I was able to attend two of Dr. W. Edwards Deming's courses on Total Quality Management before his death a few years ago, and I will always be happy that I could avail myself of that knowledge. Dr. Deming had few uncertainties about his theories and, in fact, pronounced them with such force and confidence that hardly anyone in the audience would ever rise to challenge him. Still, there was one principle that seemed dubious to me from the first, and time has only reinforced my belief that Dr. Deming was wrong about it.
Dr. Deming preached fervently that the system or process determined the productivity of the worker, rather than the other way around. He felt that personnel selection had little to do with the prosperity of an enterprise, but rather that the executive strategy and the implementation of that strategy were almost totally responsible for the performance of employees.
There were several reasons for his thinking. First, he was a statistician, and he had to have as few variables as possible to make his mathematical formulas work. Second, he spent most of his career with a Japanese population that was homogeneous, monocultured, and backed by an excellent educational system. Finally, he worked almost exclusively with industrial manufacturers that employed thousands of people, who performed more or less the same repetitive jobs day after day. Had he worked with small service organizations such as dental clinics, physicians' offices, or retail merchants, he might have formed a different idea about the value of personnel selection.
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As I have moved away from Dr. Deming on this one point, I have come to endorse what Larry Bossidy, CEO of Allied Signal Corporation, says about the importance of the work force: "Ultimately, you depend on people, not strategy." That has certainly been true in my orthodontic experience, and I believe most professionals would agree. The most miserable moments I have had in my practice have been when my employees were incapable of helping me deliver the orthodontic services I desired, or of ever learning the required skills.
In this month's Readers' Corner, Dr. Jack Sheridan asks 50 JCO subscribers about their personnel selection methods. It seems that only about a third test their applicants for dexterity, general intelligence, or emotional stability; only 38% routinely check references from previous employers, and fewer than one-third have any kind of structured training program. If this anecdotal survey is representative of orthodontists throughout the United States--and I have an idea that it is--there is plenty of room for practitioners to improve.
I wouldn't want to overstate the value of written preemployment tests, because they are clearly limited in what they can reveal about potential candidates. When I was using only one examination that tested general IQ, I discovered that many of the "smartest" people could never adapt to being chairside assistants. They didn't possess enough dexterity, or had too much anxiety, or simply didn't enjoy the work enough to become good assistants. Some of the people who eventually turned out to be my best employees could not even take the exam because they didn't read English. These discoveries are not surprising in light of the studies by Harvard's Howard Gardner, who has found at least seven basic intelligences. To my knowledge, there is not yet a single examination that tests for all of these traits.
When I began to use a more comprehensive test that was recommended by a psychologist, the first person I hired based on her test score proved to be immune to most of my training. She was a sweet-natured, attractive college graduate, but just couldn't seem to focus enough on the tasks at hand to learn them well. I'll never forget the experience that simultaneously convinced both of us that orthodontic assisting was not her thing. She was helping me recement a loose band, and I asked her to blow a little air on the tooth. She looked at me quizzically, shrugged her shoulders, pursed her lips, bent down over the patient, and began to "blow a little air on the tooth". It is seldom that unsuitability is so clear to both employee and employer. Thankfully, she quit a few days later.
There are simply too many attributes that pencil-and-paper tests cannot reveal about people--their sense of humor, their response to stress under particular circumstances, their resentment to structured tutoring, their work ethic, their ability to focus on the work, their ability to work independently. There are also dangerous habits such as drug use that written tests will not uncover. Yet any additional information about a future employee is better than going in blind, which is apparently what most of America's orthodontists are now doing.
Failure to check with previous employers is perhaps the most egregious error an orthodontist can make. Much of human behavior is habitual or, as behaviorists would say, conditioned. The habits and personality traits that characterized someone in a previous job will manifest again. This is particularly true when it comes to assessing honesty. I have a couple of friends who had several thousand dollars stolen from them, and they later discovered that simple phone calls to previous employers would have alerted them to these employees' basic dishonesty.
Orthodontists really need to know more about selecting, training, and retaining competent personnel, because our success--professional, economic, and emotional--depends on it. In fact, there are so many good reasons for selecting capable staff members, you would think we would have figured out by now how to do it routinely. In this issue of JCO, I review a cassette series by Charlene White (no relation) that sheds some light on the subject. The title, Orthodontic Hiring Made Easy, may be somewhat euphemistic, because there is no way to make this chore "easy", but Ms. White's suggestions can certainly help systematize what is now largely done on an ad hoc basis, with equivocal results.
Unfortunately, proficient people have more employment opportunities in the service industries than ever before, so future staff searches are likely to be even more difficult. The cost of training people who subsequently fail will continue to grow, while the process of firing incompetents without serious legal, political, and economic repercussions has never been harder. The profession awaits the intelligent efforts of someone or some institution that can help solve this important problem.
LWW