One dentist’s reflection on how the best innovations are brought to life—and kept alive—in everyday practice
Doctor, have you ever discovered an idea that you instantly realized was precisely what your practice needed? Whatever its source—magazine, meeting or a conversation with peers—you lovingly transported this electrifying information to your office.
At the onset of the next staff meeting—why wait for the agenda?—the knowledge was unveiled, to the aggregate approbation customarily accorded a newborn. The perfect action plan was sculpted, proper commitments made by appropriate people and the idea launched to the fanfare habitually reserved for a moonshot.
Then, after a month or two, you realized your office had quit doing it.
For too many years, I lived with the frustration of being incapable of consistent execution and the follow-through of genius. Still, some valuable ideas did become a permanent part of our office. What determined life or death for these concepts? Did the capricious whims of a sometimes-fickle fate or the collective tides of an office biorhythm govern success or failure? After years of consternation and lucubration, I identified the malevolent force that kept restraining our ability to grow and prosper.
And just as creator Walt Kelly’s opossum character Pogo so sagely predicted: “We have met the enemy, and he is us.” It was my belief and commitment, or lack of the same, that determined the fate of ventures. Let’s consider how and why.
My practice held 90-minute staff meetings twice a month for 40 years. (Leadership rotated throughout the team, except for old Doc Wilde, who tended toward prolixity and needed to shut up and listen.) The meetings were vital to team building, which perhaps more than any other factor determines happiness and success, but also played a critical role in our quest for constant improvement.
Ideas made real
Examples of great ideas poured forth from this venue, included going from 15- to 10-minute scheduling units, which resulted in an immediate and rather astounding uptick in monthly production.
I first sketched the concept of expanded hygiene on McDonald’s napkins while traveling home from a state dental meeting. Our hygiene team used two operatories and included a hygienist, her dedicated chairside and one front office person in charge of their scheduling.
When pay shifted to a percentage basis, productivity increased 50% the first week and never declined. Before, remuneration was identical during open time or when working. If someone canceled, why not have a cup of coffee? But, when paid on production, as are dentists, unscheduled blocks were aggressively filled. Their pay increased by the same 50%, which I gladly paid because it’s nice to begin a month knowing that the practice will net at least $10,000 from hygiene alone.
Another valuable appurtenance to evolve was morning clearings. I arrived early, reviewed every record, then discussed my notes on the day sheet with the entire staff. Comments such as, “There’s a financial issue; don’t treat beyond what’s scheduled” or, “They just returned from their daughter’s wedding” were added.
Once done with patient concerns, staff had the opportunity to state they were “clear,” that nothing impeded top performance. But on occasion, someone had a sick child, wasn’t feeling the best or shared other concerns. All the team was able to support them, and my reaction to a less-than-stellar performance was much different, having been made aware of an encumbrance that they loyally worked through.
Employing a “high-tech” approach (stopwatch, pencil and 3-by-5 cards—the term is relative) to accurately time every procedure enhanced our ability to stay on schedule, which reduced stress while skyrocketing production. I had initially set length of appointments by ... well, guessing.
Our first timed procedure was an anterior endo, for which we’d allotted 60?minutes. (We always allowed a standard 10 minutes for administering anesthetic and timed restorations separately.) When a mere 13 minutes was required to complete the root canal, even inside my obdurate head, much more than a lightbulb turned on.
After measuring every type of procedure we performed 10 times, we averaged the data to achieve precise scheduling times.
Cost: bupkis. Result: incredible. We functioned like a Swiss watch. I can’t conceive of another idea that could enhance your practice more than this. Things don’t have to be challenging to be valuable and, per usual, staff does all the work anyway.
But failed and discarded concepts still haunted the tomb of great ideas. Why couldn’t we bring these worthies to fruition? One recurring disappointment was our reluctance to ask patients to refer friends and family. I’ve heard it recommended often and praised highly, and believe it’s a practical, straightforward practice building plan that costs nothing.
