The Us vs. Them Trap: How Team Division Destroys Profit and Patient Care

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Episode Transcript

Paul (00:56):
Recently something happened in my practice that I
think you will relate to.
So we have this policy thatbefore any patient can get on
the schedule for treatment,their balance has to be
pre-collected.
It's a system, it works.
It keeps patients committed totheir appointment, it cuts down
on the same day cancellationsand it really avoids all the
awkward money conversations onthe day of treatment because we

(01:19):
have them on the day ofscheduling.
So there's no more newquestions about the insurance or
what do they cover or what doesit cost and everything.
So it gets all that stuff outof the way.
But sometimes the patientsschedule their next visit in the
back, maybe with the assistant,maybe with the hygienist, and
then the back then brings thepatient to the front to
pre-collect that payment.
Now this often puts the frontdesk team member in a weird

(01:42):
position of being the one whonow has to be the bad guy.
They're the one that has to nowenforce the policy and collect
the money.
The person in the back made theappointment.
Now the person in the frontcomes up and they say, okay, I
need the money.
So in order to handle thisissue, we made it our policy
with our team that if the personin the back schedules the next
visit, they must also be theperson that tells the patient

(02:04):
about collecting the copay andthen they walk them to the front
so that the front can take thepayment.
And that is where the troublestarted.
We had a patient come in as anemergency and the assistant
scheduled the root canal andcrown in the back.
They went over the treatmentplan, they went over the fees,
they got them on the schedulefor two days later, but they

(02:24):
never mentioned thepre-collection of the copay.
And that's when the patient wasthen walked up to the front and
the front person mentioned itto the patient and the patient
was really surprised and kind ofupset about it.
She said back there, I didn'thave to pay anything.
So the person in front was kindof frustrated because they

(02:45):
didn't do it in the back and shedecided well, you know what,
it's not my problem either.
So then she told the patientdon't worry about it, we'll take
care of your payment later.
Now our front desk team member.
She knew the rule, she knewthat she was supposed to collect
, but she was frustrated thatthe back hadn't done their part
and explained it to the patientand instead of addressing it she
thought you know what?
This isn't my problem.
If they didn't set this upright, I'm not going to be the

(03:07):
person to fix it.
So she waved it off.
She told the patient not toworry about it and when the
patient came back for treatmentthey hadn't paid anything and of
course we tried to collectafter the treatment.
Now this person came into mypractice.
They went in the back, they hadthe treatment done.
Now this person, also at thefront desk, thought about
collecting at that time too,before the treatment, and she

(03:28):
said you know what?
Not my problem, they shouldhave told them about it in the
back.
So now we did the treatment andwe go to collect afterwards.
And you can imagine the excusesfrom the patient.
I was told I didn't have to payanything.
I thought it was covered.
So now we got an upset patient.
Now everyone's pissed off.
The front's pissed off becausethey got put in this situation.
The back's pissed off becausethe front's not doing their job.

(03:48):
And the bigger issue here isn'tjust that we didn't get paid up
front.
The real issue is what causedit.
It's this us versus themmindset.
The back dropped the ball.
The front didn't want to be thebad guy, so they let the
patient slip through, just tomake a point.
Now, does that sound familiar,that attitude of, well, they're

(04:09):
not going to do their job, I'mnot going to do mine either.
It's a front versus backstandoff that happens in so many
dental offices and it's one ofthe most damaging dynamics that
you can have in your culture.
So today we are going to talkabout where this us versus them
attitude comes from, why ithappens and, more importantly,
how do you change it so thatyour team stops working against

(04:32):
each other and starts working asone.
Now you are listening to theDental Practice Heroes podcast.
I'm your host, dr Paul Etchison.
I'm an author of two books ondental practice management, a
dental coach and the owner of alarge group practice in the
South Suburbs of Chicago.
I want to show you how to builda team-driven practice that
runs without you, so you canmake more money, work less and

(04:54):
enjoy more time doing the thingsyou love.
I practice just one day a weekand I wanna teach you how you
can do the same.
Now, one thing that we have toacknowledge is that there's a
hidden divide in every singledental practice.
It's just human nature.
We can't get around it.
Owners they often think thattheir staff doesn't care Staff.

(05:15):
They often think the owners aregreedy or they're blind to
their struggles.
The back thinks the front islazy.
The front thinks the back hasit easy and doesn't understand
how difficult their job is.
And in the middle of all thistension you can get the not my
job attitude, and that's whenthe little acts of pettiness
creep in.
A ringing phone gets ignored,rooms don't get restocked or

(05:39):
flipped.
Someone leaves work earlywithout finishing their duties
or the closing duties.
Somebody shows up late andskips the morning routine.
And it's often not laziness,that's not the problem.
It's frustration with otherteam members that causes this.
Now I'll give you an example.
I had a client whose teamoffered blankets to patients,
now, every night.

