Job satisfaction as a dimension of success
As we discussed in Part 1, Newsome1 suggested the following important interconnected indicators of success:
Customer retention;
Customer satisfaction;
Perceived service quality;
Employee retention;
Employee satisfaction;
Internal service quality.
The last three of these are clearly related to job satisfaction. Newsome emphasizes this by stating:
‘The people who work in an organisation are its lifeblood: its heart and soul. This is true for any business, but particularly so for service organisations. Two of the chief characteristics of services are that people are part of the product and for most of the time customers are present in the system’.
Frances and Roland Bee2 stated:
‘The quality of customer care offered to internal customers is just as vital as that offered to external customers, and that in successful organisations everyone operates as though all their colleagues are cherished and important customers’.
The concept of ‘internal customers’ can probably be traced back to Deming.3 He suggested 14 points for successful management of people in order to produce quality products and services. We have already discussed in Part 1 the clear relationship between the concepts of ‘quality’ and success. Deming was an American statistician who is considered to be the father of the modern quality movement. He states as his 9th point:
‘Break down barriers between departments. People in research, design, sales and production must work as a team to foresee problems that may be encountered with the product or service’.
When he elaborates on these rules later in his book he refers to the different departments as being ‘customers’ of each other. Further to this he encourages the concept of continuous self improvement and education for the whole workforce and real leadership towards a common purpose in place of supervision.
Lund4 makes team happiness the central business objective, from which he believes success will flow. He makes this fundamental point:
‘Unless people are happy within themselves, it is hard for them to be consistently pleasant to those whom they serve’.
This work is cited as inspiring the world cup winning manager of the England rugby union team, Sir Clive Woodward, to success! In this regard, Richer5 agreed with Lund and wrote:
‘My experience demonstrates that treating your staff better will make your business perform better. It is no good saying you cannot afford to treat your staff better: you cannot afford not to’.
Richer can rightly claim to know something about ‘success’. His shops, Richer Sounds (which sell Hi-fi and TV equipment) were declared the busiest in the world (as measured in sales per square foot) by the Guinness Book of Records for four years running. Job satisfaction can be measured by internal satisfaction surveys. Richer suggests that it is vital to convince staff that when these are carried out that they are strictly anonymous. Staff retention is another method recommended by Richer, but he admits that this is ‘the crudest yardstick’. Absenteeism can also be measured. Richer quotes the national average to be about 4–5%. He also suggests measuring customer service/satisfaction as a way of gauging staff motivation and states:
‘I would bet that if you have a branch or department generating a high level of customer complaints, its labour turnover, absenteeism and shrinkage rates would all be high, its profitability low and the staff will be unhappy. These factors are inescapably related’.
If our primary focus, in order to achieve success is ‘patient satisfaction’, it seems that we must also endeavour to lead a happy dental team in order to achieve this. In recent years, we have begun to recognize a set of qualities required of people to succeed, particularly in the ‘service’ and ‘caring’ sectors of work (and in life generally). We have come to call these qualities ‘Emotional Intelligence’.
Goleman6 suggests that people who can manage their own emotions, motivate themselves, show empathy with others and build successful relationships tend to enjoy more successful (and healthier) lives, both professionally and personally. Goleman, in this publication, popularized the concept of ‘Emotional Intelligence’ (EQ). He suggests that the essential qualities of the highly emotionally intelligent individual, as summarized above, are a more important indicator of potential success than high Cognitive Intelligence (IQ). Furthermore, he suggests that more educational emphasis should be placed on teaching these skills, which he believes can be learned, in our schools. He states:
‘What factors are at play when people of high IQ flounder and those of modest IQ do well? I would argue that the difference quite often lies in the abilities called here Emotional Intelligence, which include self control, zeal, persistence and the ability to motivate oneself’.
There is much debate about the origins of the concept of Emotional Intelligence and many authors have attempted to define it concisely. Some authors have been critical of Goleman for developing the concept of Emotional Intelligence too broadly. If a concept is too broadly described, it can become very difficult to define precisely and therefore difficult to measure.
Mayer and co-workers7 recently developed a definition of Emotional Intelligence as follows:
‘Emotional Intelligence is the ability to perceive emotion, integrate emotion to facilitate thought, understand emotions and to regulate emotions to promote personal growth’.
In this respect, Pau and colleagues8 found that dental students with low Emotional Intelligence scores engage in smoking, drinking and high risk behaviour in response to stress. Those with higher scores tended to use reflection, appraisal, social, interpersonal, organizational and time management skills to cope. Presumably, this would render the more highly emotionally intelligent students better able to relate positively to patients. Becker et al9 examined the contribution of Emotional Intelligence to a dentist's success in implementing a relationship-based model of dental care (as taught by The Pankey Institute for Advanced Dental Education Florida). They concluded that:
‘Emotional Intelligence in general appears to be a key component in successful implementation of the Pankey model’.
The core of the Pankey philosophy states:
‘It is essential for the dentist to establish a deep, mutually rewarding relationship with the people whom she or he treats’.
So, if they had established that dentists who are committed to this philosophy tended to have high measured levels of EQ, it would not have been surprising. What they actually did was to survey 144 dentists who had spent at least six weeks of training at the Institute. They compared the degree to which they had implemented the Pankey philosophy using a 92 item self-report instrument with each individual's self-assessed EQ score. Those with the higher EQ scores were more likely to have implemented the model, particularly in the areas of diagnostic skills, relationship building and business practices which benefit both the patient and dentist. The areas of Emotional Intelligence which had the strongest correlation to implementing the philosophy were:
Emotional self-awareness;
Reality testing – the victory of judgement over raw emotion;
Assertiveness;
Self-actualization – the ability to engage in one's passions and talents.
It will be clear from this brief look at the concept of Emotional Intelligence that the communication skills of the dental team are important in this context.
Kay and Tinsley10 stressed the value of relationship building with patients in practice success. They make the point clearly that patients choose dental practices primarily on the way they are treated as people. They continue by suggesting that health outcomes for patients are likely to be more positive when effort is made to build good relationships with patients and not where effort is focused on technical excellence alone. They state:
It is not possible to truly ‘help’ and ‘care’ for patients in a way that will cause them to trust and have a high regard for you without good interpersonal skills. It is by your communication with your patients that they judge you.
Freeman and Humphris11 agreed with the opinions of Kay and Tinsley. They stated:
Communication is key to successful dentist-patient interaction and can contribute to a thriving dental practice.
The foreword of this book,11 by Wilson, has the following opening paragraph:
Effective communicating is fundamental to success in clinical practice. Indeed, many tensions between patients and members of the dental team, in particular complaints, stem from failures in communications.
This publication also stresses the importance of good communication between team members in practice success and stress prevention.
Burke and Freeman in their book, Preparing for Dental Practice,12 aim to prepare senior dental undergraduates and vocational dental practitioners for the full responsibilities of General Dental Practice with a holistic approach to patient care and treatment. They devote one of the six chapters of this book to the importance of the dentist-patient relationship in practice-building. In particular, this chapter stresses the importance of good communication with patients to build what they refer to as the ‘treatment alliance’. They describe an optimal ‘treatment alliance’ as existing when dentists and patients work and communicate together towards the common goal of oral health. They state:
‘It seems that those patients who are made to feel welcome are listened to and are encouraged to participate in their treatment decisions, are those who express greater satisfaction and remain loyal to the general practice’.
