Most business problems, as well as most of the challenges I hear doctors struggle with, have a foundational misunderstanding of what management is and how the owner doctor fits into that definition. Most of us struggle with questions about who should do what and the embarrassing truth that few of us understand how to manage, much less lead our teams. From your position of an employee to owning your own practice, each of us needs to be very intentional about how we see ourselves in the process of running a practice. Like most doctors, I used to have the attitude that all I really wanted to do was clinical dentistry. I really did not like “managing staff” and dealing with patient’s concerns. My strategy, I guess, was to just hope that my employees would pick up the management side of dentistry and let me do the “doctor” stuff.
What a revelation in attitude, engagement, and results occurred when I finally looked at becoming accountable for assembling a team, creating a culture, and coming up with a vision that those I led could commit to. For me, this took a decade. But the good thing about this facet of a successful practice is that it can be learned. If you think you are a good leader, look over your shoulder. If no one is there, you are not a leader. You are just taking a walk. This topic puts a mirror up in front of your current as well as your historic management/leadership battles: barriers that each of us face in order to create that perfect culture that will drive a Super General DentaI Practice. I want to address the mistake that nearly every dentist makes in his or her career chasing the myth of great management.
Just so we are all on the same page, let’s define and describe “management” in any business. Keep in mind that all management begins as a transactional strategy, but that is not entirely good. It is always based on rules and regulations, much like a policy manual. It forces your employees to check the boxes and follow the rules or leave. This type of structure, by nature, creates a “carrot and stick” business culture based on fear of being fired or disciplined. These rules are there to create compliance with the regulations you have detailed in the rules they must follow as a condition of employment. While each of us needs to define our job descriptions and the rules and regulations, you will fall short of assembling a productive team. Transactional management, at best, will only give you a group of people who work together, a shortened stay for the average employee, poor morale, with purely results based management leading to uninspired employees that are consistently looking for more pay and a better culture.
As I see it, transactional management is based on a philosophy of “scarcity”. Scarcity is a zero-sum philosophy: It is finite, winner and loser, and not compatible with effective leadership. These doctors tend to want to only identify weaknesses in others in a sort of lose-lose scenario by always judging people. This overall negativity demands that you always need to be in control. There is an identifiable lack of creativity and engagement with your employees. I have seen this manifest in staff members that are always afraid to make decisions or try new ideas, because failure in itself will be viewed as a weakness and dwelled upon. In a complete reversal of what it should be, recognition is coveted by the doctor but never shared with the staff.
Your goal should be to move away from “transactional management” towards “transformational leadership”. It is fundamentally driven by vision based on core tenets of your mission and philosophy. This relationship with your team, rather than just a group of people working together, will align their needs to the needs of the office. The team you assemble will embrace change as an opportunity to grow in the practice as the office gets better and better. There is a shared purpose and shared values now, and that creates a synergistic commitment to a strong culture through teamwork.
Rather than scarcity, transformational leadership is based on abundance. You will demand a win-win relationship with your team. You become partners in the practice. One of the three pillars of a Super General Dental Practice is “staff ownership”. Owners show up early and don’t leave until the job is done. There is high communication and shared responsibility. Your staff will work hand and hand with you and others on the team. While we all understand that we have weaknesses, we judge others by their strengths. This will automatically push a culture where we reward accomplishments and empower each team member to strive for a better result. When we create a culture where people truly participate, you don’t need control. Your team knows what needs to be done, and they do it. In my offices there was never a reason to micro-manage anyone. Each of the team members held one another accountable for doing their jobs regardless of the challenges of the day. They even self-policed each other. They would not tolerate a mediocre staff member or even mediocrity in the owner doctor.
So, the ultimate goal in leadership is to assemble a committed team and they only need to know the desired end result. In this way, there is really no need to “manage” your team. As a leader you should become and remain part of that team.
