The Dentist as Facilitator

My work as a personal-effectiveness coach—particularly the work with dentists and their practices, as well as with executives and their organizations—has led me into a new area of learning called facilitation. This is the process of supporting the work of a group with particular aims and goals in mind. In this article I will expand beyond what I have written about facilitation in The Eleven Essentials of Effective Staff Meetings (coachingpractice.com).

What's that, you say? You've read it?

Skeptical Worker:

Yup, I did. I even visited your Web site and read your other articles, and while the material is interesting—and, God knows, my organization is in the Dysfunctional Organization Hall of Fame—I still can't get past the notion of bringing an outsider into our meetings. I guess maybe it's my fear of upsetting the apple cart. Besides, I doubt I can get the boss (or my staff) to buy into it. Sorry. I can't see exactly how your stuff would help or how it would improve our business.

Skeptical Boss:

Yeah, well, I am a boss, and I can't quite get to the place that lets me trust what would happen if I really allowed my staff members to speak their minds or give them a serious say in what we do. I want to hold on to control. Hey, I'll be honest—I admit that the work you describe really scares me.

Okay, let's start by acknowledging that it is scary—but that doesn't mean we should use that as an excuse for inaction. Life is scary, change is scary, growth even more so. The real question is this: do you want your group to function so that it supports enhanced performance and personal growth (for you and the other group members) using an organizational process that can be replicated to support all the work of your organization?

Huh?

Right. Let me simplify: do you want to have more fun, feel more satisfied, and, oh yes, make more money to boot?

If the answer is yes, then read on. In this article, I will describe the work of a facilitative leader (a concept largely drawn from the work of Roger Schwarz1 in his book The Skilled Facilitator). It is a blueprint for the work that you must do. The work is not easy—no magical "Three Simple Steps to Instant Perfection"—but the reward is great: a well-functioning team in your practice or business.

THE PREMISE

The best functioning organizations are made up of people who work from certain assumptions about their core values. The major assumption is that the group knows what is required for the organization to be productive and flourish. Organizations are not successful solely because of individuals. Although personal responsibility and progressive leadership are indeed crucial, the operative pronoun must be we if success is your goal. The ability to bring groups (the popular word these days is teams) together to function in a coherent way is the most challenging work of any leader.

Skeptical Boss:

Sounds like chaos to me. How can I be a leader if I'm always thinking about WE?

Well, it isn't easy, but the payoff is fantastic. Let's face it: an effective facilitative leader must have the deftness of a surgeon, the courage of a bullfighter, and the compassion of an angel. The leader's goals should be the same as those of every member of the team, because facilitative leadership is collaborative leadership. The organization (ie, your dental practice) is value-based and works from certain shared, explicit assumptions—call these mission or vision statements, if you will. As Peter Senge2 writes in his book, The Fifth Discipline, since we all work from values that are uniquely our own,  shared values are important for a group to work effectively. A facilitative leader helps the organization (team) members reflect on what they are doing and improve their ability to learn. The leader helps others learn how to learn. Many dentists see learning only in terms of doing, only in terms of performance. And certainly, improved performance is the goal. But when we think about this process as mechanical, as simply improved effectiveness, we lose sight of the need for empowerment and commitment. Because each person works from his or her own value system, compliance is a very short-term outlook on improved performance.

I'm losing my hair already. So if everybody has their own value system, what else can you do but make them COMPLY?

The facilitative leader is, in effect, the teacher of a new course for staff (let's call it Leadership 101). But here's where it gets tricky. If the teacher is committed only to imparting a certain body of knowledge, then the benefits of the learning are likely to be short-lived. This is because the teacher controls. The method suppresses challenges to organizational assumptions, and without curiosity, enduring change is impossible. The staff sees the Leadership 101 course as the latest or newest leadership or management fad, and rightfully so. But as we all know, fads come and go.

You bring up a great point: how does one lead employees who are supposed to lead themselves? Many advanced thinkers in the field actually question the capacity of even heroic and visionary leaders to provide this kind of leadership.3 Yes, a leader must be responsible for his or her own learning and for motivating and inspiring staff, but the leader must also know that even if one does these things well, fundamental organizational change may still be outside of our capacities. So what do we do?

The values of the facilitative leader must have at their core the following process skills.1

No. 1: Safe and Trusting Container

Proper decision making must rest on the ability to inquire. A facilitative leader must know the key distinction between inquiry and advocacy.2 The ability to ask questions and disagree and to do so without retribution is essential. That is the only way that valid information is obtained. There must be no undiscussable issues. A critical component of information gathering is the ability to create a safe and trusting container, a place where honesty and curiosity are welcome. Frequently, staff members don't speak up because they are scared of what might happen.

No. 2: Free and Informed Choice

Valid information is important only when staff has the capacity to influence the decision-making process. Power must be shared, or the information gathering is properly seen as a ruse, manipulative, or worse. If staff must trust the facilitative leader during information gathering, the leader must trust his or her staff to effect the ongoing decisions of the organization positively.

