Chapter 5: When It Isn't Working

Most owners wait too long. They hope the problem will fix itself, avoid the conversation because the schedule is full, and then, after one bad day too many, fire someone abruptly with nothing written down. That sequence is unfair to the employee, demoralizing for the team, and legally risky for the practice.

This chapter covers the better path: figuring out what kind of problem you actually have, documenting it properly, using progressive discipline, and, when it comes to that, ending employment legally and with dignity. It builds on the feedback habits in Chapter 4: Managing a Dental Team.

Employment law varies significantly by state, and sometimes by city. This chapter explains general principles for US employers. It is not legal advice. Consult an employment attorney licensed in your state before you terminate anyone, before you offer a severance agreement, and whenever the situation involves a complaint, a leave of absence, a workplace injury, pregnancy, or a protected characteristic. An hour of an attorney's time before a termination is far cheaper than defending a claim afterward.

Key takeaways

Diagnose before you discipline: a skill problem, a system problem, and a conduct problem need different fixes.
Document as you go: dated, factual, specific, and shared with the employee. Notes written after the decision to fire carry much less weight.
Progressive discipline usually runs from a coaching conversation to a verbal warning, a written warning, a final warning or improvement plan, and then termination. Serious misconduct can skip steps.
At-will employment is the default in every state except Montana, but it does not permit firing for an illegal reason, and timing near a complaint or leave request creates risk.
Use a termination checklist so final pay, benefits notices, system access, and property return are handled correctly, and use exit interviews to learn why good people leave.

Diagnose the problem before you try to fix it

"It isn't working" covers very different situations. Ask which of these you are facing before deciding on a response.

Type	What it looks like	Usual first response
Skill gap	Trying hard, but cannot yet do the task to standard: slow room turnover, claim errors, weak radiographs	Training, a clear standard, practice, and a timeline. Check whether onboarding covered it.
System problem	Anyone in the role would struggle: unrealistic schedule, missing supplies, conflicting instructions from two dentists	Fix the system. Disciplining a person for a broken process drives off good employees.
Conduct or effort	Knows the standard and can meet it, but does not: lateness, phone use chairside, rudeness, skipped steps	Clear expectation, then progressive discipline if it continues
Fit	Competent and decent, but the role or pace is wrong for them	An honest conversation about whether a different role, schedule, or practice would suit them better
Serious misconduct	Theft, falsifying records, violence or threats, harassment, intentional privacy violations, working impaired, deliberate infection control violations	Immediate action, often suspension pending investigation, then likely termination. Call your attorney.

Something personal may also be going on: a health problem, a family crisis, a pregnancy. You should not ask about medical conditions, but you can say, "I've noticed a change, and I want to check whether anything is going on that we can help with." If an employee raises a medical issue or requests leave or accommodation, you may have legal obligations under the ADA, the Pregnant Workers Fairness Act, FMLA (employers with 50 or more employees), or state law. Stop and get advice before taking any discipline.

Documentation that holds up

Documentation serves two purposes. It makes expectations unmistakable to the employee, and it creates a record showing that any eventual termination was for legitimate, consistently applied reasons. Documentation assembled after the decision to terminate is much less persuasive than notes written at the time.

What good documentation looks like

Dated, ideally written the same day.
Factual and specific. What happened, when, who was involved, and the effect. Not adjectives about personality.
Tied to a standard the employee knew: the handbook, the job description, a written procedure, or a prior conversation.
States the expectation going forward and the consequence if it is not met.
Shared with the employee for formal warnings, with a signature confirming receipt (not agreement) and space for their comments. If they refuse to sign, note that with a witness.
Consistent. If two employees are late the same number of times, they should get the same response. Inconsistent treatment is the backbone of many discrimination claims.

Example: weak versus strong (hypothetical)

Weak: "Jen has a bad attitude and is always late. Talked to her about it."

Strong: "March 12. Jen clocked in at 8:14, 8:09, and 8:21 on March 5, 7, and 11. The scheduled start is 8:00 and the handbook requires staff to be ready to see patients at start time. On March 11 the 8:00 patient was seated at 8:25. I met with Jen at 12:30 today, reviewed the dates and the policy, and asked what was going on. She said childcare drop-off has changed. I explained that the 8:00 start is required for the role, asked whether a different start time or schedule would work, and told her further late arrivals would lead to a written warning. Jen said she would arrange earlier drop-off."

Notice what the strong version does not include: speculation about motives or opinions about her personality. The childcare detail is there because she raised it and it bears on schedule options, not because it was asked about.

What goes in the personnel file

Offer letter, job description, signed handbook acknowledgment.
Training records and credential verifications.
Performance reviews and improvement plans.
Written warnings with signatures and employee comments.
Commendations and positive feedback, which show fairness.

Keep medical information (including hepatitis B vaccination records and any accommodation paperwork) in a separate confidential file, and keep I-9 forms separate as well. Records retention rules vary; see the compliance chapter.

Progressive discipline, step by step

Progressive discipline means escalating consequences for a continuing problem, with a clear warning at each step. It gives the employee a fair chance to improve, and it builds a record if they do not. Your handbook should describe the general process while reserving the right to skip or repeat steps depending on the situation, so you are not locked into a rigid sequence. Have an employment attorney review that language.

