Showing posts with label Practice. Show all posts
Showing posts with label Practice. Show all posts

Greg Winteregg DDS – Adding an Associate to your Practice


When discussing associates, thirteen years in private practice and close to as many as a trainer/consultant have taught me one hardbound rule: there is definitely a right and wrong way to go about this associate business. Every week, I answer questions from colleges who feel that they need a dental associate in their office now or are entertaining the idea for the future.







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Greg Winteregg, MGE, dental associates, dental practice







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(Part I of II: Adding Dental Associates to Your Practice)





When discussing associates, thirteen years in private practice and close to as many as a trainer/consultant have taught me one hardbound rule: there is definitely a right and wrong way to go about this associate business. Every week, I answer questions from colleges who feel that they need a dental associate in their office now or are entertaining the idea for the future.





Although there are a number of different factors to consider when adding a dental associate, here are some of the key ones:





1. When should you get an associate?



2. How would you structure compensation?



3. What's the best way to find one?



4. What are the important points to cover when interviewing?



5. How will you integrate them into your practice?





Let's start at the top: When should you get an associate?





Although this is probably the most important question, it is also where I see the most errors made. Let's say you are doing moderately well, still have some openings in your schedule and get about 10 new patients per month. You decide to expand your hours and bring in an associate to become more productive. The reasoning seems sound – you are adding more hours and providing more treatment opportunities for your patients – but this rarely works. New patients don't magically show up, the associate is unproductive and unhappy. You either a) let him or her move on or b) start moving work from your schedule to make the associate busier/happier. The net result is less profit and a problem, i.e "how do I keep my associate busy?"





In this scenario the office was in no position to justify adding an associate. As such, this begs the question: How do I know when the "right time" is? To answer this question, ask yourself the following:



a) Is your practice growing (or has it grown up to now and you just seem to have "maxxed out")?



b) Are you scheduled efficiently?



c) Is your business profitable?



d) Is your schedule relatively full?





If you answered "Yes" to all of the above, now is probably a good time to add an associate.





I'll give you this scenario: Your practice has rapidly (or steadily) expanded up to a point where you can't take in more patients than you currently are. You are operating efficiently and the office is profitable. You just can't see more people and things start to book out a couple of weeks in advance. Now is the time to add that associate to serve three purposes:





1) To provide faster and more efficient service to your patients,



2) To lighten your schedule so you can focus on the type of work you want to do and



3) To increase practice productivity.





If my practice was in the above situation, I would look at adding an associate – perhaps one to two days a week to start and roll from there.





From a practical standpoint, I would also look at how many charts I had. In my experience 1,000 charts, if handled efficiently, can potentially keep a doctor and hygienist productive. Also, maintaining a ratio of one doctor to one hygienist seems to work best. If you are already have two full time hygienists (who are booked), chances are you need an associate now. However, you also need to consider the other points above.





Business survival is inexorably connected to expansion. If the office is well-run (which would mean that it was expanding at least a little bit), there would come a time when you couldn't produce any more yourself and would need an associate. The level of production that will require an associate will be based on your style of practice, fees, type of dentistry you do, etc.





At MGE (http://www.mgeonline.com) we suggest you get an associate when there is more work than you personally can handle and patients are being pushed out on the schedule too far.. How long is too long for them to wait? Although this is ultimately your decision, it shouldn't be more than a couple of weeks. Too long of a wait is just not good service!



One of the questions asked above when deciding whether or not you should add an associate, asked about expansion. How much expansion do you need? To start, are you even getting enough new patients to support yourself? How many should you be getting? This depends in a large part on how you practice, but I'll give you a basic formula to use:





a. Take your total number of active charts



b. Multiply this by 20%



c. Divide "b" by 12 (months in a year)



d. The figure from "c" above gives you the minimum number of new patients you should be getting on a monthly basis to maintain your practice's health. Note that this is just to keep you going. You would definitely need to exceed this number to add an associate.





Example: Dr. Smith has 1200 active charts. 20% of this is 240. 240 divided by 12 is 20. To maintain a healthy practice, Dr. Smith should be getting at least 20 new patients each month.





