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High-Reliability Organizational Concepts: Insights of Value to any Dental Practice

7/30/2018

What can dental practices learn from high-risk industries?

July 30, 2018
Trude Henderson

When we think of a place where miracles happen every day, where the highest focus, safety and consistency are absolutely critical, what scenes first come to mind? A surgical suite at a children’s hospital, the control room of a nuclear-powered submarine, or the busiest airport in the world? The industries that first initiated the use of High-Reliability Organization (HRO) concepts included the aviation, nuclear power, manufacturing and military sectors.
Few organizations are as at-risk or mistake prone as these, but the principles underlying the success of HROs offer insights that can prove invaluable to you, the dental practice leader. A skeptic might respond, “You’re putting dental organizations in the same league as those other ones? Isn’t that comparing apples to oranges?” The answer might surprise you. HROs are adept at hard-wiring certain valuable behavioral traits into any organizational culture, with the potential to mitigate adverse or threatening effects. Please allow me to explain how these insights can be beneficial to your dental practice improvement strategy.
Let’s begin by defining what an HRO is: an organization that conducts relatively error-free operations over a long period of time, making consistently good decisions that result in high quality and reliable operations.”
Don’t you want your dental practice to be such an organization?
Below are some key takeaways that can help you obtain superior performance at every level of your organization:

HROs maintain a keen awareness, a “sensitivity to operations” and systems. They pay close attention to what is and what is not working. They know if they are winning or losing at any given moment. Decision-making and operational initiatives are based on information obtained via observation, surveys and other metrics. And they take action to prevent errors.
1. Transparency and trust go hand-in-hand. People who are generally open and honest inspire greater esteem and confidence than others. The same applies to dental practice leaders and employees, both.
2. Dental practice leaders that encourage transparency usually have higher-performing teams than those that do not. To quote Peter Drucker: “What gets measured gets improved.”
3. Remaining mindful of where you are now and where you want to be helps you fill in the gaps, increasing the likelihood that you will achieve your goals. Tip: put dental practice metrics in front of your staff every day. Challenge the team to openly discuss ideas for improvement.
4. Continuous feedback can result in better decision-making because it helps dental practices learn more, improve their processes in real-time and reduce inconsistencies.
5. Big data, identified, analyzed and distributed appropriately, can be transformative, ultimately making a positive impact on day-to-day operations.
HROs resist the temptation to accept ‘simple’ explanations for problems. They ask a lot of questions and challenge long-held beliefs, potentially resulting in improved source identification and understanding underlying causes.
1. Dental practice leaders should strive to provide a safe, open environment where their employees feel free to express their ideas and concerns. Albert Einstein defined insanity as “doing the same thing over and over again and expecting different results.”
2. Ask “why” as many times as necessary to get to the bottom of any issue. We covered this in more depth one of our previous blogs. Check it out!
3. Encourage employees to search for ‘blind-spots’ and challenge ‘phantom-rules’ (long-held organizational beliefs) that serve to maintain the status quo, and commonly prevent dental practice improvement strategies from even getting off of the ground.
HROs are “preoccupied with failure.” Employees at all levels are encouraged to ponder the types of problems that might result in work processes breaking down, slowing down or becoming dysfunctional. In addition, they routinely share their concerns and become involved in developing best practices across departments. Furthermore, they are deeply concerned about complacency, routine and lack of engagement.
1. Dental practice leaders should seek to de-stigmatize failure by communicating the importance of viewing challenges and negative feedback as opportunities for improvement. The best leaders and employees remain calm, focused and on point when faced with the toughest challenges. Be sure to set the example and reward such behaviors!
2. Dental practice leaders should provide frequent opportunities for meaningful conversations and collaboration. Sharing ideas gives your employees a sense of purpose, while providing mutual benefits to the practice and the team.
3. Ensure that proactive behavior is fully understood and implemented. Settling for less can result in demonstrably negative consequences for employees, patients, budgets and practices alike.
4. Taking proactive steps, such as anticipating the needs of patients, can provide a customized, more personalized experience, setting your practice apart from the pack.
HROs “defer to expertise.” Leaders push decision making to the front lines and genuinely listen to people equipped with the most knowledge and experience regarding the task at hand, regardless of their title or status. They encourage conversations and problem-solving in the work area, as opposed to the occasional conference room meeting.
1. Try to discuss and resolve issues on-the-spot, rather than waiting for the occasional conference room meeting, but make sure that your conversations are out of earshot of your patients. In his January 19, 2018 blog titled, ‘Wow’ customer service for dentists: a competitive advantage” Roger P. Levin, DDS said: “Create a culture of excellent customer service among the staff—Talk about it every morning in your daily business meeting, refer to it throughout the day, and celebrate wins.” We wholeheartedly agree and would add the following: From our experience, skipping the 10-minute daily huddle can be a sure way to demotivate your dental team and de-rail your practice improvement strategy. If you want employee commitment, don’t cut corners here.
2. Level the playing field so that more people are included in the problem-solving process, thus generating ‘real impact.’ Said Ray Lewis, “Greatness is a lot of small things done well.”
3. Draw on experts to solve problems. Research indicates that experts can better understand problems and identify trends and meaningful patterns.
4. Establish strong and diverse partner ecosystems, comprised of employees, patients and partners. Research reveals that high-performing organizations prioritize people and form robust partnerships.)
HROs “are resilient.” They relentlessly stay the course, never abandoning the continuous improvement process, always seeking for better, more efficient ways of doing business. They are efficient problem-solvers and continuous learners.
1. Be a leader and a pioneer. Don’t be afraid of change or a challenge. John Quincy Adams said, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”
2. When hiring and promoting dental employees, look for people who appear resilient in confronting obstacles. Resilient employees can help inspire others to remain calm and stay the course during stressful or tough times. They can be your best cheerleaders!
3. Never stop learning as an organization. Most employees want to learn and grow, and as the world continues to evolve technologically, it is indispensable to the growth and profitability of your dental practice. The alternative to a learning culture is a static one that mindlessly repeats mistakes and suffers from high turnover, due to employees who are present in body but not mind.
4. Say ‘Thank you’ often because it can help foster resilience. Employees who feel appreciated are more likely to endure the bumps in the road and continue moving forward. Employee energy, both positive and negative, can directly impact patients. Happy people equals happy, loyal patients!

