• Denise Ciardello

When Minor Infractions Become Major


You have worked hard to make the rules in your office as concise and crystal clear as possible. You don’t want to be a tyrant; however, you are responsible to uphold so many rules and regulations from the state dental board, OSHA & HIPAA, state, city & county laws. Now with the addition of the Coronavirus, those responsibilities have expanded to include the many steps you need to take to protect your patients, team and yourself. “We’re all in this together” is the battle cry. Yes. Yes, we are.

How do you ensure that everyone in your practice knows the rules and regulations, along with the ‘systems’ to complete those rules that you require? You write it all down; it’s called an employee manual &/or a protocol book.

With all the changes since March, there is a whole new group of systems that the team needs to follow. Have you included the new systems – the Covid systems?

Are you requiring:

· Temperatures/Pulse Ox taken on patients? Employees? Once or twice a day?

· Who maintains that log of information?

· Are masks worn all the time in the office? By everyone?

· What are the new disinfecting steps to be taken? By whom?

Instead of modifying all the different sections in your current books, we recommend adding a Covid section in the employee manual &/or protocol book.

Employees are expected to know and abide by all office policies. Human nature dictates that there will be employees that will ‘break the rules’. The degree of these infractions will be determined by the office manual and supervisor of the employees. Furthermore, the degree of the infraction may also decide the degree of the consequences.

At times, it is helpful to understand why an employee breaks the rule(s). The most common reason we hear is:

1- I didn’t know. If this is true then there needs to be training or re-training of possibly the entire team. If an employee states that they didn’t know they were acting outside of the office’s policy, and it’s the 1st time that this has been addressed, the employee deserves the benefit of the doubt.

2- It’s easier/faster this way. You may want to perform an immediate review of the ‘rule’ to determine if there needs to be a modification to an easier/faster method; or there needs to be training or re-training with the employee (and possibly the entire team) to explain why the rule is to be followed the way it is written.

If there is a flagrant offender of the rules, the way it is handled will set the example for the whole team. If the supervisor merely turns his/her head to the offense, then expect this behavior to soon be embraced as the ‘new rule’. If Becky is constantly late to the morning huddle, while Mary gets reprimanded for her tardiness to the huddle, expect Mary to point to Becky’s behavior. The rule of thumb for employees is typically, what you do for one – you do for all. By the same token, what you accept from one – you accept from all. If there is a special consideration for Becky, it needs to be made known to the team so it is not expected to be the norm.

Violations of the rules, whether blatant or unwittingly, need to be addressed immediately, or at least as soon as possible, in a private setting. The purpose of handling it quickly is because the action is still fresh in the person’s mind. This will allow that person the ability to better absorb the information and retain the importance of their infraction. At the same time, it is important to define the importance of the offense in terms of the office policies.

“Susan, it is against OSHA standards to walk out of the operatory with gloves on. Please remember de-glove prior to escorting a patient to the front desk.”

“Betty, it is against office policy to be 45 minutes late to work without notifying the office manager. This behavior will not be tolerated and there will be serious consequences if it happens again.”

What do you do when the minor infraction becomes a major infraction?

· The employee who is notoriously 5-10 min late now is 30-45 minutes late 3 days in a row.

· The hygienist that always forgets to document that extra PA is now not documenting the findings of the perio exam, forgetting to probe or is constantly running 30 minutes late with their patients.

· The chatty check out admin team member who talks incessantly about everything is now is talking to patients about other patients.

· The insurance coordinator who continues to allow the aging report grow to unacceptable levels.

Assuming that this is not the first time the office manager or owner is having a disciplinary discussion with this employee, these are the steps addressing increased poor behavior

· Keep it short and stick to the facts of this particular infraction

· If a previous counseling has occurred, have on hand those warnings or reports.

· If it’s worth having the counseling meeting, excuses do not matter. You will want to allow the person to defend themselves, and again emphasize the reason they are having the meeting

· Always define what future consequences will be if the behavior continues.

· If this meets the action for termination, additional step will need to be implemented: - Empathize, but remain confident in the reason and decision for termination - Be prepared to give next steps for exiting purposes - Be prepared to escort the employee out of the building (if you anticipate some sort of unpleasant reaction)

We have so many things to remember throughout the day – what supporting documentation we need to include with each claim, what x-rays we need to take, what are the correct materials for this particular procedure. It is never fun to have to address discipline issues with the employees. The best thing is to make sure that all employees have the ‘rules’ and consider reviewing them in team meetings. When someone does step out of line, address it immediately. Follow your protocols with regards to steps to termination. By making the rules so concise and crystal clear, employees will know that they are terminated due to their own choice. It’s never fun, however it is the human side of running a business.

Denise Ciardello, Consultant


Denise is co-founder of Global Team Solutions. A professional speaker and published author, her enthusiasm and knowledge about the dental profession has helped many dental teams. She brings experience, insight, and creativity into her management style, along with a sense of humor. In a profession that can cause anxiety in some dental employees, Denise’s consulting approach is to partner with doctors and team members to help them realize the dream of creating a thriving, successful practice.

Denise can be reached at: denise@gtsgurus.com

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