Positive Motivation for Employees
I realize this is a subject that I discuss rather frequently, but it is also the area of dental office ownership that causes the most stress (and distress) for the dentist. Simply stated, most dental practices operate at less than 50% of their potential primarily because the staff and the doctor are not a cohesive team. They are just showing up and going through the motions. Their hearts, their souls, their minds, their joy, and their creativity never make it to the office. Woody Allen is quoted as saying that 90% of success is showing up. That does not apply in dentistry or any other profession with which I am acquainted.
Part of the problem is that we business owners are almost schizophrenic at times in dealing with our employees. We are in an age and a society that promotes egalitarian values, so we often try to be one of the “guys” on an even level. That is understandable from a societal perspective, I suppose, but it is too often overdone, and it is naïve to the extreme.
There are some realities that we must face as business owners and employers, if we want our businesses, our families, AND our employees to prosper. He (she) who writes the check is the boss, and that cannot be disguised or ignored no matter how uncomfortable we may be with the idea of bosses and employees. Human nature will complicate a relationship that is too close between bosses and employees no matter how much both parties seek to avoid these complications. The inescapable fact that someone is the boss and someone is the employee does not make the person who is boss superior, or better, or more worthy. It just gives them a different role to play on the stage of life as described by Shakespeare. An important key to being a good boss is being comfortable with the role.
Some bosses are too overbearing and arbitrary. Attila the Hun may have been an effective leader of barbarian warriors, but his style will not work in a dental office. There are organizations that operate best when individuals need only show up and go through the motions assigned in an acceptable way. (In fact, a lot of dentists I know would settle for that in their offices.) An army in combat, a manufacturing line, and even some parts of sports teams require absolute discipline and limited individual creativity for success. (I realize this does not apply throughout any of the organizations cited, but it does at the more basic levels.) Although I believe a lot can be done with very detailed Job Descriptions, internal protocols, and training in dental offices, there is at all positions in dentistry also a need for creativity. Steelworkers, the guys who walk girders and erect the skeletons for large buildings, call their low-level managers “Pushers” (or they did 20 years ago). That descriptive management style will not work in today’s small business. While the relationship in a dental office must recognize that all are not on exactly the same level, the days of kings and subjects is passed.
Just as the relationship between boss and employee must adjust to our modern concepts of egalitarianism, the relationship cannot be too collegial either. If you are the dentist and your best friends are your employees, there is the potential for concern. What kind of real friend can say no to someone who wants more money or more time off for good, or bad, reasons? How can the other employees be anything other than concerned when the boss has a particularly close friendship with a particular employee? And then there are the too frequent extramarital relationships that exist in dentistry. Although I would rather not, I must discuss this a bit.
A dental office contains all the elements necessary to foment romantic liaisons. Young, attractive, females who are often financially struggling are working in uniquely close proximity to more financially established males who sometimes become bored with their jobs and lives. Typically, women seek security while men seek proof of their manhood. Even if neither is particularly evil or predatory, our culture encourages promiscuity and no longer condemns those who stray. Unfortunately, anyone who has fallen prey to this temptation knows the downside or will soon. The pain is usually so great as to completely negate the original attraction. In as kind a way as I can, I want to suggest to those who may be tempted or have already succumbed to temptation, “Rectify this immediately. This is a practice corrupter that will cause even greater problems than you already have.” If there is a boss taking advantage of his position with a vulnerable employee, you have the potential for blackmail and even legal action brought against you. If there is a boss who is beguiled by an inveigling employee, I would ask the employee how secure a future relationship might be with this dentist? If you were able to take him from his family, could he be tempted by another version of you in a few years? It goes back to the best advice I ever received from my father. “Don’t do things you know are stupid. We have too many things we can’t control to deal with already.”
Sorry about that sermon, but so many innocent lives are involved, and it is an issue of some significance in dentistry. Actually, my real interest is discussing positive motivating factors in dental offices. The first is where money fits as a motivator because that is the area that gets the most attention from both management and employees.
First, it is important to understand the psychology of why people act and react as they do especially as that relates to salaries and bonuses.