To conclude: High-Reliability Organizations have a sense of purpose, and they understand that the right behaviors drive long-term excellence and sustainable results. More specifically, the results suggest that these high-performing organizations offer a plethora of valuable insights to dental practices wishing to consistently accomplish their goals, avoid errors and keep their practice improvement strategy on track.

Read my other articles on topics such as Leadership, Operational Excellence and High-Reliability Concepts:
Ten Steps You Can Take Right Away to Improve the Reliability of Your Dental Practice
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.

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7 More Suggestions as to How You, the Orthodontic Practice Leader, Can Motivate Your Staff

7/23/2018

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Ever thought about asking employees what motivates them?

July 23, 2018
By: Trude Henderson
In her article, “Love your Space: How to Encourage Employees to take Pride in the Workplace” (Business.com, February 22, 2017), Bonnie Dewkett provides more food for thought for those of you dental and orthodontic practice leaders who read our last blog on how to motivate employees. She succeeds in conveying the importance of the issue when she cites the Gallup State of the Workplace 2010-2012 Report, which stated that employee disengagement results in a loss of $450,000 billion in productivity every year. Below are her suggestions, accompanied by some of our own for dental and orthodontic practice leaders:

Coax your employees to peep outside of their silos. Dewkett says that even when employees are superlative at their jobs, they may fall short of their best if they don’t understand the impact of their work on other departments. She suggests that you should “allow employees to visit or shadow other departments, speak with customers if they don’t already do so as part of their regular position, and even test the product or service your company provides.” In addition to improved productivity there is this: “When your employees understand the other positions in the company, you will have a greater chance to fill job openings with internal candidates.” We at ToothFairy wholeheartedly agree and would add that from our experience, when employees understand the ‘why’ behind the ‘what’ they tend to take action with greater confidence and conviction resulting in more enjoyment in their job duties and improved communication with patients and co-workers. In addition, practices report a decrease in patient grievances. This “Operational Excellence” best practice is a win-win!
Provide feedback on at least a monthly basis. Doing so less often “may allow poor habits to linger too long and the motivating effects of positive feedback to wear off.” ToothFairy's pilot study found that supervisors observed staff exhibiting higher enthusiasm and better communication with patients immediately following a training session that explained how poor communication can negatively affect the outcome of treatment. But as weeks went by, the enthusiasm declined, as did the effective communication, especially if the supervisor wasn’t providing continuous feedback and coaching, or was away at another office. This brings our attention to the importance of generating excitement and maintaining it with effective coaching. Training, coaching, and continuous feedback are three important components of high-reliability continuous improvement and the ability to sustain growth.

For more information on the subject of feedback and engagement, we encourage you to read one of our previous blogs that introduce dentists to Gallup’s Q12 survey. It emphasizes the importance of supervisors providing regular feedback (we recommend continuous two-way feedback) and a simple and cost-effective solution to help ensure an engaged dental team.

