Most dentists tell me that providing clinical care is a breeze compared to managing their team. This is understandable considering irksome staff-related issues dentists struggle with, including:
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Employees who require constant oversight
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Employees who don't follow carefully crafted protocols
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Employees who request to leave early or take days off too frequently
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Employees who are more invested in their phones than in the practice
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Team conflicts, drama, and cliques that bleed into meetings
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Employees who do the bare minimum but expect maximum compensation
Also, some dentists believe they're handcuffed into retaining every employee because there isn't a pool of more competent ones to replace them. Others are so discouraged that they consider early retirement. How do we alleviate their stress and fix these in-office issues?
Negative reinforcement cycle
As a consultant, I'm interested in patterns of behavior and their root causes. Have employee work ethics and capabilities truly tanked since the pandemic? Is this a generational thing? Or is this drop in employee performance due to a leadership issue?
I've concluded that dentists and employees are engaged in a negative reinforcing cycle. Employees are less emotionally connected to work while dentists are uncomfortable about providing the direction and effective feedback that employees need to perform better. Each party needs something different from the other, but nobody can have an honest, productive conversation to change this dynamic. As a result, everyone is locked into a dance of disappointment and unexpressed frustration.
So why do employees underperform? Let's divide the answer into two categories. As you review these reasons see which apply to your most frustrating employee.
Why employees don't do what you want
Employee-related reasons:
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Employees want to comply but don't know how (training issue)
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Employee knows how but lacks confidence (support issue)
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Employees don't want to because they don't see the need
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It's uncomfortable to do or they would rather do something else (motivation issue)
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Employees don't have the capacity or skills to do it (competency and job fit issue)
Environmental reasons:
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There isn't the time, space or equipment to do it (resource issue)
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Employees are paralyzed by competing priorities, confusing directions or frequent changes in direction (leadership issue)
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Employees have never been explicitly told what to do (communication gap)
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Employees are not given feedback, so they don't know they're not performing well (feedback gap)
Diagnosing your employees
Identifying why a performance gap is occurring is critical because it influences your response. While I don't know of a Star Trek-type tool that can diagnosis this for you, there is a pithy yet surprisingly insightful diagnostic question you can ask yourself:
If they were promised the ultimate reward, could this employee do what I want them to do without my oversight?
If the answer is yes, then you've determined that the employee can do the job but either doesn't want to or can't because of external barriers. If you answer no, then the performance gap is due to poor training, a lack of competence or the environment.
This leads to another set of diagnostic questions:
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If the performance gap is related to a lack of motivation, why aren't they motivated? Is there anything you can do to engage or inspire this person? Is this a temporary issue or is this a job fit issue?
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If it's a competence issue, would additional training or coaching help? Have you done everything in your power to upskill this employee? Are they capable of learning and implementing? Have you seen evidence they are coachable? If not, this may be an unfixable job fit issue.
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If the performance gap is due to your leadership or the environment, are you willing to make changes? Can you do this on your own or do you need leadership guidance?
The tough love mirror
I observe that the biggest reason dentists are so frustrated with their teams is that they're paralyzed by indecision, second guessing, and fear. They choose to suffer in silence at the office only to offload their frustrations at home.
But this fear-based mindset puts dentists in a vulnerable position. Here's a scenario to demonstrate:
Dentist A's practice lost $130,000 in potential production in the last seven months due to the large number of unfilled hours. The dentist must dip into savings to pay their monthly expenses. The front desk team insist they're working hard, but they can't change patient behavior. They believe it's not their fault that patients get sick, forget their appointments, can't afford treatment, or choose to go to an in-network practice. The dentist feels uncomfortable challenging them in case they leave, thus stagnating the practice.
How would you diagnose the root causes of this continuing issue? Are the employees correct in that open appointments are caused by environmental factors (which they can't change), or are the many openings due to their lack of motivation/skills? And, most importantly, what should the dentist do to pull everyone out of the quicksand?
Many issues in an organization are generated by external factors and then minimized or amplified by employee behavior. The solution isn't to assign blame but to develop accountability. I'd advise the dentist to meet with each employee separately and design a performance improvement plan that outlines the specific new actions they must take to tackle this problem. The plan also includes how and when the dentist will examine their efforts and results. It is a contract that holds both parties responsible.
This approach necessitates a shift in the dentist's mindset: they have acknowledged a difficult truth, which is that everything in their practice is the way it is because they either made it that way or tolerate it being that way.
Making a change
Once you recognize this, you can take ownership for your team's issues. If your employees don't do what you want them to do, it's because you have inadvertently taught them that this is acceptable. But you have the power to change this dynamic! If you want them to change, then the change begins with you.
