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Delegation

Dentists have heard the word “delegate” for years, yet many still do not believe it can actually work for their practice.  However, delegation with proper planning creates a team of skilled, responsible professionals.

The key is skill.  Skill results from training and hands-on experience.  The energy and talent of a team working together are synergistic, with the whole being greater than the sum of the individual parts.  If your staff has not displayed much in the way of energy and talent, yet they have the capabilities to become a synergistic team, investigate the need for training.  Begin a planned program to train individuals in all skills that can be legally delegated in your state.

For in-office training and quality control, develop comprehensive training manuals, one for business office systems and one for clinical procedures.  These vital manuals allow you to control the quality of your care and provide the staff with consistent standards and written clarification of your expectations.  Video/audio tapes, books, workshops, seminars and tailored consultant training are all excellent mentors for staff development.  To monitor staff training and learning, you can create a simple test.  Take a few moments to write down the basic points you want the staff member to gather from the learning experience you have selected, e.g., a book or tape.  Next, word these key points in the form of fill-in-the-blank, essay, or  multiple choice type questions.  Instantly, you have a written method to evaluate the degree of learning that took place.  Then,  together, you and the staff member agree upon a training completion date and a date for the written and/or oral evaluation.

DOCTOR FOCUS

I have heard from various management sources that  it is important for a doctor to spend time with his patients in non-doctoring pursuits such as casual visiting, adjusting patient drapes, and the like.  That may be true in a practice where only a few patients are seen daily or where the doctor is satisfied with a practice that sputters along.  Nonessential contacts are the first to go in polishing up procedural delivery for mega achievers.

Seating the patient, draping him, charting routine information, positioning radiographs, removing a patient’s glasses, and hosts of other mundane tasks  must be done by someone whose hourly rate does not approximate the doctor’s.

My focus, when I am with my patient, is solely on the patient’s problems: to find solutions and to offer treatment alternatives.  My time is too valuable in our accelerated practice to spend playing Trivial Pursuit with patients.

When I address my patient, I expect him to have  been totally prepared for  whatever procedures are scheduled for that appointment.  Preparedness allows me to focus strictly on the business at hand.  If I only spend 3 minutes of nonproductive time on each patient in a day of perhaps 40 patients, those 3 minute  time periods add up to two wasted hours!   Looking at it another way, saving  those 3 lost minutes allow me to incorporate 2 more productive hours into my day.  At my hourly rates, we are talking about a ton of increased productivity each year by only saving 3 minutes on each patient.

If my hourly rate is $450, 2 hours saved is $900 of increased production in a day and $180,000 of increased production in a 200-workday year.  Our goal, you will recall, is to work smarter, not harder.  Saving a doctor’s time is one of the surest and quickest ways to accomplish that fact.  Smart doctors do the doctoring and hire others to perform non-doctor duties.

“When I get busy, I’ll hire more staff,” comes the cop-out plea.  No, you won’t.  People with this attitude will never get busy.  They are as busy now as they ever will be because they are not planning for growth.

The Reverend Robert Schuller of the Glass Cathedral fame in Anaheim, California, says:  “Plan your work and work your plan.”  Sound advice.  Planning for staff to take over non-doctor chores is a winner’s plan.

We always attempt to have one-half person more on staff than we need to get the job done.  Hiring an extra pair of hands allows us to:

  1. Accept an increased patient load when it occurs.
  2. Prevent a breakdown or slowdown of services delivered when staff absence threatens production.
  3. Train staff into specialty areas of individual expertise.

 

For example, we have one person responsible for supply orders.  Her job is to see that we never run out of supplies, that we get the best price when we buy supplies, and that we never build up too much inventory — which ties up money and hurts both cash flow and profitability.

We have a rotating responsibility among staff to change X-ray solutions,  and to clean the staff lounge.  Other staff members have job divisions such as collection, recall, insurance, keypunch, bookkeeping, and secretarial.

I carry this idea so far that I never run my personal chores such as picking up dry cleaning, making greeting card purchases, and performing scores of other repair, replacement, and buying functions that are part of daily living.

Chauvinistic? Probably.  However, the lady who performs those functions for me does so lovingly and she has been doing them for almost 12 years. Her efforts allow me to concentrate without distraction on what I do best.

