Attracting Peak Performers
for Twenty-first Century Private Practices

Jason B. White, M.B.A.

The quality of team in a dental practice constitutes an absolute limitation on the level of achievement for the doctor. It is the team who facilitates productivity, the team who stimulates desire for the finest dentistry. It is the team who promotes confidence in the doctor’s skills and integrity. It is the team who permits the doctor to thrive economically. More than the accountant, banker, or lawyer, it is the team who positively influences the practice’s gross and net. The doctor will gain more economically, clinically, and behaviorally when a talented team is present even with a mediocre doctor than when there is a mediocre team and a talented doctor.

It is easy for a doctor to say, "I want to find team members who are warm, empathic, bright, committed, accept responsibilities, are self-motivated, personally mature, and care deeply for people in the practice." It is not difficult to attract applicants who lean toward these traits. However, it is very difficult to create and maintain an environment, which excites and challenges these people.

After interviewing thousands of auxiliaries, two psychologists from the University of Nebraska found eight common themes present in high performing team members:

1. Mission. They saw their work having a purpose that went beyond tasks they performed.
2. Interaction. The quality of their interpersonal exchanges was quite high.
3. Rapport. They had the ability to create warm, caring relationships.
4. Gestalt: intuition. This is the ability to see the whole picture when only small pieces are available.
5. Self Esteem. They genuinely like themselves.
6. Activation. They are "action" people who get things done.
7. Empathy. They feel what others feel.
8. Work Relationships. They can work well with their peers.

Research indicates that there are two major factors affecting a doctor’s ability to attract people such as these:

1. The median age of the American population in 1980 was 30. By the year 2000, it will be 36.3. The number of Americans between the ages of 18 and 24 will decrease by 20 percent by 1995. This group provides dentistry with most of its personnel, and the decline is currently exerting upward pressure on compensation for team members. This means that in the future more energy and money will be spent on keeping people employed because replacements will not be easy to come by.
2. The reasons women work have changed dramatically. Nineteen seventy-seven was the first time in our country that there were more employed females than employed males. Today women work:

A. To seek out an identity
B. To become economically self-actualized
C. As an extension of their individuality
D. For the same reasons men work

It only makes sense that a woman who works for these reasons will not feel good in a practice where she perceives the doctor is treating the female employees poorly.

What is the effect on dental acceptance by patients in a practice where the team feels they are treated poorly? Although most doctors realize auxiliaries have value greater than "from the wrists down," it is critically important that they remember this fact: "People go where they are appreciated and stay where they are recognized." This holds true for the team as well as patients.

As we seek to keep talented people in dentistry, it is essential that we recognize what we are up against. In a national study of more than 4,000 dental offices and more than 300,000 team members, 80 percent of the surveys indicated the following complaints from the team:

1. Long hours
2. High stress
3. Low salary
4. Low growth and lots of boredom
5. Poor communication

Strangely enough, the doctors in these offices indicated the same complaints about their jobs:

1. Doctors work longer hours than they would like.
2. They complain of high stress.
3. They are frequently bored by the routine of dentistry.
4. There is low growth potential.
5. They are aware of the poor communication in their offices.

What is surprising is that four to eight people or more who work together 30-50 hours per week in 600 to 1,400 square feet, in such close proximity that they are often in physical contact with one another, share the same problems, but no one talks about it.

Today, only two to three percent of what this work team producers is essential. Except for the emergency visit, most of what today’s dental team produces represents optional procedures. This means that the doctor/patient relationship is becoming more voluntary in nature. Much of the time there is no compelling reason for a patient to accept the doctor’s recommendations.

Consequently, until someone voluntarily sits in that chair, opens his mouth, and says, "let’s do it," the doctor does not have the opportunity to use the full complement of his or her diagnostic and technical skills. This is why a practice with a high performance team has a potent marketing advantage today. The single most distinctive characteristic of successful dental practices is their ability to have people that want fine dentistry. This is the responsibility of the team, not solely the doctor.

Psychologist Fredrick Herzberg identified two basic incentives he believed we all have for working:

1. Hygiene factors. These include salary, hours, fringe benefits, vacation, sick pay, etc. Hygiene factors are anything quantitative that is inherent in the job.

2. Motivation factors. These factors are attitudinal and most often cannot be quantified. They exist within the person, and are not part of the organization. Dr. Herzberg discovered five main motivation factors:

A. Recognition. The desire to be seen as an important person.
B. Fulfillment. The ability to satisfy personal values.
C. Growth. The desire for a future of choice, which is not limited to a job description.
D. Shared Information. The need to have access to information on more than a "need to know" basis.
E. Autonomy. The desire for independence and responsibility with authority.

Research has indicated that low achievers tend to favor hygiene factors in their jobs. They want standards imposed upon them. High achievers, on the other hand, expect a high level in hygiene factors; they demand a high level in motivation factors. For these people, excellence is an internal issue, not something to which they have to be directed.

Low achievers are stressed by the uncertainty that high achievers want. High achievers hate the rigid structure and rules that give low achievers their security. Thus, a dental practice will greatly affect which type of person it attracts and keeps by the choices it presents.

To recognize high achievers, look for the following attributes:

1. Optimism
2. Participation in life
3. Seeing themselves as significant
4. Possessing mission and drive
5. Realism
6. Energy
7. Acceptance of others
8. Good use of role models
9. High sense of priorities
10. Resilience
11. Self-revealing
12. Willing to make long-term intimate relationships

Exhibit A:

DENTAL ASSISTANT
CRDA. Exp, poss jobshare
To full time. Nice office.
Call Kathi. 555-9876

DENTAL HYGIENIST
3-4 days/wk + Sat per
mo. Call Debbie. 555-4321

Exhibit A shows a typical dental classified ad: short, full of abbreviations, most often unsigned. Others appear as "blind" ads which ask people to respond to a nameless box number. What is the message here? Do they convey trust, openess, or any of the qualities doctor purport to want in their team members? As for the style of presentation, these ads are short because abbreviations save dollars, a questionable choice when finding peak performance team is so vital to the prosperity of the doctor and team. What do these ads communicate beyond job requirements in days and hours, and basic hygiene factors? Do they excite a person who wants to be recognized as important, fulfilled, and growth seeking? When a doctor’s ad emphasizes hygiene and ignores motivation factors, most applicants will be low achievers.

