Navigating a toxic dental office: Eliminate discord through open communication

June 12, 2015
The environment at the office is unhealthy. It's not that the air is toxic-it's more that the culture (i.e., the underlying navigational system that directs the office) is broken.

BY Dorothy Garlough, RDH, MPA

The environment at the office is unhealthy. It's not that the air is toxic-it's more that the culture (i.e., the underlying navigational system that directs the office) is broken. Harmony, communication, and collaboration have crumbled like the banks of a raging river, eroding the team. The injuries are chronic and often become inflamed with frequent angry behavior. The staff is polarized, creating gulfs between the multiple generations in the workplace.

As the new office administrator, Sarah recognizes that an arsenal of techniques and tools will be required to bridge the gap of corroded relationships. Over the years, she has made a habit of creative thinking and is armed with the "discovery cycle," a powerful tool to disrupt old thinking and spark new thinking.1 Sarah understands that many of us naturally adhere to our own point of view without exploring possibilities for multiple right answers. She knows that disruptive thinking is key to change.


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Over the last six months as the office administrator, Sarah has worked to gain the trust of the staff. She has taken the tactic of coaching every member of the team, encouraging them to observe their own behavior in potentially volatile situations. Thought-provoking questions have been asked, stimulating critical thinking. The office has revamped its mission statement and identified the individual strengths, talents, and preferences of its team members. The process is fluid, ongoing, and moving in the right direction.

Yet old habits die hard and Sarah recognizes that she doesn't have all the answers. A lasting shift in attitudes will require time, diligence, and networking with multiple sources. The doctor also recognizes the logic of networking and has agreed to hire a consultant, one that is an expert on communication between multiple generations.

The consultant knows that the greatest opportunity for generating ideas lies within the team. The staff is diverse and the consultant's role is to stimulate discussion about the differences and similarities of the four generations. Her role is to shift the negative energy to a positive energy. This will only happen if everyone on the team feels safe. The environment needs to be respectful, open, and transparent with a suspension of judgment. The consultant adopts a tactic of curiosity, one that will spark the team to explore the strengths (and shortcomings) of each generation and develop a creative plan for how the office can maximize this rich diversity.

In-office networking guidelines
1. Suspend judgment-Create a safe environment where biases, labeling, and accusations are eliminated.
2. Remain curious-Seek to learn the reasons behind thoughts, policies, and actions, and adopt the attitude that it is interesting.
3. Remain open to possibilities-Look for multiple right answers and weigh the pros and cons objectively before choosing direction.
4. Practice good communication skills-Listen before speaking, be transparent, communicate authentically, and speak the truth.

Early on, it is identified that the millennials in the office wonder why some current policies and procedures are necessary. They have felt that they are being asked to perform their duties simply because that's the way it has always been. One small breakthrough occurs when the team examines why the patients aren't recording their own appointments on appointment cards. It seems a redundant task to the younger staff, and it is agreed to adopt their suggestion. Changing this procedure not only speaks to the youngest workers but is more efficient and instrumental in reducing broken appointments.

Everyone in the office recognizes that their Generation X members are independent, confident, and experienced. They are the next generation of leaders and proclaim themselves as change agents who can bridge the values gap between older and younger generations. They do this by exploring flexible and creative models for the work-life balance for the entire team. Although the baby boomers and traditionalists place team at the pinnacle of devotion, they begin to see the younger generation's point of view that having balance in life does not mean they aren't committed to the practice.

The consultant prods the team to imagine what the drivers are for each of the generations. Gradually, individuals begin to open up, adding their thoughts and ideas to the mix. The baby boomers reveal that they are proud of their strong work ethic, dependability, commitment, knowledge, and experience. However, dialogue uncovers that although the boomers see themselves as revolutionaries for change, others in the office see them as being stuck and upholding the status quo. This revelation is a trigger for the boomers. With guidance from the consultant, discussion remains open and nonaccusatory; barriers begin to crumble. The baby boomers express they genuinely want to make positive changes to the organization by questioning assumptions, and request support in disrupting old habits. They know they will only be able to give their best if they can deliver it in such a way that unites the team.

Every team member sees the one traditionalist staff member as being loyal, dependable, and responsible, with a strong work ethic. The long-time employee's historical contribution is recognized and applauded. However, there is a gap in communication with the younger workers, who think the traditionalist is "out of touch." The traditionalist, in turn, expresses to the younger generations that faster is not always better. As they delve into the discussion, they identify not only their differences, but also acknowledge their many similarities.

In listening to one another, the team finds that under the strata of age diversity lies a bedrock of unifying needs and expectations. For example, a 50-something hygienist was amazed to learn that younger employees want the same things she does: respect, creative challenges, the opportunity to add value, increasing responsibility, recognition for contributions, and flexibility. The only difference is that the younger team members want, expect, and demand these at the beginning of their careers. They know it no other way.2

Everyone begins to understand that they are each responsible for their careers, lives, and families. As part of the workplace bargain, each person must develop a healthy sense of WIIFM (what's in it for me), as well as continue to work alongside the best people of all ages as a team. Recognizing the similarities and having a clear vision will be the beacon for bringing the team together.2

The entire team agrees that bringing a consultant in to help find solutions to their plight has been a productive collaboration. All players are acknowledging the strengths and contributions made by everyone in the office. Age is no longer an issue and the effectiveness of the team is being measured in the willingness and ability of team members to leverage their strengths and their contributions to the practice.

Sarah, the doctor, and the consultant are pleased. They know there is more to be done, but they are well on the way to mending the divisiveness in the office. Sarah will be receiving coaching from the consultant for the next six months to implement experimentation to solidify cohesiveness. The waters have been calmed and although realistically there will be the occasional storm, the environment is being transformed, the air is clearing, and everyone is feeling a positive shift. A novel culture is being birthed, one that is producing a healthy work environment where everyone is appreciated. Old wounds are healing, and with attention and adherence to open communication, this new culture will stick. RDH


1. Dyer J, Gregersen H, Christensen CM. The Innovator's DNA: Mastering the Five Skills of Disruptive Innovators. Boston, MA: Harvard Business Review Press; 2011.
2. Martin CA, Tulgan B. Managing the Generation Mix. Amherst, MA: HRD Press; 2006.

Dorothy Garlough, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change in both the dental and corporate worlds. As an international speaker and writer, Dorothy trains others to broaden their skill-set to include creativity, collaborative innovation and forward thinking. She recognizes that engagement is the outcome when the mechanisms are put in place to drive new innovations. Connect with her at [email protected] .