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How to Document an Underperforming Employee in Dentistry

UPDATED 04/12/2023

Documenting employee performance issues is challenging on both sides of the table. Employers don’t enjoy delivering an unpleasant message, and it is difficult for dental employees to hear that they aren’t meeting expectations.

When you fail to address concerns with productivity, behavior, and skills, you risk disengagement among other team members who must pick up the slack or engage in inappropriate conduct. 

The good news is that documenting dental employee performance issues doesn’t have to be painful. When handled thoughtfully, your employee can leave the meeting engaged, inspired, and motivated to improve performance. 

What is an Employee Performance Issue?

Employee performance issues are those situations in which a team member isn’t contributing to the practice as efficiently or effectively as you would expect, given the individual’s role, skills, and experience. In some cases, poor performance presents an inability to master critical job functions, such as creating error-free patient records or mastering your billing platform. In other cases, it’s a matter of productivity. The work - when completed - is acceptable, but your employee simply doesn’t produce at the rate needed to keep your practice running smoothly. 

Performance issues may also be related to behaviors. For example, team members may lack the sort of patience and courtesy necessary to keep the office environment positive and deliver high-quality patient care. Finally, it could be an issue with policy compliance. Every business has rules, no matter what industry you’re in, and dentistry is no different. Some employees fail to follow those rules for a variety of reasons. They may not understand the policy, they may have personal challenges that make it difficult to comply, or they might deliberately choose to ignore the requirements for any number of reasons. 

The nature of the performance issue - and the underlying or root cause - makes a difference in how a performance document is written and what is said in the discussion. Clearly, a skills gap would be handled far differently from a situation in which your employee knowingly shared patient information without authorization. 

Why Documenting Employee Performance is Important in Dentistry

There are a variety of reasons why documenting employee performance is important, but five stand out as particularly critical to the success of your practice: 

Performance Improvement

The most compelling reason to document employee performance is to support improvement. Ensuring your team member understands where there are gaps, what you expect, and how to get there is critical to changing behaviors, acquiring needed skills, and complying with policy requirements. Sometimes, bringing the issue to an employee’s attention is all it takes to prompt the necessary changes. Communication and collaboration are keys to performance improvement. 


The annual performance review process often has a bad reputation, because team members are unpleasantly surprised by the outcome. That happens when performance concerns aren’t addressed in a timely manner throughout the year but instead left for the performance evaluation discussion. By documenting employee performance throughout the year, you avoid these sorts of surprises. There is full transparency when it comes to employees’ performance against expectations, and the annual review is simply a round-up of information that has already been communicated. 

Contemporaneous Documentation

No matter how careful you are during your staffing process, the fact is that occasionally you will make a bad hire. Once in a while, you will have an employee that lacks the knowledge, skills, and/or ability to meet the expectations of the position. While it is generally possible to terminate employment due to poor performance without any warning, you face risk when you have no documentation to support the decision - and it isn’t enough to put the information on paper after the decision is already made. On-going, contemporaneous documentation of performance issues carries a lot more weight if your decision is challenged.

Employee Engagement

Your goal is to have a team of hard-working dental employees who get along well enough to keep your practice running smoothly. Failure to address performance issues when they crop up can destroy the sense of camaraderie. The work needs to be done, whether everyone is pulling their weight or not, which means your most productive employees will have to make up for poor performers. Eventually, that eats away at engagement, and the more productive employees develop feelings of frustration and resentment for the poor performer - and perhaps for you if you haven’t taken action. 

Patient Experience

The highest priority in any thriving dental practice is excellence in patient care. That includes providing a positive experience any time patients interact with your practice. A poor performer can wreak havoc on your patients’ experiences in an endless number of ways, from errors in records to unprofessional remarks - and worse. Documenting and addressing any performance that negatively impacts patient experience is critical to correct the issue right away. 

Though this isn’t an exhaustive list of reasons to document employee performance, it does cover the five most important when it comes to the success of your practice. Documentation is the first step in supporting improved performance, creating transparency with your team members, maintaining records of performance concerns, preserving employee engagement, and preventing negative customer experiences. 

How to Document an Underperforming Employee

How you prepare and deliver documentation to underperforming employees can mean the difference between improvement and further decline. It never feels comfortable to hear that your performance is poor, but you can help to inspire employees to improve, rather than leave them discouraged and defeated. Try these five steps to move through the process in as positive a manner as possible. 

