Advisory Inquiry: Team Organization

Q: “I bought a small dental practice a couple of years ago, and have two front-desk employees, two assistants, and a hygienist. Two of the employees (one front desk, one assistant) transitioned from the prior owner, the other three I’ve hired as the practice has grown. The problem I’m having is that there is growing tension between the front desk employees and the clinical employees. I get the feeling that because the front desk manages the schedule, they feel as if they have a sense of authority over the clinical employees, as if they are “in charge” of the office. It’s frustrating to the clinical employees when the front desk dictates when lunch breaks or time off can be taken, for example, and frustrating to me when I overhear the front desk employees criticizing how a clinical employee handled a patient. This is not how I want my practice to run, but it’s hard to control what happens at the front when I’m seeing patients all day. We don’t have an office manager, and I’m the one responsible for making sure everyone gets along and does their job. How can I make my front desk employees see that they’re not the ones in charge just because they make the schedule, and make my clinical employees understand that the only person they need to report to is me?

 A: In small businesses with a flat organizational structure (no managerial hierarchy), it can be difficult to set limits on authority from one department to the next, especially in a dental practice where the practice owner is treating patients all day and isn’t able to manage in the moment. There are three things you can do to address this issue, and proactively prevent future issues of this nature.

1) Meet with your Team. As a group, and on an individual basis if necessary. Set a designated lunch time (say, from and make your expectation clear that if 11:30am – 2pm, depending on your patient hours) and let your front desk team know that unless a patient immediately requires attention, employees are allowed to take their meal break at any point between during this time frame. If you need coverage in the office at all times, let the team know breaks will need to be coordinated with other team members. Specify that all PTO requests should go through you (for time management, it would be wise to have a system – paper or digital – that allows you to approve or deny requests at your convenience). A well-written policy in your Employee Handbook would also help address this issue.

You should also meet with your team members individually on a regular basis to check in, ensure goals are being met, etc. These conversations provide the perfect venue for feedback on other team members as well. In talking individually with your clinical employees about how they feel the front desk team is handling issues, you’ll have the opportunity to reassure your clinical team members that your opinion of their work is the only one that matters in this practice. You’ll also have the chance to address these types of issues with your front desk employees privately and set goals and expectations as to how they should be conducting themselves in their responsibilities.

2) Create an org chart. This is a great example of why organizational flowcharts are helpful, even in a small practice. Having a visual representation of who is “in charge” of whom (and who isn’t) is beneficial to making the clear expectation that you are the owner and responsible for handling disciplinary matters, benefits administration, etc. for the people you manage.

3) Manage in the moment. You sound as if you have overheard these critical conversations regarding the behavior of your clinical employees, but did not act on them. Many practice owners prefer to avoid confrontation if possible, but sometimes it’s necessary. When you hear one team member criticizing another, speak up! Let them know in the moment that if they have an issue with how a team member is conducting themselves, they need to raise it with you directly. You might find that all it takes is you putting a stop to the office gossip once or twice before team members cease their critical diatribe. Once they realize that you are paying attention to office happenings beyond your chair, they’ll get the message.