his article is part 2 of a 3-part series that describes the Essentials of effective staff meetings, their ground rules and their structure. These Essentials were inspired by inquiries from colleagues who asked how we keep our meetings on track and productive. We don’t offer our technique as the only way, just our way. Part 3 in this series will tell what actually happens in our meetings, the nitty-gritty. Lest the reader think that everyone on staff follows the rules all time, let me disclaim that notion. We break the rules because we are not perfect, and then we work on our imperfections. We strive to be better. Isn’t that how it should go in the real world? We feel we have created a regular, professional context to work on our imperfections, and that is pretty neat!
“You know what’s wrong in America—I mean maybe it’s wrong all over the world, but I can’t speak for Buenos Aires or Tel Aviv or Cairo—but here in America what’s wrong is customer service. Every place I go I’m shocked by how inattentive workers are to customers, and yes, it’s easy to call the workers lazy, unfocused, or even worse (in my day we really knew how to work!), but the real fault lies at the top. It has to start with the lack of training, because despite fancy-sounding Mission and Vision Statements and Strategic Plans, there’s a real disconnect between the written word and what actually happens, between the high-sounding words and the behavior of the bosses. Are folks told not to chew gum or not to take personal calls? Are they taught the proper language and tone to use or how to be polite and how to dress? Skin and sexy are in fashion these days, but are they appropriate for business? Hardly. And what is more important, do the workers know why these behaviors convey the right or wrong message to customers? I’d bet they’re not trained. I wish the bosses knew, really knew, how all of these little things say, “We care” or “We are indifferent” ... “Customer service is what we live for” or “Customer service is just not our thing.” Imagine how much good will, how much business and market share, and how much money is lost by inattentiveness!
This rant, with more or less the same words, is repeated on a continual basis (usually by older folks, often cranky) just about everywhere in Anywhere, USA. Customer service is a dying art, and often we well-meaning practitioners don’t realize we are the ones putting the nails in the coffin.
How do you make customer service an integral part of your office culture? Every patient-staff interaction, every doctor-to-staff or staff-to-staff interaction, and every educational experience has to have as its goal the improvement of customer service. In our office we use staff meetings, held regularly and according to a prescribed format, as the model for relationship-building, which is another way of saying the ongoing improvement of quality and customer service. The meetings function not only to improve the nuts and bolts of the practice, the ever-so-important day-to-day operational issues, but also to enroll everyone, and I mean everyone, as customer service people. The result is that our dental practice has become a relationship-building organization. We are relentless about this, and you need to be too. Nothing screams, “We are exceptional!” more clearly than a staff that is extraordinarily attentive to all of the details of the patient experience. The Staff Meeting allows us to place this patient experience under a microscope, dissect it, and find ways to improve in a painstaking, deliberate, and focused manner. We feel that the relationship-building we do with each other is also the most powerful way to enhance our relationships with our patients. They, after all, are our customers.
What will follow, in this and a subsequent article, is the format of our Staff Meetings: the Eleven Essentials and the rationale behind each. Some of them have substantial support in the literature of business, leadership, and organizational life, while others are largely intuitive and need little else but a certain level of awareness and common sense.
THE ELEVEN ESSENTIALS OF EFFECTIVE STAFF MEETINGS
(2) No Interruptions
(3) No Titles, No Privileges
(4)No Hanging Back,
(5) Written Agenda
(6) Issues and Good Stuff
(7) No Defensiveness Permit-ted
(8) Support the Facilitator
(9) Leadership Training: An Ongoing Task
(10)Teach Communication Skills
(11) Encourage Humor
Essential 1: Punctuality
We place this Essential first because without it we simply cannot achieve the primary goal of providing oral healthcare that respects both our patients and ourselves. It is also placed first because while this seems the easiest Essential to master, so many doctors and staff just don’t seem to get it. This continues to surprise me. We all know how devalued and disrespected we feel when we’re kept waiting at the post office or the bank, yet we have a hard time really appreciating how our patients feel when we disrespect them the same way. In our Staff Meetings we practice collective punctuality. As Woody Allen said, “Eighty percent of success is showing up.” I would add the words on time to that statement and up the percentage to ninety.
