Most dentists tell me that providing clinical care is a stress-free breeze compared to managing their team. That’s understandable when we consider the employee issues dentists struggle with.
- Employees who require constant oversight because they don’t seem to have the skills or motivation to do their jobs.
- Employees who ignore carefully crafted protocols because they decide each patient is an “exception” or because they “forgot” the process.
- Employees who request daily to leave early or take days off.
- Employees who are more invested in their phones than in the practice.
- Team conflicts, drama and cliques that literally bleed into meetings.
- Employees who do the bare minimum but expect maximum pay.
If this wasn’t stressful enough, dentists believe they’re handcuffed into retaining every employee, because there isn’t a pool of more competent ones to replace them. Dentists feel so beaten down; some are considering early retirement.
What the heck is happening?
As a consultant, I’m interested in patterns of behavior and their root causes. Have employee work ethics and capabilities truly tanked since the pandemic? Is this a generational thing? Or is this drop in employee performance due to a leadership issue?
I’ve concluded that dentists and employees are unfortunately engaged in a negative reinforcing cycle. Employees are less emotionally connected to work while dentists are uncomfortable about providing the direction and effective feedback that employees’ need to perform better. Each party needs something different from the other; but no one knows how to have an honest, productive conversation that can change this dynamic. In fact, both parties are afraid to have this conversation so instead everyone is locked into a dance of disappointment and unexpressed frustration.
So why do employees underperform? Let’s divide the answer into two categories. As you review these reasons see which apply to your most frustrating employee.
Diagnosing Your Employees
| Employee-related reasons | Environmental Reasons |
| – Employee wants to comply but doesn’t know how. (training issue) – Employee knows how but lacks confidence. (support issue) – Employee doesn’t want to because they don’t see the need, it’s uncomfortable to do or they would rather do something else. (motivation issue) – Employee doesn’t have the capacity or skills to do it. (competency & job fit issue) | – There isn’t the time, space or equipment to do it. (resource issue) – Employee is paralyzed by competing priorities, confusing directions or frequent changes in direction. (leadership issue) – Employee has never been explicitly told what to do. (communication gap) – Employee is not given feedback so they don’t know they’re not performing. (feedback gap) |
Identifying why there is a performance gap is critical because it determines your response. While I don’t know of a Star Trek type tool which can do this diagnosis for you, there is a pithy but surprisingly insightful diagnostic question you can ask yourself.
If a million dollars was riding on it (or if their life was on the line) could this employee do what I want them to do without my oversight?
If the answer is yes, then you’ve determined that the employee can do the job but either doesn’t want to or can’t because of external barriers. If you answer no, then the performance gap is due to poor training, a lack of competence or the environment.
This leads to another set of diagnostic questions:
- If the performance gap is related to a lack of motivation, why aren’t they motivated? Is there anything you can do to engage this person? Is there anything that does inspire and energize this person? Is this a temporary issue or is this a job fit issue?
- If it’s a competence issue, would additional training or coaching help? Have you done everything humanly possible to upgrade this person’s skills? Is this person capable of learning and implementing? Have you seen evidence they are coachable because if not, this may be an unfixable job fit issue.
- If the performance gap is due to your leadership or the environment, are you willing to make changes? Can you do this on your own or do you need leadership guidance?
The Tough Love Mirror
As a consultant, I observe that the biggest reason dentists are so frustrated with their teams is that they’re paralyzed by indecision, second-guessing and fear. They choose to suffer in silence at the office only to offload their frustrations on their spouses at home.
Dentists seem to be saying to themselves, “I need this employee more than they need me so I’ll tolerate almost anything just to keep them here.” They reason that it’s better to put up with an under-performing, frustrating employee than to have an open position. But this fear-based mindset puts dentists in a vulnerable position. Here’s how this played out with one dental client.
Dentist A lost $130,000 in potential production in the last 7 months due to the large number of unfilled hours. The dentist has to dip into savings to pay their monthly expenses. The front desk team insist they’re working hard, but they can’t change patient behavior. Their position is that it’s not their fault that patients get sick, forget their appointments, can’t afford treatment or choose to go to an in-network practice. The dentist feels uncomfortable challenging them in case they leave the practice. Now the practice is stuck.
How would you diagnose the root causes of this continuing issue? Are the employees correct that open appointments are caused by environmental factors (which they can’t change) or are the large number openings due to their lack of motivation or skills? And, most importantly, what should the dentist do to pull everyone out of the quicksand?
Many issues in an organization are generated by external factors and then minimized or amplified by employee behavior. The solution isn’t to assign blame but to develop accountability. I advised the dentist to meet with each employee separately and design a performance improvement plan that outlines the specific new actions each employee will take to tackle this problem. The plan also includes how and when the dentist will examine their efforts and results. It is a contract that holds both parties responsible.
This approach represents a shift in the dentist’s mindset. She has acknowledged a difficult truth, which is:
Everything in your practice is there because you put it there or because you tolerate it being there. Everything.
Once you recognize this, you can take ownership for your team issues. If you have a practice culture where employees don’t do what you want them to do, it’s because you have inadvertently taught them that this is acceptable. But, like Dorothy and her ruby red slippers, you have the power to change this dynamic. If you want them to change, then the change begins with you.
