Denise Ciardello is a professional speaker, published author, and cofounder of Global Team Solutions, a practice management-consulting firm that brings clinical and administrative teams together through customized practice development and coaching. She is the president of the Academy of Dental Management Consultants (ADMC) and a member of the National Speakers Association (NSA). She is an expert in efficient business systems and helping practices improve marketing results, professional image, and the bottom line. Her enthusiasm and knowledge for the dental profession has motivated many dental teams. You may contact her at denise@GTSGurus.com.

Denise Ciardello

	Performance reviews – the two words that immediately emit groans, eye-rolls and that pit-in-the-stomach feeling. But the best offices will conduct these on an annual basis.

	This is a great time to look back at past performance and develop a plan for future, personal growth for the employee. However, many times these meetings are used to address unwanted behavior that may have occurred several weeks or months ago. The reality is that unwanted behavior should be corrected immediately and should not wait for an annual or pre-scheduled meeting.

	It also does not need to be a formal meeting. A quick conversation in a private area is sufficient to drive the point home that this is behavior that is not tolerated in this office. I wish I had a nickel for every time I heard “If only I would’ve said something when it first occurred.”

Related article: Know when it's time to fire an employee

	The major point to remember, however, is that although it may not be a formal meeting, it still must be documented as a verbal counseling. This is where most employers drop the proverbial HR ball. Documentation is the one thing that will protect you, whether it involves clinical notes or employee guidance. And just as the meeting doesn’t have to be formal, neither does the documentation.

	Let’s review some steps for staying on top of the documentation game in the HR arena.

	It is advisable to document immediately. Memory fades with time; in order to record the exact words or actions, write down the interaction as soon as possible.

	You do not need a form for each counseling session. A simple handwritten note is adequate. However, there is information that absolutely needs to be included:

	If it is a behavior or action being addressed for the second time, the written documentation should include what the consequences could be if it continues and the employee signs it. This should chronicle the verbal discussion (date and time) and allow the employee an opportunity to make comments. (Need a counseling form? Email 

	Details need to be thorough and factual. Subjective observations are weak in the eyes of an outside observer, should this ever go to the level of a judge, jury or unemployment representative.

		“Betty made major mistakes with her insurance claims processing - costing the office $2543 in adjustments” instead of “Betty doesn’t care about her job.”

		“Bob raised his voice and was involved in a verbal fight with a patient at the front desk. He called the hygienist a stupid diva at the team meeting” instead of, “Bob has seemed agitated and argumentative with everyone.” Or worse: “Bob just hasn’t been himself lately.”

	You will want to think about who will look at this later to determine if it meets the factual criteria. Some employers have the discipline meeting, and then have the employee write down the discussion that occurred.

Just as the details need to be factual, so do the consequences. A simple “This behavior must change” is not sufficient for future effects. Detailed, measurable performance guidelines are in order:

	“Jane has been advised that future infractions of the dress code policy will result in progressive discipline, which may include being sent home for the day without pay or even termination.”

	All employee documentation must be kept in the employee’s personnel file. This could be a folder kept in a locked drawer or cabinet or in digital form on the employer’s computer.

Related article: How to manage the employee you hate

	There are very few people who like to have these uncomfortable conversations, however, it is necessary to maintain the culture of your practice. Immediate discussions work best at redirecting unwanted behavior or actions. Many times, people are not aware of a bad attitude or sharpness in their voice. A simple acknowledgement of the activity is all that is warranted to correct it.

	Keeping emotions and opinions at bay by being factual and objective goes a long way and provides quick, understanding results. Remembering to properly document these conversations will save you in the long run.

Articles

Disciplinary issues shouldn't be a formal event - but you should take steps to protect yourself.

The right way to talk to employees

	What goals are set in your office? Daily? Weekly? Monthly? Any? This is one of the first questions we ask and 90% of the time the answer is crickets.  ‘We know we should’ or ‘We’ve talked about it’ or ‘We just try to schedule/collect as much as we can everyday’ are the typical responses. As we discuss the schedule with the clinical team, we hear things like ‘We are twiddling our thumbs one day and don’t have time for a bathroom break the next’. I would like to break down the necessity of goals and define the mindset needed when discussing goals.

	First, when we ask if an office has a goal, the follow up question is: Do you recommend having a goal? We answer with a resounding YES! How do you know you’ve hit your mark when you don’t know what the mark is?