“Reputation is what people think I am. Personality is what I seem to be. Character is what I really am. Our goal should be to blur the lines between the three until they are the same”. Jim Clemmer
In that vein and in an effort to put feet to this topic, I am including this Doctor Review sheet for you to use and allow your staff to review your performance. For most doctors that do this, I would recommend that it be completely anonymous. Send them the document, allow them to type their answers and scores without putting their name on it and then print and collate the reviews. For 90% of the doctors that do this, you will want to think that the reviews are not correct because they tell a story far different from what you thought they would have said. Straight to the point, if this is the case, you’re just a legend in your own mind. My suggestions are that you discuss your cumulative score with the staff, try to understand how you might improve, and then post it in the staff area and do your best to work on the areas you fell short in. Doing this will show your commitment to improvement, and your goal to be part of the team. Do this and win the hearts and minds of your team.
Performance Appraisal Form for Doctor __________________
In the following sections, circle the number for the rating definition that best describes the doctor’s performance.
Quality Of Clinical Work
- Makes frequent errors; frequently produces clinical work that must be redone.
- Produces clinical work that is passable, although quality needs improvement.
- Quality of clinical work is good. Makes few mistakes.
- Clinical work is very functional and aesthetic. It makes me proud to work for this dentist.
- Clinical work has a high degree of functionality and aesthetics on all work produced. I can enthusiastically recommend my dentist.
Quantity Of Work
- Very slow. Seldom completes treatment in required appointment time.
- Requires constant prompting from team in order to complete treatment within appointment time.
- On time record is satisfactory. Most patients are seen on time.
- Very good time manager. Stays on schedule on all appointments.
- Superior time manager. Frequently completes appointments ahead of schedule and has time to see emergency patients without making others late.
- Frequently rude or blunt.
- Only talks to patient about the doctor’s own interest.
- Talks to the patient too long, making the whole team run late.
- Consistently very good with patients and seldom runs behind. Leaves patients with a good feeling towards the office.
- Extremely skilled in dealing with people. Goes out of the way to be helpful and courteous, but never runs behind.
Ability To Present Cases
- Consistently talks over the patient’s head and fails to prioritize needed treatment.
- Consistently talks over the patient’s head but attempts to prioritize needed treatment.
- Explains case in laymen’s terms, but fails to prioritize needed treatment.
- Explains case in laymen’s terms, generally prioritizes needed treatment and sometimes emphasizes the most important next step.
- Clearly explains case in laymen’s terms, always prioritizes needed treatment and clearly identifies the most important next step.
Ability To Motivate Case Acceptance
- Fails to create any sense of urgency for needed treatment.
- Creates an inappropriately strong sense of urgency for needed treatment by emphasizing unlikely consequences of refusing or postponing treatment. Patients feel pushed into treatment.
- Attempts to create an appropriate sense of urgency but fails to explain consequences of refusing or postponing treatment. Patients do not understand why treatment is needed now.
- Attempts to create an appropriate sense of urgency and explains the likely consequences of refusing or postponing treatment to most patients. Patients understand reason for urgency.
- Effectively creates an appropriate sense of urgency and explains the likely consequences of refusing or postponing treatment to all patients. Patients are motivated to book treatment.
Ability To Train Team Members
- No training is provided. Team members must sink or swim.
- Minimum training is provided, but instructions are unclear. Feedback is negative or never offered.
- Minimum training is provided and instructions are clear. Minimum constructive feedback is offered.
- Adequate training is provided and instructions are clear, however feedback is negative or never offered.
- Adequate training is provided, instructions are clear and feedback is constructive.
- Poor attitude. Unfriendly and uncooperative in contacts with team members.
- Usually cooperative. May occasionally have problems in this area.
- Works well with team. Gives constructive directions and takes direction from team as well. Cooperative.
- Alert to needs of team members and is willing to provide assistance. Doctor is quick to respond in a constructive manner.
- Goes out of the way to be cooperative, gives constructive directions and provides assistance. Works exceptionally well with team.
Ability To Show Appreciation
- Never expresses appreciation of team or individuals.
- Expresses appreciation to the same favored individuals, while ignoring the contributions of others.
- Offers words of appreciation after the team has begged for them. They come across as too little, too late.
