“Tales from the Troubleshooter #5”

As published in Dentinal Tubules here’s the fifth instalment of Jimmy’s story.

Tales from The Troubleshooter – Case 1. Jimmy’s story.

Part 5. People – Asset or Liability?

The Seven Pillars of Dental Practice Management© are:
Financial Controls

Accountants show equipment as an asset and the wages owing to staff as a liability. I am not qualified to argue over the strict definitions but any practice owner knows that a dental chair that has failed to operate on a fully booked Monday morning is a liability. A receptionist who can call all the patients whose appointments were booked several months ago and then confirmed by text to explain, apologise and rebook leaving them feeling sorry for the owner is a real asset.

In Jimmy’s practice there existed a hierarchy of staff. The “practice manager (PM)” and “head nurse (HN)” were part-timers who considered themselves to be a cut above the remainder of the team which comprised two full-time and one part-time dental nurses and a full-time receptionist.

There was little or no communication between PM & owner or the rest of the team.   The PM started work at 8am and left at noon thus avoiding any opportunity to have regular conversations with Jimmy. She was responsible for initiating and transmitting claims – she wasn’t all that good with the software so I estimate that tens of thousands of pounds of claims were not made.

PM & HN were the only people allowed to do any ordering, unfortunately they had no idea of efficient stock control or just in time ordering. The result was that there were huge outstanding bills with some suppliers, with large amounts of  the ordering seemed to be done on an arbitrary basis and there was certainly no budgeting.

They (PM & HN) had betrayed the trust show in them by giving themselves a 50% pay rise 12 months earlier, whilst giving the rest of the team 3%. They bought luxury tea for their own use and had bought a special coffee maker that only they were allowed to enjoy.  These two were definitely a liability.

Staff meetings were irregular and usually consisted of Jimmy having a moan about something or other and telling everyone to “shape up or ship out”.

I could go on but I’ll stick to the problem of dealing with their control. The HN jumped ship within a week of my coming on board, the PM was not quite so easy. In spite of supervising and controlling the appointment book so that a shortfall of 14.5% was achieved requiring a 10% clawback from the PCT, we were not able to sack her for negligence. Jimmy, in his frustration, had written several notes to her exercising the language of his native Glasgow so any attempt at dismissal would have resulted in an employment tribunal. Therefore we had to go down the redundancy route – this was done with excellent legal support, took a month or so to accomplish and was expensive but necessary.

Then we were able to get to the work of improving the rest of the team.

The first step was to introduce weekly staff meetings where everyone felt safe to say what they thought. Contributions were invited and new ideas were welcomed. The two full-time nurses had been at the practice for more than five years and were full of suggestions to make things run better.

That was immediately followed by a pay increase for everyone.

Next came a programme of delegation and education resulting in an increased involvement with and awareness of the practice as a business.

  • The nurses were given a budget for purchasing.
  • Appraisals were introduced, much to the initial apprehension of the team. Once they got to grips with them and realised it was a non-judgmental exercise they really enjoyed the experience.
  • They were all told that they were expected to reach and, if possible, exceed the GDC requirements for CPD and as much assistance as possible was given so that their personal development plans could be realised.
  • Training in software use and impression taking meant that they became far more involved in patient care.
  • The receptionist took on a number of administrative duties that had previously been closely guarded by the PM – and took them in her stride. The result was clarity about several stages of the patient journey.
  • Every team member became responsible for monitoring a variety of performance indicators.
  • Conversion of the PM’s office to a room for discussion with patients and parents meant that the nurses were able to communicate better. The result was an uptake in private treatment and better motivated patients with fewer failed appointments.

The past twelve months has seen an increase in morale, a decrease in absence and a team that is starting to behave as a team rather than a collection of bullied individuals. Patient complaints have reduced – they were running at one or two a week at one point. The biggest challenge has been to get them to believe that they are all valued. They still have a tendency when asked why they do something in a particular way to reply, “because “X” (the PM) said so” – old habits die hard.

One challenge that remains is getting Jimmy to get out of the way of his team, having abdicated rather than delegated for five or more years, leadership of a small team hasn’t rested easily on his shoulders.

So, to answer the question that’s in the title of this piece, all people can be an asset if they are treated properly and bad ones are a liability if you tolerate them becoming such.


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