THE END OF THE APPOINTMENT, PATIENT DISMISSAL
Patient retention is increased and the value of today's experience is enhanced when patients know what has occurred at today's appointment and what to expect next. This is done at the end of the appointment with the patient dismissal.
Our Goal:
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Instill appreciation in the patient for today's dentistry.
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Set expectations to encourage people to keep their continuing care and other follow up appointments.
The patient dismissal provides the service of communicating what was accomplished today and what to expect as a result of the treatment, and the purpose for their next appointment.
The process should occur at the end of both the hygiene and operative visit.
Please see this as an opportunity to:
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Communicate facts
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Develop Trust
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Enhance the patient's perception of the teams interest and caring.
Patients who feel that quality time is spent on their behalf will be eager to refer their friends and relatives to you.
THE PROCESS
This process is performed by the chairside assistant at the end of the restorative appointment and by the hygienist at the end of the hygiene appointment. It will take only a few minutes but is highly effective in building quality relationships.
Step 1: The hygienist or dentist completes the procedure that was scheduled for today.
Step 2: Place the patient in an upright position in the dental chair with the protective napkin still in place. This acts as a psychological "seat belt" when coupled with the statement of expectation (next).
Step 3: The team member sits in the dentist's chair and faces the patient. Good eye contact is important. This creates a professional tone for the dismissal.
Step 4: The dismissing team member verbally prepares the patient by using a benefit statement:
Mr. Jones, so that I can answer any questions you may have and let you know what was done today.....
I'm going to spend a few minutes with you reviewing your treatment before I escort you to the appointment area.
Step 5: Tell the patient what happened today:
Mr. Jones, during your periodontal screening, I found some initial signs of periodontal infection on your upper right side. I took a full mouth series of x-rays to determine if the supporting structures such as the bone are affected at this point.
Step 6: Tell the patient what kinds of symptoms, discomfort and post operative care to expect.
You may experience some slight discomfort after a procedure such as what we did today. You may wish to rinse with 1/4 teaspoon of salt in 8 ounces of warm water three times today to help reduce any soreness you might feel.
Give out any printed material that's appropriate at this time.
Step 7: If the patient needs another appointment, now is the time to sell the patient on the time or day that you want to see them. This should be the day that this procedure fits in to your goal scheduling system sot that your productivity is maintained. The appointment that you are to mention to the patient should have been discussed at the morning huddle.
Mr. Jones, the x-rays indicate that the bone has not yet been severely affected by the initial periodontal disease. In order to reverse the disease process before it worsens and begins to affect the supporting structures, we need to see you as soon as possible to begin a sequence of root planing. because of the nature of the procedure, it is important that I see you for a morning appointment in a week to 10 days; that's why our appointment coordinator will be scheduling you for a morning appointment when we go out to the front desk.
IF THIS INFORMATION COMES FROM THE CLINICAL TEAM, IT IS MUCH MORE ACCEPTED BY THE PATIENT.
The team member doing the dismissal must adhere to the appointment guidelines which were communicated at the morning huddle.
Step 8: For you to motivate the patient to return at a specific time or day, they must know why its important to return. This reason will be more compelling if its directly tied to the patients hot buttons. Give the most important reasons to return with a benefit statement and tie it in with the emotional motivator or concern.
(Benefit) Mr. Jones, you spoke with me about how important it is for you to keep your teeth and not end up like your father who had dentures. You are already on the road because you are here today. Should this treatment be delayed, I'm concerned that the infection will progress and cause damage to the bone that supports your teeth.
(Procedure)... Because of this it will be very important that you keep your next appointment with us. The root planing will allow us to remove the bacteria that is causing the infection. SO that you are comfortable, we will be anesthetizing the area on the upper right. I will be focusing on that area during the root planing and I will show you some new techniques to help you keep that area clean.
(Feature Statement) .... Periodontal disease advances very quickly. Catching this disease early and reversing it quickly gives you an excellent prognosis for having your mouth returned to it's healthy state.
Step 9: You will enhance your position if you inform the patient who they will see next time. It's a courtesy and is one more step to assure that they understand the scope of their visit.
Mr. Jones, do you have any other questions?.....Now that we've finished, I'm going to take you to Judy, our appointment coordinator. She will schedule that morning appointment for you in the next 7 to 10 days.
Step 10: Be sure to give the patient time to ask questions. Doing this while the patient is seated communicates how serious you are about addressing his needs. Also, it gives the patient an opportunity to reveal concerns that could prevent him from returning or for paying for it later. You should discover all objections now so that you can discuss them in privacy. This precludes the patient from having lengthy conversations at the front desk where there will be interruptions and lack of privacy.
