Expectations

Communique subscribers who live in the US are likely familiar with Dental Economics, a dental trade journal which has been published for many years by Pennwell. When Dick Hale retired a few years ago, Dr. Joe Blaes was appointed the editor and in the four years of his editorship, Joe has transformed the magazine from one which was often overlooked to one which commands the attention of many. Because many people, myself included, had come to regard Dental Economics with some disfavor, Joe’s work has been a breath of fresh air.

Now I must admit that I am a bit biased on this issue. In the fall of 1999, Joe (an old friend) invited me to write the 3-M Dental sponsored series for 2000. I accepted with delight and authored twelve
articles in the series I titled Mastering the Art of Communication. That series attracted a huge following, and I am told that the number of reprint requests topped the list. I believed that Dental Economics readers were hungry for help in communi-cations, and the response to the series bears this out. If you have not read DE in some time, you may want to give it a try. You can also access the back issues
of my series by visiting the website: www.net32 .com.


The principle upon which each of the dozen installments is based is that how you think is significantly more important
than what you say. Good communications skills begin with your frame of mind and attitude. The words you choose are merely a reflection of your thoughts.

This year, Joe has again invited me to submit a series, and I have agreed. My focus for 2001 is Communications Skills for Successful Relationships, and I have just completed the March installment. With the ideas I incorporated in to the piece fresh in my mind, I am prompted to introduce you to some thoughts on expectations.

It’s too much to expect, but it doesn’t hurt to ask
It’s too much to expect, but it’s not too much to ask

Mary-Chapin Carpenter/Don Schlitz

Expectations are reasonable only when they are clearly conveyed, fully discussed, and agreed-to by all parties. Until this happens, they are merely wishes, hopes or assumptions which are not likely to happen.
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The less you convey your expectations to others, the greater the likelihood that they will remain unmet. While some expectations border on the trivial, others are profound in their implication. I remember a conversation during which a dentist complained to me about a particular employee’s mode of dress. “I think it is highly inappropriate for her to come to work in skin-tight animal print fabrics or short patent-leather skirts like the one she is wearing today,” he said. When I asked about the dress code he had outlined at the point of her hiring, he sheepishly acknowledged that he had not thought to provide guidelines at all. “Don’t you think she should be able to figure that out for herself?” he asked. Apparently not.

Because this dentist failed to outline a dress code, he could not presume anyone would be able to divine his wishes. Moreover, when she “tested” the dress code the first time by wearing leopard skin, she received no direct feedback that she had overstepped a boundary. The dentist conveyed neither his initial expectations nor his reaction to her choices. In the absence of information to the contrary, why would she not believe that those choices were perfectly acceptable? I am amazed by how often employment relationships end for unmet expectations at this level, and yet I am convinced it happens every day.

 As dentists become more sophisticated and as practices promise more to their patients, employee performance expectations are raised. In some cases, these expectations are never communicated; in others, they are merely hinted at, like the scent of perfume from an atomizer. In many cases, dentists strive to paint a picture of the practice vision, mission or philosophy; yet, the language is so unclear and non-specific that team members can bring a very wide range of interpretations to bear. Concepts like “strive for excellence” and “demonstrate a spirit of caring” are far too general to have any real meaning. Because these notions are intended to convey very specific expectations, dentists must provide more precise direction and guidance. For example, many dentists want their employees to engage in meaningful conversation that is relevant to the patient’s care, yet employees may initially interpret “talk to the patients” as a green light for more superficial, social conversation.

As I mentioned in Communique #128 (Rounds), dentists are often stymied by how to get a hygienist or another staff member to dispense with the chit-chat in favor of discussion focusing on the patient’s dental issues and treatment recommendations. When I ask these dentists to tell me how that desire was conveyed, I learn that this, too, is often

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an unexpressed expectation. Not unlike the more trivial issue of dress codes, this profoundly important agenda cannot be assumed to be shared when the expectation has not even been announced.

