"More Than Compensation" - Strategies for Dental Team Retention (feat. Doug Gray)

In this episode of the "The Dental Domination Podcast," Dan Brian and Doug Gray, CEO of Dental Business Solutions, discuss the critical issue of staffing and retention in dental practices. They explore the foundational elements of effective communication, organizational design, and the importance of recognition in retaining employees. Doug shares insights on performance evaluations, compensation transparency, and strategies to combat burnout among dental teams. The conversation emphasizes the need for a supportive work environment and the implementation of structured processes to enhance team dynamics and overall practice success. This episode is a must-listen for dentist owners interested in building a practice culture that retains top talent — without relying on salary increases and bonuses alone. Check out the show notes for more information.

TAKEAWAYS

• Retention is more than just compensation; it's about communication.
• A solid foundation of communication leads to successful practices.
• Organizational design and clear job descriptions are essential.
• Recognition and performance evaluations are key to employee satisfaction.
• Compensation transparency fosters trust and motivation among staff.
• Burnout is a significant issue that needs addressing in dental practices.
• Dynamic communication can improve interpersonal relationships within the team.
• Creating an ideal work environment starts with effective leadership.
• Investing in team training is crucial for long-term success.
• Regular check-ins and feedback can enhance employee engagement.

Transcript

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All right, welcome back to the Dental Domination Podcast. My name is Dan Brian. I am with DentalScapes, but I'm not here to talk about that marketing company today. I'm here instead to dig into something that I think will resonate with a lot of dentist owners out there. And that is staffing. And specifically when it comes to staffing today, we're going to be talking about all things retention. And I think if you're listening and if you're working, in any way, or form related to dentistry today. You know that staffing and retention is an increasingly difficult challenge for a lot of practices out there. And so I think there's going to be a lot of relevance in the conversation ahead for you all. So I'm really excited today, though, to welcome a special guest, Doug Gray. Doug Gray is the founder and CEO of Dental Business Solutions. They are a consulting firm for dental practices. And he is based in Arizona, but serves clients across the country and might add in Canada. So looking out for our neighbors to the North. But in any case, Doug, thank you so much for being here today. I really want to, you know, just welcome you to the show and give you a few minutes if you don't mind to just take, take a bit and introduce yourself to our audience. Thanks, Dan. You did a great job. I can just add a little spice to it. I've been in the dental industry for 30 years, worked with close to 100 practices in my career and every type of organizational design you can imagine. I've been with DSOs, Heartland, Signature. I've worked with single locations, large group single locations, multi-group, private groups, you name it. I've helped dentists purchase and sell dental practices. I've brokered the practices. I've experienced a lot of success in a couple of hopeless situations. So you can say I'm a realist when it comes to the business of dentistry. Yeah, as have we all, I think. True. Yeah, cool, cool. So, you know, Doug, you and I have talked offline a lot about this retention issue. And, you know, one thing that that you have always said, and I think it's so true, is that retention is really just the tip of the iceberg. And there's a lot that's happening, quote unquote, below the water line that really impacts it. What do you mean by that? You've said that that, you know, retention is so much more than what I think a lot of practice owners are considering. Where would you start with? it starts with, communication, honestly. And, one of the things that I've done, throughout the course of my, career and my, start with my, consulting firm, dental business solutions is I've created a graphic that is called the pyramid of successful practices. Of course, I. switch back and forth and call it the successful practices pyramid, but it's pretty universal. So once you get your communication in place, everything builds on top of that. It's basically like a house. If you've got a house built on a solid foundation, it's going to withstand a lot of the shifts and tremors of everyday life. very similarly, if you have a solid foundation of communication, then you're going to have a successful organization that weathers all of the shifts and the turns and twists of the dental industry. So. And that foundation is really important because, you know, one thing that we've talked about previously, and I know is top of mind for a lot of the dentist owners probably listening in today, is that, you know, compensation is always going to be a factor in terms of finding and retaining the right team. But there are a lot of non-monetary reasons why dental teams stay in place and thrive. and getting to your point of that foundation, what are some of the keys beyond communication in general that practices need to be focusing on in order to build that team that's going to stay long term? Yeah, one of the things that, you know, once you've got the communication foundation in place, the next level up is what I call the organizational design. And you've got to make sure that that is solid. It's clearly defined. And honestly, if you've got a team