People perform at their absolute maximum when they are working cheerfully with their heart, not just their body. You cannot capture the heart and soul of an employee with an increased salary. Salary and wages feed the body, not the heart. Most employers, especially in small businesses, think the relationship between boss and employee is improved as salaries increase. Salary and wages are for work already completed, and they are NEVER responsible for improved employee productivity. Salaries can be a de-motivator, but they are NEVER a motivator. You cannot pay enough to gain loyalty and hard work from employees. How else can we explain professional athletes who make millions a year and still under-perform and are disgruntled? Leadership captures the heart. Salary only captures the physical presence. Money motivation has a place, but it can only be used for short-term objectives. While salaries must be competitive, to get the best from employees requires more than money.
Part of the confusion some have is confusing compensation with incentives.
Compensation is paid for work that has already been done. Incentives are offered for future excellence.
If effort has been consistently excellent in the recent past, a bonus as compensation for that effort is appropriate so long as it still fits in the basic overhead limits. Certainly, if this compensation is a result of a properly outlined bonus/incentive plan, it can encourage future excellent effort, also. However, unless there is a clear, fair and easily understood bonus/incentive plan already established future excellence will not be encouraged by past compensation. While I heartily endorse one-time rewards for extraordinary performance as fair and farsighted, this should not be the only type of incentive plan in the office. A good bonus/incentive plan can be effective as a motivator, but most are so poorly conceived and explained that they actually have the opposite effect.
No matter what the approach the practice must be kept healthy financially, or everyone loses. Part of the problem we often face with new clients is that salaries already exceed acceptable standards while greater effort is required. When salaries are already out of line (20% of gross production) there are only two options available. Either salaries must be reduced or production must be increased.
Although I am going to discuss forced personnel changes, because there are times when that is necessary, this is almost never an option for bringing salary overhead within acceptable standards. For reasons beyond our control there are people on this planet who are simply just too negative, too damaged, too immature, or too lazy to be a member of an effective team, and dentistry is a team effort. If you have an individual who is holding the entire office back, you need to solve that problem immediately and humanely. While not all people were blessed with a positive upbringing and outlook on life, they must learn to leave that at home. There is no acceptable excuse for souring the entire office or fomenting discontent. A negative person can be employed so long as she/he is not in a position of leadership. Negative leaders will spoil the entire team’s efforts. (If the negative element is the dentist, that is a particularly difficult situation. Often we find that the dentist’s negativity can be resolved if the surrounding team and/or financial circumstances are improved. Sometimes, though the doctor needs to undertake deep personal or professional analysis. This is very important and should not be ignored.)
In most cases the best way to bring salary overhead into an acceptable range is to raise the production to the level that the salaries are no more than one-fifth of the gross. In more than 9 out of 10 cases when we go into an office that is the issue we face. Then, the great challenge is how to effectively motivate this team to the degree that they can raise production while salaries remain the same. A combination of techniques is used, and the approach varies from dental office to dental office, but there is always an answer.
I have reread this several times in order to shorten it so that I can get into more specifics, but I think it is going to have to spill over into the next essay, which I promise to complete by week’s end. I have overstayed my welcome this time, I fear.
These few weeks since Memorial Day have been challenging on a personal level. Thursday after Memorial Day our eighteen-year-old graduated from High School with all that attendant excitement and angst. There were visitors from out of town to be picked up and delivered, graduation parties, college issues to settle, etc. all that week. When our twenty-one-year-old came home from college for her graduation, he reported that he wants to transfer to a school nearer home rather than complete his fourth year at in Texas. Although he has valid reasons for the move, there are a lot of things that have to be done in order to get that move completed by second summer session here. One was getting a Florida driver’s license. As he was driving my Lincoln to the drivers’ license office he was rear-ended by one of our elderly citizens giving him a sore neck and me a smashed car to be repaired. Both will recover, but both required special attention. When I got back from the clinic where he was checked that evening, I discovered that we now have a new grandson (Nicholas Richard Gebhart) some two weeks early.
Everyone has gone home, the car is in the shop for repairs, our son is back in Texas temporarily, my wife is in Minneapolis being a helpful grandmother for the newborn (as well as his eighteen-month-old sister and her beleaguered mother, of course), and things are beginning to settle down a little so that I have a bit of time to think and to jot down these few notes. As I sit here catching my breath with dozens of unanswered emails, faxes out my ears, and a stack of paperwork that overflows the in basket, I think, “ When will life ever settle down?” Then, I think how lucky I am and have always been. We can choose how we deal with life. This like all life’s challenges will pass and contribute to the continuing tapestry that is a full and happy lifetime. To quote the incomparable Jackie Gleason, “How sweet it is!”
