It may be argued that Team building is merely a popular buzzword in today’s business world. However, it can be demonstrated that the time and effort (which can be enormous) required to develop a well-informed, clearly communicating group of co-workers, will pay off in ways that are hard to imagine until you’ve done it. Once the group of individuals comes together with a common goal and a common vision, it can formulate plans for systems, support the doctor in innovative ways and take a large step toward creating a place of work that everyone is more likely to enjoy.

The process requires a commitment of time for meetings with the help of a facilitator. During these meetings, the group can work together on the issues previously described, such as communication skills, mission statement and generally learning how to be a cohesive entity that pulls together for the common good of the practice and themselves. This does not happen by itself, does not happen without some bumps along the way and it does not happen because the doctor dictates it—it requires both guidance and trust by the owner/doctor. To jump into that unknown realm will be an adventure, but one that can surprise even the most skeptical. Assistance from an outside facilitator is invaluable to the process of Team-building. Let’s examine the steps and stages involved in this process and how the outcome will benefit the practice.

Facilitator

It is not uncommon for dentists to surprise parents by having children come into a practice and cooperate fully with every direction from the doctor. While the parents are amazed, the dentist recognizes something universal in human behavior—children will usually manipulate their parents and misbehave for them far more than they will for anyone else, in particular an authority figure. Likewise, many of us might maintain an air of bravado behind the wheel of a car until pulled over by a policeman. Suddenly our demeanor shifts to polite, understanding, attentive and different in almost every way from our earlier behavior. Is it any surprise, then, that employees have difficulty approaching “the boss,” no matter how good the relationship, when they have difficulties, suggestions or problems? This is not about the doctor; it is about human nature. If the decision is made to work toward building a genuine Team, a facilitator will prove invaluable in that she can provide the safety net for employees to open up. This can, in my opinion, only be done initially with an outside person and with the explicit approval, if not encouragement, of the doctor. We have been working with a facilitator for 10 years and are still learning from her every time.

Long term project

It is unrealistic to assume that an undertaking as grand as building a Team can be done in a short time. Any doctor embarking on this goal should assume the goal is months, if not years away. In our society of instant gratification and easy access, this may provide one of the biggest challenges to pursuing this worthy end. Dentistry is primarily task oriented and often sees a tangible result in a 30-minute appointment or perhaps, at longest, a one-year treatment plan. To consider a project of lengthy duration will require mental discipline on the part of the dentist. Not only will it require time, but the progression of the process will not always be linear. There will definitely be ups and downs and possibly even moments when the doctor will feel like “chucking it all.” If the doctor understands the value of Team (with a capital T) and has a clear vision as to its role in the practice, it becomes easier to stay the course during the frustrating times. The process in our practice showed many signs of Team after a couple of years, but to have attained the goals I had foreseen required almost 10 years.

Meetings

Regular meetings are critical to the evolution of Team. These are not the basic, short, end-of-morning meetings, but rather ones that have been scheduled ahead of time so that everyone can attend. They should be a minimum length of half a day. Holding the meeting at a neutral site is also more effective than trying to squeeze everyone into the lounge or sitting in the waiting room, which is rarely configured to have a discussion or to work as a group. We rent a meeting room in a church just down the street from the office for our meetings. It is inexpensive, clean, roomy and has tables and chairs that we can set up in any layout we prefer. In spite of “losing productive time,” I suggest making these meetings on a regular workday. This will insure attendance and will send the message that it is genuinely important. There are many ways to arrange these meetings. In our practice, we have had two full day meetings and two retreats (of two days’ duration) each year. The retreats are overnight and are required in our practice. We see it as not only a learning time, but also a time for everyone to spend time together outside of the daily work schedule. This raises morale and enhances our appreciation of each other as human beings rather than “dental assistant” or “receptionist.” As time goes on and the Team evolves more and more, the full day meetings may be supplanted by your own internally run monthly meetings. In our practice, we hold monthly meetings (half-day) that include material formally withheld for facilitated sessions.

Resistance

Some individuals, once they recognize that they are being required to step up to a higher level of personal responsibility, may choose to leave the practice. This is to be expected. At these moments, it is of great importance that the doctor is clear about his Vision. Surprises may be in store for the employer as he sees some of the “best employees” leaving. If the value of Team and the goals of the practice are well defined, it will ultimately become clear that the best employees will be Team players and will both support and embrace the Team concept. Resistance may come in many disguises. Some employees will sabotage the meetings by dominating meetings with personal issues that may reflect their unwillingness or fear to deal with other employees effectively. Others will prefer the more traditional power structure of a company, where the “boss” is the “king” who holds court and makes, monitors and enforces all the rules. This is an easier path for employees, but one that fails under many circumstances. In our experience, we have had retreats where an entire morning was spent dealing with an inconsequential issue that had become a “big deal” to two employees. It was a strenuous and fruitless session. Both employees eventually left the practice.