Step 1 - Stay Objective and Fact-Based

Writing a performance document requires a bit of finesse. While you want to be sure to cover the concerns clearly, you don’t want your comments to come across as a personal attack. You can accomplish your objective by sticking to facts and objective descriptions of the behaviors you have observed. Instead of “You are unprofessional,” try “On multiple occasions, you have been observed raising your voice towards the office manager.”

Examples are particularly helpful in illustrating the problem. Instead of, “You are the slowest one in the office,” try “On an average day, you complete three follow-ups. The average among your peers is six follow-ups.” 

Step 2 - Reference Your Employee Handbook

Your point is made more easily when you can reference the specific policy or procedure of concern, so your Employee Handbook is an important resource when creating performance documents. For example, instead of, “Your attendance is poor,” try “You have had eight unscheduled absences in the past six months. The Employee Handbook states that the maximum number of unscheduled absences permitted is three in a six-month period.” 

Assuming you apply the policy consistently to all team members, this language emphasizes that the performance document is an objective measure of your employee’s adherence to the requirements of your practice. 

Step 3 - Discuss the Feedback 

In some offices, performance documents are left in mailboxes or emailed, but this method of delivery is not especially effective. Instead, have a conversation with your team member about the concerns, leaving room for two-way communication around the challenges the employee is experiencing. This helps you uncover opportunities to provide additional support and training. 

More importantly, such a conversation gives your employee an opportunity to be heard. Getting a chance to tell his or her side of the story may not impact your decision to issue the document, but it lets your employee know that his or her feedback is valued. That makes it far more likely that you will see performance improvements. 

Step 4 - Document the Discussion and Delivery of Feedback 

As mentioned, documenting performance conversations when they occur builds a case if the time comes to terminate employment. Make sure that you have an electronic, timestamped record of when performance documentation was delivered, as well as the date, time, and content of the discussion. Ensure this information can be easily located and retrieved if needed. 

Step 5 - Follow Up on Action Steps 

Every performance document should include a plan for correcting the issue, along with step-by-step actions the team member can take to reach the expected level of performance. Include a deadline for demonstrating the performance improvement or mastering the required skills, along with milestones along the way to be sure your employee is on-track for success.

Hold follow-up conversations to review progress against the action plan and provide feedback as needed. These follow-up discussions also allow your employees to share any obstacles they have encountered in meeting the performance expectations. 

As you write the performance document and hold the related discussion, remember that your role is to empower your dental employee to succeed. Encourage improvement, recognize successes, and show confidence that these challenges can be resolved. Often, this type of encouragement allows your employee to leave the meeting confidently in his or her ability to resolve the issue - a critical element in improving performance. 

Employee Documentation Template

It’s true that many types of performance are best described and evaluated in narrative form, but a basic quantitative evaluation in your employee documentation template can be helpful in measuring performance against peers and improvements along the way. 

Consider a rating system in each key performance area, for example, attendance, patient care, productivity, and so forth, as well as a free text section for adding details of the performance concerns, examples, and expectations. This method combines the best of both techniques, allowing you and your employees to understand the extent of an issue at-a-glance but then offering the level of detail necessary to understand the concerns thoroughly. 

You may wish to have employees complete self-evaluations before you address performance concerns. This is helpful in understanding how employees view their own behaviors and skills, which can change how you approach the performance discussion. 

Final Thoughts

The bottom line is that leaving poor performance unaddressed creates various problems. The biggest include continued performance issues, the risk of developing disengagement among other team members, and an inability to deliver high-quality patient care. However, addressing poor performance doesn’t have to be a pain point. 

Create performance documents that are objective, fact-based, and aligned with the policies outlined in your Employee Handbook. Include an action plan that supports team members in bringing their performance to a level that meets expectations, and follow up regularly to evaluate progress towards those goals.

Fortunately, you don’t have to manage the documents, self-evaluations, milestones, and follow-ups manually. New technology handles all of the logistics for you. That makes it simple to focus on developing effective documents that are likely to prompt improved performance. 

Contact HR for Health here to learn more about the tools and resources available for documenting underperforming employees.

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HR for Health is one of the nation’s leading Human Resources Management Systems (HRMS) used by small to mid-sized practices. 

Quick note: This is not to be taken as legal or HR advice. Since employment laws change over time and can vary by location and industry, consult a lawyer or HR expert for specific guidance. Learn about HR for Health's HR services