Most employees want to do well on the job. Both intrinsic and extrinsic rewards are valid goals toward which workers strive. They need and want fair and accurate appraisals based on standards of performance that explain what the business owner expects of them. Practice owners should not compare employees with each other, but instead should evaluate them based on how well each performs on the job. Appraisals must identify individual outputs or goals. They must also be honest to be effective. If employees perceive the appraisals as dishonest (e.g. performance was not adequate but was rated as adequate), then the appraisals will be ineffective. Appraisals should evaluate skill, knowledge, responsibilities, and special certification levels but not the job’s worth. Employees should not view appraisals as punitive but as suggesting ways to improve. The employer must incorporate a formal response system so that the employee can relate their personal performance to the review.

Given these requirements for fair and accurate performance appraisals, it is little wonder that both manager–dentists and workers view them suspiciously. Everyone appraises each of their associates continually and informally. (Coffee room gossip frequently concerns people who are not present.) Practitioners also continually assess (informally) workers’ appearance, behavior, and motivation. Yet when practice owners begin a formal review system, there is often initial resistance from staff and the owner–dentist. Employees fear job appraisals for reasons of job security and reprisals. Practice owners are fearful because of the time needed, the responsibility for objectivity, and the loss of personal power to a “system.” Once a proper system is in place and working, however, both employees and employers generally find their fears to be unfounded.

PERFORMANCE APPRAISAL AND REVIEWS

A performance appraisal and review (PAR) has two general purposes. First, it justifies personnel‐related actions. By objectively appraising work done, the manager has a solid basis for actions such as a promotion, rewards for past performance, a probationary review, or a warning for unacceptable behavior. Secondly, a PAR helps in counseling employees. Managers can better use staff by improving performance, assigning work more efficiently, meeting employees’ needs for growth, recognizing potential, and identifying training needs.

The result of the PAR should not be a surprise to an employee. Practitioners ought to give immediate, constructive feedback every day. If an employee performs excellently at a task, the dentist should praise them on the spot. The dentist should let the employee know (sincerely) why this was a good performance and how much that means to the practice’s success. The employee likely will repeat this behavior or action. Conversely, if someone does a poor job, the dentist should tell them on the spot (in private) why the behavior was unacceptable and what they can do to improve their performance. Most employees will try to improve.

PARs have several spin‐offs as well. They help in the selection/hiring process. Selection of the best person for any job is a difficult task. To find the best person, employers first identify job‐related behaviors and qualifications so that they can hire someone who meets those criteria. This is the basis of a PAR system. Instead of an informal, intuitive idea of the traits needed, practice owners generate a list of specific characteristics from the review process. They can use properly conducted PARs as contracts. By using PARs for feedback, goal setting, rewards, and punishments, dentists can motivate employees to accept change. Practice owners are on much more solid legal ground when they take personnel actions if a PAR system is in use. They can objectively show reasons for promotions, raises, and dismissals. The use of a PAR system can improve employee involvement in the practice. Employees who do tasks often define acceptable behaviors better than their managers. By defining goals and objectives and gaining the active participation of employees in the process, business owners improve the performance of the whole organization.

DISCIPLINING EMPLOYEES

Most employment experts suggest that the proper way to discipline employees involves a system called “progressive discipline.” In this system, the employer provides and records feedback given to an employee about their performance, suggesting ways to improve faulty performance. If the employee does not improve their performance, each round of discipline becomes progressively more severe until the employer fires the employee.

Progressive discipline encourages employees to improve performance. It also documents their poor performance. In the progressive discipline scenario, the employer gives an employee who is not performing to expectations a verbal reprimand, with methods to improve their performance. The employer notes that reprimand in the employee’s personnel file. If the employee continues to perform poorly, the owner gives written notice (again with a copy in the personnel file) and methods to improve. If the employee shows no improvement, the employer suspends them for several days, warning them of possible termination. Continued poor performance leads to firing. By using this method, employees cannot reasonably claim that they did not know their performance was below standard or that their job was in jeopardy. It is also fair in that it encourages the employee to improve performance; it does not simply threaten them.

Progressive discipline requires that the employer keeps written documentation of all warnings to employees about their performance. Fortunately, this is not as big a problem as it initially sounds. As the discipline becomes more severe, the documentation needs to be more thorough. (Initial counseling may warrant a two‐line note, jotted down in the employee’s personnel file.) Written documentation must include the following:

• Reason for the problem.
• Corrective action to improve performance.
• Employee comments.
• Employee’s signature and date.
• Employer’s signature and date.

