Conflict Resolution and Reducing Turnover in Dental Hygiene

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Jolene Diode, RDH was daydreaming while finishing up her 3:30 PM patient. In her mind, she was reviewing everything she had to do that evening before the guests arrived at 7:00 PM for her beloved husband’s surprise 40th birthday party. She had one more adult periodontic maintenance appointment that afternoon and hoped to leave promptly at 5:30 PM. For whatever reason, she glanced at the computer screen and noticed a new entry on her hygiene schedule for a new child patient at 5:30 PM Jolene’s face turned a bright shade of red, but she worked hard to keep her composure. Finally, when she was able to excuse herself from the patient for a few minutes, she marched towards the front desk with tears in her eyes and asked Noel, the front office manager, for an explanation. Noel blew her off, saying she assumed Jolene would still be finished around 5:30 PM even knowing in advance that Jolene had to be out at that time. Jolene, a recent graduate, didn’t know how to handle the situation and banged on the front desk, knocking over a large decorative ceramic giraffe which hit the tile floor and broke into several pieces. The situation went from bad to worse and Jolene ended up in the patient restroom, bawling her eyes out.

Have you ever experienced anything like this scenario in your practice? Want to learn how to avoid drama, hard feelings and hygiene turnover?

Leadership and resolving conflict go hand in hand and dental practices that lack this important management component have high employee turnover. Today’s stressful dental environment often alienates dental hygienists and in recent years, before the COVID-19 pandemic, workload and immediate supervisor are often mentioned as a major contributor to turnover.¹ Now, during the pandemic, hygienists are feeling even more heat (in more ways than one including the wearing of an N95!) from having to compensate for hygienists who have quit or who have not yet returned to a full workload. Maybe, instead, your front desk person thinks the hygienist is a superhero who doesn’t need the bathroom or a lunch break or maybe he/she is scheduled to treat patients every 30 minutes. 

Reducing Turnover and Handling Conflict

In my decades of clinical practice, I’ve frequently noticed ineffective resolution and management of conflicts. Examples of this included unclear or wishy washy communication and a misunderstanding of the perceived area of disagreement. Sometimes, believe it or not, the solution is simple. Here’s an example: a busy hygienist (yes, me) blew up at a dedicated dental assistant because the assistant took a photo of the hygienist’s (mine) dirty instruments in the sterilization room sink. The hygienist (me) didn’t have time to clean her tray because she was late in seating the next patient and the dental assistant’s job was to clean the providers’ (dentist and hygienist) trays. The hygienist immediately marched into the DDS practice owner’s office and told him what happened. (I couldn’t help myself at the time and my blood was boiling.) The DDS practice owner did his best to diffuse the situation and remind the dental assistant that it was her job to clean trays, but the conflict continued, and the assistant and hygienist continued to verbally attack each other. Suddenly, the dental assistant blurted out, “I love you” to the hygienist (yes, me) and, believe it or not, the two of them talked, hugged and the problem was resolved!

In the above example of conflict, the hygienist (me) felt an immediate threat to her needs. Our relationship in the practice was complex and we respected and liked each other. In the end, the hygienist and assistant solved the problem themselves and just let it go but oftentimes this is not the case.

During and post COVID-19, healthy environments may be harder to achieve, at least in the foreseeable future. Breakdown in communication and collaboration can lead to increased patient errors and a lack of continuity. Let’s review some of the ways to assess and handle conflict in the healthcare environment. Discuss these issues at a team meeting, keep them tucked away for future consideration or add some of these items to your employee manual.

Depending on the size of the dental practice, monitor employment engagement levels through employee surveys. In small practices, this can be done verbally as a small group or individually. Watch for signs of disconnect like unhappy employees. Watching for more serious issues like absenteeism or tardiness may indicate job-related issues.

