Handling your frustrations as a clinician and ending the day on a high note

Every now and then practices run into murky water with the clinician being dissatisfied with the dental nurse during clinic.

Usually it is the case that the clinician does not want to upset their nurse by informing them at the time about a dissatisfaction. Instead they hold it in. This either results in the nurse being unhappy with the clinician as they are ‘moody’, ‘distant’ or ‘hard to get on with’. Or the clinician tries their best to hold it in, finally snapping after a period of time, be it a day, a week or a month later. Lastly the clinician may go to the lead nurse or manager to vent their frustrations for them to then handle with the nurse.

When any of this happens it is not great for either party and long term problems start to brew.

My advice is this:

If as a clinician you are unhappy you need to be pointing things out as they happen. Dental nurses do not like to get it wrong, whether it is a set up or retraction technique. Big or small we always want to get it right and support the clinician we are working with effectively throughout the day.

For an emotionally mature dental nurse a quick point in the right direction will not phase them. If they are less experienced and not used to feedback and therefore do react by becoming emotional, you may need further support when communicating. However using the system of ‘pointing things out as you go’ tends to cause less emotion anyway.

If, in a worst case scenario, a nurse was to react by banging doors and being unpleasant then you do need to go to the PM as soon as possible to have this dealt with. This situation I can assure you is a rare one but seems to be the one clinicians fear and the reason why they do not feedback as they go.

My tips are-

1. For set ups always check the set up before you call the patient in, often things go wrong because the clinician has called the patient in without the nurse being ready.
2. If you are with a patient and unhappy with a set up then you must say in front of them “Laura thanks for setting up X, can you please prepare Y for me instead?” This is a really nice way of asking for what you require in front of a patient. Make sure your tone of voice is jovial, then ensure you say thank you and are making eye contact if possible with the nurse.
3. At the end when the patient leaves the room you can then provide more detailed feedback to the nurse as to why you don’t want X for that procedure you will only ever use Y.
4. I would advise that clinicians do keep a daily log on dissatisfactions, such as poor stock control, leaving you unsupported, poor techniques etc. This way repeated problems can be dealt with by the manager as this then falls into capability management rather than a one off slip up. (You also need to note down the great things they do which I discuss shortly.)

Is it not advisable to say nothing at all, all day, and then turn to the lead / PM with a list of problems. Nurses should have heard the feedback direct from you and then if persisting concerns occur they can be addressed. It is quite hurtful to a dental nurse to be pulled up by their lead or PM to discuss concerns the clinician had with them that day or the day before. The standard question upon hearing this is “Why didn’t he/she tell me? Why am I hearing this from you?”. This does not support the working relationship in anyway and causes further breakdown.

Ending the day on a high –

Clinicians are usually great at saying ‘Thank You’ to their nurse at the end of the day. Whenever I ask the nodding of heads as a confirmation is always strong. It’s a ritual, part of your scripts to say thanks. You would never leave without saying it. I understand that but you can make it much more meaningful.

The best thing that you can do throughout the day is take notes about the excellent way your nurse has supported you.

• A difficult patient who your nurse had to have strong communication with to keep still, open wide etc.
• A nervous patient who they reassured throughout to help you both.
• A great retraction with the mirror for the patient with the really strong tongue!

There will be many things throughout the day, just note a couple.

Then at the end of the day instead of just saying ‘thanks’ you can say:

“Laura, today was great [and then give examples as above] great retraction with the mirror for the patient with the really strong tongue. Thanks so much, I’ll see you tomorrow, have a lovely evening”.

This will leave your nurse feeling great. And then going forward if you do need to point something out they won’t be offended as they know you look for the good in them too.

Lastly if you have had a day where you have had to provide feedback and it has been uncomfortable to you then the day is still ending on a high.

 

Laura

 

 

 

 

 

The power of a Trainee badge

This blog post relates to the front desk team, following on from a conversation that I had with a wonderful team a few weeks ago.