“In life, as in football, you won’t go far unless you know where the goalposts are.” – Arnold H. Glasgow

	A goal defines what are you scheduling for everyday. Just filling the holes doesn’t cut it. There is a cost to opening your doors. This is the starting point. Know you overhead – the true overhead of running your business. (if you need help with determining your overhead, contact us at: 

) Once you know your yearly overhead, divide it by 12 for a monthly number. To determine a daily goal, you will take the monthly number and divide it by the number of days that the office will be open for each month. Typically, the hygienist daily goal will remain the same each day so only the Dr’s goal will change.

Related reading: 3 ways to set social media goals that work for your dental practice

	This is your BAM (Base Amount to Meet). This is the total needed to keep the doors open – to keep the lights on, pay for supplies, rent, utilities and meet payroll needs. We have found that if the team is aware of this number, they will understand and appreciate the need to know the BAM.

	There are two ways to think of this goal:

	Hopefully, your team will be in the mindset of #1 because it should be just the beginning. At times, I wish we would just call it BAM since the word “GOAL” means that you have achieved the top, the end, the apex. In football or soccer, when you make a goal, you’ve achieved your purpose. In this scenario, we are at the bottom line. This is actually the starting point for where we are going.

	Sometimes upon further probing with the Dr., we find that a goal is not set because when a goal is met, the team expects a bonus. Now, in my opinion, we are comparing apples to oranges. If a bonus is in the discussion, it is not with meeting of the goal, yet for exceeding the goal. The goal in the aforementioned discussion is based on production; the goal on any bonus needs to be based on the collections in the office. A bonus can only be paid on monies collected, again exceeding the totals of meeting overhead.

	Taking this conversation a bit farther, let’s say that the team would really like to go to the Midwinter conference in Chicago next year, buy a piece of equipment, or participate in a team building retreat – the team may set a BHG (Big Hairy Goal). Let’s say that the monthly goal is set for $90,000 – again we are talking about collections – the goal is moved to $92,000 with the additional $2,000/month going toward the BHG. No bonus is calculated until the $92,000 mark is exceeded. There are thousands of ways to create a ‘bonus’ system; our strongest recommendations always include calculating it based on collections. (If you are looking for bonus systems – contact us: 

	To wrap up this discussion, each office needs a goal – a target defined – whether a bonus is paid out or not. If you don’t have a target, you will hit it every time.

“People with clear, written goals accomplish far more in a shorter period of time than people without them can ever imagine.” – Unknown

	The mindset should be that the BAM goal is just the beginning; it is the reason you can keep your lights on every day; it is the 

 mark to meet. A team is stronger knowing that together they have a target to aim at and will together celebrate reaching that target. An additional goal – BHG – could be set to aim for a long-term goal such as a trip or piece of equipment that the team is really wanting. We are a competitive society and having a goal, a target, to reach is something in which we all can relate. Let us help you reach your goals. Contact us at: 

What goals are set in your dental office? Daily? Weekly? Monthly? Any? This is one of the first questions we ask and 90% of the time the answer is crickets. ‘We know we should’ or ‘We’ve talked about it’ or ‘We just try to schedule/collect as much as we can everyday’ are the typical responses. As we discuss the schedule with the clinical team, we hear things like ‘We are twiddling our thumbs one day and don’t have time for a bathroom break the next’. I would like to break down the necessity of goals and define the mindset needed when discussing goals.

A goal by any other name is a BAM

. We hear so much about it in the news today. It's no longer the mean boys that beat up kids for their lunch money or even the mean girls that don't invite other girls to the mall.

	Now we have cyber bullying that has kids putting vile, vicious comments about other kids on social media sites. The word spreads like wildfire through all the “hangout” channels. It has such a negative effect on young impressionable minds, which has forced kids to change schools, drop out of school and, in some very sad cases, even led to death.

	Bullying, unfortunately, is not limited to kids. We see many adult bullies. I don't know if adult bullies were bullies as children or if being bullied as a child caused them to grow up to be bullies; however, it seems to be getting worse in the workplace.

			The employee who is always right and never allows anyone to change a system, though his or her way is quite antiquated

			Passive aggressive behavior that causes everyone to constantly look over their shoulder for the sabotage that will make them look bad, wrong or unethical

			Yelling, screaming, demeaning, constantly correcting/monitoring or outright demoralizing others

			Singling one person out of the pack to “pick on”

	The workplace becomes a hostile environment with a decrease in production due to the employees trying to avoid the bully or the inefficient systems that prevent growth in the company. A bully can select one person or can bully an entire team. The need to control a person or an environment seems to be the target of a bully. The methods that a bully takes are akin to that of a domestic abuser picking the time, place or circumstance to be caring or kind and when to inflict pain, all of which is emotionally abusive.

