Tuesday, September 14, 2010

Who's the boss

Hey all,

I just signed up to do the Halloween Candy Buy Back. This is what it is: I will buy back all your Halloween candy. I will pay kids $1 per pound of candy. Then I will send all the candy oversees to our troops. I haven't done it before, but I have heard about it and have always been jealous of the guys that do it. So, I just did it. I am having a banner made for my sign (which I can use every year) and am making a press release as we speak.
Hey, I think this would be good press. And I can rid the world of dental decay one kid at a time. Not much going on otherwise.

Today's topic is going to be on Office Hierarchy. Who is the boss?

I am going to speak from a dentist's perspective. So let's talk a little about the different styles there are. I am going to list them in no particular order, and I am not going to knock any style because they all have benefits and issues.

There is the dentist that is a dictator. This style is, "This is my office. I dropped all the Benjamins to get this thing going. I am the chief. I like to make all the decisions and all decisions that I don't make have to go through me." The good about this one is the employees, for lack of a better term, "know who's boss."
Now, if you are an employee and are reading this or one of my employees reading this, don't get all bent out of shape. Let me explain myself.

When you come into a dictator's office there is none of this, "I think he/she should do this and when he/she does it, I think they should do it this way." No, this doesn't happen, because this is not even in the realm of possibility. Because if you mess around like that you would be gone in a heartbeat. This kind of dentist does not mess around. It is like North Korea: if the government hears about you complaining or talking bad about them, you end up in jail or you end up floating in a river.

The issue with this style is that you are on an island at work and, while that might be just fine for some dentists, to me, making all the decisions is very difficult and draining.

The second style of running an office is the exact opposite of the first. In this style, the dentist hates managing an office so he/she farms this job out. You will see this type of dentist hire an office manager and let this employee run the show, so to speak. The way they feel important is having the office manager give them a report. They can get involved if they so chose, but if things are running smoothly then they try to stay out of the way. This style is appealing to the dentist because they don't have to manage people or insurance or missed appointments or anything. And if something does go wrong they can blame someone else. They get to do dentistry and be concerned about teeth and that is all.

The issue I find with this one is that when there is an issue in the office and they want to change it, they get frustrated because they don't know how to communicate. So they leave it alone (hoping it will get better, even though they know it won't). And the only time they really speak up is when they are so pissed off they explode in anger. They yell at the staff but the only one they are really mad at is themselves because they should have spoken up when this fire was a spark and they know it.

The next management style is an office democracy. The dentist and the staff constantly work together to make decisions. For the dentist that likes to make decisions but doesn't want to hold all the responsibility, this is the perfect place to be. This gives the staff some ownership. In theory, they would be invested in how the office does. The job becomes a little less than a 9-5 thing.

But the issue is that have you ever tried to get 9 women and one man to agree on something. You give people decision-making power, and they might take this a little too far. One person is a little more forward than the others and the quiet person feels slighted because they haven't been heard. Or when you make a decision that wasn't what everyone wanted (say it was a 60-40 vote), 40% of your staff is going to be upset. (Please see the present American government.)

These are the three that I am going to cover today. Of course, there are blends of all of these, but I think I have hit a majority of the ways to govern.

Now here is my take. I have seen all of them. I have a friend that is a dictator. He is a super guy, but has always built a wall between him and the staff. He doesn't get emotional. Most things are black and white. There are things you can do and things that you can't. If you talk about him behind his back, you will be terminated.

There is complaining. I don't think they even have much of a Christmas/Holiday party. This is just how he rolls.

I am a people person. I am an approval-seeker, so I want constant feedback from my staff. So this style doesn't work for me, but I can tell you when poop is hitting the fan you will hear my say, "I wish I did it like he does it."

Democracy. I think it is awesome for our country, but it is tough in a dental office. I do govern this way sometimes. Like I said earlier, some people are going to be upset. Now you know that I have an alpha dog assistant and she kind of chews my ear off everyday about the way I should do things. Then she goes around and makes others understand (being very politically correct) her train of thought. Now, with the staff I have now, everyone really gets along and making a decision is easy. But this way doesn't work all the time in my office, or it might not work at all in other offices.

The office manager way of governing is the way my father did it. And it worked well for him. He is not a very confrontational guy, so if there was ever a staff issue, the office manager took care of it. She took care of insurances, she took care of getting the carpets cleaned, she talked to the lawn guy about the dry spots in the grass, she ran the staff meetings, she hired and fired. She did it all. The problem is, we don't have an office manager anymore so now we are kind of aimlessly governing.

For the first 10 years of practice, I was able to punt all decisions. If I was having a staff issue all I had to do was go to her. Let me tell you, this is a great way for a young dentist to get started. I was so concerned about not hurting a patient and getting my dentistry right it was nice not to have to deal with ANYTHING.

Now though, I think I am a combination of all three. There are times when I am a dictator. It is not always, but I have found it in me to put my foot down on some issues. It is tough for me, but I realize to be a good leader and to make myself happy sometimes I have to do it MY way.

I run the office like a democracy most of the time. I feel like it gives the staff some ownership and it makes them feel heard. And I think they make good decisions most of the time. I mean, they are consumers too. They know how about customer service. Just as long as they know they are making a decision that I would make. "How would John do it?"