Look for more imaginative ways to recognize top performers. Dewkett reminds us that employees might need more than a paycheck to motivate them; praise can be sent in the form of emails or letters, or “for a more formal approach, try offering financial bonuses or recognition ceremonies that show your employees you appreciate their efforts.” One of the pilot practices implemented the so-called “Spirit Fund,” to which the practice owner contributed money based on goal accomplishment, and employees collectively decided on what team-building events to spend the money on. Activities included spa visits, dinners, and theatre shows. Orthodontic practice leaders report that the “spirit fund” has proven to be a very successful multi-purpose motivational tool.
Encourage continuing education. Dewkett points out that from internal educational programs, employees can learn ways to improve customer service; from external programs, they can learn about the latest developments in their industry. We at ToothFairy have found that a good brand is born and nurtured on the basis of the most up-to-date knowledge. Dental practices that never stop learning, including practicing and perfecting sales and communication techniques designed to improve treatment outcomes and answers to the questions and objections patients have, tend be light years ahead of practices which don’t.

Research has shown that orthodontic practice leaders who put training and continuing education on the back-burner, failing to keep pace with the changing environment, fall short in the quality of care they provide. Patients suffer, the doctors and staff suffer, and the brand ultimately suffers. The pilot study revealed that some treatment coordinators were unaware of their sales role, and their poor production numbers and close ratios were a direct reflection of their misguided beliefs. Once they received training to help them understand why it is critical for them to play an active role in the sales process, their performance improved.
Today’s busy orthodontic office environment requires staff to be skilled at performing multiple, complex tasks in an efficient, cost-effective and safe manner. When the actual level of job performance and the expected level of job performance don’t align, training or re-training may be necessary. The best dental practice leaders use their creativity to keep staff and doctors interested in attending training sessions. Lunch-n’-learns or daily huddles are good opportunities for brief training sessions. The industry is flooded with a variety of training courses and delivery options, but sometimes staff and doctors simply need to be reminded rather than trained. Remember, the purpose of every training or continuing education session should be to change behavior in such a way as to add value to every visit by improving the patient experience - and the business.

Build rapport between employees. Dewkett writes: “When employees get to know each other better, your employees will want to do their best for their internal customers. Team building activities are a great way to foster these relationships… One great way to create camaraderie is to have a company service day where your employees volunteer their time in the community. They will feel a sense of pride in what they worked together to accomplish, all while getting to know one another.”
A clean, orderly workplace should be a priority. Dewkett says that in addition to making the workplace more conducive to productive endeavors, tidying up and organizing the office is in itself an excellent team-building activity, and helps reduce cleaning costs. During our pilot study, we found that supervisors committed to an orderly workspace helped produce a less stressful and more productive environment than those who didn’t. Several years ago, Toyota Production Systems created the 5S system, which is based on the premise that productivity will increase and the employee’s job will become easier if he/she is not faced with constant clutter. Many organizations currently embracing high-reliability and operational excellence principles utilize the 5S System today, and you can learn more about it here.
Simply ask employees what will best motivate them. We encourage dental practice leaders to do this sooner than later. You might be surprised by what you hear!

We know that many dental and orthodontic practice leaders find engaging staff to be a challenge, and hope that the ideas found in this blog and its predecessor will be helpful. To read Dewkett’s article in its entirety, please click here.

Read our other articles on topics such as Leadership, Operational Excellence and High-Reliability Concepts:
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.GetToothFairy.com.

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Engendering Employee Engagement – A Dental Practice Leader’s To-Do List (Part 2 of 2)

7/21/2018

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Published on July 21, 2018
By: Trude Henderson
In yesterday’s blog, (“Engendering Employee Disengagement – Seven Dental Practice Management No-Nos”), we discussed Dr. Travis Bradberry’s list of demotivating behaviors. In this companion piece, we turn to those behaviors he says can be most useful to managers striving to motivate their teams and provide some recommendations specifically for dental practice leaders.
Bradberry suggests that once a manager has stopped the negative behaviors outlined in his article, he/she should do the following:

