Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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169 Build The Patient Experience with Travis Frederickson : Dentistry Uncensored with Howard Farran

169 Build The Patient Experience with Travis Frederickson : Dentistry Uncensored with Howard Farran

9/29/2015 12:00:00 PM   |   Comments: 0   |   Views: 423

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AUDIO - HSP #169 - Travis Frederickson

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VIDEO - HSP #169 - Travis Frederickson

Travis Frederickson shares what it means to have a symbiotic approach to your practice, and exactly why patients flee some dental practices.


Travis is the founder and president of C4 Practice Services, a consulting firm focused on the Patient Experience for both dental and medical practices. For more than 20 years Travis has been teaching, writing, speaking and consulting with small businesses and government entities, with a focus in the last decade within the dental and medical professions. Travis holds undergraduate degrees in health education and athletic training, with advanced degrees in leadership and administration, and is formally Disney trained. Combine that education with his experience; you and your staff will be enriched with high quality education that you can use immediately. You won’t be bored or disappointed.


Howard: It is a huge honor today to be podcast interviewing the man who's on the cover of the book I'm holding, Travis Frederickson. I assumed that this picture of you was Photoshopped until I saw you live and you're just as handsome live as you are on your book. How are you doing today?

Travis: I am fantastic. Thank you. It's an honor for me to be able to participate and I appreciate it.

Howard: Well, I said in my book that business is people, time, and money but dentists … Business only has three [inaudible 00:00:39], you make something, sell something, watch the numbers. Dentists just want to make something. They went to school forever to learn how to fix a tooth and they just don’t want to think or think enough about how to be customer focused. I can't think of a bigger rock star in customer service than yourself.

Tell our viewers, because unless you’ve published in a root canal textbook they might not have heard it, tell us your background. You go all the way back to Disney.

Travis: Yes. You know, my educational background is in education and leadership. That's where my degrees are held. I realized that when I looked for a place to be able to apply what I'd learned to, I realized that dentistry really lacked a leadership element. Everything that was being done in dentistry, in the administrative element of dentistry, was being done, and still is predominantly, in management and management is a great tool when you have a level playing field. You can manage the heck out of everything that happens consistently every single day. The nuance is, with dentistry, the profession of dentistry seems to, from an outsider's perspective, it seems to have evolved or changed and become far more consumer centric as far as what the consumer wants from that but dentistry itself hasn’t made that shift.

To enable that to really occur you have to take the best of both worlds. Sure, there are still systems that have to be put in place. There's still management that needs to occur, but if the people aren’t trained how to think and to think and react appropriately to the consumer that you're serving, then you're likely to make mistakes along the way. I think most people understand, truly you understand as I've learned more and more about you and your writings and everything that you talk about, especially in your columns it's become more obvious in recent years that if you're not serving the people that come to see you and all you're doing is taking care of the issues that those people have, you're missing a huge opportunity and those people are going to flee. That's exactly what happens.

I call it, Doctor, I call it the symbiotic purpose of any service industry, but particularly in dentistry, there's really a dual purpose to what happens in dentistry. One element of that is what you do, what I call the clinical aspect. The second element of that, or what I call the business aspect, is really all about service. Unless you have those two things working together patients are going to flee. They'll come to you but they will eventually flee because the only thing they can judge is how they're being served. They can't judge how well you do what you do. They can only determine what they know. That's true for all of us, we can only determine what we know.

My background really was, and is, from the bend of leadership and how to apply leadership into a dental practice and what that really means to the practice and essentially what it means to the bottom line.

Howard: The Italians say that a fish rots from the head down. As the CEO, you create the corporate culture, you create whether or not the staff feels like they're engaged and they feel safe to share thoughts and get on board verses and a dentist they're afraid of and everybody stays quiet, and the hygienist doesn’t want to diagnose, or the assistant doesn’t want to answer your question because she's afraid psycho is going to come in and get all mad at her for talking to a customer.

Your job is probably the hardest job in dentistry because I look these dentists in the eyes and I say, "Well, what's going wrong in your practice?" and they'll say, "Oh, well, you know, some corporate dentist chain opened across the street from me." I'm like okay, well, every time I meet someone I say, "How long have you lived in this city?" and they'll say, "I've lived here my whole life." I'll say, "Well, how old are you?" They'll say, "60." I'll say, "How many different dentists have you gone through in your whole life?" It's just a revolving door.

No one can keep this patient in the office so what difference does it make if there's a corporate dental office across the street or your best friend harry? You're both going to run that patient off in five years. It's the dentists who can get the whole team involved with the customer and keeping customers for life that make all the money and has all the success.

Travis: Absolutely. That's where Disney comes into this whole picture and that's why I love Disney so much. When you understand the Disney culture, and especially with Disney parks, and they play a large role in the effect that we have with doctors that we have a privilege of working with. When you understand that what they do is really the very same thing that dentists do, it's just that dentists don’t get it yet. They're not there yet. They're not on-boarded.

What is it, Doctor, that really you do in a dental practice? Again, we've got that clinical line and we've got that business line. The business line is what causes the results for the business that you're truly after. I characterize those in three results. Every dingle result is after three results. One, we want people to respond. We want them to respond affirmatively to treatment that we recommend and, from my perspective, we want them to respond to optima treatment. Not just treatment, we want optimal treatment. We want them to respond to what we're asking them to do in a favorable way. We want them to return to our practice. We want them to return for treatment and we want them to return for their on-going care. Then, number three, we want them to refer. Those are the three results. That's it. There's only three things that practices want people to do.

Well, in Disney, it's the exact same thing. They want them to have a great time. They want them to return, come back again, which they get about 80% return rate on the people who go through the gates of a Disney park, and they want them to refer others, which is astronomical as far as the percentage of people who refer others to a Disney park. Disney enjoys more people than any other theme park across the world. If we understand how it is that they actually make that happen, how they can get that type of success, and we put that in place in a practice, we understand it's all about the experience. It's all about the patient experience. If we can really understand what are the things that need to be in place because that experience you're not giving them a Disney experience, you're giving them a patient experience and that is particular to your practice.

