Why Most Dental Practices Fail New Hires in 90 Days—And How to Fix It

You did it, you hired someone great. But here's where most practices go wrong. They stop leading the moment that the paperwork is signed. It's like, I got that over with now. It's not on me. It's up to them to succeed, and we want to make sure that we have appropriate structures in place for that person to succeed. With 46% of new hires failing in the first 18 months, onboarding isn't optional. It's everything. So this is part three of our three part hiring series and it's where you learn how to turn hiring into lasting results. Welcome back to the Next Level Practice podcast. I'm your host, Kelly Damer. This is episode three in our special series of recruiting, hiring and onboarding. We've covered the hiring crisis, we've covered how to hire, and now we're going to be closing it out with the most overlooked piece of all the onboarding. Because without it, you'll just keep rehiring, retraining, and recycling team morale. So let's talk about how to onboard the Next level way. In this episode, we're going to be breaking down why onboarding starts before for day one, the three milestones of a great onboarding experience and how to assign mentors, track progress, and really create ownership for that fresh team member. The first 90 days really determine whether that new hire becomes a top performer or just another turnover statistic. What's interesting is that that 46%, almost half of people who are failing in their first 18 months, I would guarantee the majority of employers know that that person's not gonna work out in the first 30 days and they take 18 months for it to really come to fruition and like what we call be successful elsewhere. Right, okay, so pre onboarding, how to set the tone before day one. If you'll remember, we created a different experience in hiring and recruiting where we were really focused on vision, purpose and values. Finding alignment with our fresh team member in the practice, letting them know that this was something different specifically around culture and result. So we want our onboarding experience to mimic and mirror that as well. And that starts with pre onboarding. We really recommend sending a nice welcome email, maybe mailing a swag bag, having flowers delivered, delivered for day one, or even at their home before they come into the office for their first day. It's also a nice touch if you want to have your team record a video letting them know how excited they are for the team member to join. First impressions really stick and this is your opportunity to make sure that there's a continuity from that difference in the, in the recruiting process all the way to onboarding. Week one, really day one, culture, expectations and observation is what you're looking for here. This week is for connection, it's for clarity and for context. It can be very overwhelming walking into a new practice and starting a new job.

Right.

So you really want to set very realistic expectations. That first day, that first week where you're walking them through mission, you're introducing them to a mentor and you're reviewing KPIs and systems. But don't rush productivity on the first day. I really recommend having the person just get settled in understanding the technology that's being used and then setting some distinctions.

Right.

So the first distinction is the difference between fresh and new. New, you'll notice I'll start to call this new team member actually a fresh team member. And we want to set that context with the person because they're bringing a fresh perspective to things. New kind of has a connotation where it's like, you know, a fish out of water, like they're the new one.

Right.

Fresh means you're bringing a fresh perspective and they might have a really great suggestion or a way that they have done things in the past that they can integrate into this practice. And fresh gives them permission to do so. Whereas new kind of is aligned delineating them for the rest of the team.

Right.

So that's something that I really like to make sure that we clarify with our fresh team members is that distinction of fresh, not new. The next is the distinction of who to report to for what. And I like to break it down into three areas of being, doing and having. Being is who they would go to for their mentor. So I like to do this where if you have a fresh clinical team member, assign their mentor as someone on your administrative team so that they're getting to connect and support cross departmentally. Being is who they go to when it comes to mentor. And that could be things like the way that we interact with patients, how we create really great first impressions. Anything that has to do with our beingness doing is more around agreements, roles and responsibilities. And so they're doing would be their direct report whether that's a team leader. Hopefully it's a team leader, not the doctor who's managing the team. So they would go to the team leader. Whoever their direct report is is who they go to for the doing. This part of the role having is things like benef compensation, you know, payroll, anything that has to do with HR is there having. So if you have a Designated HR team member or outsourced company that you work with, really making sure that there's clear delineation of who that person is setting up direct deposit, if that's a thing, if there's benefits to get enrolled in, if there's any time off that they need to be aware of how that accrual happens, if that hasn't already been discussed in the hiring process as well. So I really like to distinguish that B do have who they go to for each of those. It could be that they go to the same person. Highly recommend having a mentor in place that's not the manager so that their multiple people nurturing and supporting this fresh team member. Like I said, a lot of times learning just the technology, if it's a different practice management software or some of the different technologies that you have in your office, setting an expectation that the first day or two, really just getting comfortable with those things, they might need a more in depth training depending on what their role actually is. So sometimes I think we overlook that because we get used to that technology. So you really want to set some clear expectations because that can be very overwhelming for some team members. The other thing that I would really recommend doing in week one is to review agreements. So next level practice, we recommend having a book of agreements that is reviewed quarterly, added to daily, weekly, monthly, whatever it might be, and then reviewed quarterly among the team. And it could be things like at Complete Health Dentistry Northern Pennsylvania, we agree that we are on time for daily huddle means is that we are butts and seats at 7:58 ready to go.

