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Treating More Than Just Symptoms: Current Solutions for the Economy

Recently, I was in the hospital with pancreatitis. It was extremely painful, sudden, and scary. What I have learned from that experience is that while this was a surprise in its materialization, it was neither unpredictable nor unavoidable. It was a result or symptom of some deeper root cause. In this case it was ignited by a side effect from my cholesterol-lowering statin drugs. Hmmm…talk about feeling like you can’t win! Wouldn’t it be nice that when we deal with a particular symptom, that we could eradicate the chance of it happening again? Un­fortunately, more often than not, the symptom is merely the result of some undealt-with or ignored causes that have been going on long before the symptom even reared its unattractive head—metaphorically speaking that is.

Imagine an average day at the practice, your schedule is pretty full, you just wrapped up an appointment with Mr. Reliable, and you are waiting for Mrs. Pennypincher to show up to insert her crown on tooth No. 31. You reflect for a moment on how reluctant she was to get the treatment done because she wasn’t feeling any pain or sensitivity. She had only just come in to re­ceive her biannual cleaning. There she was, sitting in the chair, and you had just gone over the findings with your hygienist. Your hygienist is a good team member, but you don’t think she educates the patients well enough on what needs to be done. As a result, you find yourself speaking to patients at length about what you want to do for a treatment plan for them.
In Mrs. Pennypincher’s case, you even remember the glassy look she was giving you when you told her she needed a crown. Figuring that glassy look stood for a "yes" to the treatment, you then sent her up to the front desk, in a crowded reception area, to get set up for her next appointment—this appointment in fact. You didn’t have time to speak with her after that since you had been already asked to move on to your next patient. However, you vaguely remember that your front desk team member had said something along the lines that it had been difficult to schedule her for the treatment. You even recall that Mrs. Pennypincher had said, "Crown? What crown? I didn’t hear the doctor say that I needed a crown," but she had made the appointment anyway. Come to think of it, you now remember that you had received a message from one of your team members that Mrs. Pennypincher had called in and asked many questions about why the treatment was necessary. She had reportedly even seemed rather upset when she finally got off the call. That was a month ago, and Mrs. Penny­pin­cher was now 21 minutes late. And, when you go up to speak to the appointment coordinator about her appointment, you are met with a bit of a cold shoulder; no surprise at the missed appointment and an attitude that reflected a bit of resignation and frustration. Actually, when you go back through the appointment book you see that she had missed quite a few appointments. Furthermore, you have noticed that your team as a whole doesn’t seem all that happy lately. In addition, your accounts receivable is way too high. What is going on, and what are you going to do?


The first thing you might think to do is "fire" Mrs. Pennypincher and all of the other patients that seem to think it is OK to miss their appointments. Then, you might as well as fire your team while your courage is high. (Perhaps they don’t like what they are doing anymore.) Then, maybe you should go home, sit down, and plan a vacation. Problems solved! Hmmm…really? This is a prime example of treating the symptoms and not curing the root causes. Let’s address a breakdown of what the symptoms and causes may be and how to eliminate them.

Importance of a Treatment Coordinator
All right, so Mrs. Pennypincher missed her appointment. Are you surprised? Given the scenario that was just presented, she had left confused and perhaps even a bit embarrassed. Maybe was feeling that she had been "sold" into treatment that was not even needed. Maybe one missed appointment can be justified, but remember, there were many. There are a few ways to drastically decrease broken or missed appointments, and to decrease the number of upset patients. One of those ways is to have a dedicated treatment coordinator. This role is very important in educating the patient on the treatment presented and answering any questions they may still have. The coordinator will then achieve an agreement to move forward with the treatment and discuss the payment method that will be used—all of this is done in a private room. Looking at Mrs. Pennypincher’s experience, education on her condition in an understandable fashion, a solid written agreement with investment to move forward, and the privacy to have an open and honest 2-way conversation were all missing in her previous visit.

