Dental Practice Heroes

The Us vs. Them Trap: How Team Division Destroys Profit and Patient Care

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Paul:

Recently something happened in my practice that I think you will relate to. So we have this policy that before any patient can get on the schedule for treatment, their balance has to be pre-collected. It's a system, it works. It keeps patients committed to their appointment, it cuts down on the same day cancellations and it really avoids all the awkward money conversations on the day of treatment because we have them on the day of scheduling. So there's no more new questions about the insurance or what do they cover or what does it cost and everything. So it gets all that stuff out of the way. But sometimes the patients schedule their next visit in the back, maybe with the assistant, maybe with the hygienist, and then the back then brings the patient to the front to pre-collect that payment. Now this often puts the front desk team member in a weird position of being the one who now has to be the bad guy. They're the one that has to now enforce the policy and collect the money.

Paul:

The person in the back made the appointment. Now the person in the front comes up and they say, okay, I need the money. So in order to handle this issue, we made it our policy with our team that if the person in the back schedules the next visit, they must also be the person that tells the patient about collecting the copay and then they walk them to the front so that the front can take the payment. And that is where the trouble started. We had a patient come in as an emergency and the assistant scheduled the root canal and crown in the back. They went over the treatment plan, they went over the fees, they got them on the schedule for two days later, but they never mentioned the pre-collection of the copay. And that's when the patient was then walked up to the front and the front person mentioned it to the patient and the patient was really surprised and kind of upset about it. She said back there, I didn't have to pay anything. So the person in front was kind of frustrated because they didn't do it in the back and she decided well, you know what, it's not my problem either. So then she told the patient don't worry about it, we'll take care of your payment later. Now our front desk team member. She knew the rule, she knew that she was supposed to collect, but she was frustrated that the back hadn't done their part and explained it to the patient and instead of addressing it she thought you know what? This isn't my problem. If they didn't set this up right, I'm not going to be the person to fix it. So she waved it off. She told the patient not to worry about it and when the patient came back for treatment they hadn't paid anything and of course we tried to collect after the treatment.

Paul:

Now this person came into my practice. They went in the back, they had the treatment done. Now this person, also at the front desk, thought about collecting at that time too, before the treatment, and she said you know what? Not my problem, they should have told them about it in the back. So now we did the treatment and we go to collect afterwards. And you can imagine the excuses from the patient. I was told I didn't have to pay anything. I thought it was covered. So now we got an upset patient.

Paul:

Now everyone's pissed off. The front's pissed off because they got put in this situation. The back's pissed off because the front's not doing their job. And the bigger issue here isn't just that we didn't get paid up front. The real issue is what caused it. It's this us versus them mindset. The back dropped the ball. The front didn't want to be the bad guy, so they let the patient slip through, just to make a point. Now, does that sound familiar, that attitude of, well, they're not going to do their job, I'm not going to do mine either. It's a front versus back standoff that happens in so many dental offices and it's one of the most damaging dynamics that you can have in your culture. So today we are going to talk about where this us versus them attitude comes from, why it happens and, more importantly, how do you change it so that your team stops working against each other and starts working as one.

Paul:

Now you are listening to the Dental Practice Heroes podcast. I'm your host, dr Paul Etchison. I'm an author of two books on dental practice management, a dental coach and the owner of a large group practice in the South Suburbs of Chicago. I want to show you how to build a team-driven practice that runs without you, so you can make more money, work less and enjoy more time doing the things you love. I practice just one day a week and I wanna teach you how you can do the same.

Paul:

Now, one thing that we have to acknowledge is that there's a hidden divide in every single dental practice. It's just human nature. We can't get around it. Owners they often think that their staff doesn't care Staff. They often think the owners are greedy or they're blind to their struggles. The back thinks the front is lazy. The front thinks the back has it easy and doesn't understand how difficult their job is. And in the middle of all this tension you can get the not my job attitude, and that's when the little acts of pettiness creep in. A ringing phone gets ignored, rooms don't get restocked or flipped. Someone leaves work early without finishing their duties or the closing duties. Somebody shows up late and skips the morning routine. And it's often not laziness, that's not the problem. It's frustration with other team members that causes this.

