Lesson 6: When It Is Not Working

Every practice has a version of this. Someone is not working out. The owner knows it. The team definitely knows it, because they have been quietly covering for four months and have adjusted the workflow around the problem. Nothing has been said, because the conversation feels confrontational and the office is busy and maybe it will improve.

It rarely improves on its own. What happens instead is that the standard drifts, the people carrying the extra load get resentful, and the owner eventually acts suddenly and emotionally, which is unfair to the person and the worst possible footing legally. Avoidance is not neutral. It is a decision with compounding costs.

This final lesson covers the other end of the arc: feedback that is useful, documentation that holds up, improvement plans that are genuinely designed to work, and the honest recognition that sometimes the role is simply wrong for the person. The Practice Guide chapter on when it is not working holds the long form reference. What follows is the sequence and the judgment.

Diagnose before you fix

Underperformance has a small number of causes and they call for completely different responses. Before the conversation, work out which one you are looking at.

They do not know what is expected. Far more common than owners believe, especially where the expectation lives only in the owner's head. If you cannot point to where the standard was communicated, this is your problem before it is theirs.

They do not know how. A training gap, often created by fragmented onboarding. Cheaper to fix than to replace.

Something is in the way. The system, the schedule, missing equipment, a coworker, an unclear handoff. The person may be doing their best inside a broken process.

Something outside work. People have health events, family crises and hard years. How you must handle categories of this, including medical conditions, disability and protected leave, is governed by law, and improvising here is exactly how practices get into trouble. Route it to your attorney before you act.

They can and they will not. Genuine performance or attitude issue. This is the one people assume first and it is less common than the other four combined.

The role is wrong for them. A capable, decent person in a job that does not fit how they work. No amount of coaching fixes a fundamental mismatch.

Each gets a different response: clarify, train, remove the obstacle, get legal guidance, address directly, or change the fit. Firing someone whose real problem was never knowing what you expected is an expensive way to discover you had a communication gap.

Feedback that is specific, not personal

Performance conversations go badly for almost always the same reason: the feedback is about the person rather than the behavior. "You have a bad attitude" is unanswerable. Nobody can agree to change something they cannot see, so they defend themselves, and now you are arguing about character.

Compare: "In the last two weeks you have arrived after the huddle started four times, on the eighth, ninth, fourteenth and fifteenth. When that happens the assistants do not get the schedule changes and the first patient runs late." Specific, observable, dated, tied to a consequence. Much harder to argue with, and much easier to actually fix.

A structure that works in a small practice:

1. State the observation. Facts, dates, what you saw or what the records show. No adjectives about the person.
2. State the impact. On patients, on the team, on the schedule, on the practice. This is the part that explains why it matters, and it is frequently the part that is genuinely new information to the person.
3. Ask. Then stop talking and listen. You will sometimes learn the cause is something you did not know about and can fix.
4. Agree what changes, specifically, by when. Not "be more careful." A named behavior, a measure, and a date to check.
5. Write it down and follow up on the date. An agreement with no follow up teaches everyone that the standard was optional.

Do it privately, promptly, and about one thing at a time. A list of eleven grievances delivered at once is not feedback, it is an ambush, and the person will remember the tone and none of the content. The managing chapter goes deeper, including how positive feedback carries half the load of the system.

Documentation: boring, and the thing that protects everyone

Most small practices document almost nothing until they decide to terminate someone, then produce a sudden burst of paperwork. That pattern is visible to anyone who later reviews it, and it reads exactly like what it is.

Build the habit instead. After any substantive performance conversation, write a short factual note: date, who was present, what was discussed with specifics, what was agreed, and the follow up date. Facts and commitments. Not opinions about character, not speculation about motives, not anything about health, family or any protected category.

Write it assuming it will be read by the employee, by an attorney, or by a government agency. That assumption improves the writing considerably.

Document the good as well. A file containing only complaints is not a record, it is a case. A record showing the person was recognized for good work, coached on specific issues, and given a genuine chance to improve is both more accurate and more defensible.

Keep personnel records properly separated and secured, and be aware that what must be kept, for how long, where certain categories such as medical information must be stored, and who may access the file are governed by rules that vary by state and by record type. Confirm those requirements rather than inventing a filing system.

