By Mary Osborne, RDH 

One way to involve patients in making choices about their health is to ask for an invitation to give information. Everyone on the team can look for ways to get permission before taking action. For example, if the dentist observes bleeding or plaque while doing an initial exam, the dentists often say, “The hygienist will help you with that.” That’s okay but getting an invitation for the hygienist is even more helpful. Instead of telling the patient what the hygienist will do, the dentist could ask for an invitation. “Would you like the hygienist to help you with that when you see her?” Patients typically say yes, and that sets the hygienist up for a different conversation when she sees that patient.  

When the hygienist sees a note that the patient wants some help removing deposits in a certain area, she has been invited to give information. The hygienist can say, “So, I understand from the doctor that you’d like to have some help with being more effective at removing the deposits that are around this tooth on the lower right.” 

In this circumstance, I might ask the patient, “What have you tried in cleaning that area?” I pause and allow the patient to think and speak. Perhaps they would demonstrate how they brush or floss in that area. If I do make a recommendation to a patient, I like to follow it with, “Is that something you’d like to try?” 

The dentist and hygienist are a team, and the patient is the third team member in partnering for health. In ideal practice, all clinical and front office team members are part of the collaboration and share their understanding of the patient with each other. Many times, especially with elderly patients, I find there is a family member who is a health partner, and we can invite them to participate in consultations. In dentistry, when we become trusted health advisors to our patients, we can also influence their choices in other areas of their health.  

When we listen well, we can filter our information through the lens of improving overall health. We can make connections between their perspective and our own. When we understand the patient as an individual with special circumstances, opinions, and emotions, we can help them get in touch with their own aspirations for health and help them move toward those goals.  

By John C. Cranham, DDS 

Every dentist finds it challenging to take time to train their team members.

Here are a couple of examples of how I’ve added time to my own day by advancing my team’s skills:

 I fired myself as the practice photographer. My goal was to have multiple people in my office who know our intraoral and extraoral image protocols and who can take the photos at the same high level of quality. To do this, I built “training time” in our schedule to teach photography. Now, while the patient is in the chair, I have the “photographer” show me the photos. We look at them quickly. Occasionally there is one that needs to be retaken, and I will explain why. The quality has become consistently high. By having multiple photographers in the office, my primary dental assistant can focus on something else when needed.  When I am working up a case, I often show them why I needed a specific photo. They take interest in their part of the process and the case. Engagement in their work rises. Always clearly share the why. 

I’ve also trained my team on how to fabricate deprogrammers. I’ve trained them all, checked their work, and explained the why behind our standard. We now have four people who can do that, too. This means we have a good product we offer patients and get it out in a timely manner when my primary assistant is busy.  When it comes to training your team, you will set a standard, and your team needs to know you are serious about it, but you can do this without being stern or making them feel bad. For example, in my office, if they take a bad photo or make an unacceptable deprogrammer, I explain why and ask them to retake the photo or remake the deprogrammer. As they redo something, they learn from their mistakes. I am patient with them. I tell them I made the same mistakes while I was learning. 

By Edwin “Mac” McDonald DDS  

Effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. In Part 1 of this series, I described Phase One: The Ending Zone, the time during which your team is feeling the loss of the familiar and coping with uncertainty. In Part 1, I also listed communication strategies to help them cope. Let’s look at what is likely to happen as you and your team continue to transition through change. 

Phase Two: The Neutral Zone 

During this transition phase known as the “Neutral Zone” or “Chaos Zone,” team members grapple with the loss of the old ways and the unfamiliarity of the new. Competency levels vary, and individuals may feel consciously incompetent or consciously competent. What do I mean by that? 

Some may feel they now know what they didn’t about the change and understand the value of it. They are ready to navigate the change emotionally. Others may feel they are starting to “get it” and deal with it. And others have become champions of the change and model confident competence in making the transition. Others will still experience confusion, stress, doubt or skepticism. This is when leaders need to step up and put on an encourager and coaching hat. 

Strategies for Managing this Phase 

• Discuss Strengths Utilizations: Encourage team members to identify how the change allows them to use their strengths differently and explore new opportunities. 
• Open Conversations: Lead them in conversation and empower them to create solutions as issues of the transition arise. Foster teamwork and purpose as you converse with them, so they feel vital to the practice. Encourage them to talk among themselves and lean on one another as a team because you want to retain that team. Express your appreciation for them navigating and embracing the change. You can take them outside of the office for a social meal that does not feel formal and they can feel connected even outside the office.  
• Provide Support: They will feel the need for information in order to feel secure. Ensure communication networks are open. Bringing in a transitions coach helps. Consider what HR resources you can make available to support individuals during this challenging phase. 

