Reading Gallup’s 2021 book Well Being at Work: How to Build Resilient and Thriving Teams by Jim Clifton and Jim Harter, has challenged me to think about:

How do we develop a dental practice in which all team members thrive?

The things that immediately come to my mind for improving front office and clinical team morale are respect, appreciation, having a voice, genuinely fair compensation, and workplace flexibility to manage true personal urgencies such as illness and maternity leave–without feeling you are letting down the team. To reduce stress and enable all team members to do their best work and experience connection with patients, dentists can improve block scheduling to focus on doing more procedures in a single appointment while seeing fewer patients in a day.

Perhaps, more things will come to your mind.

5 Elements of Net Thriving Teams

Through millions of interviews worldwide, Gallup has found there are five universal elements of well being. Gallup says they are the five things that count most and that we need to focus on to develop “net thriving teams.”

Career well being: You like what you do every day.

Every day, you and your team members have opportunity to do the type of work that you individually do best and have unpressured time to do your personal best. As dentists, we often talk about doing more of the dental procedures we love doing most. What does each of your employees do best and want the opportunity to do more?

Social well being: You have meaningful friendships in your life.

For dentists, a meaningful friend is apt to be a like-minded colleague or mentor. Your best friends might be a “mental Board of Directors” — the voices of influencers you trust running through your head. But do all your team members have a meaningful friendship at work? Collaborating around a central philosophy of care helps build meaningful relationships.

Financial well being: You manage your money well.

As dentists, we talk at The Pankey Institute about defining for ourselves what is enough money to lead a balanced work life and personal life. It is also appropriate to talk about what is enough to maintain a practice in which every team member can financially thrive. As small, private employers, what changes and team buy-in might be required to wisely stay on track?

Physical well being: You have energy to get things done.

Eat properly, get healthy sleep, and exercise daily. Foster a spirit of health within the practice. Live it. Celebrate it. This will become part of the team culture that enhances the well being of everyone.

Community well being: You like where you live.

Humans innately strive to be part of something bigger than themselves and to support the social environment in which they work. Our practices are communities that often feel like large families. We can create and foster a practice vision that includes “being a thriving, supportive, well being community.” We can “write that on the wall” in our team meetings and in how we interact with each other and the patients we serve.

Closing Thought

A culture of well being puts overall well being upper most.

I encourage you to think and journal a bit about the actions you can take to support the five universal elements of well being…the five universal elements of a thriving life.

Why is well-being at work so important now?

In the latest Gallup organization interviews, one in four Americans reported feeling a lot of sadness the previous day. During the pandemic, a mental health crisis has impacted employee and patient sense of wellbeing. A large 28% of U.S. employees reported feeling burnout on the job very often or always. One-third of Americans have shown signs of clinical anxiety or depression, and the current state of suffering globally has risen significantly to seven in ten people worldwide.

The authors of Gallup’s 2021 book Well Being at Work: How to Build Resilient and Thriving Teams, Jim Clifton and Jim Harter, say “The right place to start reversing this trend is in the workplace. People want a good job with a good manager where they can use their strengths every day,” and this book empowers leaders and managers to create thriving cultures that involve (emphasize) employee participation and focus on the wellbeing of everyone involved.

Of course, when I read this book, I found it immensely applicable to dental practice. I was energized to communicate with you the basic Gallup findings and add my personal push for dental practice owners, leaders, and managers (in most cases, private dentists) to focus on building resilient, thriving teams. And Mary Osborne and I offered to start a Pankey Virtual Study Club centered on just this, titled “Ignite Your Team.”

Currently in our world, when the overlapping demands of work and life are greater than ever, maximizing employee wellbeing takes on urgency.

Flexibility within a framework is the future of work

Clifton and Harter state that “Organizations have the power and responsibility to improve their employees’ wellbeing. When leaders and managers cultivate the whole person at work — not just the employee — they promote the success of every individual in the organization.”

To maximize your team’s wellbeing, Gallup’s leadership experts encourage us to regularly gather feedback from employee about their opinions, needs, and experiences, then make decisions based on not only this feedback but also our experience, foresight, and understanding of the business (dental practice) and its goals. In a dental practice, this means placing high value on a culture that is positive, supportive, and focused on the overall wellbeing of yourself first and team members next, so together you can focus on the wellbeing of your patients.