Step 11: Once all questions have been asked, remove the napkin and adjust the chair so that the patient can easily leave the room. Escort the patient to the front with his chart.
When this process is done correctly, you will find fewer last minute cancellations or no shows and your schedule will be more productive.
1. List the dollar amount of the recommended dentistry.
2. List all recommended procedures and whether they're cosmetic or operative dentistry.
3. Note what is going on in the client's life that will benefit from the recommended dentistry and be worth the fee. This is a list of non-clinical benefits to this particular client.
4. In order to do this, make a list of what we know for sure about this client, such as:
A. GenderB. AgeC. Marital status, with or without childrenD. Spouse's information, i.e., name, job, interests, activitiesE. What do we know about the client's life that would indicate her values or attitudes?F. What is the personality style of this client? This will affect our method of presentation.
5. Make some assumptions about the benefits of the recommended dentistry to the client's lifestyle.
6. Create questions to be asked which will verify your assumptions. In other words, the answers to these questions will clarify how she feels about the benefit. This will help you present the case using benefits that are real rather than assumed.
7. Once you've established these benefit questions, create the framework for the questions. Write out how you'll introduce the questions and make it in the context of the client's current situation. For example:
"Tina, when we met last, you mentioned that you'll be taking a test to become an insurance adjuster so you can help your husband in his line of work."
This is the context, now comes the question:
"How important to you is your first impression when you meet with clients to appraise their insurance needs?"
Before you start the clarification process of your assumptions, it would be beneficial to ask the client if it would be all right to ask questions to help them understand the treatment that's being recommended. This makes it okay with the client to ask questions before you actually get into the discussion of the treatment plan.
By doing that, the patient will perceive "personalization" of the treatment plan. It will let them know that they have a say in the dentistry; they won't just be waiting for you to tell them what they need.
8. Once your assumptions have been clarified, it's time to present the case. This is done through making an initial benefit statement and following that with a recommendation of procedures to create the benefit. For example:
"So we can make your teeth more stable and give you an investment that's long-term, the doctor has recommended that we do . . ."
Each procedure needs to have a benefit statement go with it so the client can understand why that's being recommended.
9. Let the client hold the study model with the wax-up completed in her hands. Look directly at the client with the study models in between you. This will allow you to look at the study models and the client's face for non-verbal communications. The client's face will project clarity or confusion and we'll want to know that before moving on to another point. Confusion must be clarified immediately or it will ruin the entire presentation. Having the client hold the study models keeps them focused on what you're saying and gets their tactile, as well as their visual, senses involved.
10. Remember that at this point a fee has not been quoted.
11. Once you've presented the recommended dentistry, ask the client for a decision. This can be done as follows:
"Tina, if we can do all this that we've talked about, is there anything that would keep you from going ahead with it?"
This is a closing question. The patient will answer with one of the following objections:
A. MoneyB. TimeC. PainD. No urgencyEach objection must be handled with the objection formula we've previously discussed and dealt with individually. Since we have not yet quoted a fee, this will probably be the first issue to come up. When the client asks for it, be ready to quote it. Now it's appropriate.
In quoting the fee, ask:
"If we could fit this into your budget comfortably, would that allow you to go ahead?"
This will draw out any objections other than money. At this point, we need to go over the available payment plans and end that discussion with:
"Assuming we can work the finances out for you, should we go ahead and schedule our first appointment?"
Points to Remember:
1. You must be prepared and not do it at the last minute. This means that you and the Client Coordinator must have ample time in advance to discuss the clinical needs of the case as well as create the questions to clarify the assumptions about the benefits to this particular client.
2. Each client is different, and when you lose sight of that, you have lower case acceptance.
3. The dentistry is not the focal point of the consult, although it's an important piece. The client needs to understand the benefits that are potentially available and be asked to talk about what those benefits will do for them. If you tell them what the benefits are, it won't be the same.
When the client identifies the benefits, they further sell themselves on the dentistry. This takes the pressure off the doctor and the Client Coordinator and makes the process more fun.
To better serve the individual needs of our patients through enhanced office communication among the staff!
Who should be there? All staff working that day
Where should it be held? In the hygiene room or a private area
What time? Ten to twenty minutes before the first patient arrives
How? The meeting may best function by dividing it into three "quickie mini huddles." The first session will work best as the dentist goes over the previously reviewed charts of the hygienist. The hygienist will bring to attention pertinent clinical data such as changes in medical history, radiographic, periodontal, and restorative needs.