	How do you know if bullying is occurring in your office?

			Is there one person that everyone - or most people - avoids?

			Do you have someone who has suddenly become isolated?

			Have you been told by an employee that they are being bullied?

			Do you hear verbal abuse or demeaning from one employee to another?

	First, address the situation. If you are being bullied, plan to speak to the bully personally. This is probably the most difficult step. However, by looking that person in the eye and stating your feelings, you are defining how you expect to be treated. You must stand up for yourself.

	You will want to remain professional and just like with any conflict resolution, keep your comments concise and use plenty of “I” statements.

	Accusatory statements only fuel the fire and reduce the chances of your desired outcome.

	If the belittling continues, it is time to climb the chain of command, taking your concerns to the manager or boss. If the bully is your manager or boss and you do not receive any satisfaction by bringing the situation to light, possibly it is time to take your skills elsewhere. Your mental health is not worth remaining in a hostile environment.

	If you are the employer and suspect or have been told there is bullying occurring in your office, you will want to address it immediately. Unfortunately, many times the person being bullied is a more valuable employee than the bully, yet chooses to terminate employment. This is a lose-lose for the practice because the bully will simply find another target. And the cycle continues.

	Using words like personality conflict or difficult person softens the disruptive behavior without truly defining the behavior. One expert, Tom Engelhardt, said it wisely when he said, "Words denied mean analyses not offered, things not grasped, surprise not registered, strangeness not taken in, all of which means that terrible mistakes are repeated, wounding ways of acting in the world never seriously reconsidered. The words' absence chains you to the present, to what's accepted and acceptable."

. It should never be allowed or tolerated. Create a zero-tolerance zone and have an open door policy to allow victims an option for discussing the problem. A bully can be a cancer in your office that eats away at the productivity of your practice and the morale of your team. Growth will be stunted and lead to constant employee turnover. Take a good hard look at the behavior of all employees. Is there a problem that needs to be addressed?

Bullying. We hear so much about it in the news today. It's no longer the mean boys that beat up kids for their lunch money or even the mean girls that don't invite other girls to the mall.

Do you have a practice bully?

	We live in a world of instant gratification, surrounded by digital technology that fuels this hunger for immediate knowledge. How many times have you been out with friends and someone asks a question that no one can answer handily?

	Gone are the days of having to look it up in a book, or actually having to go to the library to find the answer. Now, someone merely grabs their phone and asks, “Siri – who won the first Super Bowl?” Siri answers and everyone is instantly gratified with the knowledge and continues on with the discussion.

	It’s an easy way to continue the flow of conversation because, prior to the answer, two or more people were not in agreement with the story progression.

Related link: Help your office manager succeed

	Last week I was in a client’s office and was working with the office manager–let’s call her Becky–on creating some systems for more efficient accounts receivable (A/R) management. It seems that her numbers, though still within acceptable limits, are out of control for her (and our) standards.

	As we began discussing her current method of operations, the hygienist interjected, asking, “Is it ok to do sealants on my patient?” Becky exited the screen we were viewing on the computer and accessed the insurance section to see what the “rules” were for sealants for this patient’s plan, and checked the patient’s account to see if the patient met the age limitations. She looked up and answered the hygienist.

	We got back on track with our review of her processes. About that time, the assistant asked if the new patient could have an FMX, the aforementioned steps were repeated and Becky answered her assistant. The doctor interrupted our conversation with a question about whether Dr. Endodontist down the street was open on Mondays because the patient in his chair needed to go over there immediately.

Related link: Office manager role evolution

	It was about this time that I realized that Becky didn’t have a problem with time management; she had a problem with an identity crisis. Her co-workers viewed her as a human Siri. My experience has shown that this happens in most offices–there is one person who is constantly called to do everything from fixing computers to answering questions that should be available to the team elsewhere.

	We broke off our conversation about A/R, and moved to a conversation about how Becky can empower her co-workers with the tools they need to complete their tasks.

