Cathy Sundvall

Orthodontic Products September 2005 Publication

Delegation and Training

Advice for orthodontist and the clinical team

Delegating tasks in the operatory is one of the ways in which anorthodontists or clinical supervisor can draw on the strengths of the entire clinical team to manage the patient flow, increase efficiency, and reduce overall stress, while providing exceptional customer service..

Delegation is also a way to empower clinical team members. When the orthodontistsdelegates responsibilities to team members, it demonstrates a confidence in their skills and supports their professional development.

One reason that orthodontists don’t always delegate specific tasks is the issue of accountability with regard to clinical assistant licenses. This legal aspect requires the doctor/supervisor and clinical team members to be knowledgeable about a state’s clinical assistingguidelines as well as each assistant’s skill level and competency. Even with these challenges, learning the skill of delegation, training your clinical team and trusting they will fulfill their roleare necessary ingredients for today’s orthodontist practice, especially as the practice grows.

"If you’re going to be in a business of any size, you’re going to have to develop the kind of leadership qualities that allows you to attract good people, guide them, encourage them, and ultimately trust them — and let them go and do their jobs. Oh, sure, you have to take deep breaths occasionally. But mostly, you have to trust them."
- Bill McGowan, founder of MCI

TRUST IS A MUST

Have you ever delegated a procedure, to a clinical team member, only to check the patient and find yourself looking at something very different from what you prescribed? Or maybe the results were not up to your standards? Due to this phenomenon, many orthodontists sometimes feel it is easier to do the work themselves. As an example, say you go to check bands that have been fitted by an assistant, on all of a patient's molars. The distal lingual portion of the lower right second molar band needs to be seated more and the lower right first molars buccal tube is sitting too far mesial. You struggle with the decision between making the necessary adjustments yourself or having the assistant refit the bands. At that moment, you don’t trust the skills of the clinical team member and decide to make the necessary adjustments. Ideally, the clinical team member should have done the adjustment, freeing you for procedures that cannot be delegated.

If you struggle with a low level of trust in your clinical assistant’s abilityand you want to raise it, start gradually. Presenting someone with a difficult procedure when they are not used to such challenges will be extremely stressful for both of you. Successful delegation starts with easier procedures and allows confidence levels on both sides to grow. Then, you can assign another procedure that builds on the first one.

Here is a series of steps to take to make the process of delegation easier and more effective:

  • Understand the goal of delegation is not just to get rid of the work; nor is it just to keep the clinical team busy. The ultimate goal is to increase the productivity of the clinical team and the practice while maintaining exceptional customer service to your patient family.
  • Do not fall into the 'I can do it quicker and better' syndrome. Of course, you can do it quicker and better, you are the expert. If you do fall into this syndrome, you are not delegating; you are doing the work while they watch. . You will be stuck in a rut and keep your clinical staff in a rut, too.
  • Meet with your clinical team members and describe the desired results of the varied clinical procedures performed in the practice. Be very clear, about what you expect as the end product.
  • Make sure your clinical team members understand each step of the procedures by asking effective, open-ended questions such as; “Can you explain to me how you would go about bonding a partially erupted lower right second molar? “ or ask the team members to write out the protocol for handling the procedure. Tip: Save the protocols in a training manual for future training, review and updates.
  • Get a buy-in from each clinical team member that they are up to the tasks. If they do not feel capable, you might consider further training and coaching. Tip:Develop a checklist of all clinical procedures and test staff for abilities regardless of their tenure. Example:

Sterilization procedures

Polishing techniques

Isolation techniques

Bonding procedures

Fitting bands

Mixing and recementation of bands

Fitting headgear

Fitting, delivering, adjusting appliances

Mixing and taking impressions

Archwire bending and placement

Ligation techniques

  • Make your expectations clear and ensure the clinical team members know what their job entails and the quality of the outcome. Question: Do each of your chairside assistant have a job description (detailed) and side duties/secondary assignments for special tasks clearly documented/prioritized and understood by all team members including your administrative staff?
  • Support your clinical team by providing resources for continuation of learning. Ask what resources will be needed and provide them. Question: What training tools do you have available, have they been updated, and are the tools accessible for the clinical team? How often do you block out time in your schedule for training classes?
  • Share the task of reading orthodontic publications and journals with your clinical team. Tip: Assign each team member a publication, ask themto read and clip articles that would be pertinent to the continuing education of the staff. Have each team member give the highlights of their articles at your monthly staff meetings.
  • Empower your clinical team -- let them do the work, but agree upon legal limitations of procedures and develop checkpoints along the way so both of you will know how it is going.
  • Energize your team members -- when the task or procedure is complete, acknowledge their effort and provide instant feedback.