Topics

The topics discussed will range from tangible issues, such as scheduling effectively, to more general ones, such as communication skills. A blend of topics will usually provide the most comfortable and effective format, in that it becomes quite enervating to exclusively take on emotional issues, such as conflict resolution. In our meetings we spend time learning about active listening, giving feedback and goal setting, as well as numerous topics that are task oriented, such as how to fit general anesthetic cases into our schedule. To be more specific, the following are descriptions of sample topics we have covered:

? How to invite parents into the operatory to be with their children during appointments
? What to say when a child asks if she is “getting a shot”
? When and how to approach a Team member with whom you have conflict
? How to fit emergencies into our schedule
? Which information is important when a new patient calls for an appointment
? Why we do one procedure (e.g. stainless steel crown) over another (a filling) in some cases
? Where the parents should be during restorative visits and how to coach them to be helpful
? How to listen to negative feedback without getting defensive
? How to meet parents’ styles to provide proper guidance at initial visits

This is not the entire list, but does provide some idea as to the breadth of topics covered. As one can see by reading the list, some topics are obviously related to actual patient care. Upon further consideration, it can also be understood that the more effectively the entire Team works together on a similar agenda, the more effectively the patients will be served and the better experience they will have.

The Values and Vision

The basis for much of this training must first come from the owner/dentist. Prior to beginning a Team process, it is vital that the doctor has a clear Vision (see Dental Economics, March 2001). This is the blueprint and the foundation on which the practice and the Team will be built. The meetings provide the time and organization to clarify the doctor’s values and vision as well as the ways to implement them into action. The facilitator must know the doctor’s plan to be effective in moving the process toward those goals. When the values have been clearly defined, the Team can embrace them and work together to create systems that will support them. By involving them in the process, Team members will have a greater sense of ownership of the systems and will be more likely to support them enthusiastically.

The Benefits

Each doctor will find different benefits, depending on the specific goals being sought. For some, it may be the relief from “having to figure everything out.” For others it may be the satisfaction in seeing a group of people about whom he cares learning new skills that are applicable in many parts of life, both in the office and in the home. For still others, it may be the ability to let go of the role of sheriff, judge and jury. In my own experience, it is all the above. Perhaps the greatest source of satisfaction to me is the realization that my Team is very nearly a totally self-running group that requires only encouragement and occasional guidance from me. I still need to make some decisions, such as capital outlays or choices of appropriate materials, but the establishment of my Team has freed me to “just be a dentist.” Earlier in my career when I still maintained a more traditional power structure in my practice, I would generally be far more exhausted by the non-dental issues of the day than anything I was doing in anyone’s mouth. I hold it as a satisfying achievement that I have become an interchangeable part in my practice. This may have been frightening to me at one point, but no longer. In fact, as I write this article, my practice is literally at work, providing the same high quality care that I would expect. This is occurring in spite of my absence. My partner is a skilled and able practitioner, but it is my Team that provides the continuity of care, given our partnership arrangement. That is to say, the two of us alternate weeks or work and the practice continues to provide a level of care with continuity that I believe could only have been done through the creation of Team. These are my two principal benefits from the lengthy process to which I committed—twenty-six weeks off each year without concern for the quality of treatment and level of caring for the patients in our practice. This feels like a rich reward to me and is a payoff far beyond my expectations.

Your goals may be different than mine and your path may take a shorter course. No matter what your Vision, the chances of making it become a reality are tremendously enhanced with a genuine Team in place. There are doctors who have heard the term and apply it casually to their staff. I hope this article has provided some insight into the difference between staff, which requires constant attention and guidance, versus a Team, which is a group of people who have heard, understood and embraced a Vision and then works together to make it happen. When I look back on the time, money, effort and sometimes emotions I have invested in the process, I can say without hesitation that it was worth it. I write this while listening to the pounding Pacific surf from the veranda of a time-share in Cabo San Lucas, Mexico. I can fully relax and enjoy this moment because I know that the children and parents in our practice are receiving the same care right now that they would if I were treating them in Olympia. My own Dream Team has been central in creating my own dream life. You can do it, too.