The Weaver

We are care providers who are motivated by personal missions that direct our actions in a work environment. The personal missions we take on give meaning to our daytime work and shape our personal lives. Much like the artist weaving a creation, you fill the yarn carrier with the colorful threads, choose the weaving patterns, and create your environments.

To influence a dental practice, acknowledge the different threads of inquiry, knowledge, and care.

Suzanne Piersak, RDH, BS

We are care providers who are motivated by personal missions that direct our actions in a work environment. The personal missions we take on give meaning to our daytime work and shape our personal lives. Much like the artist weaving a creation, you fill the yarn carrier with the colorful threads, choose the weaving patterns, and create your environments.

A new model is emerging in the business arena. One of the top 10 trends listed in a 1995 issue of Training & Development is change management, which blends together knowledge of need assessment, systems analysis, and process management. Additionally, it is behavioral science`s theories about learning among adults - as well as leadership, team building, and conflict management - that tie the business and the human components together. In our analogy with weaving, the upper threads represent business components, and the lower threads represent the human components. They are arranged in varying patterns and produce the uniquely woven tapestries we know as our dental work environments.

Through facilitating learning, change agents (and you can become one) benefit patients, doctors, and staff members. They help their offices become learning organizations. Specific imperatives are identified in the book, Sculpting the Learning Organization. These are the mandatory obligations of change management:

- Create continuous learning opportunities.

- Promote inquiry and dialogue.

- Encourage collaboration and team learning.

- Establish systems to capture and share learning.

- Empower all toward a collective vision.

- Connect the practice to its environment.

Learning what it takes to survive in our rapidly changing profession will transform your work environment into a cutting-edge dental practice - cutting edge to both patients and employees. Change and learning are embraced. In this environment, individuals are considered one of the most valuable assets when they are skilled, open to learning (and change), and, in the case of dentistry, when they connect and develop relationships with the patients and the other staff members.

Together, individuals can work together to support the requirements for effective change. Change is not easy, and it is usually resisted vigorously. But individuals who understand the needs of patients and the practice will identify problems, identify system glitches, and identify communication gaps. Their actions promote inquiry. Inquiry facilitates learning; learning precedes change.

A change agent takes care to shield sensitive egos. A change agent also estimates losses in revenues and excessive spending. A change agent adopts the role of patient advocate. Actions are introduced and implemented that empower all of the stakeholders - patients and staff - toward a collective vision. The actions promote your leadership skills and create a "leaderful" organization.

The dental organization facilitates communication through a defined communication system. Some parts of the system are job descriptions, office policies, and other forums for communicating.

Ready for intelligent change?

As dental hygienists, we are empowered to increase the Dental Intelligence Quotients (DIQs) of the patients we care for. As employees in dental practices, we can affect choices through information, as well as effectively facilitate changes in the work environment. By identifying weaknesses, the practice is helped in accepting change. "Change readiness indicators" are factors that hurt the bottom line of dental practices. Have you witnessed some change readiness indicators?

- Painful losses of revenue, patients, and time.

- Valuable employees who have left the practice.

- Obsolete technology.

- Incessant conflicts.

- Apathetic coworkers.

- Dentists "putting in their time" while doing their jobs.

- Lack of family and work balance.

- Excessive absences.

All of these characteristics translate into losses for the practice, the patients, and you. Concrete measurements and statistics will help prepare for change. It is important to see and accept real losses. By accepting the existence of measured losses, dental practices will begin heading toward a state of change readiness.

For example, excessive conflict is one readiness indicator. Identifying the source of the conflict will help derive a suitable intervention to solve it. If the conflict is related to miscommunications about coworkers` responsibilities, a beneficial intervention is devising job descriptions. This is a basic exercise identified by William Dyer in the book, Team Building.

Each person in the office should have input into the process through identifying chief job responsibilities by stating seven to 10 phrases beginning with action verbs. A dental hygienist`s job description may include some of the following:

- Perform preventive care services for patients.

- Document patient records utilizing the SOAP format.

- Reinforce diagnosed treatment and recall intervals.

