Meet with team members individually and encourage an open dialogue. This is your opportunity to get to know them better, and find out more about them. For instance, ask questions like:  

• Do they need help with anything, and if so, where?
• What tasks are most comfortable for you, and why?
• What tasks are least comfortable, and why?
• What is the most frustrating aspect of your job and why? Encourage them to elaborate and give examples.
• What are the biggest distractions they encounter?
• What aspect of dentistry would they like to learn more about?
• “What can I do to help?”
• How can I help you make patient flow better?
• What do you need to help you grow your role in the practice?
• What can your team mates do to better assist you in your role?

Allow them time to think about their answers, don’t rush them. Think of this process as similar to presenting treatment and payment options. Silence does not necessarily mean ‘no’, it just means they are collecting their thoughts. Give them the courtesy of time to consider the question and respond.

Next, find out if they know and understand your vision for the new practice. Do they share that vision?

Lay the groundwork for handling gossip, communication issues.

Review job descriptions and make any modifications to adapt them to your expectations. Review the current performance evaluation used. If none exists, create one and implement it.

Have measures in place to make sure you know if your hygiene team is profitable.

Generate reports that will help you understand how the team is working. Create one for your assistants as well.

What about raises or bonuses? How do you know what to reward if you don’t know what you are measuring. Establish and communicate your guidelines what, when and how you will determine salary or bonus issues.

Are you tracking the number of patient contacts made and appointments scheduled each month to reactivate reluctant, overdue patients.

Are you measuring the number of cancellations in your schedule each day and how many of the changes were filled? Who is making the calls? How are they getting the patient into the schedule?

How much treatment did you recommend last month and how much is scheduled? Are you tracking this number?

The list could go on, but these questions/answers should be among your top priorities when working with an inherited team. Remember, they have questions and concerns just like you do. Establishing clear and easy-to-understand guidelines will go a long way in determining your long-term success as a new practice owner.

Not only do dentists need an annual plan and budget, they should have at least one annual ‘Board of Directors’ meeting to review relevant information pertaining to the immediate past, present and future of the practice.  This Board is ideally comprised of:

1. Doctor
2. Dental Consultant
3. Dental CPA
4. IT person
5. Software rep
6. Financial adviser
7. Insurance broker (medical, auto, liability, building)
8. Supply rep
9. Bank or loan rep
10. Practice Administrator or Office Manager

This type of meeting keeps you focused on the present and helps you clarify your vision for the future. This minimal amount of time spent with your advisors will not only help you provide direction for your practice, but allow you to spend more time on performing dentistry in the long-run. In school you relied on your professors, clinical advisors, and counselors to guide you. Why stop now? Now is the best time to surround yourself with other experts. 

While the idea of organizing and running an annual meeting might seem daunting, it doesn’t have to be if you break it into its component elements. The same goes for the time commitment. An hour or two is all you need to obtain the peace of mind that your business is moving in the direction that you want it to – forward. 

What should be on the agenda

The agenda of the meeting is to discuss the practice’s state of affairs, what changes might be recommended before putting the budget in place, what “rainy day fund” might be needed if technology replacement or additions are needed, and other relevant issues.   

Ideally, the meeting shouldn’t last more than two hours. The dentist and consultant, along with your practice administrator or office manager should set the agenda and run the meeting. The consultant can act as Facilitator while the Office Manager can record the meeting notes. 

Each member of the Board contributes to the meeting by reporting on their area of expertise and how it impacts on the future of the business. Allot a defined time for each report to ensure the meeting doesn’t ramble.

Review old business along with new items. Ultimately, you want to exit the meeting with an Action Plan. The action plan includes what needs to be done, who will do it, when it will be accomplished, as well as who receives the information.

In order to plan your budget you need to answer a multitude of questions:

• How well did you do the past year?
• Do you need to increase your budget in a specific area to accommodate new equipment purchases?
• Do you need a loan for the purchase?
• Do you want to “budget” for the new item and purchase part way through the year?
• How are you going to increase your production/collections to achieve a higher profit?
• Will there be raises for the team? If so, when and how much?
• How well did you do with non-surgical periodontal therapy in your practice? Do you need to improve this area?
• What CE will you take? Your team?
• How many vacation days will you take?
• Are your HIPAA, OSHA and HR systems up to date and compliant?
• Are there going to be any changes in your practice software that requires upgrades in hardware?
• Are there any issues with current hardware?
• Is backup working well both onsite and offsite?
• Is there a way to save on supplies?
• Lab costs – will they increase or decrease?
• Are you buying a CEREC or Cad/Cam?
• What education will you need to implement new equipment purchases?
• Are you considering adding treatment rooms/renting more space?
• Are you considering buying another building/practice? (See below.)
• How much money do you need to put away for your retirement?