Step	Used when	What happens	Documentation
1. Coaching conversation	First instance of a minor issue	Private conversation using the describe, impact, ask, agree structure from Chapter 4	Dated manager's note
2. Verbal warning	The issue continues after coaching	A conversation explicitly labeled as a warning, stating the expectation and the next consequence	Dated note recording that a verbal warning was given, what was said, and the employee's response
3. Written warning	The issue continues, or a more serious first offense	Meeting to review a written warning listing specific incidents, the standard, required improvement, a timeframe, and the consequence of no improvement	Signed warning (receipt acknowledged), employee comments, copy to file
4. Final written warning or performance improvement plan	No sufficient improvement after a written warning	States clearly that further problems will lead to termination. For skill or performance problems, a 30 to 60 day improvement plan with measurable goals and scheduled check-ins	Signed final warning or PIP, check-in notes
5. Termination	The problem continues after a final warning, or serious misconduct	Termination meeting, after attorney review	Termination memo stating the reason, consistent with prior documentation

Performance improvement plan template

The gap: the specific standard not being met, with examples and dates.
The goal: what meeting the standard looks like, measurably. ("All claims submitted within one business day of service, with no more than two rejections for missing information per month.")
Support: training, resources, or schedule changes the practice will provide.
Timeline: the plan's length, usually 30 to 60 days, and weekly or biweekly check-in dates.
Consequence: that failure to meet the goals may result in further discipline up to and including termination.
Signatures: employee and manager, with space for comments.

Hold every check-in on schedule and write notes. A PIP that is created and then ignored until the end date looks like a formality, because it was one.

When to skip steps

Some conduct warrants immediate suspension or termination without progressive steps: theft or embezzlement, falsifying clinical or financial records, violence or threats, harassment, working under the influence, intentional disclosure of patient information, or deliberately endangering patients. In these cases, a short paid or unpaid suspension pending investigation lets you gather facts before deciding (paying exempt employees during suspensions has its own rules, so ask first). Interview witnesses, preserve records and video, write up the facts, and call your employment attorney before acting.

At-will employment and its limits

In every state except Montana, employment is presumed to be at will: the employer or employee can end it at any time, for any lawful reason or no reason (NCSL). Montana requires good cause after a probationary period. At-will status is real, but it has important limits:

Illegal reasons are still illegal. Firing someone because of race, color, religion, sex (including pregnancy), national origin, age, disability, or genetic information violates federal law for covered employers, and state and local laws often cover more characteristics and smaller employers.
Retaliation. Firing or disciplining someone because they complained about discrimination or harassment, reported a safety issue to OSHA, filed a workers' compensation claim, requested leave or an accommodation, served on a jury, or took military leave can be unlawful even if the underlying complaint was mistaken.
Protected concerted activity. Under the National Labor Relations Act, most non-supervisory employees can discuss pay and working conditions with each other and raise group complaints, whether or not there is a union.
Public policy exceptions. Many states protect employees who refuse to break the law, including an assistant who refuses to perform a duty she is not licensed for.
Implied contracts. Handbook language, offer letters, or verbal assurances about job security or mandatory procedures can undermine at-will status in many states.

Timing matters. The riskiest terminations are those that closely follow a protected event: a complaint, a leave request, disclosure of a pregnancy or medical condition, an injury report. Even if performance problems were real and long-standing, the timing invites the question of whether the real reason was the protected event. This is exactly where contemporaneous documentation and attorney advice pay for themselves.

Before you terminate: the pre-termination review

Before any termination, work through these questions, ideally with your employment attorney.

Checklist: pre-termination review

Is the reason clear, legitimate, and stated the same way in the documentation?
Did the employee know the standard, and were they warned about the consequence?
Is there contemporaneous documentation for each step, signed where appropriate?
Have others who did the same thing been treated the same way?
Has the employee recently complained, requested leave or accommodation, disclosed a medical condition or pregnancy, been injured, or engaged in any other protected activity?
Do recent performance reviews support the decision, or contradict it?
Does anything in the offer letter, handbook, or an employment agreement limit your options or require a procedure?
Is the employee 40 or older, and will you offer a severance agreement with a release?
Do you know your state's final pay deadline and required separation notices?
Have you spoken with an employment attorney licensed in your state?

The termination meeting: legal and humane

A termination meeting should be short, private, respectful, and final. It is not the time to relitigate every problem or to negotiate.

Logistics

Who: the owner or office manager plus one witness (usually the other of the two). Not a crowd.
When: at a time that minimizes disruption and embarrassment, often at the end of the day or before patients arrive. Some managers prefer early in the week, so the person can reach payroll or benefits contacts with questions the next business day.
Where: a private office, not the break room or an operatory, and never in front of patients.
Have ready: the final paycheck or its timing under your state's law, benefits information, any severance agreement, and a list of property to return.

