It seems that in this new dental economy, many offices are struggling to find and keep employees. Yesterday I got a call from a doctor who lost her “office manager” to another business that wasn’t even in the dental industry. While she has struggled, as many have, in maintaining a full team, she seemed especially upset that her office manager was gone. During the conversation I asked her about her office numbers, which at best were average to below average even when she had her super star office manager. I asked her why, with a very average result, she thought her office manager was so good. She basically said that she felt good about turning over the leadership and management to the office manager and she could be more productive. I reminded her that with production at about $600,000 a year, I wouldn’t think that this employee’s management skill set was all that great or maybe her own productivity was not so high. She kind of deflected that reality with a statement that she was just so darn busy that she didn’t have time to do everything. I asked her if she had a job description for her lost office manager. The answer was: “not really”. I asked her if she had trained the office manager upon hiring her. The answer was: “no, not really”. When asked how she on-boarded staff in any position, she answered: “I’m not sure what you mean”. You get the idea. It’s a mediocre practice: a doctor that is not accountable for the practice, a protocol for staffing that does not exist, and she is wondering why things aren’t going well.
Too often, I see doctors and their practices struggling to find a solution to overhead, productivity, and patient marketing and retention. In most cases, I see a high turnover of staff, few new patients, few direct referrals, and an out-of-control overhead spiral. The doctor’s response is taking more continuing education to improve their clinical skills. As it turns out, this strategy misses the true causes of their problems. High overhead, low productivity, staff unrest, and poor team performance are usually just symptoms of a lack of leadership in your practice. Perhaps there is a golden triangle of competence in practice management, leadership, and clinical acumen?
We have all been pushed by so called practice management gurus to “delegate” the day-to-day “management” of our practices to an “office manager”. I can hear those same “experts” say: “Just do the clinical and let the office manager take over everything else”. If your consultant is saying this, fire them. It demonstrates a complete lack of understanding of group dynamics and purpose driven management skills.
Far too many office managers exist by “positional authority”. In other words, their title or position gives them the authority to dictate policy. At best, they follow orders. At worst, they alienate the staff through intimidation and poor people skills and run off patients. Add to this that the doctor does not train them, give them an adequate job description, measure their performance, or create consequences while never actually giving them any real authority to hire and fire, change processes, and see the data that would really help them keep a hand on the management side of the practice. The problem is you, as the doctor, don’t want to “manage” the practice but are reluctant to let go. By abdicating your leadership and management role you set yourself up for failure and poor productivity with high staff turnover. When there are problems in a practice, it is always caused by the doctor. By your decisions or lack of them, you own the results. Your systems are precisely designed to give you the results you are getting. The buck stops with you. You want different results, then change the systems. Do something different. In a business sense, most practices of average production really don’t need an office manager. You really need someone at the front desk to take on certain tasks that an office manager might do, but the last thing you need is a person with a title, in an office that does little, that has no authority to really lead and manage, while never being trained or paid based upon results. Sure, when you are doing $2,000,000 to $5,000,000 a year, you need someone that is the center of your leadership team.
Doctor, you need more than an office manager. You need to “partner” with a TEAM LEADER.
A Team Leader is someone who provides guidance, instruction, direction, and leadership to a team for the purpose of achieving results. A group of staff members do not necessarily constitute a team. Teams are developed and grown. It is no longer enough to have just “good” staff members. You need excellent employees. Your practice will never go any further than the one person with the lowest level of commitment to the vision for the practice. It is the responsibility of the team leader to collaborate and put feet to your vision. It is reasonable to expect your team leader to manage your office and your team during working hours, but you are responsible to define “reality” in your practice and monitor their progress. You, the owner, should develop the culture and your team should guard and execute on it. The team leader will create the systems and help the staff embrace the vision on a day-to-day basis.
