Category: Leadership

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

2/1/2019

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.

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Millennial Employees: 6 Things for Dental Practice Leaders to Consider

8/16/2018

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Published on August 16, 2018
By: Trude Henderson

In two other blogs (on June 12th and June 27th,), we called attention to articles dealing with what dental practice leaders should know about Millennials as patients and as mothers of patients, respectively. Today we are focusing on a piece regarding Millennials as dental employees. Sally Mckenzie, in an article last February 8th in Dentistry IQ (“What you should know about your millennial dental team members”), discusses the distinctive mindset of the millennials working in practices today. She maintains that as members of this generation comprise the future of your practice, and given your desire to make your organization effective and productive, it is vital to understand six of their most important characteristics. Accompanied by our reactions, you can find them below.

Millennials are self-confident, perhaps excessively so. Many of the people in this demographic have been raised by parents who made a priority of building their self-esteem. As a result, especially when they’re new to your dental practice, they may not be the most detail-oriented employees. The writer says that you can address this by providing “detailed job descriptions, performance measurements, and continual feedback.” From our experience, if not properly addressed, the behavior of any overly- confident employee can turn your dental practice upside-down, leaving dental supervisors and practice owners wondering who is really in charge.

We have all had to cope with people like this and I recently coached a practice manager with such an employee. It was quite common for the latter to engage in untimely and needless chatter that contributed to prolonging huddles and depleted productivity and engagement. The solution that we chose was one that established clear expectations behind closed doors, including a discussion about the proper chain-of-command, a review of the job description and meeting etiquette, and the need for two-way feedback.

In situations like this, I recommend that dental supervisors get to know their employees better. It is ironic, but quite common, for dental employees like these to keep their distance without sharing much personal information. They crave your attention, but what they say too often comes across as complaints or requests regarding work. Exchanging stories about things you are interested in outside of work, or things you have in common, can be effective for expressing empathy and building rapport and trust. Gently slip in a few stories regarding life lessons or valuable experiences. Regardless of your strategy, stay positive yourself, document everything and keep communication consistent and open, so that your yearly performance review doesn’t turn out as a surprise or a "gotcha" session.
They are fast learners. This generation is, of course, highly tech-savvy and exhilarated by new technologies. McKenzie’s suggestion: try to identify the things that excite them and integrate them into their job duties— for example, provide them with continuing education or send them to trade shows. We would add that a good brand is born and nurtured using the most up-to-date knowledge, whether you’re educating your patients, staff or doctors.

We at ToothFairy view this as a huge opportunity for dental practices. Many consultants agree that having a good brand and a well-trained team are critical to long-term success. Dental practices that never stop learning, including practicing and perfecting sales and communication techniques designed to improve treatment outcomes, provide a customer experience and bottom-line vastly superior to those that don’t—not to mention, a happier, more engaged dental team!

As a low-cost solution, we recommend identifying employees who love to teach others new things and channel their energy to impart their knowledge during weekly or monthly meetings. Furthermore, we agree with Marcus Buckingham and Donald Clifton, authors of Now, Discover Your Strengths, in that strengths can often lie dormant and/or be overlooked. By encouraging employees to mentor others, you not only empower them to use their talents, you encourage the exercise of teamwork and ownership in the entire team. The authors said, when referring to the best organizations, “It must watch for clues to each employee’s natural talents and then position and develop each employee so that his or her talents are transformed into bona fide strengths.”

We recommend that you look for employees who are 1) good at a particular task (exhibit attention to detail, a high-reliability behavior) and 2) enjoy performing the task. This method can help you identify someone with a real talent or strength who can likely be a good role model and teacher. For example, if you have someone on your team who you have noticed is enthusiastic about and very good at communicating with insurance companies, they likely have a natural flair for communication. It might be worth asking them to share their tricks-of-the-trade with a small group. Keep in mind, though, that not all individuals like team interactions, particularly those of an introverted personality.
Millennials demand a work/life balance. They are reluctant to stay past 5 p.m., which can be off-putting to many boomers, who are used to working long hours to advance their careers. The best response: allow them flexible hours, but, says the writer, “just remember to hold them accountable.” We recommend focusing on results - more specifically, high-reliability behaviors that help determine whether your practice is “winning or losing” at any given moment. Examples of such behaviors: attention to detail, sustained focus, an emphasis on quality and integrity, communication (includes customer service) and teamwork.