I am reminded of two “Rich-isms” or teachings that Richard A. Green promotes within the Pankey community.

1. Always recognize that the team that co-develops a framework of structure and systems, embodies and operationalizes these systems. “If they help form it, they own it and support it.”
2. Make your office look more like an educational organization by creating a developmental, coaching, counseling, and consulting culture. Listen to the team. Involve team members, while considering your values and life-long vision supporting your mission and purpose.

What adds up to a thriving life?

In this new book, we learn that Gallup’s 100 million interviews worldwide have resulted in five universal elements that “add up to a thriving life.”

1. Career wellbeing: You like what you do every day.
2. Social wellbeing: You have meaningful friendships in your life.
3. Financial wellbeing: You manage your money well.
4. Physical wellbeing: You have energy to get things done.
5. Community wellbeing: You like where you live.

To develop a “Net Thriving Team,” start with reflecting on and journaling about these five stages of wellbeing. I’ll be back with “Zeroing in on Wellbeing at Work (Part 2)” next month.

For years now, I have followed this simple reflective process. I hope it proves to be helpful for you in your personal and professional growth. My reflection BAG contains Blessings, Accomplishments, and Goals. 

Blessings  

List all the blessings you are grateful for; family, friends, satisfying work, freedom to worship, health, warm home, living in America, etc. Give thanks for the blessings of life. Gratitude is essential to the journey, and too frequently in our “push” to “get ahead”, we forget our core blessings. Compared to these Blessings, getting ahead isn’t the most important thing. INVOLVE YOUR FAMILY THIS YEAR…even your two-year-old will feel the gratitude. 

Accomplishments 

Summarize all things you accomplished throughout the year. This is such an important step to write down because it never ceases to amaze me, when I reflect, just how much I have accomplished. I always need my calendar for this one because I find I forget all the little things I did do throughout the year. The journey can be so (apparently) slow and frustrating, that seeing how far you progress each year is very important. 

Goals 

Now that you are grateful for the mess you have gotten yourself into, write down your goals for the coming year. Come up with 20-30-50 ideas. Many times, the “best” ones are the last few that pop into your head. Remember the Pankey Cross and plan in all areas, Work, Love, Play, and Worship. Know Yourself, Know Your Patient, Know Your Work, and Apply Your Knowledge (this is a part of that). Spend as much (or more) time and money on the behavioral - communication aspects of care as you do the technical aspects of dental care. Plan to integrate Joy, Wonder and Relationships into your work. 

Set Aside Quiet Time to Reflect

Please set aside quiet time to do this. The first time it may take several struggling hours. I reflect several times a year and still set aside a few hours, but it has become almost like meditation for me and is one of the most important things I do for myself. I do this to continually refocus my efforts and to enhance gratitude. This has become part of my personal Peace process.

Thinking Beats Regurgitation

Throughout our education process we dentists are taught to memorize and regurgitate…not to reflect nor to think (I believe, at times, thinking is beaten out of us). We look to others to provide us the “answers” we might be missing that will guarantee our passing the tests (success). Sometimes we glance at someone else’s success and, thus, we let others define success for us — and we all are obsessive enough to bust our butts for an “A” to please someone else. If we just miss being perfect, we feel like such a failure. And for those of you paralyzed by needing to be perfect…Perfection is a disease. The goal is excellence, not perfection. John Wooden said it best:

“Success is the self-satisfaction in knowing you did your best.”

It’s critical to have discussions with team members about what behavioral influence entails.

Behavioral conversations are efforts with patients to encourage health. They involve discovering current perceptions and encouraging choices for improved health – especially dental health. Considering today’s understanding of the oral-systemic connection to overall well being, we owe it to our patients to continually offer them the opportunity for health.

Avoiding the BS Trap

As such, it is essential to consider that social conversation is not behavior conversation. I call it the BS trap. Yes, there is a social component to behavioral. Connecting on a personal level is critical.