that has these job descriptions. Let me, let me kind of go into a little more detail. The organizational design in which positions are identified in an organizational chart and responsibilities are attached to each position. If you're in a small practice, that's pretty easy because the owner dentist is the CEO. He is the CFO. He is the CEO. He's all those three letter titles. that you can think of. pretty much every hat on the rack. Exactly. Then you usually have a lead assistant, a lead hygienist, and a patient services or front desk manager. That's simple. If you're bigger, you need to assign the following responsibilities to your leadership team. And here's where I do a selfless promotion of you. But you need to have a marketing manager. stop you. You have to have a marketing manager that is attentive to anything and everything that is marketing. And that's not just advertising, that's networking, that's making sure that you're getting referrals to the practice, that all new patients are treated in the fundamental way that you want them to be treated. So you got to have a marketing manager in place, call Dan, he'll get that set up for you. and help you with anything and everything marketing. You also got... it. That is just for new listeners out there, that is not the point of this show, but I do appreciate a good shout out. Thank you so much. Always glad to help. You've also got the clinical management. That's usually your dentist or dentists, financial management, HR and facilities. That's all the secrets sauce that you have to have identified in your organizational design. My selfless promotion is that and shameless promotion is that I've got a low tech exercise that I put my clients through with the leadership team so that we can easily identify who's going to do all those duties and responsibilities. And then the next thing I do is define each job with the job descriptions and a list of tasks. So that is really critical. And I can tell you kind of a anecdote, I had a client in the Bay area that brought me on board right after they had been recruiting for a hygienist and they had thought they had hired a hygienist and on day one, the hygienist ghosted them. Didn't even show up. So I sat down. that. Yeah, I sat down with the leadership team, ran through their recruiting process and it turned out that everything was very verbal and they had not identified and defined the job description, let alone the task list. And there were a lot of unknowns and uncertainties. we, some, we summarized that this person didn't jump because there just was too much ambiguity to the position. make sure you've got the job descriptions with task lists and you share that in the recruiting process and you're going to have a lot better, a lot less stress. And it's beyond just processes, people, know, team members in the practice, they want, you know, like we've, we've talked about before, it does go beyond compensation in terms of retention and keeping the right folks in the right seats. And folks want ownership of certain things and they want to feel like the work they're doing is valuable in that they own that. And I think people want a sense of responsibility and fulfillment. And that's something that You really can't have unless you have those things defined. Is that fair to say? That is spot on. And I follow all of the research that they do time and time again. And you'll see in study after study, year after year, that the biggest reason for turnover is recognition within the organization. Either the lack thereof or the fact that they are getting recognized. It's just critical. you can ask the question, well, what is that recognition? I can tell you that it's simple. Performance evaluations. You've got to have the performance evaluations. And I can hear everyone in your audience groaning right now, but it is the secret sauce. It is the nugget. So how do you, when you're consulting with a practice, maybe a practice that's not consistently done performance reviews or maybe even done them at all, that's not at all unheard of, where do you advise that they start with that process? I actually that's perfect timing. Cause I have a client in Oregon right now that we just put those in place and it was a process where you get, I have the outlines for all the job descriptions and all of the task lists. And what you do is you gain the, approval, the input from existing team members and recognized leaders in the organization, they go through and they look at the task lists, they look at the performance evaluations, they add their input and information, and then you formalize it and put it in place. once you've got those task lists, and let me be also a little more specific. There is a job description. And that job description, it is very general when it comes to the expectation and it's pretty subjective, but the task lists that is more important because it actually lists out what the expectation is on a daily, weekly or monthly basis. And it breaks it down to say what your clinical tasks are. what your management tasks are, what your leadership tasks are, and what your team member tasks are. And in the performance reviews, you can actually go down task by task and discuss the individual's performance for these particular tasks. What I like to do is because performance evaluations have a subjective twist to them, this task by task evaluation adds a little more objectivity where, yeah, where you can actually rate their ability to do each task. If they are spot on, well, you celebrate that. And that's the recognition that employees are looking for. Hey, I did this task perfectly where let's say it's patient intake, you always make sure that all of the documents are signed. We give you a high rating for that. They