Amy Morgan, CEO of the Pride Institute

	Compensation is one of the most complex operational systems in your dental practice. However, when implemented effectively, compensation can be a catalyst for growth, motivation and enhanced morale and performance.

The way you compensate your team sends a message about the vision and culture of your practice. In short, it personifies you, your goals and your focus as the leader. A strong compensation system reflects your values and beliefs regarding individual recognition. Your choices communicate what kind of team members you want in your practice and what behaviors are valued.

However, compensation is also an emotionally charged topic. It magnifies very personal issues such as respect, self worth, appreciation and validation. As a result, it’s not unusual to see the approach to this important system powered by guilt, confusion and fear. With that in mind, we find a lot of bad habits centered on team compensation in our dental community. The top five bad habits are: 

Insisting on entitlement pay versus merit increases

Setting an expectation that once per year your team can expect a 2-5% cost of living increase no matter how the practice – or the individual – has improved (or not) is referred to as entitlement pay. Original wages and benefits are offered to an individual to do the job they were hired to do. Increases in those wages can only be merited by additional growth. Entitlement wages produce no motivation to grow, while merit increases celebrate new levels of success and achievement, both personally and professionally.

Compensating by the gut (or tummy ache)  

If there are no set expectations or goals to interpret success, then decisions about compensation can only be made through judgment and perception - and judgment is hard wired to miss the mark. If the dentist is motivated by fear, he or she may feel held hostage in wage negotiation. If the dentist is a “glass half empty” pessimist, scarcity will rule and there will never be a precedent to celebrate success. Or, if the dentist must be liked to feel successful, no performance expectations will ever be enforced. This leads to managing by the gut, which never works for the leaders or the team.

Treating everyone the same – therefore celebrating mediocrity

Whether wage, bonus or benefit, if you treat all of your team equally, you are treating most unequally. When everyone gets the same, what happens to your poor performers? Your superstars? In an effort to treat everyone fairly, it’s easy to homogenize the group or motivate them to the middle. To be effective, compensation must inspire team members to move to the right of the bell curve.

Pulling wage increases out of the owner’s pocket versus increased profitability

This aligns with the bad habit of entitlement pay. In order for the individuals in your practice to experience growth, the practice must grow! If your practice has not seen improvements in profitability and you incur new expenses due to a salary increase, that increase must come directly from the owner’s share. If you continue to do this, you have trained your team into believing their efforts do not impact the outcomes of the practice. If your team exceeds personal job expectations, it will directly impact your practice. When that occurs, they deserve a salary increase!

There is nothing worse than a leader who sets unclear or no expectations, doesn’t praise progress and then announces no salary. Behind cries for higher wages are almost always feelings of lack of appreciation, inclusion or respect. You want a team to be motivated? Talk to them!

Don’t beat yourself up if you recognize any of these bad habits in your practice. This is your opportunity to enhance employee motivation and contribution in a year that demands new levels of excellence from you and your team. Here’s where you can start: 

 Set a vision and goals for where you want your practice to be. Involve your team. Make sure they know what benchmarks need to be met. Incentivize great performance by creating a potential pool for individual merit increases based on the achievement of these annual goals.

Make sure you have all the written tools needed to guide your team members to new levels of success. This includes customized job descriptions, statistical interpretation of growth, training plans, progress notes, etc.

Learn the fine art of effective growth conferencing for you and your team’s sake. Carve out time to meet with each team member to discuss goals for growth. Make sure they can see how their efforts will result in the practice achieving success. Check in with them to ensure they are focused and winning. End the year with a salary review to highlight strengths and opportunities and to reward compensation increases when warranted.

Catch your team in the act of doing things very right or almost right and communicate, communicate, communicate!

 Create a culture that demands continuous improvement and recognizes and rewards efforts big and small.

And finally, respect and honor your team. Compensate them based on merit and growth and watch them reach for the stars!

Articles

 Compensation is one of the most complex operational systems in your dental practice. However, when implemented effectively, compensation can be a catalyst for growth, motivation and enhanced morale and performance.

Top 5 compensation mistakes dental practices make

 guess on what topics the majority of The Pride Institute’s phone calls for “help” were based on, I would have to say half of the calls are from hygienists who feel under appreciated, undervalued and underused, while the other half come from dentists who are, quite frankly, a little anxious about their relationship with their hygienist(s). Considering the No. 1 secret to succeeding in these challenging times is a modern, interactive hygiene experience, we need to get to the bottom of what seems to cause frustration for the key players involved in continuing care.