Have a great week,
Hurston Anderson
813-963-7228
In Memory of War Heroes
Memorial Day is a time to remember our war casualties, and it coincides with high school graduation in many places as well.
I grew up 20 miles east of Dallas in a small town (then anyway) called Sunnyvale. The town was so small that there was no high school, so we were bussed everyday to the larger town of Forney across the Trinity River in the next county where there was a high school. My graduating class contained only 37 students, so obviously neither town was very large those thirty plus years ago. Now, the area is just part of the Dallas suburbs.
Of the 37 students in our class, 17 were male. Of those 17 males, 2 died in Vietnam. Others from our school were lost in that war in the class before and after ours. Did Billy and Fred give their lives in vain? It seems like a lot of people believe that they did. I do not think so. I think they were heroes whose sacrifice has finally been proved despite the thoughtless rhetoric of the past thirty years by individuals with questionable objectives. There was much discussion about that war, and I will be swamped with disagreements to my previous statement, but I want to point out one salient fact. Ultimately, the west defeated communism, which has been responsible for more deaths, repression, destruction, and inhumanity than any other movement in the history of mankind. Estimates are that Nazism killed upwards of 10,000,000 individuals. Yet, estimates are that Stalin alone murdered 60,000,000 of his own citizens in his maniacal paranoia. Had America backed down some forty years ago in the face of overt invasion by a communist country supported by both the USSR and Communist China of a neighbor, it is possible that communism might not have ultimately failed. It was important for the totalitarians who called themselves Communists to realize that the west was not soft, nor softheaded. The shine is definitely off the great intellectual (sic) concept of Socialism and the repression wrought by socialism’s political brother, Communism. No, I believe my classmates, my cousin from CA, and the thousands of others who died in Vietnam are heroes who died for the ultimate freedom of hundreds of millions of people around the world, and after some thirty years historians are begrudgingly admitting the same thing. Forget the historians, though, ask those walking the streets of Vilnius or Tbilisi or Kiev or Moscow, if you want to know what the collapse of Communism has done for mankind.
Of course, soldiers are dying right now for their country and for the ideals we hold that are so odious to those who despise freedom. Personally, I did not have to raise my flag for this holiday weekend. I have displayed it night and day since September 11 and will continue until no American soldiers are under fire by the enemy. That may be longer than my allotted time here on Earth. I hope not. For some strange reason patriotism has somehow been translated by some as dangerous, unfettered, exclusionary jingoism. What a hurtful misrepresentation that is. Luckily, that was not the case in 1776 or 1945, or those critics would not now have the freedom to criticize so smugly.
I suggest that the Memorial Day weekend is a special time not only for remembering but for living our lives as fully and wholly as those who sacrificed theirs for us would have wanted us to. We owe a great deal to those who paid the ultimate price for freedom, and one way we can make their sacrifice more worthwhile is to try every day to make this a better society for all. That is why they gave their lives. This may mean pausing a few seconds before snapping back at our children or spouse, waving another car ahead that is trying to enter the highway (even if they are pushy), smiling at the staff in the dental office the first thing in the morning and the last thing at night. Give others the benefit of the doubt even if we are sometimes disappointed. Francis Hutchinson, the Scottish philosopher, maintained that God gave mankind the basic precepts of knowing the right thing to do, and that we knowingly violate those when we act selfishly, meanly, etc. Well obviously, I am seriously condensing his life’s work, but the basic concept is that we know how to do the right thing, if we choose to do it.
Memorial Day is not only the day we pause to remember those who died for their country, but it is the traditional start of summer in the US. Just as their lives gave us life celebrating their sacrifices is followed by the liveliest time of the year. I like that, and I think they would, too.
Tuesday morning let’s all decide to smile just a few seconds more and soften our tongues with our staffs and coworkers. Let’s not violate that inner voice that is telling us to do the right thing, and our businesses will benefit enormously, not to mention our lives.
I realize there is not much here about dentistry, and I usually try to segue in some way into dentistry even on the holidays. Unfortunately, not a single one of my classmates became a dentist. That would have been a great transition. However, of the 37 who graduated in my high school class four earned PhD’s, two became MD’s, and two are CPA’s. So far as I know not a single criminal or reprehensible individual has come from the group, although I did hear that Mike Swindell became a trial lawyer, so we did have our blemishes. (For those with lawyers in the family, sorry about the cheap shot, but all that advertising to create lawsuits that goes on here in Florida leaves a bad taste in one’s mouth for the profession in general. Their professional association really should clamp down on that stuff, but I suspect it is much too successful).
