The Front Desk

Jan. 1, 2005
A day of smooth sailing with those appointments begins right up front.

A day of smooth sailing with those appointments begins right up front.

by Cathy Hester Seckman, RDH

As long as there have been dental offices, there has been conflict between staff members. The hygienists are annoyed by the chairside assistants; the receptionists think the hygienists are prima donnas; the business staff can’t stand the receptionists; and the lab assistant feels put upon by everyone.

The most serious conflicts can happen between front-office staff and back-office clinicians, because their areas of responsibility are so different. When a front-office worker is in charge of the schedule for a back-office worker, the conflict can get really personal.

Suppose the receptionist, Rachel, has been told by the boss to see that the hygienist’s schedule is full. Rachel takes that command seriously, and keeps Harry moving like a hamster on a treadmill.

“She doesn’t even give me time to go to the bathroom!” Harry complains. He feels powerless and manipulated, but he hasn’t considered that Rachel is trying to follow orders the best way she knows how.

“He spends half his appointment time chatting!” Rachel counters. She feels righteous about following the boss’s direction, but she hasn’t taken Harry’s working style (or his bladder) into account.

The problem can get even worse when the boss doesn’t give Rachel any orders at all. The dentist might be too busy, too inept, or too uninterested to know what the hygiene book looks like. If Rachel isn’t motivated, Harry’s schedule may begin to look like Swiss cheese.

“He’s just standing there,” Rachel complains. “If he’s so worried about his appointments, why doesn’t he get on the phone?” She may not understand that if she keeps Harry busy doing hygiene, everyone benefits, especially the patients.

“I’m not getting paid to make phone calls,” Harry counters. “But I can’t do my job until she does hers.” He might not realize that if he cooperates with Rachel instead of fighting her, everyone benefits, especially the patients.

If hygienists ruled the world (or at least the dental office), we could think of lots of creative ways to solve this problem. But since we’re not in charge, we pretty much have to take what we get in the way of a scheduler. How can we work better with our fellow employees?

Aretha Franklin could have told you the answer to that one back in 1967: R-E-S-P-E-C-T.

Respecting the front

According to human resources professional Arlene Vernon, PHR, of HRx, Inc., in Eden Prairie, Minn., it’s vital for the dental hygienist to offer openness, friendliness, and respect to people at the front desk. “You have to be really aware of how you’re coming across to them. Just because you have more education, that’s no reason to treat them with disrespect or disdain. You’re not more important than anyone else on the team.”

It can be a tough balance, Vernon says, for hygienists to ensure that schedulers understand their style, their needs, and their timing for providing hygiene services. “Each staff member has his or her own responsibility for serving the patients,” she says, “but sometimes there’s a lack of mutual respect (between staff members) in this relationship.”

There are several causes, Vernon says. “The tone of the hygienist/scheduler relationship could have been established by previous individuals who have held these roles; by the culture and morale of the office; or by the individuals currently performing these responsibilities.”

Sometimes, Vernon adds, there can be a hierarchical perception that the hygienist, having more education, is at a higher level in the practice. That can make it more difficult, she believes, for a relationship to be mutually respectful.

Just as one scheduler could ruin the team, so could one hygienist.

A hygienist shouldn’t approach the front desk with that famous prima donna attitude, Vernon believes. “Understand their sensitivities. Don’t walk up there thinking, ‘I’m the queen; follow my lead. I’m better than you because I make more money.’”

One way to show respect is to keep the scheduler in the loop throughout your day.

“Walk up and let them know when you’re behind, and why,” Vernon suggests. “Did you have a tough patient? Did the dentist make you wait for an exam? Was someone late? Keep the front desk posted on your progress, and see what can be done. Ask for their help.”

“The front desk,” she continues, “takes the heat when the waiting room’s full of your patients. If you keep them informed and make sure everyone works together, they won’t feel like they’re being blamed for something that’s beyond their control.”

A good way to earn respect is by honoring the scheduler’s efforts. If Rachel gives Harry a generous 60 minutes for a recare appointment, that doesn’t mean he has plenty of time to goof off.

“A hygienist needs to utilize time efficiently,” Vernon states. “Are they filling that 60 minutes with chat and socialization, or are they getting right to work to give themselves time to complete their appointment, reset the operatory, and still take a bathroom break?”

Morning meetings can make the day run smoother for everyone, even if the meeting is just between the hygienist and the scheduler. If you can look at the day and anticipate problems because you know the patients, let the scheduler know that, Vernon says. “For example, have two elderly, slow patients been put back to back? If you know ahead of time that something will cause you to fall behind, you’ll have to work your day around that. Explain the problem to the scheduler, and suggest how it could work better next time.”

Keeping in mind Vernon’s suggestions about giving and earning respect, offer to help. A hygienist should never hesitate to share ideas, chase down charts, or make a few phone calls when necessary. Vernon also favors making notes in the chart that can help a scheduler know how to appoint a patient next time.

