The workplace, family and marriage are often greatly impacted by our ability to provide consistent feedback to people we interact with on a daily basis. It can impact the work performance of our employees and the quality of our relationships at home. As a consultant, I interview many employees across the state where I consistently hear a desire for meaningful feedback from their employer and a desire for stronger relationships. Considering the average dental office spends 25% to 35% of their revenue on employees we would do well to become students in the art and skill of effective feedback. It affects every area of our lives. As father of six children I can vividly remember times where I missed the target in an effort to provide meaningful "feedback" to one of my children or even worse my wife of 44 years. Feedback can come in many different forms which can be either subjective/objective or destructive/constructive and be heard quite differently than we intended! At the School of Dentistry we all remember reviews that brought either exhilaration or disappointment. The learning process must be woven with encouragement and constructive correction. A great resource for assessment of employee engagement is Gallup’s Qr2 Survey. “Twelve important questions to engage employees.” These principles apply as we develop employees or teach students. This will help you understand where your employees line up with engagement in your office. It will also give you a hint of your return on investment in staff salaries. A fully engaged and energized staff member will make a great contribution to office growth.
Will you improve the art and skill of how you provide feedback to your team? Major studies indicate the lack of employee engagement exists across the workforce (Gallup). Investment in this area could provide immense financial and job satisfaction for all involved. Let’s start with a simple self-assessment of ourselves! Have you developed a process for conversational feedback when engaging your team members or is it shot from the hip? Would you start a complex treatment plan without a plan? As doctors we often overlook our role of developing others on our team, this requires reflective time to make a plan of communication coupled with metrics the employee understands are their responsibility. Think back over the past few months and evaluate your ability to provide feedback in the development of your team. Has it been effective in bringing about the desired change or rewarding exceptional performance? I am including two references for your development. Warning! Feedback and employee development is often avoided, or procrastinated because it is uncomfortable, or the skills were never developed because you are just too busy in the dental chair and your office manager has not acquired the effective feedback skills.
Following are some tips to strengthen your feedback system to enhance a thriving culture and growing employees.
As employees grow your organization grows, take the time to invest in these critical skills, no less important than our endodontic or restorative skills “I believe that everyone is a leader at some point in time, we have a choice how well we lead.”
Building a relationship the first step
1) Telling someone something is not the first step in feedback. The Gallup survey reveals employees want to know the boss or management cares about them and takes time to listen to them. When this takes place it opens the door to receive feedback.
Making regular deposits in the brain bank is critical
2) I like the model of depositing “positive feedback-appreciation and affirmation” regarding an employee performance, like a bank account. When critical feedback is needed, which I call a withdrawal, you have built up deposits in the account for the withdrawal to take place. If you find it impossible to make positive deposits it may be time for the employee to be on probation or dismissed.
A multi-lingual mind set is required
3) Become multi-lingual, by this I mean understand that we all have different communication styles. We often have to speak the language of the employee we are engaging. I often have a dominant boss come to me saying, "Jim, I don't understand I provide feedback and my employee starts to cry or get angry, I just tell it like it is." The employer often does not realize they are perceived as being rude, cold and ineffective in empowering their team member. Two great tools to improve our multi-lingual skills are the DiSC instrument and the Strength Finders. I use one or both of these with all of my clients. Understanding our own language and that of the people we are evaluating or developing can be a major factor in our effectiveness. Acquiring and applying these skills can take your practice to the next level!
Develop a feedback toolbox for diversified situations
4) Feedback can range from simple affirmation such as saying, "great Schedule!" or, "you were really organized for the complex procedure". Affirmation of individuals is tremendously underutilized, yet it is a powerful transformer of attitudes. A recent comment from a doctor, “Why should I have to affirm them, that's what I pay them to do?” The absence of affirmation impacts an organization and the quality of service and employee retention. The most effective feedback is conversational directed with the individual not at the person. Having the skill to create an interactive conversation is most valuable. Often we fail to define clear metrics that indicate the objective quality of the employee performance. These should be written, clearly defined and objective. Feedback can be simply verbal or include a written report and scheduled meeting. One size does not fit all. The leader must have the knowledge and discernment to differentiate poor performance or have you failed to train and equip the individual to do the job or acquire the skill?