One of the things that Disney does exceptionally well is that they don’t just sit back and wonder, "Am I getting the result? Am I getting what I intend to get?" They measure it and they measure it constantly. They have what were called lead measures and they have lag measures. The lead measures are based in surveying [inaudible 00:09:20]. The lag measures are based in gate receipts and number of people through that gate. If we truly understand the data aspect of this and we understand the lead measures of this then we can create something that people will want to respond, return, and refer on a consistent basis. That's how you get loyalty.

Howard: Your website,, What is that all about and what exactly do you do? I mean, do you actually get on an airplane and fly to a dental office? Is this coaching through phone calls and Skype? Tell us about what you do.

Travis: I appreciate that opportunity and thank you for the plug. Really what we do is help people get results, period. That's all we do. That's all I'm interested in. My job is to teach and to train and to coach depending on where the doctor is, what they really want, and essentially what result do you want to get and how quickly do you want to get there. That determines the level of engagement with us. Our job is to teach, to train, and I take that very seriously.

In other words, the thing that I like to do the least, going from least to greatest, the thing I like to do the least is just tell you. I'm going to tell you what it is that you need to do because I know that that's not going to be ultimately effective. What I have to do is hold accountability to that. Or hold something accountable whether it's the organization or the practice as a whole or whether it's the individuals within that practice. If we hold them accountable to the result that we're after, then they tend to absorb those leadership principles that will lead them to that result.

Howard: How successful is this?

Travis: Very. We have not had a practice yet that's put our things into place that hasn’t seen an increase toward the result they're really after. If you're after new patients, we'll be able to make that happen. If you're after an increased bottom line, we'll be able to make that happen. If you're after a more congenial culture that provides a greater patient experience, we'll be able to make that happen. Again, there's not a cookie cutter approach. I realize that there's a lot of places out there that do a cookie cutter approach. Here's our system, put this system in place and you're going to be just fine. You know what? They work, Doctor. They work repeatedly; that's why they're successful. The dynamic though is that what we've seen is that those cookie cutter approaches will take a practice from being average to good.

Now remember, I said that Disney, one of the things they do absolutely best is that they monitor the results that they get. What they know is that good is not good enough. What we know from our experience, from thousands of patient satisfaction surveys, and from the marketing groups that we've put together, what we know is that in health care in general and in dentistry specifically, good is only as good as the next ad that that patient receives. They will bolt for something that they perceive to be a greater value.

We have to move that notch from good to excellent. Once we get to excellent, we have a loyal patient. We have somebody that's going to stick with us and they're going to respond, return, and refer on a consistent basis. If we're just good, you know what, the dentist down the street, across the street, they're good too. In good, that's all right, until something better or until I perceive something better to come along and then I'm going to jump.

Howard: But that dentist thinks … I do the best root canals in town. I mean, I get a puff of sealer out of every canal of every molar I've ever done, but when I go to dental offices to pick up some dentist for lunch or hanging out, you walk in there and no one makes eye contact with you. They hand you a clipboard to sign in like your some cattle, sheep, or pig that's shown up to be slaughtered. What I've always noticed and most of my consultant friends say is that you always know the office that's collecting a million and doc is taking home 400 because within one split millisecond of when you walk in the office you either feel the energy and karma that they want to see you or you're just walking in some library and everybody's doing tasks and there's just no connection. Do you agree with that or disagree with that?

Travis: I entirely agree with that from this standpoint, and here's the secret to that and I'll just share with you what's in the books and I'll share with you what it is that we've found to be effective over years of doing this. That culture, okay, and that's what you're talking about. What is the engagement level with the people that come through the door with the culture?

The culture is made up of three things- staff, structure, and setting. Staff is on the top of that pyramid. We use it as a pyramid approach. Staff is on the top of that pyramid. They have the greatest influence as to whether or not they're going to move that person to that stage of excellence but it's not staff alone. Structure, policy, and procedure, and setting, our physical location, where we are and what it's like on the inside also makes a difference. You can have wonderfully charming staff like one practice that I went into I was asked to put …

Howard: What did you call these three things? The three what?

Travis: These are the three elements of culture. They're the things that make up the culture of any practice.

Howard: The three elements of culture.

Travis: Yeah. What we call them are the Three Ss of Experience.

Howard: Okay.

Travis: Staff, structure, and setting. Staff can make a huge difference but if we really are out of whack in our setting, in other words you pull into your office and there's cracks in the driveway, there's sidewalk differences in height that make it difficult to navigate, there's weeds coming out everywhere, there's marks or hand marks all over the door before I ever get in, I'm already in a mindset. I already have an idea of what kind of care I'm going to receive before I ever walk in that office and it doesn’t have anything to do with staff. That's a setting issue.

Or I get in, and just like you indicated, I get handed a clipboard or, even worse yet, somebody is on the other side of the glass … We still have practices out there, Doctor, with glass dividing the patient from the people that are there to actually "serve" them so I have to slide the glass over. After I pick my eyes up from the computer screen I have to slide the glass over to even wonder why are you here. Then give them that clipboard. That's policy and procedure. They're just doing exactly what it is that they were taught to do. What result are they getting? That's what's most important. What is my result? If the structure is off or the setting is off, even the most charming personality is not really going to be able to overcome these things very well.

Now, conversely, I could have a beautiful office where the setting is just absolutely gorgeous, have the right policies and procedures in place, and have a guard at the front desk that won't allow anything past, either on the phone or in person. Those other two, structure and setting, cannot overcome bad staff. We have to really have all three of those things working well and working in tandem to be able to create the experience that people are really after.