Remember, effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. 

By Clayton Davis, DDS 

About 15 years ago, my wife and I were on a trip to New York City. My laboratory had told me about two dentists there who practiced together and did an amazing amount of cosmetic and restorative dentistry. Their best month was about six or seven times more than my best month, so I was curious. I knew they had studied with some of the same mentors I had. They had gone to Pankey and Dawson. They have a a comprehensive approach. While I was in New York, one morning I told my wife I was going to visit their Manhattan office and see what I could learn. 

Their office had reasonable furnishings (nothing fancy) and a reasonable level of equipment. It was tidy with nice staff. It seemed similar to what I have in my office. I sat down with the dentist who was there that day, and he shared with me what they do in their practice. They do a fair amount of marketing in health and beauty magazines that are circulated in the New York City area but otherwise it all sounded very familiar to my practice.  

A few moments later, there was a knock at the door. It was the hygienist, and she said, “Doctor, ready when you get a chance for your examination. Mr. Anderson is in today, you may not recall, but he had said that he wanted to get his veneers done after his daughter graduated from college. That was a couple years ago when he said that, and his daughter is graduating in June, so it’s time to bring that up again. I mentioned it to him today, and he’s scheduled to start that in July. So, when you want to come on in and talk to him about it, that would be great.” 

She walked away, and I looked at the dentist. I said, “What just happened? The hygienist handled everything about moving that patient forward for treatment. I can’t get mine to do that. As a matter of fact, we’ve had conversations, and they don’t seem to feel comfortable doing that.” 

He said, “I don’t know. We talked to them about it, and they’re tremendous about it. They really help our practice move patients into treatment.” 

I went home wondering how I could move my hygienists in the same direction, and an old business concept came back to me. If you want to improve something, you need to come up with a way to measure it. So, I came up with a form for logging what I call “Hygiene Points” and presented it to my hygienists. We talked about how we want to improve our ability to move patients forward with their treatment through the hygiene department. I simply asked them to score themselves on how it went at each appointment in talking to patients about any kind of treatment that came up. 

As each patient passes through hygiene, they receive a score. The lowest score, a score of 1, is for when I come into the operatory, talk to the hygiene patient, bring up some previously recommended treatment, and they go ahead and schedule it. A score of 2 is for when the hygienist finds a problem like a cracked tooth and says that it needs to be monitored. A score of 3 is for when I’m in hygiene and diagnose something new and get the patient to commit to schedule treatment. A score of 4 is for when the hygienist gets previously recommended treatment scheduled at the front desk without my involvement. A score of 5 is for when the hygienist takes an intraoral picture and points out a problem to me and I get a commitment to schedule. In other words, they say, “Let’s take a picture of this. I want Dr. Davis’s opinion on it when he comes in the room.” And then because the hygienist was concerned and I confirm in front of the patient that this is an issue that needs to be addressed, the patient schedules treatment. The collaboration and communication go so well, this is worth 5 points. And then the ultimate score is 6 for when the hygienist gets a commitment to schedule treatment for an obvious problem before I come in to confirm the diagnosis.  

The first couple of months that we used this scoring, we recorded a baseline monthly total.  After that, the competitive instincts of the hygienists kicked in and they wanted to improve their total score each month. I did not give them a reward incentive, and over two years, more production was coming out of hygiene. The old saw “You can improve what you measure” has certainly increased restorative collaboration and revenue in our practice, and the pursuit of higher Hygiene Points has been fun. 

Laura S. Harkin, DMD 

I’m the owner of a third-generation dental practice. My father was a special person who cared for his patients as much as he did his dentistry. One important piece of advice that he gave was to make sure that my patient records were always complete and pristine. He said, “Anything that you are sending to the laboratory or to a specialist, even down to how you write your lab script or note, must be precise. And the reason is not only to minimize adjustment at the end but to also set an expectation for the same level of care returned by the lab or specialist.” 

