Our profession is morphing before our very eyes yet we are often too busy to notice the change taking place just outside the front door. As often as we press the refresh button on our computer, we should clean and refresh the lens we look through to examine our practice. By doing this exercise of assessment on a regular basis, we protect ourselves from drifting into a practice of the past instead of one progressing into the future. Let's be honest, the complexity of establishing a practice or taking on an associate - who has extremely limited technical skills and experience, while carrying the burden of student debt in the $200,000 to $300,000 range - makes it challenging at best for everyone. Many young graduates who return and visit with me discuss the struggles they face with their debt and the limitations they confront - with dental skills and career choices. The corporate model has focused on young dentists and has become increasingly appealing to this population as they multiply across the country. How do we respond to this rapidly changing world where the half-life of knowledge becomes shorter and shorter?
A few recent changes further illustrate our need to refresh our screen; iPhone 7, cars without drivers, scanning in place of dental impressions?
An approach I use with students and recent graduates is to continue learning and become a life-long learner and student. We often establish fixed behavior patterns as time moves on and we become more and more comfortable. Although the
Experience garnered through time is invaluable, an open mind with the desire to grow and achieve is a crucial part of progressing into the future.
Develop a fresh outlook
Think of yourself as a toddler who just started learning to walk. In the wide eyes of a child this fresh view of the world is perceived as the start of a new journey, a journey of endless possibilities as they embrace each opportunity to fully explore. With renewed vigor and the unsurpassed eagerness each new discovery holds, the toddlers' quest is almost unstoppable.
As you enter your new world, forget preconceived ideas about what ‘should be’ versus the reality you see in front of you. As our industry evolves and our patients along with it - we should be asking ourselves; do we need to make any adjustments or take a look at how external forces are affecting us internally? How do we view our patients, the practice and our overall growth? Is what you’ve been doing all along and what you are comfortable doing enough – are we always searching for opportunities that achieve our goals and provide growth for staff as well as the practice?
The following suggestions may be uncomfortable for some, as different personality types handle each situation differently. Some may feel “things are good, we’re doing fine, don’t rock the boat, why change anything?” Renowned author Jim Collins states, “Good is the enemy of Great” and that “Greatness is not a function of circumstance. Greatness it turns out, is largely a matter of conscious choice, and discipline.” If we choose to stay comfortable and are not willing to risk something different or unusual, we end up settling for the ordinary or worse – mediocracy.
How may I help you?
One of the most endearing opening statements a new patient can hear is, “How may I help you?” (An attitude of serving each other and the patient - must permeate your office. Patients feel it as well as sense it.) This has to be the attitude of everyone and must come from the receptionist as soon as the patient walks through the door, the hygienist greeting the patient as she is seated in her chair and the doctor as he works with patients and staff.
By the end of the appointment we should know our patients well enough to know what they value. With that knowledge, presenting a treatment plan in a language they understand and in terms of what they value most. It provides clarity for them and the ability to make a decision to move forward. Fifty percent of dentistry is related to the treatment of disease while the other fifty percent is related to treatment that is elective. (What’s important to the patient and what outcome do they want?) The staff member and doctor should be able to answer that question after the first appointment.
Two words that all ages value and understand are: preserve and prevent. “We would like to preserve your existing teeth and the oral health that provides structure for; your smile, how you eat, and at the same time be free of pain.” In addition, we want to “prevent any future problems that can cause other issues and create more expense” - preserve and prevent becomes your mantra. Get ownership from the patient “is that what you are interested in and what you would like to do?” Preserve and prevent.
Practice how you communicate a patients’ needs. Everyone processes information differently. If you have not communicated with terms that a patient understands and with consideration to what they value, the patient will not feel confident enough to move forward. People will spend their hard earned money and invest precious time – one what they VALUE. Your goal as a leader is to develop and influence people to make healthy choices that will benefit the quality of their life. This will be a lifelong art and a skill that continues to develop. Without this level of understanding and how important that communication is to the patient, a practice becomes extremely limited with little or no potential for growth.
Some weekend and holiday emergency patients were some of my greatest raving fans. These visits can garner greater benefits to your practice than a paid TV commercial or newsprint advertisement. Making yourself available (even when it may not be convenient for you) is a key factor in growing your practice. A good principle to remember that aligns with “how may I help you?” – it’s not about you, it’s about the patient.
Many of the things I am discussing focus on engaging the patient. If you do not engage the patient, they probably won’t come back and if they do, they will not be part of your referral base. Engaging the patient and staff members to be loyal to you and your practice starts with the heart. This is a very difficult concept for many physicians and dentists to comprehend.
