Perfecting Your Team

By Dana C. Ackley, Ph.D. Originally published by ACT Dental.

No dentist practices alone. At minimum, you probably employ an assistant, hygienist, and receptionist. Many of you have multiple people in those roles, as well as an office administrator and perhaps a finance person. You also may work with other dentists. Your profitability, your patients' comfort, and your own pleasure in your practice are tied directly to how well you and all of your staff operate as a team.

So, how is your team doing? Do any of these comments sound familiar?

  • "We keep 'solving' the same problems over and over again."

  • "We often run out of materials despite having set up a 'foolproof' system of when to re-order."

  • "I can't get my staff to show up on time."

  • "My staff bicker and argue over nothing. It makes my stomach hurt. I wonder what my patients think."

Teams with these and other kinds of problems often suffer from difficulties in their psychological infrastructure. I am not suggesting that team members have psychological problems, but rather the team has not established a shared infrastructure to govern the ways that members relate to each other. The answer, therefore, is not to fix individuals. Just as most occlusal problems involve the interaction of several factors, team problems are usually based in interpersonal interactions. The path to team success is to adjust the interactions.

Let's explore a model of teams that will give you ways to solve these kinds of problems. By the way, don't feel alone. The vast majority of dentists have not been trained how to create and maintain a high performing team. Therefore, many dentists suffer the same problems that your team does.

Five Essential Behaviors of a Team

Five sets of behaviors set strong teams apart from those teams that erode profits and patient satisfaction. Picture a pyramid with five levels. Each level builds on the one below.

Trust: The foundation level of all good teams is trust. As you read those words, and nod, you are probably considering whether you trust your team mates. This is an important question but slightly misses the main issue of team trust. Rather than focus on others, members of high performance teams ask themselves "Am I behaving in a trustable manner?" In other words, each team member puts the focus of this question on themselves.

The kind of trust that builds teams involves each person's willingness to give up the pretense of perfection. Team members must be willing to acknowledge and be open about their mistakes and weaknesses. The need to be perfect causes us to lie to each other (and ourselves) because we fear attack for our weaknesses. When team members fear attack from co-workers, as evidenced by bickering and blaming, communication is impaired. No one has the right information. The team is hampered from being able to correct errors and shortcomings that are always a part of human life.

As leader, to contribute to the creation of trust, you can do two things.

  • Give up your own need to be perfect or invulnerable. Be willing to admit to flaws and mistakes in behaviors that affect what the team is trying to get done. If you have trouble selling dentistry, as many dentists do, acknowledge it to your team. They probably already know it and will admire your candor.

  • Be psychologically trustable. Accept other's flaws. This does not mean that you overlook mistakes. Rather, when wrong things happen, help the team member(s) grow needed skills. Or, since all people have some flaws that cannot be overcome, you may choose to create team strategies to compensate for such shortcomings. In other words, decide that mistakes create a teaching opportunity, not an opportunity for you to indulge your frustration.

Conflict: The second level of the team pyramid is the ability to engage in constructive, unfiltered, passionate debate about ideas. Constructive conflict is not about personalities or motives. It is about ideas, policies, procedures etc. Members of great teams discuss and debate, often with great energy, ways to best serve the business purposes of the entire team. Every team member has a stake in the welfare of the practice. It is to everyone's benefit to engage in conflict that leads to the very best ideas and ways of doing things.

Constructive conflict is impossible without trust among team members. Only when team members can know that their colleagues are not working to get "one up" can they take the risks of trying out ideas and challenging others.

To have constructive conflict on your team:

  • Encourage the team to openly and passionately disagree with others' ideas. Model this behavior yourself in a spirited yet respectful way.

  • Do not allow disagreements to become personal, i.e., about motives or personalities. For example, if your receptionist does not fill a hole in your schedule, do not imply that she is lazy (or stupid) even though those thoughts may pass through your mind. Talk with her about the procedures you want her to follow for filling your schedule. Inquire about factors that may interfere with her compliance with your request.

  • Likewise, when there are conflicts between members of your staff, require that they discuss their differences in terms of ideas rather than personalities.

  • Do not engage in triangulated communication. This means that you don't listen to Mary complain about Sue. Rather you insist that Mary talk directly to Sue about her concerns. (You may or may not choose to facilitate their discussion as long as you don't get yourself trapped into taking sides.)

Commitment: The third level of the team pyramid is commitment - commitment to a common purpose - such as your vision and mission, as well as agreed upon strategies and tactics to achieve your vision. You can tell if your team is having trouble with commitment if agreements are not kept. In other words, do you find that staff members agree to do things in a certain way during team meetings, but later, people don't follow through.

Why does this happen? Unkept agreements usually mean that, during the decision-making/planning phase, team mates did not air their differences. In other words, there was insufficient conflict. Insufficient conflict is common because most people avoid conflict. One reason is that it can get personal and thus hurtful. Another is that people fear loss of control. So they pretend to agree while planning to do things their own way later on.

To overcome this barrier to a great team, recognize that, actually, most mature people don't always need to get their way. They just need to be heard and respected. Once their ideas have been seriously considered, most folks are willing to go along with another decision if necessary.