No. 3: Internal Commitment

When staff can affect free and open decision making, the members will be more likely to feel that they are working from their own interests. This is more than a feeling; in truth, the various value systems of the people in the organization have actually been given a voice. To understand this notion better, think of the opposite, ie, compliance, and appreciate the limits of a compliant workforce.

Okay, I'm beginning to see this. You let them air their views; you listen to what they say. They feel that they OWN the decision making. And I'm supposed to become a combination of Buddha and Mother Teresa overnight.

No. 4: Compassion

That's all it takes. Everyone has it. A facilitative leader must embody compassion married to accountability—"tough love" in popular-culture terms. This requires knowing that the responsibility to the organization and its mission ultimately outweighs the personal needs of the individuals in it. Of course, this is not a simple either/or proposition. Every member of an organization needs to be seen (and to see themselves) as professional—and with that professional identity, the right choices will be made.

Sounds reasonable—but I need help, big time. Can you break this down a little, give me some kind of technique to do this stuff?

You bet. Let's begin by looking at ...

THE BEHAVIORS

No. 1: Transparency

The first behavior of the facilitative leader is transparency. To understand this fully, try thinking of its opposite: opacity. As a leader, being opaque almost always leads staff to think the worst in any situation. What a way to build loyalty! All of your actions must be open to staff, including the reasoning and the intent behind those acts. This is another way of saying that one must act with integrity; the thoughts and actions behind a leader's words must be congruent. Think of not only sounding believable, but being believable. This behavior requires courage because it says to staff that you trust them, really trust them.

Let me see if I understand you correctly. You want me to actually expose my thinking process and my intentions to staff?

Yep.

But I want to get things done—what happens if my motives are self-serving and I'm not acting in the best interests of the person I'm speaking to?

That's exactly the point. If your intentions run counter to the expressed values and commitments of the organization, you are already being inauthentic or worse. Your work, in that case, becomes much harder. How do you realign what you say and do with the organizational belief system that exists in the organization? (Oh, and by the way, not being transparent is really easy to spot, so you're not fooling anyone but yourself and doing great damage to the organization.)

No. 2: Curiosity

This behavior is a sure mark of an effective facilitative leader and a cornerstone of any organization that values learning. A leader must be open to the opinions of staff and the reasoning behind those opinions. This ability to be open leads to an appreciation of how imperfect our decision making—and our thought processes in general—often are. Curiosity supports our ability to be humble, and it is from this humble place that great contributions from everyone on staff can occur.

I'm humble—I'm humble as pie! But look, as the owner and the dentist don't I have the right to have my opinions prevail? Isn't that how it ought to be?

A right isn't the correct way to describe it. An assumed privelege,  maybe. I do know that if you run your practice or business in a unilateral, I-have-the-right kind of fashion, you will dramatically limit the contributions of your staff. You will disempower them. Your office (business) may even be efficient and well-run, but the ramifications of your failure in this area will surely inhibit the growth of your staff members. PS,  don't be surprised when they decide to move on, perhaps to jobs that nourish them in a way that you can't.

No. 3: Systematic Thinking and Acting

A facilitative leader appreciates that the organization is a system and that his or her role is as a steward for that system. This requires the following: (1) an acute awareness of the morale of every staff member, (2) an ability to delegate and trust the decision-making capacities of other staff members, and (3) perhaps most importantly, an awareness that the leader

doesn't know everything. Humility, as I mentioned earlier, allows others to shine and grow.

Systems thinking, as op-posed to short-term and linear thinking, has the huge advantage of appreciating the unintended consequences of a particular action. The literature calls this a feedback loop, and the failure to appreciate this almost certainly means that each individual, at some level, is operating unconsciously. The feedback loop allows the facilitative leader both to recognize contributions to performance and to assign accountability in a way that allows the staff to appreciate itself as a living, functioning, growing organization.

This stuff sounds interesting, but it's really complicated. All I want to do is simplify how things get done, improve efficiency, reduce waste, and ultimately improve our bottom line. What you're describing sounds like I have to be aware of everything all the time.

I think the language that describes the process is actually more complicated than the process itself. Systems thinking is not some overlay on reality; it is reality. See if this story helps.

Sally, your assistant, has been at odds with the front desk person. Sally feels that you have not been sympathetic to her position. Recently, some tension has developed between Sally and you, and that tension is reflected in the operatory. Your patient notices that something is different between you and Sally; until now you almost always worked very harmoniously. Today something is awry, and today you have presented a comprehensive treatment plan to the patient. After the presentation you are called out of the room for a moment to do a recall exam. The patient, who has known Sally for a long time and trusts her opinion, asks her about the appropriateness of this complicated (and a tad intimidating) treatment plan. Sally, who is still perturbed at the perceived slight, is not terribly enthusiastic about anything associated with you at this moment, and she responds in a really noncommittal way: "I guess it sounds okay," she says. Sally is not even aware how her response is experienced. The patient sees this flat answer as a negative statement about the treatment plan and decides to "wait for awhile" before proceeding.

