Guest column: Coping With Conflict – Part Two

A Layperson’s guide to resolving conflict in the office

By Daniel A. Bobrow, MBA

President, American Dental Company

Part two in a series of two articles

In last issue’s article, we discussed models and tenets used to resolve conflict. In this part, I’ll go over the skills necessary that, once mastered, can greatly assist you in managing and resolving conflict in your office.

Active Listening

Truly listening and showing with your body language a sincere desire to know what the person is saying is vital. A person must feel that they are being heard for any resolution of any conflict or problem to occur. This can be further demonstrated by some of the points below.

Mirroring

Restating conceptually what is said to you to confirm your understanding. Care should be taken to “neutralize” statements by eliminating or changing words that are emotionally charged or are accusatory.

Pacing

Another method has to do with understanding and matching the tone and pacing of a person’s speech pattern, and, if needed slowing it down. The goal being to calm the person so a more productive conversation may take place.

BATNA

This is an abbreviation for Best Alternative To a Negotiated Agreement. It involves asking the person to consider what the best possible outcome will be if a mutually agreeable settlement can not be reached. An example of the use of BATNA is: “Joseph, I know you don’t like making reactivation calls in the evening. But you’re the only one on our staff who is capable of doing so. And you remember the mess we were in before we brought you on. What do you think will happen if we just stop doing this?” Embedded in this sentence is another technique called stroking (see below).

Reality Test

Similar to BATNA, reality testing attempts to get the person to see that his or her proposed solution is unrealistic, or at least, not optimum.

Blame Yourself, Not Others

A great way to neutralize tension during the mediation session is for the mediator to take responsibility for any misunderstandings or uncomfortable situations that might arise. For example, if a party grows impatient while the other party is speaking, you might say “I’m sorry for not giving you an opportunity to speak, Sam. Just as soon as Bill finishes, you’ll have your chance.”

Ask “Harmless” Questions

Ask “leading” questions: especially when the parties seem to have reached an impasse, ask “safe” questions that get the parties talking again. For instance, you might say “Whose turn is it to get lunch today? I’m starving!” or “By the way, did I remember to thank you both for helping me juggle those four patients this morning? I owe you for that one!”

Stroking

Let the parties know that they’re doing a great job in the mediation, and you really appreciate their willingness to sit down and talk things over. It’s too bad more people are not willing to talk and listen.

The goal of all the above techniques is to get people to see for themselves why resolution of the conflict is in everyone’s interest, including theirs. If someone feels that they are being manipulated, or that a solution is being forced upon them, the parties to the conflict will be less likely to adhere to the proposed agreement. Remember that agreement is not the sole criterion of success. In fact, if either party feels the agreement is “forced on them,” it may do more harm than good.

An Ounce of Prevention

One way to deal with conflict is to create an environment where it is less likely to arise. One way to do this are to anticipate the kinds of conflict between staff members, doctors, and patients, then implement systems and training to prevent these situations from arising. Examples include:

“Personality Conflicts” between staff

Implement some form of compatibility assessment into your employee screening procedure, as well as for current employees. Doing so can help you understand who is most suited for working with whom. Employ active listening and caucus tools (see part 1, last issue).

“Trust is an essential ingredient of a productive and profitable environment,” says Dr. Ira S. Wolfe, DDS, president of Success Performance Solutions. “The willingness of people to exchange ideas and collaborate is thwarted when people are selected and promoted on the basis of skills and experience alone. ” People have to be able to get along with their co-workers in order to have a winning team environment. Wolfe’s SMARRT management process encourages and facilitates matching people who are compatible with the job, the team, and the practice culture. There are also testing procedures that help choose the right person for the right job and assesses their potential compatibility with other staff. Find some technique, test, or company who has experience and proven results in this area to help you with this. Doing this properly will result in less conflict and stress, and higher practice productivity.

Patient Complaints about being kept waiting

Implement a policy of notifying patients in advance if the doctor is running late. Promote a “no waiting policy” as part of your mission statement or declaration of principles. When the occasional complaint does occur, be prepared to use disarming verbiage such as “The doctor asked me to apologize to you for not being able to see you. He is busy with a procedure that has proven more involved than we anticipated. He assures me he will do everything he can to see you as soon as possible. Is that acceptable to you Mr. Jones?” Doing so before the complaint arises in the first place is a great way to show your sincere concern for your patient and respect for their time.

