I thought I would share some things we do regarding hierarchy.

1. Admin Hierarchy
I have a PM or a senior DA in each practice who answers to an overall PM of the entire group

Hierarchy is very important especially if you want a passive business that runs itself with only little input from you. However more than just having a hierarchy, it’s important that the staff are made explicitly aware of the hierarchy. I’ve been blessed with very good, loyal, senior staff from day one but I’ve often let them down by not making their position known to other staff and thus, they don’t get the respect that they perhaps deserve from more junior staff.

Further, the more difficult thing about hierarchy is when dentists and PMs clash. Or when dentists get involved and interfere with the work of the PM that is none of the dentists business and where their input is not required. For example: rostering is the responsibility of the PM. It’s not upto the dentist to choose who their DA is in a particular day – they go off the rosters. If you have dentists interfering with this or trying to have things there way, you absolutely must support your PM, in my opinion.

Another difficulty is dentists getting involved or acting as an advocate for auxillary staff. This often, either gives voice to an auxillary staff member who is doing something incorrect, or gives them an assurance that they have an ally should management talk to them about an issue and this causes problems. In short: I hate dentists getting involved in staff issues without understanding the entire situation.

We actually have a question in our dentist interviews that tries to weed this out now before we even hire haha.

2. Clinical hierarchy

I regularly put my best and most experienced DAs with new dentists we hire (experienced or not). This is part of our QC process and I really value their feedback on what the dentist does and how they are with patient communication. My best DAs are aware of the importance of each clinical step for our major procedures so if something is not being done well, we are informed quickly.

We had an ADC grad dentist with about 10 years of experience who worked in the public system starting with us. She lasted three days before she was let go and my auxiliary staff had a massive role to play in picking up gross deficiencies in both her clinical ability as well as patient communication. She left behind lots of caries in quite a few fillings she did.

Sometimes graduates when they first start, use the experienced DAs as a source of information. The DAs know that they can help and provide input clinically but only when asked.

If our DAs think a dentist is not doing something correctly, either clinically or with their communication, they will always tell the senior dentist or myself at each practice. They NEVER approach this with the dentist them self.

A recent example was a dentist that was constantly doing unplanned work when they only had a little time left in the appointment and running into lunchbreak/finish time. The DAs informed the PM who then asked me how we should approach the situation as it was happening frequently. This dentist would not have received the information well had it come from the PM. When I approached it with the dentist, they were more than happy to change how hey did things.

For owners who are at the practice everyday, these issues may not arise frequently. However, if you go on a long holiday, or maternity etc, it’s something that you should address with all staff so they are aware. I also would urge you all never to let a non-clinical staff member have authority over a clinician with regards to clinical matters.

If you have enjoyed this post or benefitted, please like, share or comment below.

Others – please input how you might do things – what you agree or disagree with so everyone can benefit

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