2- Your Staff

Your staff is the gatekeeper of your practice. By the time your patients see you, they already have an impression of you based on what they have seen and heard from your staff.

Addressing issues regarding staff is one the most important steps in improving your practice's performance.

Before we do this, let's organize these concern into six general areas:   

• Hiring Staff
• Staff Training
• Staff Evaluation
• Staff Retention
• Staff and Practice Image
• Firing Staff
  

• Hiring Staff

Is this not one of the most difficult elements of running a practice?

Finding good people who know what they are doing is tough, but not impossible.

One important fact we should accept is that it is very difficult to accurately judge people solely based on their resume and a short interview.

Having said this, you should always have a probationary period after hiring new staff members. This allows you to evaluate their work performance, as well as their progress. When evaluating employees.

You should prepare a series of questions that place them in real situations where they must come up with real solutions. This approach gives you a better idea of the types of thinking process each person uses.

Assistants:
For assistants, the easiest way to hire someone is through a work interview. Since you are working with them yourself you can judge their skills pretty fast and make a decision quickly. What I look at is not necessarily specific skills, but their potential and learning ability, in addition to their overall attitude (especially toward patients and other staff members).

Anyone can just do what you tell them to; what you are really looking for is someone you can trust when you are in the next room, someone who has trouble-shooting skills, and has the ability to handle stressful situations and unhappy patients.

Front Office:
Finding a good front office staff is more difficult. It is also harder to evaluate them in a work interview since you are not directly supervising the front office. However, you can design scenarios that put them in challenging situations and see how they respond.

For instance, have a phone conversation with them where you act as though you are a new patient, then see how they handle it. Give them a treatment plan to present. Come up with any other scenarios that commonly occur in your office and see how they would deal with them.

Simply giving someone a questionnaire to fill in and reviewing their resume will not provide you with enough information to make a sound hiring decision.

Another thing to consider is that in most cases, employees take around two to three weeks to show their skills and potential. If you don't see what you were looking for, do not unnecessarily drag the situation out any longer. It's hard to find a good employee, but it is much more difficult to deal with an inefficient staff member over a long period of time, not to mention the risk of compromising the entire practice. 

The final issue I want to mention here is experience. I strongly believe that the emphasis placed on staff members needing to have experience is quite overrated. I agree that an experienced new staff member may make the transition smoother and bring something to the table, but the opposite can be true too. When a new employee with twenty years of "experience" from working in one office comes to your practice to start working, do you really believe he/she brings a wealth of knowledge with them, or a load of bad habits?!

I am not trying to discredit experienced people, but let's be honest; we are not talking about rocket science here, we are talking about a profession that needs at the most a few months of training. In other words, I prefer an enthusiastic fast learner with a great attitude over a so-called experienced staff member who is not willing to move forward or learn new skills.

Review "Payroll" in the "Overhead Test" section for more on this matter.

• Staff Training

Training staff should be easy, provided you have efficient systems in place. If you need more than a week to train a back office staff member or two weeks to train a front office person on at least the basic tasks, there are two possibilities:

1. You have hired the wrong person.
2. Your systems are not setup correctly.

A simple way to figure out the source of the problem is to see how many new staff members have problems with your training system.

Staff training does not end after a week or so. As a dentist, you need continuing education; it is no different for your staff needs. They should continuously train and review existing systems, as well as learn any new procedures and policies of your practice.

Many of us may be good practitioners and even know how to run a successful business, but it may be challenging for us to teach our ideas to others.

See "Systems" for more tips on training

• Staff Evaluation

Although there are different tools you can use to evaluate your staff, the important thing is that you do it on a constant basis. I recommend the following methods:

1. Monthly evaluation forms
2. Recording staff activities

• Monthly Evaluation Forms

Every month I enclose a sheet of paper (see below) with my staff paycheck. This shows them that:

1. I am watching
2. I care about the quality of the work they do
3. I will hold them accountable

The form is designed to be simple and easy to understand. It gives your staff a breakdown of what is important to you, and makes of judging staff performance much less confusing.

