Most dentist's training, on the business side of running a practice, is reduced to a few credit hours if they do not have or earn an MBA. Regrettably, dentists are not taught how to run the business side of a practice in any part of their studies, not in college, dental school, or even post-graduate school, as all the focus was placed (many will argue appropriately) on the quality of the care they were to ultimately provide. In fact, according to some researchers and industry professionals, less than 1% of dentists start their practice with a true business plan (not the one required by the bank to get a loan, but a true strategic plan for the new practice!). Thus, dental school has not appropriately or effectively prepared dentists to run and successfully operate a thriving business, which is where potential patients are ultimately served. Furthermore, an immense population of dentists are functioning absent any sound values and ethics of money, time, or organizational operations--they are just winging it. Most do not even look to either research, operate from a proven model, or seek the education needed in communication skills that would ultimately provide them with the ability to effectively communicate with their potential patients or staff members regarding the values of good quality dentistry.
….an immense population of dentists are functioning absent any sound values and ethics of money, time, or organizational operations--they are just winging it….
As an offered example, as an experienced manager of over 20+ years, 15+ of which has been as a practice manager and now part of a team of consultants, I have witnessed dentists who have systematically destroyed their business, organizational culture, and morale. I have also witnessed dentists who were unwilling to heed professional advice either internally from me as their Chief Executive of Management, or externally, |
from external business professionals from hired consulting firms. The stubbornness to internally reflect and or listen to established professionals proved to be catastrophic to some through the swift reduction in office productivity, to ultimately the loss of their practice all together. Our team feels that to avoid all of this, dentists need a clear understanding followed by actions regarding the three key elements of: team dynamics, patient file management, and system and policy formulation and updates, while also understanding why there is a resistance to change effort feedback. Thus, seeing and directly experiencing this carnage, we offer the following discussion regarding each key element, as a contribution to the industry, with the hopes of influencing specific and broader discussions, which could lead to effective actionable change, and for the sole purpose of the betterment of small and large dental practices alike.
Team Dynamics
As a personal example, while serving as a practice manager, I was responsible for the overall running and continuity of the practice, to include work flow. In one office, I often had to deal with the fostering of collaboration between each staff member, to include the doctor/practice owner. I found that many within the team were not versed on the key elements of practice operations, which included understanding and being able to handle and deal with client/customer needs outside their area of expertise. This lack of ability directly affected the continuity of services to clients, as clients were referred to multiple internal departments to answer what turned out to be simple questions needed to make a final decision associated with the doctor’s recommendations. This lack of continuity resulted in the loss of revenue and client confidence, some of which whom ultimately chose to find another office. Cross-training is one way to ensure that each team member can attend to client needs, without the loss of continuity in services and anxieties associated with client pass-off's.
Job enlargement, sometimes called horizontal loading, is an approach that potentially increases job expansiveness and skills by having the worker perform supplementary and diverse tasks, but all at the same level of responsibility and challenge. Job rotation is also a form of horizontal-loading, as the responsibility level of the tasks stays the same. The rotation (e.g., working with other doctors and or practice managers to learn their techniques and systems of operation, etc.) can be arranged according to almost any time schedule, such as hourly, daily, or weekly schedules. An important element to successful job rotation and cross-training in non-certified positions, is training and commitment, particularly in a small dental practice, as work relationships and verified skills are critical to successful collaboration and the ultimate accomplishment of desired overall practice outcomes and goals; starting with formulating and maintaining trust. However, how does trust play out in the team, in the context of available literature, industry practitioners, and support organizations, in terms of performance and productivity, one might wonder?
True Trust, in the context of the team, as it relates to performance and productivity specifically, is required to create the condition and team culture and demands transparency in each team members attitudes, contributions, and interactions (Dyer et al., 2013; Lencioni, 2002). Each team member, according to practitioners |
like Lencioni (2002), should feel no reason to be defensive with each other regarding their interactions or opinions, as each member should feel comfortable and safe with being vulnerable with each other (Anderson & Anderson, 2010; Lencioni, 2002). A team that is comfortable being vulnerable and candid with each other, while also operating within an environment free of the desire for individuality, is better suited for high productivity and performance (Anderson & Anderson, 2010; Curry et al., 2012); if the aforementioned conditions are absent, according to scholars, the teams output will suffer due to a need to consistently manage team behaviors and attitudes, vise team energy, and focus being placed on team outputs related to the teams mission (i.e., productivity and performance) (Anderson & Anderson, 2010; Curry et al., 2012;Dyer et al., 2013; Harvey & Drolet, 2006; Lencioni, 2002).