Staff Member refusing to implement changes or “grow with the practice.”

Caucus with that person employing the techniques covered above. Through good communication and active listening you can get to the source of this team member’s unwillingness to work with the team. In many cases, you may discovering something more fundamental going on that has farther reaching implications for the practice.

Another way of preventing conflict is to hire, then educate and motivate staff members to recognize the value of the work they do, and the value of the practice to its patients and the community. Involvement in charitable groups, for instance, can give the practice team a sense of shared pride, and serve to put in perspective the disagreements as self-indulgent exercises that neither the practice nor staff members can afford.

As I am writing this, I am experiencing a poignant example of potential for conflict. I am working on my laptop on a return flight from a conference I’d attended. A rather ample gentleman was seated in front of me. As he reclines his seat, my laptop is thrust into my abdomen. I struggle in vain to position the laptop in a way that will not restrict my breathing. Out of desperation, I at last say, “excuse me sir, I’m sorry to distrub you, but I wonder if it would be possible for you to bring your seat back up just a little bit and still remain comfortable. I realize these seats were not designed with the use of a laptop in mind, but it would be a great help if I could continue working on this article as I am under somewhat of a deadline.” He was immediately accommodating.

In addition to my choice of words, the fact that I had earlier helped this same gentleman avoid a bump to his head by pointing out the open overhead cargo bay no doubt set the stage for his cooperation. As to what I said, I was careful not to use accusatory or demanding language that suggested blame or that I was entitled to anything. I also showed a respect for his comfort, and directed the cause for the situation to the design of the seats. Finally, I offered a reason why I needed to continue my work.

Final Thoughts

Remember, an agreement needs to last, especially if between staff members.

A number of resources are at your disposal if you would like to learn more about how alternative dispute resolution (ADR) can help you achieve more harmonious relations in your practice. Which are appropriate depends on factors such as the number of staff members and the types of conflict you experience. I invite interested readers to contact me if they would like to learn more about these powerful techniques.

Daniel A. Bobrow, MBA is president of the American Dental Company, a Chicago-Based Consultancy serving the dental profession. He has mediated and arbitrated various cases. He is also Executive Director of Climb For A Cause, a non-profit Foundation whose mission is to provide health care treatment and education to people in need worldwide. He may be reached at 312-455-9488 and

Dbobrow@AmericanDentalCo.com or

Director@ClimbForACause.org.

Putting Your New Employee On the Job

If bringing on a new employee involves another employee leaving, see to it that the employee who is leaving writes up how all of the duties and functions of the job are to be performed. The employee would then place all of those detailed descriptions in the existing “Job Description” manual for the particular position. This manual would include, but not be limited to:

  1. Any little things that are required of the post on a day-to-day basis which are successful.
  2. Special things that the “old” employee does that she feels are beneficial and helpful to the doctor, the other staff and the patients.
  3. Anything that a new employee would need to know such as where things are kept, where things can be found, who handles various functions, specific policies relating to that position, etc.

The doctor and the office manager should review this “write-up” and make any necessary additions, changes, modifications so as to ensure that a full job description has been put together.

If you are in the process of filling a position where there is no one available to do this job write-up, then the office manager should put this together the best she can and add it to the general job description.

PERSONNEL FILE

The Office Manager should create a personnel file for the new employee that contains:

  1. A full job application and resume
  2. Any other forms used in the hiring process
  3. Any tests, if taken
  4. A copy of the signed acknowledgment of office policy and job description
  5. A checklist of everything the Office Manager will be doing with the new employee to bring her on post

OFFICE POLICY AND BASIC TRAINING
Give the employee his/her own copy of your Office Policies and Job Description manual and have him/her read through the policies within a stated period of time. Once the person has had an opportunity to read the policies, sit down with that person and handle any questions with regard to your policies. Have your new employee sign their copy of the Acknowledgment Page that indicates that he/she did receive, read and agrees to abide by the policies.

Ensure that the Job Description contains:

  1. The Office Purpose, Product and Ideal Staff Member.
  2. The Purpose, Product and Statistics of the position.
  3. All the relevant procedures and write-ups relating to the job.