Howard: Every time I call back a dentist, they shoot you an email and they say, "Can you call me," or whatever. I call them back. I would say 50% of the time it goes to voicemail and if they answer the phone, of those that answer the phone 80% just say, "Can you please hold," and click. What are your thoughts on that because isn’t that first impression set in lead? You never get a second chance to make a first impression. What would you think of a customer trying to get into your dental office and it goes to voicemail or gets a, "Can you please hold,"?

Travis: I think they're less likely to get in. That's really the bottom line. Again, what's the result? What we tend to find, Doctor, in every situation most every practice that I've ever had the privilege of working with is getting the exact results that they’ve trained people to get. They don’t engage me unless they don't like the results they're getting. Does that make sense? Those are the very things that we call barriers. Why in the world would you erect barriers from anybody getting into your practice? But most people don’t understand those things and so we give them scripts or we give them certain policies and procedures that they're supposed to follow but what we fail to do is teach them to think. That's the key of today's practices.

Yes, can the systems work? Yes, but nine times of out of ten … Doctor, I would ask you. I don't know if you saw patients today or not, but if you saw patients today and you did more than one filling, chances are you did fillings differently. Now, I'm not a clinician, I don't know a whole lot about that, but no two fillings, I'm guessing, are the same. Just like no two people are the same. If we can't think through the people that are walking through the door, we're losing opportunities every single time.

Howard: When you're coaching an office, what is the low-hanging fruit? What do you usually have to do? Do you usually have to switch out people? I mean is it like you're coming into the Raiders football organization … Well, where are you living out now?

Travis: In Idaho.

Howard: You're in Nampa, Idaho?

Travis: Correct.

Howard: You're either a Cardinals fan, or a Seahawks fan, or a Denver Bronco fan.

Travis: I'm a Cardinals fan. I grew up in Phoenix so.

Howard: Oh, that's right because you went to NAU, right?

Travis: I did, uh-huh (affirmative).

Howard: When you're going into an NFL … you know there's 36 franchises. When you're going into an NFL team, a dental office, are you usually walking in there and evaluating the players saying, "Sorry, but we got to get rid of this wide receiver and the quarterback," or are you more likely to go in there and say, "Let me see if we can salvage them first,"? Then, can you salvage these personalities? I mean, Southwest Airlines says, "We hire on attitude and train for skill." I always wonder when I'm in a lot of dental offices are they that dysfunctional because the dentist is micromanaging, controlling, or does the dentist, while they're at the [inaudible 00:19:41]Institute, and the Spear Center, and the [inaudible 00:19:43] Center, not taking HR serious enough and interviewing?

Like the last two hires I've done, I mean, we literally interviewed 30 people for a spot. I take HR as serious as looking for a quarterback for the Cardinals. I think that the dentists do not take HR serious. They'll run an ad on Craigslist, two people will show up Monday and they'll hire one of two, whereas I'm more likely to hire a temp service and cover that position while I take a long time looking for a player for life.

What is your average success rate? I mean, are you usually going in there switching them out, training them? If you train them, what's the chance you can get them to think and have the right attitude?

Travis: Great question. What we look at, again, is everything around the principles of effectiveness. Going back to, Doctor, what are the results you want to get? What are you truly after here? Then we can back up from there and say, "All right. These are the results you are currently getting here, here are the results that you are getting, look at the gap. Here's this gap." That gap is made up of staff, structure, and setting, so what are we doing with structure and setting that will make a difference in that gap? If we tweak structure, we tweak setting, or we don't find problems in those, we know that the problem is staff.

If it's staff, we then evaluate staff based upon are they getting result, not are they answering the phone correctly. Are they treating people nicely? Are they whatever? Because all of those are they doing this, those management tasks? If it's not getting the result, they aren’t getting the job done, period. Do they know how to schedule? Well, yes, there's people on the schedule in various places, but do they truly get the result? If you're saying you want to see X number of patients per day and you're not, if there's a gap in there, then you know what, she may not know how to get that result. We can train that.

Then we look at our assessment model. Our assessment model is very simple. If you think of it in a circle and you’ve got two polar ends of a plus sing, two polar ends here and two polar ends here, this polar extreme on the vertical says, "Able/Unable." This one says, "Willing/Unwilling." All we're really trying to do is get people to willing and able. Now, if they're unwilling, they're gone. That's just the end of it. If we sense resistance, they're going to be gone. If they're willing but not yet able, we're going to determine whether or not they can be able or whether they're capable, if they have the aptitude to be able to make those gains.

Everything concerning people … We went into a staff three years ago. We had an office that the doctor said, "We're not even close to our potential." We went in, did the assessment, found that absolutely to be true. In our patient satisfaction scores in that particular practice, exceptionally low. It was all based on the people so all but one of that particular staff were let go and replaced because they were in such a condition that change needed to happen now or they were going under. Duration, or the time that we have to make this shift, has also to do with that.

Some communities there isn’t the depth to be able to do that. In your market in Phoenix, you’ve got a huge depth but if you’ve got a practice out in some small town someplace where they really don’t have a depth chart, you’ve got to work harder at training the right things. Again, it's not about the training, it's about the assessment. It's about results. Are we getting the result that's intended?

You know, too, I've been to your practice. I know where your building is. I know the demographic that you serve. You serve your demographic well. Your personality does, your demeanor does, and you capture the essence of what that demographic is all about. Would that necessarily work in downtown Manhattan? I don't know, but we have to look at the results.

It's not a matter of just saying, "Here, plug this into your practice and everything's going to be fine." What are the results you're after? What are the staff, structure, and setting that we're using to get to that result? If there's a gap between those, we've got work to do. We just need to figure out where that is and we make the appropriate shifts.

