Friday, January 27, 2017

Overcoming Challenges in Relationships

In December 2016, I completed a course with Dr. Paul Homoly about the craft of being a speaker. I have had a dream of being a keynote speaker for more than 20 years, and now, I am finally ready. 

I already have three speaking engagements booked, and two of the organizations are outside of dentistry. My first keynote speech is titled “Success Is All about Relationships,” with a secondary story about the people in our lives being a gift. With this topic in hand, and the holiday season having recently been upon us — which emphasizes positive family relationships and goodwill toward humankind — I started thinking about my relationships and how they have affected my families, both my biological family and my work family (team), as well as some problems that have occurred that are difficult to resolve. Allow me to tell you about some of the people in my life, the interactions with whom have taught me lessons over the past years.

My wife and I are both members of large families. My brother-in-law’s wife is not from a large family, and in her small family, she has managed to avoid certain relatives, including her mother and sister. After being involved in a small dispute with her, my family was not invited to their holiday celebration. My children were particularly hurt seeing their cousins posting pictures online; they did not understand why they were not invited. I don’t know how this will get resolved or even if it will get resolved. My wife’s close-knit family is slowly being divided by this one person.

I also have encountered problematic interactions with one of my employees in particular. I hired Freda* many years ago. She is a hard worker, a fast learner and had a successful career as a server in a busy restaurant chain in Calgary, Alberta, Canada. She understood teamwork, high levels of customer service and more. She was a great hire, but as time went on, she brought her personal issues to the office. She withdrew and stopped talking to people at lunchtime. She was banging drawers, rushing around and putting things away in haste, leaving the rest of the team scrambling to find things they needed — and not in a timely manner, which affected its ability to provide high levels of customer service to our patients.

Although Freda’s words stated she wanted to be a part of our team, her actions showed otherwise. To remedy this, we worked with Freda, providing her with coaching. We also provided team-based communications training for the whole office. Despite our best efforts, we ultimately found a way to help her find a different place to work. Over the course of the following six months, our productivity, production, collections and general happiness at work measurably improved.

These are just two examples I can share about dealing with challenging relationships — sometimes you can change them and sometimes you can’t. I have two families: my biological family and my work family (my team). We cannot change our biological family. We do not choose to whom we are related, nor who our family members marry. We can choose who the members of our work family will be. Success is dependent upon how we chose to navigate our relationships. The challenge is to overcome the difficult ones — or, if that is not possible, to focus instead on those relationships in your life that are positive and choose to build new ones.

May 2017 be a year of positive and fulfilling relationships for you all, in all of your families as we strive for success.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

*Name has been changed.

Tuesday, January 24, 2017

The Employee Review Conundrum

The blessing and curse of my group practice setting is having to relay/discuss/vote on decisions amongst my partners. At times, it’s a godsend — aka, those times when I have few if any ideas and I thusly appreciate the variety and breadth of opinions amongst my counterparts. Other times, though, it leads to disagreements and some heated discussions when opinions differ. 

One of the more recent discussions I can recall was around the idea of employee reviews. We’re a growing, multi-location practice with more than just a handful of employees now. Multiple doctors rotate locations on a daily basis. Although I’ve grown into having the confidence to be able to discuss a situation with a staff member in the moment, there are plenty of times in the midst of one of those days when I barely have time to check my email — not to mention discuss with my assistant the proper protocol for room restocking or CAD/CAM mill maintenance. It’s tough, and I’ll be the first to admit it.

I clearly recall a conversation with one of my assistants years ago about their previous boss who kept a Post-it® Note stack in his pocket on which he’d write down his employee’s issues, as well as potential teaching moments and growth opportunities. Although doing this would be tempting, I don’t care to be known as that boss. So sometimes, while it’s fresh in my brain, I calmly (err … not all the time) present growth opportunities to teammates. But often, instead, I’m on to the next thing — a DOL onlay prep, for example — and poof, there goes the idea to seize a teaching moment.

So what’s the solution? I’ve spent the past few weeks working on our operations manual, an organizational flowchart, etc. — the things any midsize or large corporation has to have in order to function effectively and efficiently. In section four of my ops manual is the page that covers employee reviews. We’ve never had ’em. Well, we did, and two team members quit.

So lies our conundrum. As owners, practitioners, Type Aers or simply just plain humans, we tend to focus our energy on the negative. Why?! This is just common nature, but it also is a poor quality to have, at best. Even when it comes to my best assistants, patient care coordinators or associates, I could list 20 things I wish they did better without any prep time. I’d honestly have to give thought to come up with the 20 things they do great — which is so unfortunate, because in piecing together the ops manual, they each did 200 things well! But for some reason, the growth opportunities that cross my mind on occasion are the ones that stick, the ones that I remember come review time.