Electronic Files
While some scholars may have equated messy people and creativity and the use of foul language as a correlation to higher intelligence, we advocate for the antithesis of this ideology when it comes to leadership in a dental practice. Messy files, and or the lack of established effective communication systems through verbal and nonverbal responses, as well as through the efficient use of policies and systems could lead to practice paralysis.
Most practices have recognized the value in having patient electronic files (e.g., easier for providing information to insurance providers and sharing patient needs to other collaborating dental offices, etc.). However, the question is, how to convert and how long would it take; for example, do they have to scan them all starting from patient file A through Z? You may be saying that is too much work and you will never finish, but me and my team have a way for you to do this without being overwhelmed. |
Systems and Policies
Almost every office I worked at, concerning policy formulation and implementations, either did not have, were outdated by years, or did not pertain to the practice altogether. One practice I worked for had a policy manual, however, it was 12 years old! Furthermore, many of the practices, in my experience, did not even have a manual to begin with, and what was even more troubling, the doctor(s) seemed to not even care or take action; relying instead on verbal directions as their alternative. I have even created and presented policy manuals and systems, on my own off time, and still received no support, gratitude, or implementation; needless to say, I do not and would not work is such a work environment ever again. Many expressed, or implied through a lack of action, that they were not affected by not having any policies or systems, as by not having any, they, as a result, give more discretion to fire non-compliant employees. When trying to create a collaborative culture bonded in trust, they could not be more wrong!
Policies and procedures are among the first things company leaders need to establish. Policies provide needed information for the record that protect both the dentist and their staff. Policies are stated rules and standards that, if done effectively, elevate any ambiguities related to business operations. At its core, policies interconnect an organization’s culture, values, vision, and overall philosophy. They are considered a course or principle of action |
adopted or proposed by a business. Policies outline what employees can expect from their organization (e.g., employee benefits, vacation rules, customer relation expectations, and established systems of operation, etc.). Policies are adopted by an organization to reach its long-term goals and are characteristically available in a booklet, electronically, or other form that is widely available to all within the organization. They also document company expectations from employees (e.g., code of conduct, privacy agreements, etc.), and what potential customers and their surrounding communities can expect from the organization (e.g., customer service guidelines, community outreach issues and initiatives important to the organization, etc.).
Policies also lay the foundation for labor principles, while also providing some rules for decisions and actions, if needed, regarding any violations or suspected deviations from job descriptions, performances, or requirements. In short, policies create a clear and level planning field which allows for the creation of trusting relationships through transparency, while equally laying out solid ways to measure success for both the business and its collective staff.
Policies also lay the foundation for labor principles, while also providing some rules for decisions and actions, if needed, regarding any violations or suspected deviations from job descriptions, performances, or requirements. In short, policies create a clear and level planning field which allows for the creation of trusting relationships through transparency, while equally laying out solid ways to measure success for both the business and its collective staff.
Why Do Leaders Resist Feedback?
Organizational leaders resist feedback for any number of reasons, stemming from personal issues, professional issues within or outside of the organization, or a combination thereof. From a personal side of things, one example could be that leaders personally identify with more of an authoritarian type style of leading, and despite seeing the negative implications of their current approach through feedback, emphatically resist changing. Professionally speaking, the leader may, for instance, perceive that the costs of the presented recommendations (i.e., feedback) is too high, thus, resist. Another example could be that perhaps the posed feedback challenges the status quo, a condition that the leader has grown very accustomed to, thus they resist the requirements for learning new things. Change management practitioners also provide the field of organizational development a few reasons why leaders or people resist feedback. For example, scholarly practitioners Dr. Dean Anderson EdD and Dr. Linda Ackerman EdD advocated that resistance to change can stem from a threating of any one or combination of what they referred to as human core needs. In fact, in their collective text Beyond change management: How to achieve breakthrough results through conscious change leadership, Anderson and Anderson states that “we each have six human core needs” (p. 140), when it comes to dealing with change initiatives as a member of a team within an organization; Table 1 represents the six human core needs as outlined by Anderson and Anderson.