It's not about individual people. It's not about Susie or Anna or Bob or Sam, that's not what it's about. It's about matching everything to what we call vision. What is the big picture of this practice. In other words, not what do we do but why are we even here. If we can answer that bigger why, then we can find the people that will satisfy that. That's what Disney does so well. That's what Southwest does so well. In fact, Southwest interview procedure is unlike anything else. Disney's interview procedure around hiring let's say a Disney Princess is unlike anything else because they know exactly what it is they're looking for and they're not going to find that just in interaction. They have to watch how they react. They're watching for how they react to different people and different situations.

That's why if you fly on Southwest frequently, which happens to be my number one airline because of their timeliness and because of their service levels, but in the 60-some odd locations I went last year alone on Southwest, I get the same service nearly every time. Now, they may not be singing the same jingle at the end, they may not introduce things in the same way, but they hire the same personality. They deliver a unified message and that message is based around their vision, nothing else.

Howard: I want to ask you this question. I see this a lot on Dentaltown. I've been on the Dentaltown boards probably three-four hours a day from '98 to 2015 and dentists are always saying, "I'm almost nauseous, I've got a pit in my stomach and I want to throw up. I need to talk to my hygienists about this issue." They're sitting there venting this whole story on Dentaltown and I'm just reading that like, "Wow. You're venting this whole story on Dentaltown. Isn’t that a misdirection?"

It's like when people come up to me and they’ll say something, I think some people say it's gossip and it's not. a human will come to and they’ll vent about this person and I'll say, "The problem with what you're doing is you're venting and it's going to make you feel better, but you haven’t addressed the problem. You should not be feeling better, secreting oxytocin and serotonin venting to me. Why aren’t you having this functional conversation with this other staff member or your hygienist?" They literally are afraid of their staff. They're afraid to have an uncomfortable conversation. What do you say to the dentists listening to you right now who has all these things he wants to talk about with his assistant and his hygienist but he just would rather throw up than have a conversation?

Travis: Doctor, I totally understand what you're saying because I've been in that very situation far more frequently than those who are confident in the business realm of operating a business. That truly is what it comes down to, understanding that you are running a business. Doctors, by in large, dentists, by in large, are caring empathetic people. That's why they chose the profession that they did. They want to fix teeth. There's some security in hiding behind that mask and knowing that when I open the mouth and look inside the thing that I hate the worst is actually having to interact with that patient because that's the place where I don't have confidence.

I am much more comfortable when I get to open your mouth and put my hands in side and actually do the thing I've been trained to do.

In all of the training and preparation that you have in dentistry, the most successful doctors, and you have far more experience in this than I do with all the doctors you run into, the ones that rise to the top are not the ones that are the most clinically expert. They're the ones who have the greatest ability to engage. That's what it's all about. Well, guess what. In dealing with staff issues, it's the same thing. It comes back to what is it, Doctor, that you're focusing on. You hit it. They're focusing on the fear.

Do you understand that when you have a compelling vision that superseded me as the individual doctor, that supersedes anybody in the staff, that that compelling vision is really the thing that we're bouncing everything off of so it's not about, again, me as the doctor. It's not about you as the employee A, B, C, D. It doesn't matter which one hygienist, front desk, assistant, doesn't really matter. It's about this vision and we're not doing what we need to be doing to achieve this vision, whether it's me as a doctor, whether it's you as a staff member. If I focus on that, if I focus on the experience that the people who actually pay us want and need from us, then having those conversations is really about them. It's not about me. It's not about as a staff member. It's about this vision. It's about what it is that we're providing. It's about the service that we give. That's what becomes central.

We go to great lengths in what we call our Vision Quest Process. We go to great lengths spending two days in a wonderful, magical place helping them understand what services in dentistry is really all about. At that point, we don’t just change the mind, we change the heart. When that changes, everything changes.

Howard: Where is this magical place?

Travis: Well, there's two of them in the United States, one in Florida and one in Anaheim, California.

Howard: You take dental office teams to Disneyland or Disney World?

Travis: We'll generally take the doctor and maybe one other individual that they would like to have that's a key player to help them develop vision and really understand what that means in the world of dentistry. Once they come back from that that sets the stage then for how we have to close that gap. We spend two days totally immersed in that setting. We do have practices that then want their staff to go have that experience as well so that they can truly understand the nature of service.

Howard: Is this a private for your client, or is this like two events a year that you do?

Travis: The Vision Quest itself … There's two events. One we call the Vision Quest and the other one's called an Immersion Experience. The Vision Quest is all about developing vision and that's a private one-on-one situation. The Immersion Experience is a one-to-many situation but only within that particular practice. It's helping them understand what is our vision and how do we truly go about doing what we do to carry it out.

Just this morning I was working with a team leader in a practice. This is a three million dollar practice. They have done the Vision Quest, they've done the Immersion Experience and they’ve trickled different people to the Immersion Experience. Talking with this brand new team leader, who happened to be with us in the last Immersion Experience for this particular practice, she said it is night and day different the people who truly get it from those who just cannot comprehend what it is that we're actually talking about. It's not an intellectual exercise as much as it is an immersive exercise where you really can't help but to change through that process.

Howard: My podcast fans, almost every single time they email me, it's always the same thing. They are commuting to work and they're commuting an hour, that's probably 80%. The rest, probably the next 15% are on a treadmill or a bike. About 5% right now are doing dishes and laundry and vacuuming and everything. I'm trying to set up to … Lots of different dentists need lots of different things but I want you to walk through in your two decades of experience this individual dentist … With Dentaltown, with the internet, with the podcast, we're no longer alone.

Talk about who's the perfect client for you. You're talking to thousands of dentists right now. What red flags could you describe where a dentist, one of my listeners is listening to this and saying, "Oh yeah, he's describing my problem and he's got a hammer and a screwdriver to fix this." So they know that you're the right solution for them. How would you define your best dentist consultant customer looking back like I can really help a dentist if she's got these issues or these problems.

