Delegation Versus Abdication

Delegation is essential to the financial well-being of a practice.  The existence of well-trained clinical and administrative staff allows a practice’s doctors to focus on their unique (and high value) competencies.

The concept of clinical delegation is well-understood by dentists, and is something that they first encountered in dental school.

However, delegation of the administrative functions in a practice is something that is normally encountered much later when a dentist becomes the owner of a practice, and it happens without the dentist having the benefit of any training. 

Compounding the lack of training on how to effectively delegate administrative responsibilities is the fact that most dentists judge themselves by how their practice performs clinically and take no comparable pleasure from having a practice that is smoothly administered.

The combination of lack of training and low level of interest often create a “perfect storm” where dentists unconsciously fall into the trap of turning delegation, which is desirable and beneficial, into abdication, which can be dangerous.

So what is the difference between these two concepts? It can be summarized as follows:

Delegation is the devolution of tasks or responsibilities, but with accountability to the practice owner. Abdication is the offloading of responsibility, but with no corresponding answerability.

In a clinical setting, accountability is clearly understood by dentists. You have ownership of, for example, a poor impression taken by a dental assistant, and you have a clear responsibility to ensure that clinical staff have suitable training in CPR to be prepared to handle medical emergencies.

Clinical accountability is aided by the regulated nature of dental assisting and dental hygiene, where members of these professions are trained, tested, certified, and normally required to maintain their competency through continuing education. Also, the dentist’s knowledge of the work carried on by clinical team members is normally fairly high.

In contrast, there is no required certification to be a receptionist, financial coordinator or office manager. Most people in these positions have received their training on the job with you or while working at another dental practice. While there is considerable information and training available to people in administrative positions, it isn’t mandatory or comprehensive. And to make matters worse, unlike the clinical situation, the doctor is usually less knowledgeable about what goes on in the administration of his or her practice than the people who hold jobs in that area.

It’s a recipe for disaster. You are asked to oversee people who often have little formal training in their jobs, without your having the benefit of either detailed knowledge or any idea of how to exercise oversight. Furthermore, if you are like most dentists, keeping an eye on your front desk isn’t a responsibility that you enjoy in any case. So it doesn’t take much to convince you to just step away from what goes on there (i.e. abdication).

So what should a dentist do to increase accountability? Here are some ideas:

  1. Remember that accountability is more than an abstract concept. There is a tendency to believe that, because you sign someone’s paycheck, they are accountable to you. In an abstract sense this is true, but you derive no benefit from this relationship unless it translates into actual oversight.
  2. Effective oversight requires knowledge. Administration is not a cruel joke that the world has played on the dental profession; it is a vital link in the chain between the treatment of patients and your financial well-being. So learn to do the basics in your software — enter treatment, print reports and process a payment. Learn to do the key functions of your office manager in his or her absence. Learn what the most important reports from your practice management software are and what they mean.
  3. Be the boss. This does not mean that you need to be “bossy” but it does require you to make some rules and stick to them. Here are three rules that every practice should have:
    • Documentation of activity. Every administrative person needs to document what they do and how they do it. If they become ill, retire or move away, their “institutional knowledge” shouldn’t disappear with them. This requires a detailed job description (not the kind used when hiring) plus some backup information (references to the manual for your practice management software, etc.) These “position guidebooks” should be consolidated with each of you and your office manager keeping a copy.
    • Cross training — this is closely aligned with the previous point and is intended to ensure that your practice doesn’t grind to a halt because of the unplanned absence of one person. You should be one of the people cross-trained in your office manager’s duties.
    • Mandatory vacations for all staff. The best way to test your cross training is to put it to use. So make every employee take at least two consecutive weeks off each year when the office is functioning (times when the office is completely shut down do not count — the real point is to have someone else filling in for the employee). In addition to ensuring a distribution of your institutional knowledge, having other people temporarily fill administrative jobs provides one of the best chances of catching embezzlement.
  4. Trust, but verify. There are a few things that every practice owner needs to do in order to ensure that their practice records have integrity:
    • First, you need to review day-end information from your practice every day to ensure that your work was accurately recorded and to be alert for suspicious transactions.
    • Verify that the correct amount of money was deposited in your bank account. This verification should include both the “physical” deposit (cash and checks) and amounts deposited electronically. Normally, this necessitates waiting a few days for delayed amounts such as credit card payments to reach your bank. Verification should be done via electronic banking; a deposit slip is not sufficient.
    • It is important to ensure that your daily reports “articulate” with month-end reports. This is to ensure that there is no after-hours activity in your software that is hidden from you. We have developed a spreadsheet that does the heavy lifting for you.

While the process of managing the activities of your practice’s front-office staff can seem daunting at first, the basic steps outlined here will give you a great start.

We offer a terrific product called Office Protection System helps practice owners establish accountability. Please reach out to us if you would like to learn more.