Written by Don Deems, DDS, FAGD Friday, 31 December 2004 19:00
In comparison to other small businesses in the United States, most dental practices do not fail financially during their first 5 years. Nevertheless, the toll exacted upon their owners—most often dentist-owners—can be profound. Dental practices are affected by employee turnover, absenteeism, and other workplace problems. The dentist-owner may suffer the consequences, including stress, fatigue, and behavior modification. In reality, even the most highly successful dentists encounter difficult periods in their practice.
Developing a practice that is emotionally healthy is paramount to achieving personal and professional success. The dentist?s willingness to look openly at and address workplace practices and to develop healthy workplace practices in the office will have a profound effect on contentment and fulfillment.
This article will address a topic highly relevant to successful dental practices: creating and managing a practice that is psychologically and emotionally healthy for employees and owners.
THE COST OF NOT HAVING A HEALTHY WORKPLACE
Even more important than technical skills, the ability to manage a practice will determine the practitioner?s success. Of course, technical skills and knowledge are paramount to clinical success in dentistry, but appropriate concern for the health of the workplace may ultimately determine professional fulfillment.
Unhealthy workplace practices account for a high rate of employee turnover, increased absenteeism, high levels of workplace stress, chronic conflict, emotional abuse, work sabotage, and even workplace violence. Employees? perception of their work-life imbalance becomes amplified, health and well being may suffer, and costs for medical care, insurance, and time off due to illness will increase. Employees can develop drug and alcohol addictions as a coping mechanism for dealing with stress. The result will be a decrease in productivity, profitability, and fulfillment.
When the workplace environment is unhealthy, the cost exacted upon the dentist can be staggering. Dentists can suffer from the same stress-related maladies as the employees and can become angry, disillusioned, disappointed, depressed, and overly fatigued. It interferes with the ability to enjoy life's work. The passion for dentistry is lost, and even worse, for helping people—one of the major reasons for individuals to become a dentist. And because of the solo ownership nature of most dental practices, it is unclear if others feel the same way.
MAKING A DENTAL PRACTICE A BETTER PLACE TO WORK
In 1999, the American Psychological Association (APA) recognized and understood the tremendous cost to businesses of any size of not having workplaces that are conducive to sound psychological health. That year, this association introduced an award to recognize organizations that made a commitment to workplace well-being and creation of a psychologically healthy workplace for employees.1
According to a 2000 poll by the APA, two thirds of both men and women say work has a significant impact on their stress level, and one in 4 has called in sick or taken a "mental health day" as a result of work-related stress.2 Healthcare expenditures are nearly 50% greater for workers who report high levels of stress.3 Any organization that recognizes these issues and strives to address them not only helps its employees but improves the organization. When workers can manage stress and balance their work and their life, productivity improves. Workplace practices can have a significant effect on employee commitment, satisfaction, and health.4,5
When the economy is challenging, companies (and dental practices) seek to cut costs associated with employees, such as reducing health insurance benefits, decreasing work hours and fringe benefits, and placing less emphasis on work environment enhancements and improvements. Expending more effort and money to create a healthy workplace might appear to be a better choice in times of abundance rather than during an economic downturn, but this is not always true. These investments are needed when the workplace environment is unhealthy.
WHAT IS A HEALTHY WORKPLACE?
There is no single model of the healthy dental workplace. No one practice is exactly like any other. In general, practices that are healthy are those that have engaged employees: the employees feel invested in the success of the practice because they see the practice has invested in their success. Practices have begun to see real benefits to investing in their employees' emotional and physical health.
Improving communication throughout the organization (thereby increasing employee involvement in decision-making) or providing flexibility to balance work and personal issues are significant workplace practices. In fact, according to a 2002 job satisfaction poll conducted by the Society for Human Resource Management and USA Today, these are among the most important issues for employee satisfaction.6 Prince has stated that companies are finding that not only do healthy workplace practices make employees more satisfied, but also more productive.7
Clear and candid communications, a voice in decision-making for employees, a fair employee performance evaluation system, and recognition for individual and team performance are needed.
Cawley, et al, looked at the importance of a fair employee performance evaluation system that gives feedback and enhances performance. They found that when given the opportunity, employees actively participate in performance appraisals (voicing their opinions), and consequently there was an increase in perceived fairness of the appraisal process, increased motivation to change following the appraisal, and increased ratings and satisfaction of the appraisal process.9
Parker, et al, examined variables that contribute to safe work practices, namely the quality of communication, job autonomy, supportive supervision, and safe-working protocols. They determined that managers can do more than introduce rules, punishments, or other control measures. They must also demonstrate a supportive, coaching management style, enrich the workplace by enhancing job autonomy, and communicate and share information with their employees.10
Brown and Leigh demonstrated the impact of a perceived healthy psychological climate in the workplace on employees' effort and performance. The components of that climate were the extent to which management was perceived as flexible and supportive, role clarity, freedom of self-expression, employees' per-ceived contribution toward organizational goals, the adequacy of recognition received from the organization, and job challenge.11
Policies must consider personal and extended family needs.