FAMILIARIZING THE NEW EMPLOYEE WITH THE FACILITY
Be sure to take some time to familiarize your new employee with the office, showing him/her where things are, what they are, who uses what, etc. Walk through the practice with your new employee, and allow him/her to ask questions and take notes. Familiarize the employee with how your flow line works, and why you have set it up that way. You could develop a “New Employee Scavenger Hunt” to facilitate this.

GETTING TO KNOW THE OTHER STAFF:
Have the new employee sit down with each of your other employees and get to know them a little. This is a great time for that person to find out what each staff member needs and wants from them.

Your new employee will now feel much more comfortable and able to “get on with it”. Put the person on post and let him/her begin.

Ensure that ongoing training is occurring on the following:

  1. The use of proper organizational requests
  2. Graphs and stats
  3. Written communications
  4. Asking for referrals
  5. Office organization

Case for Change in Dental Education Curricula

The American Dental Education Association’s (ADEA) Commission on Change and Innovation in Dental Education (ADEA CCI) was created to serve as a focal meeting place where dental educators and administrators, organized dentistry, and the licensure, accreditation, and examining communities could meet and coordinate efforts to improve dental education and the nation’s oral health.

An objective of this commission is to guide dental schools by discussing systemic efforts to foster change and innovation in dental education. As a facilitator of change, ADEA CCI is committed to providing leadership and oversight for a collaborative and continuous process of innovative change in the education of general dentists so that they enter the profession competent to meet the oral health needs of the public and to function as important members of an efficient and effective health care team. To that end, the Commission created two landmark articles published in the Journal of Dental Education, which is published by ADEA

The two articles, “The Case for Change in Dental Education” and “Educational Strategies Associated with Development of Problem-Solving, Critical Thinking, and Self-Directed Learning” address the rationale for change while examining a number of mounting issues, including the high cost of education, the need to promote the provision of oral health care to all Americans, and current students dissatisfaction with the state of dental education.

Answering these questions begins with determining best practices for helping dental students acquire skills necessary for their careers in dentistry, and ultimately become experts through lifelong learning. These papers offer ADEA CCI’s first recommendations on benchmarks that faculty and academic planners can use to assess the degree to which their curricula include learning experiences associated with attaining mastery of the dental profession for future graduates. “Scientific advances driving the delivery of health care are taking place at lightning speed. We can no longer afford to base our education programs on the memorization of present day facts. Programs developing tomorrow’s health care providers must concentrate on the creation of lifelong learners capable of providing evidence-based care that meets the need of society,” said Dr. Kenneth L. Kalkwarf, ADEA President and ADEA CCI Chair.

ADEA CCI’s activities are based on four guiding assumptions:

Assumption 1: Diversity of dental school curricula is a strength of dental education;

Assumption 2: Dental education has been and must remain firmly rooted in scientific discovery;

Assumption 3: Dental education must change in significant ways to develop students into lifelong learners;

Assumption 4: Achieving meaningful change and innovation in dental school curricula is a systemic process.

The Commission consists of representatives from ADEA, dental schools, the ADA Board of Trustees, the Commission on Dental Accreditation, the ADA Council on Dental Education and Licensure, the Joint Commission on National Dental Examinations, the dental licensure community, the ADA Foundation, and allied and advanced dental education programs.

SOURCE: AScribe Newswire

Music, Physics, A Sailboat and Dentistry

Profile: Dr. David Matthews

Practice: David R. Matthews Dental Group, LLC

Location: Eugene, Oregon

Music, Physics, A Sailboat and Dentistry

A music teacher with a penchant for physics, Dr. Dave Matthews changed careers after ten years of teaching music to become a dentist. A graduate of the University of Oregon in 1970, Dr. Matthews taught music in Dallas, Oregon until 1980 when a compelling desire to practice dentistry took him to Oregon Health and Science University’s Dental School. After graduating in 1984, he started his second professional career, this time as a dentist.

For the next 12 years, he practiced what he felt was excellent general dentistry. But he hit a production plateau that he couldn’t break free from. As part of this, Dr. Matthews had problems effectively managing his employees and his new patients had dropped precipitously to an average of four per month. He didn’t know why. As he was untrained in practice management, including how to best hire, train and deal with employees and market for new patients, he was at a bit of a loss as to what to do.

“We weren’t productive, we had no office procedures and I had no skill in confronting people positively,” said Dr. Matthews. At the time, he was producing about $200,000 per year.