• Record Your Staff's Activity

One of the biggest challenges in staff management is to keep track of who did what and when. This is especially an issue when you have a larger office. If you don't keep good records, then you cannot be fair to your staff.

I have divided a binder into different sections, one of which is for staff evaluation. Each staff member has a page. Whenever an employee does something wrong, misses something, comes in late, calls in sick or asks to leave early, I write that information with the date in his/her section. It is my office's human resource department!

This is a valuable tool in evaluating the performance of my staff; it allows me to compare them fairly, and bring their weak points to their attention. These methods help me systematically evaluate my staff, and also keep them on their toes.

• Staff Retention

Staff members choose to stay with you when they are comfortable working with you, and have a dynamic workplace that combines work, some degree of challenge and a little fun.

Contrary to what you may think, it is not all about money. Yes, money is important, but it is not everything. I strongly believe that you can hire quality staff with reasonable salaries and few benefits, and still see loyalty if you treat them right. By this I don't mean that you have to do everything they want. What I am suggesting is that you maintain a balanced management style.

Everyone keeps talking about the importance of staff retention, and I don't necessarily disagree. But when you have a staff member who has lost his enthusiasm completely and sees himself as entitled to his job, maybe losing that employee is not such a disaster!

I am sure some of you have had an experience with that one staff member who has been with you for years and thinks he/she owns the office; the one who walks in at the time of her liking and leaves at her discretion, and who treats the patients with an attitude and tells everyone what to do. There are times when, before you realize it, you have lost control of your practice and don't know how anything works anymore. Is this the "staff retention" you want?

I don't understand what the big deal is. Even though you don't want to change your staff every six months, a gradual change of staff with an average turnover of two to three years can actually be beneficial to you. Let me explain why:

1. New staff members have more energy and take tasks and responsibilities more seriously.
2. Injecting fresh blood into your practice every once in a while gives the rest of the staff a heads up and keeps them on their toes.
3. You can save significantly by keeping staff who may not have twenty years of experience, but are more enthusiastic about new ideas and are more up-to-date.
4. With a good system in place, a new staff member can blend in smoothly without the usual stresses of training.

It is challenging to keep your staff motivated year after year, without giving them more every year. Now, if there is a reason for a raise or for offering additional benefits, I have no problem with it. But sometimes staff members get bored, and demand raises only because they have been with you for X number of years. If you automatically give it to them it hurts your revenue and teaches others a bad lesson. If you don't, it can create even more trouble.

My experience has shown me that a majority of complications start with a staff member who has worked with you for 2 to 3 years. One way to keep a reasonable rate of turnover is to only give a staff member a raise when you have made more money and he/she has contributed to this improvement. Your staff should only get paid more if they have helped you make more, period. If you follow this simple rule, inefficient staff members will end up leaving you when you refuse to give them a raise, and effective and valuable employees will stay with you for years. This attitude also aids in successfully controlling your Overhead.

We have been scared of the negative effects losing a staff member may have on our practices. Even though these concerns are sometimes valid, setting up effective systems that are not reliant on individuals will ease these apprehensions.

• Staff and Practice Image

I pointed out that image is the single most important factor in marketing a practice. Your staff plays a major role in shaping this image.

Image is not just about how good we look, but how well we take care of ourselves. If your staff wears a uniform that looks like an old, $5 patterned lab coat, no one is going to accept a $5,000 treatment plan from them!

If you want high dollar patients and case acceptance, you must be presentable. Your patient does not know what an Empress crown is, and he doesn't care about a porcelain butt joint; he is buying your practice's image, not crown margin! If your practice image is worth $5,000, he will pay for it.