We repeatedly discussed it during staff meetings, role-played, polished our language, even developed a bonus based on the number of new patients seen. But that critical request was seldom made because, truth to tell, I never felt comfortable asking.
The problem was congruency, or lack of the same. Ralph Waldo Emerson said, “What you do speaks so loudly that I cannot hear what you say.” I could force myself to lead by example and ask ... for a while. But staff discerned that this excellent idea conflicted with my principles. My subconscious lack of commitment (consciously, I did everything I could to have this implemented—at least by others for whom the request didn’t seem so blatantly self-serving) doomed the effort. Were failed concepts badly conceived or poorly developed? Nope, merely incongruous with the office leader’s inner truth.
Yeah, but what does the loss of these abandoned ideas signify? A little time, energy and money wasted. No real harm done, right? I’m not so sure.
We obviously forfeited growth, but consider how you react when sensing someone’s actions vary from his or her beliefs. At best, it makes one question; at worst, it destroys trust in that individual and further proclamations must now be evaluated and analyzed, rather than taken on faith.
I contend that Earl Nightingale was correct when he maintained that had honesty not been invented, it should be as the surest way to guarantee success.
Accepting care is critical to financial success because no treatment occurs until a patient says yes. Nothing will increase case acceptance more than the palpable trust exhibited by staff for doctors. Seeds of doubt can destroy this literally priceless attribute, which like virtue can’t be purchased, only earned.
So how does one avoid such “priceless loss”? It’s imperative to know your mind, and this can be accomplished through value clarification. But fair warning: While no math is involved, the process requires deep introspection, so you’ll have to think.
Find a quiet place where you will not be disturbed, secure a fresh cup of coffee, plus a pen and sheet of paper with your current topic emblazoned atop. In every venue you explore, the critical question remains: Do I believe in this enough to give it my full backing? Hoping doesn’t cut it. Half-support has no place. Asking others to do the labor results in frustration and failure.
As a simple example, do you want your children to keep their rooms clean? Nagging begets sporadic cleaning fits, lots of blaming and hurt feelings. Maintaining a pristine house and garage (i.e., being a living example of your values) works.
Another value illustration: A staff member asked to meet after work. She informed me that for a litany of reasons, she needed additional income. After hearing her out, I nodded understanding and asked how she intended to make herself worth more: perhaps by mastering new skills or accepting additional responsibility?
She seemed nonplussed, so I explained that asking to receive a benefit without offering additional value was akin to standing before a fireplace and saying, “Give me heat, then I’ll give you wood.” As ludicrous as this seems, my teammate’s request was more absurd. She asked for heat (more money) without even promising later wood in the form of significant contributions.
I’d like to report an epiphany when she realized this request violated her values (and mine) of earning what she received. Unfortunately, this young lady desired money, not philosophy. Sadly, she got neither.
Many dentists need and desire more income but, like my youthful assistant, lack awareness of the need to become worthy before receiving. G.V. Black—the old union scout, fellow Iowa graduate (not a classmate) and widely acclaimed father of dentistry—insisted that professionals are obligated to remain perpetual students. Take him at his word, for it is through personal and professional growth that one excels.
Find a focus
I’m an avid outdoorsman, but after hunting season ends, I pick one topic for a winter of in-depth analysis. I study texts, go to courses and focus on such procedures in-office. Perhaps you avoid endodontics? Consider how three months of concentrated effort could enhance your skills while keeping revenue in your practice. (Once occlusion is profoundly understood, the entire dental universe changes).
Although it is possible to increase income without doing all that work—robbery, winning the lotto and selling drugs leap to mind—I know of no way to accomplish this that is consistent with my values. John Ruskin also put the kibosh on the easy way by saying, “The common law of business balance prohibits paying little and getting a lot. It can’t be done.”
To have more, first become worthy. Then receive.
One seldom gets to quote an opossum twice in the same venue, but the embattled Pogo’s words still ring true for dentists: “Gentlemen, we are surrounded by insurmountable opportunity.”
Carpe diem. Fight to excel, then enjoy well-earned rewards.