Communication skills for successful relationships — Chapter 9: Feedback

by Sandy Roth

Relationships within the team had deteriorated significantly over the previous six months; the staff meeting ambush ended all speculation about why. Dr. Leland had hired Joanna without consulting the rest of the team, and it was clear that she, not the doctor, was the focus of their resentment. It didn't help that the rest of the team had been together for many years and had grown into a tight group.

Yes, Joanna was a bit of a bull in a china closet, and she made the normal amount of mistakes in judgment and performance. But her boundless enthusiasm and energy was part of what had encouraged Dr. Leland to hire her — a bit of new blood. Moreover, she was a dynamite assistant. She picked up on jobs without being asked, followed up with the lab about case turnaround, and centralized the ordering of supplies. While Dr. Leland privately acknowledged his appreciation for her contribution, the team's initial resentment only deepened.

Joanna was never quite sure what she was doing wrong. No one ever complained to her directly and she was reluctant to ask. Dr. Leland did come to her a few times to relay messages she suspected came from the others, but he claimed not to share their concerns, so she guessed she should continue to work in the same way.

The air thickened. Whenever Joanna walked into a room, ongoing conversations abruptly stopped. Sometimes, she overheard snide remarks. The rest of the team excluded her from their social lunches, and she could almost feel the conspiracy deepening. As Joanna sensed her co-workers' increasing animosity, she aligned herself more closely with Dr. Leland, hoping to gain his more public support. But it never came.

At the last team meeting, virtually out of the blue, the hygienist began listing Joanna's infractions, but giving little evidence. She flatly stated that everyone was unwilling to tolerate them any longer. Unprepared for the onslaught and confused by what she considered groundless charges, Joanna reacted like an animal backed into a corner. She knew she should not be so aggressive, but she felt ambushed and alone. It was clear that everyone else had come to the meeting fully prepared to pin her to the wall.

Dr. Leland listened, not knowing quite what to do. How could things have gotten so out of hand? He didn't want Joanna to quit, but he couldn't afford to lose his other staff members, either. He hated conflicts like this and knew he would have a difficult time sorting it out.

My husband Doug and I have two parti-colored cocker spaniels, Max and Willie. Cockers require a fair amount of care, including regular baths and weekly grooming. Good breeders take pains to ensure that their dogs readily accept this level of care. They begin bathing puppies when they are just a few weeks old — when they are just little bits of squirmy things and not dirty at all. But at that age, baths are not for cleaning. Rather, their purpose is to teach the dog that getting a bath is a normal part of being a dog. If you wait until the dog is older before giving it regular baths, it will more likely be resistant. The moral of the story is that if you want to incorporate something as an expected and natural part of a routine, begin it early and do it often.

Feedback works the very same way. Identifying, hiring, and retaining excellent staff is a major issue for many dentists. Doctors faced with staff losses are anxious to hire quickly and are prone to cutting corners. They omit the very steps that ultimately ensure hiring success. Unfortunately, dentists rarely implement the time and resources necessary for a proper training and transition plan, which should take place during the first six weeks of employment.

A proper training and transition strategy is a formal structure that organizes all of the areas of training into a logical and reasonable sequence of priorities. A training plan should first determine each area of emphasis and identify the nature of the training. It should also include a sponsor — who is going to supply the training. (If you would like to see a sample of such a plan, send your name and address to me at [email protected]). At the end of each week, the dentist, new employee, and relevant team members gather to evaluate progress, give each other feedback, re-evaluate priorities for the subsequent week's training, and deal with any issues before they become big problems.

While the primary purpose of these weekly meetings is to ensure that the new employee is properly trained, there is a secondary agenda: to give the puppy regular baths from an early age. When you establish evaluation, feedback, discussion, and adjustment as an expected and natural part of employment relationships, staff evaluations will not be a problem as your "puppies" grow into "dogs." Because dentists and other team members are unaccustomed to giving feedback, and staff members are unaccustomed to hearing it, these events are as unwelcome as a bath for an unprepared dog. In too many cases, the first formal performance review occurs only when serious problems arise. By then, so much water has passed under the bridge that the evaluation is negative, awkward, and mostly a formality prior to dismissal. One thing is certain: No one ever becomes highly successful in the absence of performance evaluation and feedback. That you can take to the bank.

Feedback is a serious issue for every practice. Although most people know intellectually that giving feedback is essential, it is easy to justify not doing so. Consistently, people are concerned about hurting feelings ... and maybe being hurt themselves. To complete this issue, I'd like to share a simple eight-step process that will create a more positive atmosphere for giving feedback. Next month, I'll complete our work on feedback by introducing over a dozen concrete protocols every group can adapt to it's working relationships. Remember, problems rarely go away. They just get more difficult to handle.

