Dr. Cliff Ruddle, a noted endodontist from Santa Barbara, California, has often said publicly, "success leaves clues." In essence, if something has been done before, it can be done again. Trial and error is a time-honored method for learning. It is highly effective (ie, nothing teaches like experience) but very slow. Modeling is a far more effective method. In its simplest form, modeling means to study the methods and business practices of successful professionals and employ the same techniques. If it has been done once, it can probably be done again. Modeling successful dental practices allows us to more easily achieve our objectives and avoid the pitfalls that lead to failure.
An analogy to demonstrate modeling is pottery clay throwing. A master can shape a bowl or plate within seconds. The novice may take an hour to create a shape that might remotely resemble the same object. The difference is practice and technique. The novice, once learning from the master to center the clay properly and apply the correct pressure, can achieve the same result. The novice could struggle for many months learning the basics alone, but a more effective strategy would be coaching until throwing the clay becomes second nature. The key ingredient is repetition of a successful technique made easier through observation and practice.
Business success in a dental practice can have its roots in the same modeling of successful ideas that have worked elsewhere. Dentistry, while it is unique in some ways, is a business, albeit a professional and compassionate one, where value is exchanged in the form of professional dental services for money. Without profit, we as a profession would not exist nor could we serve the public good. The successful strategies that work for businesses of all types apply to dentistry. How often do we complain about the "business" part of our practices, including our staff? As a group, we want to do dentistry and get paid for it without all that other "stuff." Like it or not, we are in business, and market forces affect us.
Each of us could reap substantial rewards by creating a gap between where we are now and where we would like to be. If we tell ourselves we can't, we won't. However, if we tell ourselves that there is no force on Heaven or Earth that will stop us, we probably will succeed. Seeing what is working elsewhere and modeling the behavior is a good starting place. We do not need to re-invent the wheel.
Get ideas from dentists and successful professional people you admire. Ask specific questions about what is and isn't working for them. Can their strategies for professional growth be incorporated into yours? Share your experiences in return. If your colleague does something particularly well that you would like to incorporate in your office, study the successful method in detail so that you can actually implement change. For example, if another practice has an embezzlement protection plan, it's not enough to say, "We need an embezzlement plan too." What is needed are the actual forms and written methods, which can be explained to and implemented by staff.
Break down each of your goals into a series of measurable and achievable steps that are possible given where you are now. You will be amazed by how much you are capable of, once you believe it is possible and see the value of such a change.
Decide daily, in every way possible, to make a concerted effort to improve your practice in some small fashion, so the cumulative effect is a major change in your overall efficiency and quality. The Japanese call this incremental daily improvement in product and service "kaizen." As you gain insight, perhaps you may opt for a modest change implemented slowly. Such small changes are every bit as valuable as major ones, in that they start a process of movement toward an intended outcome. No plane takes off without a destination; no team starts a game expecting to lose. Coasting on inertia usually ends up downhill. Start now with small projects and build toward your ideal. Conversely, sometimes the simplest adjustments will make the largest difference. Take baby steps, walk, and then run toward your intended target.
I have had many lunches with fellow dentists over the years, and this has afforded me the opportunity to ask and observe what factors have made some dentists very satisfied with their practices, and others not. I have learned, more than any single factor, a mind closed to new ideas and a lack of vision that is implemented daily limits success. Conversely, a willingness to look at things with an open mind, and a written and fully executed business plan, make all the difference.
What follows are a series of strategies that I have learned by modeling successful dentists. Of course, there are many additional success strategies, but these stand out as the ones that have helped me most. These may not work for everyone, but I suspect they will take the reader slightly outside the usual comfort zone to consider a different perspective and invite change.
DO THE THING YOU LOVE
Loving your work establishes a foundation from which all other professional success will follow. Could Michael Jordan fly through the air so gracefully and powerfully if he did not enjoy his work immensely? You are the superstar in your office. It is your home court, the place you display your special talents and competence. Dentistry is just too difficult to perform well if money is the only reward. The public does not appreciate how difficult our jobs are, and those close to us may not either. The pats on the back we give ourselves are the most important. We know when we have nailed a case, and we should be our own worst critics when we fail to live up to our best. A critical re-examination of all the powerful reasons we opted for our career is a great place from which to reaffirm our commitment to dentistry. If you don't really love going to the office, maybe you should do something else.