Also, depending on where you are in your business life, discuss:

• What is your exit strategy?
• Will you hire an associate?
• Will you change your current associate become a partner?
• Will you sell to a corporation and work for a few years?

While the concept of a Board Meeting may feel odd at first, doctors who have made this a part of their annual planning routine know first-hand the benefits and peace of mind it brings to their practice.

Doctors become so involved in “doing dentistry” and caring for their patients they sometimes don’t take the time to work on the business side of their practice. As one example, when is the last time you held a staff meeting? If you ask your colleagues, many will tell you that having staff meetings is a waste of time because they are nothing more than unproductive “gripe” sessions.

Why have a meeting?

In my experience, however, these meetings are what you design. As a business owner, you set the stage for how your business will be run and you lay the foundation/groundwork for team meetings and how they are structured.

Each meeting should ideally have a facilitator, a recorder, and the participants. Each person on the team contributes to the agenda. A sheet for agenda items is placed in the staff lounge or in an area where each member of the team can add an item to be discussed at the meeting and how much time they think it will take. If you have a good internal email system, you can also ask for agenda items from team members in this way.

The facilitator sets the “stage” for the meeting, setting up the easel/flip chart with markers, making copies for every one of the agenda, having a new action plan sheet available for the recorder, and puts a message on the machine/a sign on the door/whatever needs to be done to prepare for the meeting and make certain the team meeting is not disturbed, except in cases of a patient emergency.

The recorder will go over old business/action plan items to check on progress or completion. If discussions take a turn and stray off topic, the facilitator’s job is to bring everyone back on topic. If a topic takes longer than the time allotted, the facilitator asks the team for a consensus, to either table the topic and continue with the agenda, or continue with the topic and adjust the agenda for a future meeting. The entire team votes on which direction to take.

Meetings’ focus

The meeting the first week of the month is focused on finances. While your practice is built around your relationships with patients, you need to be fiscally aware to run a business. The team needs to understand that there is a consequence of caring for patients and that a fee is involved for the services we provide.

During weeks two and four, an hour is set aside for team training. How many times do you purchase a new piece of equipment while attending a trade show or seminar but then when you  return to the office, you don’t take the time to learn how to implement it effectively into the routine of the day, or have the team develop their skills and knowledge in using that new piece of equipment or improve their skills?

The time it takes to develop your teams skills and expertise is a small overall investment. Training meetings are also centered around building our communication skills. What we say and how we say it to our patients can make a world of difference between a patient accepting and completing treatment, or saying, “I need to think about it”. Every scenario needs a script and the team members need time to practice their skills to “own” the dialogue so it sounds authentic and not robotic.

The third week of the month is teamwork meeting. This meeting is centered around the entire team and follows the same format as all of the other meetings. This meeting can be based around review or working on OSHA, HIPAA, CPR trainings, workshops to tweak, develop and implement new systems. This meeting can take the form of a celebration or planning a patient appreciation event.

Team meetings are never “gripe sessions”. They are learning sessions – if someone has an issue with someone else, that discussion is to be handled privately. If a team member has a concern about a system, the topic is brought to the meeting for discussion (on the agenda), and a solution is devised. It is each individual’s responsibility to contribute to the team effort and to the growth of the practice. How does this happen? Leadership! Who is the leader of the team? Like it or not,  as the doctor and business owner, you are.

This is one where doctor needs to make a decision: can the doctor treat someone without knowing their medical history?

Considerations:
— Does the patient understand the importance and link between their medical health & dental health?
— Did you offer to work in “private” with the patient to complete the form and have them sign it?

As healthcare providers, we need to understand why a patient might refuse to sign a form.

For instance, is it because they have trouble seeing? Reading? Comprehending? Are they afraid to make a mistake? Are they unable to write or spell, which could be a source of embarrassment to them? Having a family member who is dyslexic, I know it can cause stress when having to complete a form, especially if they feel they will be judged on their spelling and writing. For elderly patients who may have macular degeneration, completing forms is impossible.  

On a related note, remember, this is an opportune time to discuss the link between medical and dental health, taking the opportunity to educate the patient as to the importance, and why. As you know, patients do not feel it is important for their dentist to know about their medical history, so we need to start asking direct and leading questions, such as:

1. When was the last time you visited your doctor, urgent care, or any other health care provider? (This question often sparks them to think a little more about their last visit.)
2. What medications, vitamins or supplements are you currently taking? If they are a returning patient, review their medication list with them?
3. Ask them about family history of periodontal disease, diabetes, heart disease, cancer, etc. This is helpful for as a risk assessment.
4. If there were any hospitalizations since their last visit. (Give them the exact date they were last at your practice.)
5. Any new medications? Are you using any eye drops? Vitamins? Dermatology meds? Fish oil or herbal supplements.
6. Any changes in the dosage of your medications?
7. Is there any need for antibiotics before a dental treatment?
8. Any reason, we cannot take dental x-rays today? Pregnancy? Recent medical x-rays?