What gets measured and reviewed gets attention
5) Feedback with metrics requires further planning, conversation and understanding. The School of Dentistry has many metrics in place and is in continuous pursuit of calibration of multiple faculties providing consistent feedback to students. Calibration without a mentoring relationship will short circuit the learning process at schools and offices. The most effective learning and growth takes place when clear metrics, healthy communication and dialogue are in place. Both parts of your brain (ANALYTIC +RELATIONSHIPS) need to be engaged for maximum learning to take place.
Establish a time and place for important feedback
6) Selection of time and place are important components of creating an atmosphere to provide meaningful feedback. A common statement I hear from many employees, "It's been 3 years since I have had feedback or a review, I really feel devalued. It's always going to be in a few weeks.” It makes a statement to the employee or family member. “I am important because time is being given to me and someone is listening to me in a conversation.” Time and listening are two great tools for meaningful dialogue.
Dentistry in the 21st century requires more than dental skills
7) We are often expecting change when giving feedback for growth and improvement, but without planning and developing our own skills we fall short of our expected out come. A skilled leader and communicator will develop a personal feedback style that recognizes both excellence in performance and addresses standards that do not meet the core values and expectations of your organization. We cannot relinquish the important development of this Art and Skill of Feedback in our home or office. It requires multiple factors to be in alignment: time, planning, dialogue, understanding of the multi lingual nature of relationships and clarity of the topic being addressed. This will lead to mastery of a powerful feedback system. It shuts down the commonly used system of accuse and defend often leading to frustration and confusion between doctor and employee.
Where Do I start?
I have provided several references for your reading in addition to a complimentary telephone conversation on this topic. Acquiring a coach, taking courses and reading on the development of people are all ways to grow. Take the time to develop this skill set to enhance your leadership and growth in your practice and life. It will lead to growth of everyone around you. “Leaders become great not because of their power, but because of their ability to empower others”
Is Your Feedback Effective?
Dr. James R. Schroeder practiced dentistry in Richmond and is the founder of Leadership by Design. If you have any questions or would like help implementing a change in your office, contact Dr. Jim Schroeder at 804-897-5900. email@example.com.
 GALLUP, October 8, 2013 “Worldwide, 13% of Employees are Engaged to Work” by Steve Crabtree  IF YOU WILL LEAD-Enduring Wisdom for 21st Century Leaders, by Doug Moran ISBN: 978-1-932841-58-9  THE FIVE LEVELS OF LEADERSHIP, Proven Steps to Maximize by John Maxwell, page 9 ISBN: 978-1-59995-365-6
It is truly a dynamic stage of life in our dental profession with many implications for us as individual practitioners. Currently I have the unique opportunity to work with young graduates entering the world of dental practice, coaching established practices making decisions to strengthen their practice and the senior group of dentists contemplating their exit strategy. Each of these groups has different needs but they all share the common denominator of entering the road of the unknown. Skills and tools required for successful decision making go far beyond those acquired in our professional training. Hopefully you have read the excellent information provided by the VDA leadership that the changing landscape of our profession will impact all of us in different ways depending on our stage in the life cycle of our profession.
Regardless of the stage of your career, the knowledge base for decision-making has increased dramatically. How does one begin to understand the new tool box necessary to navigate the storm taking place in the health care profession? We start with our own self-assessment of our skill and knowledge base outside dentistry.
Allow me to share a recent experience with two dental students to illustrate a critical skill needed to begin planning and developing our personal tool box. Student A comes to me with a vigorous complaint that all of his patients are lousy and everyone cancels their appointment! Student B presents to me that he has too many patients and they all want to come in as soon as possible! This story has great implications for each of us to examine how we draw conclusions and make strategies to move forward in our practice.