So I am hesitant to begin the practice of scheduling such reviews, for fear of having the negatives outweigh the positives. I’m worried that scheduled reviews would simply turn into counseling sessions during which my teammates would “lay it all out there” — their disdain for another employee, for example. I would be careful not to anger the good/great employees with the little tweaks that would make sense in my head to outline at the time, but inevitably, I probably would just come off as nitpicky. The objective would be to be completely honest, so that my employees would actually grow and improve from them. Worst-case scenario, we would track legitimate data/records for the rare times when we would need to consult the human resources company to formulate a notice of unemployment form.

So, yes, there is clearly valuable information to be gained from reviews, but also hesitation and unease surrounding them. So how do you all handle reviews? Are they a regular (annual, biannual, quarterly) part of your practice? Do you have a magic method for focusing your energy on the positives? I’m interested to hear your thoughts.

I’d like to keep the reviews topic in my ops manual, and I’d like to eventually use scheduled review time as growth opportunities for my staff, but maybe more so for myself. I have to be a good leader, too, just as much as my employees must meet expectations, and part of that is actually leading: teaching, consulting, convening, instructing and communicating. It’s part of my job description.

Donald Murry III, DMD

Friday, January 20, 2017

The No. 1 Reason to Measure Your Patients’ Satisfaction

Recently, I had an interesting conversation with an owner colleague (Dr. Colleague) regarding the various means by which he and his staff solicit patient comments (via comment cards, website, text message, etc.). He was concerned about the number of patients who were moving their records (attrition; aka, churn rate) and figured it must be associated with insurance, patient relocation, changing jobs, big-box dental chains, competitor’s fees, etc. By the way, Dr. Colleague is a talented dentist with excellent clinical skills who has been practicing for more than 25 years. Suffice it to say, his office collections were more than $2,600,000 in 2016, and he is a popular doctor on the speaking circuit. 

Yes, I said, “collections,” not production. As a sidenote, in my opinion, production means almost nothing. It primarily serves as a benchmark from which to measure your collections and also as “bragging rights” for those of us who sit chairside at continuing education (CE) programs and tell our colleagues how successful our business is. Right or wrong, I believe this is where we get some of our satisfaction. After all, we are only human.

With regard to measuring patient satisfaction, a deeper dive into Dr. Colleague’s operation revealed that his team was trained (by a marketing firm who was selling their product) to be selective in seeking customer feedback. Unfortunately, Dr. Colleague’s team only solicits comments from customers who have displayed obvious satisfaction during their patient visit. Prior to dismissing the patient, the employees are incentivized ($1 per “positive” review) to implore the “satisfied” patient to write a review through a third party (marketing product) that is then uploaded into the dental business website.

By the way, I have no issue with team members and dentist asking for reviews or referrals. After all, I was trained in this highly internal marketing concept during my years at Hilton Hotels Corp. It is a powerful and effective way to build a patient base and is simply smart business etiquette. However, in Dr. Colleague’s case, employees were led to believe that positive reviews will offset negative reviews and that little attention should be paid to the poor reviews. This is simply wrong! There are no ifs, ands or buts about it, and no data to support their contention. Indeed, poor reviews can be vetted for the time being. However, is this any way to do business? Meta-analysis, please?

As clinicians with various levels of training and experience, we all have one thing in common. We know what it is like to experience failure (that sunken feeling) during a dental procedure and fall short of achieving the outcomes we expected. The patient or dental assistant may not detect our struggles, but we do. This built-in “feedback loop” has its advantages and serves to help us understand our limitations and/or the areas of clinical dentistry in which we may need CE or mentoring. After all, if we don’t meet the “Standard of Care,” we may have to deal with the U.S. Drug Enforcement Administration or State Dental Board. If a patient files a complaint, for any reason with any dental board in the United States, the dental board has a duty to investigate, and it will. So how does this relate to measuring patient satisfaction? We need to make sure we have a system that invites and allows every disgruntled patient to voice their opinion. Further, we need to acknowledge their frustration and concerns and take action to improve upon our deliverables, including the most important of all: five-star customer service. Without a conduit to voice their displeasure, it is only a matter of time until our patients will take to the “airwaves” (Yelp, Google, social media, etc.) and share their displeasure with the world.