Printable Morning Huddle Forms
Concurrently, the clinical assistants will be reviewing the dentist's charts with the administrative assistants. Particular attention will be given to the amount of time needed for each restorative procedure to make sure we are in synch with what is scheduled for that time period. The clinical assistants will make predetermined best possible times to see emergencies. The administrative assistants will give any pertinent information to the clinical assistants that might impact our treatment (i.e., medical history changes, financial and personal data).
The second mini huddle will be between the administrative assistants and the hygienists. At this time, schedules can be verified and altered as needed to give the proper amount of treatment time. Again pertinent patient information can be given to the hygienists.
Simultaneously, the clinical assistant will review the charts with the dentist to give information needed for the day's schedule.
Also, the administrative assistant will announce the goals for the day and how much we're short by, if any.
Lastly, the dentist will do a final check with the administrative staff to see if there are any needed changes or items that should be addressed.
Adjourn. Hopefully, we can get this down to ten minutes. I suggest late arrivals have the privilege of contributing $2 to the doughnut fund. I know it sounds like a lot but let's have fun with it!
Charisma: What Can It Do For Your Case Acceptance?
By Kate Fitzgerald
Often, in the day-to-day routine of doing business, we forget that we are in the people business, not the tooth business. Building trust and developing rapport to discover our patients’ desires are the keys toward a successful lifetime relationship.
What makes a productive dental practice which consistently reaches its goals and enjoys a tremendous success rate of case acceptance?
Charisma. Tony Alessandra, Ph.D. is a professional speaker, marketing strategist, applied behavioral scientist who is also the author of Charisma: Seven Keys to Developing the Magnetism that Leads to Success (Warner Books, 1998). He defines charisma as:
"The ability to influence others positively by connecting with them physically, emotionally and intellectually."
The common myth is that you are either born with charisma or you aren’t. But most people, if they learn the appropriate social skills and tools, can develop it. And, in becoming more powerful, they don’t take power away from others, they actually give themselves and others the power to achieve successful outcomes."
Alessandra’s Seven Main Components of Charisma:
1. Your Silent Message
You make a statement about yourself even before you open your mouth. This is your "silent message" and it can include everything from your posture to your positiveness. In short, it’s the way you carry yourself physically, emotionally and intellectually.
There are five categories of silent messages:
A. Physical: You can’t have charisma unless you make a good first impression physically. Look at how you dress, shake hands and smile. Do you make eye contact when you talk to people?
B. Intellectual: How mentally fit are you? Work on strengthening and expanding your mind. Every day we see many different people from many different situations in life. We must be prepared to speak about a wide number of subjects.
C. Psychological: How do you think about yourself and your goals? And not just your own personal and professional goals, this includes the practice’s. Do you share the doctor’s mission and philosophy? "We each have up to 50,000 thoughts per day," says Alessandra. "How many of yours are positive?"
D. Emotional: How do you feel about yourself, your goals and the practice’s goals? How we feel about ourselves and where we work each day comes out in many ways. If you see yourself as successful, others will too.
E. Spiritual: The spiritual has little to do with religion, but a lot about your attitude toward other people, your level of caring and your ability to help others.2. Your Ability to Speak Well
The ability to communicate well to patients can make a critical difference in their acceptance of your recommendations.
A study conducted by AT&T and Stanford University revealed that the top predictor of professional success is how much you enjoy and how good you are at public speaking. All speaking is public speaking. It’s just the size of the audience that changes. Keep your patient in mind at all times. Say what you need to say, but don’t rush through your delivery with an onslaught of words or technical phrases. Know the difference between treatment, features and benefits.
3. Your Listening Skills
These skills are rarely taught and infrequently practiced. But when done well, they make others feel special in your presence.
While we hear, we only pretend to listen. Listening doesn’t just mean shutting up while someone else speaks, though it’s a good start. Listening, INTENTIONAL LISTENING, takes more work than that. It’s the physical process of hearing. It also takes intellectual and emotional effort. To get a full appreciation of your patient:
A. Develop a list of 20 "Needs Development" questions to use in your initial interview to discover what this patient is all about.
B. Remain objective while figuring out what’s really being said and what’s not being said.
C. Observe and interpret their body language.Listening is a commitment and a compliment. It’s a commitment to understanding how this patient feels, how they see their world, and it’s a compliment because it says: "I care about what’s happening to you; your life and your experiences are important."
