Written by Amy Morgan Thursday, 31 August 2006 19:00
Do you spend a fortune on technological advances but feel unable to incorporate them fully into your practice? Innovation is often stalled due to resistance to change or the daunting challenge of implementing broad, sweeping improvements while running an already busy practice. For these reasons, some dentists shun new technology entirely. As a result, many are missing out on the substantial benefits of today's technological advances.
What does a successful, high-tech practice look like? To demonstrate, let me introduce you to Dr. Bradley Dykstra, a respected Pride Institute alumnus. He is a general dentist in Hudsonville, Mich, whose articles have appeared in Dentistry Today. To highlight the technological advances that Dr. Dykstra uses to enhance the new-patient experience, let's describe the visit of Mary Smith, a typical new patient.
Illustration by Nathan Zak•During Maryís brief wait in the reception area, she watches the Smile Channel (CAESY, A Patterson Company) on a large plasma screen. Seeing segments on veneers and tooth pain gives Mary ideas for improving her smile and a heightened awareness of dental health issues.•Mary is escorted to a photo room, where an assistant takes digital full-face and smile photos. They are instantly added to Mary's electronic chart and available to doctor and team for treatment planning and for identifying patients by appearance without having to ask who they are.•The assistant takes a digital panoramic x-ray, then escorts Mary to a treatment room with computer screens behind and in front of her chair. The assistant reviews her dental and health history with her and enters the data into her e-chart.•Dr. Dykstra can view Mary's panoramic x-ray from any computer in the office and instruct his assistant to take additional x-rays.•Mary meets Dr. Dykstra, who establishes a relationship with her by asking open-ended questions and active listening. During the co-diagnostic examination, he calls out his findings to Mary and to his assistant for entry in the e-chart.•As Dr. Dykstra takes intraoral photos of areas of interest and uses the DIAGNOdent laser (KaVo) to assess suspicious areas, the new methods, along with the doctor's relationship-forming skills, build Mary's confidence in him.•After leaving the room, Mary mentions to the appointment coordinator that she is going on vacation in Hawaii. The staff member enters the information on•"Team Talk," a feature of Mary's e-chart, where her personal comments as well as other important information are recorded and instantly available.•During the consultation, Dr. Dykstra reinforces what was co-diagnosed in the clinical exam, which indicated that Mary has periodontitis. An intraoral picture and x-ray magnified almost 100 times dramatically show bone loss and tartar spurs.•Dr. Dykstraís exam also revealed that Mary does a lot of bruxing. On her smile and intraoral photos, she clearly sees the signs of wear. The doctor's compelling, magnified images and persuasive influencing inspire her to accept full treatment.•Mary meets with the financial administrator, who instantly pulls up Dr. Dykstra's treatment plan on her computer screen, prints it, reviews it with Mary to establish payment options, and schedules Mary's next visit.
In subsequent visits, team members easily open and refer to Mary's photo and personal relationship-building information, making her feel recognized, unique, and cared for. They instantly see Mary's treatment for the day, x-rays, and other vital information without having to rummage through a paper chart. Mary will experience dental lasers and other technologies that promote the highest level of comfort and care. It is no surprise that Mary and others like her become loyal, committed patients who value, accept, and follow through with treatment, and enthusiastically refer others to the state-of-the-art practice.
Do you want your patients to have this kind of experience? If so, read on to learn the 5 critical steps that Pride Institute teaches dentists like Dr. Dykstra to establish a high-technology practice and state-of-the-art care.
ONE: DEVELOP A VISION AND STRATEGY FOR TECHNOLOGICAL ADVANCEMENT
Halt! Before introducing technological change, the leader must have a clear, compelling reason for the upgrade. Otherwise, the staff will feel the new method is just another task in a series of tasks that can feel like drudgery. How many times have you re-turned from a dental convention excited about introducing innovations, only to get the look of the dead from your staff? It's not a piece of equipment that creates excitement; itís the outcome the equipment can provide that in-spires. A "vision" is a compelling picture of a future outcome that ties to the practiceís values and inspires doctor, team, and patients. A vision aligns the goals and actions of staff and doctor in a focused, efficient way.
