeting with some personal updates, congratulations (birthday, new puppy, wedding, etc), or an update on someone’s problem, such as a relative who is ill. The idea is to create a sense of family. If everyone knows at least some personal details about the other members of the team, they take a personal interest. They care, which is the first step in building a safe place to relate to others on a personal and professional level.
c. Create an agenda with just a few key items. It’s better to cover fewer items in depth than to try to go through a laundry list quickly.
d. Make sure that the agenda items are specific. Example of a good agenda item: “Suggestions for improving the flow to prevent bottlenecks at the front desk.”
e. Someone has to lead the meeting, and that person need not be the doctor. However, the leader has to be tuned in to body language and verbal cues. The leader should ask people for opinions and keep the discussion moving. No one person should be allowed to dominate the discussion, and no one should be allowed to sit silently through the entire meeting. Everyone’s opinion counts.
f. Use affirming language. When someone comments on another person’s points, the introduction should be something like this, “I see your point, but I want to look at this problem a different way.” Not everyone can be right; not every suggestion is helpful, but everyone has a right to their point of view.
g. There is a balance to be struck between running a tight meeting where the agenda is followed very closely, and an open-ended conversation among friends with side conversations and people jumping in with ideas. A rigid meeting structure (think boardroom) has its limitations; allowing people to talk among themselves as long as they stay on topic fosters exactly the kind of familial discussion you are trying to achieve.
h. Thank everyone for their participation and follow up with action steps to affirm the relevance and importance of the meeting.
3. Show vulnerability.
Mr Coyle goes to great lengths to illustrate this point. My interpretation of this concept is that the teacher learns from the student. So many times, doctors feel pressure to solve every problem in the office and have all the answers.
Team members are a great source of information. They want to be led, but they also appreciate the opportunity to provide input. One doctor confided that she was chronically running behind schedule. The problem was not that she was spending too much time talking to patients, but that, try as she might, she just could not get everything done within the time allotted, which was considered to be appropriate for the procedures. Finally, she decided to show vulnerability. She sat down with her assistants and asked them what all of them could do as a team to be more efficient. Some of the suggestions seemed very straightforward. For example, one assistant said to the doctor, “If you need an x-ray, ask us to take it right away, not after the patient is numb and you are ready to start.” (This exchange is also an example of “build safety”; the assistant felt comfortable making the suggestion because she had the doctor’s permission.) Other suggestions were more subtle, involving the interplay of personalities and short bursts of communication on the fly to save time. The result was a noticeable increase in production. Also, by running on time, the doctor reduced stress in the office and improved patient satisfaction.
4. Establish purpose.
This term is also found in The Culture Code. In many dental offices the purpose of the practice is only implied, not explicitly stated. If employees are not connected to a larger purpose, there is a danger that practical considerations will dominate their thinking. As one team member put it, “I work because I have to. The pay is not bad, and the hours are good. It’s a job.” People who watch the clock and grind through the day are not the best or the most motivated employees.
One great discussion question for a team is, “How does the work you do here connect to your passions in life?” When individuals delve into this question, they often articulate core beliefs. They may talk about the satisfaction they derive when a patient who came in full of anxiety leaves with a smile and a thank-you. They may tell a story of how they educated a patient who had been putting off needed dentistry for years and with encouragement decided to go forward with treatment that saved their teeth. Another team member may talk about the joy they felt when a patient was so excited to be able to eat their favorite foods again.
Dentistry is a very personal business. While “mission statement” may sound cold and corporate, asking people to relate their passions to their work is a good way to build a useful mission statement based on shared values and emotional satisfaction.
5. Use positive reinforcement.
An expert in child behavior modification who works with school administrators and teachers told me the following story. An elementary school math teacher faced the white board and started drawing triangles. She asked, “What type of triangle is this?” Someone shouted out, “isosceles!” The teacher, without taking her eyes off the white board, said, “correct” and started to draw another triangle. Another student shouted out, “How many days are we going to do this? We did all this yesterday!” The teacher, annoyed, turned to the student and told him that he had to raise his hand and wait to be recognized. The teacher quickly lost control of the class, as many students talked out of turn and did not pay attention.
The solution to the problem was to set expectations and provide consistent, positive reinforcement. Whenever a student does something right, such as raising their hand, the teacher says, “Good job of raising your hand.” If someone shouts out an answer, even a correct one, the teacher says, “I’m only going to recognize people who follow the rules.” A hand goes up and the teacher calls on the student. The teacher again acknowledges that the student is meeting expectations. In a short period of time, students learn that undesirable behavior (talking out of turn) will get them nowhere, while desired behavior (raising their hand and waiting to be called on) will result in praise. The result is behavior modification.
This psychologist also uses the analogy of NFL coaches working with an accomplished quarterback. If the coaches only commented when the quarterback was doing something wrong in practice, he would get discouraged. Instead, the coaches give positive reinforcement when the quarterback does something right. “Great follow through! Keep it up!” Even the best of the best need positive reinforcement.
In some dental offices, it is unfortunate that silence is sometimes used to signal that all is well. Only when there are problems will there be a negative comment from the doctor or office manager. Letting people know that they are doing a good job with a simple phrase is part of good management. Examples:
- “Great job filling the schedule!”
- “You really made that patient happy.”
- “Perfect response to that question.”
- “Thanks for staying a few minutes late.”
- “Your attitude is outstanding.”
Just as doctors practice dentistry, they should also practice management. These principles are designed to demystify the process and allow doctors to run a successful business with the ultimate goal of serving their patients.