Hey Dental Team, Who’s The Boss in the Dental Office?

I frequently ask dental team members a disarming question: “Who’s your boss?” Almost all the time I get this unfortunate answer: “the doctor.” It is probably the correct answer but still not a good answer, because in so many dental practices, the doctor wears too many hats: clinician, manager, and CEO. The manager hat has to go.

This problem is seldom seen in medical practices. When a surgeon is in the operating room, he or she is not likely to be interrupted by someone saying that another employee wants Tuesday off and that is not going to work; team members complaining that the workload is not fair; or pleas for help dealing with a patient who insists on coming in tomorrow even though there is just no room in the schedule.

In dental practices the multi-tasking doctor is always under siege. Team members stalk him or her in the hall, the private office, and sometimes the treatment room. Decisions need to be made and only the doctor has the authority.

It is revealing that the organizational chart of most dental practices consists of the doctor at the top, with a flat line listing of all employees below. Everyone other that the doctor is on the same level on the chart. In business parlance, this means that the doctor has many “direct reports”—a small army of employees who need to get the attention of the boss/doctor throughout the day.

The solution is for the doctor to designate a true office manager, someone with the authority—not just the responsibility—to manage the practice and make day-to-day decisions. The office manager reports directly to the doctor, who of course oversees decisions, but the rest of the team all report to the office manager. In this way, the doctor can focus on treating patients while the office manager handles administrative matters.

No practice is too large or too small for a manager. Whether the practice has four, forty, or four-hundred employees, there needs to be a designated office manager to rescue the doctor from most managerial tasks and ensure that the doctor is kept busy cranking out dentistry, which is the way the business generates revenue.

Too many management tasks sap production time and wear down the practice’s greatest asset—the doctor. Years ago, when the pace of life was slower, offices were not bulging with technology, and patients were not in such a hurry to get back to their over-scheduled lives, the doctor could run the business and treat the patients. Now, however, the practice of dentistry is becoming more complex by the day and the overhead monster is threatening to eat the profits. To ensure continued practice success, the doctor needs to concentrate on dentistry, while the office manager does the rest.

For many practices, particularly small ones, having an office manager is a change of culture, and I help often practices with this transition. When the organizational chart is redone and team members are trained in new roles and responsibilities , everyone benefits from a more logical distribution of duties.

Next week: The political clash that occurs when team members want to go around their boss (the office manager) to talk to the “real boss” (the doctor).


Seven Ways Practice Administrators Can Motivate the Dental Team

To motivate the dental team, use these seven suggestions:

1. Praise Good Behavior Regularly to Motivate Productive Team Members. It is easy to spot bad behavior, but most people in a dental office at any given time are doing a good job. When you are looking for problems, it is possible to overlook the people who are working in the trenches and keeping the place humming. Notice good behavior and comment on it. Recognition is a great motivator. Keep a log of how many times you praise individual performance. Chances are it is not enough to motivate the dental team.
2. Get the Doctor On board the Praise Train. Team meetings should not devolve into gripe sessions or a post mortem of yesterday’s challenges. Find ways to praise people in meetings and make sure the doctor takes an active part. When the doctor notices, everyone notices.
3. Shut Down Gossip. What would you do if a team member started smoking in your office? You would no doubt shut down that behavior right quick, as they say. You need to establish and enforce a no gossip zone. It is just as important as a no smoking zone because gossip is nasty habit that can destroy a practice.
4. Confront the Malcontents and Slackers. You can be diplomatic or direct, but you cannot let complaining and unproductive workers slide by without calling them out. They will either get the message and improve, leave the office, or be asked to leave. The morale of everyone else cannot be dragged down by one or two people. Like it or not, as a practice administrator, you are a cop. You need to lay down the law.
5. Put the Whiners to Work on Solutions. A great way to quell a whiner is to ask for a written list of suggestions. Ask them to include ideas for implementation, a timeline, and a budget if their suggestions will cost money. Discuss their proposal at a team meeting. If they have good ideas, then try to implement them. If not, then the whiner will get a fair hearing and it will be time to move on.
6. Reward the Team. People play slot machines for hours because they never know when the machine will pay off. “Random interval reinforcement” is a powerful motivator. Do the unexpected: everyone gets off an hour early one day; lunch is catered in one in a while courtesy of the practice; you have a party to celebrate a productive quarter, etc. You break up the routine and give everyone a reason to thank you and congratulate each other on a job well done.
7. Use the “Broken Window” Approach. There is a philosophy in law enforcement, too complex to explain fully in this space, that says that the police should respond to minor crimes (such as someone throwing rocks and breaking windows in an abandoned building) to prevent major crimes from happening later. In every dental office, there are customer service standards. When one small standard is not observed, the bar drops just a little lower. Over time, the practice is no longer distinguished by first-class service. If, for example, every new patient is supposed to receive a hand-written thank you note after the first appointment, then stay on top of that protocol, lest you go down the slippery slope and find more egregious problems later.

Practice administrators do a great job. These suggestions are another handy checklist to motivate the dental team.


Urgent Specialty Referrals: Clear Communication is Key

To gain insight into specialty referrals and the need for clear communication, it is instructive to consider a famous story from the aviation industry.  Some years ago a foreign airliner that was approaching a major airport in the United States crashed short of the runway. The pilots had advised Air Traffic Control that they were low on fuel. The controllers were giving the pilots instructions for a priority landing when the crash occurred. However, an investigation revealed that the pilots had only said that fuel was “low”; they did not declare “a fuel emergency.” The controllers later said that they would have cleared the plane to land immediately if they had known that the fuel situation was critical.

In dental offices, urgent referrals to specialists are sometimes made using ambiguous language. If the referring office asks, “How soon can you get this patient in?” the response may be, “Tomorrow.” In this case, the office manager at the specialty office may have every reason to believe that she is doing a great job. However, if the caller really meant to say, “Can you get this patient in today?” then we have a failure to communicate.

There are three parts to an urgent referral:

1. The referring office should ask if the patient can be seen in the specialist’s office today, as soon as possible. No ambiguity.
2. The reason for the urgency should be stated. “Dr. Smile would like Dr. Specialist to see the patient today because she is experiencing discomfort,” for example.
3. If it is an urgent matter, then the referring office should always make the call to the specialist’s office for the patient. Allowing the patient to make the call is not a good idea. It is courteous and efficient for the two offices to communicate with each other and secure the same-day appointment.

Communication between referring and specialty offices can be a challenge, but plain speaking can avoid misunderstandings and get an urgent case to the specialist’s office as soon as possible.