Creating a healthy and respectful dental office environment is essential for team members and patients. By fostering mutual respect, effective communication, and recognizing each team member’s contributions, we can achieve better patient outcomes, higher job satisfaction, and a more harmonious workplace. With reports of a dental hygiene workforce shortage, it’s crucial to ask whether dental offices are creating positive work environments that retain their staff. Unfortunately, the results of the 2023 Healthy and Respectful Workplace Survey conducted by the Canadian Dental Hygienists Association (CDHA)1 indicated that 60% of respondents either experienced or witnessed a poor work environment. Let’s explore the dental hygienist’s experiences in the workplace, examine the impacts, and identify key strategies that can drive positive change and enhance the overall well-being of everyone in the dental office.
Experiences of dental hygienists
In the 12 months preceding the 2023 survey, 6 in 10 respondents reported experiencing or witnessing workplace mistreatment. The most common forms of mistreatment were incivility, verbal and non-verbal abuse, harassment, and bullying. Clients were the primary source of mistreatment (22%), followed by co-workers (dental hygienists, dental assistants, and front desk staff) (20%) and dentists and office managers (both at 17%).
According to survey data, dental hygienists who are younger, have fewer years of clinical experience, and self-identify as a minority experience higher rates of mistreatment in the workplace.
Anecdotally, dental hygienists report that their appointment times are often shortened to accommodate additional patients. They mention that front desk staff increase billing units and that they feel pressured to recommend extra services that are not based on client needs. Additionally, they note that they are not compensated when a client cancels. Would we expect a nurse in a hospital or medical clinic not to be paid when they don’t have a patient to attend to?
The number one source of mistreatment is clients. Unfortunately, dental hygienists report that threats and inappropriate comments made by clients are often not addressed, and they are told to tolerate the client because the client is generating revenue for the dental practice.
Another factor that significantly affects the workplace experience is work-related pain and discomfort. In a profession with high rates of repetitive stress injuries, 87% of dental hygienists who responded to the 2023 survey reported experiencing one or more medical issues.3
Impact
What are the impacts of unchallenged mistreatment in the workplace? Dental hygienists report losing respect for the offending person, experiencing high rates of stress, and avoiding colleagues. Dental hygienists also report that it affects their motivation and confidence in their skills, which can affect patient care. Approximately 39% of survey respondents considered quitting their jobs, and almost 14% quit their jobs.
Replacing staff members has a substantial financial impact on a dental office. It’s been estimated that it costs the office six to nine months’ salary on average.2 Immediate costs include recruiting and training new employees, and there is often reduced productivity as new staff adapt, potentially affecting patient care quality and satisfaction. This, in turn, can lead to lost revenue and damage to the office’s reputation. Additionally, the increased administrative burden on the remaining staff can cause burnout and further turnover, creating a costly cycle. The financial impact affects the office’s efficiency, patient retention, and long-term profitability.
Work-related pain and discomfort also affect the workplace experience. It leads dental hygienists to reduce their hours, and it decreases their efficiency and performance. Twenty-two percent of survey respondents are considering leaving the profession for this reason. Additionally, they often face substantial out-of-pocket costs for treatment due to a lack of health benefits.
Strategies
The CDHA survey found that respondents without a workplace policy on bullying and harassment were more likely to experience mistreatment. It’s crucial to have such a policy, revisit it regularly with staff, and enforce it transparently, regardless of whether it is with staff or clients. The policy should outline inappropriate behaviours and consequences for offenses. Currently, only 55% of respondents reported having a workplace policy on bullying and harassment.
Dental offices must respect team members’ scope of practice, knowledge, and experience. Aside from oral health assessments, blood pressure and oral cancer screenings, dental hygienists record proper dental hygiene diagnoses, develop a client-centred treatment plan, provide oral health education, perform recommended treatments, and follow up on care rendered. Alongside documenting services in clients’ records, some offices require dental hygienists to enter billing information and book the next appointment. And let’s not forget that dental hygienists are also responsible for adhering to the infection control guidelines set by their regulatory body and setting up the operatory for the next patient. Ensuring the schedule allows them sufficient time to perform all of their duties without feeling overwhelmed is critical.
Survey data show that recent graduates experience more mistreatment. To support them in their new role, dental offices should offer longer appointment times and paid training sessions. These initiatives will ensure they feel comfortable and confident with clients and can provide exceptional care. Give feedback kindly and remind staff that recent graduates will have questions as they adjust to their new position.
To keep staff physically and psychologically healthy, dental offices could provide them with a health benefits package or share the cost of a benefits program. Other strategies include ensuring an ergonomic design of dental operatories, scheduling time for sharpening, and replacing instruments and equipment promptly as they wear out. Worn instruments are less effective, forcing dental hygienists to exert more effort, putting additional stress on their hands, neck, and shoulders, causing repetitive strain injuries, and potentially causing client discomfort.
Dental hygienists have identified the critical features of a positive work environment as respect, good communication, teamwork, compassion, and strong leadership. Effective leadership involves treating staff professionally and civilly, fostering a collaborative environment, addressing conflicts respectfully and promptly, and recognizing the dedication and productivity of team members. By modelling these key behaviours, everyone on the oral health care team, including the practice owner, can contribute to fostering a positive work environment.
Conclusion
Although this article mainly focussed on dental hygienists’ experiences, we can assume that, if dental assistants and other co-workers were surveyed, they would most likely report the same issues in the workplace.
A negative dental office environment impacts staff well-being and patient care, leading to high stress, loss of confidence, and decreased job satisfaction. However, by enforcing workplace policies, respecting team members’ expertise, providing adequate training and support, fostering open communication, ensuring supportive management, and promoting a positive and psychologically safe culture, dental offices can create a healthier environment for staff over the long term and positive clinical experiences for patients. These improvements enhance job satisfaction, improve patient outcomes, support staff retention, and contribute to the overall success of the practice.
References
- Canadian Dental Hygienists Association, Cummings H. 2023 Healthy & Respectful Workplace Survey: Executive Summary. Ottawa: CDHA; 2023. Available from: https://files.cdha.ca/Career/HealthyWorkplace/HWSurvey_exec_sumary_infographic_EN.pdf
- Wise-up Wednesday from Zane Benefits: Employee retention strategies for dentists; real costs of losing an employee. Dentistry IQ. March 9, 2016. Available from: https://www.dentistryiq.com/practice-management/staffing/article/16352101/wise-up-wednesday-from-zane-benefits-employee-retention-strategies-for-dentists-real-costs-of-losing-an-employee
- Canadian Dental Hygienists Association. 2023 Healthy & Respectful Workplace Survey: Work-Related Pain or Discomfort. Ottawa: CDHA; 2023. Available from: https://files.cdha.ca/Career/HealthyWorkplace/pain_and_discomfort_infographic_EN.pdf
Donna is an honours graduate of the Canadian National Institute of Health (CNIH) dental hygiene program in Ottawa and holds a Bachelor of Arts degree in psychology from Carleton University. With a background in general and periodontal practice, she transitioned into a role as a theory and clinical educator, eventually becoming the pre-clinical coordinator at CNIH. Currently, Donna serves as the manager of professional practice at the Canadian Dental Hygienists Association (CDHA), where she plays a key role in supporting dental hygienists to achieve a healthy and respectful workplace.