One Root Cause of the Silence and Lack of Empathy Too Often Seen in Dental Practices (Part 2)

Silence and lack of empathy are killing your dental practice

Today I am following up on last week’s blog and plan to share with you the first of three main root causes of the silence and lack of empathy (Merriam-Webster defines empathy “as the action of understanding, being aware of, being sensitive to and vicariously experiencing the feelings, thoughts and experience of another”) that can plague dental practice. This will involve my asking questions that can help you determine whether you have issues that bear looking into further. In doing all this, I will draw on my experience working with High Reliability Organizations (HROs) and on the results of the 3-year-long pilot study.

The root cause under discussion is simply lack of leadership. Silence and a lack of empathy are both undesirable communication-related behaviors, and a large majority of problems in a dental practice can ultimately be traced back to a breakdown in communication.  Even the best-equipped teams, under poor leadership, may not be able to salvage the situation.

Patients who are delighted with your service are more likely to be loyal to your practice, even if competitors offer the same service and treatment options, as they cannot duplicate your people and your culture! However, when weak or distracted leaders are in charge and exercise the kind of hands-off approach known as laissez-faire leadership, it’s not likely that your practice as a whole will demonstrate enough value to satisfy patients to sustain it in the long run.

As Eileen Morrissey, RDH, said in a recent article (“Serving at the Pleasure of the People: Clinical Excellence Does not Excuse the Absence of Basic Etiquette,” RDA Magazine, September 1, 2017): “Serving patients cannot be limited to providing optimum clinical treatment. It has to be the entire package.” We couldn’t agree more and would like to reiterate the point we have made several times in the past: essential as it is, technical competence will not by itself enable your dental practice to enjoy its full potential. We would also like to repeat something else said many times before: whatever is going on within your culture is almost always transferred directly to your customer experience, and vice-versa.

The most successful practices are based on deeply shared values (we recommend that you make a list of these and make them very visible to staff and doctors) that define their success in concrete terms, for the benefit of staff and doctors alike. Such values are shared and reiterated in daily collaborative huddles.  Like the results of such huddles, performance metrics, including e-survey patient feedback results, are given priority and help the team understand where they are now and where they need to be in order to create the most value for patients.

silence is caused by lack of trust

High Reliability Organizations (HROs) are headed by proactive leaders who stay the path, actively helping staff and doctors connect or reconnect to the “why’s” behind their tasks (Gamble, 2013). In addition, they are not afraid to hold people accountable when they deviate from the practice’s standards. They are, however, skilled at building relationships with team members based on trust and enlisting their help in solving problems. They understand that the more issues are identified and resolved in the work area (not in the occasional conference room meeting), the better, because once patients take their grievances to social media, the damage is already done.

If your turnover is high, you should do your best to understand ‘why’ via exit and team member interviews.  Research reveals that most turnover is misdiagnosed: practice managers too often attribute it to problems in the personal lives of employees or a fit/job mismatch, when in fact the majority leave because of their supervisor. Our pilot study revealed that when employees feel underappreciated and/or that their supervisor fails to recognize and utilize their talents to benefit the practice, they become disengaged (as shown in a poor attitude, impatience, silence, or lack of empathy in their conversations with patients) and then leave the practice. We found, however, that the opposite is true if supervisors engage daily in two-way feedback with employees and empower them to exercise their talents in the course of their work.

In every practice, people are greatly influenced by those who exemplify and model defined values, whether or not they have an official title. If the values aren’t specifically defined by practice leaders, staff will define them on their own, often with devastating results for both the practice and the patient experience.

The pilot study found that practices failing to properly define, communicate and model values functioned poorly because staff wasted a lot of time trying to figure out what they should be doing and how they should be doing it.  This, in turn, led to many formal and informal procedural inconsistencies that transferred directly into shortcomings in the patient experience. These included employees being immersed in their personal cell phones, ignoring patients or looking down while clicking on their keyboard with a patient directly in front of him/her, and failing to follow up with patients or address their concerns in a friendly, empathetic manner. An employee’s attempt to minimize the importance of such behavior by saying that “it was just a bad day,” is unacceptable.

Laissez-faire leadership can work very well for businesses that require trial and error in order to perfect products and services. This often applies to engineering firms, advertising agencies and research organizations – but not the stress-prone, schedule-packed dental office.

How Do You Know if You Have an Issue?

The following are some questions you can ask yourself designed to help you determine if your practice might be on “auto-pilot” and suffering from the kind of leadership that can generate poor communication, including silence and/or lack of empathy with patients:

  1. In the past 30-days, has your practice had at least one patient complaint related to communication? Examples include:  “I left a message but nobody returned my call,” “My daughter was in pain and upset when she left your office, and nobody bothered to console her or explain what the procedure entailed,” “Your front desk was unresponsive when I asked a simple question.”dental practice empathy silence
  2. In the past 6 months, have you had employee turnover that seemed abrupt and/or excessive?
  3. In the past 6 months, have you had at least two complaints from employees stating that they asked a question, made a suggestion or raised a concern with their supervisor, but that it was not answered or acknowledged?
  4. In the past 12 months, have you had at least two employees (excluding new hires) who have displayed signs of confusion over job responsibilities or tasks, or shown poor performance overall?
  5. Do you often skip daily huddles due to competing priorities?
  6. Do you normally learn about about patient concerns/complaints from social media, or when patients try to contact you directly?
  7. Are case conversions or referrals down or inadequate (e.g. too many patients falling through the cracks or not visiting your practice at all)?

If you answered “yes” to one or more of these questions, we recommend that you investigate further to see if you in fact do have an issue.  HROs are keenly aware of their operations, on the look-out for the smallest signs that their work processes might break down. They resist the temptation to accept ‘simple’ explanations or excuses regarding problems.  Long-held beliefs are challenged because people, processes and technologies change. And, most importantly, they take proactive measures designed to  prevent problems from arising in the first place, and take immediate actions to solve them when they do! At Identify one of our cardinal rules is: never ask a question that you are unwilling to address. We feel strongly that you should approach our questions to you in the same manner as you would our e-surveys and patient feedback. After all, gaining insights or collecting feedback and then failing to act on it has no value!

Daniel Goleman, the author of Working with Emotional Intelligence, said, “How customers feel when they interact with an employee determine how they feel about the company itself.” Very simply put: your dental practice cannot afford the high cost of laissez-faire leaders. Based on our experience, dental practice leaders must make a concerted effort to make people, communication,  customer service and process improvement their priorities. Great communication, practice improvement and the expectation of providing a high-quality customer experience cannot be delegated down or merely organized into a program. It requires a culture where every single manager, supervisor, doctor and employee is engaged every day.

In our next blog, Part 3 of the series, we will discuss other root causes of the silence and lack of empathy often haunting dental practices.

Please read Part 1 in this series, “Could Silence and Lack of Empathy be Killing your Dental Practice?”

Read the article by Eileen Morrissey, RDH,

Works Cited

Babcock & Wilcox Technical Services LLC. (2008). High Reliability Operations: A Practical Guide to Avoid the System Accident. Amarillo: U.S. Department of Energy.

Gamble, Molly. (2013, April 19). Becker’s Hospital Review. Retrieved from

Goleman, Daniel. (1998). Working with emotional intelligence. New York: Bantam/Doubleday/Dell.

Shingo Institute. (2016, Jan). Leading a New Era of Enterprise Excellence. Retrieved from

The Lewen Group. (2008, May 1). Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. Retrieved from Agency for Healthcare Research and Quality:


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