Right?

That would be an agreement that we would recommend putting in your agreement book. And it could be for many different things. So reviewing the agreements so that that team member, the fresh team member can really get acclimated with some of those important things that are outside of a handbook. The other thing that you want to make sure is that all of these things are clearly listed in that onboarding checklist. An Excel document where you have everything listed. You should have it be like complete this, this and this within day one. And that's basically like any sort of HR paperwork. Again, maybe meeting with their mentor, meeting with their direct report and starting to understand the technology. Complete this, this and this in their first week and keep going right day 60 through 90 as well. All of the things that you want them to be integrating on fresh team member onboarding checklist. The last suggestion we do this internally at next level and I think it's a really great practice is our fresh team members actually Send an end of day, almost like a book report. Like, what did they learn that day? Again, bringing that fresh perspective to life. Because, you know, you have a team member who's maybe been there for 15 years. It's very much so. Like, this is the way we've always done things, and sometimes the original intention of things gets lost along the way. So when your fresh team member is actually sending an end of day, maybe it's an end of week, if that's more appropriate for your practice, they get to really outline certain things that they're learning. And you might have a seasoned team member who's like, oh, wow, I forgot that that was the original intention or that's why we used to do things. So, again, that fresh perspective is really helping, number one, the fresh team member integrate, and you can keep an eye on what they're learning. But number two, it might actually support your existing team and getting back to the original intention of things if that maybe got lost somewhere along the way. So that's really week one, how to set clear expectations. Again, it can be very overwhelming. So you just want to make sure that that person knows that exactly where they're at in this moment is perfect. And then we really want to ramp up things.

Right.

So I mentioned earlier that that where it's like 50% of team members who don't work out, it's almost 50% in the first year and a half. Most likely you have a good idea if they're going to work out or not in the first 30 days. I would bet that you have a good instinct on that. So week two through four really ramp up those expectations. I've experienced this before. I'll be the first to admit it, that I make a new hire, that person starts, and I'm like, oh, I messed up that person. You know, whether I got duped during their interview process, maybe I skipped a step. And I know I shouldn't have skipped a step. That's why we say hire slow fire, fast, right? And then I've got them on the team and I'm like, this is just not going to work out. Whether it's not a culture fit, their expertise isn't matching the resume and what they portrayed in the hiring process. I'm not saying that that's every single team member, right? But sometimes that does happen. And the cost of keeping that person on is really, really large. Especially if you're keeping them for 18 months. That's a long time. So weeks two through four really ramp up some expectations, you know, still let them Shadow. Then let them lead with backup. Weekly check ins, feedback loops and values alignment are key. We like to say let them learn one, let them see one and then let them do one. So they're learning the process, they're observing someone and then they're trying it on their own. It's not that we need to ramp up so much that we scare them away. We just want to ramp up and make sure we're holding them accountable. Specifically to things that were expected and talked about during the hiring and then even the onboarding in week one. At week four, you should be hosting or holding your first review with that team member. I've experienced this before where fresh team members during their first review their a little nervous.

Right.

It's pretty overwhelming again for them. And so I really like to just keep that first review supportive. Make sure that it's something that you're working through with them to really set expectations of what you look to see in each of the questions. Set them up for success.

Right.

Be clear on their measurable metrics. I think that's one of the most important things that we can do is make sure there's clarity around that at next level. For some of our practices we really believe that and have an agreement in place that raises aren't just something that happens annually. It's not just something where it's like oh you've been here, you get another, you know, 3, 5%, whatever it might be. Right. Raises and compensation increases are something that we believe should be performance based or if you have a role change. Right. And that would be appropriate. Maybe if it's a more of a management role or a leadership role or just a change completely. That would be one example of when a compensation change is appropriate. And we have an agreement in place where just because you're having an annual review doesn't mean that you should expect a compensation increase just to be tied to that. And instead we really flip the script and have it so that our team members are the ones who are requesting that change, change and review in their compensation and they're putting it together in a really nice report that has industry standards in the area. They're looking at what their return on investment is for what they're producing for the, for the company and they've tracked all that and then they propose what they're looking for and then there's a negotiation that happens.