Psychological research can impact workplace conditions so as to create workplace policies and practices that affect the human condition.12 It was noted that 85% of the US work force now live with family members; 62% of mothers with infants and toddlers, 68% of mothers of preschoolers, and 77% of mothers of school-aged children are em-ployed; and 69% of all men and women have elder care responsibilities. It was concluded that "One outcome of these shifting demographics may be a legitimization of the work-family balance issue such that companies become more aggressive in establishing policies and practices that are more family-friendly."
Earlier, Fernandez quoted the Public Personnel Management journal as saying, "Employees who perceive supervisors as understanding of family related demands have better attendance, are more productive, and stay with companies longer."13
Zedeck and Mosier re-viewed the difficulties of balancing family and work de-mands. They examined different approaches organizations can take to ease this burden. They discovered that family-friendly organizations are praised as the most desirable companies to work for. They also found that workers who are absent to deal with family issues can lead to decreased productivity, preoccupation with childcare problems can cause decreased concentration at work, and trouble with scheduling childcare often causes lateness.14
The National Research Council found that a lack of social support from supervisors in regard to family issues was highly correlated with employee depression, low levels of organizational commitment, and the number of physical complaints that were filed.15
Employee Growth and Development
Offering programs that deal with workplace stress and conflict and allow easy access to psychological services.
The importance of addressing mental health in the workplace was examined by Sauter, et al, and they proposed specific mechanisms by which organizations might become more psychologically supportive. In 1990, it was noted that 11 million people reported health-endangering levels of mental stress while at work, including excessive work load, lack of job/career security, and poor interpersonal relationships in the work environment.16
Hatfield noted that the United States was the world's most technologically advanced nation, but only ranked fifth in terms of productivity per worker. He stated that worker stress is one major reason for this contradiction.17
Systems can be implemented to improve employee morale and bolster job performance. One such program that contributed to employees' growth and development is a program at the Ohio State University College of Osteopathic Medicine. Its program included increased communication, input into decision-making, adequate coverage for needed vacations and absences, and recognition of accomplishments and contributions.
In the healthcare setting, a 2-year longitudinal study showed that the introduction of stress-management programs in hospitals correlated with reduced malpractice claims. The stress-management programs included having consultants implement policy changes to manage stress, such as encouraging employee feedback and having employees watch a videocassette training series on understanding stress. Also, an employee counseling program was implemented that allowed employees and their families to seek help for both work-related and personal problems.18 The efficacy of psychoeducational stress-re-duction programs in improving both psychological health and job performance of emergency medical workers has also been examined. Three types of stress reduction treat-ments were examined: progressive muscle relaxation, coping skills training, and interpersonal awareness training. All 3 interventions were associated with improved performance on both psychological and job performance measures.19
Easy access to a wide range of psychological services, not just traditional substance abuse programs, means that employees are more likely to experience a psychologically healthy workplace. Baba, et al concluded that having mental health problems in the workplace resulted in decreased job involvement, satisfaction, and performance and increased turnover and absenteeism.20 Martin published statistics on the impact of mental health on a company's profits. Depression, for example, costs businesses $47 billion a year in disability claims. Martin also reported that depressed employees were less productive.21
Health and Safety
A priority should be placed on employee health and safety.
There are numerous studies that illustrate the impact of placing a priority on health and safety in the workplace. One of the most important was by Gebhardt and Crump. This report outlined a number of fitness programs that have been implemented by various organizations and the positive impact realized by those organizations.22
Practicing dentists are aware of Occupational Safety and Health Administration (OSHA), state, and federal guidelines and mandates for having a workplace that is free of potential health dangers as well as the protection that is needed for employees. Additionally, preparation of workplaces for potential medical emergencies serves to comfort employees and emotionally prepare and support them during these times. Having medical emergency protocols, CPR training, and readily available equipment such as an automated external defibrillator and portable oxygen tanks are just some of the actions companies take to promote a healthy workplace.
Recommendations for Creating a Healthy Workplace
(1) Get help. Consultants, professional coaches, psychologists, counselors, human relations specialists, and therapists all can contribute to the effort to create a healthy work environment. It is important to work with someone familiar with healthy workplace practices, with a focus on dental practices.
(2) Be honest and listen to the consultant and to the employees. Is the workplace healthy or unhealthy? Each practice should be evaluated on the criteria set forth in this article and by the APA. Staff should be involved in that evaluation.
(3) Discuss strengths and weaknesses as a team. Enlisting the feedback and opinions of staff is one way to begin to create a healthy workplace.
(4) Dentists do not attend dental school to learn how to run a business and manage the everyday personnel, personal, and business aspects of a dental practice. Clinical expertise will not help here. The dentist must not allow ego to get in the way of the changes that are needed.
(5) Engage and encourage all employees to develop programs, strategies, and actions that meet and address healthy workplace practices. Other dental practitioners who have accomplished this should be consulted. It is also important to discuss this issue with other business owners not in the dental field and enlist their advice and assistance. It is important to read available literature on good workplace practices.