As a team, we have spent time evaluating our models and photos to discuss how they can be improved and to recognize our highest standard. Recently, I became a little concerned about some of the radiographs we’d taken in the office. I encountered a few bitewings in which I was able to see the bone levels or the image wasn’t anterior enough to check the distal of the canine. So, as a team, we set aside time to review current x-rays and discuss the diagnostic qualities that we seek to achieve in each type.  

A team huddle provides built-in time and a safe place to do something like this. While reviewing the images, it became very clear that the team knew how to take vertical and horizontal bitewings. They also had a clear visual for how the images should look. Sometimes, however, a team member was shy about retaking an x-ray for they worried that a patient would be uncomfortable with the process. Other times, I imagine, they felt pressed for time and hurried to move down their checklist. 

Our review of images reinforced the level of care we collectively aim to achieve in all facets of our clinical day. Just as we strive for beautiful, mounted study casts, we take our x-rays with intention for our ourselves, our referral sources, and, above all, our patients. Consider taking a team meeting to share each other’s tips and tricks for taking x-rays in patients with difficult anatomy, a gag reflex, or missing teeth. Our own team members have a wealth of knowledge that sometimes doesn’t move from one treatment room to the next! 

By Pina Johnson, Professional Certified Coach, and Edwin (Mac) McDonald, DDS 

B.F. Skinner, a noted 20th century behavioral psychologist, conducted an intriguing and provocative experiment using laboratory mice. Using behavioral conditioning he was able to condition one group of mice to believe that through their actions they were able to determine their fate. Using the same methodology, he also succeeded in conditioning another group of mice to believe that there was nothing they could do to alter their fate. 

He then placed the first group of mice, the ones that believed their actions mattered, into a large tub filled with water. As anticipated, this group of mice, when placed in a life-threatening situation, acted instinctively and began to swim to the side of the large water-filled tub. Upon reaching the edge of the tub the mice were able to crawl out to safety. 

The second group of mice, the ones that believed that their actions were meaningless, when placed in the tub of water, simply sank to the bottom and drowned. Appropriately, the lack of responsiveness displayed by the second group of mice was termed “learned helplessness.” 

Culture Lifts or Sinks Ambition 

Belief that our actions and choices matter is essential to “making things happen.” 

According to Edgar Schein, an icon of modern leadership thought, the primary function of leadership is to create an organizational culture. The culture that we choose to create will influence every aspect of our organization and ultimately determine our dental practice’s success or failure. 

Value-based leaders understand the power to alter the course of the organization does not reside with a few; it is shared by many. Organizations with cultures based on shared beliefs and purpose are higher performing. Leaders of the highest performing organizations foster cultures rich in collaborative decision making and a profound belief that everyone has influence. 

Counter Learned Helplessness by Empowering Self-Confidence 

We have come to recognize that good-old “self-confidence” is a learned competency, and effective leaders create organizational cultures that promote and teach self-confidence to each individual team member. This is accomplished by empowering teams through collaborative decision making and ensuring each team member has been given the knowledge, skill, support, resources, and appropriate authority to accomplish each task required to meet the shared goal. 

Unleash Teamwork and Creativity 

In organizations with shared leadership cultures, human self-confidence is unleashed beyond saving oneself to act in the best interest of the organization. Knowing that our individual actions will have some effect on our organization’s future (and thus on our own future and the future of others we value) compels us to want to take actions that have positive benefit for everyone. This is “meaningful” for the individuals within the organization. This raises their engagement in the work and simultaneously generates a sense of wellbeing.  

In our dental practices, “We are serving others with empathy and care to ultimately improve their wellbeing.” This is a form of love. It begets appreciation and reciprocity. When the slings and arrows of daily life initiate negative thoughts of being out of control of a situation, remembering our purpose and prior successes enables us to see disappointments and frustrations as opportunities to create a new type of approach and carry on. 

The goal for effective leaders is to allow all of this to happen in a psychologically safe environment in which our staff need not fear repercussions for their well-intended actions even if the outcome of these actions is less than ideal. By creating organizational cultures that are psychologically safe, we draw out our organizational creativity which is often stifled by the psychological repression found in command-and-control cultures. 

Creative thinking is considered to be one our highest-level cognitive functions and has been found to be a distinguishing characteristic of exceptional organizations. The wise leader understands that their organization is best served through shared power, collaboration, and utilization of their organization’s collective creativity. 