Travis: Sure. Thank you. They're hungry. That's really the best description I can provide. The people that tend to get the best results are the ones that are the most hungry for those results. They come at both ends of the spectrum. I'm talking about the doctor that's been at 400/500 thousand in production. They’ve been there for three, four, five years and they just can't seem to get over that hurdle and they don't understand why. I'm also talking about the ones that are at a million and a half, two and half, three million dollars and they want to go to the next level. Inevitably it's the doctor that wants to go to the next level but hasn’t yet been able to figure out why. That's one characteristic.

The second characteristic that we tend to find that is the most ideal, are the ones that are saying, "You know what? I've got great people. I really do have great people and I'm not getting greatness out of them. What can I do, how can I get greatness from these individuals so that we can have a great patient experience so that we can have a great practice?" If we can get those folks, we can truly help them because they are the ones that, again, they're ready, they're receptive. This isn't easy.

Yeah, we can create a cultural shift. You want to truly get to the bottom line of what is it that's effective, we can create that cultural shift and we can help your practice make that happen, but we can't sustain it. You have to do that work. This isn’t easy. There is a hammer, there is a nail, but that nail is going to creep up. The boards are going to creak and the wear and tear is going to cause [crosstalk 00:35:28]

Howard: What if a dentist says to you, "Travis, look, I'm just not that guy. I'm not that guy."? Do you see instances where a dentist just wants to look in the mouth and hands this all over to the office manager or maybe his or her souse? Do you ever see that work or does the dentist have to be that guy?

Travis: There's two things that you just asked about so let me try and address both of those. The first is …

Howard: That means I'm a good question asker. If I can squeeze two questions into one I must be a pro.

Travis: Great job. The first element of that is, "Am I that guy?" The answer to the question is, Doctor, if you own your own practice, you better be that guy. You can establish vision and get out of the way. The majority of practices that we work with, that's exactly what we want to have happen. Doctor, establish the vision, hold true to the vision, and get out of the way. You’ve got wonderful people, let them be wonderful. Unleash the potential of these individuals. Then we teach them how to nurture that so that they can perpetuate that process over time.

The second element is sometimes there are people in the practice that are not [inaudible 00:36:46] practice for the vision. For example, oftentimes when we have a spouse involved in that situation, and I know this is going to be wonderful to talk about, when you have a spouse involved, sometimes the very first thing that we have to do is dismiss the spouse because the spouse's objectives tend to be different than the vision of the practice. If they are aligned, fantastic, we'll be happy to use them because nobody's going to be as loyal as that individual.

Same thing with a practice manager. Now, we can take a practice manager and turn them into a practice leader. That's what we're ultimately after. Bottom line is, Doctor, the practice is led by the vision. The people are there to support the vision. Whether it's the spouse, whether it's the practice manager, or whether it's just a strong personality that's been a hygienist that was there before that doctor ever acquired the practice, really doesn’t matter. It's the vision that ultimately becomes the most important thing and we have to unify around that vision. Once we have that, we can manage through the rest.

Howard: You'll hear them at dinner say … I see dental spouses as one of two. One is the victim because the doctor makes her work there. She hates it; she doesn’t want to work there. She's missing three kids at home all day long. She feels horrible they're in daycare. It's like, man, you can't have an employee who doesn’t want to be there. When you walked down the wedding aisle how did it come to do you promise to be my wife to you're going to be my office manager? How did that happen?

Travis: Great question. Often times on the Vision Quest process we request the spouse to be involved. One, because we're not only determining … In most practices … I'm going to back up a step. In most practices the doctor/owner, that practice exists as a means to a greater end so not only do we have to develop the vision of the practice, we also have to develop the personal vision of that individual. If there is a spouse, that spouse needs to be involved in creating that personal vision. Then how can we utilize this tool, the practice, to achieve this greater personal vision? We have to have them involved.

Just the exact thing you talked about right there I'll often bring up when I have both of them together and say, "Okay. Look, you had this support going through school. They supported you as you were in dental school. They supported you when you were first starting out. They kind of became integrated into this practice." At least when they start out most practices are managed by necessity, they're not led, they're managed by necessity. We needed this person, they were cheap, we plugged them in, they were loyal, I knew they weren’t going to cheat me so everything was fine. What we fail to do is see the bigger picture. Once they have established that bigger picture, then we can have a real conversation on whether or not this is best for our family, whether or not this is best for our relationship.

You know, I've worked with countless doctors that 90% of the conversations they have are about the practice. I'm saying to them, "Is that why you got married so that you could go home every night and spend 90% of your time talking about the work that you do? Is that really what it's all about?" And have to reconnect to the purpose of that relationship which then eases them back out of that because they realize that life has become the practice, which is unfortunate. That doesn’t generally sustain. That's how I choose to deal with those things.

We really have to take it on a one-to-one basis and see, okay, is this really what we're all about and are you an asset. Bottom line question, Doctor, is this: Does that involvement enhance or detract from the patient experience? Period.

Howard: My passion is since I started Dentaltown the magazine in 1994, years before the website in '98 is that the problem I deal with is that the dentists, they know what they know but they just don’t know what they don't know. You can go spend three days with them at an implant symposium and they'll talk about bone grafting until 3:00 in the morning. You're reading the body language from their assistant, their wife, their spouse that there's a world of turmoil going on their office and nobody cares about what implant system you're going to buy or that he's going to come back on Monday and start doing bone grafting. They're just so obsessed in the implant and the root canal that they are almost not even aware of what's going on.

I want you to try to help my listener, what are some other red flags that the patient experience is not going as good. Are there any measurements because … I'm guilty of this. Yesterday I did a molar root canal and for an hour and fifteen minutes I might as well have been on Jupiter or Saturn or Pluto. I mean, I had no idea what's going on in the rest of the office. I believe a lot of my homies are like that. They have no idea what's going on. What are some red flags that this guy who's commuting to work, that you could describe where he's saying, "Oh yeah, maybe that is happening in my office."?

