Hygienists and Dentists: Caring Enough to Confront

In Embracing Coworkers, Impacting Patients by Holly Anne Mitchell

My mother has a saying: “Care enough to confront”. If the issue and the person are important to you, you will find the courage to face the issue head-on. To see confrontation as an act of caring seems counterintuitive, and sometimes leaves you with a dry mouth and wet hands. But this act of caring and courage is the only way to bridge the gap when we’re on opposite sides of an issue.

Let’s talk about the divide happening in our industry right now between dentists and hygienists. Many dentists are upset that their hygienist does not feel comfortable coming back to work, making them feel unsupported by their staff. Many hygienists are upset because they don’t feel they are being heard or protected from the exposure risk of the Coronavirus. 

Perhaps the relationship was already like a fractured tooth, and the stress of COVID-19 has created a pain that can’t be ignored. Yet anytime we experience pain, we can finally become aware of the areas we still need to heal and grow. This fracture is a symptom of missing processes, an opportunity to reshape the way we operate and improve the health of the relationships and organization. Every Laverne needs a Shirley, every Bert needs an Ernie. Let’s confront what’s missing, and get these dynamic duos back together. 

How to Heal (Communication)

Change language

Power dynamic language can be demoralizing and incite resentment in any relationship. Think of the dentist calling their team members “the girls” or even worse “my girls.” Avoid gender-specific language that could be perceived as diminutive. Replace it instead with “colleague, friends, allies, and teammates.” The possessive language also seeks to overpower another, such as when the hygienist calls the practice’s patients “my patients” instead of “our patients”. Offer language that demonstrates mutual respect and collective interest like “our clinicians, our team, our providers, or our top-notch hygienists”. 

Ask questions to create goal alignment

Dentist to hygienist: “What do you need to feel comfortable coming back to work?”

Hygienist to dentist: “What do you need from me to help the business recover?”

For both: “What’s your biggest fear coming out of this, and how can I ease that fear?”

Two Ears, One Mouth 

Stephen Covey’s 5th habit remains an abiding principle of effective leadership: “Seek first to understand, then to be understood.” When emotions are high, create safety by allowing every team member to be interviewed alone by a senior manager and express their concerns. Group communication and digital communication alone are ineffective in times of crisis. One-on-one human voices are the best way to inspire trust, just as you do with your patients. And apologize if you’ve kept people in the dark or out of the loop.

Increase communication relative to the level of complexity and anxiety

When decisions are made and communicated, explain the thinking behind them, and share resources to catch people up. Remember in Math class when we had to show our work? Bringing people along the why journey. The how-did-we-get-here is just as important as the what’s-happening-next to gain buy-in. For change management to be effective, communication must keep pace with the level of strain on the organization. If the change is hard, or the emotional strain is great, increase the level of communication. Remind the team that everything is a first draft and subject to change and that their flexibility will be called upon to get us through this crisis. 

How to Restore (Process)

Identify decision-makers and decision-making process, involve all stakeholders

When deciding on policies that have a high level of friction and a high level of impact such as redesigning our patient journey, involve all stakeholders in the process by practicing decentralized decision making by way of a decision committee. Bring a representative from each impacted party to the table to survey their group (don’t forget to include the patient as a stakeholder) and provide insights and suggestions to decrease the friction. Once recommendations from the committee have been made, decide how you will decide (one decision-maker, a small group of decision-makers, or consensus?). After the decision has been made, ask the committee to support the implementation and communication of the decision.

Create new roles relative to risk tolerance

Define duties and responsibilities relative to risk profile (Is the employee risk-mitigating or risk avoidant?). There may be opportunities for team members to return in a new capacity if they are risk avoidant (i.e. treatment coordinator rather than chairside hygienist)

Define our standards of care and safety for patients and team

Having high standards gives people a sense of pride in the place they work, as long as we stick to them. Decide and document your protocols to create clarity. Use recommendations and research from reliable sources. Train the team on your protocols to build confidence, competence, and consistency. Create an audit system, peer accountability checkpoints, and/or checklists to decrease errors and maximize effectiveness, and consider nominating a clinical officer to oversee the standards we have set. 

Define the relationship, domain, and scope of the initiative

Much of the tension between hygienists and dentists stems from a confusing oscillation from independence to dependence. The same kind of relationship drama of closeness and space that exists between intimate partners. Without clarity on the domain, role expectations, and a communication cadence, we cannot expect the relationship to be a true partnership. Instead, it will be two people vying for control and respect–a recipe for an eventual breakup.

We must define the relationship by asking the following questions:

  • Is the hygienist a producer/independent or employee with benefits/dependent? Or both? What does the doctor need during the times they are not producing?
  • How is performance/success measured? Production-based or otherwise?
  • Does the doctor provide a coaching relationship to help the hygienist improve performance and an educating relationship to improve their clinical skill?
  • Is the hygienist permitted to perform all duties within the scope of their license?
  • Is the relationship one of thought partner/co-clinician or executor/auxiliary to the doctor’s thoughts?
  • Are there written standards of care for preventive, perio, and restorative and do we stick to them?
  • What are the hygienist’s goals for career, lifestyle, and finances, and are those goals possible within the organization? Do they support each other (and more importantly do they feel supported) in their respective goals? How specifically do they experience the feeling of being supported?

By caring enough to confront, and focusing on effective communication and process, we can heal what’s been broken.  Making the relationship stronger than ever. And the one who benefits most from an aligned care team? The patient.

Be Well,