restorative/cosmetic/orthodontic/emergency sales as a result of the enrollee being glued to the practice... & considers the BIG PICTURE of many years of premiums received & resulting hygiene exams…he or she might WISELY elect to raise the incentive to each team many times higher per enrollee than the conservative $10 suggested above.
7. Simply hand an employee a check (or preferably cash!!) immediately after they do something extraordinary! This is at the owner or manager’s discretion. Make this extremely visible so all employees can see. Yes, I know that we suggested making sure that any & all incentives are objectively measurable, predictable & precise. However, in addition to these incentives, if an employee does something great, reward them with a big splash!
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10. How to Ensure That Your Rolling Average System Will Fail:
In the decade + since we last updated this paper, chrisad PGAs have enjoyed around a quarter million in-office visits with our clients in every state, most provinces & many nations. In addition, we currently (mid 2023) maintain a growing & active database of nearly 1,500 client offices.
We have found that the most surprising weakness of the rolling average system is that our client’s staff had frequently simply not been trained to understand what they needed to do in order to attain the goals & increase their monthly income!
Frequently, staff we interview are not aware that they have an incentive system.
While these Rolling Average systems encourage staff ownership of the practice… & fosters a spirit of teamwork & involvement…we must remember that your staff may not understand what YOU
naturally & intuitively understand!
In addition to the failure of staff training, if the practice fails to adhere to chrisad-suggested & proven in-office or over-the-phone communication protocol, it will be very difficult for the practice to appreciably grow…great incentives or not…no matter how much or type of marketing we do.
Issues related to money…such as patient’s time off work/school & insurance…are VITALLY important HUGE VARIABLES in the growth process. However, the patient’s pride will rarely allow them to tell you why it is that they are not accepting & returning…or are quietly telling family & friends to stay away!
In the words of Dr. Henry Kissinger: “Trust but verify.” Staff must be repeatedly trained as to how to attain practice goals, how 77
to optimize their communication touchpoints… & their performance must be statistically monitored on a regular basis!
Because the Rolling Average system is designed to make everybody in the office a beneficiary of the overall growth of the practice, one would expect that everybody in the office would be more eager to ROW THE BOAT IN THE SAME DIRECTION, seize on new growth opportunities…or more aggressively identify
& correct areas of weakness.
While staff will commonly make suggestions as to how everybody in the practice can more efficiently attain goals, this does not always happen either!
For instance, (as we have mentioned) additional staff (especially hygienists & doctors) & operatories are almost always needed in order for growth to continue…but staff frequently don’t proactively suggest these additions!
Why? Usually, we have found that many staff simply cannot understand that in order for practice growth to occur, the practice’s new & returning patient productive capacities must first be expanded!
They simply cannot grasp why the practice has leveled off in one or more areas.
In other cases, employees simply do not like change! Change means more work for them! They fail to see the connection between this change & their improved life!
In addition, they are commonly fearful that the newly added person (inherently required in any growing business) will be better than them, make them look bad… & /or work harder!
Even though the Rolling Average systems we are suggesting herein are extremely simple & transparent, some staff are illogically fearful that the addition of new staff (or the cost of 78
adding a new operatory) will negatively affect their personal income levels…or their rolling average incentive amount.
All of the potential shortcomings of this Rolling Average system can be overcome through proper staff selection, regular training…combined with regular open & HONEST
discussions… & other interaction with the Doctor-Owner/Manager.
Another potential failure of this system is when the Doctor-Owner/Manager fiddles with this Rolling Average incentive system…the way they have been trained to do when adjusting a crown… & they intuitively…but unknowingly…make a fatal adjustment.
To be honest, there probably are few if any practices in the U.S.
that exactingly use the Rolling Average outlined herein. Many use one or two of the components. Others make minor (but not fatal) alterations…particularly related to our production basis for compensation.
While most of these in-office alterations have resulted in only minor (if any) negative effects, the only element that should be altered in the Rolling Average plan is the amount that is paid per incremental increase. This dollar amount is inherently tied to the number of employees & economic standards of the local practice market area.
We are dealing with intuitive human behavior. The practice owner/manager typically (erroneously) believes that their practice or market is “different” & therefore the adjustment is warranted.
We are dealing with human behavior.
I can assure you that…as relates to dental patients' thinking & behavior…human behavior doesn’t change much from Zurich or Guatemala City…to Hamilton, Newark…or Hanford!
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Typically the practice owner/manager will hear some speaker, GURU or “EXPERT” at a dental convention (or online!!) who promulgates about how well their bonus system worked. They usually will simply tell you what you want to hear…versus what you NEED to hear!
Most of these “EXPERT’S” practices are GARBAGE by our standards.
However, what the doctor-owner may not understand is that this
“GURU” system might have had success in only one practice…or in a very limited number of offices…over a short period of time… & that other economic dynamics may have had a significant impact…or this incentive-related success may have occurred long ago.
For instance, many huge practice successes have occurred in marketplaces that were artificially ( often illegally) advantaged…such as the Southwest U.S. in the 1990s (particularly Las Vegas), Florida in the 1960s thru early 1980s… & the “oil belt” (Texas, Oklahoma, Colorado, Montana, Alberta) during the 2000–2008 oil boom period.
In these skewed & advantaged marketplaces, even the silliest of approaches would have worked!
But apply these approaches to DEPRESSION ERA Detroit or Phoenix in 2010–2013… & you are dead!
In a broad sense, any & all practice managerial approaches that were successfully utilized in these uniquely advantaged marketplaces can NOT be successfully applied to the rest of the U.S. & Canada!