As Robert Cialdini says in his book “Influence,” people like doing business with people they like. In a relationship-based practice, full engagement with patients is critical. Engagement increases the likelihood of being listened to and influencing healthy behavior.

AND, we must avoid the BS trap. Conversations need to be about them, not us. Conversations to influence values and behaviors need to be about patients. So, how do you know when social conversation has slipped into BS?

Encouraging Meaningful Discussion With Patients

The key is to realize when you are interjecting yourself into the conversation. Avoid personal words: I, me, my, mine, us, we, our, etc. It is not about us – our story – but about the patient, the patient’s story, the patient’s health values, and their objectives.

Avoid:

• “I went there …”
• “When I did that …”
• “My experience …”

How do you shift from social (the starting point in conversations) to behavioral? Have one or two powerful questions to shift the conversation:

• “How are you feeling about your health?” (Perhaps more powerful than: “What has changed in your health?”)
• “What are you doing to enhance your health?”
• “How are you taking good care of yourself?”

Then “Stay in the Question.” Continue to follow the thread they share. Remember …

Their first response is not the answer. It is their first response.

Questions are NOT the key. Listening is. Go below the surface.

• “What else?”
• “What do you feel?”
• “Say more about that.”
• “Do you have any ideas?”
• “Tell me more about …”
• “Yes, I understand.”
• “I’m glad to know that.”
• “Thank you for sharing that.”
• “Is there anything else?”
• “What is your suggestion?”

These questions work both ways. Teaching you to turn the focus onto the patient and teaching the patient to communicate their needs more clearly.

Have you read this article from team behavior expert Mary Osborne on understanding a hygienist’s true expertise?

The ABCs of dental office organization tell us how to prioritize our time, energy, and resources so that we can provide the best care possible. In Part 1 of this series, I discussed the definition of the three main ABCs: administrative tasks, behavior tasks, and clinical treatment.

Read on for how to implement an understanding of these principles into your practice efficiency protocol:

Dental Office ABCs: Prioritizing

How can you get better at organization and adherence to the ABCs? Here are three steps – 

1. Ask each team member to list all possible administrative tasks. This includes tasks they do not need patients to be present for or where they need uninterrupted time for maximum efficiency. You should generate your list as well.
2. Next, have them create a list of behavioral tasks.
3. Finally, have your team members delineate their clinical processes. This should lead to discussions on tray/room set-up, treatment preparation, and efficiency.

These lists can be developed by each person in the office prior to a staff meeting. Then, in a team meeting you can discuss each person’s “top 3” and consider periods in the schedule throughout the week where each team member can carve out A – B – C times.

A Productive Daily Conversation

For example, our business associate at my dental practice sets aside Thursday morning for uninterrupted “A” time to catch up on delayed insurance claims, payment calls, etc. This means our relationship coordinator/primary chairside rotates to handle incoming calls and our assistant chairside rotates to chairside duties. Everyone loves the cross-training and variable challenges.

The coordinator answering the phone does not need to be under pressure. If a call comes in for the business associate, they simply state, “Sue is busy right now. May I have her return your call in an hour?” or some such reassurance.

When done well with open respect of each person’s priorities, this can evolve into a daily conversation. For example, the relationship coordinator may ask for uninterrupted time to call a certain patient about emotional support or a referral to a specialist. The business associate may request time to call an insurance company.

Have fun with it. Your approach will evolve and remember that mistakes are the fruit of great progress. Celebrate/laugh at them. Keep at it and the ABCs will change your practice.

Efficient office organization leads to effective office functioning. It frees team members up to take care of people. It can greatly increase effectiveness – defined as helping people make choices appropriate to their health and improving efficiency of care delivery.

Dental office organization starts with understanding tasks and roles:

ABCs in the Dental Practice

A = Administrative Tasks

These are tasks that can be done when patients are not present. For example, planning next week’s schedule for effectiveness or following up on and processing insurance claims.

More examples:

• Filling the hygiene schedule.
• Working the re-care system.
• Supply ordering.
• Treatment planning.
• Specific treatment pre-planning.
• Review of x-rays, charting, and chart notes. 

B = Behavioral Tasks

These are usually communication efforts with patients. Focused, uninterrupted time is available.

