(Part 3) More Root Causes of Silence and Lack of Empathy in the Dental Office

February 1, 2019
By: Trude Henderson

I am following up on last week’s article, “One Root Cause of the Silence and Lack of Empathy Too Often Seen in Dental Practices (Part 2)” (September 23rd) and plan to share with you, the dental practice leader, the last two of the three main root causes of the silence and lack of empathy that can negatively impact dental practices. In doing this, I will continue to draw on my 27 years of experience working with High Reliability Organizations (HROs) and on the results of ToothFairy’s 3-year-long pilot study of dental practices in the Western United States.
Getting down to business: the second root cause under discussion is simply lack of resources.
That pioneer in the science and art of measuring popular opinion, George Gallup, began a worldwide study of the level of human satisfaction in the 1930s, including job satisfaction. In the 1970’s, Dr. Gallup reported that less than 50% of employees were satisfied with their work. Today, his organization reports that this figure has dwindled to an abysmal 33%. Employees are apparently less engaged than ever before.

You might ask, “What does lack of resources have to do with lack of engagement?” The answer: “Almost everything!”

Dr. Gallup’s survey questions, famously known as “Q12,” are crafted with an eye on actionability-- things that supervisors can take action on and make a noticeable difference in employee engagement. The Gallup question to employees that I will focus on for the purpose of this discussion is: “I have the materials and equipment I need to do my work right.” From our experience, this question easily translates to, “Do I have ALL the resources necessary to do my work right,” - tools, technology, adequate staff for the workload, access to supervisors to solve problems, air-conditioning and even comfortable, spic-and-span uniforms.
Years ago, I had a conversation with an employee and asked them if there was anything that I could do to help improve their job satisfaction. To my surprise, the employee said, “Yes ma’am, these uniforms that previous management ordered are hot, itchy and uncomfortable.” This employee’s readiness to respond helped me realize the importance of asking such questions and how the answers are so closely connected to outcomes (a great patient experience, meeting practice goals, etc.). In collaboration with the team, we chose new uniforms that made everyone happy.

Remember to always treat your employees at least as well as you want them to treat your patients.

There are definitely areas of your practice in which it is a major mistake to economize. Not having enough staff to handle the workload, for example, is almost certain to negatively affect your employee morale and customer experience. When employees are overloaded with tasks (including an overbooked schedule) and with no help on-the-way, stress mounts proportionately and management sends the message (without saying it) that either pinching pennies or quantity over quality is more important than the customer experience. When this happens, staff and doctors either don’t or won’t make the time required for providing the quality patient experience that results from careful listening and satisfying ‘emotional and physical concerns’ as they relate to treatment. Our 3-year pilot study revealed that such practices tend to attract more low-value patients, the ones shopping around regarding price rather than value and the first ones to demand a full refund when the slightest thing doesn't go their way!

According to Gallup: “Getting people what they need to do their work is important in maximizing efficiency, in demonstrating to employees that their work is valued and in showing that the company is supporting them in what they are asked to do.” We couldn’t agree more.

We recommend that practice leaders educate themselves about Q12 and then educate their supervisors, making frequent use of its questions to gain insights about engagement. One of the easiest ways to accomplish this is to provide each employee with a notecard during a staff meeting so that they can privately answer your own engagement-related questions. Another is for you to contact Gallup directly and for only a $15 per-interviewee fee, conduct a full and thorough engagement assessment, beginning with a baseline.

The third root cause of silence and lack of empathy in your practice is poor job fit.

Many practices fail to hire and retain the right people—which can make all the difference. What is needed: “high fit” (defined as “how well a candidate or employee matches a job and organization” (Hogan, 2017)), staff members. Such people know how to demonstrate value, meaning that they have the ability to interact well with patients, ask the right questions and answer objections effectively —that they, in short, don’t exemplify silence and lack of empathy.
Based on my experience conducting personality profiles over the years, using the assessment tool that I recommend called Hogan Personality Inventory (HPI), I have encountered three extremes when it comes to behaviors. Before I discuss these, though, I would like to point out that we have found that about 1 in 7 candidates fit the criteria for HPI "high fit.” In addition, I recommend that practice leaders view assessment data as only one piece, not the whole part, of the hiring process. Experience, education, references, background checks - all must be taken into account.

The first extreme, a common characteristic among some millennials and high-fit candidates, is "resistance to feedback" from peers and supervisors. This is usually due to extremely high self-esteem.  I almost always have to remind supervisors that high-fit sales professionals in any industry, and treatment coordinators, for example, in the dental industry, are not always the easiest people to manage, but the best of them, and the ones that will take your practice to the next level, are self-confident, empathetic, self-motivated, outgoing, dependable and lifetime-learners (all characteristics, of course, attractive to dental professionals). These high-performers are best compared to thoroughbred horses who are primed and ready for the Kentucky Derby!