And I think I run the office with an office manager sometimes too. The way I do this is by giving staff responsibilities. I will make someone responsible for a project. I tell them to make it their own. I will ask someone to get the carpets cleaned. I will ask someone to be in charge of a marketing plan for us. I will put someone in charge of all our aquariums. So everyone will be an office manager at some time or another. It seems to work. Again for me it is all about making them own this place, which I hope gives them more of a reason to like their job. And when they like their job and do it well, I am so much happier.

That's that. What do you think? Am I missing something? How do you manage?

Have a great Wednesday,


DMDrep said...

It sounds like you are a passive aggressive democratic dictator - a perfect way to run an office.

I just wanted to say that you hit the nail on e head - I have 60 active close relationships with dentists and you are absolutely right on how most of these offices are run. The most successful are usually somewhere in between the dictatorship and the democracy. The staff have input, they work as a team but everyone knows who ultimately is boss and there is utmost mutual respect.

Success in Dentistry and Life!

Anonymous said...

You have one awesome assistant, I sure hope you are paying her alot.

Suzan said...

The controlling question is does the dentist choose the dentistry to be viewed as a commodity or viewed as a health service? The former being predominantly transactional and the latter predominantly dependent upon the quality of relationship.

Presuming the latter; All behaviors are driven by values. When people share core values, they have a compass in hand. Road maps don't serve when the landscape changes and it does constantly. Therefore, a dictator, benevolent or not, handing out road maps doesn't work. A democracy is neither road map nor compass. The challenge is for the dentist, who is the only one who can hold vision and therefore lead, to select those who share fundamental and core values. Such values represent due north on the compass...for everyone. They are not "bought" they are personally owned and cherished. All actions are discussed in terms of how closely they coincide with due north. Shared ownership is an outcome of shared values. Ownership is not awarded, it's felt. The organizational culture is an outcome of those shared values. Since they are personally owned and cherished - decisions and actions come "naturally". The organization can be authentically represented without rule, order and policy and be highly responsive due to the subsequent decompartmentalization of operations.

Hiring skill over values, tolerating incongruence of core values, lack of clarity of personal core values and/or inability to articulate them so they translate to the business compass thus operations, or an inability to discern values of condidates (prospective team or clients) are matters to be concerned with unless one is more inclined to treat symptomology which changes quickly, unexpectedly and leaves the "boss" scratching their head and wanting to abdicate. If dead heads are on a team; did they get hired that way or made that way? A tip; fire fast and hire slow. The uncovering of core values is a skill and requires considerable time and deliberate conversation.

Elizabeth said...

I've thought about this a lot, thus the delay in commenting. I think that Suzan makes an excellent point... and I'll think about that when I'm eventually in a position to hire staff or an associate. At one of my offices our values all line up - generally everyone is a really hard worker, despite the fact that we're all on salary and don't have a lot of pressure on us to work hard and produce. We just all do it because its our nature. This office is run somewhere in between a dictatorship and democracy, but at the same time our office manager has a lot of input in how things are run. But, since we usually agree on the big issues, we're generally happy. So, I think it just totally depends on your office. I work a couple of days in a community health center, and it would be easier if it was a dictatorship. Currently its more like a democracy, it isn't working. Its hard to keep the staff motivated, and one of them has a particularly bad attitude and has the potential to ruin everyone's day. If it were up to me she would be out of there, but I'm not in charge, and well, I don't know the ins-and-outs of hiring and firing, so maybe I shouldn't be so quick to say that. In any event, most of the time a good percentage of the office is unhappy because no one ever agrees, even on minute things like who can take x-rays first or where to store materials. Its hard to tell who is running the show over there. Then, as the non-director, non-boss dentist, what do I do? Do I get involved in squabbles between assistants? (I don't.) Do I tell assistants to come to work on time and not leave until the day is done? (Sometimes I do.) I'm not sure.
Anyway, thanks for reading my super verbose opinion on the matter. Have a great weekend!

Suzan said...

Elizabeth I feel for you. Being a soldier is a tough job and I would support you in being just that. It may be helpful to keep in mind that questions will serve you far better than opinion. Formulate them carefully and center them on global issues; does that serve our patients better? How do you see your actions as being helpful to (our shared purpose)? EG: Can I count on you to be here on time and not leave until our patients are served completely? Interestingly enough, modelling is a powerful form of behavior. When you demonstrate being inquisitive over being "right" (opinion) it inspires thinking more than defense. Consider this; what would the world be like if more people worked to understand rather than be understood (and be right)...if they articulated the others perspective. It decompresses their need to be right. Sadly, most people who are "in charge" in dental practice, suffer from insecurities and title (or role)bringing them something they seem to need - a "better than badge" if you will. Passive aggressive behaviors coincide. Good luck on soldiering and keep your mission in mind; to make a difference which I read between the lines! I'm sure you know, it helps to pull you through even though there will be times when in walking the mine field you want to give up. Soldiers just know how to recognize the mines and go around them. Best to you Elizabeth!

gatordmd said...

I worked at a community health center for 5 years one day a week. I couldn't believe the ineptitude. There was not incentive to work. So they didn't.
They were the quintessential government worker.
But I don't know if you plan on owner your own thing one day but this is great practice. Dealing with staff can make your day so much fun and rewarding. But it also can be the hardest.
Take it from a "passive aggressive dictator" get rid of the bad egg early. If you are waiting for it to get better it won't (just keep that in the memory bank).
Hope this helps.


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.