Why Your Office Manager Isn’t Growing Your Practice (And How to Change That Fast)

Most dental offices don’t have an office manager problem—they have a role definition problem. We promoted the best front desk performer, gave them a title, and then left them buried in tasks with no roadmap for leadership. In this conversation, I share the exact KPI-based bonus system that transforms a “super admin” into a true leader who aligns team behavior with the practice’s goals and delivers measurable growth.

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Episode Transcript

Paul Etchison (02:51):
There's a huge difference between a regular
employee and a manager.
And in dentistry, most officemanagers are not managing the
practice.
They're just really good atfront desk and admin work.
They're basically the seniorreceptionist at your practice.
And they become that person,like the go-to person, the
person that everybody goes tobecause they always have those

(03:13):
answers.
And they're valuable to yourteam in that regard, but not
because they're creating systemsand not because they're
creating an environment at yourpractice where other people can
thrive.
They're often the person that awell-intentioned practice owner
gave a promotion and a titleto, but never really expressed
what they wanted the officemanager to truly do.

(03:33):
And here's the tragedy theseso-called office managers, they
are working hard.
They are hardworking employees,but they're not doing anything
to move the practice forward.
Now, I work with so manyoffices where I hear the owner
say, Yeah, my office manager,they're busy as hell, but they
don't really manage.
They just do front desk workall day.

(03:54):
And the reason is simple isthat your office manager, they
can be busy all day and they canstay busy without even touching
anything that grows thepractice, without ever managing,
without ever leading, withoutever creating anything, any
systems, anything like that.
And just like you, as thepractice owner, they get sucked
into doing the business ofdentistry instead of working on

(04:16):
the business.
They do the tasks, they doeverything that needs to get
done, but they don't ever makeany investment in the future of
the practice or scaling.
And often this can be due to anumber of factors, one of which
being that there's not a methodor system for onboarding and
training.
So your quote, office manageris the only one who knows how to
do everything.
But that is a dangerous andvulnerable place to be in as a

(04:40):
practice owner.
Because if you lose thatperson, you're gonna be in big
trouble.
So today, I'm gonna show youhow to transform your office
manager from a task doer into areal leader by using a simple
KPI-based bonus system thataligns their daily behaviors
with the big picture of thepractice.
Now you are listening to theDental Practice Heroes podcast.

(05:04):
I am your host, Dr.
Paul Etchison.
I'm the author of two books ondental practice management, a
dental coach, and the owner of alarge five-doctor practice in
the south suburbs of Chicago.
If you want a practice and alife that allows you to make
more profit while taking aninsane amount of time off with
your family, you've come to theright place.
All right, let's dive in.

(05:25):
So today we're talking aboutwhy so many offices have an
office manager that is not trulyan office manager.
We typically call them theglorified front desk employee.
They're the super admin.
So why don't these officemanagers actually manage, even
if they want to?
Well, the fact of the matter isthey are amazing at tasks.
They know every insurance rule.

(05:47):
They are the go-to problemsolver on the team.
They run around, they put outfires, they deal with upset
patients, and they feel valuablepersonally as a team member
when they're busy.
But the thing is, is they willnever rise to the level of
leadership because when we lookat it, they were promoted
because they were like maybe thelongest tenured front desk

(06:08):
employee, or they were the onlyfront desk employee that knew
how to do everything.
But the fact of the matter is,is they're drowning in tasks and
they're reactive, they're notbeing proactive, and most of the
time they don't even know whatleading even looks like.
These office managers, theywant to lead, but they've never
been given the roadmap.
So if your office manager'svalue is based on the number of

(06:31):
tasks that they can do, theywill spend their whole career
buried in the tasks and theywill think that they're doing a
great job and that they're sovaluable to the team.
And I'm not saying that they'renot, they are, but that's not
what you want out of your officemanager.
So let's talk about creating abonus system that is not only

(06:51):
something where it's win-win forthe owner and it's win-win for
the office manager, but it'salso a leadership tool.
Okay, it's not a money tool.
It's not about making moremoney, it's about giving them a
way to lead the team.
You see, most doctors theythink that bonuses are the
motivation.
No, that's wrong.
The bonuses, they need to beabout alignment.

(07:12):
They need to teach your officemanager what to focus on, and
they set the boundaries of whatthings and what behaviors at the
practice really move theneedle.
And then they also give theoffice manager a tangible and
real metrics that they canevaluate their performance on.
So let's talk about what is agreat office manager bonus.
What does it look like?