Travis: Sure. Great question. Again, I totally understand where you're coming from because the majority of doctors, again, are trained to do things. I have to say, too, that we as consultants oftentimes have created this monster in that we've become very adept to just fulfilling what the doctor says they need which is give me this program, give me this solution, give me this and it's going to take care of it. Why do I go to that CE course? Because I think that the next thing is going to actually make the difference. It's not.

It's the patient experience that make the difference. How do we know that? Well, first of all, are you asking your patients about their experience? Are you actually doing patient satisfaction surveys? I'm not talking about Yelp and I'm not talking about what you see on the internet or the two or three questions that are asked by a provider that's really there to provide a different service and they try to tag on this ancillary thing. That isn’t what it's all about. Are we asking specific questions to monitor specific results within our practice? 99%, no we're not.

How do we determine whether or not we had a great patient experience? Well, we ask staff. I promise you, because I ask staff. When we take staff surveys and we put them against the patient satisfaction surveys in the exact same practices, staff will say that they're doing at least a point or more better than what they're consumers are saying on the exact same questions. We really don't know how to measure ourselves very well.

You asked about the red flags. What are the things that I can see? If I'm not doing vision satisfaction surveys, what are the things that I can see? Referrals. How many direct referrals do I get from existing patients? If those numbers are not exceptionally high, and when I say exceptionally I'm talking about 50% or more of our new patients are direct referrals, then we probably are not providing a real good patient experience.

The one number that nobody talks about that I think is probably the biggest number that anybody could look at … and again I'm going to give you another secret nobody has to pay for this … recall. Let's say your practice right now is doing 50 new patients a month. If you look six/seven months in the future and you're still seeing the same number of hygiene patients that you were seeing six and seven months prior, you haven’t increased that number of recall patients by individual, you have got a lousy patient experience. They're not coming back. They came to you, they gave you an opportunity, and you blew it.

If you're seeing 50/60, I've got one practice that sees over 200 new patients per month and I said, "Let's go back. Let's take a look. Let's take a look at what you're doing. You know what? Because your 14 [inaudible 00:45:33] should be busting at the seams because you've been seeing 200 new patients a month for the last year and a half and if you are not busting at the seams because you're getting [inaudible 00:45:44] % of those folks back in, you’ve got a patient experience problem somewhere."

Howard: If a hygienist works 40 hours a week and she works 50 weeks a year, that's 2000 hours. She could see 1000 adults twice a year for a cleaning. Then if you divided that by, say, 25 new patients a month … If we just take … Let me just simple math. 1000. She can see 1000 people a year. Divide that by 25 new patients a month, it'll only take 40 months or 3.3 years to completely fill her up. Yet it seems like every office you look at, the hygienist doesn’t even work 40 hours a week. She works three days a week and she's been the same hygienist there for ten years. It's like if she works 24 hours a week and you've had that same capacity for 10 years yet your office gets 30 new patients a month, you're saying that you should be looking at the patient experience.

Travis: I think you better. You better be looking at the patient experience and you better find a way to expand your capacity. If people are wanting you so badly that you are full and you don’t have another place to put people in, you better find ways to expand your capacity. Are there more hours? Later hours? You bring up an excellent point, Doctor, and that is that so often our practices are designed around how many hours does the doctor want to work, how many hours does the hygienist want to work, and we forget about that, you know what, none of that matters. What matters is who wants to come see us, when do they want to come see us, and are we available when that need exists because if you are, fantastic, you're going to do well. If you're not and you're closing the doors to people who want to come see you, then they will find other places who are more accommodating.

Howard: How long have you been in dentistry? How long have you been doing dentistry?

Travis: Specific in dentistry about a decade now.

Howard: Okay. In a decade, so these new kids are coming out of school. They're kind of just born now. They just walked out of school, they're getting a job. You’ve been doing this a decade. What do you think of the health of the industry a decade ago versus now and where do you think it's heading a decade from now? I know you can't make predictions or read the future, but where do you think it's gone over the last decade and where do you think it's heading over the next decade?

Travis: If you were to ask me that five years ago this is the answer I would give you that dentistry as a profession is moving from a professional service toward a commoditized service. What I mean by that is that people are becoming far more attuned to we have to serve the people that we want as our patients. We have to be there to serve them. More and more doctors, more and more practices are getting on board with that. We see the successes of the corporate practices. We see the successes of, in your area, like Pacific for example, that have these processes down to a T and they open up in markets in a systematic way. They know exactly what they need to do and they run those systems consistently.

I think what dentistry has to learn from that is that there is a positive to that and there are drawbacks to that. What every practice is going to have to do, in my opinion now, where are we today? We are in the middle of that shift. What we have to realize is something, something has to distinguish us from everybody else out there because whether it's you or whether it's the doctor two blocks down the road or it's the doctor five miles away, or the doctor in another state who you went to school with, when it comes to actually doing what you do form the perspective of the patient, when it comes to actually doing what you do, it's all the same. You all do the same thing and you all do it in the same way.

From your perspective as a professional, very different. You can judge those things but the patient can't. It's understanding that the differentiating factor is service. How are we serving the people that we're privileged to have walk through our door? If we don’t have a mindset that we are privileged to serve them … I find it very interesting. If you go back and look at the history of the posts that I've had on Dentaltown in the different categories that I look at on a regular basis, when I post something that says, "Doctor, are you there to serve the patient or is the patient there to serve you?" most every one of those posts gets ignored. They just go on to the next thing because we really don’t want to look at that too hard. The difference, Doctor, is in service. I think some people are catching on.