• Make sure that the goal of each new hire aligns well with company goals and discuss this in great detail regularly, especially if it involves the hygiene department. Make sure scheduling is reasonable and consistent and give everyone adequate time for breaks and lunch.
• If an employee feels that no one “has their back” it is an indication that there are problems in management that need to be addressed. Provide a safe outlet for these kinds of issues with a speedy response to correct these problems.
• Employees often respond favorably to incentives and perks. Acknowledgement and appreciation for their contribution is very important and some employees want to hear that they are doing well and that they have a future with the dental practice. Years ago, an employer used to hand me my paycheck and he always thanked me for my contribution to the dental practice. Every time he did this, it was an important validation of my work. A workplace that values employees and demonstrates this on a regular basis usually has happy employees. Great benefits and perks plus a salary that is in line with tasks and responsibilities goes a long way.
• Keeping employees engaged in their work for as long as possible will reduce costs. It is estimated that as much as 1/3 of the departing employee’s salary is required to replace them.²
• Sometimes bullying emerges in the workplace and managers can decide to look the other way. Don’t! Act on bullying accusations. Any type of disruptive behavior not only threatens the morale and emotional wellbeing of staff, but it can also affect patient safety. Create a zero-tolerance policy for bullying in your employee manual and clearly define unacceptable behavior.
• Interdisciplinary team care is sometimes difficult for some dentists to apply if they tend to be treatment oriented. Integrative care is a newer model of comprehensive patient care which dentistry in the U.S. has been slower to adopt than medicine. Physicians learned that they alone cannot meet the full range of patients’ medical and health-promotion needs, and they rely on non-physician health team members in the delivery of health care. In some European countries, much of the routine clinical work traditionally carried out by the dentist is beginning to be undertaken by a trained therapist. The integration of dental care and oral health is linked to the concept of “putting the mouth back in the body” with a focus on prevention for all age groups. Dental hygienists in the U.S. get bored easily in dental practices where they are viewed as “one of the girls” or even worse “a cleaning lady or gentleman” who does prophys. Dental hygienists are expanding access to care through dental therapy and it’s becoming a new workplace model with advanced training.³ Hygienists in any type of dental practice are sometimes underutilized for their expertise in prevention and should be recognized for their uniqueness as a primary health care provider. The future of U.S. dental care is about the dental team as opposed to any single dentist.
• Large dental teams need a “go to” manager who can diffuse conflict. Most conflicts are based in emotion and usually end up as a power struggle. When it comes to hygiene scheduling, the struggle is usually between the front desk and the hygienist. So, how does a practice manager handle it? Make sure you empower both the front office person and the hygienist so talk to them separately. Ask the front office person to give the hygienist courtesy of approving her schedule, making sure she has enough time for each patient which will ultimately influence the delivery of patient care and limit the hygienist’s experience of work stress.
• Recognize conflict early and pay attention to body language and mood changes. Being proactive and active listening requires focus on the speaker who is explaining a situation. Do it in a calm manner, define the problem, and make sure there is a clear understanding of the issues.⁴

A solution requires managing a conflict that successfully meets the goal of reaching an acceptable outcome for all parties involved. There’s nothing more frustrating than working in a dental practice with an atmosphere of chaos and animosity. Workplace overload is common today and most hygienists want to focus on patient care and leave office drama behind. At the end of the day, a health care worker wants to shut the practice front door, knowing that he/she made a difference in the life of every patient.

References

1. https://www.dentistryiq.com/dental-hygiene/salaries/article/16350568/career-satisfaction-survey-coping-with-stress

2. https://blog.mcquaig.com/revolving-door-of-employee-turnover/1. https://www.dentistryiq.com/practice-management/dsos-and-corporate-dentistry/article/14174176/why-do-associate-dentists-leave-dsos

3. https://www.adha.org/resources-docs/Expanding_Access_to_Dental_Therapy.pdf

4. https://journals.lww.com/nursingmanagement/fulltext/2012/02000/keeping_the_peace__conflict_management_strategies.13.aspx