By Pina Johnson Professional Certified Coach 

 What motivates teams is a question that has been asked for as long as someone has been seeking solutions for organizational performance. The day of top-down (or command-and-control) leadership is gone.  

Daniel Pink, in his 2009 book Drive: The Surprising Truth About What Motivates Us, takes a deep dive into the decades long effort to understand the research around human motivation in the modern workplace. Consistently, employers believe they are doing a great job of recognizing, rewarding, and motivating their employees. The people that work for them report the opposite. The tension between the two groups is observable and measurable. In this book, Pink discusses the key patterns that are consistent in what motivates people., takes a deep dive into the decades long effort to understand the research around human motivation in the modern workplace. To his credit, he uncovers the key patterns that are consistent in what motivates people. 

What doesn’t work—external rewards and punishments 

Although there are times and places to administer rewards (carrots) and consequences for behaviors that violate the organization’s values (sticks), “carrot and stick” strategies do not work and have not been working for quite some time. In fact, according to a great deal of research, these strategies reduce performance over time after a brief initial improvement when they are introduced.  

What does work—internal motivations 

Research has clearly demonstrated that there are three primary internal motivations that drive team member engagement: 

1. Autonomy 

1. Mastery 

1. Purpose 

Autonomy over your work appears to be the strongest driving force among those three. There are many aspects to autonomy that you can explore in Daniel Pink’s book. My takeaways are that people want: 

• Control over how they do their work 
• Ability to creatively enhance the methodology of their work 
• A strong voice in the direction and future of their work 

This begs the questions:  

• Have you met individually with each team member and talked about this?  
• Are you giving them the freedom to do their jobs well?  
• Are you developing them with training opportunities and direct challenges?  

Responsibility without authority creates frustration. Responsibility demands autonomy. 

Mastery is defined as the desire to get better and better at something that matters. You can feel the natural connection to Autonomy as the desire to improve is based in each person’s unique gifts, talents, skills, and desire to use these for something important.  

Control seeks compliance. Autonomy seeks engagement. When a person becomes fully engaged in an activity, and is challenged enough to be stimulated, they can lose themself in that activity be it work or play. That optimal state of peak performance is described as flow. Mastery happens in and through those experiences of flow. Mastery is a mindset that requires a great deal of grit and becomes the infinite game that we never complete. 

Purpose answers the question for each person: “What are you supposed to do with your one short life?” When the organization has a clear purpose, the individual understands their role in that purpose. When they connect the organization’s purpose to their own life’s purpose, then you have a powerful force at work. Is the purpose of your organization clear? Have you asked the key people in your organization what their purpose is? Have you helped them to connect those two purposes?  

Our responsibility 

As practice owners and leaders, we are people developers. Everyone possesses a unique set of gifts, talents, hopes, dreams, and ultimately a life purpose. Unlocking that unique set of internal motivators for everyone on your team is the key to building an abundant future. That future is defined by a transformational mindset rather than a transactional mindset in which power is limited by time, redundancy, compliance, and efficiency.  

Each person motivates themself. Our role as a leader is to help our team members, one at a time, to discover, connect with, and unleash their powerful internal motivators. Then together, as a team, we can channel all of that discretionary energy into a shared mental model with a laser-like focus on the organization’s clearly defined and stated purpose.  

Pina Johnson PCC is a Certified Professional Coach with the International Coach Federation, and as a former practice administrator, she has over 20 years of experience in the dental field. Her coaching strategy and emphasis lie in developing leadership skills and practice cultures that produce peak-performing teams along with increased productivity and profitability. In her private practice, Pina specializes in group coaching. Partnering with Drs. Joel Small and Edwin (Mac) McDonald at Line of Sight Coaching, she coaches many dental teams with great success, resulting in increased employee engagement, reduced stress, improved performance, and enhanced communication. Pina received her professional coaching certification from the University of California, Davis. Upon completing her training, she was invited back to serve in multiple capacities as a UC Davis coaching program faculty member. Pina has been a featured speaker covering topics including, The Neuroscience of Trust, Management Behaviors that Foster Employee Engagement, and How to Talk So Your Staff Will Listen, and Listen So Your Staff Will Talk. 

Pina is a Member of the American Association of Dental Office Managers, Dental Speaking Consulting Network, Dental Entrepreneur Women, International Coach Federation, and the ICF Sacramento Chapter. 

