A Compelling Reason to Think
Friends of Samuel Johnson once accused him of writing an eloquent judicial appeal on behalf of a condemned man who was certainly not an intellectual. Dr. Johnson denied the ghost-writing with what has become a famous aphorism: "When a man is to be hanged in a fortnight, it concentrates his mind wonderfully."
You might say the same about an orthodontist who suddenly needs to hire a new employee after several years of little turnover in office personnel. Suddenly, the need to concentrate compels us to rethink and, perhaps, redefine the characteristics that bring the best employees to our offices and keep them there.
At a time when services account for more and more of our Gross National Product (now 74%), businesses have rediscovered the importance of the people who actually deliver these services. Customer-contact workers make up the fastest-growing segment of the U.S. labor force, and companies are scrambling to hire, train, and retain ordinary people who can perform extraordinary services for their value-driven customers.
Therefore, for orthodontists, finding people who are resilient and resourceful, empathetic and enterprising, competent and creative has never been more difficult, because we are now competing with large companies for the same people. In addition, the fear generated by the AIDS epidemic may have discouraged some potential employees from developing an interest in a dental assisting career. I think the problem of orthodontic personnel recruitment will only increase over the next few years.
Every practice management survey conducted by JCO has shown that the most productive and profitable offices are those that maximize the use of their office personnel in the delivery of orthodontic services.1 Orthodontists who continue to consider their staff members as mindless drones who only wash instruments and mix cement had better prepare themselves for a lower standard of living, because the only way to efficiently deliver treatment to a large number of patients is to enlist the help of well-trained and enthusiastic people who will extend their doctor's care, skill, and judgment. I know many will complain that such offices can't deliver high-quality orthodontic treatment, but I've visited enough of them to know beyond any doubt that quality and quantity aren't necessarily exclusive. Although the nostalgia of a simple office with a single orthodontist assisted by one or two people has an allure for many professionals, trends in dental office economics will soon make this kind of practice as anachronistic as a 50-acre cotton farm.
It seems clearer every day that an excellent staff is the key to an orthodontist's success and profitability. Unfortunately, it is also abundantly clear that our techniques of employee selection remain less than adequate. In the March 1990 issue of JCO, Mel Mayerson offered readers about as good a technique of selection, hiring, and training as any orthodontist's I've seen.2 But when we compare even this method with those of Fortune 500 companies, we begin to understand the extent and severity of our disadvantage. Marriott Hotels, for example, now employs a sophisticated computer program developed by Aspen Tree Software of Laramie, Wyoming. Aspen Tree has found that potential employees are much more honest with computer-generated questionnaires than with human interviewers. The company has also discovered relationships between successful employment and seemingly unrelated behaviors and beliefs. Using such programs, Marriott and others have steadily decreased the attrition rates of new hires and dramatically lowered their costs of training.
After 30 years in this profession, I must admit that I still have only the foggiest of notions about the qualities we're looking for in employees. But I'm more certain than ever that cognitive ability is only one of the features a good employee brings to the orthodontic office--and it probably isn't the most important. To my knowledge, no one has yet compiled a practical list of qualities shared by successful orthodontic employees. One study showed little commonality among good orthodontic staff members, but this may have been a defect of the test instrument.3 Although no test could be foolproof, there is little doubt we could do better hiring if we had the knowledge, skills, and relational data bases now being used by top American companies.
Sadly, the software companies that could help us have little incentive to do so. In a conversation with Brooks Mitchell, founder of Aspen Tree, I learned that neither orthodontists specifically, nor dentists generally, have the numbers to justify his company's expenditure of resources in collecting and sorting the data that could form a useful hiring program. It looks as if someone within the profession would have to perform such a task, and since profits may be meager, it would probably be a labor of love.
Nor should we count on our educational system to help us find the people we must have to run a successful office. The kindness, sympathy, enthusiasm, conscientiousness, and tolerance of stress our employees need are not part of any school curriculum I know. There is strong evidence that these skills may be genetic and, thus, unteachable.
As though selection itself weren't difficult enough, recruiting a good team is only the beginning of the process. If we hire talented people and treat them badly, they will be inattentive, careless, slow, and rude to patients and parents. Hal Rosenbluth, who runs a 3,000-employee travel agency in Philadelphia, says we need to hire nice people, treat them well, encourage them to bind emotionally with the company, train them continuously, and equip them with the best technology. Then customers and profits will follow.4
No one ever said that managing an orthodontic office would be easy. If it were, more people would be doing it and doing it well. But this difficult task is becoming even harder, and we need some new tools to help us.