Written by Don Deems, DDS Thursday, 30 November 2006 19:00
A successful dentist of 25 years, Bob has had more than his share of ups and downs in building a practice that most dentists would be proud to own. By current industry standards, he’s doing well. But there’s the other side of his practice that we dentists know only too well, the side that can’t be easily measured, the intangible aspect of being a dentist-owner-manager, the side that consultants and other industry experts can’t quite understand because they aren’t in our shoes.
You know Bob’s practice, because you live it. Bob struggles to keep his staff together, motivated, and sometimes even getting along. Employee turnover occurs more often than he likes, and hiring a new team member, not to mention the training to get the new team member productive, takes a lot of his time. And applicants for jobs in a dental practice seem to be fewer and fewer. He feels his practice isn’t large enough to have an office administrator, so he has to deal with many of the day-to-day personnel issues, which frustrates him. He’s tired from always having to keep everything together, and after so many years in practice, his energy is beginning to wane—just at the time he should be at the peak of his practice in productivity, profitability, and enjoyment.
Illustration by Cheryl Gloss
In fact, Bob’s practice has demanded so much of his time over the years, he’s gotten accustomed to not having time for anything else. Mostly, Bob feels drained, but he’s so invested in his practice that everything else takes a back seat. Besides not having the emotional and intellectual energy he once had, he has little time to enjoy his family and friends, and although he’s collected lots of toys for hobbies and interests, they, too, take a back seat these days. It’s easy to understand that Bob doesn’t have the time to take care of himself personally, and it’s showing on his aging face. He just doesn’t enjoy coming to work like he once did, and he’s lost the zest and excitement he once felt.
What’s wrong with this picture?
A HERD OF BUFFALO
In their book Flight of the Buffalo, authors Jim Belasco and Ralph Stayer discuss the old leadership paradigm that held that the leader’s job was to plan, organize, command, coordinate, and control. In essence, the old organization was very much like a herd of buffalo, which are absolutely loyal followers of their leader, even to their death. Buffalo stand around and wait for their leader to show them what to do. When their leader isn’t there, they just stand around until the leader shows up.
How much does this sound like your practice? Do you feel the strain and pull at your energy, ideas, talents, and enthusiasm to keep your team going, like Bob’s practice?
In Flight of the Buffalo, the authors propose that instead of having “buffalo mentality,” that you adopt a new leadership paradigm built around the following principles:
- Leaders give ownership for the work to those who do it.
- Leaders create the environment for ownership where each team member wants to be responsible.
- Leaders coach each team member on the development of his or her personal capabilities.
- Leaders model for their team members by becoming fast learners and encouraging their team members to do the same.
A FLOCK OF GEESE
Belasco and Stayer came up with a brilliant metaphor for this type of leadership, which they named “Leading the Journey.” Picture in your mind a flock of geese. As you know, geese fly in a V formation; the lead goose position changes often, allowing other geese to take the lead position. Each goose has a role, both as a leader and as a follower, and has areas of responsibility to the group under every situation.
As you might guess, making this a reality in your practice is not the quick-fix approach that many business gurus and consultants advocate. The transition out of your old “buffalo-leading” will be met with confusion—and perhaps some resistance—as you move into getting your team to work in a V formation. It is a process that will personally challenge you to move out of your comfort zone and let your team members lead. This process is self-perpetuating by design and will allow quick adaptation to the changing workforce, economy, and technology...every aspect of your practice that seems to vary at an ever-increasing speed. Begin by following these steps, in this order.
STEP 1: WHAT IS GREAT PERFORMANCE FOR YOUR PRACTICE?
Do all team members in your practice know what you consider to be Great Performance (GP) for their positions? Do you have a clear picture of what GP for your practice as a whole is to be? Do you have a solid understanding of what GP is for your role as dentist-leader-owner of the practice?
Start by taking the time to write out exactly what that means for your practice, each team member, and yourself. Get very clear on what you envision for your practice: the look, the feel, the mix of procedures; the style of care you want to provide; your philosophy of practice; how you want each and every patient to feel in your office... and so forth. Share all of that in detail with your team.