We start and end the meetings on time. We make sure our prior patient’s appointment ends on time. And if we must end a particularly stimulating or fun conversation sooner than we would otherwise prefer, so it goes. We use time as a way of organizing our work and don’t accept the notion that we are victimized by it. The staff meeting hour is collective property, and even the boss isn’t entitled to decide how it is to be used. In time we develop the self-control to avoid starting conversations we know we’ll have trouble cutting short. I cannot stress it more strongly: we do not try to be on time, we are on time. As the advertising geniuses at NIKE once said: Just do it! It’s good for your office, and it’s good customer service.
If you think punctuality is of no great consequence or the mark of a passionless, mechanical person, and if you think that rudeness is unavoidable and an obsession with manners is old-fashioned, then I offer the following story about a patient survey we conducted a few years ago. Mind you, we have a substantial patient base, we’re a significant referral source to many dentists throughout the country, and we’re respected by our patients and colleagues. Surprisingly, when the results of the survey came in, our most outstanding feature was not our service or warmth, our wonderful laminates, or our state-of-the-art technology. It was our ability to see—and dismiss—our patients on time. This does not surprise us, because we believe that punctuality is part of honoring our contract with our patients.
A recent New Yorker cartoon captured this point perfectly. It depicted a receptionist telling a patient in a medical office, “I know your appointment with the Doctor was at 10:00, but his appointment with you was for 11:00!”
The point is, of course, that time is a social commodity, and when we make an appointment it is a social contract, a promise. To break this contract harms the relationship. To honor it nurtures the relationship. Pretty simple. And pretty good customer service!
“Time is the coin of your life. It is the only coin you have, and you only can determine how it will be spent. Be careful lest you let other people spend it for you.”
Essential 2: No Interruptions
Common sense, right? It would seem so, but so often interruptions are tolerated, focus is lost, and people wonder why Staff Meetings aren’t productive. During our Staff Meet-ings, we activate our answering service and instruct it to say, “Dr. Goldstein and staff are in a Staff Meeting and will return all calls at 3 PM.” A message like this lets your staff know you are serious about the meetings and will not permit interruptions. (And by the way, we do not eat or drink at these meetings. After all, eating and drinking are a form of interruption, and as harsh as this may sound, it reinforces the notion that the Staff Meet-ing is a work hour.) Second, the message conveys our organizational seriousness to our patients. “Wow,” they might think, “that’s an interesting activity for a dental office. Only the best organizations have regular Staff Meetings, and it’s pretty impressive that my dental office does, too.” (Please notice I am using the pronoun my, for it is exactly that sense of ownership and belonging we seek to promote.)
Both staff and patients begin to connect the value of the care (dentistry and service) with this Staff Meeting activity. Staff members know that Doc is really serious about keeping the office efficient, contented, and focused on relationship-building, and patients relate the extraordinary level of friendliness and care to this activity. Again, customer service—but also a very powerful form of internal marketing that supports practice growth as it generates personal referrals (the best kind).
Essential 3: No Titles, No Privileges
This Essential, perhaps more than any of the others, says that the office leader is prepared to give up the command-and-control leadership model and become a coach, a nurturer, and a far more sensitive and powerful leader than is possible when barking orders is the only modality of communication. That is the challenge of this Essential—and it is indeed a major challenge, particularly for the doctor.
Doctors (especially, alas, male doctors) have received an education that is shockingly deficient in leadership training. We (this writer included) are taught to be tough, individualistic, and retributive, qualities not exactly conducive to good leadership, but so subtly embedded in the culture of our society that we hardly know we’ve been trained—or, should I say, brainwashed? This angry-male, command-and-control technique is not without a following. After all, General Patton used it to help win a war, and Dr. Phil is using it on someone’s television set right now. But we all know how we feel when we’re treated like mindless drones—not very good—and so we as practitioners must lead the way out of command-and-control and into relationship-building and authentic interactions.