Examples:

• Talking to new patients on the phone.
• Care instructions following treatment.
• Treatment conversations.
• Financial arrangements.

C = Clinical Treatment

Here the patient is present. Ideally, treatment has been organized and so thoroughly thought-out beforehand that care proceeds rapidly and efficiently.

I have heard it said that treatment can be fast and good, fast and bad, or slow and bad. Slow and good is virtually never possible.

Speed and efficiency respects the patient’s time and emotions. This is why effective clinical organization must include pre-planning. 

Understanding Office Roles

If you understand these roles for yourself and each team member, your week can proceed much more effectively. Many dentists do not feel “productive” unless they are chairside spinning the high speed, but this is not always the case.

If you consider your role in the practice as similar to a CEO (vision and implementation) and/or COO (efficient operations) you must consider “A” time important.

If you consider yourself an advocate for your patients, your “B” time – especially quiet time to ponder treatment options as well as learn and grow in communication – is essential.

To increase your dollar per hour productivity, you must practice continual chairside improvement and time management in treatment procedures. This is the only way to accomplish more work in a single day.

To be continued …

Listening is a skill everyone likes to talk about but very few actually know how to enact. It’s more challenging than we might think to really shut our mouths and pay attention without constantly interrupting or adding our two cents.

In my last blog, I talked about offering an empty presence and letting the person finish their story. Here, I cover other important listening skills. We should all make the effort to speak less and hear more.

Become a Truly Great Listener

Listen for Their Heart

Listen for the feelings behind the words. Can you hear voice fluctuations? Can you read their eyes? Feelings of regret, fear, grief, hope, etc.

Using the balloon symbolism, I picture a red balloon filling with their emotions as I listen for feelings. There is no higher form of communication than heartfelt, empathetic listening. The balloon symbolism may feel silly, but it will help.

You cannot be heard until the patient’s emotional bubble is deflated through your quiet confidence and empathetic understanding.

Ask Permission to Go Forward

When you ask for and receive permission to offer advice, you are much more likely to be heard. This is truly one of the most intuitive questions you can ever ask and does wonders for building rapport: “May I give you some initial thoughts?”  or “May I have permission to consider what you have told me and study possible solutions?” 

Once a person has given you permission, they are more likely to become a partner in solutions. 

There is no greater gift of healing, expression of love and builder of self-esteem we can offer those special people we care about most, including our family, friends, patients, co-workers, and community, than listening. Everyone wants to be heard.

How do you practice listening skills? Let us know in the comments section below!

Dr. Pankey had an advantage most of us do not that made him a world-class listener. Often labeled a disability, Dr. Pankey was hard of hearing. Because of this, he had to learn how to listen intently to his patients.

Dr. Pankey learned to listen for feeling over content. Listening is a skill that can be developed and improved. It requires intention and attention. One must practice! Here are a few tips that help:

Actionable Skills to Become a World-Class Listener

Offer Your Empty Presence

Most important of all is the intent to be present. Be here, nowhere else. Never enter a room without taking a deep belly breath to quiet the sympathetic, judgmental lizard brain and enhance the empathetic brain.

Empty presence is being fully available for the patient with no agenda, no busy talk going on in your mind, no judgment about what is said, no mental correcting or explaining chatter going on in your head for when you get a chance to talk.

I like to imagine an empty white balloon completely devoid of anything. My objective is to simply let the person fill it with their own thoughts and feelings. Really focus on what they say and how they say it and especially the feelings behind it. You are a gatherer of their information, not an explainer, corrector, teacher, or judge.

Let the Person Finish Their Story Without Interruption

Take a deep belly breath again once they have gone silent. What they just told you is simply what they first told you. There is probably more. When a person has finished their story, the silent period is when they are understanding what they just said.

Silently offer your open heart with compassion, allowing them time to spill out everything they need to say. Silently count to 10 before speaking, then use simple encouragements: “Is there anything more,” “Yes, I understand,” “I’m glad to know that,”  “I’m sorry to hear that,” or “Tell me more.”

To be continued …

Do you want to develop an emotionally engaged, relationship-based practice where people choose you over the insurance-driven option? It is not going to be your technical knowledge that does this. It is in how you touch people’s hearts.