	It starts with a foundation that both the dentist and hygienist can be passionate about and willing to move forward together on. Don’t even think about hiring, training or coaching a hygiene team to new performance levels without the following:

for the practice and the hygiene department. A vision is the “why” you and your team do what you do, not the “how” or “when.” If you want a “state of the art, warm and caring practice that exceeds your patient’s expectations, where ideal oral health leads to complete health and well being, where the hygienist serves as co-pilot with the dentist in partnering with committed patients to provide the very best in dentistry,” then you can hire and coach for the specific knowledge, skills and abilities and attitudes (KSAs) that will support and promote that vision.

	Your vision should be in your hiring ads, your training plans, reward models and be a daily part of feedback and coaching. What gets acknowledged gets repeated. When you acknowledge through your vision you motivate team members to new levels of success.

 that includes: the vision of the practice and the continuing care department; the desired outcomes of the department; the department’s key statistics; the “KSAs” of the position; and a list of all the tasks, in priority order based on the practice’s strategies and goals.

	What KSAs are important in your hygiene team? Is it advanced periodontal/clinical techniques? Is it customer service and communication skills? Advanced teamwork and self-directed skills? Don’t assume a new hire or existing team member knows which skills are vital to continuous practice growth.

	What statistics/benchmarks will be monitored? Will you monitor hygiene production per day or per hour? Will you monitor no-shows and cancellation percentages, case acceptance percentages on patients of record, the number of adult fluoride, anti-microbial and sealants done on patients in any given month? Is room turnover more important than an excellent hygiene patient debrief that reduces no-shows and cancellations?

	When there is a long list of actions that a position is responsible for, you can’t assume the employee knows which tasks are priority. In the absence of the leader prioritizing, the hygienist will default to what he/she feels most competent in. If I believe I have great clinical skills, but  I am uncertain about my ability to handle patient objections, guess what my focus will be? The more complete the job description is, the more empowered a hygienist will feel in taking these opportunities to the next level.

 that rewards performance and direct contributions to the practice’s growth is essential. Myopic bonus or commission plans focus on just one aspect of the job description. What happens when a hygienist is commissioned on direct hygiene production only? You get a team member who believes the only valuable outcome is production. Don’t you want a self-directed hygienist who actively participates with the rest of your team to achieve ALL of the practice’s goals: treatment acceptance, raving fans who actively refer, ideal balanced scheduling models and co-pays collected at time of service?

	An excellent wage and reward plan incentivizes team members to grow in all directions. Growth conferences, salary reviews and informal feedback opportunities are essential to making that compensation model come alive.

	How do you know how much you can afford to pay your hygienist? There are several formulas to analyze a hygiene department’s profitability. One of the simplest is the “30-40 Rule.” Hygiene gross salaries and benefits can be in the range of 30 to 40% of direct hygiene production. Within that range there are many opportunities to ensure a well-compensated, informed and committed employee who WANTS the practice to grow.

	These are the fundamentals of establishing a forward moving continuing care department. Without them, inspiring new levels of performance can be frustrating. Implement the basics and the No. 1 topic for phone calls to Pride will dwindle to nothing!

Amy Morgan is the CEO of The Pride Institute. She is the author and co-author (along with Sharyn Weiss) of more than 20 books for dental professionals. Her latest releases are the Pride Institute’s Building Blox (a series of topic specific, interactive staff training modules for systems training including scheduling, marketing, telephone skills and much more). This article is an excerpt from Pride Institute’s Team Performance System (a 3 book series on how to hire, train and compensate employees). For more information on the Building Blox and Team Performance System, visit 

 If I took an educated[1] guess on what topics the majority of The Pride Institute’s phone calls for “help” were based on, I would have to say half of the calls are from hygienists who feel under appreciated, undervalued and underused, while the other half come from dentists who are, quite frankly, a little anxious about their relationship with their hygienist(s). Considering the No. 1 secret to succeeding in these challenging times is a modern, interactive hygiene experience, we need to get to the bottom of what seems to cause frustration for the key players involved in continuing care.

Ask Amy: Looking for a few good co-pilots

How do I get my team motivated to think like an owner and go the extra mile?  First and foremost, no one can motivate anyone to do anything. Motivation has to come from within! It’s an internal process, a reason to act a certain way based on the good ole’ radio station WII FM (What’s in it for me?). So if that’s the case, why are there jillions of books, lectures and articles written on this very topic?


	 
	You may not be able to force motivation, but the leader is responsible for creating a culture that influences people to high performance and promotes motivation.
	 