If we then go to the future and say, "Where is the profession going to be?" Those who are successful, I don’t care if it's corporate or private practice, those who are successful are the ones who will serve their demographic in the way that demographic wishes to be served. Those who are unsuccessful will bring in things that don’t work. For example, in our area very agriculturally based. We had a practice come in, a very high-end cosmetic practice where you could go in and get your nails done and all, failed because it doesn’t fit the demographic. It's not what the people here want or expect. If they're paying for that they think they're paying far more than they should be. It will work in some demographics but not in this one. One size fits all dentistry, it's gone. It's on its way out. If you have a one size fits all model that happens to work for you it's because you have a demographic that happened to fit in.

Howard: I like to look at the extreme. When I was in MBA school, the world has 1645 billionaires and they can really show when you focus on thing how you can rise to the top. I look at Pacific Dental Services with my buddy Steve Thorne. His dad was a dentist and he didn’t want to spend one hour on continuing education to learn how to do a root canal [inaudible 00:52:05]. He wanted to get right after the patient experience, the business side of it, and now he has 500 offices and is the king of the mountain. These billionaires and hundred millionaires like Rick Workman and Steve Thorne, they're showing that the people who rose the highest in most number of offices … Like Rick Workman's a dentist, he hasn’t seen a patient in 25 years. Steve Thorne decided to skip dental school. Rick Kirschner of Comfort Dental, I think they're at 350 offices, he hasn’t seen a patient in 25 years.

Then I go into an office and the dentist is doing clinical dentistry 40 hours a week while the business is on fire and burning down and they just [inaudible 00:52:46] like a rat on a treadmill. Then they'll say, "I'll do the business staff Friday afternoons. I'll just work a half day on Friday." Then every day Friday at noon they say, "Screw it," and they go golf. I say, "Well, if you're really going to do it a half day a week, why don't it be Monday morning when you're just refreshed and ready to go?"

I want you to talk next about your book. I'm holding your book The Patient Experiences, Four Lessons from Disney to Dentistry. You also have a Dentaltown CE course 101. How much of that book is in your Dentaltown CE Practice Leadership? Talk about your book and your online course on Dentaltown which everybody has been raving about for a long time.

Travis: The online course on Dentaltown, Practice Leadership 101, really goes over the basics of leadership and what leadership can do for a practice, really understanding what vision has to offer. The book really goes into deep detail. In fact, the first parts of that book are research based. It's all the best research around leadership and what leadership does within a practice. For example, if you synthesize Jim Collins work in Good to Great and say, "What are the aspects of Good to Great that are applicable to a dental practice?" 98% of the doctors our there don't even know who Jim Collins is, much less understand the principles of Good to Great. Well, you know what? If you don't, you're missing something huge.

I'm certain in your MBA program, masters level work in business administration, there's 60 plus 90 hours of concentrated work on how to run a business and here you have doctors coming out of school who have maybe 3 or 6 hours in the business aspect of dentistry. Maybe that used to be sufficient when there was a 1 to 2500 or 1 to 5000 ratio of doctors to potential patients. It isn’t going to cut it anymore. People like you who have spent the time, energy, and effort to learn business can make all the difference in the world.

My book, my class, my new book, all of it are centered on understanding the leadership aspects of business. If you at least have a rudimentary understanding of those things, then you can understand the importance of having a driving force, something that will carry the practice. Something that is larger than the doctor, something that's larger than the patient, something that's larger than each individual staff member in there because those are the things that are going to compel people to want to be at their very best. A paycheck isn’t going to do it. Money will only sustain for so long. Research after research will tell us that money is really number six, number seven on the list of job satisfaction. It's simply not going to work.

What I've tried to unpackage in the book and some in the course, but you can only do so much in an hour, is to truly understand what the understanding of business can do for you. Then in the book in particular, the book that you held up, that one goes into great detail toward the end on what it takes to create experience. There's an entire research base on what it takes to create experience. But you have to have something upon which that is based so the business aspect has to even become more important than the experience aspect. It's a prerequisite you might say.

Howard: Where does the name C4 Practice … C4, I think of an explosive. Isn’t that the explosives they use, C4?

Travis: It is. That's exactly right and that's what leadership can do for any business.

Howard: It's named after the C4 explosive?

Travis: You know, the name is meant to be remembered. I want it to trigger something and most people, once they hear C4, they get it. The remember it.

Howard: Right on. How does one of my listeners get the book The Patient Experience, Four Lessons from Disney to Dentistry by Travis A. Frederickson from How do they get this book?

Travis: They can go to and it's there available. They can order it there. Or they can go to Amazon and get it there. There's both the paperback version that you have, there's the electronic version if they wish to go that route. The price on our website is the same as the price on Amazon. It's comfort level to what people want.

Howard: How much is that price?

Travis: Ten bucks.

Howard: The digital version, it's like a Kindle reading digital book?

Travis: It's a Kindle book, yes. Mm-hmm (affirmative).

Howard: You have a Kindle book or a paperback or a hardback?

Travis: Correct.

Howard: Because one of the things I'm wondering, I'm hoping about, I'm really excited about is [inaudible 00:57:39] saw the next big thing coming and dentists love their smartphones. The difference between the desktop is I have to sit here and take an online CE course. We put up 350 courses, they’ve been viewed a half a million times. The neat thing about the smartphone when the computer and internet went into the phone is they're multi-tasking. I think most humans are a little ADD. I think the reason people eat in movie theaters because the movie's not making them feel good enough so they have to throw in popcorn and a soda and some chocolate. I think they love podcasts and audio because they're cleaning their garage and they're driving to work, they're multi-tasking.

Next month we're launching an audio section on the book. Our business model is you can sell it on the deal for ten bucks or you can do it for free but I'm really hoping you read this and send us an audio file so these guys … because most of them have an hour commute each way. How long do you think it would take you to read this book?