Have a great holiday weekend,
Hurston Anderson
Forney High School
Class of 1965
(813) 963-7228
PS: Our website www.WiseDentist.com contains many of the Weekly Tidbit essays that have been sent over the past five plus years. In addition, there is info about our practice management workbooks and lots of other free stuff.
Yo! What’s the Plan?
There is a rather large audience for these Weekly Tidbits. At present the count is about 30,000 dentists and other dental professionals in eighteen countries spread across six of our seven continents. If anyone is forwarding his or her copy on to Antarctica, please let me know. That would give us a clean sweep of the continents. I have never quite been able to reconcile my thoughts on Greenland, but we do not seem to have a dentist there either, although there are a few in Iceland. (Incidentally, why are there only five rings in the Olympic emblem?) Since the vast majority of readers are the result of direct referrals, I thank you.
Amazingly, of these 30,000 at least 75% are not happy with their practices at present, or at least that is my estimate from my correspondence. To some extent that is a healthy statistic because complacency can result in lethargy and ultimately indifference. To stay current and vibrant as individuals and in our businesses we need a healthy amount of uneasiness. Standing still while the world is moving, if possible, would result in falling behind.
The key is not to worry but to act, though. One of our themes of our website is “Wise is he who thinks before acting, then acts decisively.” The corollary to that would have to be, “Dumber than a rock is he who needs to act and sits around worrying instead.”
A dentist should receive as compensation for his/her education, knowledge, experience, and practice-ownership risk 40%-50% of the practice income. The % is generally lower when the production is lower and higher when production is higher. For instance, it would be about normal to see a practice producing $40,000 per month return to the dentist/owner $16,000 per month ($192,000 per year) while a practice producing $100,000 per month should return closer to $50,000 per month to the dentist/owner per month ($600,000 per year). Do not believe that I am exaggerating. I see hundreds of dental office results each year.
If your return is falling below 40% of practice income, it is time to be concerned, and if your return is falling below 30% of practice income, it is time to consider panicking. In either case, it is definitely time to act.
In the business world every successful business has a plan of action for what it expects to do for the short-term, mid-term, and long-term to reach its objectives. First, though, it has to have some objectives. Some dentists go from year to year not happy with the progress of their practices but never putting on paper what their goals and objectives are for the practice. Instead of “ready, aim, fire” the approach is “ready, fire, complain”.
Every dental practice should have a statement of why the practice exists. It should next have a list of goals and objectives termed not just financially but also clinically and in humanitarian terms. How does one know if one is succeeding, if the terms are not defined?
After setting goals it is next important to create a plan of action for how to get from here to there. It is like looking at a map when you are going to take a trip and plotting the course. Well, it is a little harder, but it is also worth a little more time considering what is at stake. In general, list steps to be taken to reach the goal in measurable time periods. For instance, write down realistic expectations for the first year, the second year, and the third year. Longer periods of time should be included for more long-term goals like retirement, etc., but for practice improvement and growth, for building a new office, for hiring an associate or taking on a partner, for reducing work hours, etc. action plans should be for no more than three years. For a real world example, look on our website at a sample Action Plan we actually produced for a client. (The name was changed and numbers slightly modified to protect anonymity, but this is a real situation.). Click here for ACTION PLAN SAMPLE.
If you don’t like it, change it, but don’t go off on tangents. Investigate, cogitate, and “act decisively”.
I think this NBA Championship Series and the Stanley Cup Series have some of their leagues’ best “floppers”. I am reminded of the incredible blow that Cassius Clay (maybe already Ali) delivered to floor the mighty Sonny Liston some forty years ago. It was so hard a swing that just the wind from his fist carried enough power to knock Liston out cold. You have to give these athletes some credit for their power too, but then, I see why so many are moving into films and television, too.
Have a great day,
Hurston
813-963-7228
www.WiseDentist.com
PS: It might be useful for those who are not happy with their practices to have us do one of our free evaluations to see where you are. Click her for FREE EVALUATION. From that you can set some realistic goals and create a solid Action Plan, or we can help, if you like.
Eliminate Cancellations in the Doctor’s Schedule, Too!