In almost all business settings, the dominant organizational structure, or learning model, places the doctor or teacher up here and everyone else down there. Worse than not allowing for humility, it actually promotes arrogance. Our “no rank or privilege” Essential allows the leader to be vulnerable and humble, ie, to be human. It lets the staff know there really are no glib, hard-and-fast answers to ongoing interpersonal issues in the practice. It is a terrific thing for everyone to see the leader (the dentist-practice owner) accepting the state of not knowing as a precondition for true learning. This is real modeling, and to many in the field of leadership training, it is the most authentic form of teaching.
At the effective Staff Meeting everyone is equal. You leave your title and privilege at the door (don’t be scared, you’ll be able to pick them up when the meeting is over). No, this is not the 60s and I am not advocating a leaderless group or total chaos. Each of our Staff Meetings has a designated leader called the facilitator, who holds the center of the meeting, keeps it on track, and makes sure the rules are followed. Since this job is rotated, the design creates an atmosphere of both discipline and inquiry. If the doctor is a participant in the meeting with no particular rank (not the facilitator) and behaves as just another staff member, a really powerful message is sent: the doctor is not a know-it-all and wants to learn as well. In a real sense, learning is demanded because ours is an office culture of transformation. We insist on growth.
One of our agreements is that things said at the meeting cannot be used badly or meanly afterward. No recriminations are allowed by anyone; the doctor is prohibited from holding what is said by the staff against them, and the staff is prohibited from taking advantage of the doctor’s openness outside of the meeting. We are particularly clear that opportunism is not tolerated.
In our culture, this Essential is practically unheard of. In most organizations, leaders have overarching authority and govern because of rank or educational degree. In our Staff Meeting, for its hour or 2 each week, power means being sensitive to others, being articulate and persuasive. And while this model is challenging, no other organizational form has the capacity to empower and engage the entire staff. But it isn’t words, even nice-sounding ones, that move people—ultimately behaviors carry the day. In the beginning your staff will not believe you are relinquishing your rank, even for an hour—but as trust grows over time, they will indeed believe it, and an extraordinary openness will develop. This openness cannot happen in a traditional boss/worker setting. It is much too threatening to all of us.
Let your Staff Meeting be a setting without rank.
“He who speaks without modesty will find it difficult to make his words good.”
Essential 4: No Hanging Back, No Monopolizing
This feature of the staff meeting is directly related to the skill of the facilitator. (At the early stages of this process, this will likely be the doctor, but as soon as possible the role needs to be shared among all of the staff.) The facilitator has the authority to insist that participation is mandatory, that everyone needs to work as hard during the meeting as they do during the rest of the day (different work, to be sure, but work nevertheless). The central concept is a staff fully and equally engaged in the work of the office. (By the way, it is important to go back to Essential 3 to realize the importance of an egalitarian structure. When rank and privilege exist during the meeting, the ability of the staff to be open and honest is severely restricted.)
Our diverse staff has a broad range of skills and capacities, and it requires a firm and tender hand to get everyone to play. Some folks are shy, embarrassed to speak, not particularly self-confident in groups, while others can’t stop talking. Over time these differences among the staff will smooth out. Knowing when to “give in” and when to “harden your position” will take some getting used to. Sometimes this won’t be so easy to do. But take heart—over time, it will indeed happen.
Essential 5: Written Agenda
Someone other than the facilitator should be designated to keep a written agenda and take occasional notes. These notes and agendas provide the history of the process and can be referred to as needed. (They can also serve as the written history of the practice, for those of you who have memoir writing in mind.) Recently, we have also found it helpful for the facilitator to summarize the work done and the decisions made during the meeting. This process of summarizing is not an easy skill to learn, but over time it will support focused listening and improve effective follow-through.
So there you have them: our first 5 Essentials: (1) Punctuality; (2) No Interruptions; (3) No Titles, No Privileges; (4) No Hanging Back, No Monopolizing; and (5) A Written Agenda. Meetings, even the best intentioned of them, need structure, and we are confident that if you adopt these rules, or some reasonable facsimile, you will see great improvement in both staff and patient relationships. In my next article, the remaining 6 Essentials will be discussed, including how we put the Essentials to effective use.