Keep in mind this formula assumes a couple of conditions exist:



a) The new patients are fee-for-service.



b) The doctor has an acceptable skill level when it comes to treatment presentation and acceptance (which is reflected in production and collections).





If you want an associate, I would recommend that you far exceed this 20% factor. This is where the "MGE New Patient Workshop" comes in handy – whether you want an associate or not. If you want more fee-for-service new patients to keep your practice healthy, to expand or to make it possible to add an associate the "New Patient Workshop" is the solution.

Change Management In Practice: Why Does Change Fail?


“Resistance to change may be active or passive, overt or covert, individual or organised, aggressive or timid……… and on occasions totally justified.”

Sadly most significant change fails to meet the expectations and targets of the proposers. The failure is given the catchall name “resistance”, yet resistance can be principled and creative as well as from vested interest. Top management is frequently unreasonable in its expectations and time scale, forgetting the process it...







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change management







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“Resistance to change may be active or passive, overt or covert, individual or organised, aggressive or timid……… and on occasions totally justified.”

Sadly most significant change fails to meet the expectations and targets of the proposers. The failure is given the catchall name “resistance”, yet resistance can be principled and creative as well as from vested interest. Top management is frequently unreasonable in its expectations and time scale, forgetting the process it went through when it decided to make the change.

An effective change manager will prepare an organisation for change in the early stages of project definition and stakeholder review, by taking managers through a similar sales process and responding to their apparent resistance: the “creative conflict.”

This process is likely to improve the project definition and buy in. It will also ensure that it is clear the moment resistance becomes “vested interest.”

It is unrealistic to expect an independent change manager to tackle vested interest resistance but the change director can use his or her intervention as a signal to the organisation – such interventions should be few but telling.

An independent change manager is a cross between a foil and a lightning conductor – the foil ensuring that positive energy is deflected to the right place, the lightening conductor removing negative energy from the organisation.

Avoiding failure: managing resistance

Resistance is a key element in why change fails.

A recent informal UK survey of 120 government transformation programmes identified that:

• 15% achieved their objectives
• A further 20% failed to achieve their objectives but were nevertheless regarded as satisfactory
• 65% were unsatisfactory.

A subsequent discussion forum on ecademy.com identified 7 key reasons why change fails. (The list is virtually identical to one made by Kotter at Harvard 15 years ago).

1. The organisation had not been clear about the reasons for the change and the overall objectives. This plays into the hands of any vested interests.

2. They had failed to move from talking to action quickly enough. This leads to mixed messages and gives resistance a better opportunity to focus.

3. The leaders had not been prepared for the change of management style required to manage a changed business or one where change is the norm. “Change programmes" fail in that they are seen as just that: "programmers". The mentality of "now we're going to do change and then we'll get back to normal” causes the failure. Change as the cliché goes is a constant; so a one off programme, which presumably has a start and a finish, doesn't address the long-term change in management style.

4. They had chosen a change methodology or approach that did not suit the business. Or worse still had piled methodology upon methodology, programme upon programme. One organisation had 6 sigma, balanced scorecard and IIP methodology all at the same time.

5. The organisation had not been prepared and the internal culture had 'pushed back' against the change.

6. The business had 'ram raided' certain functions with little regard to the overall business (i.e. they had changed one part of the process and not considered the impact up or downstream) In short they had panicked and were looking for a quick win or to declare victory too soon.

7. They had set the strategic direction for the change and then the leaders had remained remote from the change (sometimes called 'Distance Transformation') leaving the actual change to less motivated people. Success has many parents; failure is an orphan.

Very few organisations will manage all 7! However any one in isolation will make the change programme inconsistent and aggravate resistance. Advance planning and stakeholder management will avoid some of these pitfalls. Furthermore the list is an invaluable diagnostic tool for identifying why (and where) resistance is taking place, giving an opportunity to defuse resistance by correcting the mistake.

Conclusion

• Resistance can be healthy (a pearl can result)
• Unknown, unanticipated, unquantified, unaddressed resistance will always be dangerous.
• A badly thought out process and implementation will always result in resistance
• An independent change manager can bring the independence, experience, and objectivity to manage resistance.
• A successful change is essential in creating a change culture