Yerkes-Dodson is still relevant – if you want to enjoy your clinical career

Why should a “law” described first in 1908 be relevant to everyday Dentistry (and more)?

Robert Yerkes and John Dillingham Dodson described their tests with rats that could be encouraged to complete a maze when stimulated with slight electrical shocks. When the strength of the shocks was increased however the rats just ran about looking for an escape. They concluded that arousal levels helped to focus attention and motivation on the task at hand but only up to an optimum point and after that point fatigue appeared and performance declined.

Research has found that different tasks require different levels of arousal for optimal performance. For example, difficult or intellectually demanding tasks may require a lower level of arousal (to facilitate concentration), whereas tasks demanding stamina or persistence may be performed better with higher levels of arousal (to increase motivation).

The first image shows the classic inverted ‘U’ shape of a difficult task (placing implants, molar endo, treating some children are examples that come to mind). It also shows a continuation without decline of more simple tasks which can be maintained for longer without reaching a point influenced by fatigue (examinations, routine restorations on well adjusted patients).

 

 

The second image shows the typical “stress curve” where performance takes a while to peak if we are under too little stress, then goes through a short period of optimum stress before reaching too much and heading down through exhaustion to burn out.

The reason that I have written about this is that we need to look at the time periods that these curves represent from the short (an hour say) to long (months or even years). There are different challenges that dentists face with differing solutions.

Firstly of course there is the fatigue that comes from trying to do too much challenging work in a short period of time. This results in high stress levels and possibly poor performance on a daily basis. Often there are time management issues where we are obliged to match our performance to the patients availability. This can see a clinician “coasting” by dealing with the relatively straightforward whilst at their peak in terms of readiness and responsiveness but then having to find reserves of energy when the patient “demands” treatment at later times in the day. I have never understood why dentists are reluctant to tell the patient exactly when and why they would like to see them. My own experience in a practice with large numbers of children was to insist on seeing under 11s for any treatment (examinations excepted) first thing in the morning. For the most part when people have reasons explained to them and can understand that it is for their benefit then they will comply with your wishes.

Also to consider are the long term problems of fatigue that arise from the day after day, just doing it without time off. Even in the best time managed (at a relatively micro level) practice if there is often not enough time spent away to unwind, recharge the batteries and recover, then burn out will creep up on you. The prodromal signs are a lack of efficiency and, more importantly, effectiveness.

Dentistry is still a macho occupation for many who seem to get a perverse enjoyment from overwork. It’s sad but true that for many there is an opportunity to build the life they want but put obstacles in their own way as if frightened of taking control.

Time management on both micro and macro levels is hugely important, ignore it at your peril. Get help if you need it.

Time to review your associate contract?

A couple of years ago I asked a specialist dental lawyer friend of mine why her firm suggested using the BDA associate contract rather than writing one of their own, she replied that as the BDA contracts are the the mostly widely used they are regarded as the industry standard. She went on to say that the longer and more complicated the contract the more likely it was that there could be challenges and disputes both of which cost money to resolve. (Simplify, simplify)

Times change, bringing changes in the context of contracts, therefore the content needs to evolve.

The BDA has updated their template dental associate contract to reflect these changes; the amendments include clarification around:

  • Practice hours.
  • Time away from the practice.
  • Locum cover.
  • Provision of equipment.
  • Hygienist services.
  • NHS contract requirements.
  • Private fees.
  • Confidentiality and data processing.

I am still surprised by how many associates and principals do not have a formal agreement in place or, where they do, there is no regular formal review of working arrangements. When I visit a practice to carry out a Practice Business Health Check I ask about not only “if” but also “when” contracts are in place and reviewed.

With the self-employed status of associates coming under increasing scrutiny it is important for both parties their contracts are contemporary. 

BDA members can access the relevant updated contracts on the website here: New Contracts

 

GDPR = Got Desperate People Rich(er)

Chicken Licken says the sky has fallen – #94

Lee Gilbert’s thoughts on GDPR,

“It seems every type of company from Accountants, HR Advisory firms, Law Practices, IT companies, Greengrocers and Candle Stick makers… have been jumping on the band wagon of running seminar’s on the subject without truly understanding (or having read in some cases!) the Regulation and its subsequent Recitals.”

It’s Regulation 2016/679. It’s 88 pages long and there are 173 Recitals…. by the way.

Some people say complying with GDPR requires extensive planning and in some cases, a complete change in processes and procedures.

The reality, for most, is the change is minuscule.

It should not be ignored but the changes and updates required are so small you could argue they merely constitute the best practice many organisations have been applying for some time.

Put simply, GDPR is designed to clean up some poor practices conducted by the few. It is the many though who are feeling the brunt.

Cynical? Moi?

Link to the full post

So you can be pregnant and sacked….

From the Lexology newsletter.

Can a pregnant employee be fairly dismissed if their employer does not know they are pregnant?

The story starts:

Ms Thompson had been employed just over a month, and was still in her probationary period, when she found out she was pregnant. She experienced pains and was admitted to hospital but did not tell her employer the reason she was admitted to hospital. RECCL therefore thought she should have arranged the hospital appointment in her own time. She also had an altercation with a customer and when picked up on this by RECCL she shot off to the toilet in tears and was sent home.

On 3 August 2016 RECCL decided to dismiss her because of her emotional volatility, performance and because she did not fit in with their work ethic. On 4 August 2016 Ms Thompson told RECCL that she was pregnant. When she returned to work on 5 August 2016 she was given a dismissal letter dated 3 August 2016.

The full story HERE is well worth a read.