4. Your Persuasive Talent
If you want patients to accept your recommendations, you must remember that they do things for their reasons, not yours. Your challenge is to discover and appeal to those reasons. Find out the patient’s needs, goals and values and then focus on how you can help them reach, or at the very least, enhance the process toward, those goals. Discover their "non-clinical benefits."
5. Your Use of Space and Time
Your use of space and time sends important signals. For example, if you violate a patient’s physical comfort zone by, say, standing too close to them or touching them when you shouldn’t, you may offend them and cause tension. (We call this The Silent Side of Communication.) Similarly, if you abuse their sense of time by being late, you can negatively affect the relationship. How you honor or violate another person’s personal space and time will affect the amount of tension or trust between you.
6. Your Ability to Adapt to Others
You remember The Golden Rule: "Do unto others as you would have them do unto you"? Not everyone wants to be treated the same as you.
Alessandra has come up with The Platinum Rule:
"Do Unto Others as They’d Like Done Unto Them."The Platinum Rule means respects for others. It’s an attempt to break down the them-versus-us mentality and concentrate on "us." It’s a potent tool for helping building rapport by meeting your patient’s desires and your own.
J. White and Associates have examined the four personality, or rather, social, styles of people much more deeply in our workshop Social Styles and How They Affect the Acceptance of Dentistry which describes four behavioral, or social, types:
A. Drivers are forceful, take-charge people. Their impatience, and sometimes their insensitivity, may make you wince. Driven by an inner need to get results, they’re more concerned with outcomes than egos.
B. The friendly, enthusiastic Expressive-type is fast-paced and thrives on admiration, acknowledgment and applause. This person loves to talk, and while strong on fresh concepts, is usually weak on execution.
C. Amiables are the teddy bears of the human zoo. Rather easy-going, people-oriented and slow-paced, Amiables tend to drag their feet when it comes to change, preferring routine ways of doing things.
D. Analyticals are result-oriented problem solvers. They seek results in a quiet, low-key way. Analyticals are thinkers, persistent, independent and well-organized, but are often see as aloof, picky and critical.
7. Your Vision, Your Ideas
Make sure you’re communicating some tangible and specific goals in the here and now so that the patient can connect with your vision. Patients have to be focusing on what they can do today to make things be what they can be in the future.
Charismatic people possess an almost childlike faith in their vision and their ability to create change. People will follow leaders whose vision inspires them and makes their lives more meaningful.
Make sure that you feel passionately about your commitment to the recommended dentistry. Even if you are not the doctor actually delivering the treatment, you must be able to back up the doctor’s recommendations. You’ll never influence anyone if you don’t feel strongly about it yourself.
As you apply these ideas, get together with other team members for feedback. There’s often a gap between how we see ourselves and how others see us. You’ll be looking for feedback that will add a 360-degree picture of yourself.
We all need these skills because they help build trust and commitment. And trust and commitment are the bedrock of successful case acceptance.
The potential to be more charismatic is within you. And the payoff for doing so has never been higher.
Exceeding Patients’ Expectations
(Part I)
By Kate Fitzgerald
When people seek the services of a dentist, they don’t consult the professional journals, write to their congressman, and normally don’t scan the yellow pages, they talk to other people. They ask their friends for advice and suggestions. The first thing they want to know is not how competent the doctor is but rather what sort of person is s/he? Very seldom are we judged on our professional and technical ability. People just assume we know how to treat their dental problems. What they want to know, what they really care about, is how we treat people.
Whether we like it or not, we are going to be classified by our patients. Figuratively speaking, they are keeping "book" on us and the book is opened every day. There is never a day that goes by that we are not being awarded gold stars for merit or being penalized with black marks for lack of it. To put it another way, the image we project is vitally important to the growth of the practice.
Exceeding Patients’ Expectations (Part II)
Obviously, patients come to us because they are in need of our services. They need dentistry. They want health and comfort. Whenever we restore the incisal angle, construct a bridge or do anything else that we have been trained to do, we are fulfilling that need. However, this is not enough, our patients need more than fine dentistry. They need to feel important and appreciated. The best way to improve our human relations quotient and the quickest way to make ourselves more successful is to fulfill this universal need. John Keats called appreciation "the substance without which food loses flavor, home meaning, and work its zest." Don’t underestimate its importance. We all need other people to help us feel important and appreciated, to confirm our own sense of personal worth. We all want to be recognized and noticed as worthwhile human beings.
