the 10 commandments helpful to have a set of rules for how you will behave to ensure your visits are...
TRANSCRIPT
The 10 Commandments
• Helpful to have a set of rules for how you will behave to ensure your visits are consistent and as helpful as possible
• Rules for before,during and after the visit
The 10 Commandments
Before the visit
1. Contact the dentist to explain the purpose and structure of the visit
2. Ask the dentist if they have any concerns and what they want to get out of it
The 10 Commandments
During the visit
3. Be prompt/keep to the agreed schedule
4. Listen, be non-judgemental & empathetic
5. Prioritise
6. Be knowledgeable
7. Help dentist/practice address issues
8. Give both positive and negative feedback in an assertive way aspects and leave on a positive note
The 10 Commandments
After the visit
9. Ensure all reporting done within agreed time frame and format
10.Ensure that follow-up arrangements are met
CHANGE MANAGEMENT
THEORY AND PRINCIPLES
Change management
A brief outline of some general principles of change management in business.
All of these theories can be applied to dental practice, and it is the practical application which is an important part of this course.
“The only thing that doesn’t change is that everything changes”
I I Ching, the Book of ChangesCirca 2000 B.C.
WHY CHANGE?
‘It is not the strongest species that survive, nor the most intelligent – it is the one most adaptive to change’
Charles Darwin
IDENTIFYING THE NEED FOR CHANGE
‘It is impossible to change organisations which do not accept the dangers of their present way of doing things’
John Harvey-Jones 1993
DRIVERS FOR CHANGE
‘Dissatisfaction with the status quo is not enough to create change on its own – there needs to be a vision of the future and the first few steps mapped out on the path to get there’
Bourne 2002
“Make sure that when you look at the horizon, that what you see is not the
edge of your rut”
VISION
Proactive
• Most practices will be reactive and wait until outside forces dictate change to them.
• Proactive practices will seek to influence change for their patients and their own gain
CIRCLE OF CONCERN
NO CONCERN
CIRCLEOFINFLUENCE
CIRCLE OF CONCERN
PROACTIVE FOCUSPOSITIVE ENERGY ENLARGES THE CIRCLE OF INFLUENCE
CIRCLE OF
CONCERN
CIRCLE OF INFLUENCE
REACTIVE FOCUS NEGATIVE ENERGY REDUCES CIRCLE OF INFLUENCE
CIRCLE OF CONCERN
INFLUENCE
CHANGE = CURRENT PAIN ,
VISION ,
EASE OF FIRST STEP
X
X
DRIVERS FOR CHANGE
• Changing market forces
• Customer demands
• Increasing competition
• Financial considerations
• New legislation
When your organization is changing?
Organization’s Culture
Nature of the Change Resistance to Change
Change DynamicsLeadership for Change
Keep these factors in perspective
What is the practice culture?
THE SPIDER’S WEB CULTURE
• Revolves around a central person who is all powerful. What they say goes !
• e.g. the Maxwell Empire
THE GREEK TEMPLE STYLE
• Each person has a rigid area of responsibility• There are many rules and regulations• e.g. The Civil Service, The DPB ?
THE STAR CLUSTER
• A collection of individuals working in the same organisation, but largely working on their own projects with no collective objective
• e.g. Many dental practices, legal firms etc..
THE MATRIX CULTURE
• Emphasis on getting the job done with teams to achieve targets on the way to common goals
• The emphasis is on the outcome, not on rigid rules and hierarchies
During a practice visit..
• How may you identify the practice culture?
• What impact may this have on the way you implement change?
When your organization is changing?
Organization’s Culture
Nature of the Change Resistance to Change
Change DynamicsLeadership for Change
Keep these factors in perspective
TYPES OF CHANGE
• Incremental change or radical change
• Continuous improvement or step change
• Participative or directed change
Bourne 2002 Change Management
When your organization is changing?
Organization’s Culture
Nature of the Change Resistance to Change
Change DynamicsLeadership for Change
Keep these factors in perspective
Why do people resist change?
“It has been said that the only people who want to change are babies who have wet diapers.”
Rev. Sharon Patterson, Ph.D.
“Resistance isn't an indication that something is wrong with what you are trying to change. It is an indication that something is happening.”
James Hunt
Signs of resistance
• Confusion
• Immediate Criticism
• Denial
• Malicious Compliance
• Sabotage
• Easy Agreement
• Deflection (change the subject)
• Silence
• In-Your-Face CriticismMaurer, Rick, Beyond the Wall of Resistance, 2
Identifying resistance
• What communication skill is required to identify the type and level of resistance?
When your organization is changing?
Organization’s Culture
Nature of the Change Resistance to Change
Change DynamicsLeadership for Change
Keep these factors in perspective
Late Majority 34%
Laggards 16%
Early Majority 34%
Early Adopters 13%
Innovators 3%
Rogers, Everett Diffusion of Innovations, fourth edition
Complexity- People’s timing
During a practice visit…
• What information might you gather to ascertain which group the practice/ practitioner is in?
When your organization is changing?
Organization’s Culture
Nature of the Change Resistance to Change
Change DynamicsLeadership for Change
Keep these factors in perspective
MOTIVATION AND MANAGEMENT
• Success is a journey from A towards B (your worthwhile destination)
• Leadership is defining B
• Management is organising the steps making up the journey
• Motivation is the desire to make that journey
MANAGEMENT AND MOTIVATION REQUIRE
MEASUREMENT
• Without measurement how do you know where you are?
• Without measurement how will you understand your progress and motivate yourself for more progress?
THE M WORD!
