Every practice goes thru a cycle of growth, plateau, slow down, and sell out. The time varies from doctor to doctor. The trick is to stimulate growth while preserving core (purpose). In looking at more than a thousand practices, I’ve seen a definite trend. Every practice will hit a plateau at a certain dollar amount per month (often about $50,000/month). The practices that break through this barrier have one thing in common: They create a synergistic effect by utilizing participative management and involving their teams to create a feeling of ownership in the practice. They consult their teams on major decisions. They share the practice numbers with the staff to encourage a team effort to increase productivity while pushing the overhead down. They share the wealth through a well thought out bonus plan. When a well-run practice does better, the staff is paid more. It is this synergism that allows a 5 staff member office to produce more than a 10 staff member office. In my practice the staff hired the staff. They even had the final say on whom I brought in as a partner. I have found that staff, and women in general, are more gifted in assessing an applicants abilities and understanding the dynamics of adding this person to the mix of an already great team. I used my staff to compensate for my inadequacies in hiring the right person. The average stay of an employee in my office was 14.5 years. Several were there over 25 years. This one fact accounts for a vast majority of the success in my practice. A staff owned practice:
- Creates high communication. Lack of communication is the major cause of system break down. Consensus building and success in execution of systems can only occur with a high level of communication.
- Has alignment of vision. This is the “purpose” of your practice in motion.
- Allows participative leadership. This creates the synergistic effect of a small number of staff succeeding where other practices need twice as many people to get to the same level. It is kind of the lean and mean approach. We all know our jobs, and purpose. We have each other’s backs. We know what has to be done and no one leaves till everyone finishes. It is the essence of “team” thinking and action. We are no longer just a random group of people pulling in different directions. We are united in purpose, and the patients can see how well we work to serve them.
- Must have shared responsibility. With any job there are consequences. Each staff person knows the game and the score. They help control the schedule to be more productive. They lower the overhead. They understand that the bonus is merely a way to share the profits from a job well done. In the best practices, the doctor, during a busy schedule, is just a pair of hands. Just another staff member doing their job. Often times the staff directs the doctor without consult to maximize the day’s productivity. A team effort for a team reward.
- Is always future focused. If you have high communication, participative leadership with shared responsibility and a commitment to the purpose of the practice, you will have a staff that focuses on the future. The stress level will drop. You will have a self-managed team. They will come to you with solutions to problems rather than being the problem. They will suggest strategies and continuing education to maximize the potential of the office and team. We will have created an atmosphere of self- starters that understand this is no longer just a job. Now it is a profession to be proud of. That I no longer have just an hourly wage, but an unlimited earning potential. That I am a valued member of a team united for a common purpose.
Patrick Lencioni wrote a book called “The 5 Dysfunctions of a Team”. It best summarizes the results of a well-run, high-functioning team.
- They trust one another.
- They engage in unfiltered conflict around ideas.
- They commit to decisions and plans of action.
- They hold one another accountable for delivering against those plans.
- They focus on the achievement of collective results.
(Don’t miss the opportunity to read any of Patrick’s books. Each one deals with critical areas of management.)
The opposite is also true. In a seminar given by Patrick Wahl, DMD, he described workplace chaos as:
- Failure to give credit.
- Failure to correct grievances.
- Failure to encourage.
- Criticizing in front of others.
- Failure to ask employees their opinion.
As we step from philosophy of leadership and management of a team to the actual day to day, the rubber meets the road applications, please keep one thing in mind. You will be recruiting your staff from a pool of “as is” applicants. Remember the blue light specials at K-Mart? The announcement would be made that there is a table below the blue light with special discounts and pricing. When you arrived at the table and looked at the products for sale you would notice a sign that warned that these items have small defects, deficiencies, and are sold “as is”. It was a “buyer beware” statement: Great prices, but buy at your own risk. People are a lot like the items on that table. Each and every one of us is sold as is, warts and all. There are no perfect staff applicants. In fact there is a common misconception about whom you should hire. I never looked for super stars. They always seemed to play for themselves. Not really a team player. One should always hire for attitude and train for skill. Always look for enthusiasm and people skills because you cannot teach this. Add perfect systems and you can’t loose. Systems are creatable and eliminate personalities from the process to create a consistent result. Systems make procedures reproducible with any staff. I’m fond of saying, “I could teach anyone to suck spit”, but I need someone who is a great communicator, who shows compassion and caring to make the patient show up, pay for treatment, and refer everyone they know. Remember: Always hire for attitude and train for skill. The final misconception is: Always hire staff with lots of experience. I have had great staff with experience but the opposite is also true. Some of the worst hires I have made were people with 10 years of experience. The problem is that they want to do it the way they did in the previous office. They are difficult to retrain. They always seem to resort to poor habits learned from a lifetime of bad training or systems. Some of the best staff members are found from different professions that would fall under the category of consumer driven businesses. I always found waitresses to be great assistants. They had great personalities (they had 30 seconds to make a good impression to insure a great tip), and they multi-tasked well. As a waitress, they would hear the ice settle in a glass and without looking would bring out the water or iced tea moments later, while still being attentive to food service at another table. Bank tellers, while paid very little, have good personalities, deal with people, and dot the i’s and cross the t’s to balance their drawer at the end of the day. They make great front desk people. Hope you get the idea. Think out of the box to assemble a great Team. One last thing: There will come a time when you will have to “free up someone’s future” (fire them). You either have the right people who are in need of training or your have the wrong people and they need to be replaced. You must make that decision. Training an employee well and having them leave the practice is not as expensive as not training them and having them stay.
