How to Hire and Retain Your First Staff Member

The most difficult transition of your career is arguably the move from employee to employer, or from student to employer. In these cases your role changes markedly from “I need to do everything possible to be liked, admired, and accepted,” to “I need to find others who will do everything possible to have me like, admire, and accept them.” The failure of new dentists to make this transition successfully has resulted in their spending five to 10 unhappy years (and sometimes their entire career) practicing in a hostage-like environment. In these instances, the tables seem to be turned from the dentist owning the practice and setting the vision to the employees running the show. This doesn’t have to happen to your career. You can learn to hold your present and future firmly in your own hands.

As you begin your practice, the first thing to recognize is that your small business is like your party. This means that you decide the guest list, the entertainment, and the outcomes—and you don’t have to invite everyone to your party. The same rules apply when you set priorities and expectations for your practice. Remember cartoon mascot Charlie the Tuna? He keeps trying to join StarKist, but is told: Sorry, Charlie. Only the good-tasting tuna get to be StarKist. You need to adopt that vision for your practice in order to find and retain quality employees who will exceed the expectations of you and your patients. How do you attract only the best tuna? You’ll need to build a fishnet that is a place where the best want to be. Here’s how to do it.

Your Ad

Begin constructing your net with the first communication between you and your prospective tuna: your help-wanted ad. Trust me, we have seen a lot of bad ads, including the following:

Is it time to make a move? Compare our office with your present situation. Must speak good English. Excellent pay and benefits, better than any practice in the area.

What does this ad communicate about the practice? It suggests that the most essential skill is to speak good English. It also conveys that the dentist is competitive with other practices, implying that he or she is looking for dental staff members who are willing to make a move exclusively for better compensation.

Here’s another bad example:

Staff member wanted. No phone calls. Reply to p.o. box only. Exp. pref., sal. negot.

This ad suggests that the doctor is hiring behind the staff member’s back, so applicants cannot openly call the office. When people accept jobs advertised like this, they may assume that they, too, can be replaced at any time in the same covert way, generating constant job insecurity. (We think it’s better to let a poorly performing staff member go as soon as you’ve made your decision, even if it means working with a reduced staff until you can hire a suitable replacement.) The abbreviations imply that the dentist is unwilling to spend money to spell out the words, so why would he or she invest any significant time or money on the staff?

We suggest that your ad read more like this:

If you want to love coming to work, then join our team of dedicated professionals. We seek a self-directed hygienist [or whatever position you are recruiting for], who will appreciate our high-quality, patient-centered, growing practice. . . .

The best ad briefly communicates something about you and your practice vision, and it never abbreviates words. The ad can go on to indicate the specific skills, abilities, and attitudes required. An exceptional ad should bring you exceptional candidates. When your phone starts ringing with hopeful applicants, congratulations, you’re in the hiring process.

You’ll need to evaluate your applicants through a series of meetings conducted by you and your team to identify those who match the vision and values of the practice and who could become long-term contributors. The entire process includes the telephone screening, initial interview, reference checks, second interviews (also called working interviews), and the very important, often omitted, team interview. (In hiring your first employee, of course there won’t be a team to conduct the team interview. However, as soon as one staff member is on board, consider yourself as having a team.)

Telephone Screening

Before you spend time building a relationship, it’s important to establish that the tuna in question is of the proper caliber. Use telephone screening to pre-qualify applicants prior to meeting them. The screening consists of a few questions you ask to indicate the applicant’s communication skills and to give you an indication of basic skills, talents, and abilities to perform the key tasks of the job description. (For example: “What made you choose our ad to respond to?” “What kind of work do you enjoy doing?” “What is it about the job we’re offering that appeals to you?”) At this stage, focus on an overview. Avoid specifics, such as a discussion of salary compatibility or the details of the person’s prior experience. You want to meet many applicants, so don’t screen too tightly. Don’t fall into the trap, as many dentists do, of making hiring decisions after meeting only a scant few candidates. Many dentist erroneously perceive a scarcity of employees in their area, which throws them into a panic, which then causes them to hire the first person showing breath on a mirror. Yes, we’ve heard it all—that there’s only one hygienist in a 550-mile radius, or that the first applicant the dentist meets is the only person in town who can work a computer. In the long run you will invest far less time, money, and resources, and maintain a higher quality practice, by leaving a position vacant for a while than by hastily hiring someone who doesn’t fit.

Initial Interview

In the initial interview, there are two types of questions to ask the applicant, each of which is essential to establishing a relationship that could potentially be long-term: job-related and behavior-based questions.

Job-related questions pertain to transferable skills from a non-dental field or actual skills from the dental field that the applicant possesses to perform the job, such as past experience making professional appointments, billing and collecting fees, taking digital x-rays, etc. Ask job-related questions to understand the applicant’s current or past experience, the ways in which he or she believes that prior skills and knowledge can be applied to your position, and the applicant’s self-assessment of past job performance and potential for future growth. Examples of job-related questions include: “What key skills have you already utilized in past jobs that could apply to the role of dental assistant?” and “What knowledge and skills would you need to acquire in order to enhance your ability as a dental assistant?”

Whereas job related questions unveil the potential staff member, behavior-based questions unveil the human being. Behavior-based questions are broader, revealing attributes such as the applicant’s character, values, needs, desires, and motivation. They may include questions like: “Take me through the key moments of your career up to now, and tell me what achievements you are most proud of.” “Describe the ideal employee that you think would fit this position, and tell me how you resemble that person.” “What do you think your references would say about you?” “How would past co-workers describe you?” “Tell me about a challenge that you faced as an employee and how you handled it.”

