Practice Management

One Important Way to Get the Best Performance From Staff

Good communication on expectations is essential to encouraging the best performance from staff. An excellent tool for fostering this communication is the performance evaluation. Used correctly, it can open a dialogue that can lead to agreement between the supervisor and staff member on areas that need to be improved and ways to do so.

Communication among staff members and between staff and supervisor (usually the dentist) is one of the most important ingredients for a successful practice. The more respect everyone has for one another and the better the communication, the better the growth and success of the practice and the happier everyone will be. Unfortunately, too often there is very poor communication within an office. The communication is not only poor with patients but also between each staff member and the dentist. Having pizza delivered to the office and "chatting" during lunch is not the basis for good communication.

It takes effort for an office to achieve good communication, and the way to continuously improve is by evaluating staff performance. The purpose of this article is to show dentists a specific way to evaluate performance. It is only through this quantitative process that one can truly measure a staff member's value.

Ingrid Kidd Goldfarb, president and owner of Trojan Professional Services, a company that provides support services for the dental profession, has said that "a structured, well-planned performance review provides clarity and direction for everyone. Part of each review includes setting goals to be achieved during the next year. It's difficult to have misunderstandings about what was expected or achieved by an employee when we refer back to the previous review."

The value of the review becomes apparent when all the parties involved have established a dialogue with good communication about areas of concern and a clear and concise discussion on the areas that need improvement for the practice to continue to move in a positive direction.

Staff members perform best if they not only know their job descriptions, but also know exactly how the supervisor feels about their performance, good or bad. Roger Levin, DDS, MBA, and president of the Levin Group agrees. He said, "Performance reviews are an essential part of managing the growth and achievement of any team member. These reviews can be made extremely positive to help people establish benchmarks from which to identify areas of potential improvement as well as strengths and weaknesses. Strengths should be complimented whereas weaknesses should result in a plan for continual improvement. This will strengthen both the individual and the overall practice."

Performance includes many areas, such as punctuality; work ethic; neatness/appearance; creativity; and, certainly, specific job skill. It is important and helpful for employees to know and understand what they are doing well, where they are average, and which areas may need improvement. For example, unless a specific script is used by an appointment coordinator, he or she may not be using the verbal skills that are best for the practice. The coordinator is responsible for the way the dentist wants the office represented on the telephone.

Another example might be a staff member who often allows his or her desk area to be messy. Neatness is especially important at the front desk. This mess may include food or drink, stacks of paper, and general untidiness. If nothing is ever communicated to that individual, how would he or she know that the dentist considers the work area unkempt and unacceptable? The answer is simply that he or she wouldn't. In such a situation, the performance evaluation can come into play.

Because employees like to know where they stand with their supervisor, it is time for the dental office to address that issue in writing. Included with this article is a performance evaluation for the reader's use. Unlike most personnel performance evaluations, this one is specifically designed for the dental practice and is appropriate for administrative as well as clinical staff (including hygiene). What is exceptional about using this evaluation is that each staff member should complete a self-evaluation. The supervisor also completes one. In a private meeting, the employee and supervisor compare the completed evaluations. This is the opening of dialogue (communication) between the two parties. Although there is an objective way to score the evaluation, it is just as important that the two parties communicate to each other what they agree and disagree with. It is here that improvement begins. It can be surprising what issues this evaluation brings to the surface. Once the supervisor has decided on a score for each heading and subheading, there is a specific formula to reach an objective "performance score." This meeting does not have to be, nor should it be, uncomfortable or negative. This is a time to discuss and evaluate specific performance. Again, the supervisor will find that staff performance will increase when every employee knows the dentist is interested in their performance and in listening to their concerns. Simply, that's called good communication. There is never a substitute for it. Dr. Joseph C. Abe, general practitioner and past president of the San Gabriel Valley Dental Society said his "experience with periodic performance evaluations has been absolutely positive. Good staff members want to be effective and do care about delivering the best services possible."

Performance evaluations help:

* To focus on strengths and weaknesses (When the dentist and staff person's separate evaluations are compared, it is often found that the employee grades him- or herself lower.);

* To focus on practice objectives and team coordination;

* To improve communication between the doctor and the staff; and

* To facilitate discussion between the doctor and staff about mutually beneficial goals.

It is important to establish some ground rules before beginning the performance evaluation procedure. It is supposed to be an objective evaluation of how employees perform in their jobs. The results of the evaluation are to be placed in the employees' personnel files so that accurate records can be kept with regard to their improvement. In some instances, this may be the documentation necessary to dismiss an employee. This process is not intended to be used for destructive criticism or vengeance but instead as a vehicle that allows the staff member to identify strengths and limitations. Once limitations are identified, a self-improvement program can be implemented by the staff member. Though this evaluation procedure is not meant to be used as a tool for "separation from employment" issues, it can help establish a case for termination (if this separation is inevitable) and help defend against wrongful discharge claims.