(07:32):
All right, the first thing, ithas to be based on KPIs, key
performance indicators.
It has to be based on KPIs thatthey can influence.
If they can't affect it, ifthey have no control over that
KPI, it doesn't work.
You have to explain and teachthem how they can influence
every KPI that you're tracking,and you let them know directly

(07:54):
that you want them to come upwith and implement systems and
new protocols that's going tohelp affect these KPIs
positively.
And number two, the bonus needsto be simple enough to track
monthly.
Complication kills consistency.
It needs to be simple, it needsto be something that you can
pull up, like your divergentdental, your practice by

(08:16):
numbers, or just run yourreports in your practice
management system and you cansee what is the performance.
And the third thing is that thebonus needs a reward behavior
that both grows the practice andis beneficial for patients and
how they experience thepractice.
So it's not, it's not justrevenue, it's not just like busy
work, it's not just beinghelpful.

(08:36):
They've got to be those thingsthat reflect the health of the
practice and further down theline affects the revenue and the
profitability.
So, what are the KPIs thatwe're gonna track for this bonus
that we want the office managerto focus on?
Now remember, what's our goal?
We want to turn our officemanager into a leader at the
practice.
So we've got to design thisbonus system carefully.
All right, I'm gonna give you alist of different KPIs.

(08:58):
I will tell you what I do in mypractice, but this is something
that's fluid.
You can come back to it, youcan change what the KPIs are
depending on what you're workingon at the practice, but you
want to make sure that these arethings that reflect the health
of the practice.
So, KPI number one that Ireally like is collections.
I mean, we all know that weneed to collect the dollars that
we produce on, right?

(09:18):
So we've got to collect no lessthan 98% of what our adjusted
production is.
So, why is this good as a KPIfor an office manager?
Well, it forces leadership.
And this is what I really wantyou to see with all these KPIs
is that there's a lot ofelements that go into affecting
them.
So let's talk aboutcollections.
It requires training at thefront desk, it requires

(09:41):
enforcing same-day payment sothat we collect on the patient
portion.
It requires better financialconversations, it requires
accurate insurance breakdownsand verifications so that we
don't mess up the breakdown andmess up the estimate, and then
the patient's all pissed offthat they have to pay us or that
you know, now we have to send abill because we misestimated.

(10:01):
So this requires training forthe front desk.
It requires enforcement of theprotocols.
And by making this one of theKPIs that your office manager is
going to track, it kind ofkeeps all those things in check.
Now, this is collections.
We're talking about a monthlybonus, but you can't look at
collections on a monthly timeinterval.
You've got to go a little bitlarger.

(10:22):
You got to go like three to sixmonths, like a trailing three
or a trailing six months.
Because you know, you'll have abig production month and your
collections are never going tobe 100% then.
Because you know, even whenyou're growing and your practice
is doing more revenue than it'sused to doing, it takes a few
months for that collections tocatch up because we're waiting
for insurance payments and such.

(10:43):
So I recommend you do this on atrailing three to six months.
So you're always looking backthree to six months.
What is the collectionpercentage?
And you want it to be greaterthan 98%.
All right, KPI number two.
I love this one.
The accounts receivable over 60days.
You want this to be less than12%.
So we're talking about balancesthat are over 60 days.

(11:06):
This KPI, this is gonna forcethe office manager to hold the
team accountable and follow upfrequently on what is the status
of the AR.
This is gonna make them focusand build systems that prevent
aging, not just cleaning up oldbalances, not just collecting up
front.
We want to do everything we canto prevent aging balances.

(11:28):
So it's encouraging them tofollow up on the balances, to
check on the AR, to follow up oninsurance claims that maybe got
denied or they asked for moreinformation, things like that.
It gives the office manageropportunities to train the team
on how to better collect money,how to better discuss and have
conversations around money.

(11:49):
And this is something that isshowing, it's like a barometer
that's showing what is thehealth of the collection systems
at the practice.
So ultimately, with this one,we're talking about consistency.
The first one is saying, whatis our collections?
Are we collecting our adjustedproduction?
But this one's showing, youknow, how consistent are our
systems here in the collectionsdepartment.
This ties into collections as awhole.
It makes sure that we're notallowing balances to go unpaid.