Let’s develop an appreciation of people as one of our primary practice goals. Let’s get into the habit of giving people our very best at all times. Offer coffee and serve it graciously, clean the patient’s glasses before returning them, use all of our resources to be prompt regarding appointment control. Let’s extend those little courtesies to our patients: hanging up their coats, offering to locate reading materials, and above all, using the patient’s name frequently. As we all know, there is nothing quite so pleasant as the sound of one’s own name.
Remember, if our patients like us, they will have confidence in us. We will be able to make a complete examination and thorough diagnosis, present the case, and proceed with the treatment with very little question about fees. The entire relationship will be marked with courtesy and cooperation.
Doing the little things better is one of the great secrets of attracting people, and consequently, one of the great secrets of practice success. Herein lies the formula for working smarter, not harder, to find our way to the top.
Effective human relations is one of the most intangible factors in dental practice and yet it is undoubtedly one of our most valuable practice building assets. It can’t be measured in cubic inches, square feet, or running yards, but its dollar and cents value to dental practice is unmistakable.
"With public opinion," said Abraham Lincoln, "nothing can fail. Without it, nothing can succeed." The politician depends on his public image to get him elected. Throughout the diplomatic world, nations depend on their ambassadors to create good will and generate international harmony through effective personal relationships. Large companies have public relations departments specifically organized to study public attitudes, help management develop policies and procedures which will create a good public image and educate the public to understand and accept the company’s policies.
Obviously, a good public relations image is equally as important in the dental office; perhaps, even more so. We deal with people on a person-to-person basis. Through us our patients form strong, first-hand opinions about our practice and the service we extend. Of course, they’re "keeping book."
Effective human relations spring from us: what we say, what we do, how we act, how we look, all help the public to form their opinions, favorable or unfavorable.
The steady growth of our practice is inherently dependent upon the image which we and the members of our team project. Effective patient relations must be uppermost in our minds and practiced continually. The important part that our team members play in establishing and nourishing that good public image cannot be over stressed. The importance of promptness, a neat and well-groomed appearance, careful attention to work habits, the maintenance of a neat appearing treatment area, a friendly disposition, consideration for every patient’s time and feelings, an overall healthy mental attitude -- all of these combine to make any practice a success, professionally, ethically, and financially.
Effective patient relations can be summed up in three small words: "I like you." If we can communicate that feeling to our patients, our patients will return the sentiment in full.
Hygiene Communications (Part I)
by Jay White
The hygienist’s role in the office is potentially one of the most significant because, in most offices, the hygienist has the majority of uninterrupted time with the patient. How she uses this time and what she says has a great impact on the level of dentistry the office performs.
The hygienist should see herself as more than a "prophy queen." Cleaning teeth is important, but patient education and motivation is what really marks the great hygienist.
Today’s dentistry is much more elective than in the past and requires greater time be spent with the patient understanding their wants and needs.
The doctor and hygiene team must determine what specifically the doctor wants the hygienist to accomplish in a one-on-one hour visit. They need to see the big picture of what they’re really doing in the office besides delivering procedures to patients. It’s important to know that there is more to your work than just a job description.
Additionally, it is the hygienist’s responsibility to help motivate the patient to return in a prescribed amount of time for their check-up. The hygienist’s verbal skills with patients will enhance or detract from the patient’s next check-up appointment.
Understanding patients’ and team members’ social styles becomes important in that the quality of the experience the patient has will be effected by the type of communication they receive.
Gaining patient acceptance of recommended dentistry can be heightened if we propose it in a way that is more appropriate for each patient’s social style. The hygienist must become aware of this; but the entire team should be included in this piece as well.
The doctor and hygiene team need to be on the same wavelength in their communications with patients, identifying what and when certain procedures are called for. A key issue in this process is conversation between the doctor and the hygienist when the doctor feels a different recommendation is in order than what the hygienist has communicated to the patient.
In Pursuit of Excellence
by Kate Fitzgerald
Excellence is never an accident. It is achieved in a practice only as the result of an unrelenting and vigorous insistence on the highest standards of performance. It requires an unswerving expectancy of quality from all team members.
Excellence is contagious. It infects and affects everyone in the practice. It establishes the criteria for planning. It provides the zest and vitality to the practice. Once achieved, excellence has a talent for permeating every aspect of the practice.
Excellence demands commitment and a tenacious dedication. Once it is accepted and expected, it must be nourished and continually reviewed and renewed. It is a never ending process of learning and growing. It requires a spirit of motivation and boundless energy. It is always the result of a creatively conceived and precisely planned effort.