The team leader fulfills a team role similar to that of captain in a team sport. They hold equal responsibility and accountability for the group’s performance with each of the other team members. Ideas, options and collective decisions on how best to accomplish the purpose and goals of the team are encouraged and supported by the team leader. When a person accepts a position as a team leader, he or she accepts the challenge of becoming both an exceptional leader and an exceptional person. In effect, the team leader becomes accountable to the team for his or her leadership performance as well as the final results of the practice. They become more than an office manager, they become a partner in the leadership and execution of your vision for the practice.
There is a litany of mistakes that most offices make in hiring an “office manager”:
- They hire from outside the office and hire them as “the office manager”. This creates that positional authority with a title, but is not supported by actually earning the title or authority. For the best strategy, you should always try to hire people that could grow into elevated positions so that when there is a vacancy in any area of management, you can consider someone already on your team. Failing this, you should never give a new employee the title of office manager. Instead, give them the workload of one, but wait until the position of leader is earned by their performance and the acceptance of this person in a position of leadership. Like cream, great team leader applicants tend to float to the top of the hierarchy of employees. They are the one person everyone respects and goes to for council and answers. They must become an assimilated hire in an already high functioning team. For the most part, I find any “title” like lead assistant or lead hygienist will become a source of contention in a well-run office. Titles say that there is a difference in the value of each employee when what you really want is self-actualized team members committed to the success of the office without needing titles. Each member of the team should share in the success and profits of the office on an equal basis. An office like this will not allow mediocre employees.
- Offices fail to adequately search for the right person, onboard them, and train for the position with well-designed office policy manuals, job descriptions, measured performance, and consequences for not fulfilling each of these. How could you understand what every position in the office would require? You have not actually held the position nor do you likely even have the skill set to perform it. It’s difficult to hire for a job you don’t understand. Systematize everything in your office.
- You pay them more than anyone else in the office. An office manager’s pay should be no more than any front desk staff member’s salary as a base. Any other pay would be based on the performance that they actually oversee and you can measure. A true office manager needs to be able to find and hire staff, as well as dismiss those that do not perform at a high level. They must be able to see the Profit & Loss Statements as well as be responsible for key areas of the office’s overall performance: new patients, collection percentages, referrals, overhead, etc.
- They should actually have a job and not just an office where they hide out. Your office manager (Team Leader) could be a hygienist or assistant but is most likely tied to the front desk positions. They need to work hand-in-hand, side-by-side with the staff. Actual Team Leaders rise to the top to occupy that position of authority and leadership without a title. They earn the position and don’t actually need a title. Consider every hiring and training in light of how do we build a “team” rather than just a group of people that work together. To do this, you will need to create a culture where the team decides on new hires and not just you.
- Whatever the job description, make sure that you figure out a way to measure their performance and reward excellence. Dedicate yourself as an owner to make sure they receive ongoing training and consistent feedback of how they are doing.
- Never hire from desperation. Hire slowly and fire quickly. Never hire someone you cannot let go. Never keep an employee that makes your life worse. The followers of a good leader need to be part of the solution and not part of the problem.
- The ultimate goal of leadership with a team leader is to create an office with committed team members, not just compliant employees. Do this and you will see that there is no need to manage them. You merely need to cast a vision to let them know what you want done. This type of commitment means that the team will self-police, never allowing a mediocre member to stay in your office.
If you are a doctor or office manager and you are reading this, go back and ask your team:
- What should I stop doing?
- What should I keep doing?
- What should I start doing?
Few leaders are successful unless a lot of people want them to be. Every success comes through the assistance of others. Conversely, many people whose performance or results plateau at some point are in that conundrum because they have cut themselves off from everyone who can help them. They view themselves as the sole source of their achievements. As they become more self-centered and isolated, they lose their creativity and ability to succeed. Continually acknowledge the contributions of others and focus on appreciating and thanking others and the conditions will always grow to support your increasing success. You will never get ahead until people are behind you. A leader can give up everything but final responsibility. Becoming accountable is how you Summit.
NEVER HIRE AN OFFICE MANAGER — DEVELOP A TEAM LEADER
Michael Abernathy, DDS