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Staff Replacement: Age, Expectations, Results

As is often the case, a doctor posed an interesting question.  Allow me to set the stage:  This was a young doctor, who had purchased a practice for too much from a retiring doctor, inherited the old staff, hired Summit to make some improvements in the practice, has become disillusioned with the old staff, old staff is slow to adapt and slow to show improvements, follow through and results, doctor becomes fed up with a front desk staff member, plans to free up her future, calls me with a question.  He tells methat the employees he inherited with the purchase of the office are impossible to motivate.  He feels like he has to micro-manage everyone and always check to see if they actually followed through with what they said they would do.  He goes on to say that:  “I am interviewing this potential staff person in 3 hours for the front desk.  What should I do and what should I ask her?

A common situation, a simple problem, with not such a simple answer.  For some reason I felt I had to give him the long version of what should take place.  The real:  What, when, where, and how of selecting, integrating, and successfully hiring the next “core” staff member.   You’ll notice that I said CORE STAFF MEMBER.  Nice thing about an economic down turn is that there are lots of great staff and doctors just waiting for an opportunity to work for you.  You have what we call a “target rich environment”.  There will never be a better time to upgrade your staff and free up marginal staff members that just are not up to the task.  The problem is that you have to become the leader that makes the right decisions in a timely fashion.  Your goal should always be to bring in someone that has people skills, is self-managed, and enthusiastic about learning and performing their job.  A “core” staff member is someone who puts the team and your vision above their own interest.  They get it.  You feel like they truly make the patients and your job go more smoothly.   Without them, the team would not function properly.  Think about it:  Why would you ever hire any other kind of employee?  Why settle for less?  Why would you pay someone to make your life miserable?  I have never regretted freeing up someone’s future, only waiting too long to do it.

As far as motivating your staff, it cannot be done.  You can inspire a great employee, but motivation comes with the candidate.  You hire for attitude and train for competence.  They should appear at the interview with motivation and people skills. This is what you are hiring.  Not 10 years of experience.  I would have to say that some of the worst hires I have ever made had 10 years experience and some of the best had no dental experience at all.  It all came down to attitude and self-motivation.  As a leader, your job is to hire the best person available, train them well, and give them authority to do the job and then get out of the way and let them do it.  In Leadership your first job is to define reality.  What is core in your practice?  What are your expectations?  How do you measure the results you expect?  It is called the “Hawthorne Affect”:  What gets measured gets done.  Vince Lombardi said it best when it comes to motivation.  Following a winning season, the coach was asked:  “How do you motivate your players?”  Coach Lombardi turned to face the reporter with a stern look and sneer and replied:  “My job is not to motivate my players!  It is to keep eleven motivated players on the field at all times”.   This is pretty black and white.  Stop hiring experience thinking they can be motivated.  Hire the candidate with motivation and people skills, you can teach anybody to suck spit.

Let me finish with the short outline of the answer I gave the young doctor with six steps to only hiring “core” staff.

  1. Have a great policy manual with detailed job descriptions.  No one takes a job wanting to do it poorly.  The problem is that without a detailed job description you are constantly changing the employee’s responsibilities without letting them know.  It is not uncommon for me to have the doctor write the job description of his assistant, and also have the assistant write what they think their job is, and upon comparison, find out they do not even resemble one another.  This is probably the number one reason your staff fail to shine.  They develop an attitude of indifference to avoid conflict.  They hide to not be picked on.  Get Patrick Lencioni’s book, “Five Dysfunctions of a Team”.  Read it.  Re-read it. Apply its principles.  One last thing:  Your policy manuals and job descriptions are never finished.  They must constantly be reviewed and updated to reflect your continual improvements and expectations.  Find a problem and solve it.  Add it to the policy manual.
  2. Remember:  You are always hiring and interviewing.  It goes back to the strategy of always looking to upgrade your staff.  As manager, you can never rest on what was good enough yesterday.  Your current staff must always be willing to change and grow.  If fact, add the ability to embrace change as a key trait of a core staffmember.  In a sense, your staff needs to see you as a consistent, caring leader that challenges not just the staff, but also yourself.
  3. The part-time staff member:  We always had a part-time staff member that really was a “Girl Friday”.  She was one of the most important people  in the office.  A part-time front desk or clinical assistant who was as good as or even better than our full-time staff.  Psychologically, the full-time staff stepped up their own game knowing that if they failed to inspire our patients, stay self-motivated, and produce results, they could be replaced.  This part-time person also was able to fill in for pregnancy, illness, or vacations.  This may sound a little harsh, but yourstaff should be a little concerned about being fired for the right reasons.
  4. Always measure what you want done.  I have a little brother who is a landscape architect.  Before he leaves any job, he always says:  “Green side up guys, green side up.”  In other words there are always one or two things in any job that should be your primary focus, or in his case, keeping the green side up.  For example:  In hygiene we always measure the production on a weekly basis, the number of crowns presented, and the number of soft tissue scaling cases begun on a weekly basis.  If a hygienist was doing all of these great, they would be doing a good job.  Front desk might be the percentage of appointments kept, percentage of money collected over the counter, and conversion rate of phone calls to appointments.  Do these well and you know you are inspiring patients and doing a great job.
  5. Consequences:  Do everything correctly but leave out consequences and you are destined to have just a group of people working for you.  When I asked a doctor:  “How many people do you have working for you?”  He answered:  “About half of them”.  The sad reality of leadership is that you have to make the tough calls.  What you allow, you empower.  Failing to act quickly to eliminate marginal staff says volumes to those trying to perform at the top of their game.  You are either a poor leader or a fool not to eliminate marginal players.  Having a staff does not mean you have a team.  Most of you only have a dysfunctional group of people hired to work under the same roof.   Your goal as a leader is to develop the team.
  6. Become a better Leader:  You might ask your staff:  “What do I need to do to become the boss, leader, or doctor you thought I would be?”  Feed your mind with great leadership examples.  John Maxwell’s monthly email newsletter is one of the best sources I know.  It is called “Maximum Impact”.  It will build a better leader, and you will build a better team.  I told you what the fist job of a leader is:  Define reality or what is core in your practice.  Number two is to preserve this core while embracing change.  The final job of a leader is to say “Thank You”.  No one ever had a great practice without dozens of people helping you.
  7. Embrace the Staff Owned model of practice management:  We have always preached a Purpose Driven, Doctor Led, Staff Owned business model.  The ownership mentality of the staff comes from involving them in the decision making as well as giving them the numbers.  Teaching them the business of dentistry.  Relying on them as a partner in your practice growth.  Never be afraid of letting someone go.  Your expectations and growth will automatically attract a better candidate for the position.  Always use your staff to make the final decision on who to keep or who goes.  They are more intuitive and will be better at understanding who will fit with the team in order to make it grow.


Never stop learning.  Find a coach and grow your practice.  Our Motto has always been:  Produce More, Collect All, and Keep Half.  Staff hiring and upgrading is an integral part in getting the results you deserve.

Epilogue:  The young doctor is one of those clients who decided that last year’s results are not worth repeating.  He hired Summit, decided he would do whatever it took and is up 20% in production over last year, has increased new patients by 30%, and lowered his overhead by 6%.  Doctors who identify problems and then do whatever it takes to solve them will make progress.  This young doctor will not be the statistical “Average Dentist” who at 54 has been involved with drugs, divorced, has no financial security, and has wasted his professional career.  This young doctor will have choices.  Call us and let us help you have a better future.