	We started with questions about insurance–more times than not the inquiry is about what insurance allows, frequencies, and age or time limitations. How does Becky get these answers? Ideally, routine questions have been answered during the verification process and noted in the insurance section of the practice management software. We find that some answers are not always readily available and may require a phone call if not on the fax or website; however, that should be the exception for routine procedures.

Related link: Boost practice productivity

	Becky can explain to her co-workers where to find the information. The key is consistency. If Becky tells the hygienists that sealant information is always in the same place and they often find it missing, they will stop going there and return to using Becky for their more accurate source of information. It’s a waste of their time and they don’t want to dig in the computer any more than is necessary. The same is true for all insurance information as it relates to time and age limitations, frequencies and standard clauses like missing tooth, replacement and number of quads that can be scaled in a day.

	We are not trying to make the clinical team experts in insurance; they have their own jobs to do. We do, however, want to give them tools to complete their jobs without having to take time out time to speak with Becky about these limitations or frequencies. What happens if Becky is on the phone or speaking with a patient? The clinical team member is forced to wait until Becky is available to answer her question or worse, interrupts a treatment plan presentation and therefore upsets the flow of conversation and then possibly affects acceptance level.

	Often, we find that questions asked should have been discussed in the morning huddle to alleviate these disruptions to everyone’s day. After all, the purpose of the huddle is to review the needs of today’s schedule/patients, not rehashing last weekend’s events or discussing the baby shower in two weeks. If you find that these are areas are not covered in your huddle, consider revamping your huddle agenda. (If you need an agenda, we have one to share: 

	Instant gratification is not bad. As humans, we prefer it and as Americans, we demand it. However, when it is at the cost of intruding on other people’s time management, consider your actions. If you are Becky–find ways to empower your team with the knowledge they need to complete their tasks and train them on ways that they can use these tools. Help them to understand that you are not Siri and before they come to you with questions, they should ask themselves, “Is this a true Becky question or am I being lazy and using her as Siri?”

We live in a world of instant gratification, surrounded by digital technology that fuels this hunger for immediate knowledge. How many times have you been out with friends and someone asks a question that no one can answer handily?

Note to office managers: Stop being in-house Siris

It seems to have always been a long-standing issue people thrown into a position in the dental practice without much training. I didn't realize just how prevalent it was until I began consulting. When 

, we were constantly amazed by this phenomenon. To make matters worse, it was often the office manager position where we found the most inefficiencies and inadequacies. We saw production numbers that would suffer and, even worse, the collection ratio was much too low.

Office managers everywhere would look at us with desperate eyes, begging for help. We looked for books, manuals, or anything to hand them yet couldn't find anything with relevance that was easy to read and understand. We decided to write the book ourselves. In 2010, “OMG! Office Management Guide - Creating Systems in the Dental Practice” was published. In 2015, we totally revised the book to make it more relevant and up to date.

Initially, we were going to hand it out as a gift. However, when we began getting calls asking where to buy it, we put it on Amazon. We were then asked to teach a course on the book. We began holding workshops on different topics within the book around the Texas and Missouri areas. In the past few years, we have been speaking more around the country, and we've been asked to take our OMG! workshops nationwide. We are pleased to announce that we have listened and OMG! is going coast to coast this fall.

The format we have found that works best is a hands-on, interactive setting. We ask the audience to not just be an attendee but to become a participant by sharing experiences, asking questions about issues they have, and helping others problem-solve. We work through several key protocols, inch by inch, and everyone has the opportunity to create a customized protocol for their individual practice. Just about every dental office has a recall system, but each office executes their system differently and then there are some without a system at all. Let's work through that and find what's not working, or how to make it better. For some of these office managers or dentists, this is the first time that they have really drilled into their insurance management process (or whatever system we are reviewing).

The topics covered will range from recall to insurance to treatment planning, etc. We also dive into team management issues such as meetings and conflict resolution.

Interaction is encouraged because we do not pretend to know it all. Some of the answers need to come from discussions with others who hold those same jobs. When we were office managers, we remember how lonely it felt because we didn't interact with other office managers. The courses we took always told us what we needed to do yet failed in teaching us how to make it happen. We want our OMG! course to dive deep into the “how.”

The OMG! workshop is attended by mostly office managers and dentists. However, we find it so valuable to an office when the entire admin team can attend with the doctor. The conversations are filled with oohs and ahs and we can literally see the light bulbs going off. It is so rewarding to us because we know that they are taking a giant step in moving their practice forward to a productive, harmonious environment. We were able to have that in our experiences and are excited that others can have that fun too.