feel better about themselves. Now we'll go into a situation where maybe your case presentation and treatment planning is getting low acceptance rates. Well, let's identify some training that we can do. Let's get you in. to evaluate your communication style and maybe touch on and improve that. Okay, that feels like support for the employee and you provide the training and then you measure subsequently and determine whether or not it's had an effect. So. Now you were talking, I love all of this. You were talking about the importance, you know, this research all suggests that one of the core factors in retaining good employees in the dental practice is recognition. And so, you know, the performance evaluation is definitely part of that, the performance review. And some of those performance reviews, depending on how frequently you do them also, Some of those are going to result in, you know, a compensation bump, a bonus or, you know, maybe a raise, but beyond just financial incentives, what can a dentist owner do to, further recognize their high performing employees in order to retain them? That is a great question. Let me bounce back and hit on the bugaboo that is the compensation. There's been a trend recently. I know that in California, there is a requirement now where there is transparency in compensation. And this is something that I'm glad to see that some of these states are finally catching up to what we've already recognized. And what do mean by that? Is that public facing or what does that actually mean? It's internal. You have a employee classification system where it's pretty basic. The good example that I like to use is we put in place a system where you've got a hygienist one. Okay. That's a defined position within your organization. They have skill set A. and then they are paid a wage range of X and Y. Then you have a Hygenist 2 team member where they have all of Hygen1's skillset plus added responsibilities and they earn a wage rate of between Y and Z dollars. So number one, when you're doing the performance evaluations and the task list evaluation, If you're seeing improvement, then you've got room within their currently defined job responsibility. Let's say for keep running with our example, the hygiene one, let's say you bumped them up another 25, 50, 75 cents an hour or a dollar an hour because they met certain expectations. You do that. at the time of the performance evaluation. So. guidelines you were talking about, that is something that is internally you were saying transparent to everyone on the team. Okay. everyone on the team will see what a hygienist one earns, in as far as a wage range, they won't know the exact amount. Okay. but it's also really important that when you do the performance evaluation, you have a followup date. That's not necessarily in a year because let's face it, a lot of the skills that we ask these team members to train, practice on and improve on. We expect a turnaround within say one, two or three months. Well, let's schedule a check-in meeting three months from now, evaluate their ability to do that job and that responsibility. And if they succeeded, then let's give them that slight bump in compensation to recognize that they are now contributing more to the team than they had been in the past. One of the frustrations that employees will tell you is, hey, I got certified in this, I improved here, I brought in more patients. I didn't see a wage increase for a whole year and that doesn't seem fair to me. So yeah, you recognize when those skills have been achieved by bumping up their compensation. And this can happen over the course of a year. What you'll end up seeing is that employees over the entire year might earn an increase of$1.25, $1.50, but they got the recognition that they were looking for. And let's go back to those studies. What do employees look for in terms of recognition? Yeah. It's the identification of a job well done in those performance evaluations and it's real time adjustment of compensation based on their ability to do the job better. Yeah, yeah. Are there other elements, you know, within the practice culture that can be leveraged then also to recognize outstanding performance? I'm thinking like, you know, those delegated tasks that each employee has within that job description. Are there ways to, you know, modify those or expand upon those as folks, you know, earn that privilege essentially? Like, what are some other ways beyond just the incremental bump in pay, which I think is fantastic. And I love the idea, like you said, of those scheduled check-ins to make sure that everything is on track and then they have something to work toward. What else do you see successful practices doing to ensure retention through recognition? Again, it drops back to the foundation of all successful organizations, which is communication. And that communication can be public recognition of employees' achievement to the next level. So you announce via email or I am a big fan of kind of chat group apps like Slack. Yep. and you can identify different channels that go to different individuals in the organization, use those as public recognition for jobs well done, letting everybody know what's going on. Those are big, those are huge. And I've really celebrated the advent of all of these apps that are out there now that communication. yeah, going back to the original point, it's communicating that employees have achieved certain objectives and have been elevated to higher roles and responsibilities. It's also having available to team members either through payroll websites that you use. I know that HR for Health is really good about this, but you can access at any time the job descriptions, the wage ranges for these different positions within