Orthodontists/Clinical Supervisors Do’s and Don’ts when delegating:

Do:

  1. Assess the patient situation and procedure first.
  1. Know the skills and comfort level of the clinical team member to whom you are delegating. If you don’t know, ask them.
  1. Give simple, clear instructions. Share your expected outcome.
  1. Give the timing for the procedure/task.
  1. Follow up with the clinical assistant.

Don’t:

  1. Grab back a task or switch assistants during the procedure.
  1. Delegate only tasks you dislike.
  1. Delegate a task that is beyond the clinical assistant’s skill level.
  1. Delegate a task at which you are not proficient.
  1. Reverse delegate by doing the job yourself.

Delegation and the continuation of learning for the clinical assistant

A word to clinical team members; If you seek more delegated tasks you must be committed to being the best at what you do. You must have the knowledge, skills and common sense to carry out the patient’s prescribed treatment and be willing to give your best effort every day. You must be highly trained and understand your practices treatment philosophy.

Here are a few ideas on the training experience

All clinical team memberswill sometime soon be attending a training class. It may be a one-hour lunch review on the theory of the Herbst Appliance a half-day class on patient motivation, or a weekend retreat away from the office revamping your schedule. It may be something for which you are paying for, or it may be something in which your practice is investing. Regardless of who is paying the bill, you are making a considerable investment of your time, energy and attention to participate.

Tips on learning:

1. Have a goal. The first thing you should do is set a learning goal. If you are already knowledgeable about the topic and have specific things you want to improve, setting your goal or goals should be easy. If this is training you are not too excited about attending, or are unclear about, you can still set a goal like: “Learn one new thing I can apply at work,” or “Learn one new shortcut to increase my efficiency.” Beginning your session with a specific goal and writing it down keeps you focused and will help you gain real practical value from any learning situation.

2. Learning is up to you. Take responsibility for your own learning experience. The training may not be the liveliest or engaging you have ever been to, but that is ok, because you have a goal in mind. Make that your focus. Perhaps the trainer is not going to cover that topic exactly. That is ok – use their expertise. Ask them at a break, probe for other resources. Stay focused on your goal. Your learning is in your control. Take responsibility for getting from the experience what you want and need.

3. Raise your hand and ask questions. Do you not understand something? Is the information is just not clicking for some reason? Ask for clarification. Do you need a little more practical, hands-on experience? Ask for it.

4.Learn from everyone. There are more people to learn from than just the speaker. The other staff members in the room can be a great learning resource. Tap into their experience and knowledge. Talk to the team members at your table or around you. Think of them as your peer coaches. These team members can help you learn during the session and might become great resources for information once the training is over.

5. Create an action plan. At the end of the training, create an action plan. Review your goal(s) and build a plan to implement what you have learned. Reflect on what you learned and resolve that you will apply those ideas too your daily task. If the training has been valuable, you may have several ideas. This is great, but be realistic on how much you can apply at a time. Build your plan recognizing that you may be able to implement some things tomorrow, but that other things might need to be spread out over the next week or more.

6. Become the trainer– One-way to solidify what you have learned, is to share what you have learned with someone else. Talk to a team member about it, or demonstrate the specifics of a procedure back in the office. Not only have you helped the other person, but also you have increased your knowledge and skills.

7.Review and practice - If you want to really retain what you have learned, set up a series of dates to review your notes and or practice the procedures you learned. Review them the evening after the training. Review and practice them the next day, and the next day. Then put a reminder on your calendar to review them one week later and one month later. Each review only needs to be few minutes long. You are simply trying to build the concepts in your mind through repetition and giving your mind a chance to spark new connections and new ideas.

In the end, the rewards of highly trained clinical assistants and the ability of the orthodontists to delegate include the cultivation of a practice that consistently develops great clinical team members and provides ample time for critical tasks and thinking for the orthodontists; motivated clinical team members who are allowed to grow professionally; and more “creative time” to devote to new projects and goals.

CONTACT INFORMATION:

Cathy Sundvall has combined her practice management and clinical expertise to consult, coach and train staff members in the areas of Clinical Efficiency, New Patient Process, Marketing, Customer Service, and Team Performance She lectures nationally, has published numerous articles and developed training manuals for Marketing, New Patient Process and Office Policies. Cathy can be contacted at 863-427-4346 or