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4 Factors Key to Improved Performance of Your Multiple-Location Dental Practice (Part 2)

9/5/2018

Published on September 5, 2018
By: Trude Henderson

Picking up from last week: in our blog appearing in August, we discussed the first 2 of 4 approaches designed to help your multiple-location dental practice provide a consistent brand and better customer experience. Below we offer simple High Reliability Organizational (HRO) strategies designed to address these challenges (see #3 and 4) confronting such dental practices, as reported in our pilot study.

Employee engagement may decline as the distance between one location and the home office increases. Why is this? The majority of employees (both current and past employees that spent most of their time in satellite offices) that I interviewed and/or surveyed said that they felt “disconnected” in comparison to employees at the home office. After asking them to explain what they meant by that, I came to the conclusion that they did not feel that they were as important to the mission as those at the home office. Some also voiced concerns that they were functioning as ‘the supervisor’ but not getting paid for it. What can you do to improve employee engagement? Some suggestions:
1. If your satellite office doesn’t have a supervisor on site at all times, consider having a supervisor in charge pay frequent surprise visits, but don’t make these “gotcha sessions.” Rather, make them team building and relationship-building lunches or lunch-n-learns, for the purpose of getting to know employees better and building trust. In addition, check in occasionally via webcam or Facetime to offer words of encouragement, as well as to remove ‘road-blocks’ that cause frustration. We found that it was common for satellite office employees to say things like, “We’re the stepchild,” or “You only get to do that if you work at the corporate office.” The goal should be to help employees feel appreciated, included and part of the bigger picture. An improvement in accountability should follow—but this should not be the main purpose of the visits.
  
  Also, don’t appear to be asking your non-supervisory employees to function as pseudo-supervisors, with the added responsibilities but without the extra compensation that this entails, just because you’ve chosen not to place a supervisor in the office. This can quickly provoke feelings of resentment that transfer directly to your customer experience!

When hiring front office coordinators, consider utilizing personality assessments as an added tool during the interview process. 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,” [2016, May 3]), staff members equipped with sales skills who know how to demonstrate value— an aptitude for asking the right questions and answering objections effectively. We have found value in assessing candidates with a Hogan Personality Inventory (HPI) to determine fit, potential and training needs. Utilizing an assessment tool helps integrate a practice’s ideal True North behaviors into the hiring process, describing how a particular candidate might align with the values based on their HPI results. Our pilot study revealed that front office teams that were 100% Hogan “high-fit” experienced 300% less turnover in a 12-month period than those who relied only on interviews, references and intuition when making hiring decisions.

Consider hiring only employees who live within a reasonable distance (meaning their driving time rather than number of miles between offices) from the office or offices that they will be traveling to, and don’t expect them to travel to too many offices. Remember: the paycheck is not usually what gets people out of bed in the morning and that if they spend too much time away from their loved ones, they won’t likely remain engaged. This is important because if they aren’t engaged, the customers they serve likely won’t be either!

The biggest challenge is sustaining any positive changes. To make them stick:
1. Make your continuous improvement efforts part of a ‘continuous conversation.’ It’s very easy to allow competing priorities to distract you and to abandon the continuous improvement process, but doing so or being “too silent” could be some of the biggest mistakes of your career. Like leadership, your reputation or brand can take years to build and only minutes to destroy. Keep the language of continuous improvement fresh on their minds!
2. Show appreciation and say, “Thank you” often. You cannot go overboard when it comes to showing gratitude. We recommend planning for visible improvements in performance and then recognizing and rewarding the people who make those ‘wins’ possible.
3. Encourage employees at all levels imagine ways that their work process might break down or cause variances, and to be deeply concerned about complacency, routines and lack of engagement. All can adversely affect the customer experience, as well as the future of your practice. Show appreciation for employees who bring these types of issues to your attention. Your first instinct may be to show displeasure in the situation, but watch your words and body language because it’s common for employees to mistake your disappointment in the situation for disappointment in them. Most employees want to please the boss and if they sense that you’re upset, they may begin withholding information. The implications for your continuous improvement journey couldn’t be worse!
4. Make sure that your onboarding process includes an explanation of your True North ideal behaviors and continuous improvement expectations. Doing so sets expectations from day-1, as well as helps to integrate employees into your practice culture more quickly. (Remember: your culture is a mirror image of your brand.) We have found that not only are supervisors more satisfied with new hires’ performance, but that new hires are also more engaged and more satisfied overall.
5. Keep doing small things because they add up. The co-authors of the best-selling The Leadership Challenge, Jim Kouzes and Barry Posner said, “You do big things by doing a lot of small things.”
6. Pay close attention to what is and what is not working, and take action when necessary. HRO’s understand whether they are winning or losing at any given moment. They encourage transparency and decision-making, and their operational initiatives are based on information obtained from feedback surveys, observations and other metrics. You can never receive too much feedback.
7. Never stop learning. Knowledge is KING and HRO’s are continuous learners. You can find a surfeit of free information at dentaltown.com/dentistry, the founder of which, Howard Farran, DDS, MBA, has said, “Stay hungry, my friends—and hustle.” We would add that you can you never receive too much instruction in anything related to leadership and operational excellence. You must always remember that, essential as it is, technical competence will not by itself enable your dental practice to enjoy its full potential.
8. Demonstrate resilience. Leaders of organizations that successfully sustain a continuous improvement journey stay the path and actively help staff and doctors understand the urgency for prompt problem solving and the need for preventing problems before they occur. They also help them connect or reconnect to the ‘why’ behind their tasks.
9. Never stop exemplifying and modeling ideal behaviors. Help your supervisors and employees articulate the connection between right behaviors and practice success! In every practice, people are greatly influenced by those who exemplify and model these defined values, regardless of whether they have an official title. If the values aren’t specifically defined by practice leaders, staff will almost certainly define them on their own, often with disastrous results for both the practice and the patient experience.