Script outline

"Thank you for meeting with me. I have a difficult decision to share."
State the decision in the first minute: "We have decided to end your employment, effective today."
Give the reason briefly, consistent with the documentation: "As we discussed in the warnings on [dates], the [issue] has continued."
Do not argue. If the employee disputes it: "I understand you see it differently. The decision is final."
Explain the logistics: final pay, benefits end date and continuation coverage information, what happens to personal items, and return of keys and property.
If offering severance, explain that it is conditioned on signing the agreement and give them the time the law requires to consider it.
Close with dignity: "I appreciate the work you have done here, and I wish you well."

Do not say: "We're going in a different direction," or offer a softer reason than the real one. A vague or inconsistent explanation invites the argument that the stated reason was a pretext. Do not make promises about references or unemployment benefits you cannot control. Do not comment on age, health, family, or anything unrelated to the documented reason.

Termination checklist

Checklist: the day of and the week after

Final paycheck issued within your state's deadline. There is no federal requirement for immediate final pay, but some states require it on the day of termination or within a short period (DOL).
Accrued PTO paid out if your state law or written policy requires it.
Any state-required separation notice or unemployment insurance information provided.
Benefits end date confirmed with the carrier; federal COBRA notices (group health plans of employers with 20 or more employees) or state continuation notices handled through your administrator.
Retirement plan administrator notified.
Practice software user account disabled or the password changed immediately; remote access, email, phone system, patient communication platforms, lab portals, supplier accounts, and insurance portals revoked.
Keys, badges, door codes, and alarm codes collected or changed.
Practice credit cards and bank access removed.
Practice property returned: uniforms if owned by the practice, loupes if practice-owned, devices, manuals.
Personal belongings returned privately.
Schedule updated, and patient-facing coverage planned (for a hygienist, who will see their booked patients).
Payroll provider notified; final timesheet approved.
Termination memo and all documentation filed.
Brief, respectful announcement to the team (see below).

If the departing employee had access to financial systems, have someone other than their closest coworker review recent adjustments, write-offs, and deposits. It is a routine control, not an accusation, and it is much easier done promptly.

Severance and release agreements

Federal law generally does not require severance pay. Some practices offer a few weeks of pay in exchange for a signed release of claims, which provides certainty for both sides. A release must be drafted by an attorney to be enforceable. If the employee is 40 or older, federal law (the Older Workers Benefit Protection Act) imposes specific requirements on releases of age claims, including advising the employee in writing to consult a lawyer, giving 21 days to consider an individual agreement, and allowing 7 days to revoke after signing. Group terminations have longer periods. State law may add requirements. Never ask an employee to sign a release on the spot.

Exit interviews worth conducting

When a good employee resigns, an exit interview is your best chance to learn what would have kept them. Most practices skip it, or conduct it so defensively that the person tells them nothing. Exit interviews are most useful with voluntary departures; a terminated employee is unlikely to give useful feedback on the way out.

How to make it useful

Have someone other than the direct supervisor conduct it if possible. If the problem was the supervisor, they will not hear it.
Do it in the last week, not the last hour, and consider a short follow-up call a month later, when people speak more freely.
Make it clear it will not affect their reference, and mean it.
Listen without defending. Your only job is to understand.

Exit interview questions

What led you to start looking for another job?
What is the new role offering that we did not?
Was there a moment when you decided to leave? What happened?
What did you enjoy most about working here?
How would you describe the way you were managed?
Did you have the training and tools you needed?
How did the schedule and workload feel over the last six months?
How did you feel about your pay and benefits compared with other offices?
What is one thing we should change?
Would you consider coming back in the future? What would need to be different?

Write down the answers and review them once or twice a year. One exit interview is an anecdote; three that mention the same scheduling problem or the same lead assistant are a pattern. Chapter 6 covers why dental staff leave and what to do about it.

After someone leaves: the team, the patients, and references

Telling the team

Tell the team the same day, briefly: "[Name] is no longer with the practice. We wish them well. [Name] will be covering [duties] until we fill the position." Do not share the reasons or the details of the discipline. The team usually knows more than you think, and discretion shows them how they would be treated in the same situation. Then ask what they need to cover the gap, and do not let the vacancy quietly become permanent overtime for everyone else.

Patients

For a hygienist or long-tenured team member, patients will ask. A simple, positive statement works: "She has moved on, and we are so glad you are still with us. You'll be seeing [name], who is excellent." Check with your attorney about any non-solicitation obligations before assuming a departing employee cannot contact patients.

Reference requests

Adopt a written reference policy and apply it to everyone. A common approach is to confirm only dates of employment and job title, with all requests routed to one person. If you choose to say more, stick to facts you can document. Never give a glowing reference for someone you terminated for misconduct just to be kind; it creates risk for you and for the next employer.

What's next

Discipline and terminations are sometimes necessary, but the best practices need them rarely because they hire carefully, onboard well, manage consistently, and build a place people want to stay. Chapter 6: Culture and Retention covers the research on why dental staff leave, benefits that make sense for a small practice, and a retention checklist. To tighten the front end of the process, revisit Chapter 2: Hiring Dental Staff, and for broader employment compliance, see Compliance: OSHA, HIPAA, Infection Control, and More.

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.