Taking the time to understand why a patient might not want to complete a certain form or forms, as well as making a concentrated effort to inform them of the importance of their medical health to their dental health, and vice versa, is vital to providing the best possible dental care to all of your patients, all of the time.

Everyone thinks it won’t happen to them. Believe me, it happens more often than you think, and often from the person you trusted the most. We’re talking, of course, about embezzlement.

In the past 25-plus years as a software trainer and practice management consultant, I’ve seen at least one office a year that has been the victim of embezzlement. Too often, doctors are shocked because they trusted their teams and did not feel it was necessary to have individual team members sign into their software with individual names and passwords.

• “We switch computers too often to change our login.”
• “We’re so busy that we can’t be bothered.”
• “They have been with me for years.”

These are just a few of the reasons I have heard over the years as to why the practice didn’t set up system security in their software.

Could this real-life scenario happen to you?

I was consulting with an office that was “going live” with entering transactions and payments into the computer. They had taken their ledger cards and entered the balances, outstanding insurance balances, and credits into the software. We walked through the process of entering checks and sending statements to accounts with balances, but the office manager of 20-plus years was having a difficult time adjusting to the changes. She liked her paper. Haven’t we all heard that before?

During the lunch break, the doctor and I discussed system security, reports, and checking audit trails. He had a hard time setting up the security system because his “girls” had been with him for such a long time. During our discussion of monitoring and using reports, he noticed that not much money had been entered in the computer, payroll was coming due, and he needed money to pay his “girls.” After lunch, I asked the office manager – was she sure she did not have any more mail for us to enter so we could continue to practice on the new system?

After a few moments, she went to a drawer and took out a few envelopes with insurance checks and personal payments to be entered. We sent billing statements to the accounts with balances. It was a great day! I left feeling good – I did a great job.

Patient receipts made out on napkins

A few months later, the doctor called, very upset. He found that his “girl” of 20-plus years had been embezzling money from him, although he had no clue how much.

How did he discover it? Patients began calling, upset when they received computerized billing statements showing balances when they had receipts written on paper napkins showing they had paid their bill.

The office manager would sit in the parking lot at lunch and have the patients meet her at her car to pay her because the “office was closed for lunch.” Computerizing saved this doctor from who knows how many more years of embezzlement, but unfortunately, he discovered someone he trusted for years had not only cheated him, but also the other team members and herself out of pension and profit sharing. We worked out a game plan for him to recover as much as possible and recoup unpaid insurance claims going back several years.

Over the past 20 years, I have seen embezzlement on every scale.

• Team members abusing prescriptions.
• Family members embezzling from other family members.
• A relatively new employee who was given the ability to delete transactions, and use a signature stamp. (At least in this case, the office prosecuted after their accountant pointed out discrepancies between 1099s received and bank deposits made.)

Sadly, doctors often decline to pursue prosecution against their embezzlers for a variety of reasons:

• They ‘feel sorry’ for the person.
• They are embarrassed the theft happened in the first place, or that it took them so long to catch it.
• The embezzlement was perpetrated by a family member.

What would you do? 

Do you have checks and balances in place?

There are innumerable areas in the office where stealing and embezzlement can and does happen, from a few hundred to hundreds of thousands of dollars. Are you doing all that you can to protect yourself and your team? Using security systems in your practice management software is a good place to start, but it’s just one step in making your practice “embezzlement proof.”

Bite wings?

Intra oral photos?

How many things did you do/services did you provide — but there is no money for it? Do you show it on the patient ledger? Does the patient physically see all of the ‘things’ you did during your exam as a line item on their walkout papers, with n/c next to it?

Do you know the mindset of patients when they see all the freebies they received during their visit and now they need a restorative appointment? The impact it has?

Do you show that oral hygiene instructions were gone over and post a code to reflect that on their walkout statement?

Build value for what you did, and what needs to be done in future:

• Why does the patient need to come back?
• What are the benefits of doing treatment versus the risks of not.
• Did you have the patient sign a consent form? How about a form that they declined treatment and will not hold your or your practice liable for the choice they are making not to proceed with treatment.
• Will there be a change in the way you expect patients to pay at the time of service, or will you continue to balance bill the patient after insurance?
• Do YOU understand the down side of doing that? Does the patient?

While it might feel good in the moment, doing anything without charging for it comes with potentially negative and long-term consequences. Giving away free treatment or services does NOT make you the cool doctor, it makes you the doctor who wonders why there never seems to be enough A/R to pay the bills, or why retirement plans are just a dream.