We’re talking about total commitment here — a focus so concentrated that nothing deters us from our goal.  If you want to become a mega achiever, I know of no other way.

With doctor focus totally in hand, we can key in on elements that create patient satisfaction with services that we perform.  Our patients perceive us to be completely organized–each person doing his or her hob in an exemplary fashion, delivering a smoothly concerted patient experience.

Many times when we have finished a procedure, our patient’s remark, “I’ve never had such an easy (or fast) appointment!”  This comment is taken as high praise, for that was our goal all along: to deliver super service in an orchestrated manner.  That attitude preserves a precious commodity called time.

I often respond, “Thank you.  You’ve just had a half-dozen highly skilled hands working for you.  We’re pleased that you noticed.”  With that comment, the seed for value received is planted.  We expect that seed to grow into value perceived.

There need be no diminution in the quality of services rendered when doctors deliver smoothly planned services that maximize their talents.  On the contrary, because they focus strictly on business and do not sidetrack the purpose, they are more apt to deliver better service and create more satisfied patients.

THERE IS A WAY TO DELEGATE EFFECTIVELY

How well you succeed  in dentistry depends largely on how well you delegate.  To accomplish what needs to be done on time, you must be able to turn work over to others — and know when to do so.

A  Doctor’s primary responsibility is to develop his/her staff members, and a primary purpose of delegation is to teach or empower the people you supervise — not just to off-load menial tasks.

Most Doctors are not comfortable delegating.  The most common excuses…

I CAN DO IT BETTER MYSELF.  Maybe so; but can subordinates do it well enough?  If you hang on to it, no one else has an opportunity to learn.  Teach them.

I DON’T HAVE TIME TO TEACH THEM.  It is true that effective delegation takes time.  You must plan, train the assigned employee and follow up periodically.  Therefore, you must weigh whether you will save time in the future.

Do you spend one day every month on this task?  If so, it is worth a day to train someone to do it for the rest of the year.

I LACK CONFIDENCE IN MY STAFF.  If you don’t trust your employees, you must examine your reasons closely.  Identify specific reasons: Cathy misplaced two charts; not Cathy is sloppy.  Watch for any unsubstantiated assumptions you might have.  Cheryl doesn’t have the math skills.  Are you sure?  Solution:  Delegate tasks that build skills — research for Cathy, math for Cheryl.

I’LL LOSE MY POWER OR CONTROL.   This is seldom a problem for Doctors with healthy self-esteem.  Effective Doctors focus on what they can accomplish through their employees, not how much they can control them.

If you feel threatened by your subordinates’ accomplishments, work on developing confidence in your own abilities.

BUT I  LIKE TO DO IT.  Some Doctors are reluctant to delegate the tasks they enjoy the most.    Solution:  Keep one or two “occupational hobbies” if you must.  Let employees grow by finding the discipline to let go of tasks that prevent you from growing.

I CAN’T FIGURE OUT WHAT TO DELEGATE AND WHAT NOT TO DELEGATE.  Delegate:  Tasks that are routine and necessary that are development opportunities for your staff…that staff  members excel at.  That’s why you hired them, remember?  Don’t delegate: Any duty that is irreversible.  Never delegate crises.  Bring in help if needed, but shoulder the responsibility yourself.  Never delegate unnecessary tasks.  It would be better to identify activities that don’t contribute to the practice’s  goals and eliminate them.

HOW TO DELEGATE

Delegation can be formal or informal, but it’s always important to be clear about your goals and expectations.  For best results:

REVIEW YOUR PURPOSE.  You must decide what must be done, who should do it, and when it should be done.

KNOW YOUR  PEOPLE.  You can’t decide who’s best for which tasks unless you learn about your staffs’ strengths and weaknesses, and their goals and desires.  Ask  for input so you can create opportunities for growth.

Key:  The “right” person is not always the “best” person.  Sometimes you’ll have a gut feeling that someone can’t handle the responsibility.  Try giving that person another task.  Delegate even to employees who resist new assignments.

HOLD A DELEGATION CONFERENCE.  Explain how the task relates to the offices overall goals.  State the results you desire before listing the required tasks.  Say we’ll need, rather than you’ll have to.  Ask for input from your staff members.

ESTABLISH DEADLINES, ALLOWING THE PERSON TO SET HIS/HER OWN DEADLINES WITHIN REASON.  Make sure the priority of the task is clear.