Most dental businesses with which I work are terrified of taking any disciplinary procedures with pregnant staff. Yet as long as the proper and appropriate measures are taken and your systems and processes are correct there is no real need to be so. I have emphasised that section in the last sentence because I find, in spite of CQC etc practices that do not fully understand the law, the systems and the processes and therefore run scared of taking appropriate action. Pregnancy regulations are often the tip of the iceberg and in spite of having reams of paperwork, or online documents, from compliance suppliers they haven’t taken the time to read and assimilate the regulations and therefore often make decisions in haste and that is when things go wrong.

Rees’s Reads #1 – Setting The Table by Danny Meyer

Setting The Table – The Transforming Power of Hospitality in Business

This book should be compulsory reading for everyone who works in any business that serves customers face to face. I believe it is essential for any dentist looking to differentiate themselves – especially from corporate practices.

Danny Meyer is a restauranteur. The CEO of Union Square Hospitality Group this books describes how his passion for food and service led to his founding, over a 21 year period, five “white-table” restaurants, an urban barbecue joint, a feel-good jazz club, a neo-roadside hotdog & burger stand, three modern museum cafes and on off-premises, restaurant quality catering company. At the time of writing he had not had to close any of them.

The basis of his an any successful restaurants is the quality of the food allied with a dedication to the best possible service. Danny describes the non-food elements as “hospitality”. His aim when opening a new venue is to, “draw the best elements of the classic, make it authentic for its present context, and then try to execute it with excellence.” 

Throughout the book he presents case studies, words of wisdom, stories of what has worked and what hasn’t, the lessons he has learned and above all how to be successful by serving the public but on your own terms.

Here are a few quotes:

Self: I have always viewed excellence as a journey rather than a destination. Taking that journey demands a form of athleticism. It is the athlete’s nature to call on all resources to compete and win. I believe it’s possible to apply to business the same skills I would apply on a tennis court or baseball diamond. I see this as a combination of innate ability, focused training, and a persistent zeal to win.

Marketing: Know Thyself: Before you go to market, know what you are selling and to whom. It’s a very rare business that can (or should) be all things to all people. Be the best you can be within a reasonably tight product focus. That will help you improve yourself and help your customers to know how and when to buy your product.

Service: Best described through what he has written of how he discovered “enlightened hospitality” after his wife miscarried twins and his life took a different perspective. He describes outlining what he considered non-negotiable about how he does business. “Nothing would ever matter more to me than how we expressed hospitality to each one another. And then in descending order, our next core values would be to extend gracious hospitality to our guests, our community, our suppliers, and finally our investors.”

People: He talks about the 51% that he looks for in employees whether they be chefs or the front of house team. He says he wants people who have 51% emotional hospitality and 49% technical ability. He seeks the “excellence reflex” in people which is a natural reaction to fix something that isn’t right, or to improve something that could be better. “This “excellence reflex” is rooted in instinct and upbringing, and then constantly honed through awareness, caring and practice.”

In the chapter, “Whoever wrote the rule…?” he questions acceptance of the status quo and the conventional ways of doing things saying, “The commitment to add something fresh to an existing dialogue informs every decision my colleagues and I make.”

I could go on but I have exceeded the 500 words I allow myself here. Just get the book, read it and be inspired.

Buy it from The Book Depository HERE.

 

The Monday Morning Quote #469

“Leadership is the capacity to look ahead, think ahead, plan ahead, and then influence other people to go ahead on the plan”

Ralph C Smedley

Health Factory

I am fortunate, and grateful, to have a brother whose inclination and job means that he has an interest in many fields of medicine. Education, research, clinical and academia all provide him with stimulation. We are able to learn from each other (although I believe the balance favours and benefits me).

A part of his New Year clear out the 2010 film “Health Factory” arrived via a pretty large download yesterday and I would urge anyone who is involved in health care to watch it and then to ask themselves some very simple questions. Start with “Why?” as in “Why am I doing what I’m doing? and “Why am I doing it this way?”.

The film questions the way health services are provided and if the current obsession with the imposition of “business” processes benefits anyone, patients or (that awful word) providers.

As you can imagine for someone who describes himself as “The Dental Business Coach” I am capable of vigorously justifying the arguments for dealing with dentistry as a “business”. However this film has made me examine what I am doing for and with my clients.

It helped me to understand why gut feeling led me to turn down more clients than I accepted last year. Finally it reinforced the beliefs and convictions that led me into dentistry in the first place and made me realise that what I am doing these days is right.

Watching what happened when Norway imposed a new system and how hospitals were rewarded for “gaming” or “creative coding” took me back to my early days of NHS associateship. The culture  at that time, encouraged speed of work and high output leading to a “pile high sell cheap” approach where the work was made to match the narrative of the NHS scale of fees. As the fees evolved so did clinical practice to maximise income. It was only when I took control back by working privately on a one to one basis with patients that I felt in control and capable of giving my best without compromise.

One can argue, and I do, that dentistry easily adapts to “business” models and even fashion. There is much that can be measured easily and should be, a lot more that could be but isn’t because the “need “ is not appreciated. However the imposition and measurement of many Key Performance Indicators is frequently a waste of time and energy providing results that signify little.

You can’t measure trust, patience, co-operation or happiness (in spite of what some gurus would have you believe).

As one of the featured clinicians said, “You end up measuring what can be measured, which will always be marginal to what the core of the job is.”

So for me, it’s a return to examining the abstract, difficult to quantify elements of dentistry. Anyone can measure things. It takes experience, and dare I say it, a certain amount of gravitas, to feel, to empathise, to understand and analyse what health means, to both patients and clinicians.

Worth a look, you can rent it and see the preview HERE.

And there are more clips on YouTube

 

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