In recent years, many “EXPERTS” & GURUS are manipulatively (usually very quietly) owned or controlled by the dental insurance industry. The insurance industry’s goal is to drive down insurance billing such as to increase their profit!!!
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BOTTOM LINE: It pays to assume your market is tougher! Use the protocols & approaches that have proven to work in the super tough economic recession (depression?) era regions & no one will be able to touch you in a normal or advantaged marketplace!
So please! We understand your natural inclination to try to tweak this plan. If you do so, please do so very carefully! Call us with your questions or thoughts! Perhaps you will have a new idea we can incorporate into future versions of this document. But it is far more likely that your new idea has already been unsuccessfully attempted… & we can let you know what happened!
11. The Ethical & Business Advantages of Treating Employees With Respect &
Ensuring Their Enjoyment
With Work.
Having a happy place to work & building a great culture is also a great incentive to come to work, stay at the same job… & perform at higher levels. Properly caring for, training & motivating your employees is part of the oil that allows all incentive systems to move freely.
They gotta be happy.
You can have the best incentive system in the world, however, if staff are treated like rubbish, this great incentive system will have minimal effect…at best!
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The old adage of “the customer comes second” comes into play here. We must treat our staff the way that we want them to treat your patients.
In a general sense, if you treat your team with disrespect, they will in fact…in turn…treat patients the same way.
Again, do you know what happens the minute you turn your back or when you are away??
We do.
Yes, even your most trusted employee.
A few years ago I had the opportunity to visit with the world HR
manager of one of the largest & most respected luxury hotel brands in the world. I asked him what he did on a day-to-day basis. He replied, “I simply walk around & make sure all employees are happy.”
All staff must be treated with dignity, respect, properly trained
& compensated in proportion to their performance.
Aside from the very real ethical issues…staff are human beings…with feelings, moms, dads, spouses & children.
They ALL have their own personal challenges…limitations & fears.
While you cannot be taken advantage of by your team…great practice owner/managers must be sensitive & caring in all staff interactions.
My personal experience is that (given the opportunity) any & all staff CAN…over time…be elevated FAR above their current station… & have the opportunity to eventually receive much greater pay.
Everyone in your office must know it.
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We must open our eyes to new opportunities! We must not think of employees as being in boxes.
The clinically average hygienist or (prohibited from practicing) foreign dentist can be evolved into a great practice manager.
We have IN FACT seen once entry level (front desk) staff skyrocket to regional multi-practice managers.
In our own company, once unproductive & VERY obnoxious employees…about whom I received constant requests to FIRE…turned into extremely valuable team members with the right training, cultural environment & extremely lucrative & tightly targeted incentive plan.
It is important that all other employees see that these kinds of hire from within opportunities exist in your practice.
This obvious & apparent internal promotion opportunity ALONE provides an incentive for every team member to work harder & stay at your office.
In fact, many huge national companies rarely or never hire from the outside. One U.S. fast food chain’s regional manager that we know of…in charge of that company’s entire state’s operations…started as a french-fry preparer. Never college. Only internal training…over many decades.
However, as we step away from the dental practice world & look at it from above…we must invoke the old adage of “you get what you pay for.”
Many dental practice staff didn’t even graduate from high school.
This may be penny wise & pound foolish.
Practices start with this handicap…but they can still win.
We are concerned that…while they try to hide it…some apparently can’t read.
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Are we shocked that they perform at lackluster levels?
Your communications with staff… & training methodologies…must take all this into consideration.
Still, these individuals all can be elevated to greater performance
& compensation levels. Listen to them. Inspire them. Monitor them. Make them part of your decision making processes. Bring them to meetings with chrisad. Respect them. Love them.
A great deal of all this has to do with the individual. We have seen arrogant, “know it all” “big time MBAs” absolutely destroy huge practices…while high school grads are often trained, mentored… & incentivized…to be the best practice managers in the world.
Some practice managers have relied on annual vacations (sometimes to exotic destinations!) & year end/holiday parties ALONE to ensure staff satisfaction & optimal performance.
However, you can’t fill your car with gas using party punch!!
There must ALSO be incentives that pay out REAL money AFTER desired performance occurs.
If one were to ONLY use vacations or parties as a reward, it would be best if the benefit was awarded only AFTER a certain growth or production goal was achieved.
But on a case-by-case basis, you might consider simply providing vacations or parties for morale or team building…without regard to hitting a certain sales related benchmark.
Nevertheless, the complaints of many clients echo in my mind: “I took them all to Aruba for a week… & paid for their spouses…but still they quit a few months after.”
It pays to elevate individuals at your office into positions at which they will THRIVE!
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As I write this section, I have just left visiting a major UK luxury brand automotive assembly facility.
We had the time to speak with some of their managers & chat with them about how they work with their employees. One divisional manager suggested that he regularly (lovingly) oversees his employees both objectively & subjectively… & tries to place them in positions within the company that would be best suited for their propensities & talents…thus leading to a happier & productive worker… & work environment.
Yes, it is ethically correct & managerially vital to build a wonderful & enjoyable workplace environment. However, all of this must be viewed as part of the overall incentive system… & coupled with financially rewarding incentives that are tightly focused & immediately PAID such as to drive performance & sales increases.
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12. Viewing NEW & INNOVATIVE
Employee & Patient Friendly Schedule Configurations as an Incentive:
In a broad &
general sense,
the hours that
dental practice
staff WANT to
work are the