You, the dental practice leader, deserve to feel proud of heading a multiple-office organization, but it is best to remember that the greatest rewards are reserved for those practice managers who make people (both patients and employees) the priority and consistently inspire a culture of continuous improvement. From our own experience, we have concluded that practices only become sustainable when their leaders model a service-oriented culture and seize opportunities beneficial to all stakeholders. Be that LEADER!
Works CitedBabcock & Wilcox Technical Services LLC. (2008). High Reliability Operations: A Practical Guide to Avoid the System Accident. Amarillo: U.S. Department of Energy.
Farran, Howard. (2017, August 29). dentaltown. The 7 Deadly Sins of Dentistry. Retrieved from http://dentaltown.com/dentistry
Hogan Assessments. (2016, May 3). Retrieved from http://www.hoganassessments.com/
Kouzes, J., & Posner, B. (2007). The Leadership Challenge. San Francisco: Jossey-Bass.
Rochlin, Gene. (1996). Reliable Organizations: Present Research and Future Directions. Journal of Contingencies and Crisis Management.
Shingo Institute. (2016, Jan). Leading a New Era of Enterprise Excellence. Retrieved from http://archive-org-2014.com/org/s/2014-10-26_4813234

For more information about High Reliability Organizational concepts, read our previous blogs:
Read Part 1 of this blog 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.
Visit Howard Farran DDS, Dentaltown.com
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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4 Factors Key to Improved Performance of Your Multiple-Location Dental Practice (Part 1)

9/2/2018

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Published on September 2, 2018
(This is the first of two articles, by Trude Henderson, on the lessons regarding performance learned for multi-location dental practices. Please stay tuned for the second half of this article and more on managing CX in multiple offices at once. – Ed.)
One of the takeaways of ToothFairy’s pilot study regarded inconsistencies in performance between the offices of multiple-location dental practices. Operating multiple satellite offices in addition to a main office is becoming increasingly attractive, especially among orthodontists. They see opportunities to minister to a geographic location that was previously under-served, as well as to boost their bottom line.
The example set by High Reliability Organizations (HRO’s) tells us that, if we wish to improve performance, including the customer experience, and maximize reliability, we must reduce system variability, including the variation that exists between locations. Careful thought, planning and accountability are needed to ensure that all your offices function with minimal system variability (e.g., procedures, communication, guiding principles and training,) because otherwise, you might face unwanted consequences, like higher overhead, an increase in employee turnover and the loss of patients.
During a baseline assessment prior to our 3-year pilot study, we conducted both employee engagement and customer experience feedback surveys of dental practices in the Western United States. The baseline provided invaluable insights and established a basis for comparing the situation before and after our operational excellence intervention. We would like to share with you 4 key lessons learned in the process, in addition to High Reliability Organizational tools and techniques we implanted, all of which helped reduce variability and promote the improvement of the overall brand. They are as follows:

Substantial variabilities in the customer experience between locations can constitute a significant threat to your brand. After collecting thousands of data points, carefully analyzing them and then problem-solving utilizing an operational excellence/ HRO approach, we can tell you first hand that the sooner you take steps you align your customer service across locations, the sooner your brand will improve.

One example that we would like to share with you involves a pattern that we noticed when we examined patient feedback from one practice with two different locations during our pilot study. Patients from the satellite office complained that when their local office was closed, they called the main office, as instructed. They reported that the front office staff there did not treat them with the same level of attention and respect as the staff at their local office. Local office staff were immediately briefed and the issue was resolved.

What we find most interesting in this episode is the fact that the same behaviors surfaced in employee engagement surveys – employees revealing how they felt demeaned and talked down to when they communicated with other employees at the main office. The lesson to be learned: be mindful of behavior-related trends, good or bad, because their effects on your customers are likely to spill over to your employees, and vice versa. Remember: “The customer experience is about how you make people feel!”

