Pamela S. Taylor

Pamela consults in the area of dental practice management systems. Her interactive workshops focus on using measurable outcomes and establishing clear accountability to improve productivity and reduce stress within the practice. She also offers tailored individual consultations, featuring systems for measuring practice performance and dealing with staff issues, such as hiring and documentation procedures. Pamela draws from her nine years in dental practice administration and has worked with practices with gross revenues of $250,000 to over $1,000,000 per year. She also owns a dental practice with her husband, Dr. Stephen Taylor in Arvada, Colorado. Contact Pamela at 303-646-3968 or by e-mail: teethgal@aol.com.

Create Problem Solvers

Success in dentistry is multifaceted: success of the staff in their ability to extend emotional reassurance to patients; success of the doctor as a clinician; and success of the practice as a business entity. Ultimately, the overall success of a dental practice is dependant on the ability of individuals to work together to solve the inevitable problems appropriately and efficiently.

Where Is Your Control Located?

Success of individuals revolves largely around their style of interpreting their experiences. Some people have a general "victim" attitude. Someone else or circumstances beyond their control caused things to happen to them. Much of their talk sounds like, "If only she'd done this . . . " "He didn't do that . . ." or "Nobody told me . . ." These people have an External Locus of Control (LOC). They believe that control over their lives, their performance and their success lie in factors outside themselves.

In contrast, people who have an Internal Locus of Control are people who perceive themselves to be in control. Even when things don't turn out "right," internal people will evaluate the circumstances in terms of what they can do to improve the situation. Internal people focus on factors of the problem that they do control. Think of people whom you consider successful. Do they complain about things they do not control, or do they focus on the pieces of a problem that they do control?

Julian Rotter coined the term "Locus of Control," which has been implemented with great success by Bill Casey, an industrial psychologist consulting in organizational behavior management. He developed the concepts on which the following information is based. Mr. Casey's foundation of behavior management techniques can be used effectively in the dental practice to create positive communication and behavior.

Evolving Internal LOC From a Concept Into an Action

An Internal LOC is the foundation on which we will develop our problem solving strategies in the practice. First, we need to evaluate the types of problems we are trying to solve, and then implement formal practice procedures that encourage resolution by internal methods.

Two types of problems occur within the dental practice:

• Problems with practice methods or procedures
• Personal problems between staff members

Practice Problems

Dealing with problems involving methods or procedures requires the attention of the entire staff. Staff meetings are the appropriate forums for these issues, where the whole staff can provide input and support for problem solving. For example, "The front desk is not scheduling enough time for each procedure, therefore, we are regularly running behind schedule."

Staff meetings are imperative to a well-managed practice. These meetings, however, are typically unpredictable, cantankerous animals that must be managed properly in order to be productive. Staff meetings conducted with minimal guidelines, or that are out of control, are usually counter- productive.

A staff meeting has three purposes: the first is regularly to evaluate the performance of the practice; second is to introduce new ideas or cover new product information; third is to address concerns of the doctor and staff, initiate feedback, and create action plans for change. Regular staff meetings are where you can feel the pulse of your practice. It is also where you ask for response from your staff. However, doctors and office managers have often had bad experiences with staff meetings. The feeling, "I don't want to have staff meetings because they will only turn into gripe sessions" is common. It is also understandable. However, it is better to manage these meetings in a more productive way than to throw away this valuable tool.

The Action Plan

To use staff meetings to resolve procedural problems and concerns, you must provide the necessary structure. The doctor or office manager should create an agenda for the meeting that will reflect what management wants to address. Post the agenda so staff has a chance to review it before the meeting. This also gives them the opportunity to add any concerns they want to address. Staff meetings are no place for surprises. If your staff feels ambushed, this will not perpetuate a feeling of trust and professionalism in your office. Similarly, management should not be ambushed with issues by the staff. The general rule is this: if it is not on the agenda, it will not be discussed at this meeting.

Systems and change in the practice should be addressed at staff meetings, so you need a protocol (rules, if you will) that encourages staff to have Internal LOC at these meetings. It is important to ask measurable, tangible things from your staff. Going in and saying, "Okay, from this point on, I want everyone to be internal," is likely to have no effect. Establish a formal practice procedure under which anyone with a concern is encouraged to bring it to everyone's attention. However, they must also bring at least one possible solution. This is a ground rule that encourages your staff to be internal. For example, "Adequate time is not being scheduled for each procedure, causing us to run behind schedule. I can compile a list of procedures and how much time we need for each. This could be posted at the front desk as a reference."