With that said, there is one good thing that can come out of poor reviews. We learn to listen and improve upon everything we do. It won’t happen on its own. Make sure you have a system that invites and solicits comments from all patients — not just the satisfied. We have to know where we are failing in order to learn how to become successful.


Thursday, January 12, 2017

Vacations: Distant Childhood Memories

Last year, a good friend of mine confessed she had a dilemma: She was trying to figure out where to spend her remaining two weeks of vacation for the year. Wait … what? Remaining?! I asked how many weeks of vacation she had started with, and she casually replied, “Five.” At first, I was stunned. Then, I was jealous. Now, mind you, she has degrees in chemical and mechanical engineering and works for a top pharmaceutical company where important drugs are being developed to combat big diseases. But she doesn’t work on the weekends and doesn’t stay past 5 or 6 p.m. during any typical workday. And did I mention the five-week vacation?

I’m aware of how notorious Americans are for leaving unused vacation on the table, and recent research confirmed that we don’t seem to be thrilled about taking time off. In fact, we seem to applaud the all-work-and-no-play mindset. When I took my rare two-week vacation two years ago (after not taking any more than five days for several years), I received many astonished reactions. True, it’s about economics for many. But imagine if we were able to train our psyches to take a few days off in the midst of a long work streak. I would argue we would have more productive days following those days off, not to mention a more positive work atmosphere and better focus. In other words, we might actually reduce burnout and do our backs and hands a favor.

However, do those things really matter to us when we have packed schedules and can’t even afford to have our assistants call in sick because they have the flu, let alone a quick getaway? Besides, I wonder if my friend can empathize with dental practice owners or dentists with a solid patient base. Maybe she wouldn’t understand that even if we have a backup dentist to take care of our patients when we’re gone, we still keep those patients in the back of our minds regardless of how far away we travel. When I was staring at the Pacific Ocean during my holiday, I’ll admit I had thoughts of a bridge I had just delivered or a surgery I might have done before I left. “I hope the patient’s bite feels good and my stitches are intact …”

Besides, each day away from the office is a loss for the dental business. Practice owners can’t simply unplug from the office mentally and financially, as my friend in the drug industry may be able to.

As the holiday season came and went, I rolled up my sleeves and got to work as dental insurance benefits came to a close, while my dear friend browsed the travel section at the bookstore to plan her final fortnight of adventure for 2016. Lucky gal. 

Zeynep Barakat, DMD, FAGD

Tuesday, January 3, 2017

Deciphering the Meaning of ‘I Chipped a Tooth’

I know this is something you hear all the time: “I chipped a tooth.” This can mean so many things, especially if it is coming from a nondentist.

“I chipped a tooth” in the posterior can be a chip off the marginal ridge next to a class II restoration that you did five years ago. And if you saw this, you might just say, “It is fine,” or you might just smooth it off. Or a broken tooth in the posterior could mean the ling cusp of tooth No. 12 just broke to the gumline and below.

The question that usually comes up at our office is: How do we schedule patients who call and say, “I chipped a tooth.”

I am a doctor who does not like to schedule a “come in and we will see” visit. I know how difficult it can be for people to take time off of work or get a babysitter just so I can tell them, “Yep, you have a chipped tooth, and we can see you in three weeks to take care of this.”

Sometimes I schedule 50 minutes for a chip on the anterior that you couldn’t see with a microscope, or I might schedule 20 minutes for a “chip” when, actually, a child fell off his bike and “chipped” the heck out of teeth Nos. 8 and 9, to the point where the nerves were hanging out.

Because I refuse to do a “look-and-see” appointment, about a year ago, we bought a smartphone for the office. First, we bought it to be able to send text messages to people to confirm their appointments. We all know that calling someone at home and leaving a message on their voicemail is about as effective as sending a smoke signal (but we tried for 10 years). And nearly everyone has a smartphone these days, and everyone sends text messages (except for Grandma Nel, who we still just call). Now that we have this designated smartphone, we just ask people to send us a photo of the tooth via text message.

It can be a little tougher for a posterior tooth, but we have had tremendous success in the anterior. For example, both of these photos were sent to me by a patient who called reporting a chipped tooth.


Looking at these photos, it is pretty comical how people perceive their oral health care needs. Now that we have this technology, we can use it to help patients schedule the correct appointment.

By the way, through my mobile service provider, adding another line to my plan only costs $5 per month. (I think I bought the phone for $99.) So I am not telling you to break the bank here. I thought this was an easy way to make the office run smoother.

Have you found any ways to make your office run smoother that you want to share? Let me know.

John Gammichia, DMD, FAGD


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