The practice has been through what I call “the cycle of the dental team” where you are stable for years and then in a click of a finger the team are handing in their notice and one by one your steady team disappears, trust me it happens.

This practice had this happen to them earlier in the year and now they have successfully recruited new front of house team members who are being inducted and trained on all of their excellent systems.

One lady had only been in the practice a week.

When speaking to them I suggested a trainee badge and they all said how much they would like it. The manager and owners really made sure they would like it and I now feel they will be on order this coming week.

The reason that I recommended the badge was that unlike dental nursing where the dentist and nurse are working together, on the front desk you are working solo with patients, no-one can but in when you are on the phone, or help you (as much as they would like to) when you are both dealing with patients at the same time.

For me the trainee badge allows the patient to relax and stay calm and be patient themselves when dealing with new team members who not only have to learn the language of dentistry they have a software to learn and a huge number of systems too.

On the Monday night prior to the training I checked into a hotel (you may of seen my insta story it was torture) it was late and the receptionist could not answer my questions, I was getting annoyed. The lady next to her had to keep butting in and answering my very basic questions. I’m assuming she was a trainee and if she had had a trainee badge on, I would of been more understanding that she had no clue about the breakfast.

A few days later I had also been in a huge queue at a trampoline park, the queue for pre-booked was larger than the queue for those who hadn’t. Turns out the reason for the slowness is the number of trainee staff on the desk. Again frustrating.

I do not feel that team members should have to say “bear with me I am new” when things don’t go to plan or when a new situation they are yet to be trained on occurs.

Lastly I know you will be thinking ‘how long should they wear the badge for?’ Six months, the full probation period and the amount of time that it really takes to induct someone.

If you have any questions about this do send them over us so we can answer them on our podcast, we record the November one next week!

Laura

 

Taking the stress out of the hourly rate

Many of you will have had an eventful summer in practice; many families, many exam appointments and many closed books. It’s always a tough month or two for many dental businesses and dentists.

Owners and associates are left feeling the stress as they know what they should be invoicing an hour and if they don’t know exactly they always have a rough idea at least!

So how do you take the stress out of the hourly rate?

For me it is about turning the hourly rate into a daily target. Therefore if you are working 7 clinical hours you need to invoice £2100 a day on a £300 an hour rate.

This is also a much better way for the front desk team to be looking at the diary when booking appointments. They will see that there is no way you can achieve that target if they then book a family of 5 in a space, before or after a large number of existing exams that are already booked.

Nurses always become annoyed with dentists who start a filling during an exam appointment. I will defend the dentists where I can (do not get me wrong I can’t stand unplanned treatment but there are always two sides!). When the team understand that the dentist has not met their hourly rate once that day and they have to do the filling at 4pm for financial reasons the team often see the other side.

You can really take the stress out of the hourly rate by taking control of your diaries! By doing so you will be able to hit your daily target as the diary is not seen as a free for all.

It is not acceptable to have a day booked full of exams just because the hygienist is in; leaving the business and clinician out of pocket.

The same applies as mentioned for school holidays. If you want to learn more about diary zoning check out this article here. This will show you how you can then achieve 70-80% of your daily target by lunchtime! Even better.

By looking at a daily target you will feel much less stressed about what you are invoicing per hour and instead feel more relaxed and therefore be more productive each day.

A little tip – we always wrote the amount due to be invoiced on the top of the dentists’ day list – it was a pleasure for them to see as soon as they arrived and that it was definitely worth getting out of bed that morning!

Laura

 

 

 

Dental practice ‘team bonuses’ in 2019 and beyond

Back in the 00’s bonuses for the dental team featured heavily in dental practices across the UK, practice owners caught on from fellow peers that this was a sure fire way to motivate team members and keep them playing their “A Game”. The language in the last sentence may allude you to the origination of the dental practice bonus!

This culture was taken from the many American practice management consultants that were present in the UK in the early noughties.

The concept is great and I have personally benefited from bonus systems financially and emotionally. But in 2019 it is a different story with many practices no longer providing bonuses or having changed the bonus structure – some removing cash incentives entirely.

