Staff meetings are hot. All of the management gurus are talking about them. Audio and video tapes are being marketed to help our colleagues bring this element into their management armamentarium. I support this. But as with so many things we have to learn, the process of learning is itself what has to be learned. That is to say there are no cookbooks. This is especially true with staff meetings. They are fundamentally about the relationships in our practice: the relationship with our staffs, our patients and ourselves. This is pretty heady stuff. That said, let's go to work.
My investment in staff meetings is substantial. Measured in terms of production time and staff salaries, it is well over one hundred thousand dollars a year. We hold two one-hour meetings per week and have done so for the past eight years. There is good value here. We have experienced growth each year and while we obviously engage in other revenue enhancing activities, our ongoing staff meetings are undeniably a major force in the overall growth of the practice. But to be quite frank, if revenue growth is your sole concern I'd suggest some other, less demanding, activities. Hopefully in these next few paragraphs I will show you that the richness of the rewards (including but not exclusively financial), far outweigh the effort.
The meeting time is dedicated to the meeting. Seems pretty straightforward. It is not our lunchtime, nor something we squeeze in. It has a kind of reverential quality for the entire staff. I stressed my financial commitment at the outset because our dental profession is left-brain, bottom-line oriented and I know of no easier way of shutting off your listening mechanism than by failing to convey the economic benefits of this activity. But the right brain plays an important role as well.
This other dimension of value, the right brain dominant one, may well be more significant than the one-dimensional return-on-investment measure. Staff meetings create an ongoing context for growth and development for the entire staff, which in turn cannot help but make your dental practice a more vibrant, exciting and satisfying work environment. I don't want to turn this introduction into a treatise on self-esteem, but we would do well to keep this fundamental concept firmly in mind as we review the ELEVEN ESSENTIALS OF EFFECTIVE STAFF MEETINGS.
But our dental offices can't simply be an environment for self-esteem enhancement without any regard to the reality that we are a business. So what is the relationship between them? It is the relationship.
Here is what I mean. Every practice management expert, both inside as well as outside of dentistry, says that success is driven by the relationships we have with out patients (clients, customers.) Chase Manhattan Bank says, "The right relationship is everything." Here is my logic: If the relationships that your staff has with your patients is at the core of your growth, doesn't it follow then, that the relationships that you have with each other must be the model? How can we use the model of a relationship-driven dental practice if we don't constantly work on the very relationships that are the foundation of our work lives? I maintain that we can't.
We start and end on time. We do this even if it means doing less dentistry on the patient prior to the meeting or ending a particular conversation sooner than we might otherwise prefer. This is something over which we have absolute control.
We do not try to be on time, we are on time. NIKE learned the distinction a long time ago. If you think the difference is a matter of semantics, please think again.
If you think being punctual is a small matter let me tell you a little story, with a huge lesson. A few years ago we did a patient survey, and mind you we have a prominent New York City practice, a referral base that is nationwide, a very well-respected office. The responses to the survey didn't highlight our warmth, our service, our wonderful laminates, or our state-of-the-art technology, no, no, it was our ability to see our patients on time, and to dismiss them on time that was cited as our most outstanding feature.
We hook up our phone to the answering service with special instructions to be given to all callers. "Dr. Goldstein and staff are in a staff meeting and they will return calls at 3P.M." While this seems almost trivial let me point out two things of significance.
This message lets your staff know that you are very serious about this meeting and do not permit interruptions. It also clearly tells your patients that staff meetings are a regular office activity. Why is it important that they know that? The very best organizations in the world know the value of staff meetings, and I bet that many of your patients, like many of ours, are both surprised and impressed by the fact that their dental office recognizes the value of this activity. It is a subtle bit of horn blowing (as in blowing your own horn).
This is an especially important ESSENTIAL for doctors, and even more so for male doctors. Why is this so? Our education has been shockingly deficient in leadership training and the training that we have received is so subtly imbedded in the culture of our society that we hardly know that we have been trained. Tough, individualistic and retributive, just to name a few of it's descriptors. It is the General Patton model, "Shut up, listen, do as I tell you, and do it now!" It is hard to capture the condescension of this approach on paper, but believe me it is there as well.
At the Effective Staff Meeting everyone is equal. You leave your title and your privilege at the door. Don't get scared, you'll be able to pick them up when the meeting is over. I am not advocating a leaderless group or one where chaos reins. We have a designated leader for each meeting and we call that person the facilitator. This design creates an atmosphere of openness and frankness. Think about this. We have agreed that whatever is said at the meeting cannot be used towards bad ends, and particularly that which gets said to the doctor, which will be a lot if the meeting is going well. Remember no recriminations.
What we are suggesting is very unusual in our culture, actually it is unheard of. In the beginning your staff will not believe that you are relinquishing your rank, even for an hour, but over time, as trust grows, they will (believe you) and an extraordinary openness will develop. It is quite wonderful but it can't happen in a boss/worker setting. It is much too threatening to them.
Let your staff meeting be a setting without rank.
This feature of our meeting is directly related to the skills of the facilitator. This person, likely the doctor initially, needs to make it clear that participation is not optional and that everyone needs to work as hard during the meeting as they do during the rest of the day. We need to go back to ESSENTIAL 3 to realize the importance of an egalitarian structure. When rank and privilege exist the ability of the staff to be open and honest is severely tested.
The no monopolizing part usually has to do with the doctor who in a lot of cases is neither very skilled at listening or getting input. Occasionally, other staff members are similarly afflicted with mouth openitis (it is the polar opposite of lockjaw).
This may go without saying for many of you but my experience with things that go without saying is that they often go without doing. Someone other than the facilitator should keep a written agenda. This same person should also take an occasional note or two when that is necessary (rarely).
