When I received the email from my old friend, a dentist who has been practicing for 14 years, I was floored. “Cindy, I’m not running a practice, I’m running a zoo. I don’t have a dental team, I have five well-educated hissing wildcats who snap at each other and at patients, who break things and lose things, and whose idea of cooperation means telling me what somebody else has screwed up. I’ve tried being kind and being rotten, but things have just gone from bad to worse. The hygienist who has been with me for 11 years, quit two months ago. The new hire doesn’t seem to know if she’s coming or going. Last week I almost fired my front desk gal because she thinks my office phone is for personal calls.  SOS.”

I couldn’t believe what I was seeing. None of this made sense. Dr. Mallard was a great dentist and a great guy with great people skills, but he was describing a place where nobody knew what was what. A place where the boss was Attila the Hun on Tuesday and Mother Teresa on Wednesday. A place with no fixed rules and no clear agendas. A place where morale was getting worse every day because everyone was thinking “I don’t know what is really expected of me. I never know what is going to happen here.”  When I called to set up an appointment, my first question was “Do you have an office manual?” I already knew what the answer would be.

I made two proposals. “Send me a list of everything you don’t like about how your team does things and set up an in-service day so that we can all sit down and work on this.

I arrived at the practice on the appointed day, distributed fat legal pads and pens, and we got to work. I explained that an office manual was a guidebook for making things work – a road map for figuring out where everyone was and where everyone should be going. I introduced Dr. Mallard’s needs and expectations, and encouraged everyone to list their own. Then I added points I had not heard anyone else mention.
 
At 9:00 a.m., management was nervous and team members were surly and silent. By 10:00 everyone was talking loudly and hurling accusations. By 10:25 people were starting to understand why there was a problem and everyone started to move away from the blame-game and towards solutions. We addressed records and responsibilities, education and vacation, snow and seniority, parking and purple hair, flex-time and down-time, benefits and bonuses, and a host of other items that needed to be clarified and committed to paper. When we broke for lunch, the mood was electric.
 
By 2:00 p.m., we had nailed down the nuts and bolts and were ready to venture into  more complex issues -- relationships and communication. By 3:15, all team members were suggesting parameters for professional conduct and performance evaluations, meetings and mentoring, incentives and grievances, safety and morale.

It was almost 6:00 p.m. when someone noticed that it was too late to continue that day. I collected the legal pads. The notes would be collated and typed up by my staff and returned to the team members for further review and approval. No one objected to scheduling a follow-up in-service day for this purpose.  Before we broke for the night, I asked everyone to thank someone or compliment someone for contributing to the project. They were surprised, but they complied with enthusiasm.

Two months later, UPS delivered a beautifully bound and illustrated manual. A month after that I got a batch of notes from the practice. “I finally feel I am valued here.” “This is now a good place to be.”  “I like my job and the people I work with.”  “I’m in charge of updating the manual in December and everyone is already giving me good ideas.”

The doctor wrote,  “ My people are helping each other, joking with one another and taking care of business. It’s a miracle.”

I emailed back. “No. It’s a manual.”
 
The article is authored by Cynthia McKane-Wagester, who is President / Founder of McKane & Associates, a full-service management company servicing health care practices. Her company’s expertise is in developing excellence in staffing systems, working philosophy, and in ensuring that all team members, whether proven or inexperienced, adapt their skills to meet the ever-changing workplace. She can be reached at her offices in Maryland at 1-800-341-1244 or  cmandassoc@aol.com .