Leadership vs. Management

Leadership is the key to getting the most out of your most important assets/investments. But what are your most important assets? Equipment, such as a chair or hand piece, is vital to your daily activities. But is it your most vital asset?  Just follow the money.

Equipment is typically a fixed cost, works consistently, and doesn’t get sick—or so we hope. Consider this though—a $1,500,000 practice will likely spend $10,000,000+ in staffing costs over the lifetime of the surgeon! Your team members interact with your customers (patients and referring doctors) and exercise critical thinking to maintain practice operations. Which is easier to replace—a “sick” chair or a sick Surgical Assistant? Your employees are your most important assets and you have given yourself 10,000,000 reasons, if not more, to demonstrate enthusiasm for developmental plans—leading your investment.

Leadership (surgeons and managers) from your practice can lead team members to develop into what the practice needs to achieve your goals.  Far too many practices focus heavily on managing employees, which can be explained as pointing out to the employee what was done wrong or not done at all.  There will always be a need to manage employees, however your focus must be to get out in front of the team and lead them—otherwise why would you spend so much on them?

Leading the team members can be explained as the following:

  • Surgeons and managers leading by example.
  • Providing the big picture so team members can visualize the destination.
  • Hold each team member accountable.
  • Use variety in your style while leading and managing.
  • Give each team member opportunity to succeed.

Change Your View

Let’s start by listing some of the reasons why some tend to avoid performance reviews.

  • “I know when we sit down to go over her performance review she is going to ask for another dollar per hour because it’s been a year since her last review….”
  • “I don’t have time for this.”
  • “I do not know what to tell her.”
  • “It is the same thing every year.”
  • “They don’t take these reviews seriously.”

Do any of those statements sound familiar?  Let’s look at why most performance reviews are destined to fail from the start.  First, the name itself is misleading.  We want performance to improve however we focus on performance reviews.  Reviews are historical.  Could you imagine saying to a patient they did not brush and as a result ended up with a deep cavity then leaving the operatory without telling the patient how you will remedy the problem (extraction) or how they can avoid this problem in the future? That focus on providing solutions or changing future habits is where we start discussing a development plan. A development plan may incorporate some discussion about the team member’s historical performance, however the lion’s share of the conversation will be about future growth, development and challenges.  Second, performance reviews are typically inconsistent or non-existent.  Lastly, performance reviews are not consistently tied to compensation. The good news is we can fix all of this.

Before you proceed with performance reviews, you need to answer two important questions.  Does the employee have a copy of the job description for their position in your practice?  And, does the employee have a copy of their performance review (ideally a development plan) that was delivered within the past year?  If you answered no to either of these questions it is likely the employee is not going to meet or exceed your expectations unless one of their capabilities is clairvoyance. The job description should be both the goal and the guide for your team member. Let’s consider a Surgical Assistant who has one year of experience in your office and came to your office with one year of general dental assisting experience as an example.  He/she should have in her possession a job description that paints the picture of the key, right hand assistant in your office.  The Surgical Assistant’s objective is to focus on continually improving and ideally becoming a lead assistant over time.  That progress will depend on his/her personal commitment to moving ahead, on the job training, learning while off the clock, the guidance/feedback they receive from you as well as the passing of time which should equate to their experience.

Job Descriptions

As mentioned earlier, your team members need job descriptions that reflect the needs of your practice. A Surgical Assistant in one practice may only be allowed to take x-rays, sterilize instruments, prepare a room for patient appointments and escort patients to and from the reception area.  In another practice a Surgical Assistant may be responsible for all the aforementioned responsibilities as well as implant treatment acceptance rates, inventory, working with vendors/reps, working with referring offices, other team member’s development and more.  A generic job description is equal to telling someone you want to go on a Caribbean vacation but not as specific as saying you want to go shark diving off San Salvador Island in the Bahamas over the Thanksgiving holiday.  Your team members need specific destinations that they can visualize.

You need several job descriptions for the positions in your practice.  And those job descriptions must be specific enough to provide an accurate road map of your expectations.  Below is a list of positions that would require different job descriptions:

  • Sterilization Technician
  • Surgical Assistant
  • Lead Surgical Assistant
  • Implant Treatment Coordinator
  • Receptionist/Patient Coordinator
  • Scheduling Coordinator
  • Financial Coordinator
  • Insurance Coordinator
  • Practice Liaison (Marketing)
  • Office Manager
  • Administrator