Excellence inspires; it electrifies. It unleashes an impact which influences every program, every activity, every person. To instill it in a practice is difficult; to sustain it, even more so. It demands adaptability, imagination and vigor. But most of all, it requires a constant state of self-discovery and discipline.
Excellence is a practice’s life line. It is the most compelling answer to apathy and inertia. It energizes a stimulating force. Once it becomes the expected standard of performance, it develops a fiercely driving and motivating philosophy of operation. Excellence is a state of mind put into action. It is a road map to success. When a climate of excellence exists, all things — team work, quality, finances, plans — come easier.
Leadership: The Prerequisite to Prosperity
by Jay White
The responsibility of creating dental offices able to quickly adapt to the fast pace of change lies solely with those in leadership roles. More often than not this is the doctor; however, in highly developed, team-centered offices, it will also be the team members. Their success depends on their ability to empower their people and to have them take responsibility, or ownership, of the practice’s objectives.
According to John Naisbitt, author of Megatrends 2000, leadership in the coming years will move toward decentralization with more decisions being made at the lowest possible level. Consequently, the classical command and control type of management style will be thrown out.
Traditional dentists tend to focus more on "hard" issues such as: 1) Quality, 2) Service, 3) Profitability, 4) Cost control, and 5) Productivity. These issues most often take the form of declining profits, productivity declines or plateaus, unacceptable patient service and personnel problems. In reality these issues are only symptoms of the real underlying issues. Dentists tend to focus on hard issues because they are easy to see, recognize, measure and, in some ways they seem easy to address.
In most cases, the underlying cause of hard issues are the soft, or the
human issues. These are less tangible and include attitudes, opinions,
mind sets, self image, self esteem values, beliefs and feelings about
how the world is organized and people’s place in it.
A team member’s performance is directly related to their state of mind . . . a soft issue. Performance, which can be measured, is a hard issue. The traditional dentist refers to these issues as "touchy-feely," and tends to think hard issues are more important than soft issues; if you ignore the soft issues, they will go away.
According to John F. Welch, Jr. Chairman and CEO of General Electric, "America has spent the majority of its time working on fixing the hardware of American business. The Japanese, on the other hand, have the software; the culture which ties productivity to the human spirit which has practically no limits."
The software of our dental offices, i.e., the culture that drives them, is where private dentistry will flourish vs. the managed care, PPO organizations which will constantly focus on the hard issues because their profit margin doesn’t allow anything else.
The challenge facing the leaders of private dental organizations in the 21st century will be how to get back to the roots of ultimate personal care with a spirit and fire that transforms team members into leaders, or stakeholders, who have a personal stake in the outcome of the business enterprise.
Lee Iacocca, former chairman of Chrysler Corporation wrote: "Every day in America 242 million people wake up, and if everyone would say when s/he gets up that s/he’s going to do some classy, quality thing today that s/he didn’t do yesterday, we’d be world beaters. Unfortunately, most people swing out of bed, yawn and figure, "Oh hell, I’ve got to make it through another day of drudgery." Their attitude is that they’re going to do what they’re told and not one thing more." The former automaker added, "Quality, after all is affected by something as basic as a person’s sense of values . . . if a person is going to do a good job, s/he’s got to like coming to work, s/he’s got to say, I’m going to help produce something great today."
In a private dental office, each team member must be engaged in making something greathappen every day. The dentist, as the titular office leader, has a vested interest in empowering this to happen.
What’s Attitude Got To Do With It?
The 80%/20% rule:
With any new idea, (i.e., the intraoral camera or not accepting insurance assignment) people’s reaction will follow Pareto’s Principle: about 20% of them will be open to it and see value in it, the other 80% will resist the change no matter how much sense it makes. The difference between these two groups is attitude, a soft issue. In an 18 year study of outstanding performance organizations, people’s attitudes were validated as the dominant factor separating high performance creative thinkers from reactive no-change thinkers.
Characteristics of Reactive Thinkers:
1. Resistant to change
2. See reasons that they can’t do things
3. Focus on finding problems to fix
4. Avoid blame or responsibility
5. Tend to be poor listeners
6. Are devastated by failure
7. Have low self esteem
8. Do things right
Characteristics of Creative Thinkers:
1. Are open to change
2. Are "can-do" orientated
3. Take responsibility for their actions
4. Are good listeners
5. Learn and grow from their mistakes
6. Have high self esteem
7. Do the right things
The new dental leader’s job is bring out the best in people. Since attitude is so critical for the practice’s success, it is essential for dentists to understand what keeps their team members from choosing an attitude which is best for the practice. Most all the evidence now focuses on the individual’s self image or self esteem as the key factor in forming attitudes. How we perceive ourselves, and how we believe others perceive us, defines our self image.