ESTABLISH A REPORTING PROCEDURE.  Schedule regular reviews.  Grant the necessary authority so the person can be effective.  Inform other coworkers that Susan will be handling recall.  Always delegate an entire task to avoid confusion.

FOLLOW UP.  Compose a memo, or ask the staff member to do so. This provides an opportunity for you to stress the person’s responsibility for the task and for  the person to commit to it.

Compliment the employee throughout the task, but review work only at regularly scheduled times.  Don’t meddle.  The purpose of review sessions is to protect against failure and advise without reducing accountability.  Your aim is development, not perfection.  Give feedback and constructive criticism.  Always give the person credit for success, but take the blame for any failure yourself.

QUALITY and SUCCESS

In 1911, Fredrick Taylor wrote a breakthrough study describing three principles for management.  In 1950, W. Edwards Deming and J. M. Juran were invited by Japan to rebuild its economy.

Deming and Juran came up with the ideas that the Japanese packaged into the system we today call Total Quality.  In Total Quality people feel they are permitted to contribute, as well as expected to contribute, because the system was designed to evolve based on their input.  I  believe this system allows the Doctor and Staff to simultaneously improve quality and productivity indefinitely.  In my own practice I have used these techniques for 18 years.

Sounds impossible?  What you need to do can be stated in three sentences:

  1. Get and keep only the best people.
  2. Make clear to them what needs to be done–define their jobs in terms of what is considered good performance and what results are expected, and measure it.
  3. Let them do it–create conditions in which they can do what needs to be done.

 

That’s it.  Like most apparently simple approaches, it works very well, but, in fact, demands a lot of hard work to make it succeed.  There still is no free lunch.

Once you have the three principles that tell you what to do, the next trick is how to do it.

You need a framework, a management philosophy.  The foundation of this framework is taken from every motivational speaker and management consultant I have ever heard.  It has just two points.

1. Doing things a little bit at a time all the time, has the highest probability of success.

We work in the real world.  We are constantly balancing one priority against another.  Problems tend to set these priorities.  That’s why crash programs and grand designs do not work.  Attack your problems a little bit at a time.  Remember:

  • Any effort is worthwhile if its done all the time.
  • Learn by doing – don’t wait for a detailed plan.
  • Start simple – take a good idea and run with it.
  • No improvement is too small to implement.  Fine tune continuously.
  • You never arrive – life and managing our staff and practice is a journey, not a destination.

2. Leading beats managing.

Your job as a leader is to get and keep only the best people, to make clear what needs to be done and let them do it.  You are attempting to create an atmosphere of job ownership.  Enthusiasm and persistent dedication always comes from the top.  In other words, you are the example, you set the pace through your leadership.

Here’s how a true leader applies these three steps.  Remember, the journey of a thousand miles begins with a single step.

ONE:  Get and keep the best people.

Acquiring and keeping good people is a leader’s most important task.  Reward them well both financially and emotionally by regularly meeting and talking with each staff member one-to-one.  Focus on learning whether each staff member understands what we are trying to do and whether they can do it.

Remove poor performers from the practice.  This is as important as finding good ones.  The best time to remove them is right now.

TWO:  Make clear what needs to be done.

Good performance means more than a list of specific tasks.  The whole job is to satisfy patients, establish good relationships and improve performance continually.  Office monitors such as vital statistics kept by your staff and discussed with them in staff meeting crystallizes important products in their job descriptions.

Invite constructive complaining.  Your staff needs to know their opinions are important.  The best indicator of a poor system is when good staff can’t perform.  Never assume that your staff is well-trained and motivated.  Ask them.

THREE:  Let them do what needs to be done.

Give staff job ownership.  Make clear who is responsible for what.  Cross-training is essential, but everyone should have an area of primary responsibility with well-defined job descriptions.

Attach authority to responsibility.  Your staff must feel you support their decisions and know that they can make mistakes.  It’s part of the learning process.  Develop a goal for continuing education.  Staying on the cutting edge, or as Naomi Rhode says, “being the 1%”, is essential.

 

Peter Drucker said “The common denominator of  all successful people is a perfect balance between thought and action.”  This is true for you as Doctor and business owner in your dental practice.  Your staff and your patients will share the benefits derived from your consistent efforts to improve the quality of your practice.