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Is dental office conflict common … as common or even more so than a typical office environment?

Anytime there is more than one person in a room at some point there will be conflict. I don’t necessarily think that all conflict is bad though. Positive changes can occur when the team is focused on finding ways to resolve the problem in the business. Conflict indicates that something isn’t working right. There are so many moving parts in the dental office that very good systems need to be in place to keep the office running smoothly. Often times those systems are either not in place or they are not adhered to by the team. I do think that conflict at different levels is very common in dental offices. People are working very closely together on a tight schedule, dealing with patients who are afraid, in pain and generally not happy to be there AND on top of that, the team is expected and must be ON all the time.

Conflict is unhealthy when it is avoided or approached on a win/lose basis, where one side is the winner and one is the loser. It has also been my experience that most people will want to avoid the whole situation hoping that everyone will settle down and the problem will just go away. Conflict management styles that are either aggressive (win/lose) or avoidant (see no evil/hear no evil) are ineffective.

 

What are some of the key causes of dental office conflict?

Throw into the mix of a tight schedule and patient issues there usually is a perceived hierarchy of positions in the office.

  1. Dentist
  2. Dental Hygienists

These two are the PRODUCERS- when their hands are moving they are making money for the office.

  1. Front office and Managers- keep the schedule full-hopefully. Answer the phone. Run the office.
  2. Dental Assistants-assist the doctors chairside and general instrument care and clean up

Here are some commom causes of conflict:

  • front office- back office conflict- For example the front office is packing too many patients in the schedule and assistants can’t keep up.
  • Assistant vs Dental Hygienist conflict- Hygienists are producers and won’t do some of the helping tasks to keep the office running. Assistants become resentful.
  • Over bearing managers who micromanage and push for more production. The beatings will continue until morale improves.
  • Dentists who didn’t go to school to be facilitators of human relationships and generally want it all to go away without dealing with it.
  • The attitudes of: “It’s not my job” or “she isn’t doing her job” is a common theme.

These are simple but common scenarios in the dental office. What causes them to be a problem is most times these issues are ignored and not dealt with properly.

Poor communication, hurtful communication mostly is the cause. Selfishness, personality disorders and some people are just mean and have bad intentions.

There is a great deal of bickering gossiping, factions -us against them attitudes in dental offices. Before you know it there are small dissenting groups in the office.

 

Why is it difficult for dental office teams (for anyone, for that matter) to face problems head on … to handle them with folks face to face?

Why would they want to when they have an attitude of I am right and they are wrong? The parties each become entrenched in their position. Win /lose attitude and stick with it even when they may have an idea they might be somewhat wrong just to save face.

What typically happens is this: two or more people have a disagreement, exchange words, gestures etc. They retreat into their own corners.

Each start to recall and think about what happened, Re create the script. Rehash the event. They replay the interaction over and over again and a story starts to take shape. A story that supports their own position and sounds to them completely reasonable, (though terribly one sided.) It becomes reality.

The other side is Wrong.

Next they go to someone else, gossip to their teammates who support their positions and dig deeper into their beliefs and an us against them attitude, win/lose mentality forms. I am right, so I have got to win and they are wrong and they lose.

Now when they have another interaction with this person they disagreed with before no matter what the interaction the person only hears what supports the story they formed in their head and they think, See! That’s confirms it! I am right and they are wrong. And around and round it goes with the other person forming his or her own story of the events. We tend to only hear what fits into our script and reinforces the script even if it is completely different then what the other persons true intent was.

 

If left unresolved, can dental office conflict potentially impact a practice’s revenue … patient flow … as patients don’t want to be around or exposed to an environment where they might feel uncomfortable?

Consider this: A dentist has 2 employees whom he is paying $20 per hour for a 36 hour work week= $720 per week, $37000 per year. So over the last month they have been bickering over petty stuff. The dentist ignores it, barely on his radar. Very easily they spend about a couple hours per week of time gossiping and stirring the pot. Tensions will escalate and it spreads through the office. Toxic work environment. The dentist paid them but they were not working and producing!

Patients definitely feel it and are aware of it! Patients will just leave an office and no one ever will know why. These patients also talk to all their friends about the office and that effects referrals and new patients coming into the office.

The direct cost of this office drama is not obvious to dentists.

For a short time a team can be in conflict with one another and still be smiling and greeting patients, addressing concerns, and handling problems. In the long run, however, businesses whose team, behind the scenes, who is bickering, gossiping, and remain in conflict is neither sustainable nor productive in human and financial terms. Firing, hiring and retraining is time intensive and costly.

I went to a pretty big dental conference a couple years back and was networking and handing out cards to dentists and teams. The dentists just don’t get it. Their mindset is to just fire the unruly team member. I had one dentist throw my card back at me and said ’I’ll just fire them!’ This was in front of her team. I felt bad for them. Turnover is very high in these offices. Dentist lose so much money in the time it takes to retrain, continuing education dollars are lost as well as the loss of knowledge the dentist paid for in training that employee.

