THE A,B,Cs, OF STAFF COMMUNICATION
The 180 Degree Journey tends to push doctors to ask the difficult questions. The phone keeps ringing, and for the last 6 months, every question posed by the caller has centered on the fact that it is hard to keep or find good staff members. It started from the day we reopened from COVID in mid-2020 and the hygienists decided that they were not going to work in dentistry as long as the government would pay them to stay home. Most of the rest of the office felt the same way. That slowly ended and then they didn’t want to work if they had to use aerosol producing instruments. I was quick to point out that we did hygiene without Cavitrons and Prophy Jets for the first 2 decades of my career, and I was fine with them doing everything by hand. That went over their head. They quickly responded that their offices couldn’t get them enough PPEs to feel safe. The argument goes on, but it seems now that every member of every team feels they should have more money. Front desk, assistant, hygienist, associate, you name it, they all “deserve” more money.
The reality is that since 2008, the average dentist has taken home about 2% less every year while overhead creep decreased reimbursements, and diminished business has lowered profits. While the days of longevity-based raises (paying people more if they worked for you longer) and cost of living raises (paying people more as the cost of living went up) died two decades ago when the average office had 75% managed care patients, which meant that we could no longer just raise our fees to offset the expected increases in pay. As a review from previous portions of our 180 Degree Dental Journey, your employees have failed to understand the math and reality of producing more but being paid in reimbursements a smaller percentage of it from managed care plans.
So, what do you do? It should begin with reassessing where you are. If you want a reasonable overhead and staff that are tickled pink with what they are paid, you have to look at the reality of profitability in a world of managed care. This self- assessment needs to begin with you understanding your Collections per Employee per month. Easy to do. Just take a six or twelve-month period and add the collections up and divide by the number of months you used to get your average collections. We have discussed this before, but I can tell by the emails, texts, and calls I get that this has not been done by the doctor, or they failed to see the importance of this KPI. Then add up the number of staff you have. Any employee: associates, assistants, hygienists, front desk, office manager – everyone not an owner – and divide the average monthly collections by the number of staff (if you have part time people then the number might be 6.5 or 10.75, etc.). You now have your collections per employee per month. If it is around $14,000/month/employee you are average. Not great, but at least you’re not bleeding out. More like treading water and barely fighting the current. You are losing, but it is so slow you get used to being average. The average dentist gets up every day and goes to work, but their passion is not dentistry. It is simply a job that acts as enough of a distraction that they can tolerate a career where time is traded for money. At this level, you will always have a 67%-75% overhead, which is not good. If you are at $20,000 to $25,000 collections per month per employee, you have an overhead less than 60% and are growing every year by 15% to 20%. If you are below $14,000/month/employee you are being swept down-stream where you can barely pay your bills and are constantly wondering why you chose this profession.
There is an answer for all of these situations. If you can’t find or keep staff, you need to assume that what you offer in pay and culture is not competitive in today’s market place. Compensation is not limited to the dollar per hour they earn. Only in dentistry does anyone look at overall compensation in that context. Great teams are the reflection of what you put into them. People have to want to stay. That falls on you. Pay is not a destination but is constantly reviewed and updated to reflect your business health and the condition of the person you are paying. It is a partnership where both sides need to be engaged and participate in making the relationship better. When we do look at the collections per month per employee it means something. You could be overstaffed, underperforming, or you are just right, and your overhead is below 60%, staff never leave, and your referrals reflect the excellence in your culture. One more reminder: Make sure you are reading The Super General Dental Practice. It is free at to download at: www.supergeneralpractice.com.