To create a good image, here are some guidelines you should follow:

1. Front office staff should have a dress code; professional clothing and dress shoes. They should be presentable and utilize perfect personal hygiene.
2. Back office should wear uniforms that are in harmony, with name tags. The uniform should be clean, ironed and preferably the same color for everyone, unless there is a practical reason to color-code different departments.
3. It is a good idea to use disposable gowns. It gives everyone's clothing uniformity, a clean and professional office.
4. If your front office staff has issues with wearing professional clothing, then a uniform is the best next option.
5. I can't tell you how bad it looks when you go to an office and every nurse or staff member has different types of scrubs on. Imagine going to a sporting event and seeing your favorite team players wearing non-matching jerseys! How would that make you feel? Can you honestly say that your team looks as strong and cohesive as always? Do you think your team seems to have lost the spirit of teamwork? Remember whatever you do in your office (no matter how insignificant it is to you) sends a message to your patients. Decide what the message you want to send is. This tells your patients that the office is not organized, and sends a message that this is not a good team where people work well together.

Message 1:
We do what we want, and come to work wearing the first scrubs that come to hand in the morning. We don't really care about how we look because we are not happy to be here in the first place. We don't like each other very much, and can't agree on something as simple as the color of our uniforms, let alone agree about patient care.

Message 2:
We are a team and all of us have a common goal, which is to take care of our patients the same way we take care of ourselves. We care about details, even if it is something as simple as a dress code; this extends to the quality of our dental services. We have prepared ourselves for today and care about our appearance, as well as the quality of our work.

• Firing Staff

Most of us went to dental school with little to no training or experience in business, and then came out the exact same way!  We had no idea how difficult it to fire someone, when you must fire a person who has a nice personality, but simply can't do what you expect. It is even harder to do if you have waited too long and have developed a level of friendship with that person.

So how do we do it?

The way I have done it has always resulted in everything going very smoothly, and has prevented any subsequent complications such as legal problems or complaints:

First of all, never make the decision to fire someone out of anger. You want to ensure that the decision you are making is the correct decision for your business and not an emotional reaction. If you are extremely upset with a person, do not react at that time. Forget about the movie-style firing, and forget about teaching everyone a "lesson". I know it may sound good when Donald Trump says it, but you will never gain anything from out at a person, “You're fired!"

What I do is assess what has happened, then determine whether it has been an ongoing problem. I make sure that I have done everything possible to re-train that person, and check that the systems in place are set up correctly. I also look to see if other staff members had anything to do with the existing problem. Most importantly, I check the binder (employee’s records), as well as the person's previous evaluation forms.

If you come to the conclusion that this is a serious problem where the person is hindering or damaging the practice, and is unwilling or unable to be trained, then you should give them a pep talk. Explain that you want to give them one last chance, and that you have serious concerns about their performance.

Then suggest that if they feel they cannot cope with the expectations, it may be better for everyone if they look into other opportunities they may have. Tell them that maybe it is your style that they cannot work with. Also mention that if they decide to look elsewhere, you will give them the time to do this, and will keep it confidential.

I have "fired" many staff members this way. After this talk, they would leave without any problems or bad feelings. Some of them even keep in touch and still come back to us for their dental work!

Now, if that person does not leave and wants to stay, you should give them a time period or a deadline of no longer than a few weeks. During this time, you expect them to improve to the desired level. If you don't see any progress, then you will have another talk with them.

Here you will have a firmer tone of voice, but still show care and concern. Inform them that you really think he/she is a great person and a good employee, but you believe that it is just a matter of not being a good match for that specific position in your office. Suggest that the way you have setup your practice does not match with the style he/she has.

Continue by saying that this mismatch makes you unhappy, and sometimes you may express this to that person. Emphasize that you don't like to treat people with anything but respect and the present situation makes it very difficult. Tell them that you think if they find a practice which matches his/her vision better, everyone will benefit. 

If you follow these recommendations and avoid firing someone solely based on your emotions, they will leave on good terms, and you will reduce the chance of complications (legal or emotional) for yourself. This will also help you establish yourself as a firm, reliable and reasonable employer among your other staff members.