WRITE DOWN YOUR GOALS AND HAVE A VISION
Let your imagination run wild, and set no limits on what you can achieve. Play with the possibilities. In your mind's eye design the practice of your dreams without letting doubt or negativity set in. If you could design the ideal practice, what would it look like, outside and inside? Where would it be located? What type of staff would you have? What type of dentistry would you perform? Would you like to specialize? What would you earn? How many days a week would you work? How much vacation would you take? What would your financial policy be? Are there certain types of patients you would like to attract to your practice? Are there certain patients you would not treat? What is stopping you from having this practice? Does the doctor down the street seem to have this practice? If the answer is "yes," what's he or she doing that you are not?
Consider the reasons why your perfect practice may not seem possible. At the core of these reasons lies an internal belief or limiting value that it can't be done, not that it is in fact impossible. It is always possible if we believe it to be so and are willing to make the changes necessary. Consider the cost in human and economic terms that will occur if you don't make changes and keep practicing the way that you are currently. Do you want to practice the way you do now indefinitely? If so, fabulous, but I think most of us secretly long for something better, no matter how successful we believe ourselves to be. The only limitations we have are those we put on ourselves. Every advance in history occurred because someone said it was possible when others said it was not. Remember, the world was once flat.
MISSION, GOALS, VALUES, BUSINESS PLAN
Do your employees know what business you are in? Can you function as a team moving in the same direction, if you believe you are in practice to provide one type of service while your staff believes it to be another? Are you in the business of fixing bad teeth, or are you in the business of making sick people well? There is a huge difference between the two. The true purpose of our work is different for each of us. With close examination, we often find that our mission is much broader than first believed.
Write a specific mission statement that in just a few simple words tells the world who and what you are. In addition, you must state clearly what your practice values are. What are the rules of ethical behavior that your practice will adhere to when confronted with economic pressures? A common value might be that the patient always comes first, regardless of the situation, conflict, or convenience involved.
You've got the vision in the form of a written mission statement. Now it needs to be translated into action by writing down a means to achieve your goals. A business plan is the document to do this. Commit yourself to a time frame in which you will achieve your goals. Distribute the plan to every member of your staff and everyone who has a vested interest in your success. Be as specific as possible. Keep the written plan where it can be visualized several times a day. Consult it frequently and measure your progress at regular intervals. Some plans may need modification as obstacles arise or new opportunities present themselves. As much as possible, anticipate problems and develop solutions before you start executing your plan. Build in rewards that are measurable and significant when certain milestones are reached.
The business plan represents the actual means you propose to achieve your goals and pursue your mission. It should clearly define your "brand" of dentistry. Are you Coke or Pepsi? Nike or Adidas? Manchester United or Bayern Munich? In dental terms, are you a cosmetic practice or a family practice, high-tech or low-tech, etc? The business plan should define clearly how you intend to attract new business, what procedures you offer (including new ones), and how you will integrate these into your practice. Your business plan should answer the important question, "Why should patients come to me instead of someone else?" In addition to the above, a well-written business plan includes:
- A mission statement
- A concise statement of practice values
- A clear statement of practice goals (financial, clinical, and nonclinical)
- A brief history of the practice (financial and otherwise)
- An honest and comprehensive assessment of company strengths and weaknesses
- An assessment of potential markets and practice trends
- Clear short-term and long-term projects that align with the company mission, values, and goals, and address areas of weakness
- All financial goals, projected revenues, and expenses.
In short, by reading the plan, an unbiased observer should be able to ascertain clearly and concisely your "brand" of practice, what you stand for, where your practice is headed, how you intend to get there, and where you've been. In addition, the document should motivate others (most importantly your staff) to want to move with you in the same direction you want to take your practice.