- Occasionally remembers to offer appreciation in a timely fashion.
- Offering appreciation is a top priority with our dentist. He/She looks for opportunities to give us encouragement.
Willingness To Support The Team Bonus System
- Uncommitted and unsupportive of producing at bonus levels.
- Gives lip service to the bonus system, but allows untouchable team members to restrict bonus opportunities.
- Committed to making the bonus system work, but inconsistent in personal support, i.e. underdiagnoses, schedules time out of the office at the last minute or fails to attend morning huddles.
- Committed to making the bonus system work for now, but unwilling to hire team members (including hygienists and doctors) who can help take this practice to the next level.
- Committed to making the bonus system work by consistently improving personal performance, encouraging team improvements and facilitating clinical and business processes that influence the team’s success in reaching their goal. Always looking for ways to expand the practice production to ensure continued raises in the bonus.
Willingness To Lead
- Avoids leadership role and is disengaged from the team.
- Dictates every decision and discourages input from the team.
- Easily swayed by uncommitted team members and ends up doing all of the work himself/herself.
- Attempts to lead the team and invite their input; however when an issue incites a confrontation he/she avoids it and never resolves it.
- Inspires the team to follow their lead and actively solicits the team’s input. Appropriately delegates work. Resolves confrontations in a way that respects human dignity and keeps the practice on course to reach its goals.
Attendance & Punctuality
- Often late or absent.
- Seldom late or absent.
- Very dependable. Comments:___________________________________________________________________________________________________________________________________________
Ability To Accept Change For Practice Improvement
- Flatly refuses to listen to all suggestions for improving the practice.
- Accepts every change that blows on the wind.
- Listens to recommendations, but always finds a reason why new ideas will not work.
- Afraid of change generally, but listens to ideas and tries some of them.
- Recognizes a need for change and can identify appropriate options for your unique practice. Embraces and implements change in an appropriate time frame.
Ability To Follow Through On Change
- Once changes are accepted, nothing ever gets done.
- Goals are set, but plans for accomplishment are not made.
- Goals are set, plans are made, but target dates are not set.
- Goals are set, plans are made, target dates are set, but evaluations of results are not done.
- Goals are set, plans are made, target dates are set and results are evaluated for effectiveness.
Ability To Ensure Practice Growth
- Drives patients away from the practice.
- Drives employees away from the practice.
- Content with practice and income level. Wants to maintain status quo.
- Sees the need for practice growth and open to suggestions for it.
- Actively seeks ways to grow the practice in order to annually increase personal, team and practice income.
- Often fails to finish business projects that they start.
- Stays busy doing activities, but seldom delivers results
- Consistently delivers results, but doesn’t care how they get them.
- Focuses their efforts on delivering results, not just staying busy.
- Consistently delivers results in a way that inspires trust.
- Doesn’t think about concerns of the practice outside of the challenges in the his/her own job area.
- Operates from a belief in scarcity. Doctor believes there is a limited amount of opportunities and credit, so he/she actively competes for his/her share.
- Operates in a way that makes people question if he/she has the best interest of others in mind.
- Operates in a way that clearly demonstrates he/she has the best interest of others in mind.
- Operates from a belief in abundance. He/She believes there are enough opportunities and credit for everyone to share. He/she seeks win/win solutions for everyone.
- Never acknowledges he/she is wrong. Justifies misrepresenting people and situations.
- Spins the truth to get the results they want.
- Sometimes there is not a match between what he/she says and does because he/she lacks the courage to stand up for what he/she believes.
- Clear on his/her values and stands up for them.
- Thoroughly honest in all interactions. Admits mistakes, and consistently honors commitments that he/she makes to himself/herself and others.
List three essential things that the doctor is doing well:
List three essential things in need of improvement:
Much of what I said today comes from a book by Dr. Joel C. Small: Face to Face: A leadership guide for health care professionals and entrepreneurs. Great book and even better words to lead by. The rest comes from 50 years of study and application in my own offices. This is how you should Summit.
Michael Abernathy DDS