For example, if you are introducing digital radiography, it is your job as leader to paint a picture of the compelling future that the innovation will bring so that everyone can get excited about it. If your vision is to give patients the best state-of-the-art care and service, then discuss with your team how digital radiography supports this goal. We learn from Dr. Dykstraís example that digital radiography's sheer size on a monitor enhances patient care by allowing people to see and understand dental conditions that they could not decipher on traditional film. This technology also enhances service and makes the staffís jobs easier by eliminating film development.
A vision without a strategy is a vacant hope. So the second part of this step is to develop the overall strategy that makes the vision possible. This includes ongoing meetings with the staff to determine action steps, assign responsibilities, and create a timeline for accomplishment. Dr. Dykstra holds regular digital staff meetings that serve as a forum to deal with the implementation process; these address problems that arise as well as team progress based on the established time-lines. Further support for technological advancement can be provided by a field trip to an office using the new technology, a course, or a vendor demonstration, as this helps both doctor and staff to visualize positive outcomes.
Develop a strategy to span several years, and remember to involve your team members in the process because you will vitally need their cooperation and commitment to implement your plan. In forming a strategy, don't try to do everything at once. This will overwhelm you and ultimately cause burnout. Dr. Dykstra points out that if you begin with practice management software that will support a digital office, then you are poised to add subsequent technology to it. You may decide to introduce computers in the operatories prior to digital x-rays so that you will have monitors on which to display the x-rays. If you begin using the computers for scheduling, then everyone can become familiar with them before other systems are added. Introducing digital charting prior to digital radiography means you will still need paper charts for the x-ray films, so you may decide to update the radiography first. Plan carefully, then proceed.
TWO: COMMUNICATE THE VISION FOR CHANGE SO THE TEAM TRULY HEARS IT
One of my favorite books, The Leaderís Voice: How Communication Can Inspire Action and Get Results! by Boyd Clarke and Ron Crossland, notes that the difference between a vision and a hallucination lies in how many people see it. How many of us have walked into a staff meeting clearly seeing a vision of what we want to accomplish, only to walk out feeling it was a hallucination? We make 4 assumptions that lead to misfires in our communication:
(1)Your team understands what you say. Dentists are prone to communicating in technical terms devoid of emotional components. You'll lose your staff if you spew factoids about the megabytes of a new hard drive. Repackage your message to fit the recipient. How will the hard drive make your team's job easier and help the patient?
(2) Your team cares about what you say. Your team listens to WIIFM, the station that plays "What's In It For Me?" Two other radio stations you need for broadcasting your message are WSI ("Why Should I?") and the most important of all, MMFI ("Make Me Feel Important!"). Your staff won't care about a change that benefits only you or the patients. There must be specific advantages for all team members in order to win their support. For example, when introducing the CAESY server system of patient education to his team, Dr. Dykstra asked his team questions such as, "How would it be if you didn't have to repeat the same information over and over to patients? How would you like watching a presentation with the patient, then elaborating on it and answering questions? Wouldn't that be easier, more effective, and fun?" Through this process of discussion, team members realize that implementing the new technology gives the patient a more visual and compelling picture of dental problems, and it also makes their jobs more efficient and fulfilling. This motivates them to embrace the change.
(3) Your team agrees with what you say. Silence is not agreement. Dentists who avoid conflicts are quick to assume that a silent team is a supportive team. A team that voices its concerns is a team much more likely to succeed in implementation than a passive team whose members will yes you to death and then go about their business as if they never heard you. The most courageous thing you can do when you introduce innovation is to provide a forum for your staff members to discuss their misgivings safely without fear of repercussion.
(4) Your team will take appropriate action. Even a supportive team needs resources, an action list, and timelines established to implement new technology. For example, when Dr. Dykstra introduced digital charting, the staff continued to cling to the paper charts. He realized that he needed more training for his staff before the new system would take hold. He took the vendor's training, realized everything the digital charts could do, and demonstrated the new methods to his staff. He agreed to lighten the schedule for a week, and his team agreed-with trepidation-to a timeline of one week to drop the paper system and go fully digital. The result was that within a single day of using the new system, with the doctor helping them with their digital entries, the staff members were able to make the transition. They never used the paper system again.