• “Measure what is measurable and make measurable what is not so” Galileo -1564
• “If you don’t measure it you are just practising” Robert Galvin, Chief Executive Motorola -1996
• “Measurements are the key. If you cannot measure it you cannot control it, if you cannot control it you cannot manage it. If you cannot manage it you cannot improve it” James Harrington -1991
ARE YOU A TELLING MANAGER ?
• Telling managers decide what to do and then tell the team
• We are going to ....................................................................
ARE YOU A SELLING MANAGER ?
• The selling manager decides what to do and then explains it to the team
• This is what we are going to do because ..........................
ARE YOU A CONSULTING MANAGER ?
• The consulting manager discuses issues with the team before making decisions.
ARE YOU A SHARING MANAGER
• The sharing manager works with the team, sharing and solving problems together
MANAGEMENT STYLE SUMMARY
• TELLING
• SELLING
• CONSULTING
• SHARING
telling selling consulting sharing
Input and compliance
PLANNING
THE IMPORTANCE OF PLANNING....
“YOU SPEND YOUR LIFE CLIMBING UP THE LADDER OF SUCCESS.....
...ONLY TO FIND IT’S BEEN LEANING AGAINST THE WRONG WALL !”
“START WITH THE END IN MIND”
Covey
“PUT FIRST THINGS FIRST”(choose your ladder)
• Concentrate on the big things
• Make a list of priorities
• Don’t get distracted by irrelevant things
Covey
PLANNING PRINCIPLES
• Where am I now?
• Where do I want to be?
• How will I get there?
• How will I know when I have got there ?
STAGES IN CHANGE MANAGEMENT
• Analyse need for change and deciding what that change should be
• Planning and managing the change as a project or series of projects
• Implementing change and managing people through it
• Ensuring the change becomes well-rooted and will not be undone
Bourne 2002
STAGES IN CHANGE MANAGEMENT
• Vision – clarifying the direction of the organisation
• Strategy – outlining how this is going to be achieved through objectives and goals
• Monitoring change – progress measured in order to observe and encourage change
• Continuous change culture Hannagan 1998
LEWIN’S THEORIES
• Unfreezing – recognise need for change and ‘unfreeze’ existing attitudes and behaviours
• Moving – new systems and procedures implemented, development of new attitudes and behaviours
• Refreezing – reinforcing changes – avoid reverting to old habits
Kurt Lewin 1947
The change balance
Drivers
Resistance
Vision
Management
Lack of vision
Proactive focus
Lack of knowledge
Can’t start
Video of Practice Appraisal
Video of Practice Appraisal
Key elements of practice appraisal
Key Elements of a Successful Practice Appraisal
• Assumptions:
- 4 dentist practice plus whole team
Objectives are to:
- check for legal/ statutory compliance
- give advice and negotiate change
- carry out a patient record audit
Prior to the Visit:
Telephone the practice to:• Introduce yourself (speak to a dentist)• Reassure them your primary objective is to be
helpful and ask if they have any questions• Encourage team to participate and prepare• Ask to assemble certificates and documents• Summarise arrangements• Get directions (be surprised if they are
accurate!)
On Arrival at the Practice
• Be punctual
• Look smart but not overpowering
• Smile
• Handshake (include team members)
• Use people’s names and greet warmly
• Pay compliments asap
• Good first impressions are essential
Take Control of the Situation Immediately
• Don’t allow pleasantries to go on
• Ask for a guided tour and don’t allow it to go on too long
Be Observant
• Appearance of outside (paintwork/garden)
• Décor/cleanliness (pay compliments)
• Attitude/appearance of team
• Confidentiality of records/appointments
• Breaches of H&S requirements
• Clinical waste storage
Be Observant
In surgery:
• Floor covering
• Cluttered work surfaces
• Old xray equipment
• Plastic bibs/hand towels
• Instrument storage
• Cold disinfecting solution
Working Through the Appraisal Document
• Assemble participants and ensure all have/can see a document
• Introduce yourself to the group and establish your credibility
• Reassure them you have come to be helpful
• Encourage all to join in – should be fun too!
Working Through the Appraisal Document
• Encourage them to make notes• Ensure you know what each dentist does• Use non-confrontational parts of the
document to build rapport• Address infection control questions to nurses• Address customer care/admin questions to
practice manager/receptionist
Working Through the Appraisal Document
• Give advice with rationales. Use self-disclosure, tell verbal proof stories
• Negotiate assertively to agree mutually acceptable solutions. Define the bottom line
• Try to ensure you can answer their questions. It is helpful to carry a reference document
Working Through the Appraisal Document
These phrases may help:
• Current thinking has moved away from…
• Many practices are now…
• I can see you’ve thought this through and I take your point, however…
• Let’s look at the best way of achieving xyz..
• You’re leaving yourself very vulnerable if..
Working Through the Appraisal Document
Avoid:
• The ‘clipboard and white gloves’ approach
• “You can’t do that”
• “Do you know what the regulations say?”
• “You must do it like this”
• “That’s wrong”
Don’t tutt or show your disapproval!!
Working Through the Appraisal Document
• Listen to and empathise with the dentist’s point of view
• Accept challenges without belittling or patronising
• Agree that some regulations seem over the top/unreasonable/expensive
• Know the possible consequence of non- compliance
Certificates and Documents
• Ensure you know what you’re looking for
• Ensure you know legal requirements for certification periods for equipment etc
Closing the Visit
• Agree points for action and time scales
• Offer help in future (if appropriate) or advise where help is available
• Leave on a positive note with a compliment and thanks for the day
Summary
• Resistance and fears• Donabedian principles of quality• Tools required• Communication skills• Ten commandments• Change management• Patient record audit• Scenarios• Key elements of practice visit
And Finally…..
• Study groups
• Workbooks
• CPD certificates
• Content of the 3rd day
• Feedback forms
• Faculty guidelines