Determine your motives and intentions. Your motive is what makes you want to raise the topic and discuss it. So, why do you really want to bring up the issue? Are you hurt? Are you embarrassed? Are you angry? What is bothering you and why? Next, look at your intention or what you hope to accomplish by raising the issue. Do you want to avoid unpleasantness in the future? Do you want to change the way the practice works or the way patients are served? Do you want to clear the air? Do you want to win?

Motive and intention are important. They frame the spirit with which you come to the discussion. In many cases, motives are more important than the message and can heavily influence how others participate in the discussion.

State your motive and intention as a preamble. Stating your motive and intention forces you to come clean. If exposure causes you embarrassment, you will want to re-examine your motives. For example, "I'm angry because you get more privileges than I do, and I'm raising this to make myself look better in the eyes of the dentist" is a motive and intention that you might want to review. If you aren't willing to state the truth because to do so exposes an inappropriate intention, it is time to examine your heart. Stop. Do not raise the issue. Abandon your ugly intent and divest yourself of your ill feelings. You are likely to hurt feelings when your intention is to do so. Address any unintended reactions. Many people tell me they are hesitant to raise an issue when they fear someone might misinterpret their intentions. That's a simple problem to solve. Just express that concern. If your fear is that someone might adopt a defensive position and not hear you out, state that concern. This is particularly important if there is a shaky history with the recipient. "I've been reluctant to raise this with you. We haven't always seen eye-to-eye, and we tend to react negatively rather than find a healthy outcome. I'm hoping that won't be the case this time, and I promise that I won't let myself go there." State your message. Now it is time to state your message clearly, and without window dressing. Don't hedge or use protective language like "I don't know that you will agree with me but..." or, "I might be wrong." Just say it. For example, "Ruth, I am concerned that you are often so tired at the end of the day that it is hard for you to be fully attentive to the patients." Give specific examples. People may not fully understand how you see an issue unless you give them a specific example. Volunteer the example rather than wait for the other person to ask for one. For example, "Ruth, when Mrs. Jones called last Tuesday afternoon, you put her on hold and forgot about her. It seems that this has happened before and I worry about the accuracy of your data entry at similar times." Immediately identify what you are asking for. Are you hoping for a final resolution or only a time for thoughtful consideration? Does the problem require immediate attention? Or, are you simply asking for the other person to be made aware of a new perspective? Whatever your position, let the other person know what you are asking. Listen. Remember that your interpretation may be incomplete or even erroneous. Now is the time for listening attentively to the other person without interruption, defensiveness, or arguments. Listen through to the end. Be prepared for defensiveness or perhaps even anger. Set aside your personal concerns and give the person the space and time to respond.Keep the discussion on the topic at handYou may find that these types of conversations result in a tit-for-tat response. "Oh yeah, well, you're always late in the morning!" If that happens, respectfully ask the person to return to the topic you raised. "I'd be happy to discuss your concerns at another time. But for now, I'm asking you to stay focused on the issues I've raised."

These simple steps will likely help you feel more comfortable addressing difficult issues. I invite you and your team to practice working through the steps on some simple, agreed-upon issues so you can gain some experience and confidence. Then, each member of the team will have some basic skills to use when other, perhaps more challenging issues must be addressed.

To learn more about how you and your team can develop stronger and more effective communication skills, call Sandy Roth at (800) 848-8326, or email her at sandy@prosyne rgy.com to request a catalogue of learning resources.

Guided Personal ExerciseIf you want your team members to function at a high level, contribute to the success of the practice, become accomplished at their work, accept responsibility for important aspects of the practice, develop initiative, and grow in their abilities, you must regularly engage in evaluations as well as give feedback every day. Consider the following questions:

1. What has the employee been hired to do? What are the expectations of the position?
2. How do your employees see themselves performing? What is their assessment of their impact and the degree to which they are meeting or exceeding expectations?
3. How do the dentist and other team members see the employee performing? What is their assessment of her impact and the degree to which she is meeting or exceeding expectations?
4. Where does the employee see herself going from here? How will that benefit the practice? What skills and training will she need? What are the expectations associated with that growth? What must the employee do in this next step?
5. What is the the perspective of the dentist and other team members on the new employee? What expectations do they have?

These steps allow for team members to be involved in evaluations. This is essential. The dentist cannot be the only person involved in evaluations. Nonclinical, administrative, and hygiene staff function mostly outside of the dentist's field of vision and hearing. Moreover, team members must become accustomed to coaching one another and to giving feedback and evaluation.

Evaluations needn't be an ordeal for either the employee or the dentist. If you get yourselves accustomed to addressing each other's performance from the start, it will be viewed as a helpful and necessary part of practice growth. And if you need something to help you remember how important this is, just think about Max and Willie. Every Wednesday they get a bath. And they love it!