How Does Your Garden Grow?

The year 2020 provided plentiful opportunities for learning to manage a dental practice through difficult times. No one could have guessed how the COVID-19 pandemic and lockdowns would impact dentistry. Many states ordered dental practices to temporarily close except for the provision of emergency services. When practices were allowed to reopen, some team members, especially those with a family member or members at high-risk, were unwilling to return to work for fear of being exposed to the virus. Others had to stay home to care for children whose schools had been closed. Last, but certainly not least, were those employees who were receiving more income from unemployment benefits than they would if they returned to work at the dental practice.

According to the most recent information from the US Bureau of Labor Statistics, the median pay for a dental assistant in the United States is approximately $19.27 per hour or $770.80 a week.¹ With 2020 US state unemployment benefits that averaged $378 per week² and the $600 per week federal benefit offered during the lockdowns totaling approximately $978 per week while practices were closed, the financial motivation for dental assistants to return to work was dampened. Indeed, 2020 tested the dental team's (and dentist's) mettle like never before.

One of the great lessons of 2020 for dentists was the need to employ engaged, resilient, and adaptable team members. To help create such a team, I use a simple two-by-two grid to categorize each team member based on two critical attributes: attitude and skills. Each attribute is scored as either positive or negative, and the resulting quadrants that employees are placed in are represented by plant-based nicknames.

Quadrant 1: Oaks (+ Attitude, + Skills)

The oak tree seemed to be the most appropriate to represent this quadrant. Oak trees are known for their strength and resilience. The wood from oak trees has been used to build houses and construct ships. It is made into all kinds of useful items, including tools, furniture, flooring, and wine barrels. Oak trees create habitats and provide food for various creatures (including dentists who enjoy truffles). When I read Shel Silverstein's The Giving Tree, I imagine an oak tree. Place team members who have both great attitudes and exceptional skills into this quadrant.

Quadrant 2: Berries (- Attitude, + Skills)

This quadrant is represented by berries, specifically the invasive Himalayan blackberry. Yes, it bears delicious fruit 25% of the time, but most of the time, it is just growing thicker and thornier, claiming more territory, and choking out everything around it. The plant is short-lived, and it leaves behind numerous spiny canes after it departs. Quickly reflect on the problematic team members you have dealt with (or are dealing with) at your practice. Is it their lack of skills or bad attitudes that frustrate you? You rationalize their lousy attitudes by telling yourself things like, "He rubs people the wrong way, but his production numbers are great." He also calls out sick a lot, misses morning huddles, and complains about snack selection in the breakroom. Don't overestimate the value of the fruit by not accounting for the cost of the thorns.

Quadrant 3: Weeds (- Attitude, - Skills)

Ralph Waldo Emerson famously described a weed as "a plant whose virtues have not yet been discovered." I prefer Merriam-Webster's definition, which is "a plant that is not valued where it is growing, especially one that tends to overgrow or choke out more desirable plants." When a berry stops bearing fruit, it turns into a weed. No good gardener will take a wait and see approach when a weed appears among the other plants. The presence of the weed prevents the other plants from thriving. If left alone, its roots will entwine with those of the useful plants and rip them out when it is plucked from the garden bed. Team members with net-negative attitudes and skills are not worthless human beings; they are just in the wrong employment situation.

Quadrant 4: Acorns (+ Attitude, - Skills)

Only acorns can become mighty oaks. I advise practices to hire attitude and train skills. Although it is entirely possible to teach someone what to do, it is nearly impossible to adjust an attitude. One of my clients hired a temporary front desk person with no dental experience as an interim fix while assessing skilled applicants to find a permanent hire. After interviewing several well-qualified candidates, the dentist called me frustrated because he and his team didn't like any of the interviewees as well as they liked their current temp. He didn't understand why the temp hadn't applied for the job. "Simple," I said. "She doesn't have the skills that you think are important." The dentist offered the job to the temp, and she accepted and quickly developed the skills necessary to excel in the position.

I define attitude as the measure of how individuals' mental states are manifested in their personal behavior. Are they honest? Do they come to work with smiles on their faces? Do they work hard during the day? Do they sincerely care about the patients, their fellow team members, and the practice? Are they still smiling and positive at the end of the workday? If so, they have a positive attitude.

Skills are a measure of the ability to perform critical tasks independently and at an optimal level. It's not positioning the high-volume evacuator correctly; it's doing four-handed dentistry. It's not about using the practice management software; it's about calling tech support when there's a problem instead of asking the dentist for help.

When deciding if employees will receive a positive or negative score for either attitude or skills, take a net-positive approach. Do they have the right attitude most of the time? Can they perform the majority of their tasks without error or hand-holding? If so, they receive a positive rating; if not, they receive a negative rating. If you are unsure about their score, it is most likely a negative. After determining net attitude and skills scores for every team member, write their names into the appropriate quadrants in the grid. You can also place them as points with relative distances from the X and Y axes if you want to track their progression over time. Once you've assessed the state of your "garden," you can better identify the appropriate steps to take to tend to it, including the following:

• Acknowledge the oaks for their contributions to the practice. Random rewards with a thank-you note are a powerful way to do this.

• Create an action plan to increase skills for all acorns. Determine what is necessary for them to become net positive on their skills score and immediately start training them.

• Hire or train acorns to replace any berries. Spend your time building skills, not adjusting attitudes.

• Terminate any weeds. Do this Monday morning-first thing in the day. Then work for at least 2 weeks before looking to rehire because you may be surprised by the increased productivity with them gone.

Author Vera Nazarian reminds us that "the master of the garden is the one who waters it, trims the branches, plants the seeds, and pulls the weeds. If you merely stroll through the garden, you are but an acolyte." Of the dentists who read this article, few will fill out the grid, and even less will take the steps to transcend beyond acolyte to master, but of those who do, 100% will enjoy the benefits of having an engaged, resilient, and adaptable team. Happy gardening!

Randy Leininger is a business coach at Troutberry with nearly two decades of executive management experience.