- Assist in performing clinical readiness procedures.

- Perform infection protection procedures according to OSHA and office policy.

- Perform gingival therapy procedures.

- Manage smoking cessation program.

- Perform and record daily maintenance on radiographic equipment.

- Perform as a team member, attending and participating in team meetings.

Share the results of the exercise at a staff meeting. By sharing the results, roles and expectations are clarified. The exercise encourages dialogue and collaboration.

Another example of a change readiness indicator may be apparent during staff meetings. The meetings may be hosted irregularly and are run so poorly that problems are never resolved. If this is the case, this forum of communcation is failing. It is crucial to remedy the situation, since effective communication is required to implement change. Mastering communication and resolving conflicts is the prerequisite for successful change.

The related article above shares some information about effective staff meetings.

Is the practice practicing dentistry without direction? It is if no formal mission statement exists. Many see mission statements as "lip service" only. But when used as a vision for the practice, it directs the practice forward to where it is heading. The mission statement becomes a tool upon which decisions are based.

An employee`s personal mission also can be formulated. Strong conflicts between the practice`s and personal missions may arise and identify a misfit. This communication can provide proof to both the practice`s owner and the employee that a change is needed. Aligned practice and personal missions will produce a better fit for the dental team. Practices and individuals that adhere to their missions have a strong foundation for commitment.

A common scenario in a dental office is to increase production through goal setting. Setting goals is a start, but the work of the team is to implement actions that reach the goals. Dental offices without the essential skills in process management will struggle.

The brainstorming described in the article, "Applying a mission to hygiene," is similar to "co-diagnosing" with a patient and identifying important needs that facilitate an acceptance of a treatment plan. Team brainstorming is a reflective learning process, and it allows collaborative learning. The process facilitates the agreed-upon required actions, and the actions produce outcomes of high performance.

Caring individuals will work to influence their organizations. You can be the weaver weaving in threads - threads of inquiry, knowledge, and care. You can identify needs and contribute to the solutions. Your actions will communicate your commitment to care. By becoming a weaver, you demonstrate that you care about doctors, dentistry, staff members, patients, and yourself.

Suzanne Piersak, RDH, BS, is a clinician and founder of Teamcare, a company dedicated to aligning "practice care" with "patient care." She has 20 years of clinical experience and a degree in human resource development. Her e-mail address is dair0005@tc.umn.edu

Resources

- Bassi, L.J., Benson, G., & Cheney, S. (1995) The top ten trends. American Society for Training & Development. 50(11), 28-42.

- Campbell, R. (1991) Developing Human Resources. 5.1-5.34: Bureau of National Affairs.

- Cummings, T. & Worley, C. (1993). Organizational Development and Change. St. Paul, MN: West Publishing.

- Dyer, W. (1994). Team building, current issues and new alternatives,3rd edition. New York: Wesley.

- Pfeiffer, J. & Jones, J.E.,editors. (1976) The 1976 annual handbook for group facilitators. LaJolla: University Associates.

- Hutchinson, C. & Stein, F.S. (1997). A whole new world of Interventions: Technologist as Integrating Generalist. Performance Improvement Quarterly.36(10), 28-35.

- Kotter, J. (1995). Why transformational efforts fail. Harvard Business Review.73 (2) 59-67.

- Lavovini, J. (1993). The human side of organization change. Training & Development.47(1), 65-68.

- Mayeroff, M. (1971). On Caring. New York: HaperCollins.

- Rosenbluth, H. & McFerrin Peters, D. (1992). The customer comes second. New York: Quill

- Scholtes, P., Joiner, B., & Streibel, B. (1996) The TEAM handbook. Madison: Joiner.

- Senge, P.M. (1990). The fifth discipline: The art of the learning organization. New York: Doubleday.

- Watkins, K. & Marsick, V.J. (1993) Sculpting the learning organization. San Francisco: Jossey-Bass.

The Agenda

9:00 a.m.

Begin meeting

9:02 a.m.

Review minutes

9:05 a.m.

Sealant proposal

9:20 a.m.

Front desk concerns

9:30 a.m.