What can the new dental leader do?
First realize that 80% of the team have been raised to focus on what’s wrong with themselves and only 20% of them were praised for what we did right. The 80% generally have negative self images and invest large sums of energy trying to keep others from seeing the weaknesses they perceive in themselves. Help these people to see small success in their days and praise them. Nothing builds self esteem faster than being successful. New dental leaders and team members will acknowledge that the practice’s success in the current environment of rapid change depends more on mutually developing each others' self esteem than on developing their clinical skills.
Secondly, the new leader must become conversant with the components of personal and organizational effectiveness. This is much more than knowing that the schedule is filled, that recall is being worked, and financial arrangements are being made. These components include personal empowerment, quality consciousness, clear purpose of the office, inspiring vision and alignment of the team. In other words, the successful new dental leader must face the real issue of managing the collective mind set, or attitude, of the team which radically affects the practice’s profitability. Improvements in practice productivity, increased levels of case acceptance, enhanced levels of personal service, increased profitability -- hard issues -- are the result of how well the new leader manages soft people issues.
It is helpful to know that people with low self esteem focus on what is not working while those with high self esteem focus on what is right and how to improve it. This is called "shifting focus." Dental practices soar when a majority of the team shift from a problem focus to a solution focus.
A large metropolitan practice had experienced a long list of frustrating turn downs on their treatment recommendations from a major state dental insurance company. The team felt put on the defensive by the insurance company’s negative communications to their patients about those recommendations. The doctor slowly realized that if something didn’t change, patient care would suffer, and that profitability ultimately would be determined by the insurance company despite all his good clinical skills. The doctor canceled days of patient scheduled time and invested heavily in communicating what he thought a private office should feel like to his team. They role played the conversations with patients that they felt would help them see value instead of focus on cost only (which was the insurance company’s orientation).
The training gave the team more confidence and their focus changed from being worried about saving their jobs if the practice declined insurance assignment, to creating a solution for the patient so they could choose the dentistry they needed without the insurance company’s interference. This led to a high level of team commitment, passion for the cause of private dentistry and, ultimately, to retaining more patients than they ever imagined possible. Not one team member lost their job.
The doctor and team focused on where they wanted to go instead of the problems associated with were they were when they began.
This doctor discovered what happens when most of the team shifted their focus to a "can-do" attitude from a "can’t get there from here" attitude. Consider the power of a 100 watt light bulb. It can illuminate a hallway or light up a back yard. If the same amount of energy is focused into a laser beam it can cut through steel. Likewise, focusing the team’s energy in the direction that you want to go gives it power.
The traditional old-style dentist responds to resistance from the staff by trying to convince them of the importance of achieving his objective. Many doctors can’t understand why their people are at all resistant. This is mostly due to the fact that most people in leadership roles don’t see the world in the way most re-active thinkers do (the 80%ers). Leaders tend to think like the creative leader or the 20%ers. Remember that 80% of people are conditioned to focus on what’s wrong and how a change may hurt them instead of the opportunity it might provide.
By asking their team members questions instead of telling them what to do, the team members discover for themselves what is important for them in doing what is necessary for the practice. This discovery process improves their self esteem, self confidence and empowers them. By asking questions there is a subtle message sent that says, "I care about what you think. Your opinion counts."
In working with dental teams, and asking them to clarify what they want more of from leadership so they can do a better job, money is seldom mentioned. In those instances where money is the issue, it takes some probing to discover what is meant. Usually the issue is, "I need more money to put up with this B.S." This translates into being unappreciated and excluded which is the result of not being asked. The real experts on the dental office, those who can solve most all its problems are its own team.
Kahlil Gibran, Lebanese Poet and Painter (1883-1931) had it right when he said:
"The teacher, if indeed wise, does not bid you to enter the house
of their wisdom, but leads you to the threshold of your own mind."
The new leader knows that asking good questions is the key to focusing his/her people on the subject at hand. Questions get people to:
1. Get people to think
2. Empower people by allowing them to discover their own answers and ownership for the results
3. Develop people who feel fulfilled, satisfied and valued
4. Build positive attitudes and self-esteem in team members
Have you ever used questions that disempower the team?