STEP 2: JOB DESCRIPTIONS…WITH A TWIST
Next, ask each team member to write a job description for his or her position based on previous job descriptions/duties and what you’ve outlined as GP for their positions. Coach team members on completeness, accuracy, and conciseness while they are doing it. Provide support in helping them organize what they do. It’s a great time to find out where there’s ambiguity, too many/too few tasks, lack of support, or overlap in duties from one position to the next. And this time, title the job descriptions “My Responsibilities to the Team,” with each team member’s name written beneath his or her job description.
STEP 3: DEVELOPING SPECIFIC AREAS OF GREAT PERFORMANCE
Ask team members to develop a list of 3 to 7 areas to which they can be held accountable for their Great Performance. For example, a front office position GP list might look like this:
- Ensure that all patients are satisfied with my assistance in scheduling, communication, and all financially related matters.
- Monitor all financial and insurance responsibilities I have to maximize the production and collection of the practice.
- Manage the schedule for highest productivity.
- Master all aspects of our dental practice management software to maximize my effectiveness as a partner of the practice.
- Present all information I learn throughout the year from continuing education courses to assist other team members’ professional growth.
- Ensure that all team members, including the doctor, are satisfied with my performance and teamwork.
Again, meet with each team member as he or she develops the specifics of the GP. Avoid doing it for your team members; this is part of the learning process for both of you. The GP should include all aspects of their job descriptions in a global fashion; it is not a relisting of the specific duties, but rather an all-inclusive overview.
STEP 4: MEASURING GREAT PERFORMANCE
The next step of this process is to develop ways of measuring team members’ GP. Again, this is their task, not yours. Each item listed in the GP will have a corresponding measurement. Using the example above, the measurements could look like this:
- Feedback from Patient Surveys.
- Monthly Practice Statistics and Reports Monitor analysis.
- Analysis of the Daily Monitor of the Schedule.
- Participation in 2 advanced training courses on utilizing our practice management software this year.
- Conducting presentations at 2 staff professional development meetings this year of information I learned from CE courses I took.
- Evaluations of my performance from each team member and doctor.
STEP 5: THE MEASUREMENT TOOLS
Now is the time to develop the measurement tools. And guess what? Right! You will be asking the team members to do it, coaching them along the way as they get stuck, need clarification, or want support. In what way can each of their GP items be measured as accurately as possible? Some will be simple, some more complex, depending on each team member’s role. To get you started, we’ve provided an example of a Patient Survey we’ve been using for the front desk position (Illustration).
Continuing with the front office position, assessments would be made for each of the 6 items of GP. For each of the 6 items in our example, a number from 1 to 10 would need to be agreed upon as a standard for which a reward system will later be discussed and implemented. In our example of the Patient Survey, the average overall expected score for the minimum of 10 surveys could be 9. You will mostly decide the level to which you expect the team member to perform in each of these areas, but the team member must agree it is attainable. A number too low will not sufficiently challenge the team member. Conversely, a number too high could have a demoralizing effect. Additionally, the type and frequency of assessments would need to be standardized for each position.
At this point, your coaching skills and managerial judgment will be put to the test: a new employee whose skills may still be developing may not warrant as high an average score to achieve, yet you may have high expectations for a seasoned veteran. To avoid potential problems, I encourage open communication with team members, both individually and together as a team. Once started, this process will be taken over by the team members, who you will also challenge and coach to have them challenge each other to raise their performance expectations.
STEP 6: MONTHLY REPORTING AND REWARDS
Two components—a monthly reporting summary to be presented at a monthly staff meeting, as well as a reward system—are needed to make the process complete. The first is simply a compilation of the GP Performance Standards in list form with the scores for the month filled in. In our example, there would potentially be 6 scores, which would then be averaged for an overall score for the month. Each staff member will gather his or her evaluations from the month, tabulate the scores, and report to the group at a monthly staff meeting. Your new role as dentist-coach will now require you to initiate productive and constructive conversation, as well as praise, for whatever results each team member achieved. Invite conversation in a nonthreatening way; make it about the job, not the person. Look for ways to collaborate and build bridges, not fences. Keep it upbeat, establish boundaries of conversation if needed, and pay close attention to nonverbal clues.