As I wrote a few days ago, this time around I want to talk about techniques for eliminating cancellations and no-shows for the dentists’ schedules. Generally, the theme is similar. That is, it all begins with knowing your patients. This is critical for so many reasons that it should speak for itself, but, in particular you want to know their habits when it comes to honoring appointments with your office. Also, the best internal marketing practice builder is for everyone in the office to treat patients like friends and family. You must know them first, of course.
Here are a few rules about scheduling patients for the doctors’ schedules, which will effectively solve the problem. They also can in many cases be applied to the hygiene schedule.
1. Never schedule patients with a past history of CA/NS. (Three strikes, you’re out)
2. Always schedule AAA (most trustworthy) type patients for Monday mornings.
3. Always record the CA/NS in computer for future reference.
4. Always ask for the “#1 phone number”!. The number you can use to reach the patient between 8am and 5pm. (Then, other numbers - cell, car, beeper, home, work, relatives, etc.)
5. Always ask permission to call patient at work! (Record in computer comments)
6. Always confirm (1) week prior for 1 or more hours of scheduled time
7. Always confirm (2) days in advance for hygiene appointments and less than 1 hour of scheduled time
8. Always confirm (1) week after hygiene cards are mailed
9. Always explain when appointing the importance of 48 hours notice if they need to cancel
10. Always place CA / NS patients on a "Very Special Call List" for " Our Very Busy Patients" (Ask for the best time, day, and # of days needed before calling to appoint)
11. Always schedule " chronically late “ patients "15 minutes" earlier than their appointed time
12. Always ask "New" patients to come in "15 minutes" early to fill out their paper work
(Never schedule “New” patients at 8am or first hour after lunch, unless paperwork is done.)
Note: Confirming by leaving a message and general rules:
1. Include our work number for them to call us back to confirm the appointed time
2. Be sure to follow up with any left messages on schedule
3. RULE: No one is confirmed unless we speak to them personally
4. Know your patient and their past history in your practice (see #3)
5. Always have your call list nearby to call " Our Very Busy Patients"
6. Pre-plan your schedule with the entire team present each week to make certain all members are able to contribute intelligence about the patients on the schedule and to be able to treat them like friends.
7. When a patient cancels we need to know the reason!!! Always record in computer! If a cancellation letter is appropriate mail it the same day. If not make sure we have everything recorded in the computer as to why the patient canceled.
Truthfully, I just pasted most of the above from our Practice Management Cookbook, Hygiene Protocol, and Scheduling Protocol. If you have one of these you can go directly there. One of the first things we do in a practice when we are asked to assist is to instill, train, and monitor this cancellation/no show protocol along with several others.
One of our clients wrote me after last week’s Weekly Tidbit and offered the following. He is a rather well-known clinician and management expert from the ArkLaTex area. Besides building and managing one of the largest single dentist practices in the country, he has written and spoken extensively on these and other subjects to dental groups.
Hurston
Liked your letter this week. I think you might have made your point a little bit better if you would have gone ahead and multiplied 30 "no shows" per month by let's say $100 (average hyg visit). That is $3000 per mo and $36,000 per year, AND that is 99.9% pure PROFIT that is flying out the
window !!!!!!!!
Also, when asking the patient to call to confirm their own appointment, I feel strongly that we should be in the habit of making bold requests. I use the following while looking them in the eyes, "Mrs. Jones, can we count on you to call us yourself to confirm this appointment when you receive it in the mail?" This is slightly confrontational but it gets a firm "yes" or "no" from the patient and lets them know that this is probably a bigger deal than they had been thinking.
Montie
There is another major element of this continuing subject, which should be discussed at length, but I’ll save it for next time. Most dentists do not like to even think about pre-planning for many reasons, but I know the results, which come from these weekly Pre-Plan Meetings, and I’ll go into that later.
Have a great day,
Hurston
813 963-7228
PS: Many of you have the Practice Management Cookbook by now. There is a discussion of this week’s subject in Section V, as well as the Hygiene and Scheduling Protocols. The methodology for establishing an efficient hygiene protocol is in the Protocol Series workbook, Increasing Productivity in Hygiene. Cookbook is $249.95 plus 19.95 shipping/handling and each Protocol Series member is $199.95 plus s/h. Fax 813 963-5974 with Visa/MC#, exp. date, and address…or call above #.
For a FREE Production Potential Analysis and Evaluation, contact me. Order on line at our store.
