Stress. In this time of Covid 19, national and local elections, shutdowns, daily adjustments to infection control, and altering financial advice from advisors, stress can become overwhelming and debilitating. Many professionals are experiencing stressors related to (1) financial security, (2) anxiety about exposure of self, team members, or patients and, certainly, of family members to Covid 19, (3) preparing for and complying with the highest standards of infection control, (4) patient anxieties, and (5) child care issues. That names a few of the additional stressors dental professionals are dealing with at the present time-in addition to the normal stressors handled every day.
What is stress? Webster's Dictionary defines stress as "any stimulus, as fear, anxiety or pain, that disturbs or interferes with the normal physiological equilibrium of an organism; physical, mental, or emotional strain or tension."
Peter Hanson, M.D.[i], in his book Stress for Success, states that:"
Stress is 80% of all illnesses. On the other hand, stress is also the key to excellence. Stress does not actually cause excellence, nor does it actually cause illness or financial losses. In fact, stress is neutral until it lands on a person. What that person has chosen to do about past stresses, and what the person chooses to do in response to present stress, will determine the outcome.
Dr. Hanson points out that "the answers to the problems of stress control are within the grasp of each individual. Each of us, as a manager of his or her own Department of One, has the power to break out of the lemming herd and turn away from the precipice that awaits the incompetent stress handler."
Dr. Hanson goes on to say that "stress can the best ally in the workplace - if it is correctly managed." Stress can stimulate an industrious response, it can encourage you to continue through difficult times, it can give you the incentive to work out problems that are making it hard to achieve difficult goals. Some stress is actually motivational and keeps us going.
Staying healthy in today’s pandemic situation requires that each person take excellent personal care in order to give the body all the armamentaria available to fight off or defend against the virus. Stress—left uncontrolled—can debilitate the immune system and compromise one’s bodily strength to ward off infection. Taking care of yourself gives you the chance to take care of others.
Job Related Stressors
A stressor is “that which causes stress.” And, as Dr. Hanson states, different factors cause stress in a variety of ways for unique individuals. What causes stress for one person may not cause stress for another. The first step toward stress control or stress management is to identify that which causes you stress. Then, working toward resolution becomes possible.
The organizational climate of your practice impacts your stress level. The better the organization of the practice, the more controlled the stress levels for all team members. Organization and management can be divided into three specifics areas: business management, personnel management, and patient management.
If your office is lacking in procedures, policies, or systems for dealing with the business aspects of the practice (i.e., scheduling, financial arrangements, time management), you are most likely suffering from a great deal of unneeded stress. Cleaning up, organizing, and refining systems is one thing you can do to control unnecessary stress.
For example, scheduling in today’s world of additional responsibilities and requirements is not the same. Adding time to appointments and reorganizing the appointment itself takes evaluation, input from team members, and even a realistic time-in-motion study in order to determine how long each appointment will actually need. Guessing is not a strategic plan.
There will never be a day when all of your systems are perfect. This is a great time to go through every system with an open mind and a commitment to “refine” each system to make them even better. W. Edward Deming [ii] told us to “be in a constant state of improvement.”
Other business management problems that may cause stress could include equipment problems, the working environment itself, or cash flow - profitability or a lack thereof. You—more than likely—have added new equipment for filtration and protection from aerosol. And, hopefully, you have worked as a team to institute alterations to protect yourselves and patients while keeping the practice flowing smoothly and productively.
Every team member, including doctors are under unexpected, unique, and perhaps, overwhelming stress. Remember, each person’s stress is unique to him or her. Keeping lines of communication open and listening to one another may never have been more important. My husband, Dr. John Jameson, says that he “scheduled time to communicate.” Nothing is more important for keeping the team together, engaged, productive, and emotionally healthy.
Interpersonal conflicts, poor leadership, and burnout are a few examples of problems in personnel management that can cause stress. Lack of communication within a team can cause a wall to build up between team members and will severely impair the production and success of your business. It is a must in all areas of one's life, both professionally and personally, to create positive gateways through which communication flows. If neglected, small misunderstandings will most likely grow into unconquerable mountains.
Difficult or fearful patients can be a major stress factor. Surveys by the ADA indicate a major increase in bruxism, broken fillings, broken teeth, and inflamed gun tissue during the pandemic.[iii] All of these issues can be related to stress. Canceled appointments, inability to pay bills, and rejection (or delay) of treatment recommendations may be just a few of the stresses that patients bring into the practice. Team members tell me that the patients each have a “story” and they seem to need more time to talk, and for someone to listen, than ever before.
Communicating with a patient at a positive, understanding, and equal level will help decrease their stress level. Treatment will proceed more smoothly and their appreciation for your “care” will solidify the relationship of trust and confidence, the two most important factors that lead to patient participation, compliance, and retention.
