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Creating a Culture of Accountability Within Your Practice


In this practice management article, internationally known seminar speaker and practice management consultant Dr. David Schwab gives advice for creating a culture of accountability within your practice. Pick up additional pointers for achieving just that by watching the video that accompanies the article.
schwab   David Schwab, Ph.D
Owner, David Schwab & Associates Inc.
Sanford, Fla.
Dr. David Schwab presents practical, user-friendly seminars and in-office consulting sessions for the entire dental team. Fast-paced, filled with humor and overflowing with "pearls," Dr. Schwab's seminars are as popular as they are useful. An internationally known seminar speaker and practice management consultant who works exclusively with dental professionals, Dr. Schwab has served as Director of Marketing for the ADA and as Executive Director of the ACP. He currently works closely with Straumann to educate doctors and team members and to help them reach their full potential.
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Most dentists tell me they love their profession, with one exception: They don't like being a cop. The dreaded law enforcement aspect of dentistry comes into play every time the dentist needs to police the behavior of his or her dental team. When team members fail to follow practice policies and protocols, the dentist has to step in to deal with the offenders. The goal of every practice should be to create a culture of personal accountability, so team members will police themselves and the dentist can devote more time to dentistry. Here are some tips for creating a culture of accountability.

Practice Vital Behaviors
Change that is intellectually easy can be behaviorally difficult. A recent search on for books using the keywords "diet," "health" and "nutrition" generated nearly 14,000 hits. Add to this the mountain of books, countless magazine articles, Internet advice, and television and radio news segments and programs on this topic, and you get the idea: People have a voracious appetite for information on how to achieve their desire to be fit and healthy. I will save you the trouble of trying to read and digest this plethora of information because it can all be summarized in just four words: Eat healthy and exercise. Everyone knows that sticking to a diet that includes fresh fruits and vegetables and exercising regularly is preferable to a diet of fast food, ice cream and sitting on the couch with the remote control in one hand and a snack in the other.

The problem is not one of comprehending solutions, but of implementing them. If the policy in the dental office is that everyone has to answer the phone a certain way, or use a particular phrase when explaining a procedure, or run through a checklist to ensure that a task is completed thoroughly, then these are the vital behaviors. No one learns how to swim or how to ride a bicycle just by listening and observing. The behavior has to be tried, mistakes need to be made, and the person has to practice the behavior repeatedly until it becomes natural.


Encourage team members to spend less time talking about change and more time practicing the behavior necessary to create it.

Set Realistic Expectations
Once you decide to focus on performance, not potential, you are ready to set expectations. Learning new behavioral skills requires time, fortitude and practice. Suppose a student wants to learn to play the violin. Even if that student begins his or her studies with an excellent grasp of music theory and great motivation, the early days and weeks of violin practice will result in more squeaks and bum notes than mellifluous music. Eventually, though, the student will progress and begin to play increasingly difficult pieces with aplomb.

When team members in a dental office attempt new behaviors, recognize their efforts. When they succeed (only occasionally, at first), offer praise. When they try and fail, encourage them to try again. For example, you may want a team member to say, in certain situations: "Mrs. Jones, we need more patients like you. Please tell your friends about us." This behavior will at first be terribly awkward, just as it was initially hard for the music student to hold the violin in the proper position. If you expect behavioral mastery at the outset, you will be disappointed and your team will be frustrated. If you are willing to coach, gently correct and beam with approval at every inch of progress, then goals will be achieved and team members will enjoy exhibiting their new skills.

Make the Evaluation Process Work for Everyone
The best evaluation process is one that gives the team member every chance to excel. Each team member should have a written job description. These job descriptions should be organized by major categories. For example, some categories in a job description for an office manager might include "front office administration," "scheduling" and "patient communication," among others. For each of these broad headings, the job description should include a list of specific duties.


A job description that is organized in this manner can be easily modified to create an evaluation form. Simply list all the major categories (but not the specific duties under each heading) on a form. Use a scale of 1 to 5 next to each, with 1 indicating poor performance and 5 designating excellent performance. Be sure to give the team member the job description and the evaluation form at the beginning of the year (or when he or she joins the practice).

The evaluation process thus becomes a test for which the employee knows all the questions in advance and is motivated to try to excel in the specified categories.

Prior to conducting the evaluation, ask team members to evaluate themselves. Then fill out your own evaluation and meet with each team member privately. If you and the team member concur, for example, that "4" is the proper rating for a certain line item, this makes the conversation very easy. If the team member rates himself or herself lower than you do, then you have the happy task of having your evaluation (the one that counts, ultimately) trump the lower score the team member gave himself or herself. When a team member gives himself or herself a higher score than you feel is deserved, you can ask for behavioral evidence from that team member to justify the higher rating. Usually, the dentist ends up pointing out where the behavior is falling short and giving the team member specific advice on how to raise his or her score the next time. In these instances, it is advisable that the dentist tell the team member that his or her behavior in this particular category will be reevaluated in, say, three months, with the expectation that there will be improvement. Giving team members a chance to pull up their "grade" is often motivational.


By identifying and practicing vital behaviors, setting realistic expectations and using evaluation forms extrapolated from job descriptions, you not only help hold team members accountable, but you also create an environment that encourages all members of the team to police themselves. When team members see a one-to-one correspondence between their behavior and their evaluations, they are motivated to succeed and proudly hold themselves accountable.

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