I will never forget the day I went to the bank to organise a new mortgage and they told me they would only accept 50% of the bonus income into their figures. My heart sank. I was earning more in bonuses than my basic salary. This was 2005.

Since then I have encountered team members who have lost benefits, had to pay back into the system and many other examples because of the bonuses they had.

The next problem being, as we all know, bonuses are not paid every month.

The bonus culture

Bonuses can also create a business culture you may want to avoid:

1. Money hungry people
2. Moody people – when the target is not achieved
3. Demotivated people – the target is unrealistic, the bonus amount doesn’t make a dent in their pocket after tax so it was not worth the effort.
4. 9-5 people

Without a doubt the money hungry people are the worst to create, I really cannot stand greedy people, I am sure we have all worked with or know at least one person like this in life!

However the 9-5 people are the most concerning group of all and if you think you may create these types of people then do not introduce a bonus system.

These are the team members you most likely do not pay the going rate for, you pay them lower than expected in your area for your type of practice. These team members know this and know that you are using the ‘bonus’ instead of increasing their hourly rate, they understandably dislike this and therefore do the exact opposite of what you excepted them to do (become motivated) and they just come in, do their job, go home. They are often emotionally attached to you as an owner and take this as a huge insult so decide that if you do not care about them they will most definitely not go the extra mile for you. Do not get me wrong they will do their job well but they will not pull any extra energy out of the bag for you.

Can bonuses work in 2019 and beyond?

The answer is yes but there is much more work to do behind the scenes. Here are my top tips:

First things first – make sure that everything is right and fair in your practice. You pay well, you provide a nice uniform, the team receive their breaks. Also make sure your HR knowledge and team training is hot, on fire hot! You need to be dealing with anyone not performing their contracted duties as they should not be receiving a bonus.

Next look at the team – what type of people are they? In what ways would they like rewarding? Days out such as the races, spa days, track days. They might be much better for your team than a financial reward.

The size of your team is important – if you have a larger team with over 10 employees providing a cash bonus is harder work.

NHS / Private mix – the higher the NHS percentage of income the lower the bonus pot will be – so will a financial reward work? Will the target be achievable and realistic?

Diary zoning, courses and holidays – if, currently as I type, you have a huge influx of families and children due to the school holiday, how are the team going to achieve the target if you do not have diary zoning to ensure you can still meet your daily target? If you are the main earner and you are off for two weeks in the month how will the team meet the target and what is the solution to keep the team motivated?

The target – needs to be SMART. Firstly take the figure of the expenses for the last year, work out the profit you wish to make and then set the target from there. Start slowly to build it up.

The pot – is a percentage of the net profit, not the gross. 5-8% is advised.

How much? – You are looking at a full time team member taking home at least £100 a month after tax. For the higher end practices aim for £200 take home after tax.

When to pay it? – pay monthly; so if the target is achieved in August the payment would go into the wages at the end of September 2019. Trust me, quarterly, bi-annual and annual bonuses do not work. It is paid pro-rota for hours including overtime hours.

How to award it? – this needs to be solely on attitude and commitment to the business and team and patients. The A team players attitude and level of energy is what you are looking to replicate. If someone is not performing their contracted duties as they should then they should not receive a bonus as they should be in capability or disciplinary. If someone has a bad attitude even once in the month the bonus is gone.

Who? – only dental nurses, front desk, TCOs and managers. Many always think the hygienists should receive ‘something’ but when they earn on average £30/£40 an hour that is a no from me. Even the very best PMs are on £16-18 PH so the hygienist is often earning double. Employed or not they do not receive the bonus.

T&C – this does not go in anyones contract ever. You have the right to withdraw and refuse the payment of the bonus, or to change any part of it at any time.

We never used to award the next payable bonus to anyone who had an unplanned day off. Simply because the team would have had to work so hard to support that absence, but many practices do a two strike rule in a rolling 12 months to be a bit nicer!

I hope this helps you and if you have any questions at all please send them over so we can answer them for you on our podcast!

Laura