Two dominant factors have appeared as major stressors for patients in my own research throughout the country: (1) stress related to exposure and contracting Covid 19 (not surprising) and (2) financial stress. Many people have lost their jobs or their businesses. Some have had salary reductions or have lost their benefits. Others have had to dip into savings or retirement for living expenses and feel the stress of “not knowing if they are going to have enough.”
Now more than ever before, your communication skills related to financing are critical. Discover a patient’s concerns (or objections) by asking questions and listening. Once you have a clear handle on the patient’s issues, your offers for resolution will be more receivable, accurate, and acceptable.
Your continuous communication with patients whether in person, through social media, e mails, or newsletters is imperative to share valuable information, to be an encourager of hope and comfort. Provide accurate information, rather than information that may be misleading or that may exacerbate the anxiety.
The first step in dealing with stress in the workplace or at a personal level is learning how to CONTROL it. The following seven steps are ways that we have found that work and work well to “control,” not eliminate but control, stress.
Let’s review each of these seven steps.
1. COMMUNICATION. Communicative skill is the bottom line to your success. No matter what your role in the office or in life, how you communicate makes all the difference in the world.
When asked what causes the most stress in the office, the number one response is “conflict among team members.” Most of the time if there is stress between or among team members, you will find that there is a “glitch” in one or more of your systems and that “glitch” is inadvertently pitting one person against the other or one department against another. Clean up the system and usually (not always) the relationship will smooth out, as well.
My dentist husband, Dr. John Jameson, sums this type of situation up with the following statement, “No one could pay me enough money to go into the office every day if I didn’t totally enjoy the people with whom I work. I thoroughly enjoy each member of my team. I care about them as people as well as team members, and they reciprocate. One of my greatest joys is going to the office in order to be with my team.”
And so, why settle for anything less? You don’t have to. Face your problems head on. Learn skills that open the lines of communication rather than close them. Learn how to confront with care. Learn how to negotiate a win-win solution to a problem. Your ongoing study of communication skills creates a team built on mutual respect. That’s essential for a healthy team and for stress control. You may have differences, but you can learn how to deal with those differences and constructively accomplish solutions.
2. ORGANIZATION. Now, more than ever before, it is imperative that you look closely at the management systems that exist (or should exist) in your practice and ask yourself the question, “What’s going well? Let’s do more of that.” “What could be better? What do we need to do to make that happen?” For a superbly managed practice, the tiny refinements make a huge difference. A well-managed practice is probably producing well but could increase production significantly if all systems were carefully evaluated, fine-tuned, and moved to the next level.
Harvard School of Business, Forbes, and Gallup have determined in individual research projects that a 5% increase in retention can lead to an increase in profitability anywhere from 25% to a 95%. Malcolm Gladwell, in his best seller The Tipping Point, says that “it is the little things that make the big difference.” Small improvements in your systems will add up to a substantial overall difference.
On the other hand, a practice struggling to pay bills or experiencing a decrease in profit margin needs to do the same thing—strategically plan for improvement. (1) Perform an analysis of where you are at the present time; (2) create a vision of where you want to go or where you need to go (a vision is always future focused); and (3) develop (write out) a plan of action for the development of organized systems and instruction for the team members to carry out those systems in an organized manner. In other words—what are you going to do to make that vision become a reality? Set goals. Develop a plan of action. Follow up and follow through.
Organization of systems and careful administration of those systems is critical for practice success and for stress control. A lack of organization in your systems will lead to chaos and “chaos breeds stress.” On the other hand, organization of, and consistent administration of, systems equals stress relief and increased revenues.
3. NO!! Once you have this strategic plan, decisions will be easier. Make sure that all decisions you make will support your practice (and life) mission or purpose. Determine which values are imperative to you—and never waiver from them. When you have to make a decision about getting involved with a particular program, going to a certain course, or hiring a new person, ask yourself the following question, “Will this help us to reach our ultimate mission?” If the answer to that question is “yes,” then you are probably making a good decision.
Good decision making based on your purpose leads you down your own chosen path and gives you the courage to say “no!”. This decision-making power will make it easier to say “no” to demands on your time that take you away from your high priorities—like family and health. This is stress control extraordinaire.
4. TIME MANAGEMENT. Practice good time management. Writing your goals, establishing time parameters, and prioritizing those goals is a definite “time management” strategy.
So many people complain with frustration that they “just don’t have the time.” They say things like, “I don’t have time to exercise.” “I don’t have time to read.” “I don’t have time to play with my kids.” “I don’t have time to design good treatment plans.” I don’t have time to do comprehensive consultations.” “I don’t have time to follow up on past due accounts, past due hygiene appointments, past due insurance.” And on and on. If you prioritize your life—and your days, and if you apply organizational savvy to your practice and to your personal life—you will have time to do anything you want to do—if you want to do it badly enough and if you see the benefits.