Some of the ground rules that will help make this process painless and productive are:

* The performance evaluation meeting should not be held during lunchtime. It should be done during office work time -- not the staff member's own time. It simply isn't fair otherwise.

* The end of the day is not the best time to have this meeting. Everyone is a little tired, and the last thing anyone is interested in is sitting down and communicating about job performance.

* The time should be established well in advance so that both parties have an appropriate amount of time to complete the evaluation form.

* Enought time should be allowed for comfortable discussion or the best results will not be obtained.

* This evaluation process should be done on the anniversary of the staff member's employment.
Following is the rating system that will give the final results so the supervisor can objectively grade staff members.

* RE: rarely equaled -- 1 point

* ER: exceeds requirements -- 2 points

* MR: meets requirements -- 3 points

* MM: meets minimum requirements -- 4 points
* FM: fails to meet minimum requirements -- 5 points

The best score will be the lowest number. The personnel performance evaluation is separated into two main headings: personal factors and skill factors. Personal factors are worth 33 percent of the total score, and skill factors are worth 66 percent. The reason for this is that a dentists hires staff for their skills in certain areas, e.g., RDA or insurance knowledge, not because they come to work on time or are congenial.

There are 14 subheadings under personal factors. Within each subheading there are one or more factors.

First, the dentists rates each factor in each subheading on the "score legend" (RE, MM, MR, etc.). The he or she totals the scores of the factors in each subheading and takes the average, which gives the score for that individual subheading. For an example, see Figure 1.

The same instructions are followd for skill areas. It is important to note that the skill areas are broken down, and each auxiliary will not be rated for each subheading. One of the skill area subheadings is treatment room auxiliary. Obviously, the front desk person would not be rated under that subheading (unless he or she is a combination assistant). The financial secretary subheading would not be completed for a hygienist.

At this point, the supervisor will determine an overall grade for personal factors and another for skill areas. Each of those grades is found by adding the score for each subheading and dividing by the number of subheadings. For example, there are 14 subheadings of personal factors. Therefore, the 14 subhead totals are added together and divided by 14 for an average. The result will be the grade for personal factors. The same is done for skill areas. Because personal factors are worth 33 percent and skill factors are worth 66 percent, the formula is as follows: (personal factor grade x 1) + (skill area grade x 2) = employee's score.

If the performance evaluation score is:

* 1 to 2.5 -- The individual probably deserves a merit raise.

* 2.5 to 4 -- The individual should receive a cost of living increase at best.

* 4 or above -- The dentist may consider separating this employee from employment or dramatically improve his or her training.

Once the supervisor has successfully accomplished the performance evaluation process and identified areas of concern, it is appropriate for him or her to investigate how this process will help the employees' performance. It has already been noted that most importantly, the communication between the supervisor and each individual is the first step to performance improvement. But, there is more.

On the last page of the evaluation form is an area titled, "areas needing improvement." Once the areas have been addressed, the issue of improving the performance in these areas comes into question. One way to tackle this issue is for the supervisor to simply ask the employee, "How do you plan on addressing the area that needs improvement?" A specific answer to this question is important. For example, "I'm going to try harder, Doctor" is an unacceptable answer. An objective must be measurable, achievable, specific and time-able. Therefore, if punctuality is a problem and the staff member is often late, the answer might be:

"Starting tomorrow (time-able), I'm going to get up 30 minutes earlier (specific) than I do at this time so that I can be sure to be here on time." (This can be "measured" by simply noting the timeliness, and it is clearly "achievable".)

So it will continue with each area that needs improving. It is presumed that the supervisor and employee have already discussed areas that have been merely average in score (MR), so headings graded MM or FM are the key areas to note.

In conclusion, if the staff is to be treated with the same respect the dentist uses for his patients -- the same way the dentist would like to be treated -- this evaluation will be most helpful. Once the supervisor and employees know and understand what is being done well and what needs improvement, the practice will reap the benefits through the improved interpersonal communication and move forward. As Dr. Joseph Abe points out, personnel want to know if they are performing well or poorly. They want to know that the dentist cares about how they perform on the job, and that he or she is interested in listening to them and discussing their performance. If a dentist wants to get the best performance from his or her staff, he or she must communicate with them through a well-designed performance evaluation process. This process is designed to be a dialogue, not a monologue. It is the time to share opinions and experiences: the good and the not so good.

Author

Jeffrey M. Goldstein is a partner in the dental management consulting firm of Barron & Goldstein.

To request printed copies of this article, please contact/Jeffrey M. Goldstein, Barron & Goldstein, 2239 Cheremoya Ave., Los Angeles, CA 90068-3006.