We are thrilled that some corporate sponsors have helped us get this message out. SolutionReach and TransWorld Systems have been pivotal in our Texas cities; Henry Schein is sponsoring our Washington, D.C., Irvine, Calif., and Chicago locations; One Mind Health and the Lending Club (formally Springstone) have jumped into our Nashville, St. Louis, and Boston events. The Whiter Image has provided Chic Flics for door prizes at each of our courses.

We are very excited that we will be taking our OMG! workshop into the wild blue yonder next spring on a Celebrity Cruise line sponsored by PES/Global Tracks.

We are able to provide 6 hours of CE through the AGD PACE program. Although most office managers do not require or keep up with CE hours, for those who maintain their RDH or RDA and even DDS or DMD licenses, it makes it more worth their while. The purpose of the OMG! workshop is to make life easier and fun while working in the productive dental office. The comments we receive simply warm our hearts knowing the purpose has been achieved.

Class sizes are limited. Register today to reserve your spot. You will be so glad you did. For more information, visit 

A course designed to unleash a dental office's potential

Have you ever noticed that everyone has differing definitions of personal space? Recently I was at an airport (my favorite location for observing people) and was taking note of the sanctuary of people’s “comfort zone.” Did a person choose to leave a seat open or sit right next to a stranger? When speaking to the airline representative, one person chose to not even touch the counter while another felt the need to practically climb on top of it to get closer into the conversation. I observed the people that were standing around the terminal talking to each other. There were the two men that must have needed to yell because of the distance between them and the other group of people with the one lady who would get up in everyone’s face as they spoke.

People define personal space based on many different factors: the relationship with the other person, for example. Couples, children, and family relations tend to have a smaller zone than when they are speaking with strangers. People who live in more urban or more densely populated areas are more comfortable with closer proximities than those in a more rural region. Americans require a much larger personal space than our neighbors on any other continent and that space is typically between 1.5 to 3 feet apart.

I would like to bring this conservation to the dental office. For those of you who sit in the “greeter” position the first place people come to when they enter your office have you noticed how some people will practically climb through the window or across the counter in order to have a conversation with you? I never worked in an office that had the sliding glass doors, yet it was always at that moment that I wished I had something to put up as a barrier. Talk about invasion of personal space! In this day of HIPAA, it’s more than entering your personal space it also violates federal regulations.

The very nature of our business is not only to invade but to literally obliterate anything close to the personal space of our patients. I remember once, as a child when I was receiving treatment, thinking that the dentist’s nose was in my mouth. Of course, that was way before OSHA required PPEs. Now as a patient, I appreciate the masks that the clinicians are required to wear. However, once the clinical exam or treatment is completed, do we revert back to respecting our patients’ personal space? Or did we get too comfortable being in their face?

This can be a vital element to increased treatment acceptance or even whether or not a patient will return to the office at all. Invading someone’s personal space can cause irritation, anger, and/or anxiety. The latter of these is already the leading factor that people avoid the dental office. It would seem prudent to respect the area (personal space) that the patient considers psychologically theirs during any conversation before or after the “oral invasion.”

Developing some personal space etiquette may be a team approach to ensure that your patients’ comfort zones are respected. These may include:	

Reading body language: If someone steps back or leans back, you may be invading their space.

Ask permission to discuss their treatment, payment arrangements, etc. These are “personal issues” and thus personal space.

When entering a room, lightly knock and/or introduce yourself.

How close is too close? It is different for everyone. As inhabitants of this world, it is our duty to value the personal space of the people around us. As constant invaders, we might want to take an extremely cognizant approach to our patients’ comfort zone with heightened levels of respect. We might find that they will be more comfortable and trustworthy of us as a dental team.

How close is too close? Thinking about personal space in the dental practice

New patients are one of the constants that need to occur in a dental office for the practice to continue growing. Many offices spend a large percentage of their revenue on attracting new patients while others sit back and hope that the new patients will somehow find their office.

How do your new patients find you? This is a question I often ask a doctor or office manager who has just told me that they need more new patients. Most of the time, the answer is, “Some from here, some from there.” How a customer finds a business (and a dental office is a business) should be the second question, right after asking for the person’s name.

“Who may we thank for referring you to our office?”

It is an easy, non-intrusive question and one that most people expect to be asked.