(05:59):
You an example I had a clientwhose team offered blankets to
patients, now, every night theywould take those dirty blankets
and one team member.
They would toss the blankets inthe washer and then every
morning she'd come in and movethem into the dryer.
Nobody ever assigned this toher, she was just the person
that always did it.
But eventually she startedgetting a little resentful.
Why am I the only one that everdoes this?
I swear if I didn't do this, itwouldn't get done.

(06:20):
So one night she tested it andshe stopped doing it.
And guess what?
The blankets they piled up andeventually got to the point that
when a patient asked for one,there wasn't a clean blanket in
the practice.
And the rest of the team saidwell, that's her job, she always
does it.
But then she thought, well, I'mthe only one who cares enough
to wash the blankets, nobodyelse cares.

(06:42):
So why should I?
And nobody ever offers to helpme.
See, the real issue wasn't thelaziness, it was the
miscommunication.
No one ever communicated whosejob or responsibility it was, so
each side had a completelydifferent explanation about it,
and that's the story in so manyof these us versus them
situations.
So how do we fix it?

(07:02):
Is it systems?
Well, sort of, but it's morelike addressing it one
conversation at a time.
There is so much power inbringing these conversations
into the light and out into theopen.
And here's the thing.
Systems for your practice, yes,they are essential, but they
don't solve everything.

(07:24):
A lot of the real problems inyour practice are cultural or
emotional, and the only way tofix them is through having
conversations about them, and asowners, we have to be the
person that's leading thoseconversations.
We need to find out what'sfrustrating our team, what's
bothering them, and we got toget it out into the open.
Because if it's not out in theopen, that's when resentment

(07:45):
starts to build and we starthaving these little petty acts
that piss everybody off andbenefit nobody.
Now we also need to realizethat most people have good
intentions.
We often villainize our teammembers and other people on our
team.
We say, oh, they're just lazy,they're just a jerk, they're not
nice.
But really we got to realizethat most people do have good

(08:07):
intentions.
They don't want to let theirteammates down, they want to do
a good job, they want to doright.
Good intentions.
They don't want to let theirteammates down.
They want to do a good job,they want to do right by
patients.
But our brains we've often gotthis negativity bias that wants
to create stories on how ourteammates they just don't care
or they're cruel or they're lazy.
And if we just stay silent andwe don't communicate about these
feelings that we're having,frustration builds and then the

(08:29):
resentment follows.
So we need to have what I callripple conversations.
All right, let's talk aboutthese ripple conversations,
because every action at yourpractice creates a ripple, and
our team needs to understandthat.
Now there's three types ofthese ripple conversations.
The first one, downstreamripples this is what happens

(08:50):
later in your processes if thisstep is skipped.
The second one, team ripples,and this is who else has to pick
up the slack when something isnot done.
And the last one is the patientripples, and these are the ones
that upset me the most.
How does it all affect thepatient experience?
And hence, since it's affectingthe patient experience, it
affects their health.

(09:11):
When your team understands theconsequences, it changes how
they see their role and theirmotivation for doing the right
thing.
The team just simply has toknow how every action that they
do or don't do, how it affectsothers and the consequences, far
from the people performing themor not performing the action,
because no job in a dentaloffice exists in isolation.

(09:34):
Everything flows together.
For example, if the traysaren't set up before the day
goes, maybe the doctor will runlate.
And when the doctor runs late,the schedule gets a little
scrambled and the hygienist getsbacked up and the patients wait
longer.
The front desk is thenscrambling to reshuffle, get
through it all and ultimately,the patient experience suffers.
I mean we're not providing asolid patient experience, which

(09:57):
means case acceptance suffers,it goes down and the patients
don't get as healthy as theycould.
So we really do a disservice tothe patient.
Let me give you another exampleNow.
At my practice the front deskthey were constantly overwhelmed
.
At one point I remember I hadsomebody come up to me and they
said it's just so hard, I don'tthink I can do it anymore.
And I started getting curiouswhat's going on with this?