If you were thinking systematically, you would have known the unintended impact an office spat can have on all patient/staff interactions. You would have made it a point to clear the air before anything bad could have happened. If I may recast Murphy's Law a bit: awareness and diligence are the only antidote to unintended (and bad) outcomes.

It is important to realize that the foreground skills—linear ones such as budgets, procedure manuals, clinical and management skills, systems skills, if you will—are indeed important, but they are not everything. Without the background systemic thought processes, things may quietly (and unconsciously) erode the office. And what's worse, you may not even see it happening. Being aware is the key. Life is a bit like this.

No. 4: Accountability and Ownership

This fourth behavior has the biggest organizational payoff. Without it, everything is dependent on one person. In the Sally/front desk person disagreement above, let's analyze what the leader could have done:

"• refused to take sides;

"• treated both parties with dignity and respect; and

"• considered bringing the dispute to the entire group to facilitate the process of conversation, rather than suggesting who is right or wrong.

Keep in mind that you and the group are building capacity and accountability. Keep in mind as well that supporting dependency will come back to bite you.

But you're contradicting yourself. The facilitative leader is responsible for the overall performance of the organization, and yet even when that person knows how to do something better, more skillfully, and faster, that leader has to step back from the problem or question. Is that right?

Well, we're not talking about locating the water bucket during a fire! If the staff person is asking a question whose answer would become clear with a bit of thought and direction, then absolutely, I would refuse to answer. Actually, I even believe that a reasoned mistake is a learning experience and is to be encouraged. My personal style is to answer such questions with silence, which loudly conveys 2 things: my opinion that the answer should come from someone other than me and my expectation that it will. You see, it is too easy for me to answer everything. Despite my knowledge and training and the reasonable chance that I will know the answer, I believe that spoon-feeding fosters a zero-growth mentality—and I refuse to do that. For this to work, you have to trust the people on your staff. If your core values and behaviors are in place, then your staff will feel supported in the journey to learn.

No. 5: The Conditions for Mutual Learning

Okay, let's face it, there's no guarantee that every staff person will embrace these behaviors or see the intrinsic worth of the core values. But that doesn't mean that you, as the facilitative leader, should bully people or use all your powers to get them to "buy into" your perspective. That would be a form of manipulation under the guise of freedom of choice. This is an important point, especially given that many leadership books advocate elaborate methods of getting staff to buy into the boss' perspective. Even if the ends of the process are good—and even if the manipulation is subtle—you will be directly violating organizational core values.

To foster the conditions for mutual learning in our dental office, we hold regular Staff Meetings and adhere to an agreed-upon format. Within this setting there is freedom of expression—without that, all of what we have been striving for is inauthentic.

Now you really have lost me. I thought getting staff to "buy into" office perspectives or strategies and tactics was the goal of effective management, and now you're telling me it's really harmful. So what gives?

Let me try to explain it more clearly. I have spoken about the difference between compliance and commitment.

Sure. Being compliant means I do something because you want me to do it and being committed means I do something because I want to do it. Right?

Right. Now make that distinction as you think about working with your staff. Do you want to work with compliant or committed people?

Committed ones, of course.

Then the important question to ask yourself is this: are you willing to take the risks, to have the courage to offer your staff the freedom to choose, when one of the possibilities is to choose not to follow you? You may have to reach deep for the answer. It's a big plunge.

The payoff? Working with a committed staff is more productive, more profitable, and more fulfilling than anything you can imagine.

I'm ready to imagine—I think. Where can I find out more?

I close with an invitation to revisit  the Web site coachingpractice.com, where you will find The Eleven Essentials of Effective Staff Meetings. These are the ground rules we use to support our learning organization, the ultimate facilitation machine.


References

1.Schwartz RM. The Skilled Facilitator. San Francisco, Calif: Jossey-Bass, Inc; 1994: 331-334.

2 Senge P. The Fifth Discipline: The Art and Practice of the Learning Organization. 1st ed. New York, NY: Currency Doubleday, Bantam Doubleday Dell Publishing Group, Inc: 1990: 186, 198-202.

3. Manz C, Sims H. Searching for the unleader: organizational views on leading self-managed groups. Human Relations. 1984;35:409"“424.



Dr. Goldstein is a 1968 graduate of the University of Pennsylvania School of Dental Medicine. He is the immediate past president of the Academy of Laser Dentistry as well as a certified professional coach. He received his certification credentials from New Ventures West after taking its 1-year professional coaching course. Dr. Goldstein is a fellow of the American College of Dentists and serves on the dental advisory board of Dentistry Today. Dr. Goldstein maintains both a general dental practice as well as a coaching practice in New York City and can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or by visiting coachingpractice.com.


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