Improvement plans meant to succeed

A performance improvement plan has two possible purposes. One is to genuinely help someone meet the standard. The other is to construct a paper trail before a decision already made. The second kind is transparent to everyone involved and damages the team's trust, because the rest of the staff can tell the difference.

Write plans of the first kind. That means:

• Specific behaviors or results, stated so that both of you would agree on whether they happened.
• A measure. What will you look at to know, and where does that number or observation come from.
• A timeframe long enough that improvement is actually possible for the thing you are asking about.
• Support from the practice. Training, a mentor, protected time, a changed process. If the plan requires nothing of you, it is probably not a real plan.
• Scheduled check ins, not just a verdict at the end.
• A clear statement of what happens if the standard is not met, written in language your attorney has approved.

Then run it honestly. Meet the check ins, give the support you promised, and acknowledge improvement when it happens. Some of these work, and a person who came back from a plan often becomes unusually loyal.

When the role is wrong for the person

This is the case owners handle worst, because it does not feel like anyone did anything wrong, and it usually is not.

Some examples recur. The warm, wonderful person at the front desk who cannot hold detail, in a role that is mostly detail. The excellent chairside assistant promoted to office manager because she was the best assistant, now doing a job made of conflict management and spreadsheets she was never trained for and does not enjoy.

Before concluding the person is the problem, ask whether a different seat exists. Sometimes the answer is a genuine role change, and a practice that moves someone to the job they are good at gets back a person who is both happier and more productive. That is not a demotion if it is handled as a fit decision and the conversation is honest.

Sometimes there is no seat, and the honest thing is to say so directly. "This role needs someone energized by the detail side of the work, and I do not think that is you, and that is not a criticism of you." People often already know. What they deserve is candor early rather than a slow accumulation of correction for being who they are.

Termination is a process, not a moment

If it comes to ending the employment relationship, understand clearly what you are stepping into. This is the single highest legal exposure most small practice owners have, and it is the area where confident internet advice does the most damage.

Here is what varies by state, and in some cases by city, and what changes over time: how at will employment operates and what the exceptions to it are; what notice, if any, is required; when the final paycheck must be issued and what it must include, such as the treatment of accrued paid time off; what notices, forms or information must be given to a departing employee; what documentation you are required to keep and for how long; how unemployment claims are handled; what constitutes unlawful retaliation, including retaliation for complaints an employee has made; and what protections apply to leave, medical conditions, disability, pregnancy and the various protected categories. Coverage thresholds differ too, and many state laws reach much smaller employers than the federal ones do.

That is not a list you can resolve by reading a website. Including this one.

What you can prepare on your own side: documentation in order and consistent with what actually happened, a standard that has been applied consistently to everyone, final pay and benefits handling confirmed in advance with your attorney and payroll provider, practical logistics including system access, keys and schedule coverage, and a meeting that is short, private, factual and humane. Two people present. No debate about the reasons, no improvised explanations, and no editorializing afterward to the team about a personnel matter.

Then take the lesson back to the beginning. A departure is worth an honest post mortem: was the role badly defined, did the interview miss something, did onboarding fail, did the practice create the conditions. The answer is often uncomfortable and always useful.

Finishing the course

The arc is complete: define the role, post it honestly, screen and interview with structure, make a clean offer and run a real ninety days, then keep people by fixing the things they feel daily, and handle problems specifically and early. The thread through all six lessons is the same one. Write down what you expect, tell people the truth, follow up when you said you would, and get professional advice on the parts where being wrong is expensive.

THE CHAIRSIDE TAKE

Have the conversation within a week, about a dated behavior and its actual impact, and write a short factual note afterward whether it went well or badly. Build the documentation habit while things are fine, because a file that appears the month you decide to fire someone tells a story you do not want told. And find your employment attorney before you need one, since the final pay rules, notice requirements and protected categories that decide whether a termination is routine or ruinous vary by state, change regularly, and are not something any website should be settling for you.

Lesson 6 of 6 in Hiring and Keeping a Dental Team

This guide is educational content and does not constitute legal, financial, tax, or clinical advice. Laws and regulations vary by state and change over time. Consult your own dental-specific attorney, CPA, and state dental board before acting.