Adjourn

Productive meetings are a beneficial way to improve overhead. Effective meetings spark inquiry, dialogue, collaboration, team learning, shared learning, reinforcement, and directed decision-making.

Bear in mind the following when setting up a process for meetings:

__ A proposal presented to the practice`s owner often will have to overcome the apathetic response that meetings are a waste of time. After researching effective meeting management and formatting an effective meeting design (and following it), you can begin to have beneficial meetings. An exceptional resource is The TEAM Handbook by Peter Scholtes, Brian Joiner, and Barbara Streibel.

n Establish ground rules at the onset. This exercise defines expectations. A consensus about each rule will establish that each rule and every member at the meeting is important. Examples of rules might be:

* Meetings will start on time and keep to the timeline that has been set.

* Participants are to come prepared.

* Actions, not people, can be addressed.

* Respect the person talking.

* Respect stated feelings. Everyone has a right to voice them, i.e., "I feel (angry, hurt, happy, thankful) when you (smoke, are late, acknowledge my skills in front of patients)."

* Participants are responsible for completing designated tasks.

__ Meetings should follow a timeline. Each item on the agenda should specify time length.

__ Post preliminary agenda and include a section for staff input.

__ Distribute final agendas with attachments. Allow adequate time for staff to review.

__ Team members should rotate meeting roles of recorder, leader, gatekeeper, summarizer, and timekeeper.

__ Record minutes.

__ Type them up and distribute to team members. The minutes will communicate team members` responsibilities and agreements for action assignments. State action items and which staff member agreed to follow it up. All team members must agree and be accountable for assigned actions. The first order of the subsequent meeting will be to follow up on action items.

Applying a mission to hygiene

A dental office seeks to develop a mission statement, and part of the objective is to connect the mission with cost analysis and the committment to prevent dental disease. In the scenario below, the office examines ways to increase hygiene production.

- An organization focused on prevention will, of course, address prevention in its mission statement: "Our mission is to prevent ... dental disease."

- To encourage team building and to realize its full benefit, team culture should be referred to in the statement. "Our team`s mission will be to serve our patient with care and compassion, to prevent dental disease, and restore the dental structures to optimal health."

- Since mission statements need to take into account a desired outcome of production, this, too, should be included. The "outcome" should "satisfy" the owner, team members, and patients. The practice owner`s satisfaction, for example, may be to produce enough today to retire by age 55. A patient`s satisfaction is quality care. The team`s satisfaction may be profit sharing. In other words, the practice mission serves all of the stakeholders - practice owner, patients, and staff.

- Back to the goal of increasing hygiene production, the team should establish a specific, measurable goal. "Next month, our goal will be a 10 percent increase over last month`s hygiene production."

- The team identifies all sources for production - sealants, fluorides, increasing the timely return of patients, etc. The team identifies a specific avenue (service) of preventive revenue. The discussion, for example, could focus on sealants done through recall appointments.

- The team identifies additional benefits for the practice, patients and themselves. "This will allow the doctor to do more restorative ... Even though sealants may be done while patients are numbing-up, the doctor can then be doing exams ... Patients will not have to come back for another appointment."

- The team also brainstorms to identify problems: "With a 30-minute child appointment, performing sealants is not really possible if prophylaxis, exam, fluoride, and BWX-rays are to be done ... Young patients require an assistant`s help to do them effectively and comfortably for the patient ... We want our patient satisfied and would go over time of appointment leaving the next scheduled patient to wait."

- The discussions lead to solutions: "The next patient may need BWXs, and the assistant may be able to seat patient in another room and take them so the sealants can be done ... The doctor can do the exam on the waiting patient with the administrative front desk person charting the findings. The assistant assists the hygienist with the sealants."

- Other related details also surface through brainstorming: "A patient with an active decay rate may have only a few premolars with susceptible grooves. This is an easy tooth to seal, but it must be prescribed by the doctor ... Additionally, increased decay in the adult patient warrants a fluoride treatment. Well, we know insurance doesn`t always cover this service, but our mission is to prevent disease..."

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