5. REALISTIC GOALS. There is no greater life management strategy than setting and working toward realistic goals. According to William James, Ph.D. the average human being only uses about 5-10% of his or her potential in a lifetime. By focusing the mind on a truly desired goal and by developing a plan of action by which you intend to accomplish that goal, you have begun the journey to both personal and professional fulfillment.
Napoleon Hill said that “Whatever the mind of man can conceive and believe, so shall he achieve.” In other words, when you zero your thought patterns in on the accomplishment of a goal and can visualize the goal as already being completed, your actions begin immediately to make that happen.
Research and studies by some of the greatest universities—Harvard, Yale, Stanford have found that the most productive individuals in organizations are, indeed, goal oriented. However, only 3-5% of these people or groups take the time to write their goals and apply strategic planning to the accomplishment of the goals. The research shows that these 3-5% are the most productive, make the highest incomes, and find greater satisfaction in their chosen life or work path.
Set your goals high enough that you are constantly stretching, but do not set them so high that you set yourself up for constant disappointment. If you set a goal, design a plan of action, and find that you have not accomplished the goal, step back and reevaluate. Is this a goal that you want badly enough that you are willing to work hard to accomplish it? You have to have what Tom Hopkins calls “an ardent desire” to make it happen.
Be willing to flex and change when necessary. The first plan is not always the best plan. However, if the goal is good, keep after it. Your clearly focused mind and the dominant order of your thoughts will be the driving factor. You can accomplish anything you truly want to accomplish. Conceive, believe, achieve.
In times such as these pandemic times, goal setting and prioritization are as important, if not more important, than ever. Focus on the things that make the biggest difference in your practice—and in your personal life. The focus will become energizing and will support healthy habits.
6. OPTIMISM. Napoleon Hill, in his book The Keys to Positive Thinking, writes the following about optimism:
PMA (positive mental attitude or optimism) attracts its benefits like a magnet does iron filings. PMA will attract people, success, and wealth to you. An optimistic outlook is irresistible. PMA shields and protects you from doubts and hopelessness. When adversity comes into your life-and it visits us all—you will be protected from despair and prevented from being overwhelmed by circumstances. In fact, PMA allows you to see any situation more clearly, so that you can turn adversity into potential success by learning from it and using that knowledge to your benefit.
It’s so easy to wallow in negativity. The world inundates all of us with negativity. You must make a conscientious effort to overpower the influence of negativity. Be careful to manage your television and screen time. There is negativity on every channel. If we “become what we think about,” then we want to be sure to feed our minds and hearts as well as our bodies.
Value yourself enough to decide to be positive. Look for the good things in your work, in your co-workers, and in yourself. Dr. Ken Blanchard says that, “We find it so easy to catch each other—and ourselves-- doing something wrong. Work on catching each other—and yourself--doing something right.” This follows a basic premise of humanhood—the human being responds better to positive reinforcement than to negative reinforcement. Catch yourself doing something right. Then, pass it on.
Read Napoleons Hill’s classic books, The Power of Positive Thinking and Keys to Positive Thinking. Apply his ten steps of developing and maintaining a positive mental attitude. You will find that these strategies work and that you will obtain a “more honest, well balanced way of thinking; a successful consciousness; an all-embracing philosophy of living, and the ability to follow through with the correct actions and reactions.” The books may have some age on them—but the truths that are shared are timeless. The world is starving for some positive hope. Be available to listen, care, and be supportive.
7. LETTING GO It’s difficult to change, we all know that. It is one of the only guarantees that we have—things will change. So much has changed since the first quarter of 2020 that our heads spin at times. When the pandemic first hit, we arranged for an honored infection control expert to do a webinar for all of our clients throughout the country. She did this on a Thursday. By the following Monday, things had already changed, and we had to do it over. Change.
If you find that you are hitting your head against a wall or are not getting the results you want and need, take a look at the systems that you have been using and see if it is time to make adjustments. The inability to change or the unwillingness to adapt to changing times will put you and your business into a tailspin. Let go of things that are not working.
Stress cannot be eliminated. The challenge and opportunity come in the ability to control or manage your response to stress. Those who "choose" to control their stress by actively and constructively managing it can learn to turn its potentially harmful force into high powered energy.
Cathy Jameson, PhD
Cathy Jameson, PhD, is the founder of Jameson Management, Inc., which offers proven management and marketing systems. Cathy is the author of eight books, including the 3rd Edition of her bestseller, Collect What You Produce, available from Amazon. Contact Cathy at firstname.lastname@example.org.
- Hanson, MD, Peter. (1996) Stress for Success Harper Collins. New York City.
- “Pandemic-Related Stress May Be Affecting Oral Health”. ADA Morning Huddle, September 14, 2020. Chicago, IL.
- Jameson, C. (2004). Great communication equals great production. Pennwell Books. Tulsa, OK
- [i] http://stressipedia.com
- [ii] https://deming.org
- [iii] HPI poll: Dentists see increase in patients’ stress-related oral health conditions, ADA News, September 28, 2020