As my fellow passenger folded himself into a center seat, he grumbled that air travel today is about as much fun as going to the dentist. Accustomed to hearing my profession being used as a synonym for anxiety and discomfort, I just smiled and nodded. He had a point, after all: the average flight, like a dental appointment, is at best an inconvenient means to a necessary end. In fact, with the progressive elimination of meals, direct flights, legroom and even restroom privileges, the proverbial root canal is starting to look like a pleasant and civilized alternative to a business trip.

That particular journey, though, wasn’t bad at all. The seats weren’t any wider than usual, the snacks were meager and every place was occupied. Yet the time passed quickly, and the passengers were generally smiling as they got off. What made this trip different was a pleasant, enthusiastic, helpful crew. How, I wondered, do some airlines (or stores or practices) consistently win the loyalty and affection of their passengers (or customers or patients)?

I found at least part of the answer in a magazine article¹ in which that same airline was singled out for its policy of "hire for attitude, train for skill." As I reflected on my experience in practice, I became convinced that we dentists would do well to take this simple phrase to heart.

Now, make no mistake, skills do matter—a lot. No airline knowingly hires an incompetent mechanic because he’s a nice guy, and you aren’t about to take on a hygienist who doesn’t have the requisite skills for the job. However, above a certain level, the degree of skill (or speed or experience) becomes less important than a candidate’s willingness to learn new techniques and adapt to your way of doing things. Equally important is his or her ability to relate to patients as human beings, addressing their individual needs and concerns without undermining the efficiency of the office.

There’s no question that attitude does make a difference. Not long ago, we surveyed patients in our school clinic to determine why they return (or do not return) for further care. We asked all the usual questions about fees, insurance coverage, parking (a big issue in our urban setting) and quality of care. We also left some blank spaces where patients could write in any other characteristics that they found particularly good or bad about their experience. One objective of the survey was to discover which of our little giveaways (toothbrushes, refrigerator magnets, calculators, mugs and the like) were most effective in encouraging regular follow-up care.

What we found was that two factors influenced our patients, overwhelming all the others: a caring atmosphere and up-to-date care, in that order. The souvenirs were appreciated, but mostly as a token of membership in our patient family.

Patients left us for various reasons—location, the academic setting, cost—but those who stayed with us did so primarily because of the attitude of the staff. (I like to think that they took our skills for granted.) It was also rather sobering to learn that the most important people to the patients, by a wide margin, were the hygienist, the assistant and the front desk staff.

Dentistry today is a team effort, and everyone on the team is a window into the office and its attitudes. By their words and behavior, they should leave the patient in no doubt that it is the dentist—not the people making appointments or sending out the bills—who is ultimately responsible for their care. If your patients are not sure who makes the decisions about their treatment, you’ve got a problem.

Admittedly, this is all rudimentary "Practice Management 101" material. What I want to stress is that the characteristics we seek in our employees and associates—caring, flexibility, cooperativeness, thoroughness—are built up over a lifetime of experience, not taught in a two-day seminar. Sure, some important interpersonal skills can be improved by training and experience (phone manner, for example, or how to calm an anxious patient). But if these are no more than a thin veneer over a bad underlying attitude, the old habits are bound to resurface in times of stress. With apologies to drill instructors everywhere, "attitude adjustment" sessions rarely succeed in the long run.

Dentistry today is a team effort, and everyone on the team is a window into the office and its attitudes. By their words and behavior, they should leave the patient in no doubt that it is the dentist who is ultimately responsible for their care.

So how exactly does one hire for attitude? Most of us, myself included, rely mostly on intuition, and that’s not going to change. But there also exist more systematic techniques to gain insight into a prospective employee’s attitude, some of which are practical for even the smallest practice. I encourage you to seek them out and let your colleagues know what works—ideally by publishing your findings in JADA or the ADA News.

Once you have found employees with the right attitude, do everything you can to hang on to them. Be fair and consistent, while rewarding exceptional effort. Encourage unconventional thinking; take suggestions seriously, even if they can’t all be implemented. And don’t neglect compensation. An energized staff will make your practice special, a good place to work and a great place to be a patient.

The second half of the philosophy is important, too, so be sure to "train for skill." Learning to fill out forms or use a new computer system will be a breeze for staff who really want to learn. Your investment in continuing education will be amply repaid.

The kind of exceptional people I’m talking about aren’t easy to find, but neither are they a textbook idealization. It is my great good fortune to work with some of them every day. Good attitude is more common than you may think; you just have to look for it, nurture it and, dare I say, deserve it.

By the way, when was the last time you took a close look at your own attitude?