Accountability without anxiety

A practice manager, a reception list and the four-word structure that turns a telling off into an agreement. Mark Topley explains how to maintain accountability and morale in the dental practice.

Transparency and understanding

A recent in-person visit to a client highlighted an all too common problem. The practice manager had handed her reception team a list of daily jobs on Monday, and by Friday several hadn’t been done, a few were half done, and she was clearing the backlog herself so it didn’t spill into the following week.

She wasn’t angry, she was tired, and when I asked why she hadn’t said anything to the team she gave the answer most people give, which is that she didn’t want to make a thing of it.

That sentence is where most accountability problems actually live. Not in laziness or bad attitudes, but in a leader who has decided that holding someone to a standard will cost more in atmosphere than it’s worth.

I understand the instinct, because most of us have never seen accountability done well. We’ve seen it done as a telling off by someone who sat on it for a fortnight and finally ran out of patience, and we’ve seen the flat morning that follows. So we avoid it, and the standard slips further.

However, it doesn’t have to feel like that. Done properly, accountability is one of the most motivating things in a practice, because people like knowing where the bar is and they like being in a team where everyone clears it. What makes it feel like anxiety isn’t the holding. It’s the surprise.

Define the standard

Two things were obvious about that reception list. The first was that it was a list of tasks, not a list of standards. It said things like ‘call the recall sheet’, which sounds clear until you realise it can mean working through every name and logging each conversation, or making four calls, marking two as voicemail and moving on. Both count. Only one delivers what the dental practice needs.

So, we rewrote it. ‘Call the recall sheet’ became ‘ensure every patient on today’s recall list has been called and the outcome logged before the end of shift’. Small on the page, enormous in practice, because it describes what good looks like rather than the activity meant to produce it.

The enemy of standards in almost every practice is assumption, and assumption is hard to spot because it looks like trust. It isn’t. It’s a leader who hasn’t yet made the obvious, obvious.

Build the loop, not just the list

The second thing missing was a loop. The list had been handed over and nothing built to bring it back, so we introduced a daily check-in where the team reported what they’d completed and flagged before the end of the day if they weren’t going to get through it.

If you can’t finish what’s been agreed, it’s your job to come and say so. ‘We got busy’ stopped being accepted, because in a dental practice you will always be busy, and busy is the environment in which standards are held, not a reason to let them slip.

That change alone removes most of the anxiety, because nothing accumulates and nobody is storing anything up.

A solid structure

For the conversation itself I teach a framework called STAND, and the name is the point. You’re taking a stand for the standards the team has agreed, and inviting the other person to stand with you. STAND stands for:

• Seek permission. ‘Have you got two minutes, I wanted to chat about something’. It gives the other person agency and signals a conversation rather than an ambush
• Tell what you saw. Specifically and neutrally, without your interpretation on top
• Affect. What it actually caused, stated plainly and not exaggerated
• Next time. What you’d like to see, or what was already agreed. This is the step that turns a complaint into an agreement
• Decide. Only if you’re the leader and it isn’t the first time. Say calmly what happens if the pattern continues. Not a threat, just clarity.

Use the structure consistently

It takes less than a minute. ‘Ben, have you got two minutes? The last few mornings surgery three has had instruments still out from the day before, so whoever’s setting up has been doing your clear-down as well as their own prep, and it’s adding 20 minutes to the day. Can we make sure everything’s cleared before you leave? That was what we agreed when we set the room standards.’

One caution. If the only time your team hear that structure is when something has gone wrong, it becomes the tap on the shoulder everyone dreads. Use it far more often for what’s going well, at something like five to one, and it stops being a warning sign.

Another recommendation is to give it away. If accountability lives only with you and your practice manager, you’re the bottleneck for every behavioural issue in the building, and standards that depend on you to enforce will slip the moment you look away.

Take one list this week, rewrite a single item so it defines the standard rather than the activity, and decide how it gets reported back. One thing, maybe two, and that’s it.

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