THREE: BE PREPARED TO HANDLE THE STAFF'S RESISTANCE TO CHANGE
Staff members are engaged in countless activities just to make the practice run as-is. Before technology reduces the workload, it can create more activities and confusion, which can overwhelm them. Therefore, the staff may view change as threatening, which triggers stress. Weíve all been at staff meetings in which the team is in fight-or-flight mode over a proposed change:
"We already tried that and it didn't work."
"Why do we need this when we're so successful already?"
"The patients won't like it."
"Oh, please donít do that to us!"
Doctors unable to manage conflict give up in the face of the teamís resistance. Our view is, no guts, no glory. This means expect resistance and handle it. Emphasizing how the proposed change will benefit the staff, as mentioned previously, is especially helpful in overcoming resistance. For example, when Dr. Dykstra introduced the scheduling of hygiene visits from the treatment room, the hygienists could easily have viewed it as more work for them. However, Dr. Dykstra stressed how wonderful it would be for them to be able to customize the hygiene visit to meet the patientís needs. As expert clinicians, hygienists know which patients will need more or less time. Therefore, scheduling their own appointments allows them the flexibility they need to give their patients ideal care.
Inertia and complacency also stem from employees feeling uncomfortable when old habits are abandoned and new ones created. They automatically revert to the familiar old ways, especially when under pressure. Your coaching and support throughout the change process keeps the staff focused and positive. Enlist those who quickly grasp the new methods to help those who are struggling. Eventually everyone will master the new skills. The biggest reason failures occur in implementing new technology is that the doctor woefully underestimates the amount of coaching and support needed. So fasten your seat belt and stay the course all the way to the point when the new skill is so integrated that the staff doesnít even have to think about it. Dr. Dykstra observes that he encountered staff resistance to change initially, but if he were to take away any of the technology today, his staff would quit - and so would he!
FOUR: MODIFY EXISTING SYSTEMS AND PROCESSES TO SUPPORT THE PROPOSED CHANGE
In the most sophisticated offices, we find that if the scheduling, financial arrangements, patient examination, continuing care, and other systems do not change to support the new technology, the implementation is thwarted. For example, when Dr. Dykstra implemented his new methods, it threw his scheduling system into chaos. He needed to keep the foundational basics of scheduling to meet production goals and optimize use of his time, but he also needed to make major adjustments in the scheduling system for new technologies. Dentists must realize that systems that worked great in the past may not work with new technology. Be prepared to reorganize.
FIVE: CREATE MILESTONES FOR SUCCESS AND CELEBRATE YOUR ACCOMPLISHMENTS, BOTH BIG AND SMALL
The worst thing a dentist can do while implementing technology is to adopt what Ken Blanchard calls "seagull management." This means waiting until an employee does something wrong, then swooping down to eat the person for lunch. In our attempts to do things perfectly, itís easy to get frustrated when the staff doesn't instantly perform new skills. If you want to stop the momentum of change, fail to acknowledge the baby steps.
New technology increases production, efficiency, and balance. This means more money for salary and rewards, more quality time for preparation, education, and celebration, and more gratification for jobs well done.
I know of no profession that is more exciting and everchanging than dentistry. We can embrace advancement with a practice culture firmly rooted in the 5 steps for implementing change. If Dr. Dykstra can do it, so can you. Pick a change you would really love to make but have been hesitant to try. It's as easy as one through 5.
Ms. Morgan is chief executive officer and lead trainer of Pride Institute, a dental management consulting firm serving dentists since 1976. For 2 decades Ms. Morgan has consulted one-on-one with hundreds of doctors to end cash-flow crises and to improve practice management. She is a lively speaker at major dental conferences and conducts seminars and workshops for dentists and teams to turn average or underperforming practices into satisfying and successful ones. For more information on leadership and management study, continuing education courses, and training materials, or to reach the author, call Pride Institute at (800) 925-2600 or visit prideinstitute.com.
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