The second is the reward system. Why a reward system? It motivates. Instead of bonus programs that, at best, reward certain team members unfairly, now you have the standards in place specific to each team member position. Have a chairside assistant who really shines? She will get high marks and be rewarded for doing so. Have a front office person not staying in formation? She won’t get the reward. That can then lead to further discussions with that team member about what training, equipment, or supplies might be needed to achieve his or her goals, what the interest level in the position is, and so forth. The possibility even exists that the team member may see (on his or her own) that he or she needs to find a different flock!
What will your reward system look like? For most, money is a motivator, but some teams may enjoy extra vacation days, trips, or any other type of perk. How would you decide? Simply put, you don’t. You ask your team members, and they come up with the reward system. Of course, you have veto power if you feel there is unreasonableness at play, but by now, it’s unlikely that would happen.
For the sake of an example, a bonus of $250 might be decided upon for every team member who reaches the minimum overall expectation for his or her position. I would encourage you not to let an 8.9 round up to a 9. That in mind, set the standards before the first surveys and such are ever completed. There need not be any surprises! Now, reward team members immediately at that meeting for their achievement according to your agreement with them.
As each team member consistently reaches his or her goals, it may be time to re-evaluate that member’s increasing role in the practice. Perhaps new opportunities await the team member, perhaps a different position in your practice is now available, or perhaps the team member’s minimum performance expectations are ready to be raised. These conversations can happen either at a team meeting or individually, but all decisions should be discussed openly in a team meeting at the appropriate time.
STEP 7: YOUR PERFORMANCE
Conspicuously left out has been your performance. You, too, get to participate at the same level with the rest of your teammates. Your patients and your teammates will evaluate you at your level of achievement and team play. I would suggest that areas of your own performance standards include, but not be limited to, the following:
• Coach of strategic thinking of team members;
• Learning and growth (personal and professional);
• Ensuring all interactions with team members and patients are characterized by integrity and caring;
• Team member ownership.
It’s important that you challenge yourself in the same way that you’re challenging your team members. Set your standards high; be a model of growth and possibilities. Your example, openness, and willingness to learn from your successes and failures speak volumes about who you are.
At this point, congratulations are in order! Here’s what you’ve accomplished:
You’ve…engaged your team in a process of creating standards and accountability to each other and to you …raised the performance bar by defining and broadening your practice’s Great Performance …opened doors of communication between you and your staff in a different way …developed measures of agreed-upon job performance …set a system for eliciting feedback from both team members and from patients …redefined your role from dentist-owner to dentist-coach. Additionally, the focus is now on the specific standards of the job and the team member’s performance of those standards, not on the person.
Have we achieved the new leadership paradigm suggested by Flight of the Buffalo? Let’s check:
• Leaders give ownership for the work to those who do it.
• Leaders create the environment for ownership where each team member wants to be responsible.
• Leaders coach each team member on the development of his or her personal capabilities.
• Leaders model for their team members by becoming fast learners and encourage their team members to do the same.
Best wishes Leading the Journey!
Dr. Deems, known as The Dentist’s Coach, is a regular contributor to Dentistry Today and other journals. Listed by Dentistry Today the past 2 years as one of the Leaders in Continuing Education, he is in both private dental and coaching practices. The only dentist to receive the American Psychological Association’s “Best Practices” Honors in 2004, Dr. Deems regularly coaches dentists across the country on topics ranging from leadership to personal growth and fulfillment, and provides in-depth workshops on this article’s topic and more. He offers a free newsletter that can be accessed through his Web site, drdondeems.com. He recently was chosen for the ADA’s Dentist Well-Being Advisory Committee and as a Consultant to the ADA Council on Dental Practice. He can be reached at (866) 663-9903.
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