As I continue in the discussion with the office that needs more new patients, I will run a new patient report or a referral analysis report. Often, the referral source for the patient is blank. How does a business owner know if the marketing money being spent is effective or if existing patients are pleased enough with their experience in the office to mention the office name to friends or family? When I ask the office why the referral source is left blank, the most common response is, “The patient left it blank when they filled out their information sheet.”

What is the best, easiest way for your office to gather this information? I believe it begins with getting everyone to understand the value of the referral source. Let’s break this part down:

Everyone in the office understands the importance of new patients.

Everyone understands the pain associated with openings in the schedule.

Everyone understands that if the schedule stays full, there is a happy doctor and (if in place) a bonus or bigger bonus.

If everyone knows that most of the new patients last month came from the entire staff asking for referrals, the push for likes on Facebook, or from a major employer in the area, the staff can continue to put their energy in that direction.

Everyone can take part in making sure that referral source is gathered and noted in the patient chart.

Promoting a practice is a team event and understanding the importance of each and every new patient is vital to the team promoting the practice. When Suzy, the scheduling coordinator, is entering information in the computer about a new patient, the referral question is asked before the appointment can be scheduled.

Knowing that the referral source is very important, Suzy will ask the patient, 

There are three options when entering this information:

 In a general dentist’s practice, 75% of new patients should be coming from existing patients.

 These are all the marketing sources. This list includes all current marketing efforts such as a newspaper, neighborhood newsletter, or flyers mailed out. Additionally, you would want to note any insurance companies you are in network with to determine which patients found you from their websites (after all, that is a marketing source as well). You can also note if the patient mentions your website, the Internet, and depending on your location, drive-by, walk-in or even noticed the new sign you just put up. If you have a spring bleaching special that you are advertising, give it a referral source name to determine how many new patients came in because of that special. All this is to determine the ROI (return on investment) for your marketing money.

Most dental software programs allow you to put in your list of referral sources, so it should be seamless to include how the patient found your office.

 This is the option to use if another provider referred their patient to you. Possibly Dr. OralSurgeon down the street had a new patient who came in and didn’t have a general dentist. You can include in this list any provider in which you refer.

When a new patient calls the office, he or she will typically remember where they got your name, possibly from a friend or they have just selected you from the insurance company’s website. If you wait until patients come in and fill out their paperwork, they will often have forgotten where they heard of you. Make this step easy for everyone to understand so they can gather this information.

When you analyze your new patient numbers, knowing where these patients came from is a great thing to share with your entire dental team. A follow up, to an existing patient, with a thank you card is icing on the cake.

The second-most important question you can ask a new dental patient

We’ve all heard the quote, “There is no I in team,” yet all we heard leading up to the recent NBA Finals between the Miami Heat and San Antonio Spurs was how it would be up to LeBron James to get the win for the Heat. The last time I checked, basketball is a team sport. The Heat have four other players on the court and several more on the bench, so why is up to one person to win the game?

Enter the Spurs, with no superstar and no one person that the world expected to “get the win.” In fact, every night had a different player who would finish the game with the most productive statistical outing. Even if you are not a basketball fan, the game that the Spurs played was truly fun to watch because they epitomized the meaning of TEAM. The overall stats for the series had LeBron with the most points, followed by seven Spurs players (of which the top three were not their “Big 3” but rather bench players). LeBron is thought to be the best basketball player on earth, but, during this series, the Spurs were definitely the best basketball 

What does this have to do with dentistry? Besides the fact that I am from San Antonio and a fanatical Spurs fan, I am also a huge proponent that it takes a true team to have an outstanding, productive, and 

 dental office. The practices that we see with full schedules all the time, patients who accept treatment, and recall patients who will not miss their appointments because they understand “it’s 

 important,” are the practices that consistently take the team approach.

Everyone is asking for referrals, which keeps the new patient stats popping. 

“Mrs. Jones, here are two business cards one with our number in case you have any questions following today’s procedure and one for you to share with a friend who may be looking for a new dental home.”

The hand-off between the clinical and administrative teams is rock star, ensuring that the doctor’s schedule remains productive. 

“Sandy, Mr. Johnson has some treatment in lower right area. The treatment plan is in the computer. Doctor will need 90 minutes and would like to schedule this appointment as soon as possible.”

The entire team is mindful of the value of recall patients, so it is second nature to look at a patient’s recall status. The assistant may ask the patient if he or she can schedule the recall appointment while they wait for the doctor. The hygienist may suggest that they schedule the patient’s children’s recall appointments while they are scheduling her next appointment. The doctor asks the assistant, in front of the patient, if the patient has his next recall appointment scheduled.