If you find yourself struggling to even hit $14,000 per month per employee, you must take a hard look at your contribution to the overall health of the practice. Surely at this number your systems and number of patients does not support the quantity of staff you have. If you are having high staff turnover, you can be assured that your pay, culture, and overall atmosphere of the office is lacking. Is it any surprise that staff will desire a better work environment with competitive pay? So, ask yourself what your contribution is to a stable workplace that should grow every year in profit. Do you have a prescribed strategy of looking in the right place for the right employee? Do you have the updated policy manual and comprehensive job descriptions that every office needs? Was the selection process for each employee created to have your staff help in making the final decision of whether to hire or not? Do you find yourself always hiring from a position of desperation rather than planned growth? Once you make the selection, do you and your team take the time to onboard that new employee in a way that helps them do a superior job while quickly embracing a winning culture? Do you continue to embrace change and measure each team members performance while giving them feedback to improve by spending the time and money to educate, train, and model the results you want? Finally, are you part of the solution or part of the problem when it comes to employee retention and growth?
Our team members deserve the best pay and finest work conditions we can afford. If you find that you cannot compete to get the best staff in your area, please take a hard look and consider the situation if the tables were turned and you were the employee. Would you be excited to work for you in your office? It is far too easy for most dentists to blame the economy, the pandemic, or poor staff candidates for continually struggling to assemble the best team they can. Clearly the fault may lie much closer to home with your own performance, engagement, and efforts. Lose those excuses and start finding your results.
In Patrick Lencioni’s book The 5 Dysfunctions of a Team, we find there are five benchmarks or bullet points common to every business that is striving to create a viable team.
- Absence of Trust: Stems from an unwillingness to be vulnerable within the group. Team members who are not genuinely open with one another about their mistakes and weaknesses make it impossible to build a foundation for trust. If there is an absence of trust some team members will not express their concerns or voice their opinions inside the group. Failure to clearly hear unfiltered thoughts from each team member will almost guarantee that you will not understand the consensus of opinion in your team. This will lead to you making decisions without actually understanding that there is not 100% agreement. Remove the barriers and encourage unfiltered communication in a “safe” environment. You need to hear from everyone.
- Fear of Conflict: Failure to build trust is damaging because it sets the tone for fear of conflict. Teams that lack trust are incapable of engaging in unfiltered and passionate debate of ideas. Instead, they resort to veiled discussions and guarded comments. The first two dysfunctions of a team will automatically create a cascade of poor results in the next three areas. They build on one another to create a false sense of communication that does not exist. These five dysfunctions are a clear indication that there is a lack of leadership and commitment in your group. In fact, it indicates that instead of a “team”, you merely have a “group of people” that work together. Big difference in optimizing your practice during this 180 Degree Journey.
- Lack of Commitment: Lack of healthy conflict is a problem because it ensures lack of commitment. Without having aired their opinions in the course of passionate and open debate, team members rarely, if ever, buy in and commit to decisions, though they may feign agreement during meetings. As you read this, I assume that some will think that conflict is bad. I would argue it is commonplace and common sense that when you have a culture of staff ownership, people will be passionate about expressing themselves because it is “our” business and not just the owner doctors. This passionate concern about every detail of the business creates a strong commitment from your team. Don’t be fooled, team members that are committed will also find times when they disagree, and you will want to hear their reasoning.
- Avoidance of Accountability: Because of this lack of real commitment and buy-in, team members develop an avoidance of accountability. Without committing to a clear plan of action, even the most focused and driven people often hesitate to call out their peers on actions and behaviors that seem counterproductive to the good of the team and the business.
- Inattention to Results: Failure to hold one another accountable creates an environment where inattention to results can thrive. This occurs when team members put their individual needs (such as ego or recognition) above the collective goals of the team. This is where most of you reading this are right now.
While you now have my short take on The 5 Dysfunctions of a Team, you need to buy the book and read it yourself. I would hazard to say that missing this point of reality in your group will hold you back. It is like having a “limiter” on your gas pedal during this journey. You just will not accelerate with this underlying handicap.
- Failure to give credit
- Failure to correct grievances
- Failure to encourage
- Criticizing in front of others
- Failure to ask employees their opinion
The Under-Managed Office
- Expectations are unclear.
- Roles are undefined.
- Feedback, is sparse.
- Poor performers can hide.
- Morale goes downhill fast.
Michael Abernathy, DDS
PS. “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