	This is not just semantics. The best definition of leadership I’ve ever seen is “leadership is influencing and inspiring people to WANT to do what you WANT them to do.” The word “want” is the key to motivation. A lazy way to approach creating a motivating environment is the old school “carrot and stick” form of reward and punishment. This model is based on the fact that your team (a.k.a. donkeys) will only work harder if you dangle a carrot in front of them or threaten them with a whip if they balk. There are fundamental flaws in this logic that makes this model unusable in today’s self-directed team environment.
	 

		 I personally believe that it is disrespectful to view your team as donkeys. Seriously, no one on your team ever looked up at the star-filled sky and said, “I want to do a mediocre job for a dentist someday and only commit to do things better if I get an extra cookie!”

		Even if you still buy into that way of thinking, what if your donkey isn’t hungry? Or doesn’t like carrots? Or the task that needs to be accomplished is unrealistic, even with the extra incentive?

		The problem with a whip (punishment as a potential consequence) is that if you continue to threaten and don’t follow through you will have a revolt. A battered individual eventually gives up and sinks into apathy.

	 
	So if carrots and sticks don’t work, what does?
	 

		Look for the intrinsic benefits to better performance: Tying the requested task to a bigger purpose, highlighting the potential for increased self esteem, increasing self worth through personal growth, recognizing and acknowledging INDIVIDUALS for their efforts that go above and beyond. This should occur 80% more than the number of times you correct poor performance.

		Create a compensation model based on practice growth and demonstrated individual merit that your staff understands and can control.

		When you do reward, involve the individual or the team in the creation, execution and follow through and make sure the reward is something they want and the outcome is achievable.

		Never forget, the small stuff always counts! Praise, ongoing communication, a sense of inclusion and respect are what inspire people to want to come to work. Without it, no amount of reward can ever be enough!

	 
	Look for more practice management advice from Pride Institute's Amy Morgan in DPR's June “Think Like a CEO” management supplement. For information about Pride Institute's team motivation seminars, call 800-925-2600 or visit 

Amy Morgan is CEO of the Pride Institute. With Pride since 1993, she is a sought-after educator who still consults one-on-one with practices.

 Q:  How do I get my team motivated to think like an owner and go the extra mile?  First and foremost, no one can motivate anyone to do anything. Motivation has to come from within! It’s an internal process, a reason to act a certain way based on the good ole’ radio station WII FM (What’s in it for me?). So if that’s the case, why are there jillions of books, lectures and articles written on this very topic?  

Ask Amy: Thinking like an owner

	You are not the only ones wrestling with this daunting task! The issue of finding comfort in the “asking” always reminds me of a Theatre 101 class I took years ago. The first rule of the stage is, before you utter one line of dialogue you have to ask yourself,

	“What’s my motivation?” Your answer will color the tone, pace and delivery of that one line.

	The same rule applies to asking for referrals. If your motives for asking are based on desperation and scarcity, your dialogue will personify that. If your motives are based on confidence and passion in your practice, that will also change your dialogue. So before you and your teammates make any attempts at inspiring patients to refer, make sure you brainstorm your unified motives and purpose for wanting to invite new patients into your practice. Taking that one step will increase comfort with the process immediately.

Now that you have a unified purpose for “asking”, here are some helpful hints.

 Only ask patients who you like, and those who personify your vision and values of care.  The saying goes, “Eagles refer eagles.  Therefore if you ask a pigeon, he will refer another pigeon.

 Wait for a compliment… then ask! Studies have shown that if a patient has had an experience that has exceeded expectations, he or she is naturally going to tell 25 other people about the experience.  So ride the positive wave.

 Follow this model and you won’t sound like a salesperson.

	Patient compliment: “I love your team.  They are so warm and friendly!”

 Acknowledge the compliment: “Thank you!”

. Quality Statement: “It’s part of our vision to provide exceptional experiences to patients like you who appreciate the extra mile!”

 Transition Statement: “You know, not all patients get to experience an ideal dental environment.”

Ask: “If you have any friends or family members who would appreciate the same warm experience, please recommend them to us. We would love to fill our practice with patients just like you.” 

 You are not the only ones wrestling with this daunting task! The issue of finding comfort in the “asking” always reminds me of a Theatre 101 class I took years ago. The first rule of the stage is, before you utter one line of dialogue you have to ask yourself,  “What’s my motivation?” Your answer will color the tone, pace and delivery of that one line.

Ask Amy: Patient referrals

	You can’t talk strategic planning without talking statistical interpretation of success, and you can’t talk statistics all by yourself. In the small business of dentistry, it is essential to keep the staff educated and engaged in your vision, values and strategies. That requires forwarding the concept of open book management as a key practice management tool.