the organization. Again, that transparency is huge. It's now being dictated by States. Like I said before, but I've always been, a huge advocate of making sure that this information is available to employees. Cause it gives them a goal. It gives them something to shoot for. And a lot of times you'll have, a patient services person. Their current responsibilities are receptionists. They're answering phones, they're scheduling patients. They want to expand their duties and responsibilities. Well, go on your employee classification system, look for the skill set that you need to move to the next position that you want to attain. And then you plan, strategize, and organize that Ascension and you give them the tools necessary and the training necessary to get to that next level. Yeah. Now we've, we've talked about, the foundation laying the foundation. We've talked about those five key areas, you know, that you've emphasized that every practice is going to need to have, really well locked down, to get to a point where you are able to build the right team, keep those folks in the right seats and retain them over time. We've talked about compensation and performance reviews and, workplace culture communication, especially important. One other thing that I think a lot of practices, maybe some of the folks listening today are dealing with is burnout. And we all know that burnout is a huge factor in dentistry for multiple reasons. And it can be a real leading indicator of retention. And so do you have any advice for dentists or practice administrators listening in today that are struggling with burnout and retaining their team. Sometimes really high performing team members simply because the stress and the burnout is too great. Yeah, what I have experienced and this is, I don't know, a little wonky. maybe it goes outside of my purview and my, expertise, but psychologists basically say that burnout is a level of stress that individuals encounter when, they keep beating their head against that wall. And, you know, They're trying as best they can, but they're trying doing the same things they've done before, but they're still expecting a different result. It's sort of like that classic definition of insanity. Yeah. what I've found is, I will go in and work with a client and we'll identify where we have slipped in the past. And I will tell you it inevitably goes back to communication. And I break that communication into two key segments. One is interpersonal communication. I call it dynamic communication and that's being able to recognize, understand, and appreciate that everyone has a communication style that is unique to them, that is preferred by them. So what I will do is I will go in and train the team on recognition, understanding, and appreciation for the different communication styles. Then we do some exercises and start to implement. Mirroring is the term that a lot of people use, but I call it adaptation to someone else's communication style. The best example I can use right now is have you ever met somebody who just, when you started talking to them, they rubbed you the wrong way and you don't know why. Never. It could have been that they talk too fast or they talk too slow or they talk too loud or they talk too softly and you just felt frustrated. there's, well that happens, but it's a process and when you can recognize those behavior styles, adapt, and you gain that greater understanding, it opens all new worlds. I had a conference that I taught dynamic communication to, this was way back in Michigan. And I talked about the four unique behavior styles that are out there. And after the training, I got an email from one of the attendees, Dennis. And he said, my God, you just changed my life because I had my brother-in-law coming into the practice. I had diagnosed that he needed a crown and he kept putting me off, putting me off, putting me off. Finally, I used the technique that you taught me because you helped me understand what my brother-in-law's communication style was. Not only did he accept getting the crown, but he wanted the crown done that day. There you go. So it's kind of, it feels like magic after a while, but once you start implementing it, it simplifies your life. It improves your relationships with family members, with team members, and with your patients. So it's huge. I think you're spot-on that you have to adapt your communication style to the needs of the patient or you know in the context of employee retention and culture building to the needs of the employee, but I think it's also Real critical for dentists dentists owners to take that leadership You know kind of responsibility and ensure that your employees are empowered and feel supported in voicing their own, you know, opinions and experiences and that sort of thing because, you know, I think in the day to day hustle of the dental practice, can sometimes I think often become the case where employees feel like they're a little bit stifled in terms of being able to speak up. And so that's super important as well. But I love everything that you just said. You know, I can't thank you enough for dropping by today, Doug. And if I have my way about it, I'd love to have you back on the show in the future. Cause I think there's just infinite things that we could talk about. But you know, one thing you were saying, offline before we jumped on was that, you know, there's this, there's this ideal day that you have in mind as a practice owner. And yet we all know that you get there at 7 a.m. or 6 30 or whenever you get there, you open the door. And that day quickly diverges from that vision. So what would you describe the ideal day looks like for the practice owner, but what does it look like in reality? And how does building