His wife Carol was still a schoolteacher when he begged her to train as an office manager at his practice. She commented that, “At that time the staff said that he didn’t talk to them. That sure didn’t help matters!”

It was at that point when Dr. Matthews turned to hiring practice management consultants in an attempt to reverse what he considered to be a very negative downward slope.

And it reversed in a big, big way.

Last year, his practice produced over $1.3 million and averaged 44 new patients per month. So, over the past 9 years of receiving practice management consulting, Dr. Matthews increased his production 650 percent and his new patients by over 1000 percent!

Carol Matthews said, “He has become a much happier person and an extremely better manager of people and all the other business aspects of running a practice.”

Dr. Matthews said, “I’ve always been interested in helping people in some way. Practicing dentistry allows me to do that, not only with my patients, but also with my staff. I love helping my staff grow in competence, not only as employees, but also as people. The ones who ‘get it’ and apply it are great to see.”

“We continue to use the consultants who helped us achieve this growth, because it makes life easier, more enjoyable and I gain more skills to create a better practice,” Dr. Matthew explained.

His success in dentistry has afforded him a rich life. He and Carol met in high school and have been married for over 37 years with two grown children. “Sailing is a big hobby. I own a 42-foot sailboat and get out whenever I can,” he said.

He didn’t leave music entirely however. He still plays the saxophone and performed in a big band in Eugene, Oregon for 15 years.

Dr. Matthews said, “I’m a much happier person and am truly getting what I want out of life. What more could you ask?”

PROFILE: EZEKIAL THOMAS, DVM

PRACTICE: RIVER FOREST ANIMAL HOSPITAL

LOCATION: SARASOTA, FLORIDA

Handling National Chain Competition by Learning How to Run a Business.

Dr. Ezekial (Zeke) Thomas has been in practice for 46 years. He is a small animal vet and works with exotics such as reptiles and birds. His father was a general veterinarian and, in 1960, Dr. Thomas went to work with his father at the practice. The elder Dr. Thomas retired in 1964 and moved to a fishing village in northern Florida and Zeke has been running it since.

Dr. Thomas had an unusual occurrence happen that prompted him to take on a practice management consulting firm. He found out that PetSmart, a large national chain, was going to be opening up about 700 feet away from his office. Numerous people told him that this would severely impact his practice and that he better do something about it. “They were an unknown,” said Dr. Thomas. “Many other vets in area also were concerned about the chain moving in and took unusual measures to prevent problems such as lowering vaccination charges.”

Dr. Thomas had been practicing veterinary medicine for over 30 years when the chain moved in. He had never used consultants before and was averaging $180,000 a year. But he knew he needed to do something, so he took the plunge and hired some outside help.

From the management skills he learned, he was not only able to retain his clientele and not lose them to the big chain, but also his production soared to over $500,000 a year in less than 3 years. And, again, at this point he had already been in practice for over 30 years, which makes this quite a remarkable change.

“The absolute biggest benefit I received from taking on a consulting firm was learning how to run a business,” explained Dr. Thomas, “Practicing veterinary medicine is one thing, running a business is another. They don’t teach you how to run a business in vet school That’s not why we were there. It didn’t make sense that some people did great coming out of school and others didn’t. The difference is what I learned through using consultants.”

Dr. Thomas has been married for 16 years to his second wife Susan and has two children from his previous marriage and two step-children. His greatest passion, aside from his family, is boating on the Gulf of Mexico. He has a 41-foot boat that he regularly takes out to help him unwind.

Dr. Thomas feels that anyone can handle any practice and cause it to grow, no matter the competition, no matter the demographics and no matter whether you are up against big chains like PetSmart, WalMart, etc. His experience shows that if you know how to properly run a business – including internal and external marketing, hiring and training staff, having proper office policies and job descriptions and financial systems in place, you can be successful. He knows this because he did it and feels that anyone could do the same.

Saliva as a Diagnostic Tool for Periodontal Disease

A University of Kentucky research study could help change the diagnosis and treatment of periodontal disease.

An article, “Salivary Biomarkers of Existing Periodontal Disease,” discusses the importance of saliva and its potential to be a diagnostic tool.