Put another way:
- You have to get the wrong people off the bus.
- You have to get the right people on the bus.
- You have to get the right people on the bus and in the right seat.
- And finally, you have to drive the bus. You are responsible for the direction and destination of your practice (bus).
Because of the “staff owned” model and my propensity to delegate in such a way as to encourage self-managed teams, many of the daily problems most doctors face simply disappear. The basics must still be there. You need a well-written office manual. It should, from a legal standpoint, cover all HR concerns along with rules, regulations, and job descriptions. This manual should also close with a binding arbitration agreement to prevent frivolous lawsuits. It should also be noted that every office manual is never finished. It is constantly updated as jobs change and challenges appear. If there is a problem that is new and you have to address it, then it should be added to the manual. The answer to every question should be “What does the manual say?” In this litigious society it is truly a lawsuit lottery with HR suits leading the way. The office manual is your first line of defense and is also your staff’s code of conduct. It will remove the ambiguity from the daily activities of your practice.
We take the time to document and train our staff. In an office where the staff makes the decisions on hiring and firing, it takes little or no time to train them. The staff always seems to attract and hire the best person for the job. In fact, in 30 years I only had one employee that I had to fire. Remember to update your training manuals and job descriptions. It is not the employee’s fault if they are not trained and monitored correctly. No one takes a position to do a poor job. As I said before: You either have the right people who are in need of training or you have the wrong people and they need to be replaced. It is no longer good enough to just have good staff. You absolutely must have the best team you can put together. Waiting to retrain someone or fire them is the worst management decision you can make. Act as soon as you discover a problem.
Every one in the office has a graph representing their performance. This graph measures the one or two things that make that position important. As an example, the hygienists keep a graph on their production on a weekly basis, the number of soft tissue patients they start, and the number of crowns they present. If you think about it, if they did well in these areas you would have a great hygiene department. The Hawthorne Effect says: What gets measured gets done. Decide what should be measured at each position, and begin today. Don’t pull the information off the computer. Make them keep it by hand and post it in the staff area for all to see. As long as the graph is going up, things are good and there is no need to confront the staff member on how to better accomplish their jobs. If it goes down, act quickly to find out why and help them turn it around. This should be done in such a way as to promote consensus of purpose with no condemnation. We are all working together to take our practice to the next level.
When it comes to an actual day of work, everything comes into play. There are large practices and smaller ones. The common one doctor, one assistant, one hygienist and one front desk office is the easiest to manage. No passing the buck. Everyone knows their job, and everyone understands that if they don’t do it, it won’t get done. The office is physically small which makes it easier for the doctor to keep tabs on what is going on. Change this formula and you are now faced with delegating more tasks and depending on others to follow thru without your direct supervision.
My office was a 9 hygienist office with 4 doctors and 14 staff members open six days a week and producing millions of dollars a year with a 50% overhead. This is the other extreme: A corporate practice with a team leader or business administrator and a lot of bodies running around all week long. Strangely enough, the core realities of a Purpose Driven, Doctor Led, Staff Owned model never changed. With the increase of people and facility size we had team leaders for the front desk, hygiene department, and clinical staff. This allowed me to monitor these areas without having to micromanage each position. Each staff member still kept a graph of the couple of things most important to their jobs. The leaders intercepted potential problems before they could grow and brought concerns from their areas to me to make a final decision on. Problems were dealt with immediately and put to rest. We never used a staff meeting as just a problem-solving gathering. We never delayed dealing with any problem until a formal meeting (team meetings were reserved for improving our systems and strategic planning). In most cases problems were solved and eliminated the day we became aware of them. The staff, through their felling of ownership and purpose, had the authority to handle most things that arose. We always had a written policy to guarantee the patients satisfaction (it is against the law to warranty a result, but not the perception of satisfaction by the patient). We either do it over or return their money. In the rare case of the patient who got upset at us, we still earned their respect by honoring our warranty and making it right. This is the service state of mind. We always looked at the lifetime value of the patient and their families rather than the one time procedure or sale.
While our manual of practice management procedures and systems consists of several hundred pages, the important foundation of how, what, why, and when we do things is controlled by the Purpose Driven, Doctor Led, Staff Owned model. Take the way you practice and let these principles govern your actions and you will be on your way to the next level of success in your practice.
Allow me to close with a quote from Francoise Chateaubriand:
“The master in the art of living makes little distinction between his work and his play, his labor and his leisure, his mind and his body, his information and his recreation, his love and his religion. He hardly knows which is which. He simply pursues his vision of excellence at whatever he does, leaving others to decide whether he is working or playing. To him he’s always doing both.”
Michael Abernathy, DDS