The heart is where trust begins. If you do not create an environment of trust for patients so they will trust in your practice, the road ahead will be difficult at best.
Once engagement has been established continues throughout the oral exam, a discussion about how you can help the patient achieve their goals, their desired needs and wants, is appropriate if a solid foundation of trust has been established. With that base of trust, you and the patient can be confident discussing treatment plans and what works best relative to their goals. Available options may need creative solutions and provide a comfort level for a patient to make the decision to move forward. This provides accountability for the services the patient will receive, and clearly illustrates its value in terms of the investment in their oral health.
Talking about the cost of a procedure or money without connecting it to patient value and oral health is prohibited – at all times. The value one obtains through oral health and preserving their teeth should be reinforced throughout their visits. We often forget we are in competition for limited dollars as the market becomes more crowded, more competitive, and we don’t have a Madison Avenue marketing budget to advertise what we do. Your team must be masters at communicating honest value in terms of patient needs. If your office staff is not excited or believe in what you do and how you do it, your patient care will have limited success.
In today’s dental market, the doctor cannot hide behind the facemask or work quietly behind the scenes. Extravert, introvert, whatever-vert, you must introduce yourself to the community. Not very many people are going to come to you and welcome the ‘new guy’ on the block. Identify twenty pharmacies, doc in the box, ER’s, and child care centers in your area. Develop a letter of introduction about you and the staff and perhaps a professional courtesy with your business card. Conversations at child development centers should also take place: “Good morning, is the director available, my name is Dr. Joe.” (The night before after you’ve looked at the website and read a little about the director, offer a compliment. “Hi Ms. Jones, I saw what a great facility you have here and wanted to let you know that I’ve just opened my practice about two miles from your center. I’ve also had training with dental accidents and dental emergencies. If you ever have a need, we certainly will do our best to see your children immediately whenever possible. I am also available for short education programs for children or parents. If your staff ever has any problems tell them to feel free to call me.” Sometimes if you have complimented them on their beautiful facility they may offer a tour or you may say “may I have a few brochures in case I have patients in need of childcare?” If they offer a tour they often will introduce you to staff at which time you can give them your card. These kinds of conversations must be done with discernment and a genuinely warm, caring attitude. Not like a pushy used car salesman. The greatest thing you must understand about private practice/public setting; in your years of school you were evaluated on your skills, in the public you are evaluated on your leadership abilities and most importantly your relationship skills.
I find these visits will not occur regularly if you do not have a deliberate plan that is marked on your calendar. (By the inch it’s a cinch by the yard it’s hard.)
Become a maniac at acknowledging people. Hand-written thank you notes, follow-up phone calls, deaths, weddings, births all make an impact, are remembered, and imprinted in people’s brains. This has to be genuine! If you don’t give a rip about people, patients, or care about their needs they see right through it! And quite frankly if that’s the case, you may want to rethink career options!
Try to find something to express appreciation and gratitude to your patient (“and by the way if you have any friends that need a dentist, please give them my card. I also have had additional years of training and have experience handling emergencies and difficult or complex dental situations and availability after hours.)
Appreciation is the fuel that energizes staff. When used properly it also allows you to address situations that did not work well or you don’t want continued.
Remind yourself that people came to you for your expertise in your field. Give them recommendations you think is in their best interest, and have a conversation about how you can make this happen for them. YOUR enthusiasm for the patient, their care, and your profession will be the barometer for your staff. Whatever it takes, wherever you are and whenever you can; show an external excitement about each day, throughout the day. Start the day with enthusiasm and excitement as soon as you arrive at the office with a cheerful greeting, and as you leave in the evening a grateful departure and “Thank you” for their work, with genuine enthusiasm about tomorrow.
All of these things will contribute to a healthy atmosphere and a growing practice. Beyond these tips are many organizational details that must be in place, understood by all staff members, with everyone working as a cohesive team. But that’s for another day. In the meantime,
“The future depends on what you do today.” – Mahatma Gandhi
The workplace, family and marriage are often greatly impacted by our ability to provide consistent feedback to people we interact with on a daily basis. It can impact the work performance of our employees and the quality of our relationships at home. As a consultant, I interview many employees across the state where I consistently hear a desire for meaningful feedback from their employer and a desire for stronger relationships. Considering the average dental office spends 25% to 35% of their revenue on employees we would do well to become students in the art and skill of effective feedback. It affects every area of our lives. As father of six children I can vividly remember times where I missed the target in an effort to provide meaningful "feedback" to one of my children or even worse my wife of 44 years. Feedback can come in many different forms which can be either subjective/objective or destructive/constructive and be heard quite differently than we intended! At the School of Dentistry we all remember reviews that brought either exhilaration or disappointment. The learning process must be woven with encouragement and constructive correction. A great resource for assessment of employee engagement is Gallup’s Qr2 Survey. “Twelve important questions to engage employees.” These principles apply as we develop employees or teach students. This will help you understand where your employees line up with engagement in your office. It will also give you a hint of your return on investment in staff salaries. A fully engaged and energized staff member will make a great contribution to office growth.