(6) It is important not to be overly concerned with the cost of the program. Most dental staff members are well paid in comparison to other businesses, and salary is generally not the issue here. In brief, for dental practices, developing a healthy workplace is usually not very expensive.
(7) Let the staff be involved. Most staff members want to do a good job and will be supportive of positive changes in the practice. It is important to listen, develop meaningful and professional relationships with them, and enlist them as partners in the practice.
(8) The dentist must continue to grow personally and professionally. Positive change by the dentist-owner can be a positive catalyst for the em-ployees.
(9) Other experts may need to be consulted. For example, attorneys are one resource who might be needed to develop agreements and policies consistent with state, local, and national guidelines, as well as to protect the dentist and his or her employees. Additionally, consultants that specialize in specific areas such as OSHA compliance can offer advice and recommendations that save time and money and re-duce stress.
(10) Meet regularly with employees. Listening, problem-solving, sharing successes, recognizing contributions, planning, and setting goals will enhance productivity and well-being and foster success.
The importance of a having a healthy workplace cannot be overemphasized. Financial and personal success is strongly linked to the ability to create, lead, and manage a healthy workplace. Now more than ever, putting effort into developing employees, offering opportunities for their growth and development, and showing genuine concern for their well-being, will both create a healthy work environment and positively affect the productivity of a dental practice.
1. American Psychological Association. Psychologically healthy workplace best practices 2004 [brochure]. Available at: http://www.apapractice.org/apo/psychologically_healthy.html#. Accessed November 2004.
2. National Survey of Public Opinion On Seeking a Mental Health Professional, Work Stress, and Related Issues (press release). Washington, DC: Am Psychological Assoc; Dec 14, 2000:10.
3. Lehmer M, Bentley A. Treating work stress: an alternative to workers? compensation. J Occup Environ Med. 1997;39:63-67.
4. Schmidt WC, Welch L, Wilson MG. Individual and organizational activities to build better health. In: Murphy LR, Cooper CL, eds. Healthy and Productive Work: An International Perspective. Philadelphia, Pa: Taylor & Francis; 2000:133-147.
5. Williams S. Ways of creating healthy work organizations. In: Cooper CL, Williams S, eds. Creating Healthy Work Organizations. Chichester, England: John Wiley & Sons; 1994:1-5.
6. Esen E, Dincin B, Frigault J. Job Satisfaction Poll. Society for Human Resource Management and USA Today. 2002:27-28. Available at: http://www.shrm.org/surveys/Job%20Satisfaction%20Poll.asp. Accessed November 2004.
7. Prince M. Employers seek to quantify work/family benefit savings. Business Insurance. 1999;33:3-15.
8. American Psychological Association. Psychologically Healthy Workplace Award [brochure]. Available at: http://www.apapractice.org/apo/psychologically_healthy/psychologically_healthy0/psychologically_healthy.GenericArticle.Single.articleLink.GenericArticle.Single.file.tmp/PHWA_Brochure.pdf. Accessed December 14, 2004.
9. Cawley BD, Keeping LM, Levey PE. Participation in the performance appraisal process and employee reactions: a meta-analytic review of field investigations. J Appl Psychol. 1998;83:615-633.
10. Parker SK, Axtell CM, Turner N. Designing a safer workplace: importance of job autonomy, communication quality, and supportive supervisors. J Occup Health Psychol. 2001;6:221-228.
11. Brown SP, Leigh TW. A new look at psychological climate and its relationship to job involvement, effort, and performance. J Appl Psychol. 1996;81:358-368.
12. Wasylyshyn KM. On the full actualization of psychology in business. Consulting Psychology Journal: Practice and Research. 2001;53:10-22.
13. Fernandez JP. The Politics and Reality of Family Care in Corporate America. Lanham, Md: Lexington Books; 1990.
14. Zedeck S, Mosier KL. Work in the family and employing organization. Am Psychol. 1990;45:240-251.
15. Ferber MA, O?Farrell B, La Rue A, eds. Work and Family: Policies for a Changing Work Force. Washington, DC: National Academies Press; 1991.
16. Sauter SL, Murphy LR, Hurrell JJ Jr. Prevention of work-related psychological disorders: a national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH). Am Psychol. 1990;45:1146-1158.
17. Hatfield MO. Stress and the American worker. Am Psychol. 1990;45:1162-1164.
18. Jones JW, Barge BN, Steffy BD, et al. Stress and medical malpractice: organizational risk assessment and intervention. J Appl Psychol. 1988;73:727-735.
19. Kagan NI, Kagan H, Watson MG. Stress reduction in the workplace: the effectiveness of psychoeducational programs. J Couns Psychol. 1995;42:71-78.
20. Baba VV, Jamal M, Tourigny L. Work and mental health: a decade in Canadian research. Canadian Psychology. 1998;39:94-107.
21. Martin A. Mental health treatment helps bottom line. Atlanta Business Chronicle. August 10, 2001: 24(10), 7B(1).
22. Gebhardt DL, Crump C. Employee fitness and wellness programs in the workplace. Am Psychol. 1990;45:262-272.
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