	Open book management is when businesses share key financial and strategic details with employees. 

	If you are like most leaders, you probably have some concerns about this method. At best, employees rarely find numbers compelling (unless they’re accountants). At worst, poorly executed numbers-sharing can result in competitiveness, frustration and mistrust. So why try?

	We know that numbers by themselves, when not tied to the bigger picture of accomplishment of goals, can feel empty. The numbers lack purpose and therefore passion. When done well, the numbers can create a self-motivated, inspired team engaged in the practice because they feel informed and in control. Jack Welch, former General Electric CEO, said it this way, “Workers in an open book setting feel a greater sense of ownership and urgency, often sparking improvements in processes and productivity, because they are all in the business effort together.”

	That alone makes this worth rising above the concerns.

	Teach the business of dentistry (not accounting)
	This is not prep for a CPA test. You are inviting them to learn about where the practice is going so they can contribute in significant ways and be acknowledged for their efforts. 

	Team training can simply mean sitting down with your staff to identify the key statistics that need to be tracked and their relevance as compared to the practice’s vision and goals for productivity, viability and quality of experience. In an article in Inc. magazine, CEO Jay Goltz described how he introduced his team to the concept of expense management by leading a role play. His VP posed as a customer and, using a fist full of over-sized bills, handed a volunteer employee $100 to make a purchase. Goltz then began to lead a brainstorm with his team, asking questions like, “What do you think our ads in the Yellow Pages cost? Rent? Health insurance?” They would then break it down to guesstimates on how each cost related to the individual $100 purchase, and take the appropriate amount of dollar bills back. In the end, the volunteer was left with a paltry $5. Per Goltz, “It was easy for employees to see that the difference between making money and losing money is sliver thin.”

	What an elegant way to introduce a team to what can be a complex topic! Imagine doing the same with a crown prep or an implant. That would be a tremendous learning opportunity for both the dentist and the team.

	Give your team the freedom to act
	Your team doesn’t worry about expense management, because they haven’t made the connection between the statistics and what they can do to react and create positive change.

	If your goal is to keep total employee expense at less than 30% of total office production and the staff is asking for a benefits increase, what average monthly production figure would support the increase? Once you have the new goal broken down to production per hour, brainstorm with team members about what they can do from their job description to help get there. Check for follow-through to ensure success.

	A team that feels empowered to act on behalf of the strategic plan is a team that takes action.

	Share the wealth
	For open book management to work, each employee must have a financial stake in how the business performs. This isn’t a hostage situation, where every time the practice profits by a dollar, the team demands two. Self-directed team members who respect and honor their leaders, want them to benefit and to re-invest in the practice as well.

	For an open book compensation model to be effective, all wage, benefit and potential rewards must be tied to increases in profitability and individual demonstrated skill (merit). This can only be monitored through statistical interpretations of success, which bring us back to why team members should participate in statistical analysis.
	If you want an inspired team willing to take creative risks and work collaboratively to achieve consensus for practice improvements, there must be the potential for personal reward.  

 You can’t talk strategic planning without talking statistical interpretation of success, and you can’t talk statistics all by yourself. In the small business of dentistry, it is essential to keep the staff educated and engaged in your vision, values and strategies. That requires forwarding the concept of open book management as a key practice management tool.  An open book?  Open book management is when businesses share key financial and strategic details with employees. 

Should you open that door?

	How many times have you woken from a sound sleep, with an employee’s performance issue weighing on you? As your heart races, you think dark thoughts-She hates me! He needs a therapist! There’s nothing I can do! I’ll just have to live with the problem until I sell the practice! This is an example of “stinking thinking” because it doesn’t give the leader any options to upgrade performance and doesn’t allow the team member the benefit of being coached to new levels of success.

	For those of you who really want to help mentor, coach and train your team members toward continuous improvement, I have good news. There are only seven reasons why a staff member experiences a performance shortfall. More importantly, only one out of the seven is “unfixable.” In the chaos and confusion of helping someone who is struggling, it’s nice to know there’s a reason for the problem and that you have the tools to address it.

	Consider this example: Emily is your Financial Coordinator. She is organized, focused and productive. She loves communicating with your patients during the treatment conference and has tremendous success in working the e-claims system. When it comes to collections calls, she experiences very little success, waits until the last minute and avoids this task above all else. What’s happening with Emily?

