Beyond Practice Management: Fear of change

Frank knew he needed to make a change. He just couldn't do it. After all, what would happen if he did do it? Frank was paralyzed into inaction.

You know Frank; you've either been in Frank's shoes at some point or you're in them now. Frank's paralysis could be about a team member who needs to be let go; a patient who needs to be asked to leave the practice; a large purchase that may cause some emotional discomfort; or even a bigger change, such as moving the practice to a better location.

Let's start with a very common occurrence in a dental practice: letting an underperforming team member go.

Most every team member I've had the privilege of working with in a doctor's office came to that office with the intention of doing a good job, being a part of the team, and working there a long time. No one likes to change jobs. During this "honeymoon" phase everyone, including the doctor, is generally enamored with the person. But that phase lasts from many months to only a few days. Then reality sets in, and the team member's true colors start showing up.

In the worst cases, those true colors show themselves in the form of performance issues. At first the team may ignore a mistake here or there, or issues with time management. But then the other team members may start gossiping among themselves about the new member's lack of performance. Animosity may develop, and soon Frank is hearing about it. Then he starts noticing it, too.

But Frank doesn't want to go through the process of hiring a new team member. He doesn't want to let the team member go because of fear that the person will file for unemployment and "raise his rate." Worse, he's afraid that that off-color joke he told her one day might just come back to haunt him in ways he doesn't even want to think about.

So Frank puts up with the underperforming team member. There's something you should know: That team member is not an idiot. That team member is more than aware of what is going on, and he or she is just as frustrated. The team member, too, wants to avoid conflict, changing jobs, or dealing with the daily gossip from the team and frustrations about his or her work.

What went wrong? How did Frank get from that new team member he was so excited about to this feeling of dread each day -- not only from working with that person, but having to hear or overhear the disgruntlement from the rest of the team?

Some hiring tips

Let me first give you some important concepts you need to apply in your practice. Then I'll dig a little deeper than the usual practice management advice.

The first concept has to do with the preparation before even beginning to look for an employee. Always start with a thorough job description and a list of desirable characteristics you want that new team member to have. Too often a doctor decides the practice needs "another dental assistant" and starts looking for someone to hire, trying to fit the position to the person. The person hired is usually someone the doctor "likes," "feels" can do a good job, and is available -- these are not the reasons to hire someone! Only when you have a thorough understanding of exactly the skills, talents, traits, and abilities needed for the new team member should any interviewing take place.

Second: Do not hire on the first interview! Several "looks" at the potential hire is needed, including following up on ALL previous employers, references, and even investigating the state dental board (for violations, if it is a licensed position), social media sites (you can learn a lot about the person on those sites!), and background checks. Yes, background checks. Please do not blindly trust that smiling face that tells you the potential hire will do everything you ask and be the best employee you ever had.

Third: Get your team involved; ask their feedback and intuition. Ask the difficult questions, such as "Why would this person NOT work out for us?" or "What do you see as potential problems?" Better to know now than later.

Finally, follow my two rules of hiring: Only hire someone you feel has the capacity to be a "10" at the position you are hiring for, and only hire someone YOU can be 100% committed to their success. Notice I didn't say a "7" or 80% committed!

Once the person has been chosen, make sure he or she receives plenty of training and guidance, has constant feedback about performance from you, and that any problems or bad habits are corrected promptly.

Now, back to Frank. Yes, it is true that he may undergo some inconveniences when he lets that employee go. It is important to be aware of what they may be, and that they may vary from state to state. In fact, if you are considering terminating an employee, make sure you understand all labor laws that pertain to your practice. If necessary, contact a labor attorney before you do anything.

When it's time to let the person go, make it short and to the point. "Susan, today was your last day with us; things have not worked out as I had hoped. I take responsibility for things not working out, as it is my duty to always choose the correct person for the position. I wish you well in a new job."

Do not try to explain why things didn't work out, offer severance pay, offer to write a recommendation, or mention anything you overheard from your team's gossiping. Yes, the now-dismissed employee will probably have an emotional reaction, which can vary from tears to outright anger and frustration. But afterward, the employee will likely be relieved, as he or she probably wasn't happy either! You'll be doing both of you a favor.

How'd we get here?

Now let's dig a bit deeper, going beyond the typical practice management advice.

What happened to get Frank into that situation in the first place? A number of things.

For one, we dentists don't like change, nor do our dental team members. Our personality traits lend us to be that way, perhaps more so than the general population. We also literally hate conflict; we'll do most anything to avoid it. Unfortunately, our ability to resolve conflict in a productive way is one of the major determinants of our success in life!

So we tolerate poor performance and don't take the time to train properly and provide feedback quickly -- and I mean the day any issue or lack of performance comes up. You must communicate quickly! (But please, not in front of patients or other team members.)

After all, we're too busy to deal with all that, right? WRONG. There is nothing more important than addressing issues and concerns and providing feedback and training to that new team member (and perhaps those existing team members you've neglected) that will pay off for you in the long run. Understand that hiring a new team member will take time out of your day and your team's day, both in the preparation process, the hiring process, the training process, and the feedback process. Make sure everyone has job descriptions and that you have an office policy manual, an employment agreement, and all the other things you've heard about but may not have done. Do it now before you have a problem on your hands. If you aren't willing to take the time to do those things, then you will continue to have a hiring-firing turnstile, a sour stomach, team problems, and an underperforming, high-overhead practice.

And what's in Frank's head? Well, we're all attracted to people who are like us. We tend to hire people we think we would enjoy being around. There's nothing wrong with that; it's just that for a team -- and a business -- to work well and be productive, you must have a balance of personalities. Having team members who are all alike -- or worse, all like you! -- is usually unproductive.

Further, Frank thinks he is just a dentist, and he has convinced himself that he can't do the things I've outlined. He CAN do it; all it takes is a little preparation, organization, and courage. Yes, we're all busy, and we think we're not being productive when we do those things. However, that's incorrect. The firing-hiring process can cost a practice as little as $5,000 to as much as $40,000 in terms of lost productivity, legal matters, and so much more. For every team member who doesn't work out, that money comes out of your bottom line. So it's best to give these matters top priority.

As Eleanor Roosevelt said, "You must do the thing you think you cannot do."

Don Deems, DDS, FAGD, is known is The Dentist's Coach, and is actively engaged in private dental and coaching practices. His latest book, The Dentist's Coach: Build a Vibrant Practice and the Life You Want, is available via his website, as well as a book he co-authored with Stephen Covey and Ken Blanchard, Roadmaps to Success: America's Top Intellectual Minds Map Out Successful Business Strategies.