Exhibit B:
Peak Performance Dental Team
Seeking a superior person for
our outstanding office. We value
personal communications with our
patients and place emphasis on team
members’ personal development. We
require a high level of self-esteem and
offer a great deal of interaction with
our team so that we may achieve
a unity of spirit and organization. For
this reason, we look for well-developed
administrative, social, and interpersonal
skills. You should apply to our office if
you want a career in dentistry, are health-
centered, and want a real opportunity to
be all that you can be. You will find our
South Minneapolis office an exciting ex-
perience. Call us at 612-123-4567.

Dr. Jane B. Smith and Team

Now look at Exhibit B: it is larger and, hence, more expensive; there are not abbreviations; it is signed by the doctor and team; and it is loaded with motivation factors. Will potential applicants reading this ad see a difference between this office and "typical" offices with "typical" ads? This ad does not show hours, days, duties, fringe benefits, or salary. Low achievers will not like this ad; high achievers will call the office for an interview.

There is, however, one problem with an ad of this kind: if the office does not perform as described, the person hired will not remain long. Office belief systems must lead to office behavioral systems. If they do not, the doctor will be seen as a hypocrite. Further, if the office presenting such an ad has not defined its own identity and values, they will have cheated themselves out of an opportunity to become significant one to another as well as to their patients.

The challenge, then, is not simply to attract highly talented people, but to provide a structure and climate in the office that is supportive of their talents. The candidates who respond to Exhibit B will not work cheap, will not tolerate routine, and will not accept instructions from a superior without question. If the practice is not organizationally and behaviorally prepared to deal with people of this caliber, this entire thought system should be avoided.

Screening phone calls begins the evaluation process. It is done to limit choices, not to perform interviews. Six traits to listen for are:

1. Spontaneity: the ability to answer questions enthusiastically without hesitation.

2. Show of feelings: caring about other people.

3. Intimacy: appropriate disclosure of themselves to others.

4. Illustration: giving solid details to back up points made in conversation.

5. Differentiation: the use of detail to describe differences between activities that may seem to be the same.

6. Organizational ability: well-organized thought patterns about information, i.e., linear logic or thematic logic.

Also listen for negatives. There are two main types:

1. Devices that put distance between the applicant and team member, i.e., long pauses or repeating the questions. They give the person time to come up with what he or she thinks is the right answer, and cover true responses. Giving too much information is also a distancing maneuver.

2. Inappropriate disclosure of information; i.e., if the information is not appropriate to fit the question, the person is probably immature.

Applicants should do most of the talking, as it is the only way to evaluate them. Unexpected, open-ended questions not requiring a "yes" or "no" answer are best. A good unexpected question to ask the applicant is if the phone conversation can be recorded. If the person’s self-esteem does not allow this, the phone screen is then concluded. Recording the conversation allows the doctor and other team members to hear what was said and also make an evaluation.

Other useful questions are: "Tell me about a job you really enjoyed and what you most enjoyed about it. "Tell me about a job you didn’t like and why;" and "Look ahead three to five years--how do you expect your quality of life to have changed?" These questions allow the applicant to direct the conversation, give examples, illustrate points, and organize thoughts spontaneously. By evaluating their answers according to the above criteria, the doctor needn’t be involved except to listen to the "A" list candidates later. Team members can be trained to screen as well as conduct follow-up interviews.

As the necessity increases for private, fee-for-service doctors to find and retain peak performing team members, it is worth reviewing why team members have historically left their employers. Reasons include:

1. Lower than expected compensation
2. No opportunity for advancement
3. Not enough respect
4. Not enough communication
5. Lack of appreciation from their employer

The following are suggestions to counteract these problems and help keep peak performing team in private dentistry:

1. Invest. Do not automatically hire the cheapest applicant. You generally get what you pay for.

2. Prepare. Have a training program for new team members. Better results will be achieved when team members understand the doctor’s philosophy and mission.

3. Focus. Establish clear and concise goals and objectives with the entire team.

4. Educate. The challenge of continuing education creates a team that can be the doctor’s single most potent marketing advantage.

5. Communicate. Many doctors seem to reserve their caring exclusively for the patient and neglect their teams. When communication is weak, motivation dies, and so does productivity.

6. Disclose. Practice numbers to the team. How would you like to play football and never know the score? Good people will demand feedback, and sharing numbers increases the team’s attitude and feeling of ownership.

7. Set a good example. The doctor should not reprimand the team for being late after lunch when s/he is also late. The doctor cannot expect loyalty, commitment to patients, and teamwork until the leader has these traits.

8. Give respect. The doctor cannot give respect unless s/he is respected. The team likes to know that the doctor will stand behind them 100 percent in an issue with a patient.

9. Don’t poor mouth the practice to the team. A good way to keep gloom and doom is to preach gloom and doom.

10. Show appreciation. The team does not feel appreciated simply by getting a paycheck. Money is important, but praise in front of coworkers or patients is also rewarding recognition.

It is important to remember that, like fine dentistry, fine people will take longer to find, require greater investment, and will be important to maintain over time. Ask yourself, how much more valuable is it to seek and maintain peak performers on the team than it is to own the latest piece of dental equipment?