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"Oh Crap!" Rhonda R. Savage, DDS

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by Rhonda R. Savage, DDS

"Rhonda, what keeps you awake at night?" I was thinking about this very question – posed to me earlier in the day by Dentaltown Magazine Editor Ben Lund after I'd asked him what he wanted me to write about – when an advertisement for Huggies Diaper Wipes popped up on my TV screen. A green box of wipes sat on a small carpet in the nursery, surrounded by baby toys. Behind the wipes box, in giant marshmallow-like letters were the words, "Oh Crap!" I instantly laughed at the phrase often blurted out by dental professionals who constantly have work on their minds.

Have worries about your practice or "oh crap" moments ever woken you up at night or kept you from going to sleep? I know I have had those worries and over the years, I've lost sleep over them. I hear these same worries across the continent, from assistants, hygienists, front office workers, and office managers, but mostly I've heard these worries from doctors.

You might be thinking, "That's not a very professional title for an article!" You're right. It's not. But it's true, and honest discussion about worries and frustrations, plus creative solutions, is what Dentaltown is all about! Audiences around the world have expressed concerns, frustrations and goals and I'd like to share some of them with you.

Issue #1: "My main concern is that we will learn effective systems today that won't be implemented into our practice because our whole office staff is separated and taking different courses."

Solution: Many times a dentist will attend a session alone and return excited to present the new ideas to his or her team. Or, team members attend without the dentist and come back all fired up, only to have the idea fizzle. And you hear comments like, "Do I have to learn something new? Will I have to change?"

How can we fix this? Team meetings and clearly defined expectations are one part of the solution. The second part is willingness to change.

Team Meetings and Clear Expectations: After a CE session, reserve at least a two-hour window of time the following week to debrief. Each team member should present two to three ideas they got from each class. Then, or at a subsequent meeting, there needs to be a discussion: Is this an idea we might implement into our practice? What are the necessary steps? Who will volunteer for the step and by what date will this be accomplished?

The main concern that the questioner noted was about implementation of effective systems. I like systems. Systems decrease stress and increase productivity. It takes time and effort to define and refine a system. Systems should be customized to the office; there's no real "cookie-cutter" system that works well. Once a system is in place and the change has been implemented, you'll always need to go back and revisit it – "How is the system working? Any problems or changes we need to make?"

Willingness to change: Know that on average 50 percent of a team, including doctors, are naturally resistant to change.

If it's the doctor, approach the doctor privately and be clear about your intent. "My intention is that you have the best practice for your patients and that we continue growing the practice. I'm concerned about (insert concern here) and I feel we need a systematic approach."

If it's the staff or a staff person, remember that the term "staff " means to support! We need to keep an open mind to change. If we're not changing and growing in dentistry, we're behind the times. If you decide to change and one person agrees vocally but doesn't go with the program, then the doctor or office manager needs to enforce the change. Sit down with the resistant person, outline the steps necessary and then hold the person accountable by following up and checking on the progress.

Often, when a system is put into place, there are difficulties and the system is abandoned too early. Commit to the change and give it time; revisit and adjust as needed.

Issue #2: "The doctor is a great person and wants to please whoever is in front of him at that moment. Because of this he doesn't always make the best business decisions or stick with them! We have unclear goals, which has divided the team and created communication difficulties."

Solution: The problem above is the No. 1 reason I get called to help in a practice. We don't get practice management-, communication- or leadership-training in school. To be a leader, you need high skills and high character. You've had clinical skill training, but when was the last time you had "character" training?

Trust and Respect: If you lead, you don't need to be liked on a personal level (although most good leaders are liked). Many people in leadership roles try too hard to be liked on a personal level and this results in ineffective leadership.

Doctors: Sit down this weekend and write down your goals. What three big things do you want to accomplish in the next 12 months? What steps are necessary? Define these goals for your team. Ask for their help and develop a plan – and then stick to it! No waffling allowed! What team members need is firm, clear, consistent leadership, not just a nice boss! They may not like all of your decisions, but they will respect you for making them and sticking to the plan.

Issue #3: "My front desk manager doesn't remember things about people. She doesn't remember to do things. I ask and she doesn't write them down. Also, I don't like hearing "I'm calling to get you scheduled for that crown." And I don't like hearing, "I don't have anything (appointments) until…"

Solution: Most often it's not a bad front office person; it's usually lack of training. There are multiple levels of concern here. My answer is a qualified one, because I don't know how much pressure is on this person. If you're understaffed at the front desk, or there's an unclear definition of responsibilities (job descriptions), the front office will be your "limiting factor," which holds the office back from potential growth.