Will you improve the art and skill of how you provide feedback to your team? Major studies indicate the lack of employee engagement exists across the workforce (Gallup). Investment in this area could provide immense financial and job
satisfaction for all involved. Let’s start with a simple self-assessment of ourselves! Have you developed a process for conversational feedback when engaging your team members or is it shot from the hip? Would you start a complex treatment plan without a plan? As doctors we often overlook our role of developing others on our team, this requires reflective time to make a plan of communication coupled with metrics the employee understands are their responsibility. Think back over the past few months and evaluate your ability to provide feedback in the development of your team. Has it been effective in bringing about the desired change or rewarding exceptional performance? I am including two references for your development. Warning! Feedback and employee development is often avoided, or procrastinated because it is uncomfortable, or the skills were never developed because you are just too busy in the dental chair and your office manager has not acquired the effective feedback skills.
Following are some tips to strengthen your feedback system to enhance a thriving culture and growing employees! As employees grow your organization grows, take the time to invest in these critical skills, no less important than our endodontic or restorative skills “I believe that everyone is a leader at some point in time, we have a choice how well we lead.”
Building a relationship the first step
Telling someone something is not the first step in feedback. The Gallup survey reveals employees want to know the boss or management cares about them and takes time to listen to them. When this takes place it opens the door to receive feedback.
Making regular deposits in the brain bank is critical
I like the model of depositing “positive feedback-appreciation and affirmation” regarding an employee performance, like a bank account. When critical feedback is needed, which I call a withdrawal, you have built up deposits in the account for the withdrawal to take place. If you find it impossible to make positive deposits it may be time for the employee to be on probation or dismissed.
A multi-lingual mind set is required
Become multi-lingual, by this I mean understand that we all have different communication styles. We often have to speak the language of the employee we are engaging. I often have a dominant boss come to me saying, "Jim, I don't understand I provide feedback and my employee starts to cry or get angry, I just tell it like it is." The employer often does not realize they are perceived as being rude, cold and ineffective in empowering their team member. Two great tools to improve our multi-lingual skills are the DiSC instrument and the Strength Finders. I use one or both of these with all of my clients. Understanding our own language and that of the people we are evaluating or developing can be a major factor in our effectiveness. Acquiring and applying these skills can take your practice to the next level!
Develop a feedback toolbox for diversified situations
Feedback can range from a simple affirmation such as, "great schedule!" or, "you were really organized for the complex procedure". Affirmation of individuals is tremendously underutilized, yet it is a powerful transformer of attitudes. A recent comment from a doctor, “Why should I have to affirm them, that's what I pay them to do?” The absence of affirmation impacts an organization and the quality of service and employee retention. The most effective feedback is conversational directed with the individual not at the person. Having the skill to create an interactive conversation is most valuable. Often we fail to define clear metrics that indicate the objective quality of the employee performance. These should be written, clearly defined and objective. Feedback can be simply verbal or include a written report and scheduled meeting. One size does not fit all. The leader must have the knowledge and discernment to differentiate poor performance or have you failed to train and equip the individual to do the job or acquire the skill?
What gets measured and reviewed gets attention
Feedback with metrics requires further planning, conversation and understanding. The School of Dentistry has many metrics in place and is in continuous pursuit of calibration of multiple faculties providing consistent feedback to students. Calibration without a mentoring relationship will short circuit the learning process at schools and offices. The most effective learning and growth takes place when clear metrics, healthy communication and dialogue are in place. Both parts of your brain (ANALYTIC +RELATIONSHIPS) need to be engaged for maximum learning to take place.
Establish a time and place for important feedback
Selection of time and place are important components of creating an atmosphere to provide meaningful feedback. A common statement I hear from many employees, "It's been 3 years since I have had feedback or a review, I really feel devalued. It's always going to be in a few weeks.” It makes a statement to the employee or family member. “I am important because time is being given to me and someone is listening to me in a conversation.” Time and listening are two great tools for meaningful dialogue.
Dentistry in the 21st century requires more than dental skills
We are often expecting change when giving feedback for growth and improvement, but without planning and developing our own skills we fall short of our expected out come.