During daily huddles, be sure to utilize objective information contained in practice metrics, social media reviews and feedback surveys to assess effectiveness, but don’t allow a surfeit of information to intimidate or confuse them, or stop paying attention but remain on the clock. Get dental team members involved in the solution if the numbers aren’t on track to meet your goals. Their ideas might surprise you because they do love a good challenge. Bottom-line: dental practice managers must have a healthy respect for millennial work/life balance if they want to have employees who are present in both mind and body.
Millennials don’t hesitate to quit when they’re dissatisfied. Whatever the cause – too many hours, inadequate compensation – millennials are more prepared than members of earlier generations to resign and look for another job, leaving you with the burden of finding a replacement. The writer suggests that to avoid this scenario, you should “talk with them about their expectations and let them know yours. Give them the direction they need while also taking the time to understand their working style and goals.” Like customers, employees need to see value. Neil Patel, who Forbes has praised as a “top 10 marketer” and the Wall Street Journal as a “top influencer on the web” has said: “Get to know your customers, respond to their needs, and give them the best value possible. You won’t just keep your customers – you’ll have happier customers.” Now, we suggest reading the sentence again, replacing the word “customers” with “employees.”
Even more than their elders, millennials crave feedback. The writer suggests providing all employees with continual feedback and detailed job descriptions. We would add that feedback between dental team members, as well as supervisor-to-employee feedback (and vice versa), is critical for a healthy culture dedicated to continuous improvement. Our pilot study found that supervisors who made giving and receiving frequent feedback a principle-based behavior, as opposed, for example, to something that only takes place in response to an incident or a performance review process, helped solve more problems, promoted higher team engagement and resulted in less turnover, than those who did not.

One of the most noticeable differences is the absence of drama experienced by the team as a whole. A likely explanation: the team was focused more on problem-solving and winning as a team, rather than on encouraging individuals to preen themselves on being "right." The challenge here is one confronting the dental practice manager, who is the one responsible for consistently modeling these principle-based behaviors, such as in the example given here, and then holding the entire organization accountable.
They insist on being paid what they are worth. Many millennials even feel that they should receive the same compensation as their more senior colleagues. McKenzie’s advice: “make sure millennials, as well as everyone else on your team, understand under what circumstances raises will be discussed and how promotions will be awarded.” We couldn’t agree more, as we are thoroughly familiar with what goes into the exhaustive compensation process. It’s simply not something that most dental practice managers take lightly, and for good reason. With this said, you can imagine what a hassle it can be when multiple employees in a large practice begin asking sporadically for raises throughout the year. Moreover, some state laws complicate the issue by restricting employers from asking employees not to discuss salary with each other. Regardless, we agree with McKenzie’s advice that you should present clear expectations upfront. Please remember that once you give in to one employee, others are likely to hear about it through the grapevine, setting off a chain reaction.

Any dental practice manager who wishes to maximize what team members of the millennial generation have to offer his/her organization should take these 6 attributes into account.

You can find the original article at http://www.dentistryiq.com/articles/2017/02/what-you-should-know-about-your-millennial-dental-team-members.html

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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4 Problems Dental Practice Leaders Must Tackle Head-On

8/8/2018

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Published on August 8, 2018
By: Trude Henderson

You must always remember that, essential as it is, technical competence will not by itself enable your dental practice to realize its full potential. 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. This includes pinpointing and solving problems as swiftly as possible and then preventing their recurrence.
You solve a problem when you understand the relationship between cause and effect and then take appropriate action. High Reliability Organizations (HROs), defined as “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,” [i] have a knack for problem-solving and communicating as a group, and do everything in their power to help prevent recurrence. What sets them apart is that they are consistently good. Their leaders encourage feedback and problem-solving in the work area, as opposed to the occasional conference room meeting, when appropriate. This is important for dental practices because rapid and effective problem-solving results in a better customer experience, lower costs and a stronger overall brand.
Below are 4 types of problems that dental practice leaders should consider addressing in the work area, as they arise, as opposed to the occasional conference meeting.

Problems of which you are certain you know the cause. If you already know the cause, it makes sense to take action right away so that the problem is less likely to be swept under the rug, and perhaps recur. We recommend that you consult the people with the most knowledge of the task at hand, then probe them regarding the possible causes of the problem, as well as possible solutions.

On the other hand, we caution you against jumping to conclusions, accepting simple explanations for problems. I recently heard about a supervisor who ran a recall report in the practice management software after learning that production had declined. The report indicated that patient recalls had been completed for the past 60 days (this practice has a policy of setting timely recalls in the practice software for every patient who doesn’t start treatment the same day; a phone call is placed for each recall and then staff checks each of them off as complete). However, the practice has a second barrier in place to double-check recalls—patient feedback e-surveys. Feedback concluded that a high number of patients had not been contacted for their recalls after all. The supervisor insisted on accepting the ‘simple answer’ (that the software was correct) but was redirected, learning that practice software recalls can be “pencil-whipped” by personnel facing time and/or management pressures. Patient feedback— feedback straight from the source— is generally more reliable.

