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Howard Speaks Howard Farran, DDS MBA, MAGD, Publisher, Dentaltown Magazine

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What is “Quality” When it Comes to Staff?
– by Howard Farran, DDS, MAGD, MBA, Publisher, Dentaltown Magazine

When I ask dentists what kind of practice they have, the majority tell me, “I have a quality fee-for-service family practice.” To that I like to ask, “What do you mean by quality?”
If you asked a mathematician or an engineer to quantify quality, they might show you Fig. 1. They would say that quality is consistency. They would say that McDonald’s is quality because every Big Mac is two all-beef patties, special sauce, cheese, lettuce, pickles, onions on a sesame seed bun. Even though you might laugh at the notion of “fast food is quality,” you can step in to any McDonald’s anywhere around the world, and when you order a Big Mac, you know what you’re getting. You don’t even have to worry about it. From Juneau, Alaska, to Sydney, Australia, a Big Mac is a Big Mac – it always tastes the same. Consistency is quality. McDonald’s is incredibly consistent. Therefore, McDonald’s is quality.

Now, low quality is when you have a large variance (Fig. 2). A large variance means a big distribution. This is when your product, your price or your service is very inconsistent. Let’s say you go to McDonald’s one time and the Big Mac only has one patty, and then the next time you go there it has two patties and no cheese, and the next time you go it has three patties and it’s twice the price as it was a week ago... frustrating, right? You never know what you are going to get with a big distribution, which is considered low quality.

My point? Tighten your variances, especially when it comes to your staff.

Any dental consultant will tell you that the number-one perception of quality in the eyes of your patients has virtually nothing to do with your dentistry but everything to do with your staff. When patients come in for a cleaning they expect consistency; they expect the next time they come in for a cleaning it will be with the same Bat-hygienist at the same Bat-time on the same Bat-channel in the same Bat-office and there will be Batman RDH standing at the front desk, ready to clean their teeth.

When your patients come in and there is someone different behind the front desk or cleaning their teeth every time, it throws up a big old red flag to the consumer and they think that something is wrong. The employee turnover formula (Fig. 3) is one of the biggest predictors of success in a dental office. According to the United States Bureau of Labor Statistics there are about 300 million Americans, about 150 million jobs and about 45-50 million job changes every year. The average amount of time a person stays on the job in the United States is three years. I would say for a dentist who makes average production and average net income, I see the same staff variance of about three years, but whenever I visit the big boys and girls – the doctors grossing more than $1 million, taking home $200,000-$400,000 a year – it is nothing to find three or four employees who have been with the doctor 10-20 years. This is how you build quality relationships with your clientele.

If you’re a patient of mine and you have been with me for 20 years, which is incidentally the same amount of time my assistant Jan has been with me, and you’re feeling pain after I perform a root canal on you, you’ll suppose it is your problem and you’ll call the office to talk to me or Jan to find out if what you’re feeling is normal. But if you’re running a revolving-door dental office and your patient is experiencing post-operative pain, sensitivity or any sort of complication, the patient will always assume it is the dental office’s fault and there’s a pretty good chance they’re going to call your competitor down the street who just sent out a direct mail piece. Guys, you have to build trust with your patients. You can’t build trust with a revolving-door staff; it has got to stop. This is why HR is the most important part of your business. Human relations is everything.

I have learned a lot of tough lessons living in Phoenix, Arizona. Sometimes keeping the best people on your staff really isn’t up to you. I’ve hired young people who have come from the Northeast or the Midwest because they “always wanted to live in the desert,” or “wanted to get out of the horrible winters.” But as soon as they get married and have kids, what’s the first thing they do? Move back home to where their parents and friends are. There have also been instances when I’ve hired someone who I considered to be top notch and who I would have loved to keep for decades, but because their spouse is in the military or had to move to where the job was, they had to leave. There’s really nothing you can do about it and it can be painful for you and your practice, but it happens. We’ve joked in our office for years that IBM doesn’t stand for International Business Machines it stands for I’ve Been Moved. When staff does leave, it’s up to you to hire the same caliber person, rather than just filling the spot with the first temp who comes along. When it comes down to it, you need to take the interview process for potentially new staff as serious as or more serious than you treat endo, perio, etc. The interview process is serious business and if you want to be successful you are going to have to learn how to win that part of the game.

The hardest part of the HR process is trying to identify the star players via a one-hour interview. I suggest a multiple-step interview process as well as involving one or two other staff members in the interview so you can get their initial feelings on the applicant. Some people have great instincts for hiring – if you’re not that great at hiring but someone else in your practice is, you need to bring that person into interviews with potential new hires every single time. Obviously until the new employee actually starts working in your practice you won’t really know if he or she will truly work out. One great tip I learned from Southwest Airlines – you should always hire on attitude. You can train a star player for the position but you can’t change someone’s personality. Skill set is important (after all, you wouldn’t hire a hygienist who had no training whatsoever), but attitude is the key ingredient in a great new hire.

The first law of customer service is “satisfaction equals perception minus what was expected.” So when I come in for a cleaning, my satisfaction is going to be “how the cleaning went” minus “what I expected.” Well what your patients expected is what happened the last time. So basically the only way you can raise customer satisfaction is to stop employee turnover. At the risk of sounding like a broken record, I have said several times in my column you only manage three things; people, time and money. Of all three, people is the most important. This skill translates to all of life.

The skill-set you use in keeping your spouse is the same skillset you need to use in keeping your staff and your patients. If you have been married five times and your average employee has only been there two years then you shouldn’t be shocked that 80 percent of your patients haven’t been in once in the last three years; and it should be a wake up call for you to begin honing better people skills. People skills – whether it is personal with the spouse and kids, whether it is professional with the staff and the patients – are the most important skills you can desire. A lot of people who have staff turnover have benefited greatly from counseling. I’m serious! Just like you would go to a marriage counselor to keep your marriage, you should go to a counselor or psychologist and get counseling because maybe you have issues that wreck your business because of the way you handle or treat your staff. You have to learn how to communicate, and you have to learn how to give praise. If you don’t want to change or learn how to be an excellent manager then you need to find someone who can handle all of that for you. Find an office manager or general manager who can take care of all of your daily HR duties. If you’re not willing to change, find someone who can successfully recruit and retain your staff long term.

It’s the goal of every dental practice to obtain quality patients. We talk about this all the time, but you have to remember “quality patients” are the folks who come through your door on a consistent basis and hardly ever cancel. Obtaining and maintaining quality patients starts with you. The sooner you can tighten up your staff variance, the sooner you’re going to see more and more of these quality patients coming through your door on a more consistent basis.
Howard Live
Howard Farran, DDS, MBA, MAGD, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, email colleen@farranmedia.com.

Dr. Farran’s next speaking engagement is April 15, 2010, at the Townie Meeting in Las Vegas, Nevada. For more information, please call Colleen at 480-718-9914.

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