(10:18):
They were just so overwhelmedwith all these upset patients
who got surprise balances.
Now we look at that and we saywhy.
We didn't know it at the time.
But as we took a deeper diveinto this, we discovered that
the insurance information wasbeing entered incorrectly at the
start by the insurancecoordinator and this bad data
entry led to bad estimates,which led to surprise bills,

(10:41):
which led to upset patients andconflict at the front desk.
So the front desk wasn't theproblem, but they were the ones
that were catching thedownstream consequences of these
mistakes that were happeningupstream by the insurance
coordinator.
So that's the point.
One person's actions don't justaffect their job.
They ripple through the teamand eventually they land on the

(11:04):
patient and your team needs tounderstand this.
So how do we break the cycle ofnot my job?
The cure is giving the teamsomething bigger to rally behind
, something bigger thanproduction numbers or the fact
that we just do it this way,because this is the way we do it
.
When your team members believein and they understand the

(11:24):
mission of the practice, theywill pick up any slack that is
created.
They will cover for each other.
They'll own their part.
But when the mission is justlike numbers and production and
vague ambiguities, you'll alwaysget things slipping through and
you'll always get thatresentment as your team notices
other people not picking up theslack.

(11:45):
So let's frame it differently.
Let's frame what's going on ina different way.
Let's use rallying cries thatcan connect every single role
that we perform back to thepatient.
Some examples like hey, let'schange someone's life today,
let's bring comfort to a patienttoday, let's help someone get
healthier, let's give somebodythe best patient experience

(12:06):
they've ever had, and all thesethings.
I mean you're saying these withyour team.
This all ties back to caseacceptance.
Every little thing we do at thepractice affects whether or not
the patients say yes or no toour recommendations, and if they
don't say yes, they're notgetting as healthy as they
should be and, honestly, that'son us.
We are failing them.
So make your mission clear,verbalize it and talk about it

(12:29):
often.
And when that mission is clearthat not my job thinking, that
just pisses us off it disappearsBecause suddenly every single
job, whether it's setting up atray, entering insurance
correctly or just answering aringing phone, contributes to
something meaningful.
It contributes to the patientgetting healthy.

(12:49):
At my practice, when we realizedthis and we started verbalizing
these things, started sayingthese things out loud,
celebrating the wins and showinggratitude for our team members
that lived this out, everythingchanged.
You felt the cultural shift.
The us versus them it justfaded away In the front and the
back.
They were working as a team andthey weren't just competing and

(13:09):
keeping score anymore.
We became one team, unitedaround delivering our best care
for the patient.
That's what I want for you atyour practice.
It doesn't just happen byaccident.
You have to orchestrate it.
You have to be part of changingand setting that culture.
So here's your takeaways fromtoday If you see at your
practice not my job thinking,call it out.

(13:31):
Show them the ripple effect.
Have those ripple conversations.
Show them how every singleaction impacts others and it
ultimately impacts the patient.
And normalize honestconversations, like saying
things to your team like hey,when this happens or when you do
this, it affects me in this way, like I would have loved for my
front desk person to say tothat hygienist or that assistant

(13:53):
that didn't tell them about thecopay Like, hey, when you
schedule a patient and you don'ttell them about the copay for
scheduling and you bring them up, it puts us in a really crappy
position to be the bad personand it makes us really nervous
and it makes us feel bad and wedon't even want to collect the
balance, which we know.
When we don't collect thebalance, the patient's less
likely to show up and they'regoing to take time on the

(14:15):
schedule from somebody else.
I mean, I know that a teammember is probably not going to
go into that level of depth, butyou get the idea.
We want them to explain howother people's behaviors are
affecting them, because I thinkthe person that's getting this
conversation said to them isgoing to say, oh my gosh, I'm so
sorry, I didn't realize that.
I will try to do better.
So normalize thoseconversations, model it and

(14:36):
remember we talk about systemsall the time on this podcast,
but they're simply just notenough.
The real fix in a lot ofpractice problems is in having
those conversations, and ifyou're looking for help in
having these conversations, ifyou're looking for somebody to
guide you through having thesedifficult conversations in a way
that's productive, that teachesyour team how to work together

(14:56):
and takes your practice toanother level, reach out to us
at dentalpracticeheroescom.
Set up a phone call with me andwe'll discuss it and I'll give
you some help.
And finally, at your practice,start being the person that is
always doing these rallyingcries.
We're defining that biggermission, we're celebrating the
wins and we're tying those winsback to our mission.

(15:17):
Because here's the truth, guys.
I mean, the enemy it's not yourteam.
We get so mad at our team, youget mad at your team, I get mad
at my team too, but the realenemy is miscommunication,
misalignment and just the factthat we're not discussing these
things.
So I want you to ask yourselfwhere has your team slipped into
?
Not my job or us versus themthinking, and what can you do

(15:41):
about it this week to help themsee how their behavior or their
role impacts the entire practiceor impacts the patients.
And, like I said, if you needhelp with those conversations,
maybe you need some helpinspiring your team.
That is what we do at DentalPractice Heroes.
All of our coaches, we've allled large teams.
We know how to create buy-in.
We know how to createaccountability.
If you want to practice likethat, reach out to us.

(16:01):
We'll show you how to do it.
Thank you so much for listeningand I will talk to you next
time.