The importance of this agenda is that it becomes part of the process of the growth and development of the practice and that is important.
This is how we begin every staff meeting and it is at the very core of their effectiveness. Our meetings, held twice weekly, set the context for the office. How does this happen? Issues and Good Stuff elicit the thoughts and feelings of each and every staff member. That is how ESSENTIALS 1-5, come into play, they help set the stage for free expression.
We start with Issues because it puts our problems on the table. The particularly valuable part of having these meeting so often is that there is very little time for problems to fester. The issues that I believe are helpful are any particular and current problems, business problems, staff problems (morale perhaps), and frequently some housekeeping issues. When I am the facilitator I try to exclude personal problems, not because they are unrelated to our work lives, but rather because they lead to psychologizing, and none of us are trained for that work. Bad things happen when we attempt to do things for which we've received very little training.
Then we do Good Stuff. The good stuff that is helpful are the small but very special things that frequently go unnoticed. A comment made by a patient about a staff member (including the doctor), an act of particular skill or warmth by a staff member, a terrific phone call, a good piece of work that someone did with a particularly difficult patient, or anything that happened for which someone should be publicly recognized.
For the left-brain thinkers among us let me share my analysis behind this format. Issues and Good Stuff are opposite sides of the same coin. The easier side, the issues or criticisms, are very common in our culture. Generally we don't have a lot of trouble finding fault with people or things. The reason the word Issues is superior to problems or criticisms is that it is much easier for the person who is the object of these criticisms to hear. It is perceived as much less personal and attacking.
The other side of the coin, and actually the side that is actually much more difficult to expose, is the praise side. Having the consciousness and finding the reason to praise is not an easy thing to do. It requires us to be really open and giving to both our staffs and ourselves. Here we really have to get personal. Impersonal praise is like passionless sex, it is nowhere.
This strange sounding ESSENTIAL is very, very important. The only way that Issues and Good Stuff works is to set up some ground rules. The most important of these rules says that you are out of order if you are defensive'. The facilitator makes the judgement. Without this rule the staff meeting turns into a complaint session, frustrating, counterproductive, inefficient and worse. It can kill morale faster than a New York minute.
By definition to be defensive involves a thought process that says we have to protect ourselves from attack. First, we take away the attacking quality of criticism and then from the other side we say that we are not allowed to be self-protective. With these two prohibitions in place we are able to listen very deeply. When we are not allowed to be self-protective, nor are we required to be smart, we listen in a quite different way. This activity is called active, empathic or generative listening, and it the basis of all true learning.
The main way that we support the facilitator is by following the rules. We don't have a ton of them though. Actually, besides the NO DEFENSIVENESS one, there are only a few others that are worth mentioning. We insist that everyone participate enthusiastically. We insist that each staff member is respectful of the process. While this may sound like common sense this manner of behavior demands a level of rigor and discipline that is not so easily achieved. Moreover, if any staff member does not respect this activity, after a reasonable training period, we find them unsuitable for employment. They could be great people with excellent skills but they simply don't fit into our culture. Participation, based on these ground rules, is the major way that we support the facilitator, which is just another way of supporting the culture of our office.
I facilitate our Tuesday meeting while the job of facilitating the Thursday meeting is rotated among the staff. This has been very helpful because it allows each staff member to experience the difficulties, rewards and satisfaction of leadership. In this structure the staff endows the facilitator with a great deal of power and trust.
This is possibly the ESSENTIAL that will be the most contentious, but no more contentious than the word leadership itself. We've been taught a leadership model that is very male, very directive, very individualistic, and generally not very
conducive to collaborative activity. Therefore the resistance to broadening the leadership comes both from the head of the office in the form of individualistic behavior, as well as from the staff which sees leadership as very risky.
If you were to ask your staff, "Who wants to be a leader"? It would be surprising to find more than one or two affirmative replies. No matter. We don't vote on the question anymore than we vote on "Who wants to have a staff meeting, or who likes a staff meeting?" The notion that the office or the staff meeting for that matter is a democratic forum is bunk. Everyone reading this knows this to be true. Think about it. So if it is not a democracy then what is it then?
In this day and age, especially in this day and age, successful organizations require a workforce that values the ability to enhance one's self-esteem. People need to have some degree of self-confidence in their minds, their ability to think and their right to happiness in order to be successful. Their workplace has to support this need for personal growth. If your office doesn't meet this need your staff will either leave or worse still, they will perform at a small fraction of their capacity. As I've said in other ways the days of automatons are over. The Taylor Model of production (from the production line model of General Motors), i.e., "Do what I say, learn what I tell you to learn, don't talk back, and most of all know your place!" is dead.
We hire and train people based on their brains, work ethic, integrity, and most of all on their desire to grow. It is my job, as the leader of the office to grow people. I assume people who embrace growth and development as a way of life will
grow our practice. With that in mind I have decided that I want to work with folks who are responsible for their work and in fact are developing leadership skills. My job, in support of this, is to create a context for growth. I do not, nor should you, reinforce the dinosaur leadership model. It is ultimately growth limiting and therefore suicidal.
This ESSENTIAL has everything to do with leadership. The ability to speak and write clearly and effectively is not only a prerequisite to enhanced self-esteem, but also a prerequisite to anything in life. Both language and communication classes (outside of our office) are supported financially by the practice. I actually believe that all educational activities by the staff are ultimately growthful for the practice.
The preceding ESSENTIALS are all pretty intense. I am intense and our office is intense. Not grim mind you, but intense. The only way that any of this works is by maintaining a sense of humor. None of us, especially me, is so high and mighty that we can't make fun of ourselves. We are human beings, wonderful in many ways and fragile and silly in many others. It is the whole package that makes this work.