Patti DiGangi, RDH, BS, a 31-year clinician, speaker, writer, and activist, says that if we truly desire to have more control over our time, we must actively take a role in making it happen. She learned years ago, for instance, that thorough charting offered a good way to control her time. “Whenever I was not in the mouth, I was in the charts, editing for needs. If the time (allowed for a patient) wasn’t correct, I would simply call patients myself and move them around to fit the time I liked. Yes, this required using my lunch hours, coming in early, or staying late, but I found it helped my days flow smoother and more profitably. I didn’t get upset because I was in control of how I would use my time. My advice is to audit charts daily.”

Oh, but wait, a veteran hygienist might think. Does anyone ever read those notes? If they don’t, DiGangi believes, they should. “The telephone and scheduling role in a practice is one of the most pivotal places that predict how a practice runs. If someone says she doesn’t have time to pull a chart, read the notes, and schedule correctly, then perhaps they are not cut out for the role they play in the practice, or perhaps the prioritization of tasks is inappropriate.”

Dee Vecchione, a hygienist in Ohio who once attended a dental “Boot Kamp,” believes firmly that a scheduler should put a caller on hold and check the chart to see what kind of appointment is appropriate. “If a patient has not been in for two years, he or she should be scheduled as a new patient. Too many things can change in that time, both restoratively and periodontally. The clinicians will need extra time to diagnose, do a perio screening, and do a treatment plan so the patient can be scheduled appropriately for the next visit.”

It’s all very well to talk about taking control of one’s time by working with the scheduler, but there’s still the boss to consider. Even a scheduler with good intentions won’t necessarily implement your ideas if the boss doesn’t back you up.

“Mention the problem at the next office meeting,” Vecchione suggests, “or ask for a private meeting with the doctor and scheduler.” If you have ideas for smoother office flow that will make both staff and patients happier, that can only be good for the office. Any dentist should understand and appreciate that, but we all know that some of them won’t.”

“Some dentists don’t want to be confrontational,” Vernon says. “The question is, will he take the lead? Will he say, directly or indirectly, that in this office we function 100 percent? Will he create a good environment for employees to work together?”

Respect, Vernon reminds us again, is the key word. “If the doctor is not respectful of all the employees, taking their needs and ideas into consideration, my advice is to find a practice that does respect you. If your leader isn’t willing to step forward and take control, you step out. It’s not easy to say or do, but sometimes it’s necessary.”

Cathy Hester Seckman, RDH, is a frequent contributor based in Calcutta, Ohio. She can be reached at [email protected].

When egos clash

When a hygienist is faced with a dentist who has abandoned his role of defining and controlling the job responsibilities of the staff, there are things a hygienist can and should do to encourage the office scheduler and help the days flow smoothly.

Dr. Solomon Rothstein, MA, MHL, DD, director of the Institute for Conflict Resolution, says a scheduler is not only an extension of the dentist, but an extension of the dental hygienist as well.

“Yes, she may have a hidden agenda. Yes, she may be baiting you. On the other hand, she should realize that in truth, the hygienist is the professional. She is there to make sure your scheduling goes without a hitch.”

To help smooth office relations, Rothstein recommends observing the scheduler’s personality - “Know who you are dealing with” - and then acting accordingly.

• Is she a sniper? She may be out to show you up or discredit you.

• Is she confused and not very organized? If so, she will try to project onto you her own inadequacy.

• Is she hostile? She may want to rob you of the ability to stay cool.

• Is she a negative person? A negativist will try to get power over coworkers as they tap the potential for despair that is in all of us.

• Is she rigid? For her, is any deviation from normal scheduling very disturbing? If she is rigid and inflexible, let her know you will try to help her keep the scheduling flawless.

Every person is different, Rothstein says, but the work still needs to proceed smoothly. Once you think you have the scheduler figured out, take action.

Stand up to the scheduler, Rothstein recommends, not in an antagonistic way, but firmly. Let her know that her behavior is not acceptable, but don’t lose your cool. Never be defensive, especially in response to hostility. It’s always wise to understand to what degree your own anger is playing a role in fueling the flame of conflict.

Wait until your anger simmers down, and then invite the scheduler to discuss a particular episode with you, perhaps over lunch. “When you said (fill in the blank), is this what you meant?” If you handle things well, she will respect you for your determination not to be the target of her own self-defeatism.

Rothstein believes there is a time when the employer must step in. “The dentist may need to assume his role of authority and say to the scheduler what you, a fellow employee, have not been able to say: ‘Look, the hygienist is the professional, and it is your responsibility to assist her (or him) in every way you can.’”

Rothstein acknowledges that a dentist may be too weak or disinterested to do this, or he may have a special relationship with the scheduler. “If the dentist can’t deal with it, and if a hygienist can’t break through to the scheduler and get her to change her behavior, it’s best for the hygienist to save herself and get another position which is less stressful.”