The study was conducted by a team of UK researchers to determine if saliva could be tested for signs of periodontal disease, a chronic bacterial infection affecting millions of Americans characterized by persistent inflammation, connective tissue breakdown and alveolar bone destruction. Results showed that saliva could be a significant component in diagnosing and monitoring periodontal disease.

“Our research team has been working on methods and point-of-care devices that could allow saliva to be used as a diagnostic fluid,” said Craig Miller, primary investigator and professor of oral medicine at UK. “Our initial emphasis is on the identification of biomarkers in saliva that will allow us to diagnose periodontal disease. We have made great strides in doing just that, as evident by our recent data published in JADA.”

“This could impact the practice of dentistry and medicine in the very near future, as health care practitioners use saliva, possibly instead of blood, to diagnose and monitor oral and systemic health. With time and continued research funding, we are hoping to realize portable devices that can diagnose a wide variety of disease conditions using saliva,” Said Dr. Miller.

In the March issue of the Journal of the American Dental Association, which was devoted to studies on the salivary glands, two feature stories and two editorials evaluated the future of saliva as a diagnostics tool. The second feature story was a study from the University of California – Los Angeles, which examines markers in saliva of patients that are correlated with oral cancer.

“Point of Care diagnostics is the holy grail for the health care in the 21st century,” said Daniel Malamud, professor at New York University, in his guest editorial, “Salivary Diagnostics: the Future is Now,” also appearing in the March issue of JADA. “Within the discipline of POC diagnostics the use of saliva and other oral samples as the source of biomarkers is particularly appealing since their collection is relatively noninvasive and well-tolerated by the patient.”

The authors of the UK study include: Miller, Mark Thomas, associate professor and chair, department of Oral Health Practice, UK College of Dentistry; Charles King, a periodontist in private practice in South Carolina; Chris Langub, scientific review administrator, office of public health research, Center for Disease Control and Prevention; and Richard Kryscio, UK professor of statistics and biostatistics

From University of Kentucky press release

Search Engine Marketing –

Why Does SEO Matter More In a “Down Economy?’

By Lisa Thayer, GoldfishNetwork.com

The question on many business owners’ minds today is “How should I market my company given the current state of the economy?” The short answer is by placing your marketing dollars in client specific, targeted advertising campaigns that have a built in accountability for measuring results.

In uncertain times, a business owner’s first reaction may be to reduce their overall marketing and advertising budget as part of a “batten down the hatches” mentality. That reaction is prevalent among companies that have experienced some reduction in business lately whether due to “the economy” or for a multitude of other reasons. While that response may give your CFO temporary anxiety reduction, before you know it she’ll be pestering you about declining sales figures.

Now is the time to step back, take a deep breath and make decisive, informed business decisions and steadfastly refuse to respond emotionally to the nightly news. Review both online and offline marketing endeavors looking for those that produce the best return on investment.

Search engine marketing can often produce a better ROI than many offline marketing endeavors due to the fact that spending can be controlled, results can be measured and you can easily make incremental changes to adapt to conditions as they continue to fluctuate. Online marketing also works for you 24/7 without accruing additional payroll expense.

If you stay the course, you may even be able to spot new opportunities and actually capture a larger segment of your market as others react instead of methodically planning a marketing strategy.

The best way to achieve optimal results online is to first have a qualified search engine professional review your website. It doesn’t do you any good to spend money to drive thousands of people to your website if once they arrive on your site the visitors don’t have a compelling reason to do business with you.

When it comes to search engine optimization and marketing “one size does not fit all”.
A good SEO review should advise you in creating “calls to action”, help to solidify your unique selling proposition, present solutions to rectify any design or usability issues, and even identify areas of weakness in your competition.

Once the SEO review is complete, you will be able target your specific customers and therefore be able to maximize your efforts and reduce your ad spend.

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients in 12 states across the United States. Lisa can be reached at (503) 783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Claims Against Dental Amalgam Lack Scientific Evidence

PANEL REPORT FINDS HEALTH CLAIMS AGAINST
DENTAL AMALGAM LACK SCIENTIFIC EVIDENCE

The American Dental Association recently announced that a review of seven years worth of scientific studies concludes there is insufficient evidence “of a link between dental mercury and health problems, except in rare instances of allergic reactions,” according to a report released today by the Life Sciences Research Office, Inc. (LSRO) in Bethesda, Maryland.