(12:12):
It makes sure those insuranceclaims are getting followed up
on, and it also ensures thatwe're collecting when we're
supposed to, when we decided asa team, this is when we collect.
These are our policies.
All right, KPI number three,provider and hygiene
utilization.
So I'm gonna give you sometargets for this.
What this means is we'relooking at a schedule and we're

(12:33):
seeing how much of that scheduleas a percentage had
appointments booked on it.
So we're making sure that we'reefficient and that we don't
have a lot of openings and gaps.
Now, for doctor schedule, Iwant this greater than 90%.
Okay.
For hygiene schedule, I wantthis greater than 85%.
So when we're looking at this,this KPI allows your office

(12:55):
manager to lead in this way.
It holds them accountable forthe cancellations at the office.
It holds them accountable forpre-collecting balances if
that's your policy on the doctorside.
Because if you pre-collect toschedule the appointment on the
doctor side, you're not gonnaget cancellations and you're not

(14:34):
gonna get holes in yourschedule.
It requires team communication.
It requires case acceptancetraining, it requires daily
huddle discipline, meaning thatwe've we're gonna look at the
day at the beginning of the day.
We're gonna be strategic aboutwhere the opportunities are, and
we're gonna make sure that wecapitalize on those
opportunities.
It requires that we're managingour confirmation policies, that

(14:55):
we're confirming patients.
And if they're not confirmed,we're following up and either
trying to get them to let usknow if they're coming or not,
or we're getting them off theschedule and we're filling it
with something else.
It requires managing the shortnotice list, our ASAP list.
It manages our recare, gettingpeople in that are overdue, all
our reactivation programs,calling the people that have

(15:17):
been in our office for years andtrying to get them back into
our hygiene program.
And it's also a reflection ofwhat is the efficiency in our
scheduling.
Are we scheduling in a mannerthat we're staying busy all day
and we're minimizing the losttime?
Now, another version of thisKPI is to track monthly visits.
Essentially, it's doing thesame thing.

(15:38):
We're making sure that we'reseeing enough visits, just like
we're making sure our scheduleis full, but the tracking visits
is a little bit less focused onthe schedule being full.
It's more about what is theamount of visits.
So the KPI of scheduleutilization is really about the
health of the schedule.
Think how much more efficiencywe could have if we never ever

(15:59):
had an opening in our schedule.
I mean, this is a huge number.
I have seen offices that I workwith gain 20 to 30% in revenue
just by focusing on scheduleutilization.
Because think about it.
If you can keep that hygieneschedule full, the doctor's
schedule tends to stay full toobecause they're seeing more
patients, they're diagnosingmore.

(16:20):
It just helps keep the doctor'sschedule full as well.
So there are a lot oftrickle-down things that happen
from making sure our schedulesstay full.
All right, KPI number four,Google reviews.
I love tracking Google reviewsbecause this is something
showing what is the patientexperience.
And it's also doing somethingelse.
It's making sure that we handleupset patients.

(16:42):
So I like to say 15 five-starreviews per month, and no more
than a single bad review.
And for me, a bad review isthree stars or less.
Now, you may decide to do thisbonus in your office with just
saying, you know what, no badreviews.
But with the amount of volumethat comes through my office, I
don't expect to get a bad reviewevery month.

(17:03):
But sometimes there's nothingyou can do and it's out of our
control.
So I would really hate to crushthe office manager bonus if
they're doing everything rightjust because we get one silly
patient that gets upset aboutsomething.
But this does force leadershipin training the front desk on
how to handle and deal withupset patients.
This is probably one of my mostfavorite masterclasses that

(17:26):
I've created that we provide forall of our DPH clients.
Nothing makes upset patientseasier to deal with and less
stressful than having a systemfor easily diffusing the
emotional component of the upsetpatient and really helping them
feel that we're on their side.
We're searching for a solutionwith them.
We're not here to get defensiveand tell them that they're

(17:47):
wrong, but we're trying to finda solution that everybody's
happy with so that nobody isupset anymore.
So it's one of those thingsthat you can train your front
desk on, or if you're a DPHclient, you get that training
included.
Now we're also training thefront desk on how to more
accurately present finances anddo more accurate insurance
estimates.
Because if we're trying to haveless upset patients, less

(18:10):
one-star reviews, these aretypically financial
conversations.
They're financial issues thatwe run into.
And where do we piss patientsoff financially?
Well, when we tell them they'regoing to pay us one thing, and
then after the claim close, wesay, oh, sorry, we made a
mistake.
You actually owe us this.
We missed this clause in yourinsurance.
We didn't realize that you wereout of benefits, things like