If an appointment is broken, it’s all hands on deck to make up the difference in the schedule. You will see everyone’s brains whizzing through the patient database to think of a name to call.

No one allows a patient to leave the office before stopping at the front desk. This guarantees the collection ratio will remain high. 

“It was great to see you today, Julie. Let’s see if Becky has any questions for us before you leave.”

It’s a team approach, not rocket science. Everyone depends on each other to ask for that referral, schedule that next appointment, or collect that money. The patient is passed around the office in a methodical way and everyone knows his or her role, what to ask, what to expect, and what their teammates expect. It’s truly a beautiful thing.

In a dental office, just like on a basketball court, teammates lean on each other, help each other, and work together to achieve their goals. When one person “falls,” the rest of the team runs over to help that person up. At the end of the day, they pat each other on the back for a job well done. There are no attitudes. There is no drama and there is not a single superstar. Rather, there is a team of exceptionally good players.

The NBA finals were fun to watch (mostly because my Spurs won), but also because the world got to witness and remember what a team sport is supposed to look like.

What your dental team can learn from the San Antonio Spurs about teamwork

I was recently attending the Southwest Dental Conference and had to step out of a class to take a call. I found some tables that were outside the exhibit hall so I parked there to concentrate on my conversation. As I hung up, I noticed something very interesting. It was in the middle of “class time” and the line to Starbucks was quite long -- so long that I was compelled to count.

There were 43 people standing waiting for coffee. I remembered walking into the convention center earlier in the day and laughing to myself at the line that was three times that long before classes began. Now I’m intrigued. I thought maybe there was a lull in the classes, which caused the line.

I sat there for another 30 minutes and watched. The line was never shorter and even grew longer at times. The most interesting part of this was that there was a counter That Place Next Door to the Starbucks that served breakfast foods, snacks, water, soft drinks, and, yes, coffee. That Place Next Door rarely had more than 2 people in line at a time.

What does Starbucks have that That Place Next Door doesn’t have? Why are people drawn to one place, even if it means that they have to stand in line and wait to be served? And, finally, what can a dental office learn from the Starbucks model to get loyal patients who are willing to go to any length for their service?

I started asking people what draws them to Starbucks, where they have to wait in line, rather than zip in and out at That Place Next Door? I kept getting one of three answers:

Consistency They always know exactly what they would be getting, how it would be served, and how it would taste, even if they don’t get the same drink every time.

Convenient There is a Starbucks on practically every corner, but the convenience also was in the variety of products served not just coffee but also items that would appeal to children. Anyone can find something to like there.

Comfortable It is trendy and has a sophisticated culture. The stores have comfortable furniture, good music, and free Wi-Fi. It’s easy to meet people there.

I asked if they realized that there was That Place Next Door that served coffee, but that didn’t seem to matter. They wanted their Starbucks.

I decided to break it down to see if a dental office could create that same atmosphere. There are obvious barriers: you don’t need to get your teeth cleaned every day, or even visit every month, so having one on every corner isn’t important and you probably wouldn’t meet up with people at your dental office, but what a great concept. Let’s give this a try:

 This is hitting the mark the same way every time. It doesn’t matter if you have a clinic type atmosphere or a fee-for-service culture. It means that your patients know and want the service that you promise them.

Imagine your patients bragging on the fact that they never have to wait to be seen at their dental office. They know to be on time because you will be. You each respect each other’s schedule.

The hygienist gives the best cleaning ever every time!

Little things are tended to like ChapStick applied during treatment, or gloves that smell like mint, a warm cloth to wipe one’s face is handed out after treatment, or a blanket is made available since the operatories are often cold to the patient.

The office is always on the top of one’s mind because the communication is second to none:

Post-op calls to anyone who has had an injection

Post-treatment letters with instructions on protecting their dental investment

Email blasts announcing whitening specials for prom, weddings, and graduations

Monthly newsletters with dental tidbits, introducing new team members or even some dental humor

Thank you cards, signed by the entire team, when a referral comes from an existing patient.

 This is not necessarily referring to having an office on every corner, but more about having dental needs met conveniently. There are ways to accommodate a patient without putting the office into a bind.

Squeezing in that little filling that was diagnosed during the hygiene visit.

Calling the specialist to help patients schedule their RCT, extraction, or perio evaluation. By the way, this is also an excellent way to create great relationships with the specialists in your area.