One of the most important points you should take from this article is the need to address soft skills in addition to technical skills for each person.  Most every job description and performance review I’ve seen concentrates on technical skills.  You definitely need team members who are proficient with key technical skills just so you can provide surgical services to patients; however, soft skills are the collection of skills that separate adequate employees from phenomenal team members.  Have you ever found yourself in a tough spot with an employee that is a great chairside assistant but they have a poor attitude or poor work ethic?  That is the dilemma surgeons find themselves in every day.  Technical skills can be taught.  Soft skills can be developed, however those soft skills are completely in the hands of the team member.  Your role is to create the expectations for both technical skills and soft skills.  Some (but not all) of the soft skills that routinely need to be improved or polished are:

  • Teamwork
  • Adaptability
  • Resourcefulness
  • Customer centered
  • Energy
  • Listening

A team member who is very capable with technical skills but does not possess the six soft skills above is unlikely to be a star in your practice.  Keep in mind, clairvoyance is not a technical or soft skill.  If you want the performance to improve, you must make the expectations specific and clear to the team member.

Developmental Plans

Once job descriptions and expectations are communicated, it is important to maintain routine feedback regarding the team member’s performance and progress.  The definition of routine feedback will depend on what each team member needs.  Newer team members will definitely need feedback weekly and monthly to ensure they are on track to meet or exceed your expectations.  A new team member joining your office with little to no surgical office experience will require approximately one year of on the job experience and feedback to become an integral part of your practice.  It will take another year to develop their proficiency and confidence to the point they are capable of working independently and can even be a resource to others.

Team members with 2+ years of experience still need annual performance reviews and routine feedback.  And this brings us back to one of the reasons why we avoid performance reviews.  The team member may want more money.  Wanting more money is perfectly acceptable if it has been earned.  Cost of living increases are typically .5% to 3%.  A 3% cost of living increase for a $18 per hour employee is 54 cents.  Those cost of living adjustments are really there for the team members with longevity.  There is definitely merit to giving team member’s more money purely for loyalty, however that loyalty should not be a factor that significantly outweighs skills.  Merit based increases is the place where everyone is happy.  Once a team member demonstrates new capabilities with technical and/or soft skill sets, they would be eligible for a merit increase.  Team members are typically happier with merit increases because the increase is larger.  Surgeons are typically happier with giving merit increases because the team member has grown and has new capabilities that will further the practice.  A team member could technically move from $15 per hour as an entry level position to over $20 per hour in a few years IF they choose to apply themselves and demonstrate proficiency with new skills.  Of course these pay rates are examples and vary greatly around the country.

Follow Through

Follow through is a two-way street.  As has already been pointed out earlier in this article, you need to provide specific job descriptions.  Once the team member knows the destination they are responsible for owning their future progress.  Learning and doing are the key elements to progress.   Team members have options when it comes to how they learn and they should exhaust all their options.  On the job training, learning while on their lunch break or at home, working with a designated trainer in your office, reading information on your website, and listening to online tutorials are a great place to start.  And here is a crazy thought, those smart phones that most folks can’t put down can be used for learning as well!  A team member’s ownership of their learning and progress should be commensurate with their pay rate.  This puts you in the position of “if you want more, you have to earn it.”

You will need to meet with your team members routinely or at least check in on their progress periodically.  They need to know you are serious about their progress, they need to know you are holding them accountable and that you or someone else there is a resource if needed.  As an owner/surgeon you need to create a 50/50 relationship with your team members where you create high expectations of each individual yet stand at the ready to lead and support as needed.  Their part is to minimally meet your expectations and provide value for their compensation.  I liken this to Nick Saban creating very high expectations for his team and retaining only the players that will take Alabama to the championship.

The Big Why

Employee compensation is part of your overhead and even I work with clients to reduce this overhead category.  However, there are a few factors that cannot be calculated when looking at your income statement.  Underperforming employees or employees that are not at their potential will cost you production and collections and that increases your overhead.  These employees can also cause increased stress on yourself and others, they can cause great employees to leave, they can cost you referral sources and turnover itself is very expensive.  Think of the opportunity cost to your practice.

Imagine if those resources spent on turnover were spent on growing and/or refining your practice!  If each team member is viewed as an asset that not only does their job per their job description but because of their soft skills, they leverage each surgeon and become part of your marketing team on a daily basis. Consistently exceeding your patients’ and referrals’ expectations will be done by your team because there is only so much of you to go around.

To keep overhead at a minimum, maintain low stress and create a practice with a wildly popular reputation you will need to:

  • Invest in your most valuable assets.
  • Create a destination with a job description tailored for your practice.
  • Provide routine feedback.
  • Be the leader more than you are a manager.

Invest the time and effort into developing more leaders within your practice to leverage yourself and leverage your future.

Posted with permission from the American Association of Oral and Faxillofacial Surgery (AAOMS) © 2018. Copying any portion of this material is not permitted without the express written permission of AAOMS.