1. Why are you behind schedule?
2. What’s the problem with the recall system?
3. What’s your problem?
4. Why did you do that?
5. Who made that decision?
6. Don’t you know better than that?
These questions destroy self-esteem, make people feel small and unimportant and reduce energy levels. They breed a cynical attitude.
What about these questions?
1. How do you feel the recall system is performing?
2. What have you accomplished so far on your chart review that you’re most pleased with?
3. What is there about that accomplishment that you most appreciate?
4. What else?
5. What are your specific objecives in extending credit to our patients?
6. Which of these objectives do you think will be the easiest to attain? The most difficult?
These questions tend to focus on what is already working, which is energizing and supportive. They also focus on benefits, which is why the benefit is important.
What Does A Good Question Look Like?
1. They are open-ended. Closed-ended questions are answered with "yes" or "no" and tend to discourage people from thinking. They encourage them to give only limited information.
2. Good questions will start with "what" or "how" not "why." "Why" questions generate instant defensiveness because they carry a judgement. "What" or "how" encourages openness and lowers defensiveness.
3. New type leaders will ask questions not only so they can hear the answer but also so the person can hear their own answers thereby gaining clarity for themselves.
4. Good questions will be "you" focused. They focus on the person answering. They ask: "What do you think we should do?" "What’s your opinion?" "How do you feel about doing it this way?" "What was significant about that to you?" Notice there are no wrong answers to these questions because the answers are true for whoever answers them.
5. Timing: The best time to ask good questions is when things are going well. Ask questions like:
A. What are you doing with the doctor’s schedule that’s allowed our productivity to increase so much?
B. What are you doing differently to cause that to happen?
C. What are you most pleased with personally about what you’ve been able to accomplish with the Accounts Receivable project?
D. What have you done to contribute to the team’s success that most pleased you?
How To Structure Great Questions
1. What is already working?
2. What makes it work?
3. What’s the objective?
4. What are the benefits of achieving this objective?
5. What can you do to move closer to the objective?
The Ultimate Test of The New Dentist Leader
Performance reviews usually are the most stress producing exercises for both the doctor and team member. Why not change that by training the team to expect more from their job description than just what’s on their list of duties. Get them to think, and give them credit for thinking by asking them to come to their next review with answers to some of the following questions:
1. Please prepare a one-page review of how you feel you’ve done in comparison to your annual plan. What do you consider the most important achievement in your area?
2. Please prepare a one-page, or shorter, statement of your personal management philosophy. Describe your personal plans for continuing education and development for the coming year.
3. Please think of ways for us to approach our accountability for the future for the practice and our joint accountability for your future in the practice. What kind of changes will be required by the growth picture we are plotting?
4. Prepare to discuss your thoughts on our competition, where we need to respond to it and what our response should be. Please think about the following:
A. Who is creeping up on us?
B. How do various competitors beat us out in service, marketing capability, and pricing?
5. Would you be willing to share your philosophy of management with our team?
6. What are a few of the things you expect most and need most from the doctor?
7. Who are you? How do you see yourself personally, professionally, and organizationally?
8. If you were in the doctor’s shoes, what key area or matter would you focus on?
9. What significant areas are there in the practice where you feel you can make a contribution but feel that you cannot get a hearing?
10. Do you have any feelings of failure in any particular area?
11. What two things should we work on toward being a great practice?
12. What will you do in the coming year to develop our three highest potential people and who are they?
Critical Factors To Becoming a New Leader
New Leaders are knowledgeable about the following:
1. The most important factor in a private practice’s success is its people.
2. The leader’s behavior highly impacts the team. Talking doesn’t count.
3. People resist being told what to do, but they readily commit to making their own ideas work.
4. To the extent people feel cared for, they will go to extremes to help those who help them.
In the future when there is even more polarization between private dentistry and the PPO, insurance-driven practices, those practices with the new leader mind set will prosper beyond their expectations.
John Naisbitt in his book Megatrends sums it up best:
"During the last few years, we have witnessed the beginning of the transformation of the U.S. corporation. The shift is from managers who traditionally were supposed to have all the answers and tell everyone what to do, to managers whose role it is to create a nourishing environment for personal growth. Increasingly, we will think of managers as teachers, mentors, and developers of human potential. The challenge will be to re-train managers, not workers, for the re-invented, information-age corporation."
The new dental leader will increasingly be tested, not by his/her dental skills, but by how s/he views and values the soft, or human, issues of the practice. In a full employment economy, where every team member is virtually a volunteer, the challenge is how keep them volunteering to show up.
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