Organizational leaders resist feedback for any number of reasons, stemming from personal issues, professional issues within or outside of the organization, or a combination thereof. From a personal side of things, one example could be that leaders personally identify with more of an authoritarian type style of leading, and despite seeing the negative implications of their current approach through feedback, emphatically resist changing. Professionally speaking, the leader may, for instance, perceive that the costs of the presented recommendations (i.e., feedback) is too high, thus, resist. Another example could be that perhaps the posed feedback challenges the status quo, a condition that the leader has grown very accustomed to, thus they resist the requirements for learning new things. Change management practitioners also provide the field of organizational development a few reasons why leaders or people resist feedback. For example, scholarly practitioners Dr. Dean Anderson EdD and Dr. Linda Ackerman EdD advocated that resistance to change can stem from a threating of any one or combination of what they referred to as human core needs. In fact, in their collective text Beyond change management: How to achieve breakthrough results through conscious change leadership, Anderson and Anderson states that “we each have six human core needs” (p. 140), when it comes to dealing with change initiatives as a member of a team within an organization; Table 1 represents the six human core needs as outlined by Anderson and Anderson.
However, though we have all six, these practitioners delineated that only one or two direct and drive the bulk of our behavior, and that when one of those core needs is threatened, resistance ensues. Block (2011) also advocates for an even more pragmatic view, and detailed that most resistance stems from a threat against the leaders’ inability to either personally or professionally control a situation, or from the leaders need to show or express vulnerability.
As an experienced dental office management professional and now part of a team of organizing consultants and efficiency experts, our team can offer workable strategies and solutions to tackle these challenges, and we do this through a developed system that will not overwhelm you or your staff. However, it will take the organizations leaders (i.e., the practice owner/doctor and managers) willingness and commitment to embrace change; something that history has showed to be a concept that is accepted in theory, but rarely achieved in practice due to resistance. We discuss our experiences and recommendations here not only as a concerned professional, but also as potential clients/customers, as when a practice lacks successful team dynamics, an effective file management system, and systems and policies, everyone loses no matter which side of the dentist chair you may sit!
If you, or a colleague you know are in need of ideas or motivations for getting organized as a workforce team, Organizing Resolutions with Starks can assist. We advise and work hand-in-hand with our small business clients, to create balance and control in their organization, and we do this through uniquely tailored organizational team strategies! |
Anderson, L. A., & Anderson, D. (2010). Beyond change management: How to achieve breakthrough results through conscious change leadership (2nd ed.). San Francisco, CA: Pfeiffer.
Curry, L. A., O’Cathain, A., Clark, V. L., Aroni, R., Fetters, M., & Berg, D. (2012). The role of group dynamics in mixed methods health sciences research teams. Journal of Mixed Methods Research, 6(1), 5-20. Retrieved from https://search.proquest.com.
Dyer, J. H., Dyer, W. G., & Dyer, W. G. (2013). Team building: Proven strategies for improving team performance (5th ed.). San Francisco, CA: Jossey-Bass.
Harvey, T. R., & Drolet, B. (2006). Building teams building people: Expanding the fifth resource (2nd ed.). Lanham, MD: Rowman & Littlefield Education.
Lencioni, P. M. (2002). The five dysfunctions of a team: A leadership fable. San Francisco, CA: Jossey-Bass.
Curry, L. A., O’Cathain, A., Clark, V. L., Aroni, R., Fetters, M., & Berg, D. (2012). The role of group dynamics in mixed methods health sciences research teams. Journal of Mixed Methods Research, 6(1), 5-20. Retrieved from https://search.proquest.com.
Dyer, J. H., Dyer, W. G., & Dyer, W. G. (2013). Team building: Proven strategies for improving team performance (5th ed.). San Francisco, CA: Jossey-Bass.
Harvey, T. R., & Drolet, B. (2006). Building teams building people: Expanding the fifth resource (2nd ed.). Lanham, MD: Rowman & Littlefield Education.
Lencioni, P. M. (2002). The five dysfunctions of a team: A leadership fable. San Francisco, CA: Jossey-Bass.