Not only are employer-staff relationships damaged by unexpressed expectations, but patient relationships also suffer, particularly when expectations change. Many practices are changing their expectations about how feesare paid, how insurance is handled, and about who will maintain responsibility for appointment details. Once a patient has become accustomed to a set of working agreements, unilateral and dramatic changes can easily jar the patient’s sense of security, especially when new expectations are not clearly outlined — particularly in advance. Clearly every business and practice has the right to change its practices and policies, but failing to convey new expectations is public relations suicide.

The other side of the coin is equally important. While we may hope others routinely share expectations they have of us, it would be foolish to presume that to be the case. Because each of us is fully responsible for our part of every relationship, we become equally responsible for a relationship breakdown if we failed to initiate a discussion of expectations. In fact, because it is in your business and

personal interest to ensure that expectations are clear, it may be more incumbent on you to insure that they are outlined. Many people try to guess, surmise, or decode the expectations of others. They take cues from informal conversation or ask third parties rather than asking the question directly to the person in question. Perhaps that is because they feel obligated to live up to expectations once they are made known. In some cases, we may simply not want to know the answer. Our parents, friends, colleagues and others may try to wield influence over our lives, but they are successful only to the extent that we allow them to do so. Remaining uninformed is not the answer.

Conveying and/or delineating expectations, however, is only the first step. What must follow is an actual discussion about those expectations which is completed with either an agreement to mutual accountability or a decision to abandon the expectations. Anyone has the right to ask you to meet a specific standard, but unless you agree to do so, they do not have the right to hold you accountable to it. This discussion is easy to avoid. It takes time. It is potentially conflict-ridden. You might be asked to become more specific or more clear when you feel unprepared. Nonetheless, the discussion must ensue, and both parties must outline those things to which they are in agreement and those in which they are not. I see examples of this frequently when team members
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discuss fees and financial arrangements with patients. Clearly outlining the fee and the mode of payment expected by the practice is a great first start, but if not followed by an opportunity for further clarification and a specific question about whether agreement has been reached, it is incomplete. “Marian, the fee for Dr. Neuhester’s services we have discussed is $X, and our first preference is that this fee be paid in full at the first appointment.” The expectation has been conveyed. “What questions do you have about this?” The invitation to dialogue has been extended. And the question, “Is that a payment arrangement agreeable to you?” finalizes the process. It is just as dangerous to make assumptions about agreement as it is to make assumptions about someone’s ability to guess your expectations in the first place. The point to begin establishing expectations is at the beginning of a relationship. When expectations are made clear at this point, it is significantly more likely that the relationship will not only survive but also thrive. A major part of hiring, for example, is constructing a written understanding of the expectations the employer has of the employee and vice versa. This is an important area frequently overlooked in many practices. Each position has expectations specific to the performance of duties as well as attitudes, work ethic, performance, code of conduct, and (yes) dress code. In return, employees have a right to identify expectations they have about performance reviews, compensation, fair play, and how their contributions will be acknowledged. Create a template to include each aspect of interest to the employer as well as the employee. Be specific, detailed and put it in writing.Likewise, patients have a right to learn about expectations as early in the relationship as they are relevant. Do not wait until after the fact. If a patient expects certain performance
from his insurance carrier and you fail to convey a different reality, you will likely receive the brunt of the patient’s disappointment. Protect yourself by initiating these conversations when you have any reason to believe the patient’s
expectation and yours are not in alignment. If you expect patients to treat your time with respect, tell them so, and ask for their agreement on that matter. If you consider appointments confirmed at the time they are made and the patient expects they can cancel as late as 24 hours prior to their time, you have a potentially serious problem that might easily be avoided by addressing the issued directly and in advance. This skill applies to almost any detail associated with patient services and patient care. Most patient relationships deteriorate over non-clinical matters such as these. This is a shame when they might so easily be avoided. It is well worth the time and effort put employee resources to work in clarifying expectations and reaching agreement before relationship breakdown occurs.It is almost impossible to recover at such a point — or at least without a few scars.
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