Paul:

Now I'll give you an example. I had a client whose team offered blankets to patients, now, every night. You an example I had a client whose team offered blankets to patients, now, every night they would take those dirty blankets and one team member. They would toss the blankets in the washer and then every morning she'd come in and move them into the dryer. Nobody ever assigned this to her, she was just the person that always did it. But eventually she started getting a little resentful. Why am I the only one that ever does this? I swear if I didn't do this, it wouldn't get done. So one night she tested it and she stopped doing it. And guess what? The blankets they piled up and eventually got to the point that when a patient asked for one, there wasn't a clean blanket in the practice. And the rest of the team said well, that's her job, she always does it. But then she thought, well, I'm the only one who cares enough to wash the blankets, nobody else cares. So why should I? And nobody ever offers to help me.

Paul:

See, the real issue wasn't the laziness, it was the miscommunication. No one ever communicated whose job or responsibility it was, so each side had a completely different explanation about it, and that's the story in so many of these us versus them situations. So how do we fix it? Is it systems? Well, sort of, but it's more like addressing it one conversation at a time. There is so much power in bringing these conversations into the light and out into the open. And here's the thing. Systems for your practice, yes, they are essential, but they don't solve everything. A lot of the real problems in your practice are cultural or emotional, and the only way to fix them is through having conversations about them, and as owners, we have to be the person that's leading those conversations.

Paul:

We need to find out what's frustrating our team, what's bothering them, and we got to get it out into the open. Because if it's not out in the open, that's when resentment starts to build and we start having these little petty acts that piss everybody off and benefit nobody. Now we also need to realize that most people have good intentions. We often villainize our team members and other people on our team. We say, oh, they're just lazy, they're just a jerk, they're not nice. But really we got to realize that most people do have good intentions. They don't want to let their teammates down, they want to do a good job, they want to do right. Good intentions. They don't want to let their teammates down. They want to do a good job, they want to do right by patients. But our brains we've often got this negativity bias that wants to create stories on how our teammates they just don't care or they're cruel or they're lazy. And if we just stay silent and we don't communicate about these feelings that we're having, frustration builds and then the resentment follows.

Paul:

So we need to have what I call ripple conversations. All right, let's talk about these ripple conversations, because every action at your practice creates a ripple, and our team needs to understand that. Now there's three types of these ripple conversations. The first one, downstream ripples this is what happens later in your processes if this step is skipped. The second one, team ripples, and this is who else has to pick up the slack when something is not done. And the last one is the patient ripples, and these are the ones that upset me the most.

Paul:

How does it all affect the patient experience? And hence, since it's affecting the patient experience, it affects their health. When your team understands the consequences, it changes how they see their role and their motivation for doing the right thing. The team just simply has to know how every action that they do or don't do, how it affects others and the consequences, far from the people performing them or not performing the action, because no job in a dental office exists in isolation. Everything flows together. For example, if the trays aren't set up before the day goes, maybe the doctor will run late. And when the doctor runs late, the schedule gets a little scrambled and the hygienist gets backed up and the patients wait longer. The front desk is then scrambling to reshuffle, get through it all and ultimately, the patient experience suffers. I mean we're not providing a solid patient experience, which means case acceptance suffers, it goes down and the patients don't get as healthy as they could. So we really do a disservice to the patient.

Paul:

Let me give you another example Now. At my practice the front desk they were constantly overwhelmed. At one point I remember I had somebody come up to me and they said it's just so hard, I don't think I can do it anymore. And I started getting curious what's going on with this? They were just so overwhelmed with all these upset patients who got surprise balances. Now we look at that and we say why. We didn't know it at the time. But as we took a deeper dive into this, we discovered that the insurance information was being entered incorrectly at the start by the insurance coordinator and this bad data entry led to bad estimates, which led to surprise bills, which led to upset patients and conflict at the front desk. So the front desk wasn't the problem, but they were the ones that were catching the downstream consequences of these mistakes that were happening upstream by the insurance coordinator. So that's the point.