Because many dentists are technically oriented, they tend to focus more on job-related than behavior-based questions. Neglecting behavioral aspects can result in hiring someone who is proficient technically, but who lacks the “softer” skills to develop positive relationships with your patients and team. The ability to communicate effectively, to be a good team player, to treat patients exceptionally, etc. are extremely important, especially when you consider that most staff conflicts in a dental office are not about technical issues, such as whether an x-ray technique is effective, but about such things as personality clashes, communication failures, and behavioral issues.

Reference Checks

Beware! We know dentists who failed to check references, only to get rude awakenings about the people they hired! Avoid problems by calling references, most importantly former employers, to validate information given on the application and to learn more about the applicant from those who know the person and his or her job performance. If you encounter former employers who are tight-lipped, their silence in response to your questions (such as “Would you rehire this person?”) can sometimes be telling.

Second (or Working) Interview

Once you have completed the initial interview and begun to build a relationship, you should have an intuitive feel for whether the person might be a long-term contributor. At this point, your intuition is based on your perception, rather than on a solid demonstration, of the person’s talents, knowledge, skills, abilities, and attitudes. You need the proof of the pudding, which is why it is very important to follow up your initial interview with a working interview for the most promising applicants. During this interview the applicant actually performs key tasks of the position.

It’s relatively easy to structure a working interview for a clinical person. You simply enlist yourself, staff, real patients, or even your somewhat helpless spouse to be the patient and to experience tasks performed by a dental assistant or hygienist, such as taking impressions or cleaning teeth.

You need to be a little more creative in structuring working interviews for front office staff unfamiliar with your systems, or for inexperienced staff in any position. For instances in which you are willing to train a promising, but inexperienced, candidate, use methods such as case studies, customer-service examples, or question-asking to reveal the applicant’s talent and potential. For example, an applicant unfamiliar with the dental practice, but experienced in the front-desk tasks of a medical practice, can walk you through how he or she would handle a claim or schedule a mock appointment. An applicant unfamiliar with the health care field can still demonstrate judgment by handling a case study, such as: “Pretend I’m a patient coming in for the seating of my crown. I’m angry because I just learned that my new crown hasn’t arrived from the lab in time for my appointment. How would you handle me?” Such exercises can spotlight essential skills that will be transferable to the new job.

Team Interview

Promising applicants who do well on their initial and working interviews will advance to the team interview (once you have a team). This is a minimally scripted, informal interview, often conducted over lunch, in which your team members get acquainted with the applicant. (Sorry, you’re not invited.) The purpose of this interview is to establish the compatibility of the applicant with the rest of the staff and to gain insight on whether all will work well together as a self-directed team. When you involve your staff in a team interview, they become much more willing to embrace and support a new staff member than they would if the person were hired without their meeting him or her in advance and having an opportunity to offer input to your decision.

Keeping the Tuna in the Net

Once you attract the good-tasting tuna, your next job will be to hold them. The net that is strong enough to retain quality, motivated employees is made of sound leadership principles. Regarding effective leadership, I love to use a quote from author Ken Blanchard of “The One-Minute Manager” book series. He says: Leadership is not something you do to people, but something you do with people. One of the biggest mistakes you can make is to spend a significant amount of time hiring the perfect staff member, and then never have another significant conversation with the person from that day forward. Your next significant relationship-building steps are to groom the person through training, coaching, and mentoring.

The problem with hiring quality employees is that once they come on board, they expect a quality relationship with their leader. So, the bar is raised for the dentist. The first thing to do in welcoming new staff members is to create a training plan that gives them black-and-white expectations. The training plan should clarify job responsibilities, prioritize tasks, offer resources (team members and materials for the trainee to consult as needed), and provide follow through so that it will be easy for the person to succeed.

Regarding the need to set priorities, consider, for example, the job of appointment coordinator. If it includes a list of 50 tasks, you’ll want to make clear that greeting new patients as soon as they arrive is a much higher priority than making coffee. Without your setting the priorities, staff members will set their own, generally selecting those tasks that feel most comfortable to them for the top spot. This can result in difficulties, such as in the case of the patient sitting in the office for 30 minutes without being acknowledged while the new staff member files insurance documents (a true story).

After you identify the priorities, diagnose the training needs by examining the knowledge, skills, and attitudes that the new employee already possesses versus what is lacking and needs to be learned. This will be the baseline for the individual’s training plan.

The last step of the training plan is to create benchmarks by which the new team member can demonstrate increasing mastery of tasks and skills, with you and your team trainers giving feedback to measure the person’s progress and to support further growth. For example, if you are training a new assistant to take x-rays, the training plan would include having the trainee: 1) observe you performing the task, then 2) take x-rays with supervision and feedback, and finally 3) master the art of taking x-rays so that the trainee can do it without supervision.

The entire hiring and training process can seem daunting to most dentists, who choose their profession because they love doing clinical procedures. However, we known from many years of practice failures that dentists can competently and effectively deliver ideal clinical dentistry only when they have developed a self-directed, competent team to keep the practice running. Therefore, the time invested in hiring and training will save you substantial time in the long-run and give you the opportunity to be the dentist you want to be. The strength of the relationship that you have with your staff and that they have with your patients is worth the investment in proper hiring and training. So, my advice is to learn these essential tools sooner, rather than later.

Amy Morgan is CEO and lead trainer of Pride Institute.

Originally published in Dental Entrepreneur, April 2007