Thursday Troubleshooter: Hygienist worried about poor performing staff members

QUESTION: I work in a practice with a variety of personalities. For the most part everyone gets along. I’ve been asked to reorganize staff and help with poor scheduling. I’m a hygienist with 20 years experience, and another hygienist works here part-time and has 30+ years experience. She is a very nice person but lacks clinical skills to see periodontal patients, and she also does not perform scaling and root planing. Patients are scheduled with her anyway and then come back to me to clean up her mess. My boss does not want to fire her but I’m concerned with how to handle the situation. It’s not fair to patients or me, so I’ve asked the staff members who handle scheduling to please not schedule perio patients with this hygienist, but this is not working. I’m becoming very frustrated. How does an office keep a loyal employee with failing skills? Also, we have a young dental assistant who has been evaluated several times and continues not to perform the job we ask. She also never completed her testing to become a CDA. We’ve reminded her several times that this is important and will help her advance in her career. We’re considering letting her go. How do you deal with all of this? Help!

ANSWER FROM SHELLY RENEE,Shelly Renee Consulting: I commend you for accepting the offer to lead the team. Lack of leadership is probably to blame for this situation. Before tackling the “reorganizing” of the team, here is what you should do:

1. Establish the practice foundation. Meet with the doctor to set your practice standard of care. This standard is your guide to measure team performance.
2. Establish protocols for each department – hygiene and assistants. Hygiene examples are: How often will a FMX be taken? When and how often will a full 6-point perio probing be done? When will you do a debridement vs. a prophylaxis? At what point will you begin to treat periodontal disease in your practice? At what point will you refer out to a periodontist? Will you use Arrestin or perform oral cancer screenings? Outline the time allotments that will be allowed for each procedure. You get the points that will need to be established. The goal is to always have a calibrated hygiene department. In other words, each patient will receive the same high level of services regardless of which hygienist they see.
3. Establish systems for scheduling, cancellation, confirmation, timing of procedures, and more.
4. Write detailed job descriptions that clearly outline performance expectations.
5. Meet with team members to discuss the new standards that will be instituted.
6. Meet with each individual to ascertain their level of understanding and gain their commitment to the new standards.
7. Decide if the team has the necessary tools to meet the new requirements.
8. Determine if any team member needs more CE to help achieve the practice goals.
9. If a team member is not willing to continue growing professionally, you must have the backbone to make the call of whether or not this is still the place for them.

Here is some sample dialogue to institute new standards – “This is a new path we’re taking in our efforts to achieve practice excellence. You’re welcome to join us in this endeavor. We will make sure you have all the necessary tools to carry out your job, and we will offer any training necessary to help you meet our standards. If the direction the practice is taking is not for you, we understand and will be sorry to see you go. We wish you well.”

Allow people the choice to stay and grow or move to another practice that better matches their needs. This is a process and it takes time to implement. Stay united with the doctor and hold your ground. It will be worth it!

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