Travis: It's a pretty extensive book so probably three or four hours of listening.

Howard: Oh, I don't think you could do this in three to four hours? You think so?

Travis: Well, I mean, not with meaning. Probably if somebody went through and just read it word for word, they could probably blast through it and at least get the main concepts. Depth, I think you're looking at at least eight hours to go through that book.

Howard: Yeah, and all my biking friends, when they go on a Saturday [inaudible 00:59:21] … Like this morning I biked to [inaudible 00:59:23] and back, two and half hours. It's funny because a long time ago everybody was listening to music and now everyone is listening to audio books. Any chance you might grace our new audio book section with a sound file?

Travis: Well, sure. I'll be happy to do that. I may start with the new book because the new one is a lot shorter.

Howard: Well, tell us about the new book.

Travis: The new book is an introduction to that and it's, excuse me for just a moment, it's The Highly Effective Dental Practice. It's really …

Howard: The Highly Profitable Dental Practice, Four Keys to Increase Production. Profit, and Efficiency. Nice.

Travis: It really is the 30,000-foot view of leadership in a dental practice. That's really what it is. Where the other book goes into great depth, this one gives you the idea or the understanding. Very brief, less than a hundred pages so we could breeze through that easily in a two-hour session and people would have at least an understanding. Then they can turn on to the course perhaps for even more information and then go to the other book for the depth of the detail.

If they want everything substantiated, that's in the first book. That's where all the research is and it says, "This is where we get this information from. We didn’t just make this stuff up." There's research behind everything that's happening and it's just taking that and applying it to dentistry.

Howard: If one of my listeners is wanting to do this, how much is your consulting? Is it a contract? Is it a year-long? Is it a la carte? How does it actually work?

Travis: Again, thank you for that opportunity but really it's tiered. What is it that you really want? How quickly do you want to make it happen? All the way from tiers of training because we package our training in such a way that you can go online and learn it. You get all the videos, you get all the information that you need to be able to put it in place. You get the accountability elements. If you just want to do it yourself or have your practice manager do it, fine, that's great. You can do that. That's going to be a few hundred or several hundred dollars depending on which one you want.

Then, all the way through that with us coaching you through that process where we actually make sure you get those things done, which is the fastest way to get the result. Then the last tier of that is that we become your mentor, we become your consultant, your coach. That can range 30-40000 dollars a year. If we have to go to that level we generally start with a Vision Quest and understanding that and, depending on where you're at, whether we go to Disney World or Disneyland and what your preference is in doing that.

That engagement right there, that engagement alone is going to be several thousand dollars. Then we set up the rest of the plan and say, "Doctor, are you ready for this? Are you committed to this? You want to make this happen?" That's where we get true result.

I don't believe, when we get to the consulting area, I don't believe in binding contracts that are going to hold you true throughout this entire process because for us to be effective, it has to be built on trust. We're going to set up the benchmarks. We're going to tell you, "These are the results you can expect from this process and if you do your part we'll tell you what to do." We know how to monitor. We know whether or not you're doing your part because we monitor every practice, every day. We know what's going on inside of your practice. As we look at those benchmarks we can see where the changes are being made. We can tell if these people are doing what they’ve been asked to do.

You're going to get result. That's the bottom line. We don't do anything that isn’t tied to result so it's really a process of engagement where no risk, only result. That's it. That's our promise. No risk, only result. If you pay us for this result and you don't get that result, you get your money back, period. That's all there is to it.

Howard: Here's what you're dealing with. Every time I've ever given a lecture, are there any questions? No questions. Then we break for a break or a lunch and then 20 people run up and they all have the same private special question. I know my homies are … What if they want to talk to you about their special, unique problem that is completely not special or unique? Do you want them to email you? Call you? Go to your website? How should they contact you?

Travis: Doctor, I want them to contact me any way that's convenient for them. If they want to go and send me an email it's Very simple. Call me on my cell phone, 208-989-3624. I've given that number out hundreds and hundreds of times. People don't abuse it. Just please let me have an opportunity to learn about you, to learn about your practice, and to learn about what it is that you want to have happen.

Howard: We'll close by … Move your head a little bit so I can read the board behind you. All our dreams can come true if we have the courage to pursue them. All I want to say is this, I think a lot of people don't get consultants because they think it's an admitting that they're a failure. I'm supposed to be a doctor of everything and I can assure you at 53 years old, if you have the most rocking hot practice, I'm probably aware of who you are, I've heard about you and whatever and all the top performers have had a lifelong diet of consultants. That's why they're at the top.

Consultants can't stay in dentistry for a decade if every time someone gives them money they lose money. It's too small of a community, the word gets out. The few that did that in my 20 years, they're gone now. A decade of staying … Just like your dental office is still there because your fixing teeth and somebody's coming back or you'd be out of business. Travis has been there for a decade because he's obviously helping someone. Somebody's giving him money and liking it and word of mouth referrals and whatever. If you have a problem, dammit, do something. He just gave you his cell phone, 208-989-3624.

In the 28 years I've been a dentist in Phoenix, Arizona, every year at least one dentist kills himself. Last year it was three. So many people have a lifelong career of just misery because they don’t have what you said behind there, have the courage to pursue your dreams. If you're having a problem, have the courage to call Travis. He just gave you his cell.

Travis, thank you so much for giving me an hour of your time, buddy. Thank you for all that you on Dentaltown, your 500 posts on Dentaltown, your online CE course. You even went to, in my backyard … three of my four sons went to college there. Now you moved up to Idaho because you wanted to be right where the McDonalds potatoes are actually grown so you can eat the French fries fresh out of the field. Thank you, Travis, for all that you do for dentistry and for Dentaltown and for so many of my friends. Thank you.

Travis: Doctor, thank you for the opportunity. Have a great day.

Howard: All right. You too, buddy.

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