Trust or the lack of it can be built within seconds. How can we best emotionally engage people? Immediately as you greet a person, focus on them – each and every time. Give the S-O-F-T-E-N approach a try:

How to Develop Trust in Only 10 Seconds

Smile: A welcoming greeting in any language.

Open up: Open body language – relaxed, welcoming, arms open, palms up.

Forward body lean: Again, welcoming, not aggressive. A slight forward lean can demonstrate attention, interest, engagement.

Touch: Lightly when and where appropriate. Studies indicate people feel a warmth of endorphins with a light human touch. A gentle handshake with the left hand also touching lightly can work. A light touch on the shoulder or arm is effective too.

Eye contact: This is the most important thing you can do to gain immediate connection. Immediately look the person in their right eye. Not to stare. Especially while you are speaking to the person. Recent studies indicate eye contact has dropped to the 30-60% range in today’s digital smartphone era. That’s a huge drop into disengagement. It drops even more when one is speaking.

We are losing human connection to the soul, yet 60-70% eye contact is ideal. Practice glancing into their right eye consistently. Yes it feels awkward at first and yes it takes conscious intent. Why the right eye you ask? Mostly so you don’t stare at the bridge of the nose and look cross-eyed, but also the right eye engages a person’s creative, intuitive parts of the right brain more quickly.

Nod: A slight affirmative nod as the person is speaking is a strong indicator to continue. Studies indicate a person even accepts criticism and correction better if one nods slightly while presenting bad news. A nod tends to indicate support, not just agreement.  

Interestingly, the reverse is also true. A shake of the head while giving supportive news can create a sense of skepticism. Yes, I can look like a bobblehead at times. Emotionally engaged attention is becoming a lost art. But it is the greatest way to touch a person’s heart.

In dentistry we have a huge advantage. We have multiple interactions every day with good folks who trust us enough to do scary things in one of the most intimate parts of the body. We can grow that trust to emotional engagement one person at a time.

What is the result of an army of emotionally engaged dental missionaries? Lots of loving people who say: “You have to go see my dentist. They’re the best in the world!” Whose world? Theirs.

How can you achieve an emotionally engaged, relationship-based practice where people choose you over the insurance-driven route? Practice, practice, practice – on people, not just their teeth. Start with your family! And love the practice.

During an occlusion-focused hygiene exam, there are certain things the hygienist should pinpoint. This will help them develop a deeper relationship with the patient as well.

A Hygiene + Occlusion Exam

What the hygienist should look for:

1. “Can you eat/drink cold things comfortably?”
2. Subtle wear facets – those shiny spots on the edges of teeth.
3. Chipping of the edges of teeth. Can you get the patient to line up an incisal “chip” with a sharp edge of a lower front tooth?
4. Fremitis – that subtle shimmying of an upper front tooth when you gently place your fingernail on the facial of a maxillary incisor and ask the patient to grind side-to-side and front-to-back.
5. NCCL – could that be from clenching or orthodontic expansion? Both/and?
6. Persistent marginal inflammation that could be a sign of clenching (or an imbalanced bite).

The hygienist’s role is to raise patient awareness –  to “discover” changes that can be brought to the doctor’s attention for long-term protection of the patient’s teeth.

The doctor’s arrival for an exam is the time that real skill and teamwork begins. The hygienist takes the lead and informs the doctor what they (hygienist and patient together) have been discovering/discussing.

Many times, the most significant questions come when I am behind and feeling rushed. Our goal, practiced for years, is for me to get in and out of the hygiene room in under 5 minutes. Therefore, our total goal together is to encourage the patient to schedule another appointment for a more thorough evaluation of any changes/discoveries.

The hygienist then supports and reassures the patient about the need for a more thorough understanding to protect their teeth and eating for a lifetime. They confirm the uniqueness of a full understanding of teeth, harmonizing bite forces, and oral-systemic health and well-being.

“This is what sets our office apart. Together we strive for the best in your total oral health prevention.”

A well-thought-out and choreographed hygiene appointment can truly establish you in the relationship-based sector of dental care.