 Does Emily know the guidelines for collections? How many days is she supposed to wait before making contact about a missed payment? Does she have model verbal skills that can support the phone contacts? Does she have sample letters and online pay notices? Or, have you just said, “Make calls. Collect money.”

 Is there a job description that lists all the outcomes and tasks in priority order, based on the vision, goals and strategy of the practice? In the absence of pre-set priorities, an individual will always default to what they are confident in (what they do best) as the priority. Emily loves patient interaction and processing insurance. Therefore, she will always do those things first.

 I am not suggesting Emily is incompetent! The definition of competence is whether or not Emily has the innate abilities, transferable skills, complete training and the practice to master the skill. That is what creates competence and it is the coach’s responsibility to make that happen.

 What is the elephant in the room? Whether real or valid, an obstacle is an obstacle. If Emily thinks there is no time to make the calls, this concern must be addressed and solved before she can move on.

This one is fun! There are two types of rewards for failure. The first has to do with someone else taking the monkey off their back, so the staff member doesn’t have to worry anymore. If Emily’s lack of collection calls has been answered with the dentist taking on the problem then-congratulations-you have rewarded failure! The other is a bit more delicate. Everyone craves attention-good or bad. If the only meaningful conversations you have with your team are those of correction, then subconsciously your team will create situations that will need to be addressed.

 Mumbles, grumbles or telepathic good wishes don’t count. In many instances in the dental practice, a team member is given a task and gets no communication until there is a flaming disaster. If you want Emily to succeed, catch her in the act of doing a “right or almost right” collection call and give her positive feedback.

 The great news is if you have reviewed points 1 through 6 above with Emily and she is still unsuccessful at collections calls, then the mystery is solved. You have a role/person mismatch! This doesn’t mean you have to terminate poor Emily. It may mean you have to re-define a job description that is win-win for both her and the practice.

	When you know that you can help a floundering employee, you will sleep better at night. Your practice will also run at a much higher level, because you coach team members to new levels of success.

 How many times have you woken from a sound sleep, with an employee’s performance issue weighing on you? As your heart races, you think dark thoughts-She hates me! He needs a therapist! There’s nothing I can do! I’ll just have to live with the problem until I sell the practice! This is an example of “stinking thinking” because it doesn’t give the leader any options to upgrade performance and doesn’t allow the team member the benefit of being coached to new levels of success.

Seven factors that influence performance shortfall

	Yes. You know you are supposed to have ongoing staff meetings. However, very few practices find these meetings productive, let alone inspiring or instrumental to practice building. It reminds me of a great quote from comedian Dave Barry who said, "If you had to identify, in one word, why the human race has not achieved and will not achieve its full potential, the word would be meetings."

	This is, unfortunately, true in many dental practices-small and large-and for the dentists who run these practices, the question quickly becomes: Why have staff meetings at all? The truth is, there are far-reaching benefits for having effective, efficient meetings-benefits that far exceed potential negatives. These benefits include:

		Practice strategies are more likely to be realistic because the people who need to implement the action steps take part in creating the plan.

		A culture of self-direction and internal motivation is supported when each team member feels that they have a say in the running of the practice.

		The team can be more proactive and flexible in anticipating and adapting to problems, obstacles and changing priorities.

		Conflicts can be handled positively-before they become divisive issues.

		Continuous learning and improvement become the rule, not the exception.

	Even though the benefits are compelling, if your staff meetings are like "Dawn of the Dead" sessions (zombie-like experiences where the dentist is droning on about something and the glazed expressions on everyone's faces indicate there is no human life force remaining), or "vomit and spew" sessions (lots of screaming, yelling and general mayhem, with no change), then making the leap of faith and having more meetings can be a dicey proposition, at best.

	The answer must be to buckle down and learn the fine art of leading effective meetings. There are two foundational elements that, if in place, will insure a good meeting that inspires follow through and results. It is the leadership team's responsibility to make sure these elements are in place so that the practice can capitalize on all the aforementioned benefits.

Element 1: Create a culture of safety and trust by establishing ground rules about behavior, participation and focus.

	Ground rules represent a collection of agreements the team makes about how they will treat one another. They create a sense of order and safety within the group so individuals can share ideas and concerns comfortably and creatively.

	Because it is crucial that ground rules reflect the office culture, you can't simply impose them on your team. To create your own set of ground rules, ask the team what agreements they would like to make about what they should and should not do during meetings. Ask, "How would we like to behave so that our meetings are safe and productive?"

		Respect each other-personality, learning style and communication.

		Be specific when highlighting challenges, strengths and solutions.

		Always be open and honest (and as unemotional as possible).