CPP Inc.–publishers of the Myers-Briggs Assessment and the Thomas-Kilmann Conflict Mode Instrument–commissioned a study on workplace conflict, finding that in 2008, U.S. employees spent 2.8 hours per week dealing with conflict. This amounts to approximately $359 billion in paid hours (based on average hourly earnings of $17.95), or the equivalent of 385 million working days.

 

You’ve mentioned some elements that cause conflict, like poor communication, personality clashes, different values, etc. … first, how important is it for the dentist, or dentists, to set the tone and provide the model for good communication?

So many articles out there on leadership! It is very important to at least have a plan or protocol to handle disputes. Most dental private practice offices don’t. Corporate owned practices generally do because they are run like an organization with HR

 

Is it incumbent on the part of the dentist and/or practice manager to hire staff that has similar values, and similar personalities? Or is that not realistic … there will always be personality conflicts of some kind?

I wouldn’t recommend it although I am sure it happens. Conflict is going to happen no matter what. Hopefully it does in a healthy way so positive change and improvements in day-to-day functioning can improve. Patients have various personalities and a one-size fit all kind of dental team would work for some patients but not all the patients. Patients are uncomfortable anyway and it is common for them to have their favorite staff member and doctor to work on them. It offers comfort and predictability for them. So varieties of team personalities and values are an asset.

 

Things like low productivity, low employee morale, employees leaving the practice can negatively impact the bottom line as well, true?

Some of the effects of unresolved conflict are:

  • Morale-Not only do employees experience poor morale, managers and Dentists do too. Note that according to Healthy Companies International, 40% of employees don’t think the person they report to deals well with workplace conflicts and believe that bosses are least likely to handle or even address conflicts.
  • Sabotage-When employees are in conflict or feel that they are being treated inequitably, they will refuse to support each other thereby completely destroying teamwork.
  • Absenteeism-The study found that 25% of employees said that avoiding conflict led to sickness or absence from work. Equally alarming, nearly 10% reported that workplace conflict led to project failure and more than one-third said that conflict resulted in someone leaving the company, either through firing or quitting. Those negatives translate into real financial losses, especially for small businesses like dental offices.
  • Turnover is a huge expense of unresolved conflict. “Chronic unresolved conflict acts as a decisive factor in at least 50% of departures Figures vary, but the turnover cost of one employee is reported to be anywhere from 30% to 150% of the employees annual salary.

 

Bottom line: unresolved conflict costs money. Yet it is the largest reducible cost to a practice.

 

What are some key steps practices need to take in order to recognize when conflict exists, and then deal with it in a way that minimizes the problem and maximizes the positive outcome?

Fundamentally, business is built on relationships. Manager to employee; employee to employee: employee to patients and so on…

In a healthy workplace, service and profit flow smoothly through open communications. As staff communication and relationships remain open, patients receive good treatment, and the business is profitable. As relationships among staff deteriorate, service erodes as well. So there is a direct link between the quality of the relationships in any business and the quality of service, production, and profit.

When we are in conflict, we say things we do not mean and we mean things we do not say. Rarely do we communicate at a deep level to express truly what we are thinking and feeling. Learn how! Spend money and time training communication skills. Make it a safe place to express differences of opinions and train to do it respectfully.

 

How important is a mediator … and does everyone have to buy in to having and agreeing with the mediator?

Avoidance promotes turnover and escalating conflict, which are expensive emotionally and financially. Realistically it is difficult, if not impossible, for people who are warring to come to peace without some outside influence or help.

Early intervention is key. How dentist address conflict will either add to or take away from their bottom line. When conflicts are handled quickly, people feel better faster, and they interact in healthier ways.

A mediator just could be the solution to help the team get back on the track to productivity and focus on the job.

As a mediator, I provide a forum and an atmosphere for communication where parties gain understanding, become understood, and work together to explore options for resolution.

That’s the key! I don’t come up with the solutions to their conflict; they do through the mediation process! And when they come up with the solution they buy into it better and it is long lasting. As a mediator, I am neutral and I don’t give advice therefore they don’t have to agree with me.

When I mediate a dispute in an office, I model and teach appropriate listening techniques. Most people think of communication as talking, however, effective communication is really about listening. Many of the most important facets of your life are greatly influenced by your skills or lack of skills in listening. The quality of your friendships, the cohesiveness of your relationships, your effectiveness at work, these hinge, on your ability to listen.

The result is a healthy office environment where increased morale and productivity can flourish. Where the dental team can concentrate on their job at hand.

I am very passionate about it.

 

 

 

 

 

 

 

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“In appreciation of your dedication to our practice, to your career and to our patients. Thank you very much for your ideas, implementations and patience/calmness you bring to all of us”

R.Lauck, J. Corley