952-432-3322

Dear Team Member:

Please fill out the attached surveys. The purpose of these surveys is to help us assess personal concerns and design appropriate program(s) to meet each team member’s expressed needs, as well as work for the entire team and the benefit of the practice.

There are no right or wrong answers. However, we do request that you choose one answer; otherwise it cannot be counted.

Your responses will in no way jeopardize your job security; rather, your honesty gives us insight as to how we can best help you.

Please feel free to call us regarding any part of these surveys. Our conversation will be held in complete confidence.

Thank you.

Sincerely,
Christian
White & Associates Practice Consulting

 

1 = Always
2 = Often
3 = Occasionally
4= Rarely
5 = Never

1. I look forward to coming to the office in the morning.
2. Our patients receive high quality care.
3. My skills and experience are utilized to the fullest.
4. I give up my lunch and other breaks.
5. I am comfortable communicating with my team members.
6. I am irritable at the end of the workday.
7. I feel good about the quality of work I perform.
8. We work together as a team.
9. I have energy to pursue personal interests outside office hours.
10. I experience back or neck pain at the end of the workday.
11. I am proud of being a member of my profession.
12. My time in the office is spent productively.
13. I miss work because of illness.
14. I leave the operatory when treating a patient.
This field is for validation purposes and should be left unchanged.

 

1 = Never
2 = Sometimes
3 = Frequently
4 = Usually
5 = Always

1. My job meets my physiological needs (allows me to be free of hunger, thirst, etc.).
2. My job meets my safety needs (allows me to provide clothing, shelter, security).
3. My job meets my affection needs (belonging; to be wanted by members of a group).
4. My job meets my esteem needs (self-respect, achievement, recognition by others).
5. My job meets my self-actualization needs (self-fulfillment, contributing to society, complete realization of one’s full potential).
6. My salary is adequate.
7. My physical working conditions are adequate
8. I have adequate job security.
9. I have pleasant supervision.
10. I have adequate fringe benefits.
11. My job description permits me to know what is required start and finish a task.
12. I make decisions and run my own work as much as possible.
13. I receive frequent, objective, and adequate feedback.
14. I have examples that showing enthusiasm for a task is rewarding.
15. Any differences in organizational values and my own values can be bridged without personal conflict.
16. There is a positive accommodation of different lifestyles in our practice.
17. Additional responsible duties are acquired in the job as I learn.
18. I am encouraged to learn other team members’ jobs.
19. I contribute to decisions, goals, and plans.
20. I take part in developing objectives and know evaluation will be based, in part, on achieving them.
21. I am made aware of how my behavior assists others in achieving team goals.
22. I see evidence which is conducive to positive thoughts about our practice as a place to work.
23. At work I experience an atmosphere of fairness, duty, and work, not an absence of supervision.
24. I experience the presence of pressure to get things done.
25. I receive swift, positive feedback when improvement is needed.
This field is for validation purposes and should be left unchanged.

 

1 = No
2 = Not Usually
3 = Don’t Know
4 = Usually
5 = Yes

1. Does our practice excel in cost-effective production; i.e., doctor time scheduling, delegation of all possible duties to auxiliary personnel, and written treatment plans?
2. Do we have daily, weekly, monthly production and overhead figures to support our decisions?
3. Do we monitor implementation of our business plan and marketing plan?
4. Do we generate a flow of new ideas and turn them into reality, or, at least test them?
5. Are the quality and speed of our decisions good and are they tied to effective implementation?
6. Do we have an office manual that is kept up-to-date?
7. Does each new team member in our practice go through a formal training program?
8. Can each team member quote fees, or ranges of fees, for all routine procedures?
9. Does each team member know the number of new patients per month for the last few months?
10. Is our practice under strict control, facilitated by the simplest, least bureaucratic means possible?
11. Do we know how much production has improved in the last six months and how much it is projected to improve in the next six months?
12. Is quality built into our incentive systems?
13. Are our team members and the quality of our service at least as important as our practice’s financial health?
14. Do we have short- medium- and long-term written objectives for our practice?
15. Are all team members informed of the day’s schedule so patients can be treated with the optimum efficiency?
16. Does our doctor present comprehensive treatment plans to patients and give them a written copy to take home?
17. Are seventy percent of incoming calls appointment calls?
18. Do we run on schedule within five minutes?
19. Do we schedule all the work that needs to be done in as few appointments as possible?
20. Do we have a daily production goal that we work toward?
21. Do we reschedule patients at the time of cancellation?
22. Do our patients address their own recall card on their last treatment visit?
23. When we call overdue recall patients, do we cite a certain condition that the doctor wants to check?
24. Do we phone patients that have not been seen in two years and ask if we should forward x-rays?
25. Do we control inventory with a perpetual inventory system?
26. Is our accounts receivable ratio more than two times the monthly net charges?
27. Are our patients informed of the approximate fee for their initial visit when they make the appointment?
28. Do we request patients to bring in their insurance booklet and forms on their first visit?
This field is for validation purposes and should be left unchanged.

 

1 - Never
2 - Sometimes
3 - frequently
4 - Usually
5 - Always

1. I know what is expected of me at work.
2. I have the materials and equipment I need to do my work right.
3. At work, I have the opportunity to do what I do best every day.
4. In the last seven days, I have received recognition or praise for doing good work.
5. My supervisor, or someone at work, seems to care about me as a person.
6. There is someone at work who encourages my development.
7. At work, my opinions seem to count.
8. The mission or purpose of my company makes me feel my job is important.
9. My associates or fellow employees are committed to doing quality work.
10. I have a best friend at work.
11. In the last six months, someone at work has talked to me about my progress.
12. This last year, I have had opportunities at work to learn and grow.
This field is for validation purposes and should be left unchanged.

 

This field is for validation purposes and should be left unchanged.

 

1. Please indicate the baseline data that you gather during a periodontal assessment, as well as the frequency (Ex: Pocket depth, YES, 1x/year)

 

2. Please indicate the frequency (Ex: Bitewings, 1x/year) at which you obtain the following radiographs:

 

 

 

 

 

 

 

9. Please check which most relates to you revolving around assessing, diagnosing, and presenting periodontal therapy:

 

10. What types of pain control are you able (per license), and comfortable with administering for periodontal therapy? Check all that apply:

 

 

 

 

 

 

 

 

 

This field is for validation purposes and should be left unchanged.