The second and third extremes, which we would like to focus on for the purpose of this discussion about low-fit behaviors, are "low ambition" and "low sociability." From our experience, people who score in the lower percentile in these areas 1) tend to lack consistent self-motivation and high competitive drive, 2) tend to lack consistent attention-to-detail, 3)often exhibit more follower behaviors than leadership characteristics, 4) tend to enjoy less frequent interactions with patients and 5) are usually more effective working alone, as opposed to in a team environment. The upshot: these behavioral extremes likely play a role in some of the instances of silence and lack of empathy that may be causing your patients to fall through the cracks or harming your dental practice in other ways.

Don’t get me wrong, many low-fit candidates are capable during an interview of coming across as friendly and outgoing, perhaps even as a perfect fit for your practice. The presence of these characteristics doesn’t mean that you should think less of them as people, but remember that your goal should be to hire the candidate of best value to your practice. They may say all the right things regarding your practice values, principles and mission. They may have keen computer skills, or have demonstrated the ability to interact well with patients in the clinical setting during a working interview. Based on my experience and research, however, if you hire them they will not likely exhibit the kind of hassle-free consistency necessary to provide patients with an outstanding customer experience across all touch points and swiftly anticipate shifts in patient expectations.

The problem is: How do you really know that you’re going to hire the right person? You don’t, because the perfect person or hiring process simply doesn’t exist. You can, however, improve your odds of hiring a strong fit by utilizing proven tools like HPI designed to help you better predict performance and weed out those with less desirable traits.

During the course of the baseline assessment of our 3-year pilot study, it was discovered that in some practices some key personnel were selected or assigned duties out of sheer desperation. In addition, one organization had a mismatch between workload and headcount. Low patient experience survey ratings and a decreasing trend in the number of referrals were indicative of poor customer service.

Many practices do unintentionally hire or promote low-fit employees, and then, due to lack of time, the pressure of other priorities or simple procrastination, don't take appropriate actions to replace them.
 
We have found that many leaders, particularly those who don’t class people, feedback and metrics as top priorities, fail to understand the impact of hiring and retaining low-fit employees. By high priority we mean engaging in daily conversations with staff and doctors (through daily huddles) and patients (through an effective e-survey tool) in an effort to gather feedback, fill the gaps and help determine the relative effectiveness of their practice.
The lessons to be learned here are: 1) your gut feeling in an interview may not provide enough insight to ensure that you have a "high-fit" candidate; 2) just because your employee performs well in the clinical setting doesn’t mean he/she possesses the social skills critical to improving sales year-over-year or providing an outstanding customer experience; 3)automatically promoting someone who may have performed well in a Treatment Coordinator position, for example, could cost your practice thousands of dollars in lost revenue and harm your brand if they are not the right fit; 4) don’t resign yourself to being stuck with someone forever! HROs readily defer to expertise when they need help—the people with the knowledge and skills appropriate to the circumstances. Furthermore, seeking the advice of a human resources professional, consultant or attorney can provide you with the piece-of-mind and encouragement necessary to take appropriate steps while keeping you out of legal trouble; and 5) make people, feedback and meaningful metrics a priority - you’ll never be sorry that you did!

So we have reached the end of our three-part series on the important but seldom discussed issue of silence and lack of empathy in the dental office setting. The main takeaways: silence and a lack of empathy can be rooted in a lack of leadership, lack of resources and poor hiring choices, with potentially serious consequences for a dental practice’s bottom line and brand.
Works CitedBabcock & Wilcox Technical Services LLC. (2008). High Reliability Operations: A Practical Guide to Avoid the System Accident. Amarillo: U.S. Department of Energy.
Gallup. (2017, September 30). Q-12 Meta-Analysis. From https://strengths.gallup.com/private/resources/q12meta-analysis_flyer_gen_08%2008_bp.pdf
Gallup News. (2017, September 25). Employee Engagement.
Hogan Assessments. (2016, May 3). From http://www.hoganassessments.com/
Rochlin, Gene. (1996). Reliable Organizations: Present Research and Future Directions. Journal of Contingencies and Crisis Management, 55.
The Lewen Group. (2008, May 1). Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. From Agency for Healthcare Research and Quality: http://archive.ahrq.gov

Read Part 1 of this article here.
Read Part 2 of this article here.
Ten Steps You Can Take Right Away to Improve the Reliability of Your Dental Practice
High Reliability Concepts: Insights of Value to any organization.
Trude Henderson is the co-founder of ToothFairy, a startup elective dental and medical practice improvement software company which delivers an unparalleled customer experience that inspires delight, loyalty and positive emotional connections to improve the lives of patients and the practices they visit. In 2016, she was the first to introduce High-Reliability Organizational Concepts to the dental industry. For questions, contact her directly at Trude@GetToothFairy.com. Follow Trude on LinkedIn:  https://www.linkedin.com/in/trudehenderson/ (no email required).
Go to ToothFairy's website: www.ToothFairySoftware.com.