Right.

So it's something that we've really trained our team on on how to do that. It's a great skill for them to have no matter what industry or business they're working in.

Right.

So if raises, if that's something that you want to integrate in your practice, or if it's something that you already have integrated in your practice, where raises don't just happen annually, make sure that that agreement is, is understood. And I like to do that during the 30 day review, let them know, hey, just so that you have clear expectations when you get to your annual review, we're not a company that just gives you a raise just for being here. If you do want to have a performance compensation conversation, what's appropriate is that you request the meeting, you bring a report or a proposal to your direct report and actually have that conversation with them where you're showing that return on investment. So I actually spend time with our fresh team members during that 30 day review, letting them know how to track their performance and what we are going to be looking for when it comes to a performance based increase conversation, which is really great to set that clear expectation during that first review. Also really recommend spending time acknowledging that team member, that fresh team member for what's working well.

Right.

Whenever you give feedback, you always want to give feedback in the context of here's what's working well. And then I like to try and find one specific area of feedback or where there's some room for growth, if it's applicable.

Right.

I don't want you just to look for something, just to look for something. But a lot of times it's like, oh, you know, this person maybe can do a little bit better with like time management or this person can do a little bit better with like feedback loop closes and communicating when something's been completed. So whatever it might be, I look to find one, maybe two areas if that's appropriate. Don't overwhelm them with all these things. If there's a lot of little nitpicky things, right. Maybe it's just, hey, getting back to agreements and fulfilling on agreements on time. So I like to really acknowledge them for what they're doing really well and then I try to find one area that I can give them some feedback on. Fresh team members do like to receive feedback so that they can understand how they can do better. Better.

Right.

And then lastly, during that 30 day review, I really like to spend a lot of time talking on professional and personal goals. So short term, within the first six months, year, long term, five years and above in the hiring and recruiting process, we really spent some time talking about what makes us different and talking about our vision, purpose and values and Ideally, that's talking about helping our team members grow, not only professionally, but personally.

Right.

So we want to walk our talk and make sure that they are clear that we want them to grow. And spending time talking about those professional and personal goals really opens up a whole dialogue and conversation, but lets them know like, hey, this is something different. This is the culture that they've been wanting. This is a company that really cares about their growth and it's going to set the tone for them to really perform well and stay. Now let's talk about days 30 through 60.

Right.

So that's really where we are evaluating and empowering them. So it's time to raise the bar. We want to manage performance benchmarks. Start giving the fresh team member autonomy and if there are red flags, address them now. Not at day 180, not at month 18. I think that you have a good idea if it's going to work out or not. So if it's something where you're like a lot of little things are popping up, just don't give up, don't throw in the towel. Support that person, give them the structure. And it could be that you support them and being elsewhere, successful elsewhere.

Right.

But it could be that those little tweaks in that course correction and conversations that you're going to be spending help them actually be a successful team member and integrate fully. So our three actionable takeaways. Number one, build that 90 day onboarding plan. Every fresh hire should have a roadmap app including checklists, goals and regular coaching. I highly recommend that you have a different onboarding checklist by position in your practice. It could be that there's a clinical one and then administrative one. It should be specific to that team member's role. The second is to assign a peer mentor. Fresh team members really succeed faster when they feel supported. So if they have a direct report, if they have a mentor, give them some guides that they can really feel supported and successful inside of their role. And then the third is to create feedback rituals. So whether that that's daily, weekly, minimally weekly.

Right.

Don't just wait for the reviews. Momentum and course correction need to happen definitely daily, if not weekly to help that person understand what they're doing well, where they have opportunities and course correct appropriately. Remember, you're not just hiring a team, you're building a culture. And onboarding is where your culture really comes to life. If you want to install this in your practice, go ahead and download our fresh hire onboarding guide that's in the show notes. It includes a plug and play 90 day roadmap with weekly check ins, key benchmarks and cultural touches. Touch Points this wraps up our three part series, so if you missed episodes 10 or 11, go back and listen. I'm Kelly Damer and this is the Next Level Practice Podcast. Here's to building a team that you don't have to rebuild.