This system provides documentation of employee performance problems if the employee files charges for a breach of employer responsibility. It also helps keep discipline consistent from employee to employee. Through the act of counseling, many employees will improve their performance so that they do not need additional disciplinary steps. Finally, the dentist may find areas of policies and procedures that they need to revise to make the office work environment more effective.

Practice owners must act in all situations of poor job performance. Failure to act tells employees that the owner has no standards for work in the office. If a dentist does not take notice of an employee’s sloppy work practices, then the others see that it does not matter if they are sloppy too. The result is lower standards and bad service to patients. Taking no action is a decision that may also prevent an employer from acting in the future in a similar situation. If the employer suddenly treats one employee differently than others for a similar act of poor performance, then they are open to charges of unfairness in the workplace.

There are several aspects to remember if the practice owner decides to use a progressive discipline system in the office:

• The goal of the system is to catch poor or marginal performance early and then help employees to improve their performance in areas where there have been problems. Early coaching becomes essential. The practice owner may require an employee to take a continuing education course or do other studies, practices, or demonstrations to improve their skills. Punishment is appropriate for employees who do not improve their performance.
• The employer may repeat a step if they believe that it will help to improve performance. For example, the employer may decide that a significant amount of time has passed since the last warning and that another warning is in order. If repeating the warning and remediation work, the employer has solved the problem without escalating to a higher level. The employee should understand, however, that repeating a step may lead to higher forms of discipline.
• The employer may skip steps for serious offenses or breaches of office policy. They will generally use all the steps for routine problems, such as attendance or general work performance problems. The employer’s judgment of the severity of the offense and remediation (if any) will help to define the steps to use.

Several behaviors are often excluded from a progressive discipline system. Employees are generally immediately fired for any of the following offenses:

• Reporting to work intoxicated or impaired on alcohol or illegal drugs.
• Stealing from the practice or another employee.
• Lying on an employment application or other practice document.
• Violating the confidentiality of practice or patient information.
• Causing a fight in the workplace.
• Bringing a weapon to work.
• Intentionally harassing someone (including sexual harassment).
• Insubordination.
• Extended unexcused absences.

The employer must talk with the employee about the problem and explain acceptable behavior and the consequence of failing to act appropriately.

Counseling needs to be friendly yet firm. Tell the employee the problem and try to identify a solution for the problem jointly. The practice owner must be sure that the employee has a way they can solve the performance problem. Often counseling documentation is brief, but the practice owner needs to save it in the employee’s personnel file in case the performance problem continues or escalates.

If an employee is suspended from work, the employer must tell the employee the length of the suspension and that it is without pay. Usually one to several days is enough to set the stage and impress the employee with the seriousness of the problem. (Some states require employers to suspend professional people – associate dentists or some hygienists – in week‐long time blocks. Practice owners should check with an attorney familiar with the state’s employment law.)

For serious problems (anything more than a verbal warning), the employer needs to require the employee to sign the disciplinary record form, acknowledging that they have discussed the problem and the corrective steps required. This does not mean that the employee agrees (they do not have to agree with the employer’s assessment), but that the employer has discussed the problem with them. If the employee disagrees or wants to explain their actions (there are often two sides to a story), the employer should write those on the form. If an employee refuses to sign the form, the employer must record (on the form) that the employee refused to sign.

Some management experts suggest that the practice owner should not include the progressive discipline plan in the employee manual. If they do, they should contact an employment lawyer first to check on the language and wording of the policy. The policy probably will not be used often, so if the rules are not followed exactly each time an incident occurs, the practice owner might encounter a problem. Employers need to treat employees equally. If the employer does not warn one employee about a particular performance problem but does warn another, the progressive discipline process may not protect the practice owner from legal action.

TERMINATING EMPLOYEES

Terminating (firing) an employee is perhaps the least enjoyable task a business owner can have. The employer should view firing an employee as the last option for personnel issues. If the recruitment and selection process has worked properly, the employer has given specific direction and performance responses to employees, and the compensation system is fair and equitable, firing should seldom be an issue. However, this is not always the case.

The practice may be better off by not having a particular employee around. If a staff member is not performing adequately, if the practice owner has given them notice of this and methods of improvement, and if the employee continues to perform inadequately, then firing may be in order. If an employee is found in gross violation of established laws, rules, or policies (e.g. stealing, alcohol impairment on the job, continual insubordination), firing is necessary. Finally, if a personality conflict has developed that severely impairs the effectiveness of the office team, dismissal may be in order.