Follow what he calls the “Platinum Rule,” namely “treat others as they want to be treated.” The psychologically astute manager should reward people in ways they like best. It is our experience that the best dental practice leaders pay attention to the individual employee’s preferences when it comes to recognition. The reason: when leaders fail to personalize recognition in a way that benefits the employee, it has little meaning or value. The idea is to “reward the behavior you want repeated,” but if the employee doesn’t see it as a reward, no one benefits. What’s the point of wrapping a gift and never giving it?
Exercise strong, not domineering, leadership. Employees don’t want to be dominated; rather, they respect leaders who are firm in the face of adversity. Bradberry writes: “People need courage in their leaders. They need someone who can make difficult decisions and watch over the good of the group. They need a leader who will stay the course when things get tough”. We absolutely agree with the statement of Stanley Bergman, 2017 CEO of the Year, “The success of any organization hinges on its people,” and challenge dental practice leaders to first, ensure that they have chosen the right people with the right skills for leadership positions and second, to invest in their greatest asset, their people. One way to do this is to embrace a continuous learning journey that includes a curriculum on a variety of topics, such as leadership, conflict resolution, waste reduction and time management, in addition to the usual clinical and customer service training. A good continuous training program is one example of a system that helps drive desired behaviors (Shingo Institute, 2012). It is true that implementing such a program is easier said than done in a schedule-packed dental practice. The reward, however, is a practice filled with skilled leaders who are focused on the pursuit of excellence; one that transforms the dental office culture and grows the practice by placing its highest priority on its people.
Competently use their communication skills. Managers must strive to be good listeners. On the other hand, they should make a point of ensuring that employees understand what they are being told to do, and are encouraged to provide feedback. The pilot study found that the dental practices failing to properly define, communicate and model values, functioned poorly because staff wasted a lot of time trying to figure out what they should be doing and how they should be doing it. The result: many formal and informal procedural inconsistencies that in turn led to shortcomings in the customer experience. A simple follow-up email, for example, that recaps a meeting, coaching session, huddle or lunch-n-learn serves not only as documentation that expectations were discussed, but can also help eliminate the possibility that dental team members either ignored assignments or misunderstood them. Be sure, however, that your approach is an open and inviting one, and to ask for a reply to confirm your email was received and understood.
Exemplify desirable behavior. Says Bradberry: “Harping on people all day long about the behavior you want to see has a tiny fraction of the impact you achieve by demonstrating that behavior yourself.” Observations of the pilot practices revealed that dental teams felt more comfortable when their supervisors provided daily but friendly coaching that offered positive expectations, reinforcement and support. On the other hand, when supervisors displayed a poor attitude or bad mood, team members withheld important information, became reclusive and worse, sometimes modeled this poor behavior when interacting with patients. Practice leaders must understand that all their behavior, whether good or bad, can directly affect dental team engagement and the customer experience, as these two go hand-in-hand.
Be candid regarding company objectives and actions. Bradberry maintains that “When managers try to sugarcoat, mask or euphemize (sic) in order to make things seem better than they are, employees see right through it.” Our three-year pilot study confirmed the importance of transparency in a dental practice. The most successful practice leaders not only believe in sharing information, good or bad, but they encourage and expect transparency among team members. They understand the importance of accurate and timely information gleaned from observations, surveys and other objective metrics when formulating a more informed decision-making approach. The more precise the feedback, the better. Moreover, we have found that when practice leaders genuinely listen to the people, regardless of their official title, who have the most knowledge and experience of the task or feedback in question, the whole organization benefits from better problem-solving and an improved customer experience.
Be humble. Managers shouldn’t convey that they feel superior to employees, but rather that their superior status brings with it added responsibility. Leadership experts and authors of The Leadership Challenge Jim Kouzes and Barry Posner remind us, “It’s fun to be a leader, gratifying to have influence, and exhilarating to have scores of people cheering your every word, but it’s easy to be seduced by power and importance.” They add that as a leader, you can, “avoid excessive pride only if you recognize that you’re human and need the help of others.”
Acknowledge that employees have a life outside the office. Top performers find overwork baffling; they wonder whether they are being penalized for their good work. Furthermore, the author contends that overwork can have a boomerang effect, citing a Stanford study showing “that productivity per hour declines sharply when the workweek exceeds 50 hours, and productivity drops off so much after 55 hours that you don’t get anything out of the extra work.” We are mindful of the skills shortage in the dental industry, as well as the negative effects stress can have on team engagement and the customer experience. Our advice is to closely monitor overtime, and adjust schedules (for both patients and employees) and job descriptions, as necessary, which could mean re-training current employees to take on new or additional responsibilities. Bottom line— get creative when you are unable to increase headcount due to budget constraints or the lack of qualified candidates.

Bradberry concludes his article with the assurance that managers who eschew the demotivating behaviors and embrace the positive ones can count on being remembered by subordinates as the kind of employer most people only dream about.
We hope you find these tips useful in managing and motivating your dental team.
To read the original article, please go to: https://www.entrepreneur.com/article/286055

Read our other articles regarding High Reliability Concepts below:
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.

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High-Reliability Organizational Concepts: Insights of Value to any Dental Practice

7 More Suggestions as to How You, the Orthodontic Practice Leader, Can Motivate Your Staff

Engendering Employee Engagement – A Dental Practice Leader’s To-Do List (Part 2 of 2)

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