The HRO lesson here: look below the surface and continue asking “Why?” as many times as necessary, in order to get to the bottom of any issue. Also look for trends. Avoid a cursory problem-solving process at all costs, because it generally leads to gratuitous repetition of unwanted incidents and mistakes that cost your practice precious time and money.
Problems you become aware of through social media reviews and real-time patient feedback surveys. Feedback provides you with new opportunities for identifying performance gaps that merely reinforce the status quo. I recently worked with a team that received a 1-star Yelp review. A mother expressed her disappointment in the orthodontic teams’ lack of empathy for her daughter’s pain during her finishing appointment. It was true that the patient had practiced poor hygiene throughout her treatment, but the unfavorable review could have been averted via an explanation that puffy, inflamed gums are likely to bleed when braces are removed. Nonetheless, as soon as the review was posted, supervisors and the doctor sprang into action and personally called the girl’s mother to apologize. They also hand-delivered flowers and movie tickets the same day. The upshot: mother and daughter were “wowed” by the teams’ swift response and the mother retracted the negative review. The practice manager shared the story with all locations as a pro-active ‘lessons learned’ to ensure that the same mistake doesn’t happen elsewhere. The HRO message to staff and doctors is: “when you lose focus, you lose value.” We would add: remain mindful and deeply concerned about complacency, routine and lack of engagement — treat others as you would want to be treated.[ii]
Problems directly affecting your customer experience. Given the amount of touch points, devices and time patients are exposed to during treatment, there are many opportunities to improve their experience. The more objective insights (e.g., those gleaned from patient feedback via e-surveys) you have, the more likely you are to ensure that your patients are valued, appreciated and well cared for. We recommend that dental practice leaders address customer service concerns immediately, which sets a good example for staff and doctors by signifying that problem-solving is a high priority. In addition, on-the-spot coaching can be useful in addressing the shortcomings noted from person-to-person, team-to- team, and office-to-office, as well as those identified in patient feedback surveys. Prompt but tactful reactions, in the form of positive coaching, can result in enhanced staff accountability and faster results. Please Note: we caution you to make sure that all conversations regarding these matters are out of earshot of your patients.
Problems having a negative impact on employee morale. Conflict is unavoidable in your dental practice, but the faster you address problems, the more likely you will be to prevent them from affecting individual and team morale, not to mention the customer experience and your organizational objectives. Every year, I meet new supervisors who express surprise at the number of ‘people problems’ they encounter daily. One of them told me recently, “If I had only known that dealing with people was going to be such a frustration and hassle, I never would have become a supervisor.” Leaders with weak or underdeveloped leadership skills often have difficulty dealing with people, failing to realize that embracing conflict is part of the job. Poor employee attitudes can affect the morale of your entire team and we can guarantee that this will have some level of impact on your customer experience, as the two go hand-in-hand.

We recommend that you have a good set of pre-defined behaviors or principles in place that set the bar high, as well as systems that align with them.[iii] For example, your hiring process should consist of a set of pre-defined principles and expected behaviors designed to ensure that your organization achieves its goals. And one of the most important decisions you, the practice leader, can make is to insist that the right people with the right skills are hired or promoted into the right positions, including leadership positions. If someone was hired or promoted before you became the boss and you discover that they are not the right fit, it is in the best interests of your position and the practice to remove and replace them as soon as possible. Unfortunately, it is not always easy to undo a bad hiring decision, but the consequences of ‘making do’ or ignoring the problem can be far worse. Furthermore, doing nothing will likely result in organizational decline, due to increased turnover, and poor employee engagement, team development and performance, just to name a few of the possible implications.

We repeat: the work area (including your dental practice’s front office and clinical areas) is the place where work gets done and the only place where value can be added to your dental practice and customer experience. You’ll be surprised how much problem-solving in the work area, geared towards continuous improvement, contributes to the high impact value delivered to the customer.

References[i] (Babcock & Wilcox Technical Services LLC, 2008)
[ii] (Babcock & Wilcox Technical Services LLC, 2008)
[iii] (Shingo Institute, 2016)

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

Millennial Employees: 6 Things for Dental Practice Leaders to Consider

4 Problems Dental Practice Leaders Must Tackle Head-On

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