Did you realize that teeth-whitening is the #1 searched product on the Internet? Whether you offer bleaching services or not, there are many products that you could offer to your patients:

Take-home whitening trays, strips, or pens

Electric toothbrushes and asking about refills at each hygiene visit. There are even travel-size electric toothbrushes that make great stocking stuffers.

I’ve heard that some offices offer different products to their patients and all “proceeds” go toward the Christmas party or some other fun event.

 This is where the customer service comes in.

Take a good look at your reception area. Are the chairs comfortable? Do you have up-to-date magazines? Is there Wi-Fi available for your patients (make sure it’s HIPAA-compliant by having a guest login and not using the main office login)?

Do you greet every patient who walks in the door? Even if the admin team is on the phone or with a patient, make eye contact and wave.

When was the last time that you sat in your treatment chairs? Could you sit/lay there for 2 hours for a crown prep?

One day while your office is in full motion, stop and listen. Is there music? Does it calm you? Is there laughter and upbeat talking like during a pleasant gathering?

Finally, look around, are the bathrooms clean, walls freshly painted, and floors free of debris?

This is true customer service. Starbucks doesn’t claim to have the best coffee, but they have an excellent business model. The reputation that they set out to accomplish meets the standard at each and every location. What is the acceptable standard in your office? Is it met every single time? Now I think I will go try that Vendi Caramel Macchiato with a reduced-fat berry coffee cake with lemon crumble.

3 things your dental practice can learn from Starbucks

There seems to be a common statement we've heard in the past few months: Betty put in her notice or John hasn't called or shown up in three days. Job-shifting is occurring more now than we've seen in a long time.

When there is a job opening in a business, the company's production numbers will always take a hit. The size and cost of the hit will depend on the structure of the company's policies, procedures, and training. According to 

 magazine, 42% of business owners state that their biggest challenge is finding and keeping skilled workers.

Before we can effectively find and even keep workers, let's first ask WHY workers are leaving. The most common reason that an employee gives for leaving is frustration. This frustration can be based on:

1. An ogre-type employer or office manager.

 This person is always grumpy, yelling, or just never satisfied. The frustrated employee often states that just a “thank you” every once in a while would have made life so much better.

 One employee is always late, leaves early, or doesn't complete his or her job accurately, yet never gets called out on it. The rest of the team works harder or suffers because of the weak link. Similarly, one employee gets preferential treatment.

3. Unwritten or underwritten company policies.

 No one knows the rules until they are called out for breaking them. This can be due to an outdated office manual or not having one at all.

 The team rarely gets a full lunch, if ever, or consistently clocks out at 7 or 8 p.m. (when the day should end at 5).

 The feeling of sabotage, blame-game, or “gonna get ya” runs rampant on a daily basis.

 This is a hard one for an employee to overcome.

If any of those six problems sound familiar, then chances are that you have a pretty high turnover rate in your office. Statistics show that each time there is a change in an employee, the business will incur a hickey that is equivalent to the size of the departing employee's yearly salary.

It is imperative to understand and learn the following strategies to minimize this cost to your practice.

The employer should always make time for an exit interview.

 This is not a job to delegate to a manager since it is your employee giving important details about your business. Create a form to fill out and include it in the employee's personnel file. Ask specific, pertinent questions that will drill down to the real reason for the departure.

Emphasize confidentiality and ask for honesty. (If you need an exit interview questionnaire, we have one to share. Send us an email at 

Understand that managing and leadership are two different things.

 Managing is guiding people to perform the daily operations in the most efficient manner to ensure that the business meets or exceeds production goals. As a business owner, you are leading your team in the direction of your goals and maintaining your mission and vision.

The biggest mistake a business owner can make is to lead without setting the correct example.

 You require all team members to be ready for the morning huddle at 7:45, yet you notoriously walk in at 7:55. You demand exact actions toward OSHA compliance, yet you walk to the front desk wearing your gloves. You lecture about no texting, Facebook, or personal calls during office hours, yet delay hygiene checks because you're in the middle of a Candy Crush Saga game.

Everyone approaches conflict differently, and that in and of itself can cause friction.

 Understand that friction can be good. It can be beneficial and it can be healthy, if it’s dealt with appropriately. Friction doesn’t mean knock-down drag-out fights. It means that opinions differ yet from those differing opinions can come creative, innovative ideas.