(18:31):
that.
So by tracking this, you'realso making sure that that's
under control.
Now we're talking more abouthow to prevent negative reviews,
but what about the 15 positivereviews?
This is that making sure thatour team is asking for these
reviews, but we're also settinga standard for patient
experience, staying on time,being attentive to the patient

(18:51):
needs.
We're responding to patientinquiries, the emails, the
texts.
We're making sure that we'reresponding to people and getting
back to people if we tell themthat we're going to get back to
them.
We're making sure that we havegood patient flow, that we're
staying on schedule, and thatour scheduling systems are
getting tweaked and adjusted sothat if they need some
adjustments, maybe we're runningbehind a lot.

(19:11):
So it doesn't just happen everyday.
We're changing things andmaking these adjustments so that
we can remain an on-timepractice for our patients.
So by looking at how manyreviews we're getting, we're
making sure our onlinereputation is improving and
we're making sure we're takinggood care of our patients.
All right, KPI number five.
This is one that I do with myoffice manager bonus.

(19:31):
New patients per doctor.
I have a target of 35 plus newpatients per doctor.
Now, if you are a well-traineddoctor who has taken a lot of
CE, you can typically get awaywith less.
But what I find, I've had lotsof associates over the past 13
years, is that my associatesneed typically 35 plus new
patients every single month.
So I want to make sure that notone associate's getting all the

(19:55):
new patients and the other onesare getting kind of shafted.
I want to make sure that eachof them see at least 35 new
patients per month.
So, what does this do for theoffice manager?
Now they're this is forcingthem to lead the team in lead
conversion, new patientconversion.
How do we do that?
Make sure we're answering thephone, make sure that we have
phone skills training, thatsomeone's following up and

(20:16):
listening to phone calls andworking with the team to give
them more training so that theycan convert more new patients.
It's making sure that we'refollowing all our systems for
getting, generating more newpatients from our existing
patients.
They're following up on theonline booking that makes it
easy for the patients.
We're making sure that the newpatients actually show up.
So if we start seeing some newpatients that schedule, but they

(20:38):
don't show up for theirappointment, I want the office
manager to say, okay, what canwe do to get more new patients
to show up?
Now in dental practice heroestraining, we have our new
patient booster system.
And that gives our clientsseven easy ways to increase new
patients.
And new patients arefundamental to having a
profitable and growing office.
I mean, let's face it, if wedon't have new patients, we're

(21:00):
dead in the water.
We need to have enough newpatients so that we have enough
demand so that we can DPH blockschedule and everything else
stems off of that.
Now, also in the realm of newpatients, this ties into block
scheduling and ensuring that weprioritize new patients over
existing patients when we'retalking about hygiene.

(21:20):
Because we want to handle ourcapacity issues at a DPH office
by expanding our hours andexpanding our providers.
That's what's going to ensureour practice continues to grow
versus prioritizing recallpatients and choking off new
patient flow.
Now, this happens when we don'tblock out for new patients.
We are always booking sixmonths ahead for our recall

(21:43):
patients.
When we get six months into thefuture, we realize we don't
have any room for new patients.
And then our doctor'sproduction gets choked off
because we're not seeing enoughnew patients.
So if we have our officemanager following this KPI, they
are checking on all of thosethings.
So I just gave you those fiveKPIs: collection percentage, AR
over 60 days, provider andhygiene utilization, Google

(22:06):
reviews, and new patients perdoctor.
And those are the five that Iuse at my office.
Now let's talk about how we aregoing to utilize this in our
bonus system.
So every single KPI is going tohave a dollar value attached to
it.
In my office, it's $200.
Now I have a big office.
You can decide what's okay foryour office.
There's no right, there's nowrong.