Calming Upset Team Members
Let’s deal with the next obvious symptom—upset team members. I know that this is probably not the case with you and your team, but I’ve worked with many teams that had a heavy feeling of drama and gossip beneath the surface. I wouldn’t immediately see it or hear it, but with time I would start hearing the complaints behind other team members’ backs and behind the doctor’s back. Some­times there were even conspiracies to have certain team members quit or to get them fired. There have also been the times when one team member seemed to be favored more than others, with no apparent reason as to why. There could be many reasons why you could have upset team members and, whatever that reason is, one of these root causes can be remedied.
First, you must do what I call "draw a line in the sand." You must declare that the way the practice is running is no longer acceptable, and that you are taking full responsibility as a leader of the practice. You want them to identify to you what they feel is standing in the way of them operating as a world class group of top professionals. All upsets or inefficiencies are rooted in one of 2 specific conditions—a missing or a broken agreement. Create a safe space for these to unveil themselves in order to get to the truth about the underlying cultural attitudes in your office. You may have had good intentions and plans, but never fully carried them out. As a result, your team may be harboring resentment that can be a silent killer of morale and results. You see, your team might even be afraid of you. Yes, you! They don’t tell you because you sign their checks.
Security, public acknowledgement, and personal recognition for a job well done are the top 3 values of a team member…if these are not regularly fulfilled, then they go to top value No. 4—asking for more money. There are many practices that keep their salary expense low by providing safe, fun, highly respectful environments that offer autonomy and rewards based upon performance.
Having a world class team is attainable. It took me years to create a top notch group, but it would have happened a lot sooner if I had stopped blaming just them and looked in the mirror.

Are you "Busy" or Productive?
Another key distinction to having a world-class team is to shift the structure of your practice from being "busy" to being productive. Establish what I call each team member’s daily primary outcome (DPO). This is in lieu of a laundry list of bulleted job responsibilities that no one can ever remember. Have each team member focus on a metric that is tied to their area of expertise and accountability. This will put more of an acute focus on every patient interaction each day. When you reward team members individually for hitting their daily score, they do more of what you want them to do more often. When this starts to compound, you will start to see major shifts in productivity. Also, this creates an interdependent team atmosphere. This is because each team member’s scoreboard relies on the person’s performance before them in the chain of serving the patient. Once the responsibilities are known to everyone, you can gain agreement that they understand each others’ role. Then, you can effectively manage your team members if and when any of them have a DPO that is below the agreed upon target. Now you are managing facts and agreements rather than emotionally thinking a person is doing well or not.
If agreements are consistently broken then you "clear the bloody mooseheads." A bloody moosehead is like the "elephant in the room," only I use bloody moosehead because it paints a pretty clear picture. Imagine 2 people discussing the weather and their children’s sporting events with a big bloody moosehead sitting on the table between them, and neither is acknowledging the most obvious issue. These obvious but ignored issues build up continually under the surface and eventually take shape in upset, resigned, disgruntled team members. To do a total cleanse, I establish a "clear and create" opportunity every morning for my clients and their teams at the "morning huddle." During this 15 minute meeting, each team member clears anything that didn’t work the previous day, or anything that could impact their performance for the current day. Then, each team member creates an empowering goal or context for the day. Clearing bloody mooseheads is a brilliant and highly successful exercise in maintaining team satisfaction and in winning goals for the practice.
The last cause could be that your team is feeling a bit taken for granted, or simply wants a little acknowledgement. It’s fairly easy to take care of that by acknowledging your team members for actions they take that improve the practice and patient satisfaction, acknowledge yourself for the great work you do, and acknowledge excellent work by establishing a bonus system for each team member.

Implement these strategies that have been outlined here, and you will have symptoms disappearing. You will shift away from simply surviving reoccurring problems, and move into a more creative mode that will allow you time and energy to serve patients more effectively and efficiently. You and your team will have glimpses of putting out fires and stretches of being lit up every day. You will soon notice that your patients, team members, and you will be happier than ever before.

Mr. Kadi, founder of NextLevel Practice, is globally recognized as the dental expert for profound results in the lives of dentists, dental teams, and their patients. Mr. Kadi talks about daily outcomes by position and bonus systems in his It Takes a Team to Close a Case tour and in his book Million Dollar Dentistry. To reach Mr. Kadi, or to get your No. 1 unanswered question in your practice answered, call (866) 926-0914 or visit the Web site garykadi.com.


Disclosure: Mr. Kadi reports no conflict of interest.

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