Smile Source Private Dental Practice Blog

Mastering the Art of Underperformance Conversations

Written by Smile Source + ACT Dental | Oct 14, 2025 6:41:15 AM

A 5-Step Model for Dentists

Let’s be real. Running a dental practice is a juggling act. You’re caring for patients, keeping an eye on production goals, and working hard to build a positive team culture. But then it happens: a team member is underperforming.

Cue the sweaty palms.

Underperformance conversations are awkward. They’re charged with emotion. And in today’s labor environment, they’re packed with legal and HR landmines. It’s tempting to avoid them, hoping the problem just… disappears. But here’s the truth: silence speaks volumes…negative ones. To your best team members, it says mediocrity is acceptable.

Why You Can’t Ignore Underperformance

In a tight labor market, ignoring issues isn’t just a short-term headache; it’s a risk to your entire practice. Here’s why:

  • It demotivates top performers. When your rock stars see others underperforming without consequence, they feel undervalued.
  • It impacts patients. Late arrivals, curt interactions, or sloppy work all chip away at the quality of care. Patients feel it.
  • It hurts production. Mistakes and absences cost time and money, and yes, that affects everyone’s bonus potential.

The bottom line? Address the issue early. Don’t wait for an annual review. If you see something, say something.

Silence kills culture and production. You need a way to address underperformance that's calm, consistent, and legally sound. This guide gives you a 5-step framework to turn that terrifying talk into a productive, empowering one that protects your practice and creates a clear path for employee turnaround.

#947 - Alan Twigg - How to Handle Difficult Conversations with Underperforming Employees - Best Practices Show Podcast


The 5-Step Productive Feedback Model

This framework works for everything from a quick hallway correction to a formal write-up. The beauty is its simplicity—it keeps you calm, consistent, and clear.”

1. State the expectation. Lay out your standard.

Example: “We have a high standard for patient care, and that includes maintaining a friendly, positive demeanor at the front desk.”

2. State the objective facts. Stick to the facts, not feelings.

Example: “Three patients this week mentioned to the hygienist that they felt rushed and unwelcome when checking in.”

3. Define the gap. Show the difference between the standard and what’s happening.

Example: “There’s a gap between our standard of friendly service and what these patients experienced. That’s what we need to address.”

4.  Emphasize the impact (the heart of the conversation). Make it about the bigger picture, not “me vs. you.”

Example: “When patients feel rushed or unwelcome, it impacts our brand and their trust. It makes the entire team’s job harder and makes patients less likely to return or refer others.”

5. Ask for commitment. Close with accountability.

Example: “We need you to commit to meeting our standard for patient interaction. Can I count on you to make the necessary adjustments starting today?”

 

When a Warning Becomes Necessary

Sometimes the issue doesn’t improve with verbal coaching. That’s when you move to a formal written warning. Think of it as both a protection for your practice and a final chance for the employee to course-correct.

Here’s what a solid written warning should include:

The Reason and Expectation: Be specific (punctuality, accuracy, etc.).

  1. Consequences: Legally, you must include the line: “If you do not improve, further disciplinary action up to and including termination may result.”
  2. Documentation: Have the employee sign the written warning. If they refuse, bring in a witness to confirm the conversation happened.

Staying on Track When the Conversation Goes Sideways

Employees may try to derail you with blame, victimhood, or distractions. You’ve probably heard things like:

  • “It’s not my fault, Joanne trained me wrong.”
  • “Why are you always picking on me?”
  • “What about so-and-so who’s always eating at her desk?”

Your move? Stay calm and pivot. You might say, “I appreciate that. I’ve made a note, and we’ll address it separately. For now, we’re here to discuss your attendance.”

Embrace the power of silence. After delivering a warning, stop talking. Don’t soften it with compliments or small talk. Let the message stand.

The Power of the Turnaround: When Employees Do Right

It's easy to focus on the negative, but the entire purpose of a coaching system is to create a positive outcome. The good news is that many employees will rise to the occasion when faced with clear expectations and genuine support. A written warning often serves as the wake-up call some employees need to fully commit to their role.

After the Commitment: How to Foster a Turnaround

  1. Provide Targeted Support: Once the employee commits to improvement, their behavior may have stemmed from a lack of skill or training, not just attitude. Invest in them by offering additional training, a mentorship pairing, or a check-in on their role clarity.
  2. Monitor, Don't Micromanage: Your job is to follow up, but not hover. Set a time for a "check-in", weekly, bi-weekly, or monthly, to review their progress objectively against the standards you set in the conversation.
  3. Acknowledge and Reward Progress: When you see a positive change, even a small one, recognize it immediately. Positive reinforcement is powerful. If a habitually late employee is on time for two weeks straight, a simple, sincere comment like, "I've noticed your punctuality has been excellent lately, and it's making a real difference in our morning flow. Thank you," can cement the new behavior.

When an employee successfully turns their performance around, you haven't just saved a hiring process; you've created a more invested, loyal, and skilled team member who understands the practice's values and their direct contribution to success.

More Tips for Handling Difficult Conversations

  • Establish Boundaries for Communication: If an employee is yelling or interrupting, immediately stop the conversation and state the necessary boundary. For example: "I understand you're upset, but if this conversation is going to continue, you need to lower your voice."
  • Bring a Witness for Heavy Counseling: When issuing a written warning or discussing possible termination, have a second manager or owner present. This provides documentation and protects the practice from future claims by confirming the discussion and the warning of consequences.
  • Invite a Written Rebuttal: If an employee refuses to sign the document, invite them to submit a written rebuttal (via email or memo) by the end of the next business day. If the case ever goes to court, this document confirms that the employee was aware of the conversation and its details, even without their signature on the original form.
  • Avoid the "Compliment Sandwich": Resist the urge to bury constructive feedback between two layers of praise. This dilutes the message and confuses the employee about the seriousness of the issue. Be calm, but be direct.

Protect Your Practice: Be Clear

Difficult conversations don’t have to be dreaded ones. With a framework in place, you can lead with confidence, protect your culture, and give your team members a clear path to improve. Because in the end, it’s not about confrontation, it’s about clarity, accountability, and protecting the practice you’ve worked so hard to build.

Need Help with HR Complexities?

Most dentists and office managers receive no formal training in managing these complex, high-stakes HR issues. If you need support with compliance, difficult conversations, or formal documentation, consider seeking outside expertise.