Orthodontic personnel principles

Dr. James Morris Reynolds offers some wise counsel on assembling an effective office team

Over the years I have asked both the staff members and the doctors to complete the questionnaire that is shown in Figure 1. To many readers, this may look vaguely familiar, or at least the questions presented may represent any number of thoughts that have arisen when, on that rare occasion, the boss really pauses to wonder, How am I doing as an employer/leader in my office?

Often what the staff member is thinking and what the doctor thinks he/she is thinking may be oceans apart. This may be compared to an interesting situation that I have encountered a number of times when I have asked members of my team to write, in their own words, their job description. Often two people whom I consider to have the same job have two very different pictures of positions, and I may have a third perception of basically the identical list of duties. One staff member will write briefly in perhaps two paragraphs his/her understanding of her duties, and the other may take two-and-ahalf pages to describe in minute detail a job I didn’t know existed!

So what has been the picture that has evolved from this interesting exercise? Over 8,000 staff personnel have been kind enough to participate along with far fewer orthodontists. After studying a few hundred entries, it became uncanny. I could look first at the area of their duties, and I could almost know the order of their concerns. Then for others, I would look at the age group they represented and could make a fairly accurate guess as to what their needs or desires were.

So let us examine the survey answers, and see if they help us better understand one another.

Business office personnel
This group ordinarily consists of older (or more mature as they would categorize their elite status) team members, and they have mixed interests. In the past, the only way to learn this task was through experience. However, recently the development of computer software programs offer structured guidelines that make the learning of this job much easier.

Business office personnel should reflect integrity, have a solid and sympathetic outlook, and an understanding of the parents’ dilemma of balancing the household budget. The concerns of business office personnel regardless of age turned out to be:

• Appreciation of a job well done
• Heath coverage

Almost all of these people 35 years and older cherished “a sympathetic understanding of personal problems.”

Single parents make up a large percentage in this group and often have children to raise, a tight personal budget, or aging parents to care for. They need an employer to listen and help with special problems.

If you hear, “Doctor, do you have a minute?” Believe me, doctor; you had better take the time. You have an opportunity to build loyalty and respect, so don’t blow it!

Laboratory personnel
These people represent a neglected but important group. Often doctors will assign the laboratory task to an experienced staff member because they presume he/she understands the function and importance of all the products that come from this beehive of activity.

Ordinarily introverts settle into this area comfortably, and they have pride in their production. You need to leave them and their work alone as far as feasible. Usually quieter, conservative, and more exacting people thrive in this position. A happy-golucky “people” person will go nuts in this job.

How do you find a round peg for this round hole? First, these people must have good digital dexterity, and they will often have a high level of neatness and structure about them. Nevertheless, the survey gives us real clues to keeping these people happy and productive. Laboratory personnel often require or need:

• More challenging assignments. This is always high on their list, and once they know their jobs and routinely achieve the near perfection they require, they may become bored. Combat this boredom by giving them other assignments or arranging professional learning opportunities outside of the office.
• Lab technicians have a high need of the doctor’s appreciation for a job well done.
• They usually like their jobs, and they look for security, stable work environments, and predictable, systematic pay increases.

Please don’t expect the happy-go-lucky, extroverted “people” person to last long or be happy with this job.

Reception personnel
We often find a variety of personalities that teem with contradictions in this area. But what kind of people should we look for? Certainly we want happy, warm people. They should give attention to detail, but the bubbly personality that thrives on people contact often lacks this trait. This job attracts people from every age group, so the task is not defined by age.

The addition of good computer software has made this job much easier to teach and to learn, which allows people with little or no experience to perform adequately. Nevertheless, the tasks are not as easy as they may appear. A new receptionist will benefit greatly by having careful scripts that cover a myriad of situations that arrive by phone or in person.

“But my child goes to school.” The receptionist must resist the temptation to respond, “Big deal! Your little dimpled darling is the only patient we have that goes to school.”

This position requires quick thinking as well as being a good listener. Carefully crafted scripts can help new receptionists overcome many obstacles. Should there be an overlap of tenure between the departing and the new receptionist, many questions and answers will naturally occur as situations arise. Nevertheless, we may sometimes face a crisis from an immediate departure due to illness, accident, elopement, or heaven knows what. These situations require scripts, so the new receptionist leaves nothing to chance.

Develop a “cue card” for every imaginable situation and try to cover all possible situations that could arise such as:

• The demanding patient or parent
• The whiner who asks for special consideration
• The chronic appointment no-show or frequent appointment changer
• A demanding spouse who interrupts the appointment routine and requires unusual tact and diplomacy

An office policy manual should offer enough clarity for every team member to understand and cover as many situations as possible.

The most cited concern in the survey for these personnel was the doctor’s appreciation of a job well done, followed by having a voice in office policies. Policy decisions need the input of all of the staff — at least request input, and then consider it.

