Leadership is not in the appointment book

7 days ago

5 min read

Dear colleague,

There is an appointment in the book on Tuesday at one. An hour with your clinic manager. It has been there since August, it has been moved three times because an emergency patient came in, and canceled twice because you were running behind and needed to eat. Today you move it again.

She says it is fine.

And it is.

She has had two things she wanted to talk to you about every single time. A hygienist who has asked about her pay twice since June and has gotten nothing but "we will come back to that." And an agreement with the dental supplier that has gotten more expensive without anyone talking about why. After the third cancellation she stopped writing them down before the meeting. After the fifth she stopped thinking about them at all.

In the middle of October the hygienist resigns. You hear about it the day she hands you the letter. Your clinic manager knew six weeks earlier.

You remember the fall as calm. Now there is a feeling of frustration and irritation.

Everything that has a time slot gets done

Look at your week, the way it actually turned out last week. The patients have a time in the appointment book. The staff meeting has a time, at least what is left of it once Monday has taken its share. Your own lunch maybe has a time.

Leadership work has no time.

That is why it gets done wherever there happens to be a gap. In the hallway between two patients. In the ten minutes before the doors open, where you also have to answer three messages. On Sunday night at the kitchen table, when the rest of the house has gone to bed and you are too tired to make a decision you will still stand behind in six months.

Dental school gave you a structure for everything clinical. There is an order, a chart, a time frame and a professional who has shown you how. The other half of your job, the one you took on the day you signed and took over the clinic, came with none of it. Nobody told you that building the time for it was your job. So it gets done in the cracks, and cracks are small.

I did it myself for ten years

When I had my two clinics, I did leadership on Sundays. I had a fixed spot at the dining table with a pile of papers, a cup of coffee and a radio playing something I was not listening to. I called it being conscientious.

It was not.

It was a man who had given the clinic's most important work the worst time of the week, and who paid for it with his Sunday and at one point with his back.

What I did not understand back then was that the Sunday work was invisible to everyone but me. Nobody in the clinic could see that the decisions were being made. They could only see that they came late. And a decision that comes late enough is the same as no decision, just with more waiting.

The objection I get every time

"I cannot afford to block two hours in my own book."

That is a fair objection, and I am not going to talk it away. Do the math yourself. Take your own production in an average hour, multiply by two, multiply by forty weeks. That is what those hours cost you in a year. The number is big enough to make you feel sick looking at it.

I cannot promise you that those hours pay for themselves before New Year. It depends on what you use them for, and on how long the clinic has run without them.

What I can say something about is the other side of the equation. Try adding up what that hygienist cost. The ad, the three interviews, the training, the months where her book stood half empty, and the patients who found somewhere else to get their teeth cleaned in the meantime. Then add what the other two on the team thought when she resigned, and how many times they have talked about it in the break room since.

You had six weeks' notice.

It was there at the Tuesday meeting.

How to book it

Start by putting it into the appointment book as an appointment. Two hours, same day, same time every week. It should look like a patient, it should be at a time where you are still fresh, and it should have a name everyone in the clinic knows. Once a week is enough to begin with.

Then decide what is going to happen in that hour. Otherwise it just gets spent clearing out email, and then it lasts three weeks at most. I would fix three things: the numbers from last month, one conversation with a person on the team, and the one decision that has been waiting the longest. The decision that has waited longest is almost always the most uncomfortable one. That is why it is still waiting.

And then decide who guards the time in the appointment book. This is the point where most people fall off, because you cannot guard it yourself. You are the only one in the house allowed to cancel it, and you are also the only one with a good reason to do it every single week. My recommendation: give the job to the person who runs the appointment book. She has to be allowed to say no when you ask to have the hour filled with a patient, and she has to know that you mean it.

The first time she says no, you will feel bad.

That is the point.

What happens if you leave it

The clinic keeps running. That is the "sneaky" part. Nothing dramatic happens the week you drop the meeting, or the next one. What happens takes six months to become visible, and you never notice it as a sequence, only as a series of single events. Somebody resigns, an agreement has gotten more expensive, a mood in the break room you cannot quite place, the constant frustration over tasks that do not get handled the way you think they should. And the feeling that you are the only one who has to run as fast as you do.

If you do something about it, you do not get more hours in the week. You get the bad news while it is still small, and you get a clinic manager who starts writing things down before Tuesday again, because she has learned that the meeting happens and that it changes something.

Look at your appointment book from last week. If a stranger had to guess from that alone what your job actually is, what would she say?

When the meeting happens but nothing moves

The next question is usually what should actually go on in that hour, once you have it. I will write more about that over the fall.

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