Dr Michael Sernik, August 2003 - “The more you know the more you need to know”. When it comes to Dental Practice Management this saying really rings true. Gone are the days where a successful practice can simply hire junior staff, spend one day on basic training and expect a smooth business operation. With expensive computerised equipment, strict sterilization protocols, computerised banking, computerised records and scheduling, database marketing, maintenance of a recall system, a tickler file, more complicated health insurance arrangements and the list goes on. Of course, you can elect to resist all these changes and try and keep it simple, but there is a trend out there and its getting more complicated every year, like it or not.

It’s getting harder to just be a dentist and leave the rest to staff.

When it comes to delegation, most dentists fall into one of three categories:

1. Those who say, “If you want a job done well, do it yourself”. These dentists have never learned the science of delegation. They micro-manage everything, staying back after hours, or squeezing management into their busy schedules. They are chronically busy and stressed. They complain about the difficulty of finding responsible staff. These dentists often find their practicing life frustrating or depressing and complain regularly about their profession.
    
2. The second category thinks they have delegated, whereas in fact they have ‘abdicated’. They hand over power but do not have the mechanisms of monitoring the details, results and quality of the work. They rely heavily on one trusted staff member. They are so dependent on that person that it becomes difficult to correct any issues related to that persons performance because they are simply too afraid that this trusted person would quit and leave chaos behind. If they have a spouse or family member helping out it commonly results in higher than normal staff turnaround due to leadership issues.
    
3. The third category dentists have sought help. The entire practice operates with clear job descriptions with a regular protocol of cross training to avoid dependency on one person and to facilitate better understanding within the team. All verbal skills are regularly reviewed with a system of role-playing. There is a system of accountability for all tasks. There is a rational reward system when income and efficiency goals are met. The practice runs on time, there is far less stress, and solid measurable growth. Staff turnaround is not a big problem but when it does occur, there is a very clear training programme enabling the new member to fit into a proven system. This dentist actually is the least stressed, the most efficient because he/she needs to focus on a few key performance indicators. (In fact, the best leaders of the largest corporations are able to simply look at 4-5 key performance indicators per day to get a good handle on the health of the corporation.) These dentists love their profession and seem to get lots of extrinsic and intrinsic rewards from their day-to-day work

Some dentists use job descriptions in the hiring process, but very few use job descriptions in the same way as progressive businesses use them.

In the commercial world, it’s standard practice to use job descriptions in tandem with an integrated process of delegation and accountability for all tasks. This process allows leaders to lead, and managers to manage.

For every position, there needs to be a written job description, a protocol for measuring results, reporting on those results, accountability and a possible reward system for achievement (rewards do not have to be financial).

For example, your chair-side assistant might be given a goal of collecting personal information from patients in order to increase the personal bond with the patient. Many patients will be more loyal and keep returning to the practice that ‘knows’ them, even if they move out of the area. At the next staff meeting, the staff member who has collected the most information could be recognised with a prize such as tickets to the cinema. When you think about it, there are many goals to target (collections ratio, cancellations, recalls, treatment plan acceptance, referrals, bad debt…the list is very long).

So now that you’ve been told will you do it?
There is a big difference between knowing what to do and doing what you know.
That’s precisely why big corporations use outside consultants. We can create compliance while minimising the effects of internal politics. Otherwise how would you approach your trusted employee with a new system designed to make her/him more efficient (and avoid upsetting them?)