If this is a question you ask yourself daily, then your practice may suffer from distributive inequity. While this term is seldom heard, it pervades the halls of many practices, destroying team morale and generally making the dentist’s life miserable. Before I define it, let me describe it. The entry to the dentist’s private office is a revolving door of endless fill-in-the-blank requests from employees that sound like this:
“I need to _________(come in early, come in late, leave early, make more money) because __________ (I am married, I am single, I am a student, I have small children, I have teenagers, I have no children, I am older than everyone else, I am younger than everyone else, I live closer than everyone else, I live further away than everyone else).”
Convincing arguments support every request. The dentists being a nice person, honors each one thinking it will improve morale, only to find it makes it worse. No matter how nice and accommodating you are, the team never lets you feel you are giving enough. You can never make everyone happy.
If this describes your team, then look at your distributive equity. Equity warps out of balance under two conditions: 1) when an employee feels they are contributing more to the practice than what they are getting out of it or 2) when an employee feels they are contributing more to the practice than someone else, but the other person is getting more out of it than they are.
Employees cannot tolerate distributive inequity. They will do something to bring balance to the practice. If you are approachable and assertive, employees bring the inequity to your attention and ask you to resolve it. If you are approachable and nonassertive, they ask for additional benefits or privileges in an attempt to resolve the inequity themselves. If you are unapproachable, employees just even the score. The best ones leave to find another job. The ones who stay behind steal from you. A few take supplies or cash, but most steal your time. They let you pay them for eight hours of work and they deliver six and a half. Distributive inequity is a condition a dentist cannot afford to ignore.
The pat answer to resolving distributive inequity is having a definitive policy manual that you vigilantly update and equitably enforce, but some dentists need more help than that. They need to have their thinking rewired. So let me reroute some cables in your brain.
You are a business. No matter what motive led you to the profession of dental healthcare, the basic truth is you are a business. You made a commitment to serve your patients specific hours of the day. Your patients pay all of your bills. Your patients pay all of your employees’ bills. If your wires are crossed causing you to think you cannot stay in practice without a specific employee, then let’s uncross them: you cannot stay in practice without your patients.
When you are tempted to bend and twist to the personal needs of a team member, ask yourself some questions. The first is “how did I become the only solution to this employee’s problem? If this person went to work at another practice where changing their hours or salary was not an option, how would they resolve this predicament? Would they put the kids to bed earlier, wake them up earlier, change day care centers, start a carpool, change carpools, save more money or stop spending money? What other options do they have to work out their personal dilemma besides changing my practice policy, compromising the care of my patients or unwisely increasing my overhead?” Remember, people always look for the easiest solution. If you are easy, then you are the solution.
The next question to ask is, “does this employee have a real personal problem, or is this a symptom of distributive inequity in the practice?” To answer that question, examine your systems.
Look at your reward system. You give your blessings to every behavior in your practice either by ignoring them or encouraging them with rewards. Employees who are frequently absent but never disciplined or dismissed are unintentionally rewarded with a totally flexible job and a work schedule they personally control. Employees who frequently come in late and are paid the same as everyone else are also unintentionally rewarded with a totally flexible job and a work schedule they personally control. Additionally they do less work and they make a higher wage per hour than everyone else. Sometimes the recalcitrant employees are the most talented in the practice and you ignore their behaviors because you want to keep them on the team. Sometimes they are the worst employees and you hope they quit. In all cases they destroy team morale and dismantle distributive equity. The reliable team members who show up everyday on time carrying both their load and that of your truant employees feel they are putting more into the practice than they are getting out of it. They also feel they contribute more to the practice than the absentee employees but they are rewarded less. If you do not resolve this inequity the steadfast team members will find a way to make you pay. You will pay in the form of training new employees to replace the reliable ones who leave you, or you will pay by wasting productive time with the incessant whining and complaining that sends your patients in search of a more pleasant practice.