Put it in writing: Most front office staff are busy people.
• Doctor: For anything you want him or her to do… give it to them in writing. Front office team members are faced with 100 to 200 interruptions per day.
• Front desk: Have a legal pad and write down everything! You can't remember otherwise! Then follow through. Read The One Minute Manager. Don't do the paper shuffle dance! Handle it once and be done. And then report back to the doctor. Mission accomplished!

Verbal skills training: Doctor, have you written down the script you would like your staff to follow? There's a system for this.

Verbal cue cards: For one week, at every phone and at every work station, have a pad of paper and ask the team to write down every question patients ask. Then have one person compile the questions at the end of the week. This will teach two things.

First, where are we lacking in communication? How can we do a better job up front to communicate with the patients? And second, the doctor's job is to sit down over the weekend and in two or three concise sentences answer the questions on his/her own. Then, get staff feedback and rewrite as necessary. Make up 3x5 cards. Put the question on one side and the answer on the other. Role play. Have a friendly contest and have prizes.

A second set of verbal cue cards can be made by taking all the common procedures in your dental practice and identifying two benefits to the buyer and two consequences if the treatment is not complete.

What if the doctor isn't certain of the best verbal skills? I recommend two resources. The first is Linda Miles' book, Dynamic Dentistry. The second is Miles and Associates' verbal cue cards. You can find them at our Web site: DentalManagementU.com under Products.

Issue #4: "I know we've had patients leave our practice, but I'm not sure why. You've talked about a customer service survey. What does it have on it? Who creates it? Who implements it? Who evaluates it?"

Solution: The best customer service survey is an anonymous one. You could do this yourself, but the best survey is done by an outside company. If you chose to do it yourself, I would ask four or five basic questions. Make it quick and easy to answer. Provide a self-addressed, stamped envelope. The basic questions would include ease of scheduling, clear financial policies, friendliness of the staff, communication with the doctor and comfort during the procedure.

The easiest way to survey is to utilize the talents of a professional company. Companies like Smile Reminder, Televox and Sesame Communications are just a few that can do surveys for you. The most cost-effective way to survey is through e-mail.

Are you routinely gathering e-mail addresses? If not, you're behind the times. A great current system is to update health history, address, phone (get cell phone numbers) and e-mail addresses all as the bib goes around the patient's neck.

Statistically the open-rate of e-mail surveys is about 27 percent. I recommend you survey new patients, restorative patients and also hygiene patients who had scaling and root planing. These companies can have an "alert" button on the e-mail. If the patient writes something negative, the button will flash. Be certain, as a leader, that the problem is resolved to the best of your ability, preferably that day!

Who evaluates it? The entire team should be reviewing the results. If patients are unhappy or leave the practice, you need to know why! Most offices are marketing for new patients. It doesn't make sense to put a lot of money into marketing (and yes, PPO involvement is a form of marketing) only to have the patients leave out the back door.

We've talked about four issues that kept dentists and their staff awake at night:
  1. Efficient systems – the need for less stress, and more attention to detail and accountability.
  2. Leadership – making decisions and being the boss.
  3. Worrying about the front desk; it's the first and most important contact your patients will have with your office.
  4. Patient dissatisfaction and happiness; celebrate the happiness now; address the dissatisfaction immediately.
Dentaltown is your solution to the "oh crap!" moments. You deserve to sleep at night!
Author’s Bio
Dr. Rhonda Savage began her career in dentistry as a dental assistant in 1976. After four years of chair-side assisting, she took over front office duties for the next two years. She loved working with patients and decided to become a dentist. Savage graduated with a B.S. in biology, cum laude, from Seattle University in 1985; she then attended the University of Washington School of Dentistry, graduating in 1989 with multiple honors. Savage went on active duty as a dental officer in the U.S. Navy during Desert Shield/Desert Storm and was awarded the Navy Achievement Medal, the National Defense Medal and an Expert Pistol Medal. While in private practice for 16 years, Savage authored many peer-reviewed articles and lectured internationally. She is active in organized dentistry and has represented the State of Washington as President of the Washington State Dental Association. Savage is the CEO for Linda L. Miles and Associates, known internationally for dental management and consulting services. She is a noted speaker who lectures on practice management, women's health issues, periodontal disease, communication and marketing, and zoo dentistry. To speak with Dr. Savage about your practice concerns or to schedule her to speak at your dental society or study club, please e-mail rhonda@milesandassociates.net, or call 877-343-0909.
Dentaltown Magazine
September 2025
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