CHOOSE THE RIGHT STAFF
Choosing the right spouse and having a strong marriage will determine a large part of your personal happiness. By analogy, choosing the right staff does the same for your professional life. In dentistry, among many attributes, we need team oriented, ethical, compassionate, and intelligent individuals to help us deliver excellent dentistry. Without such people, united in a common effort, the staff and doctor will be pulling on opposite ends of the proverbial donkey. The mission, values, and goals you outline for your practice must be commonly shared by all who participate. Goals embraced by the doctor, but not wanted by the staff, will bring conflict. The staff is either on your dental practice "bus" going toward the same destination with the rest of the staff, or they are not. A dental staff is similar to a sports team. Everyone must work together or disharmony reigns, and winning the dental practice game becomes that much harder. At one time or another, we have all been trying to move our offices in a direction not shared by our staff, and we know the inherent difficulties.
Managing employees is, in many ways, the least glamorous and most difficult part of our jobs, but potentially the most rewarding. If we solved our staff problems, how much more successful and relaxed would we be? We went to school to work with patients, not manage people. But in fact, that is where we find ourselves. We must deal with life on its own terms. As difficult as it is, we must summon the courage, within legal and ethical boundaries, to let go of the malcontent employee who quietly sabotages the office. In a business as small as a dental practice, one employee not working with the other team members can make a huge difference in office productivity and morale. How often do we find that the atmosphere and office production suddenly improves when such a person leaves? Such a malcontented employee, put into a different environment where they can thrive, is of course, happier as well.
To summarize, whether we like it or not, as owners we are in a position of leadership. If we don't lead the practice, our employees will. Like a horse pulling a wagon without a driver, they might not take us where we want to go.
BE COMMITTED TO EXCELLENCE IN YOUR TREATMENT: EARN YOUR FEES AND BE PROUD OF THEM
The difference between mediocre and excellent dentistry is often only a matter of scheduling enough time for excellence. We've all got good hands. We all could do technically perfect work (assuming a cooperative patient) if we had the time. The fees we charge should allow us the time to give the best technical care possible. Of course, the local economy market forces, dental market forces, and the dental insurance industry affect us. Even so, fees are one, but not the sole, factor patients consider in accepting treatment. The best dentistry is dentistry done right the first time. The most costly is that which needs to be re-done. Charge a fee that allows you the time to do it right the first time. Deciding what type of practice and what type of dentistry you wish to perform will make your financial policy and fee decisions relatively simple.
We are not called to be all things to all people. Some patients will appreciate your work, and others will not. Be willing to let go some patients with whom you do not enjoy working. Doing the thing you love while being compensated fairly for it will increase personal satisfaction and improve quality. Higher fees will allow us to more easily re-do work we know we could have done better the first time. Telling a patient honestly when you can do better will build their confidence because they will experience your integrity. There is no price that can be put on personal integrity from the patients' perspective; they will tell their friends.
DEVELOP A GOOD WORKING RELATIONSHIP WITH YOUR SPECIALIST
You have a wealth of good information at your fingertips. Being on a first name basis with your specialist team allows you to both learn and expand your treatment capabilities. It will also allow you to focus energy on the things that you most like to do. Your specialist should be available to you within a day to return your phone calls, be willing to host you in their offices to observe them, and be available for lunch and dinner on short notice. Use them as equal professionals, not a dental Siberia where a patient you don't want to work with is sent, never to return.
CONSTANTLY RE-COMMIT YOURSELF TO CONTINUING EDUCATION
CE is the hallmark of the truly professional dentist. CE will re-invigorate your attitude and enthusiasm, as well as increase, over time, the depth and range of the services you provide. CE will also expand your circle of professional friends and take away the isolation so prevalent in solo practice by giving a sense of camaraderie. The details and nuances of clinical practice are the things that bedevil us. CE brings directly into our hands the very best ideas, equipment, and tools available for enhancing our practices. Clinical techniques, equipment, and materials are changing rapidly. CE taught by those actually in practice is vital. Wet-fingered practicing educators can tell you what works in real life. Abundant CE is the strongest means to learn which manufacturers' product claims are true and which are not. How many products have we bought that now gather dust because they did not quite work the way they were advertised? CE can help minimize this.