Look at your payroll system. Are the people you pay the most the ones who do the most productive work? Where team members are paid by seniority and the senior team members are physically present but emotionally retired, new team members who can energize the practice and move it forward have no incentive to suffer the inequity. They refuse to carry the load of your dead weights and make less money. Only new team members who want to work less than the emotionally retired find your payroll system equitable. The bottom line is, no one is willing to work harder than the highest paid person on your team. Take a good look at that person in your practice because this team member is your bar. Everyone else will either perform below the bar, shake you down for benefits or leave.
Look at your bonus system. Does it divide the work and the wealth equally or does it create more problems with distributive equity? In some systems the bonus is based on collections only. The clinical team yawns thinking they cannot do anything to affect collections, while the front desk team labors under the responsibility of the whole system. Feeling they are pulling the weight of the practice by themselves the front desk team looks for ways to get even. In some systems the baseline changes every month and the new number is announced after the production period passes. By then it is too late. Team members get frustrated trying to hit a moving target. Feeling they are putting more into the practice than they have any hope of ever getting out of it, they discontinue all efforts to even aim at the target. They find their own way to get even, usually by stealing your time. In some systems the baseline level is based on seniority. At the beginning of the month the senior members push everyone to produce beyond their lower baseline, but once that is accomplished they sit back and coast. Newer employees fail to get the cooperation of senior members to exceed their higher baselines, so not only do they stop trying to hit their own targets, next month they refuse to help the senior members hit their target as well. In their efforts to get back at each other and get even with the practice, the dentist is left with a growing stack of bills, an empty bank account and a cranky team.
If you are working with a team of people who constantly request privileges or extort unintentional rewards, stop trying to make everyone happy. Their seemingly insatiable desires are not the problem: they are the symptom. The problem is distributive inequity. While it is true that keeping it in balance is difficult, it is equally true that you as the dentist are the one who ultimately controls it. The first step is in understanding what distributive inequity is and recognizing how it manifests itself in your practice. Then you have to determine what you are doing (or not doing!) that causes it. Ask yourself probing questions:
- Are you favoring specific employees, by either giving them more privileges than everyone else or by looking the other way when they break your rules? Are you generous in complimenting specific employees while totally ignoring the efforts of others?
- Do you punish hard working team members by giving them more work to do? Do you unintentionally reward incompetent team members by giving their work to someone else?
- Do you have a definitive policy manual that spells out not only what behaviors you expect, but lists the consequences if the employee fails to meet your expectations? Is dismissal from the practice at the end of that list? Have you updated your policy in the last year? Do you consistently and fairly enforce your policy?
- Are you allowing team members who consistently break the rules to stay in your practice? Are you allowing team members who constantly push their work off onto someone else to stay in the practice? Are you allowing team members who perform below your standards to stay in your practice?
- Are you breaking the rules the rest of the team is supposed to follow? (Ouch!)
- Is the highest paid person on your team self motivated, competent, dedicated to the practice and driven by continuous improvement? Do they model the ideal behaviors you value and project the image for which you want to be known?
- Is your bonus system based on production and collections so that all team members are accountable? Is it based on a fixed baseline that is the same for everyone? Does it distribute proceeds equally based on the number of hours worked? Does it allow your employees to increase their personal income?
Distributive inequity. You are not its victim. You are its creator. Employees need to feel they are getting as much out of your practice as they are putting into it. They need to feel that everyone else in the practice carries their own weight and receives appropriate rewards for it. What can you do to improve the morale of your team? Take an honest look at how you are running your practice. What you are doing or ignoring that creates and perpetuates distributive inequity. If you have trouble seeing it, then bring in an outsider who can. Learn how to achieve and maintain equity in your practice. It may involve painful decisions and difficult work, but the only other option is to leave your employees in a free for all effort to “even the score”. Take on the challenge and choose to balance equity yourself. You deserve to experience the joy of working with a high functioning, appreciative, happy team.