Established in 1962, LSRO is a non-profit, independent organization with a worldwide network of experts that studies issues in biomedicine, healthcare, nutrition, food safety and the environment.

LSRO conducted the independent scientific review of dental amalgam at the request of a work group made up of representatives from the National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration and the U.S. Public Health Service. The report, Review and Analysis of the Literature on the Potential Adverse Health Effects of Dental Amalgam, updates and reaches the same conclusion as two earlier reviews by the U.S. Dept. of Health and Human Services of the dental material, which is an alloy made of silver, copper, tin and zinc, bound by elemental mercury. The silver-colored material is widely used to fill dental cavities.

“This report further substantiates the American Dental Association’s position that dental amalgam is a safe, effective material to fill cavities, based on science and clinical experience,” said Dr. James B. Bramson, ADA executive director. “Countless people’s teeth have been saved by using amalgam, which is one of the most durable and affordable cavity filling materials available, especially for large cavities in the back teeth where chewing forces are the greatest.”

The LSRO report was based on a review of nearly a thousand papers from peer-reviewed scientific literature along with public comments submitted to the Federal Register and involved a multidisciplinary panel of experts in fields such as toxicology, allergy, pediatrics, epidemiology and pathology.

The American Dental Association is the nation’s largest dental association, representing more than 149,000 members.

Guidelines Change for Preventive Antibiotics

Guidelines Change for Preventive Antibiotics Before Dental Work

According to new guidelines, far fewer people need preventive antibiotics before dental procedures than previously recommended, according to a recent issue of Mayo Clinic Women’s HealthSource.

The use of preventive antibiotics for people with certain heart conditions stemmed from worries about endocarditis. That condition is an infection of the thin membrane that lines the chambers and valves inside the heart, called the endocardium. Endocarditis occurs when bacteria or germs from another part of the body, such as the mouth, enter the bloodstream and travel to the heart and attach to abnormal heart valves or damaged heart tissue.

An American Heart Association (AHA) committee found that for most people, the risk of endocarditis from dental procedures was low. Daily activities, such as brushing, flossing or chewing, are much more likely to cause endocarditis than are bacteria that enter the bloodstream from a single dental procedure.

“Preventive antibiotics before dental work are now recommended only for people who, if they develop endocarditis, are more likely to die or have serious complications,” says Walter Wilson, M.D., an infectious diseases specialist at Mayo Clinic. Dr. Wilson headed the AHA committee that recently revised the guidelines.

The new recommendations suggest preventive antibiotics before dental work only for those people with artificial heart valves, a history of infective endocarditis, certain forms of congenital heart disease and cardiac valve abnormalities following a heart transplant.

Preventive antibiotics are no longer recommended for many people who have common heart conditions such as mitral valve prolapse or rheumatic heart disease. Before their next dental visit, patients who have taken preventive antibiotics should check with a doctor or dentist to discuss the guideline changes and determine if the medication is necessary.

Source: Newswise

When the Doctor is Away

How you keep the office running

If you as the doctor/owner are planning to be away from the office – even for a day or two – the staff has some free time, too. The doctor/owner or office manager can make lists of things that need to be done.

Make sure that if your absence was somewhat unforeseen, provisions for referring emergency cases to other doctors have been arranged for, and that patients/clients have been rescheduled.

The doctor’s absence provides an opportunity to take care of matters that could not be conveniently handled on days when patients/clients are in the office. For example, this may be the time to have the walls repainted or to have equipment repaired. Of course, the owner should be consulted before this is organized.

The staff should take care of as many tasks as possible on their own, so that an insurmountable pile of unfinished business will not be waiting for your return. Mail should be opened, sorted, and placed in priority order. If any mail comes into the office that needs to be acknowledged, the office manager should send a letter informing the writer that the doctor is away, when he/she will be returning, and that the doctor will answer the letter when he/she returns. If the doctor is going to be away for a long time, a brief summary of the mail and phone calls can be mailed or emailed to him or her, or communicated over the phone.

This is a good opportunity to perform chart purges, contact patients/clients regarding their recall appointments, activate inactive patients/clients and get them scheduled, send out letters, and work on promotional projects.

The owner and the office manager should meet prior to the scheduled absence and form a plan for what the staff should work on during that period. As unexpected absence of the doctor can occasionally occur, the owner and the office manager should determine the policy to govern such an instance which would define what the staff is to do during that time.