Student A drew the conclusion that his patients were at fault. Although we are all taught self-assessment in our technical skills, rarely are we engaged in the self-assessment of our leadership, communication and ability to navigate our changing environment. My challenge to Student A was examining his communication and ability to build effective relationships and value with his patients. We have a billion dollar industry competing for our patient’s time and money. Student B invested considerable time in development of his patient relationships and recognized delivering information does not guarantee patient understanding and ownership of the information. Unless understanding has been created communication did not occur.
How does this story apply to our own practice situations?
Self -Assessment is an important part of our development as a professional. Understanding our leadership style and decision-making process is often overlooked leaving blind spots that your staffs, partners or family are reluctant to point out. Unintended negative consequences of our decisions are often overlooked and are a hindrance to practice growth. Regardless of your stage of professional growth I encourage you to be a life-long learner in development of your leadership skills. Failure to understand the development of this important skill will be the rate limiting factor in the growth of you practice and professional development. The Truth about Leadership by James M. Kouzes and Barry Z. Posner highlight ten principles:
1) You make a difference 2) Creditability is the foundation of leadership 3) Values drive commitment 4) Focusing on the future sets leaders apart 5) You can’t do it alone 6) Trust Rules 7) Challenge is the Crucible for Greatness 8) You either lead by example or you don’t lead at all
9) The best leaders are the best learners 10) Leadership is an affair of the heart
A colleague asked me “Jim what does any of the above have to do with dentistry?” My explanation was we work so hard doing dentistry and the technical aspects that our glasses fail to see beyond the mouth. This is a very dangerous condition as we are unable to see the change taking place around us and the impact it will have on our practice. Just a few examples are:
a. Blindly signing on as a provider with all insurance programs without understanding the financial and quality implications on your practice. b. Corporate dentistry and government are impacting the delivery of health care. c. The experience your patient encounters will be greatly impacted not only by your dentistry but by your ability to develop your staff. d. Future associate needs are changing as we see the class make-up of 55 % female with a growing debt upon graduation ranging from $150,000 -$250,000. Failure to understand and vet a new associate’s expectations and clarify your expectations can trigger a tremendous storm. e. Careful examination of your employee handbook to assure compliance with the ever changing labor law. f. Compliance with HPPA and OSHA. g. Regular and careful data analysis of both the expense and revenue side of your business. From that data analysis make targeted strategies to impact the metrics you want to change.
Your approach to increasing your income may center on expense reduction which can also have unintended negative consequences of poor service and low morale. Cost reduction alone will not lead to prosperity. Innovative strategies must be developed with your team to increase revenue. This can be an opportunity to move outside your comfort zone and acquire new skills.
The resources I am suggesting in this article have nothing to do your technical skills but, everything to do with your professional and practice development. At 65 years old and 30 plus years in practice I would be so bold as to say they will be the rate limiting factor to the growth of your practice.
Regardless of your current practice status I encourage you and your team to do a book study over the next month. "Our Iceberg is Melting” by John Kotter or understanding change is another tool necessary to navigate our current environment. I always found change within the dental team exciting but challenging. As a leader your understanding of change is important to be effective and lasting.
Planning and execution on a daily basis is a requirement and usually a strength for a successful dental practice, often it is so consuming we fail to take the time to plan for next year in the area of growth, examination of accurate data to make decisions on strategies that will ensure continued success. The inability to execute a desired plan often leaves us scratching our head when we realize we are in the same place as last year.
I am encouraging you to examine your glasses to assure your sight may include the immediate care of your patients, but the swirl of external forces exerting pressure on our profession and your practice. Critical areas for your growth and understanding to respond to this external swirl of pressures are self-assessment, leadership, planning and execution.
Please contact my office for a free personal profile to start your own self-assessment and leadership development. Help your staff develop through your book study.
