Great Expectations

Nov. 11, 2013
It was 2004, the year that a parenting light bulb went off in my head. My daughter had been doing fairly well in school. She was always a good student, her grades a mix of A's and B's.

by Eileen Morrissey, RDH, MS

It was 2004, the year that a parenting light bulb went off in my head. My daughter had been doing fairly well in school. She was always a good student, her grades a mix of A's and B's. At the end of her sixth grade, we sat down and talked about how she would be taking advanced classes the following year. I said that despite that, my expectations had not changed. Specifically, I wanted her to work as hard as she could, and preferably earn all A's so that she would always be an honor student. She turned to me surprised and said, "Mom, why have you never said this to me before?"

I thought, "Oh, boy, out of the mouths of babes." What the heck was the matter with me? What was so very clear in my head had never been communicated to my daughter. Did the aforementioned dialogue end up making a difference? Yes! She went on to maintain a straight A average, referencing my expectation each time we discussed her workload.


Other articles by Morrissey


I cannot help but wonder how many dental employers present clear expectations to team members regarding job performance or procedure protocols. Or, are they neglecting to do this as I neglected to present my expectations to my daughter? If guilty, perhaps we can help them rethink this and try a new way.

All too frequently in dental practices, employees walk to their own drumbeat because they have not been advised otherwise. Their dentists are perpetually frustrated because some of these team members do not live up to expectations. The problem is, the doctor never stated his or her expectations. (In some circles, this is known as a job description!)

As a consultant, I often hear dentists say, "Well, they should just know. Why do I always have to tell them?" It would be great if employees were mind readers, or realized what doctors perceive as common sense, but heck, we employees are not dentists, or employers, and we need our boss's expectations verbalized.

Last year, I facilitated a meeting for five hygienists and two doctors in a general dental practice in New Jersey. The purpose was to standardize the protocol that takes place at an adult recall visit. With that many hygienists, varying levels of experience, and a range of years since primary training, it was no surprise that each had chosen to march to the beat of a different recall protocol drum. One RDH chose to provide an oral cancer screening, and the one the patient saw six months later did not. One hygienist believed in the concept of selective polishing, while another used a coarse pumice to polish every tooth surface and every restoration. One hygienist flossed under fixed bridgework; the other did not. I could go on and on. I have to wonder how these inconsistencies in protocol impact the patients' perception of the practice.

Armed with standardization of recare visit protocol as our primary goal, we got down to business and developed a customized, step-by-step, recall visit procedure. At the close of the meeting, all present were satisfied, and not because they were in complete agreement. Quite the opposite -- compromises were necessary almost every step of the way.

The hygienists were delighted because they finally knew what was expected of them. For example, they learned they now have autonomy to decide at what point during a three- to seven-year range a new FMX should be taken. This was verbalized and logged into the meeting minutes and created as a new hygiene protocol. Hearing that from this day forward all RDHs would floss each patient at the close of the visit, was music to their ears. It meant that some would be treating patients differently than before, but this was of little concern. They now knew what they were supposed to be doing, and that they were expected to be consistent and follow the agreed-upon protocol. Expectations had been set and agreed upon by all.

The doctors were ecstatic because the hygienists had been made aware that, if given 60 minutes for a recall patient, they were expected to work 50 minutes of that hour. It was agreed upon, documented, and became part of the new way.

Not that doctors and staff will always agree about every aspect of clinical and service protocol. But if everyone is aware of the leadership's expectation, and it becomes a springboard for discussion of procedures, this can only be positive.

The follow-up necessary is periodic meetings to make sure all parties are walking the talk that has been agreed upon. The advantage of having standard protocols as part of an office policy manual is obvious, so there is always something to refer back to should any questions arise. Onward we go; it is in our hearts' core!

EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at

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