Helping vs. Dictating

How we present an issue of change is critical to how others will perceive it. Say you are taking a flight to Hawaii for a vacation. When you arrive at the terminal, the porter at your airline approaches you and says bluntly, "Put your bags on that cart over there." You may perceive the porter to be rude and perhaps you feel annoyed as you take your luggage to the cart. How different would your perception have been if the porter had approached you with a smile and said, "Please let me help you with your bags"?

This concept applies to your approach at staff meetings. The feeling that someone is dictating change can have a negative effect. The perception, however, that someone is helping -- through efforts of their own -- will have a positive impact. When we ask staff to consider how they will help implement the solution they suggest, it reduces resentment other staff may feel whom the suggestion will affect. In our second example, the staff member does not appear to be blaming the administrative staff, but instead is taking responsibility for helping to alleviate the problem. This enables your staff to work in a positive direction.

The message this procedure sends is, "I want your input and feedback. It is valuable to me. However, we are each going to be part of the solution, not part of the problem." Also, allot a specific amount of time to each issue on your agenda so you can avoid "run-away train" discussions. Schedule separate time for unresolved issues.

Personal Problems

The other type of problem within the dental practice involves personal situations between staff members. For example, "I asked Barbara to work on recall, and she stayed on the phone for forty-five minutes making personal calls." This is not a problem with a practice system, but with a particular staff member’s behavior. This type of problem deserves personal and private attention. But we also need a protocol here to encourage staff to practice internal LOC.

The Action Plan

When staff complains to you about other employees, this absolves them of the responsibility of having to face that person. It also puts you in the middle, running from employee to employee trying to get the whole story, and creates a situation where staff members gossip behind each other's backs. Nevertheless, we can encourage our people to become internal by establishing the following: When anyone has a problem with another staff member, they have an obligation to go to that person first with their concern and attempt resolution. If no settlement is reached between the staff members, they go together to their supervisor. The supervisor will then have both sides of the story, so he/she can mediate the conflict successfully.

Facilitating Appropriate Behavior

Handling personal problems by Internal LOC will have a positive impact on communication in your office. When handling a problem in an internal way, we take responsibility for our words and actions and appropriate behavior is much more prevalent than inappropriate behavior. If you are in the grocery store and someone bumps into you while walking down an aisle, you are likely to respond apologetically with, "Excuse me." In a face-to-face situation such as this, we take responsibility for our words and actions and consequently we tend to be diplomatic and tactful.

Now consider driving down the interstate when a car suddenly cuts you off in heavy traffic. What is your reaction? The usual response tends to lean heavily toward what we would consider inappropriate in most circumstances. The fact is, we will drive away and never see that person again. We don’t have to take responsibility for our words and actions and we feel free to vent, with little restraint. When people exhibit External LOC by complaining to others about someone else, their words and actions tend to be much more inappropriate. If they are asked to deal with the problem internally and take personal, face-to-face responsibility for their feelings, response is more appropriate. By implementing this formal practice procedure, we turn our staff into problem solvers and encourage appropriate communication and expression.

Keeping the Faith

A firm commitment is necessary to keep new practice procedures in place. Management has the obligation to "keep the faith" and be aware of potential situations where staff may attempt to circumvent the established guidelines. These guidelines, or protocol, are vital to establishing an Internal LOC within the office. If a staff member wants to address an issue in a meeting but offers no solution or ideas about how they intend to facilitate their solution, the issue cannot be discussed. Let the staff member know you will be happy to talk about their concern at the next staff meeting, when they’ve had time to consider possible resolutions and their own role in implementing them.

Recognizing external behavior in dealing with personal problems is important for management as well. If someone comes through the door to your office with a complaint about Mark, another staff member, your first words to them should be, "Have you talked to Mark about this?" If the answer is no, that staff member must be asked to leave until they have dealt with the problem internally. Once your staff realizes you’re serious about this, they may try more subtle ways to communicate their feelings with you. You might be washing your hands or reviewing a chart and an employee will walk up and make a comment about another staff member. This person needs to be treated in the same fashion as the employee who approaches you in your office.

In order for these procedures to be effective, the practice must reward internal behavior. Use positive reinforcement to promote this behavior and reward staff for their efforts. Be sure your staff's evaluations reflect their problem solving efforts.

Change in any organization takes commitment to succeed. Encourage internal methods of problem solving within the practice by implementing these formal practice procedures. Your staff will then be free to make responsible, productive choices.