To create commitment on your team, people must know what they are committing to. Beyond day to day agreements about procedures, every team needs an identified mission, a vision of an exciting future, and how the team will move itself towards these goals. Procedures and other day to day decisions will flow from this foundation. Creating the foundation requires an investment of time, which will be saved many times over as staff work cooperatively and in alignment with the vision and each other.

What can you, as team leader, do to help create commitment?

  • Discover and articulate the vision of your desired practice in broad terms. Great dentists, who lead great teams, will find ways to involve team members in creating the vision within broad parameters set by the dentist. Team ownership of the vision builds commitment.

  • Help each team member determine whether the vision is one they can embrace. It not, they must leave the team for their own sake as well as the team's. This is not personal. Everyone has a right to their preferences.

  • Work with remaining team members to determine the best strategies and tactics to achieve the vision.

Accountability: Accountability is essential to great teams. On high performing teams, accountability works a little differently than you might guess. Accountability is not just to leaders. All team members are accountable to all other team members with regard to how well they work towards team goals. Thus, on great teams, you will witness every team member confronting every other team member for behaviors that run counter to commitments and agreements.

For example, suppose that everyone on the team agrees to "sell dentistry" at every opportunity. The receptionist notices that the hygienist did not mention the new whitening process that recently had been put in place to her last several patients. The receptionist reminds the hygienist about the agreement to sell dentistry and points out how opportunities were missed. The hygienist, on a great team, will not resent the receptionist's comment. Rather she will say to herself "She is telling me this for the good of the team. I did forget and this reminder will help me remember in the future."

Accountability cannot develop without firm and joint commitment to vision, strategies, procedures and processes. Otherwise, no one really knows what they have committed to.

To build accountability in your practice:

  • Encourage team members to confront off task behavior. Comments must be about the behavior, not the person.

    • Good: "You forgot to tell Mrs. Jones about our new whitening service."

    • Bad: "You always forget to tell patients about our whitening service. Don't you care about the team?"

  • Encourage confronted team members to accept that they are being confronted for the good of the team, and not to interpret it as a personal attack.

  • Model the behavior you want. You will make mistakes too. Encourage your staff to "catch" you in those mistakes so that you can model accepting the feedback and changing your behavior as a result. (One dentist I know was confronted by his receptionist for not making time available for the recalls he had asked her to schedule. His response? He was grateful, and he changed his behavior so that she could succeed at what he had asked her to do.)

Attention to Results: At the top of the pyramid is attention to team results. There is an old saying known by every successful business. (Yes - your practice is a business and hopefully a profitable one.) The old saying is: "What is valued gets measured. What gets measured gets done." Your vision, mission, and key strategies will tell you what you value, and therefore, what should be measured.

Measure team results, not personal results. Personal results are nice but cannot be allowed to take precedence over team results. For example, you may choose to measure the number of new patients scheduled per month. In this case, assume that you have identified the kinds of patients who fit your practice model well and those who do not. Were your receptionist oriented towards achieving the best results for herself, she might schedule patients without regard for whether they were a good fit for your practice. She would be working towards individual results, not team results.

Attention to results cannot occur without accountability. Accountability is the willingness to be measured and to use the feedback for self correction.

To practice attention to results, you, as leader, can:

  • In concert with the team, who will think of things you overlook, identify team performance goals to help you measure progress towards the vision. Examples might include

    • Number of new restorative cases per month

    • Profitability

    • Reduced number of no shows

  • Inform all team members of results on each performance measure.

  • Avoid the temptation to become judgmental about disappointing results. Leaders who make it unsafe for team members to provide bad news get lied to. Respond to disappointing news from an "assessment" perspective.

    • Judgmental: "Our number of no-shows is unacceptable. You are doing a terrible job!"

    • Assessment: "Our number of no-shows for this month was 130% of our goal. What ideas do people have about how we could lower this number further?"

Building a great team takes great effort but provides great payoff. In order to be successful, you must learn your craft, just as you had to learn dentistry. To start, read the book that the model outlined in this article is based on - The Five Dysfunctions of a Team by Patrick Lencioni. It makes its points in story form and is an easy but informative read.

Next, it may be useful to hire a coach for yourself and team. The coach can help you assess the current functioning of your team and create an action plan for overcoming barriers to building the kind of team of which you dream. You had folks who taught you how to be a dentist because it is too complex to learn alone. The skills required to build great teams have sufficient complexity to merit consideration of hiring a guide. Your guide can provide an objective point of view and, as an outsider, is likely to see things about your team that are hard to see as a day to day team member.

A great team is within your reach. It begins with hiring great people. But even great people have to be molded into a team. This five level pyramid model may serve as an excellent road map.

Dana C. Ackley, Ph.D. is a psychologist who provides coaching and consultation to dentists and their staffs. He has been a guest lecturer at the Pankey Institute for Advanced Dental Education and writes frequently for Dentistry Today. He can be reached at dana.ackley@eqleader.net , or 540-774-1927, or EQ Leader, Inc., 2840 Electric Rd, Suite 208, Roanoke, Virginia 24018.

The comprehensive science based EQ Leader Program builds lasting change in EQ skills that make a dramatic difference in performance.


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