		Critique ideas, not people. What is a great idea to some is not so great for others.

		If you oppose, than propose. If one solution won't work, what will?

	By agreeing to follow these rules and then closely monitoring to ensure success, you will create a foundation for group collaboration and consensus. 

	A word of caution: Beware the "meetings after the meetings." When there is a perceived lack of safety, team members often engage in these informal "meet-ups" (most often in the office parking lot) where individuals share their true opinions and concerns. These informal sessions most often happen when individuals choose not to honor the ground rules and don't speak up or speak disingenuously during the formal meetings. Meetings after the meetings are so powerful that they can actually sabotage positive decisions made during your actual meeting and set the tone and strategies for future plans.

	 Prevention is the best remedy for this problem. While setting ground rules with your team, discuss the possibility of these after sessions. Set a rule that lets team members know that if they choose not to voice an objection or concern during the formal agenda, they will lose the right to criticize later. At the same time, make sure the team feels safe enough to play devil's advocate on topics that may disagree about. In fact, you may want to set a ground rule that differing opinions are welcome. 

Element 2: The team is trained on effective discussion, problem solving and decision making processes and committed to following the protocol.


	Now that you have created a safe environment for true discourse, what are the secrets that drive a team to analyze a problem and come up with workable solutions that they will (at least most of the time) endorse and support?

	During an effective problem-solving process, the team converges on a specific issue, identifies possible solutions, selects the best solution, identifies action steps to implement that solution, and finally evaluates the solution to see if adjustments are necessary. The beginning of this process is when the team defines the current situation and explores the gap between what is desired and what is actually happening.

		Where we wish to go (the desired state)

		The challenges that must be addressed in order to close the gap between the current situation and the desired situation (the solution path)

	Ideally, when making decisions on strategies that are pivotal to your practice success, striving for group consensus is imperative. Consensus agreement does not mean that everyone on the team must support an action plan with identical levels of enthusiasm. Consensus does mean that everyone can live with the strategy and work to achieve and maintain it.

	When a team strives to reach consensus on a given decision, it means that each person is granted veto power. Because even one veto can prevent a decision from going forward, the team must work together to design solutions acceptable to everyone. It requires taking all concerns into consideration and finding the most universal decisions possible.

	Team members who have the ability to reach consensus demonstrate the following:

		Unity of purpose, a basic agreement shared by the entire group regarding the vision and goals of the practice

		Recognition that the process is as important as the results

		Underlying attitudes of cooperation, support, trust, respect and good communication

		Understanding and tolerance of difference, conflicting views

		Willingness and a capability to devote time to the process

	All of this takes time, effort and investment in and from the team. It's easy to ready about the elements of a good meeting, but putting it into action is another story all together. Per Michael Doyle and David Strauss in their seminal work, How to Make Meetings Work, "There is a big difference between understanding how to make meetings work and actually making them work better. You too are going to have to do some changing and changing behavior is rarely easy. Things may seem strange and uncomfortable at first, just like a new suit of clothes. It will take time, patience and willingness to take some risks. While it will take commitment on your part, the rewards will come soon and continue to grow."

Staff meetings that work

	If I took an educated guess on what topics the majority of The Pride Institute’s phone calls for “help” were based on, I would have to say half of the calls are from hygienists who feel under appreciated, undervalued and underused, while the other half come from dentists who are, quite frankly, a little anxious about their relationship with their hygienist(s). Considering the No. 1 secret to succeeding in these challenging times is a modern, interactive hygiene experience, we need to get to the bottom of what seems to cause frustration for the key players involved in continuing care.

	1. A vision/philosophy for the practice and the hygiene department. A vision is the “why” you and your team do what you do, not the “how” or “when.” If you want a “state of the art, warm and caring practice that exceeds your patient’s expectations, where ideal oral health leads to complete health and well being, where the hygienist serves as co-pilot with the dentist in partnering with committed patients to provide the very best in dentistry,” then you can hire and coach for the specific knowledge, skills and abilities and attitudes (KSAs) that will support and promote that vision.

	2. A written job description that includes: the vision of the practice and the continuing care department; the desired outcomes of the department; the department’s key statistics; the “KSAs” of the position; and a list of all the tasks, in priority order based on the practice’s strategies and goals.

	3. A dynamic compensation model that rewards performance and direct contributions to the practice’s growth is essential. Myopic bonus or commission plans focus on just one aspect of the job description. What happens when a hygienist is commissioned on direct hygiene production only? You get a team member who believes the only valuable outcome is production. Don’t you want a self-directed hygienist who actively participates with the rest of your team to achieve ALL of the practice’s goals: treatment acceptance, raving fans who actively refer, ideal balanced scheduling models and co-pays collected at time of service?