To help avert developments like this, we recommend that you begin with the following:
1. Examine your practice across the board and pinpoint what you have been doing when you are at your best. Then make a list of the “ideal-behaviors” (we refer to these as “True North” behaviors) that you can implement, and hold staff and doctors accountable for consistently modeling them. Be sure to model them yourself and become the process cheerleader! Utilize these behaviors to recruit, hire, promote, reward and discipline employees (referred to as aligning your guiding principles with your practice systems). Be sure to list them in your employee handbook along with your mission statement, and ask employees to acknowledge with their signature that they have received a copy.
2. Don’t let variances in the customer experience or local issues go undiagnosed or unresolved. Utilize a real-time customer feedback e-survey platform designed to measure the customer experience ‘locally’ at each office, all year long. Be sure to examine the results locally rather than across the organization and then take immediate action. Marketing expert John H. Fleming, the author of Human Sigma: Managing the Employee-Customer Experience, says, “This is critical because customers experience variation, not averages. The variability within a company easily dwarfs the differences between competitors” (from “Why Consistency is the Key to Profitable Customer Service,” Gallup, August 10, 2006). This scenario is diametrically opposed to what you want to accomplish. Your goal should be to widen the gap, so that your practice stands out as the ‘cream of the crop’, so to speak. This is critical in today’s hyper-competitive market!
3. Cross-pollinate employees. By this we mean assign your satellite employees so that they periodically work in the office(s) with the people that you believe are the best models for your ‘True North’ behaviors. This strategy provides learning opportunities for all employees.
  
  You must always remember: your culture is a mirror image of your brand. Surprisingly, offices just a few miles apart can be miles apart in culture – some to such a degree that they appear completely different practices. We recognize that every office has an ideal patient, and that the advertising needed to attract and retain this ideal patient varies between offices, but this shouldn’t be confused with the ideal behaviors and guiding principles required to build your brand – globally. Our pilot study involved some practices in which the doctors and staff together spoke as many as half-a-dozen different languages, and although their ideal patients came from vastly different backgrounds, and thus they had to take this diversity into account to properly interact with them, their guiding principles remained the same.
The fact that you already have high-performing offices in place can prevent you from sensing the urgency for action to improve the performance of underperforming offices.

We suggest:
1. No matter how busy you are, make it a priority to set aside time with supervisors each month to review and discuss metrics generated via your practice management software, feedback survey results and social media reviews of all offices (to encourage greater transparency), including the low-performing ones, so that the problems stay top-of-mind. Use visuals to paint an accurate picture. To encourage team as opposed to silo culture, be sure to include supervisors from all offices.
2. Conduct daily huddles in every office and include the voice of the customer, via feedback reports and social media reviews. Encourage a free and open environment where employees feel comfortable, feel encouraged to view challenges as opportunities and free to offer innovative solutions. Make the topic of your conversations more about the customer experience and problem-solving rather than production. When your team masters the customer experience, production will speak for itself!
3. Don’t be afraid to change your leadership strategy related to a decision you made months or years prior. Things change, people change (including your ideal customer) and technology changes daily – so something that was once good enough for your father is probably not good enough for you.
4. Resist the temptation to accept “simple” explanations for problems. We all are busy and hear a lot of excuses, but don’t settle for it. Ask a lot of questions and challenge long-held beliefs so that you can arrive at source identification and underlying causes. Be aware that when it comes to asking questions, the trick is in your approach. Make this a routine part of how you address concerns, as it will appear less likely that you are pointing fingers at individuals. Look for system flaws rather than placing blame on individuals. If you detect a problem in one department, investigate other departments and offices to ensure they too don’t share the same or similar flaws. Collect as much feedback about the problem as you can prior to deciding on its source and/or cause.

These are some factors that you, the practice leader or manager, should remember when you set about the task of reducing the number of inconsistencies in your multi-office enterprise, with the goal of improving your brand and bottom line. Hopefully our non-traditional approach to dental practice improvement, comprised of Operational Excellence and High Reliability Organizational Concepts, has given you a lot to think about. We will give you an opportunity to digest it, and discuss the points remaining in our next blog.
Works CitedBabcock & Wilcox Technical Services LLC. (2008). High Reliability Operations; A Practical Guide to Avoid the System Accident. Amarillo: U.S. Department of Energy.
Fleming, J. H. (2007). Human Sigma: Managing the Employee Customer Experience. Gallup Press.
Fleming, J. H. (2017, August 25). Gallup.com. Retrieved from Business Journal: http://www.gallup.com/businessjournal/23953/why-consistency-key-profitable-customer-service.aspx
Jon M. Huntsman School of Business. (2012). The Shingo Prize for Operational Excellence: Model & Application Guidelines. Logan: Jon M. Huntsman School of Business.

For more information about High Reliability Organizational concepts, read our previous blogs
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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4 Factors Key to Improved Performance of Your Multiple-Location Dental Practice (Part 2)

4 Factors Key to Improved Performance of Your Multiple-Location Dental Practice (Part 1)

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