I have also seen creative and innovative responses that have resulted in a significant growth in office production as well as severe declines which resulted in the reduction of staff and/or poor office productivity. As dentists our creative focus is often in the clinical area of patient care. Our response to the ever changing external forces such as insurance carriers or the economy is often passive or even exhibits a victim mentality. In today’s ever changing environment we cannot afford the either choice, particularly the latter one.
Although there are many ways to ramp up your office productivity factor, today I will discuss your leadership role in the intentional development of a thriving office culture. Often we do not have the eyes to see what is limiting our practice growth because it seems totally unrelated to our dental expertise. When we hire an individual for a clinical position we are very fastidious about proper training in procedures, sterilization and equipment utilization. Administrative positions receive training in the different systems such as insurance, calendar/appointment book control and the recall system.
Unfortunately, we often overlook the development of the high behavioral and attitude standards which should be expected in all patient and co-worker relationships. We allow the new employee to bring their behavior and attitude from home, off the street or from previous places of work. This is like playing Russian roulette. You may be fortunate or skilled in selecting the right individual for the position but great cultures are not developed by accident just as beautiful smiles are not created by chance. All the external marketing can be short circuited unless we have an exceptional internal culture receiving new patients. For example, the manner in which the phone is answered is an important byproduct of an office culture and requires intense scripted training.
Behaviors and attitudes are developed outside the office often are not acceptable in a culture of service to each other and to the patient. And, there is often a certain arrogance exhibited by professionals that implies, “I don’t have a problem in this area,” or they download it to an office manager providing little leadership or expectations. More often than not the office manager is well intentioned, but ill- equipped to carry out the critical responsibility that will ultimately be a major factor in the growth of the professional practice. When providing an introduction to a new employee, I was explaining that our culture was built on serving both each other and our patients. Later that day an older employee came to me and shared that the newcomer had said, “What’s Dr. Schroeder talking about, this serving each other stuff? I never served anybody.”
Fortunately, she was teachable, and we helped her develop into a great staff member. This did not happen without teaching, training and modeling over a period of time along with a few difficult conversations which held her accountable. In medical and dental offices that I work with as a consultant, I often find the doctor ignores unacceptable behaviors and attitudes and thus allowing the lowest denominator to set the office cultural standard. This pattern fuels poor behavior from all staff members. With that cycle of behavior, patients experience poor service and leave the practice, or they do not rave about you in the community. And this is an important way in which office culture impacts the bottom line. In surveying patients, the number one reason they tell other people in the community about your office is, “I experienced great and gracious service throughout the office!” I am not discounting the importance of excellent dentistry, but very few people refer friends based solely on the excellent technical service which they received.
Great office cultures attract great employees! When we take time to clearly identify appropriate attitudes and standards of behavior, and we hold employees accountable, great things happen. Clarity of expectations, alignment and equipping our people to meet our expectations, followed by execution and accountability yield amazing results.
In all the different businesses I consult with, I always interview the employees. The top employees often express the desire to me, “Please help him/her be a leader and address the difficult/low performing people that are preventing the business from reaching its full potential.” Often the people I work with have many years of education and letters after their name but they have never acquired the skills and confidence to execute this part of their business.
Another area of culture development which is often not addressed is the differences encountered between generational gaps. Upbringing, work ethic, values, communication styles all impact teamwork. Co-workers will either clash or they will become a well-oiled machine (with respect for their differences) largely depending on the strength of the investment in teamwork and in the modeling that you provide.
Behaviors and attitudes play an important part in the growth of your practice and consequently in your bottom line. The culture of your office also plays a critical role in the enjoyment of your day. It cannot be measured on a spreadsheet, but it is woven throughout the areas of productivity, new patients and profitability. There is not much you can do about changes of the economy, but there is a tremendous amount you can do in the development of your office culture. It is the platform upon which everything is delivered. Whether your office is thriving or struggling in this area can greatly affect the return on your investment.
When was the last time you made an investment of time, fresh energy or had a conversation on growth and development of your office culture? Is the time now?
Dr. Jim Schroeder is the Founder of Leadership by Design. He has been writing about leadership and organizational growth for over 30 years.
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