	DO YOU HAVE A QUESTION FOR AMY? E-mail your questions and ideas to 

 If I took an educated guess on what topics the majority of The Pride Institute’s phone calls for “help” were based on, I would have to say half of the calls are from hygienists who feel under appreciated, undervalued and underused, while the other half come from dentists who are, quite frankly, a little anxious about their relationship with their hygienist(s). Considering the No. 1 secret to succeeding in these challenging times is a modern, interactive hygiene experience, we need to get to the bottom of what seems to cause frustration for the key players involved in continuing care.

	It never fails to amaze me how many dentists have purchased “stuff” for their practice, only to have an important piece of “must-have” technology gathering dust several weeks (or months) later for lack of use. Even in this challenging economy technology purchases are still being made, although many dentists and teams appear much more cynical when it comes to silver bullet promises or fairy tale hopes for results.

	The truth is, for a practice to stay cutting edge there needs to be a plan for continuous growth and improvement. Technology, clinical innovations and enhanced business processes are a must for a practice to remain viable in any situation. “No” cannot be the knee-jerk response when considering new purchases. Your yes, no or maybe should be based on clear-headed consideration:

		How will I realize a return on the investment in _?

	If the doctor and team plan well for a new purchase or upgrade there is huge potential for real ROI-and that is both the burden and the solution. You have to have a plan. Impulse buys are the quickest way to acquire the latest and greatest dust gathering devices; most often, they do very little to move the practice forward.

	If you want to make a purchase count, go over these strategic questions before you write that check or pull out that credit card.

1. What are the vision, goals and strategies for our practice? And how will this new technology support all three?

	Too often technology purchases are made in the spirit of competitive sports. If the answer to, “Why am I buying this?” is because your roommate from dental school bought one and you think you’re better than him or her, then this new purchase will automatically become the dust collector. If you have a strategy to be cutting edge and your budget and goals reflect an increase based on specific technology upgrades, then and only then do you have the green light to go shopping.

2. What patient profile would appreciate and value this new innovation? Do they already exist in my patient base? Can this be a “unique selling proposition” to attract new patients?

	The wrong reason to purchase new technology is when it’s based on the dentist and team’s personal gratification versus addressing the needs and desires of existing and potential new patients.

	This reminds me of a quote from Fred Lee’s If Disney Ran Your Hospital. In the book Lee states, “Selling is trying to get people to want what you have. Marketing is trying to have what people want.” When you have what people want, no selling is necessary because they are already inspired to say yes. If you have purchased technology and it feels like you have to force your patients to accept its use, you may have made the wrong purchase.

3. What is the initial cost of the new technology? How long before we expect to see not only the ROI, but a profit (by increased money, efficiency or quality of experience) from our purchase?

	When referring to cost, all direct and indirect expenses must be included when calculating a return. Does the purchase require additional lab fees, supplies, different staffing, leasehold improvements, investment in marketing pieces, etc.?

	Many dentists don’t want to take the time up front to examine the costs and then are surprised to be spending a great deal more than expected on the back end. Once you know the full financial commitment, you can plan for the appropriate ROI.

	Remember, ROI can be multifaceted and includes the possibilities of increased profit, productivity and efficiency while improving time management, decreasing stress, enhancing workplace and customer satisfaction, and much more. If the dentist and team do not demand ROI, they are not likely to realize it. An easy formula for analyzing ROI from the viewpoint of an increase in productivity and profitability is to expect a range of 3 to 10 times the initial cost of implementation. This will help you decide if the purchase will be a successful addition to the practice.

4. What statistics or benchmarks will we monitor to track and praise progress?

	When it comes to tracking success, the team can manage by judgment or manage by statistics. In No. 3 above, we see that ROI comes in many different forms, so choosing the right benchmarks for success is pivotal to test, track and adjust implementation. Are you looking for an increase in production per day/hour? Collections? New patient flow? Case acceptance? Referrals? Do you expect to see a decrease in expenses? You can only manage something that is measured and the right measurements help set priorities and success points.

5. What is the timeline to fully integrate this new innovation? What is the training plan? What resources are needed to master the new skill?

	This is a pivotal part of the strategy for implementation. Knowing what systems and staff will be affected by the new technology, having an understanding of the training and practice required and identifying how long changes will take removes stress and pressure. Most practices are like cars racing down the highway at 75+mph. There is no way a team member can open the hood and crawl out the window of the racing car to work on the engine. That might seem obvious, but a fatal flaw in implementing new technology is expecting the practice to stop everything and integrate the new purchase immediately. This can lead to burn out and feelings of being overwhelmed for everyone involved.