Chairside personnel
This is the largest and most diverse group represented in the survey. Ages of these personnel range from 18-year-olds to grandparents. The entry-level remains fairly easy for the inexperienced since most doctors are willing to assume the challenge of training neophytes.

All offices have examples of “on-the-job” training. Some show the results of thoughtful, thorough training while the sloppy, hurried offices will reflect attitudes of “watch, wait, and hope for the best.”

Frequent turnover is a problem at this position, and the least experienced person will often list “a voice in office policy” as a concern. After all, doesn’t a college freshman know better how to run the university?
Systematic training of chairside assistants must be constant and consistent. New chairside hires should be evaluated by every staff member after the first, second, and eighth week for characteristics such as:

• Team cooperation
• Empathy for patients
• Promptness
• Competence

A questionnaire for the trainee for the “doctor’s eyes only” often provides an eyeopener for the doctor and a clue for possible incompatibility in the future. This private questionnaire should have inquiries such as:

• Which of the staff is the most helpful?
• Which of the staff gives the clearest instructions?
• Which of the staff is the least helpful?

Survey exit
One final question of the survey asks the size city in which the interviewee grew up. Generally speaking, people from smaller cities change jobs the least. One of the best chairside assistants I ever had came from a small town, and she lived on a ranch with four older brothers and two younger sisters. She played high school basketball and was a second-team all-state guard. In a nutshell, she had her share of chores to do on the ranch. She learned to share responsibilities with her siblings (teamwork), and she had good eye-hand coordination and quickness from her sports training. When I interviewed her after some testing, I asked her, “Do you think you have good hands?” She replied, “Yes, I think so.” I flipped a ballpoint pen at her. She never stopped looking at me in the eye, caught the pen, and flipped it back to me. I dropped it.

When an employee asks, “Doctor, do you have a minute?” Take the time. Be a good listener because it will pay dividends.

Age grouping
What difference does the age of the staff make in how they respond to the questionnaire? First, let’s look at some of the common concerns of all ages:

• Health coverage is now a must.
• Appreciation of a job well done.
• Understanding of personal problems.

Surprisingly, some of the following seemed less important:

• Systematic pay increases.
• Union or professional recognition.
• Shorter working hours.
• Extra benefits were appreciated and were usually a welcome surprise, but they were seldom high on the list
• Although union or professional recognition seldom ranked high, those with the longest tenure esteemed it the most.

Those with the longest tenure had the most diversity in their responses. They understand the scale of compensation and know that the job pays what they receive, and it isn’t likely to change much.

Business office personnel should reflect integrity, have a solid and sympathetic outlook, and an understanding of the parents’ dilemma of balancing the household budget.

Compensation schedules should be spelled out. Clearly, this job will pay this much, and there will be no annual raises. One friend started automatic annual raises, and three employees were receiving salaries almost equal to the doctor after 20 years. Such a policy may guarantee experienced people, but they may be like the person who says, “I have 15 years of experience,” when she may have had only 1 year of experience 15 times.

Quality assessment by a semiannual or annual evaluation should be the sole criterion for a salary increase with the possible exception of cost-of-living increases for the entire staff. Generally, common sense should prevail regarding compensations. Achieving a harmonious and successful orthodontic team requires an appreciation of one another’s needs, and compensation should be commensurate with the value of the contribution to team goals.

The high ranking of “sympathetic understanding of personal problems” should not come as a surprise. Single parents, divorcees, aging or ill parents, and children in trouble require the understanding and occasional listening by the doctor to show sympathy, concern, and help.

Ronald Shapiro, co-author of the fascinating book, The Power of Nice, illustrates this point with a story, which I will paraphrase:

A valued employee appeared at the door and asked her employer if he had a minute. She then said she needed a raise. He, rather surprised, responded with, “You just received a raise 3 months ago, and I’m afraid I can’t afford another right now. She was crestfallen. He then asked, “Tell me, really, why are you here, and why do you need another salary increase?” Then the truth came out. Her daughter had been accepted to a prestigious school, and she couldn’t afford the tuition on her present salary. As a result of her asking, the employer took the time to make inquiries and found a scholarship that solved the problem. He, by caring and asking for the real reason, helped her with a personal problem that kept the employee happy, and the boss was able to keep the office budget under control.

When an employee asks, “Doctor, do you have a minute?” Take the time. Be a good listener because it will pay dividends.

Summary
This analysis of the survey contributions probably reflects many of my personal biases. Nevertheless, after practicing for many decades, I’ve had as many wonderful co-workers as anyone, and I feel qualified to have opinions based on virtually every conceivable office experience. Doctors must realize that not every employee intends to make a long-term career with the orthodontic team. Some come as temporary employees and then stay — loving the chance to work with delightful patients and congenial colleagues. Others have interests outside of orthodontics. Doctors should not resent change. Every change has its own advantages, and a good orthodontic team should be considered a journey rather than a destination. It is always a work in progress.