(22:27):
But in my office, it is $200.
And if my office manager hitsevery single KPI, they get an
additional bonus.
There's some dollar amountthat's like a bonus on top of
the bonus because they hit allthe KPIs.
Now, why does this work sowell?
Because it removes that all ornothing thing.
When we have all or nothingbonuses, we don't want the
office manager to look at say,okay, I'm definitely not going

(22:49):
to hit that KPI this month.
So I don't get any bonus.
So I'm not going to try for anyof the other KPIs.
They're independent of eachother.
So they can still get a bonusif they hit certain KPIs, but
they don't hit the other KPIs.
But then also, if you thinkabout it, we've got that
additional bonus that if theyhit all of them.
So if they're hitting just fourof them, it makes that fifth

(23:11):
one so much more valuablebecause that's going to allow
them to get the extra bonus.
And I really love having thisoffice manager bonus because it
encourages leadership.
It's not like heroics.
It's not the office managerdoing all these things
themselves.
They can't hit all these KPIsby themselves.
They need to enlist the help ofthe team.
So it encourages them to lookat the team as a whole, look at

(23:34):
providing training, look atrevamping some systems.
And I think it's reallyimportant for us as practice
owners.
We got to show that officemanager how it's more important
for them to focus on things thatscale, such as training and
leading, rather than just doingeverything themselves, because
that is a tendency of a lot ofpeople in that position.

(23:55):
So this can be the foundationof creating accountability
across your entire team becausethe OM, the office manager now,
has to start holding the teamaccountable.
So you can see how this worksinto creating a practice that
runs without you.
So I want you to choose theseKPIs.
Strategically, every single KPIforces your office manager to

(24:16):
lead a different part of thepractice, not just do the tasks
like most office managers aredoing.
But that's why it's importantfor us as owners.
We have to make theseconnections for our office
manager.
We have to make sure that theyunderstand what kind of things
affect the KPIs.
We got to show the KPIs and wegot to put them on the
scoreboard and explain to theoffice manager what kind of

(24:39):
things they can be doing toimprove those KPIs.
All right, so here are yourtactical takeaways from this
episode.
I want you to pick maybe four,maybe six KPIs that your office
manager can directly influence.
Don't bonus them on the thingsthat depend on you.
Bonus them on the things thatdepend on the team.
And I want you to attach adollar amount to every single

(25:01):
KPI, and then you add anadditional bonus should they hit
all of their KPI goals.
And then I want you to meetwith the office manager monthly.
You're gonna look at these KPIstogether monthly, and you're
gonna be speaking in systemswith them.
You're gonna say, okay, notyou're not asked talking about
tasks.
You're not saying, hey, can youremember to do this?
Did I did this?
Did this get done?

(25:21):
You're saying, what are youdoing to change this?
What new systems are youcreating to keep this from
happening or to improve in this?
What kind of trainings are youdoing?
What solutions are you comingup with?
Because ultimately we want toshift the office manager's
identity.
Remember, they were just afront desk employee at one time.
And they probably, in a lot ofoffices, the office manager

(25:42):
still is.
So we want to shift thatidentity from someone who is a
tasker that does everything to aleader that leads the team to
do everything.
And just like every otherposition in your office, when
things are going well, celebratethe wins, celebrate that
consistency.
The great office managers, theyalways perform their best when

(26:06):
they know what matters most tous as owners.
So we have to vocalize that.
We need to discuss that, weneed to be talking about what's
important.
So your office manager can bethe engine of the practice.
But you got to remember,engines only work when they're
aligned, when they're tuned up,and when they're fed the proper
fuel.
And that's what you need to doas the practice owner.

(26:28):
The moment that you start toget your office manager on
focusing on the right KPIs, theones that are tied to leadership
instead of task doing,everything changes.
They stop being that seniorreceptionist and they start
being the glue of the practice,the leader, the driver of
growth.
And your entire practice isgonna feel that difference.

(26:50):
Everything's gonna change.
So this week, pick your officemanager KPIs, build the
scorecard that you want to useand show your office manager
exactly what success looks like.
And then watch that person riseto the level that they've
always been capable of.
And if you want help buildingthis bonus system or any other

(27:11):
sort of systems in yourpractice, perhaps you want help
training your office managerinto being a real leader, please
check out our coaching options.
Go todentalpracticeheroes.com/slash
strategy so that you can set upa strategy call with me.
I will get on the phone withyou.
I'll talk about your specificpractice situation.
I'll let you know if ourcoaching options can help.
And at the bare minimum, youwill walk away that call with a

(27:33):
few action items so that youknow what to do for your next
steps to grow your practice intoa practice that runs without
you, that's highly profitableand brings so much peace into
your life because it doesn'trequire you for every little
thing.
Trust us, we do this every day.
We are true dentists, we runlarge teams, we know how to

(27:54):
change your practice.
Thank you so much for spendingsome time with me today.
I really appreciate it.
I want you to have an awesomeday.
Thank you so much forlistening.