6. How will we market this new addition to increase interest and inquiry?

	I once had a senior dental student show me a rather flawed business plan. His written marketing strategy for his potential practice startup was that he was going to: Deliver cutting-edge, modern dentistry.

	When asked who he would do this dentistry with, he had no real answer. The moral of the story is that your marketing strategy can’t be, “build it and they will come.” There needs to be a communication strategy in place from day one. Will you be promoting this on your website, creating buzz through social media, sending “e-vites” to existing patients, etc?

	The bottom line is that NO PLAN = NO PATIENTS.

	The great news is that any new technology purchase can have tremendous potential, if you follow these six steps. Dare to dream, write the check, continuously improve and watch your practice grow! 

Amy Morgan is a renowned dental consultant and CEO of Pride Institute. A highly sought-after educator, Amy still loves working one on one with doctors and travels extensively to meet with and teach those looking to improve themselves. For more information about Pride Institute's seminars and consulting, visit 

 It never fails to amaze me how many dentists have purchased “stuff” for their practice, only to have an important piece of “must-have” technology gathering dust several weeks (or months) later for lack of use. Even in this challenging economy technology purchases are still being made, although many dentists and teams appear much more cynical when it comes to silver bullet promises or fairy tale hopes for results.

Ask Amy: Before you write that check

	Amy Morgan is CEO of the Pride Institute. With Pride since 1993, she is a sought-after educator who still consults one-on-one with practices.

What are some specific ways we can increase our collections immediately?

	When it comes to collections, there are the proactive steps you can take for prevention and the reactive steps to take when you already have the problem! In either case, these steps require focus, black and white guidelines for protocols and agreed upon benchmarks to monitor success.
	
	


	
	For prevention and immediate collection increases, ask the following questions:

	1. Do we have a specific protocol that the entire team can collaborate with each other to accomplish for collecting the appropriate co-pays at the time of service?
	2. Are we collecting 30-40% of our current monthly collections over the counter?
	3. Do we offer a courtesy adjustment to inspire patients to pay in full for significant treatment?
	4. Are we offering auto-debit, online or automatic credit card payments for patient portions versus sending statements and waiting for the paper check?
	5. Do we have an effective e-claims system that turns around most insurance payments in 10 days or fewer?
	6. Do we have an effective insurance information system that allows us to keep track of current benefits so estimates are accurate?
	7. Do we have black and white guidelines on what we are willing to write off as credit adjustments when it comes to discounts, employee dentistry, trades, etc?

	If you answered no to any or many of these questions, then “the ship has sailed,” so to speak, and you may have a collections or accounts receivable challenge. The team needs to analyze the issue and take immediate steps to tackle the problem.

	To handle collection challenges, the team can reactively address the issue by doing the following.
	1. Run an accounts receivable report from 0 to 120+ days. Highlight the reports in 4 colors.

		Insurance related receivables under 20 days (no apparent glitch or problem)

		Insurance related receivables over 20 days (possible glitch)

		Patient Portion, on a written financial arrangement and complying

		Patient Portion, either not written or non-compliant

	This helps the team to focus in on the area of concern so the issue can be addressed.

	2. Once you identify an insurance or patient portion issue, start with 10 names at a time (usually highest balances first) and create specific, customized plans to address one account at a time.
	3. Analyze what created the challenges in the first place and adapt your proactive financial guidelines to address the problem.
	4. Work with your financial coordinator to create black and white collections protocols. Include issues such as the number and frequency of phone calls or letters and how to handle an “uncollectible” account.
	5. Make sure you have verbal and written templates for the most successful follow-up calls and letters so patients are inspired to WANT to pay the balance. And make sure you have had enough training and practice to address any and all obstacles that may arise from the calls or letters.

	It takes hard work and effort to turn a collections challenge around. A “spray and pray” approach during this difficult economy will create frustration for the team and the patients. If you follow these suggestions, you will be able to successfully shout-a la Jerry Maguire- “They showed us the money!”

	Look for more practice management advice from Pride Institute's Amy Morgan in DPR's June “Think Like a CEO” management supplement. For information about Pride Institute's team motivation seminars, call 800-925-2600 or visit www.prideinstitute.com.

   Amy Morgan is CEO of the Pride Institute. With Pride since 1993, she is a sought-after educator who still consults one-on-one with practices.