the right foundation, the right key areas, the right retention plan through all of the things we've discussed today, how does that begin to mold your experience into what? you've actually envisioned for your practice. Yeah. Um, we had talked about creating a verbal picture here is that verbal picture. And then I'll answer your question. Um, the ideal day is you walk in at 7 a.m. or 7 30 or 7 45, whenever, uh, you have these set. Um, but you walk into a daily huddle and everybody's there. Everybody's ready. The. Usual day is you walk in and one person is late and another person is unaccounted for. So, uh, I'm sure we've all experienced that. So the ideal day is, uh, let's say the patient services representative summarizes yesterday's activity, announces that our production and collection goals were achieved. Everyone celebrates. The actual is. patient services representative can't tell you what production or collection was yesterday. And that can be pretty frustrating. The ideal day, your care team begins to brief you on today's schedule, noting treatment issues for particular patients and suggestions for improving the day's schedule. The way it usually works is the care team walks in the door late and immediately goes to the operatory to treat the patients. So meeting blown. And then at the end of the day, at the end of the meeting, you've got patient services updating the team on upcoming schedules and events and celebrations for the practices and achievements so far this year. What usually ends up happening is the patient services person asks you in a muffled voice that they would like to speak with you in private to discuss a pay increase in various other complaints from staff and patients. There's where the burnout starts. Okay. you know, everything that you just described right there can tell you what retention is not going to be looking so rosy. yeah. So, okay. So now, so let's say someone listening to this now is dealing with that not so ideal situation. Where do you advise them to start? and I, and I can tee you up now. You've teed me up so generously before. I can tee you up to talk a little bit about the services you offer and where folks could get started. Well, it's amazing timing that you have, Dan, because I am going to be offering a free module on the successful practices pyramid where you can actually dive in and see some of this secret sauce. And it's explained in a very friendly and informal manner about how you go about creating a successful organization. And it goes into a little more detail than what we had today about building that foundation of communication and then gives you some tips and hints on putting together your organizational design. And then it goes further up the pyramid where we start talking about putting in place certain guidelines, whether it's how patients should flow, through the practice. I'm a big sports nut. My whole time growing up in my form of years, I played competitive sports. So I call it the patient flow playbook. So you've got scripted plays that should occur with every patient visit. So we go into explanation of those different guidelines. And then as you get to more technical and important legal things, we call those protocols. So there is a certain protocol that needs to be followed for a variety of topics and we offer those as well. And then at the tip of the pyramid is making sure that you devote and invest in training your team. So make sure that once you've got all the three layers previously addressed in place, that you're going to invest time and money into training the team on those things. Yeah. And if you're able to get the vast majority of that information implemented into your organization, you're going to have that ideal morning huddle, not your current morning huddle. Yep. Amazing. Amazing. Well, I think this all sounds great and Doug, I will be adding the resources that you mentioned in the show notes. So anyone listening can go on to the website or wherever you found this podcast and get the link to that module that Doug just talked about. Doug, where can folks go if they just want to get in touch with you, connect with you about a potential relationship or learn more about your business? Yeah, my website is kind of funny. It's dentalbiz, B-I-Z, solutions, plural, dot biz. So I love the whole biz idea. You can email me at degrey at dentalbizsolutions.biz, and we can connect that way. And then I've got my phone number. 520-907-5716. That's an Arizona number, so not toll free. Not that anyone pays tolls anymore. But yeah, that's the best way to connect. I'm tech savvy. We can do Zoom calls. We can meet however you like, but we've got the ability to meet you where you want to and take care of your duties needs and responsibilities. Doug. Thank you for stopping by. I really appreciate it. I think this has been a really insightful conversation and I hope helpful for a lot of folks out there. yeah, I would love to have you back on at some point if you were interested in coming. yeah, let's definitely stay in touch and we'll see what we can talk about next time. Okay, sounds great, Dan. Hey, I appreciate the time and look forward to hearing from everyone. Sounds good. Thanks Doug. Take care and thank you all for listening. If you enjoyed what you heard today or you enjoy the Dental Domination Podcast, please, please, please take five seconds out of your day and leave us a five star review on Google podcasts or Apple podcasts or Spotify, wherever you get your shows. I would really appreciate it. And it is the single best way for us to reach other dentists and practice administrators that we can help. So thank you all so much for listening. Thank you Doug for being here and we'll see you all next time. Appreciate the time.