A skilled leader and communicator will develop a personal feedback style that recognizes both excellence in performance and addresses standards that do not meet the core values and expectations of your organization. We cannot relinquish the important development of this Art and Skill of Feedback in our home or office. It requires multiple factors to be in alignment: time, planning, dialogue, understanding of the multi lingual nature of relationships and clarity of the topic being addressed. This will lead to mastery of a powerful feedback system. It shuts down the commonly used system of accuse and defend often leading to frustration and confusion between doctor and employee.
Where Do I start?
I have provided several references for your reading in addition to a complimentary telephone conversation on this topic. Acquiring a coach, taking courses and reading on the development of people are all ways to grow. Take the time to develop this skill set to enhance your leadership and growth in your practice and life. It will lead to growth of everyone around you. “Leaders become great not because of their power, but because of their ability to empower others”
 GALLUP, October 8, 2013 “Worldwide, 13% of Employees are Engaged to Work” by Steve Crabtree;  IF YOU WILL LEAD-Enduring Wisdom for 21st Century Leaders, by Doug Moran ISBN: 978-1-932841-58-9;  THE FIVE LEVELS OF LEADERSHIP, Proven Steps to Maximize by John Maxwell, page 9 ISBN: 978-1-59995-365-6
In the previous chapter of my life, I spent 14 years on the school board and 37 years as an adjunct faculty member at Virginia Commonwealth University-School of Dentistry.
Assessment is a popular mantra in the field of educational at all levels.
The Standards of Learning (SOL’s) were introduced in the 90's, established and measured to provide objective evidence that students were learning and tax payer dollars were being used effectively. Dental students are required to complete numerous assessments to assure high standards, which include very specific metrics, to evaluate their performance. It is important for the student to learn self-assessment technical skills in preparing a tooth for a crown, to instrumenting and obturating a tooth for an endodontic procedure. The vast majority of dental education is occupied in teaching and acquiring technical skills. Along with the intense technical training there is the delivery of a wide field of knowledge to develop critical thinking and judgment coupled with their technical skills.
Development of self-assessment skills in the application of this newly acquired knowledge and technical skills is essential; as no one will be looking over their shoulder as they deliver care to their patients after graduation. An ever changing knowledge base after graduation requires all health care professionals to regularly apply a method of self-assessment and ask the difficult question, "Am I current with state of the art knowledge and techniques in my profession?"
As I currently work in the field of practice transitions and development I have realized that upon graduation we enter the world of private practice and often don't transfer those technical self-assessment skills learned in dental school to all phases of our practice and business. Government, insurance and corporate forces are all having an impact on our profession and how we function and continue to be successful as professionals and business entities. I am experiencing a wide range practice models throughout Virginia that have stimulated me to raise the flag for an objective assessment process to evaluate the health of your practice BEFORE you enter into any action plan for change, development or growth.
Often, assessment is based upon a ‘feeling’ or ‘I think’ instead of well-defined standards, factual data or criteria. The reality of any business is it has three components: cost, quality, and service. As owners of dental practices we would do well to build a template that allows for an objective assessment of these three areas. This can be a major undertaking and may require outside resources where your knowledge and skill level may not allow you to complete a comprehensive office assessment. One of the greatest limitations of practices reaching their full potential is the failure to block out time throughout the year to plan, assess and develop strategies around finances, service and quality.
Understanding the financial aspects of your practice beyond, ‘Do I have enough to cover the operations in my checking account?’ may require the expertise of setting up your books that allows you to tract your revenue and expense streams to monitor your trends.
An accurate set of trends can guide you in making intelligent strategies and follow the outcomes to see if your implemented strategy was effective instead of concluding ‘I feel it was a good idea’ or ‘I am comfortable’ which is not always a good metric! A prime example is the participation in multiple insurance contracts, without a clear understanding of the trend taking place in decreasing reimbursement for procedures performed. The benefit of being a provider needs to be carefully analyzed with objective facts not feelings.
Expanding the concept of assessment can be applied in the area of service that patients receive and can further the ability of a practice/business in reaching its full potential. Having a written series of standards and training on how the phone is answered that creates the highest percentage of bringing people into the office is a major source of growth. Exit surveys of patients and staff leaving your practice can provide an enlightening perspective to the service people experience from your team.
As owner and leader your ability to develop your team is often over looked. Pursuing self-assessment of your own leadership skills which will have a major impact on your professional career is largely ignored in medical and dental education. There are many opportunities to pursue personal growth as we wear the dual hat of professional and business entity. This can be a good starting point which can equip you to develop an assessment of the multiple areas of your practice and a process to move forward.
Properly executed this can put you, the business owner and professional in the driver’s seat. Today I emphasized the importance of objective assessments to determine where you stand today. With that tool in your hand you are able to plan where you want to be next year at this time.