Paul:

One person's actions don't just affect their job. They ripple through the team and eventually they land on the patient and your team needs to understand this. So how do we break the cycle of not my job? The cure is giving the team something bigger to rally behind, something bigger than production numbers or the fact that we just do it this way, because this is the way we do it. When your team members believe in and they understand the mission of the practice, they will pick up any slack that is created. They will cover for each other. They'll own their part. But when the mission is just like numbers and production and vague ambiguities, you'll always get things slipping through and you'll always get that resentment as your team notices other people not picking up the slack.

Paul:

So let's frame it differently. Let's frame what's going on in a different way. Let's use rallying cries that can connect every single role that we perform back to the patient. Some examples like hey, let's change someone's life today, let's bring comfort to a patient today, let's help someone get healthier, let's give somebody the best patient experience they've ever had, and all these things. I mean you're saying these with your team. This all ties back to case acceptance. Every little thing we do at the practice affects whether or not the patients say yes or no to our recommendations, and if they don't say yes, they're not getting as healthy as they should be and, honestly, that's on us. We are failing them. So make your mission clear, verbalize it and talk about it often. And when that mission is clear that not my job thinking, that just pisses us off it disappears Because suddenly every single job, whether it's setting up a tray, entering insurance correctly or just answering a ringing phone, contributes to something meaningful. It contributes to the patient getting healthy.

Paul:

At my practice, when we realized this and we started verbalizing these things, started saying these things out loud, celebrating the wins and showing gratitude for our team members that lived this out, everything changed. You felt the cultural shift. The us versus them it just faded away In the front and the back. They were working as a team and they weren't just competing and keeping score anymore. We became one team, united around delivering our best care for the patient. That's what I want for you at your practice. It doesn't just happen by accident. You have to orchestrate it. You have to be part of changing and setting that culture. So here's your takeaways from today If you see at your practice not my job thinking, call it out.

Paul:

Show them the ripple effect. Have those ripple conversations. Show them how every single action impacts others and it ultimately impacts the patient. And normalize honest conversations, like saying things to your team like hey, when this happens or when you do this, it affects me in this way, like I would have loved for my front desk person to say to that hygienist or that assistant that didn't tell them about the copay Like, hey, when you schedule a patient and you don't tell them about the copay for scheduling and you bring them up, it puts us in a really crappy position to be the bad person and it makes us really nervous and it makes us feel bad and we don't even want to collect the balance, which we know. When we don't collect the balance, the patient's less likely to show up and they're going to take time on the schedule from somebody else. I mean, I know that a team member is probably not going to go into that level of depth, but you get the idea. We want them to explain how other people's behaviors are affecting them, because I think the person that's getting this conversation said to them is going to say, oh my gosh, I'm so sorry, I didn't realize that. I will try to do better. So normalize those conversations, model it and remember we talk about systems all the time on this podcast, but they're simply just not enough.

Paul:

The real fix in a lot of practice problems is in having those conversations, and if you're looking for help in having these conversations, if you're looking for somebody to guide you through having these difficult conversations in a way that's productive, that teaches your team how to work together and takes your practice to another level, reach out to us at dentalpracticeheroescom. Set up a phone call with me and we'll discuss it and I'll give you some help. And finally, at your practice, start being the person that is always doing these rallying cries. We're defining that bigger mission, we're celebrating the wins and we're tying those wins back to our mission. Because here's the truth, guys. I mean, the enemy it's not your team. We get so mad at our team, you get mad at your team, I get mad at my team too, but the real enemy is miscommunication, misalignment and just the fact that we're not discussing these things.

Paul:

So I want you to ask yourself where has your team slipped into? Not my job or us versus them thinking, and what can you do about it this week to help them see how their behavior or their role impacts the entire practice or impacts the patients. And, like I said, if you need help with those conversations, maybe you need some help inspiring your team. That is what we do at Dental Practice Heroes. All of our coaches, we've all led large teams. We know how to create buy-in. We know how to create accountability. If you want to practice like that, reach out to us. We'll show you how to do it. Thank you so much for listening and I will talk to you next time.

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Dr. Paul Etchison

Host