Kelley Brummett, DMD 

Recently, I completed growth conferences with everyone on my team. The beauty of a growth conference is that it’s all about growth. It’s all about effort. It’s all about meeting each other and becoming more aligned with the mission of the practice. If I have something I want to share with a team member that’s a concern or something new I would like them to achieve such as mastery of a new skill, I think about how I’m going to communicate it. And as I do growth conferences with the individuals on my dental team, I am cognizant that they are likely to want to receive feedback differently as individuals.  

I’ve discovered that if I ask my employee upfront how they like to receive feedback, they pause to think before responding. I wait patiently for their response because I know the response will save both of us time and energy. For example, there are some team members who want the short and skinny of it—“Give it to me straight now.” They don’t want you to hold back. There are some team members who need to be gently warmed up before they can hear the message and require thorough explanations of why. 

I’ve discovered it helps to frequently ask the “how do you like feedback” question of my team to get their buy-in of my feedback. The beauty of “feedback” is that even criticism can be framed in a positive way as the next identified step in working towards a goal.  

Those of us in dentistry know that sometimes we move fast, but there are times that we need to sit back, think through what somebody gave us information about, and then come back and have a conversation. Mary Osborne has guided us to have conversations with patients that allow us to slow down and learn more about them so they can think, hear themselves speak, and learn about themselves. I’ve decided the feedback question is also a good question to ask patients. “How do you like to receive information? Would you like to know all the details or for me to summarize?” 

I’ve learned from Mary and experiences with patients that “staying in questions” helps them grow. Staying in questions also helps team members grow. Staying in questions helps us providers grow. So, feedback—how do you give it? How do you like to receive it? How do you handle it? I encourage you to think about this. 

Are You Prepared for Your Next Hiring Challenge?

Most dentists hire during a crisis because a vacancy created for various reasons drives a need to fill a position immediately. This high-stress, time-sensitive situation often undermines the dentist’s ability to hire more strategically and therefore move their practice up to the next level. In other words, dentists tend to re-create the status quo out of desperation, rather than strategically evolve their practice over time based on how they hire and develop team members.  

Understanding what you need and want to create ahead of time (skills and values that are non-negotiable in a person) is key. Hopefully, this article will prompt you to think about this truth as well as prepare for the next hiring challenge. 

Seek These 8 Personality Attributes 

According to Avrom King (and my own experience), there are eight personality attributes that must be predominant within a care team for it to prosper over time: 

1. Optimism: Despite all the craziness in today’s world, team members routinely demonstrate a hopeful and positive attitude toward adversity and others.
2. Involvement: Team members actively pursue problem identification and resolution. They are caring and committed to seeing the practice function at an optimal level.
3. High Self-Regard (not to be confused with high self-esteem): Team members feel competent, capable, and worthy of success. They believe that their lives make a positive difference in this world, and they demonstrate it every day.
4. Missionality: Team members are committed to living clarified personal values. This commitment goes far beyond themselves. They see their life as an integral part of a greater whole and congruent with the mission of the practice.
5. Energetic Curiosity: Team members are stimulated by their curiosity about people, things, and challenges. Consequently, their positive energy is contagious, and their problem-solving ability is high.
6. Resilience: Team members are flexible and able to adapt in a healthy and functional way to routine day-to-day stressors. Consequently, they don’t avoid conflict. Instead, they approach conflict maturely and with the intention of positive resolution.
7. Self-Control: Team members know who they are, where they are, and where they want to go. They also know what they are doing – or are in the process of finding out. In other words, they are effective self-leaders with the ability to delay gratification.
8. Relationship-Oriented: Team members prosper via long-term open, honest, and hidden-agenda-free relationships. Consequently, they’re able to seek out and effectively propagate opportunities for commitment in others through those relationships.

Conduct Behavioral Interviews and Assess Emotional Intelligence 

The bottom line is that our hiring process must be behaviorally sophisticated to predictably assemble a highly symbiotic team of emotionally intelligent individuals. Conduct behavioral interviews and make use of emotional intelligence and personality assessment tests. Behavioral hiring interviews ask candidates questions about how they handled specific situations in the past and the candidates are urged to provide somewhat detailed answers about their role, actions, and results. You may ask how they feel about the experiences and what they learned from them. Knowing what they know now, what would they do differently? Don’t shy away from asking them about their life goals and what appeals to them about working in a dental office. Are they enthusiastic about teamwork and making a difference in the lives of patients?