DEVELOP A NETWORK OF COLLEAGUES WITH WHOM TO SHARE YOUR IDEAS AND FRUSTRATIONS
The phrase "nothing new under the sun" applies. If a problem confronts you, it's been a problem for someone else before, and a solution exists. We should be encouraged to talk about our failures. Keeping secrets breeds shame. Many is the solo practitioner I have observed who is working in an isolated cottage away from his colleagues and frustrated by a lack of emotional support and professional stimulation. Don't let it happen to you. Be involved outside your dental cottage in the larger professional world at all levels possible.
REVIEW ALL OF YOUR INTERNAL SYSTEMS CONSTANTLY
Room for improvement exists in every one of our practices if we look for it. For example: Is your medical emergency kit up to date, are the drugs expired, is there oxygen in your cylinders? Can your paperwork be updated to be more user friendly? Could you make your office paperless? Are your computers antiques? Can your tray set-ups be reduced in numbers of instruments? Is your office manual clear and concise? Do you even have an office manual? Make use of your internal experts, your staff, for feedback about the status of your present systems and what needs to be done. It's amazing how much we can find that needs tuning if we look for it.
BE YOUR OWN BEST CONSULTANT
Consultants have done remarkable things for some practices. Modeling successful colleagues and visiting the business section of the local bookstore can provide much of the same information, much more economically. The business section of your local bookstore is filled with creative ideas and axioms designed to make small businesses more competitive. Most consultants are not dentists by training. Most have never sat on the operating stool with a syringe in their hand with an anxious patient. Consultants telling dentists how to manage a dental practice would be like me telling the members of the English National Soccer team how to kick a ball. Consultants learn their craft by working with dentists, and I would hazard a guess that they learn a lot more from their clients than vice versa. Asking those you consider successful how they've achieved what they have can help you become your own best consultant. Look at things from the patient's perspective When was the last time you actually sat in your own waiting room to see how it feels and appears to someone walking into your office for the first time? What is the first thing you see? Are your magazines all antique copies of the titles that you read at your grandmother's? Is the patient offered a drink or a hot towel upon entering? Are business and collection calls handled out of earshot? Have you ever had someone not related to you or your office call your practice to see how he or she is treated on the phone? Does your equipment look like it belongs in a museum or is it state of the art? Do you have a logo and mission statement clearly visible to the public upon entering your practice? An exhaustive list of what the patient experiences is too long for this paper, but suffice it to say that patients experience many things in our practices that we do not. We just don't see it. They are the final judges of our success and competence. Excellence in care is not just related to marginal fit. Excellence incorporates what the patient perceives about you personally and your office. Perception is reality when it comes to customer service and satisfaction. See it as they do, and we will never look at our practice the same way again.
DEVELOP A SOUND RELATIONSHIP WITH A QUALIFIED ATTORNEY, FINANCIAL PLANNER, AND ACCOUNTANT
Is your will up-to-date? Do you have adequate insurance of all types? Are you saving for retirement at a rate that actually will allow you to retire? Are you paying too much in taxes? Are your children's college needs being taken care of? We are trained dentists, not legal or financial specialists, although we need some basic knowledge in each of these areas. The right advice can literally allow you to work because you want to, and not because you have to. Bad investments and bad business decisions can saddle an otherwise successful practice with an unnecessary millstone. This can make an old person out of a young one very quickly. Treat patients like they were your mother and father DVD movie glasses, fancy patient napkins, scented rubber dams, lavender hot towels, and other amenities are nice, but they are not why patients see us. The basics are key. The patient cares about four things: (1) Is it going to hurt? (2) How much is it going to cost? (3) How long is it going to take? (4) Am I important to the people in the office? Patients' expectations that they are going to receive excellent technical care is a given. What sets you apart is the patient's answer to question No. 4 above. Take care of your patients and they will take care of you. In short, "Do unto others..." and "The customer is king." Be genuine. People can tell the difference.
Model the success strategies of the practices you admire to develop your vision, and execute your written plan with commitment. Success does leave clues.
Dr. Mounce is an endodontist in Portland, Ore. He has published articles in many journals and lectured worldwide on innovations in endodontics. He writes a weekly endodontics newsletter via e-mail,
"Mounce's Apex," which is available free of charge. To receive the newsletter, contact Dr. Mounce at Lineker@ aol.com and give your email address.