Overcoming Challenges in Relationships

In December 2016, I completed a course with Dr. Paul Homoly about the craft of being a speaker. I have had a dream of being a keynote speaker for more than 20 years, and now, I am finally ready. 

I already have three speaking engagements booked, and two of the organizations are outside of dentistry. My first keynote speech is titled “Success Is All about Relationships,” with a secondary story about the people in our lives being a gift. With this topic in hand, and the holiday season having recently been upon us — which emphasizes positive family relationships and goodwill toward humankind — I started thinking about my relationships and how they have affected my families, both my biological family and my work family (team), as well as some problems that have occurred that are difficult to resolve. Allow me to tell you about some of the people in my life, the interactions with whom have taught me lessons over the past years.

My wife and I are both members of large families. My brother-in-law’s wife is not from a large family, and in her small family, she has managed to avoid certain relatives, including her mother and sister. After being involved in a small dispute with her, my family was not invited to their holiday celebration. My children were particularly hurt seeing their cousins posting pictures online; they did not understand why they were not invited. I don’t know how this will get resolved or even if it will get resolved. My wife’s close-knit family is slowly being divided by this one person.

I also have encountered problematic interactions with one of my employees in particular. I hired Freda* many years ago. She is a hard worker, a fast learner and had a successful career as a server in a busy restaurant chain in Calgary, Alberta, Canada. She understood teamwork, high levels of customer service and more. She was a great hire, but as time went on, she brought her personal issues to the office. She withdrew and stopped talking to people at lunchtime. She was banging drawers, rushing around and putting things away in haste, leaving the rest of the team scrambling to find things they needed — and not in a timely manner, which affected its ability to provide high levels of customer service to our patients.

Although Freda’s words stated she wanted to be a part of our team, her actions showed otherwise. To remedy this, we worked with Freda, providing her with coaching. We also provided team-based communications training for the whole office. Despite our best efforts, we ultimately found a way to help her find a different place to work. Over the course of the following six months, our productivity, production, collections and general happiness at work measurably improved.

These are just two examples I can share about dealing with challenging relationships — sometimes you can change them and sometimes you can’t. I have two families: my biological family and my work family (my team). We cannot change our biological family. We do not choose to whom we are related, nor who our family members marry. We can choose who the members of our work family will be. Success is dependent upon how we chose to navigate our relationships. The challenge is to overcome the difficult ones — or, if that is not possible, to focus instead on those relationships in your life that are positive and choose to build new ones.

May 2017 be a year of positive and fulfilling relationships for you all, in all of your families as we strive for success.



Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

*Name has been changed.

The Employee Review Conundrum

The blessing and curse of my group practice setting is having to relay/discuss/vote on decisions amongst my partners. At times, it’s a godsend — aka, those times when I have few if any ideas and I thusly appreciate the variety and breadth of opinions amongst my counterparts. Other times, though, it leads to disagreements and some heated discussions when opinions differ. 

One of the more recent discussions I can recall was around the idea of employee reviews. We’re a growing, multi-location practice with more than just a handful of employees now. Multiple doctors rotate locations on a daily basis. Although I’ve grown into having the confidence to be able to discuss a situation with a staff member in the moment, there are plenty of times in the midst of one of those days when I barely have time to check my email — not to mention discuss with my assistant the proper protocol for room restocking or CAD/CAM mill maintenance. It’s tough, and I’ll be the first to admit it.

I clearly recall a conversation with one of my assistants years ago about their previous boss who kept a Post-it® Note stack in his pocket on which he’d write down his employee’s issues, as well as potential teaching moments and growth opportunities. Although doing this would be tempting, I don’t care to be known as that boss. So sometimes, while it’s fresh in my brain, I calmly (err … not all the time) present growth opportunities to teammates. But often, instead, I’m on to the next thing — a DOL onlay prep, for example — and poof, there goes the idea to seize a teaching moment.

So what’s the solution? I’ve spent the past few weeks working on our operations manual, an organizational flowchart, etc. — the things any midsize or large corporation has to have in order to function effectively and efficiently. In section four of my ops manual is the page that covers employee reviews. We’ve never had ’em. Well, we did, and two team members quit.

So lies our conundrum. As owners, practitioners, Type Aers or simply just plain humans, we tend to focus our energy on the negative. Why?! This is just common nature, but it also is a poor quality to have, at best. Even when it comes to my best assistants, patient care coordinators or associates, I could list 20 things I wish they did better without any prep time. I’d honestly have to give thought to come up with the 20 things they do great — which is so unfortunate, because in piecing together the ops manual, they each did 200 things well! But for some reason, the growth opportunities that cross my mind on occasion are the ones that stick, the ones that I remember come review time.

So I am hesitant to begin the practice of scheduling such reviews, for fear of having the negatives outweigh the positives. I’m worried that scheduled reviews would simply turn into counseling sessions during which my teammates would “lay it all out there” — their disdain for another employee, for example. I would be careful not to anger the good/great employees with the little tweaks that would make sense in my head to outline at the time, but inevitably, I probably would just come off as nitpicky. The objective would be to be completely honest, so that my employees would actually grow and improve from them. Worst-case scenario, we would track legitimate data/records for the rare times when we would need to consult the human resources company to formulate a notice of unemployment form.

So, yes, there is clearly valuable information to be gained from reviews, but also hesitation and unease surrounding them. So how do you all handle reviews? Are they a regular (annual, biannual, quarterly) part of your practice? Do you have a magic method for focusing your energy on the positives? I’m interested to hear your thoughts.

I’d like to keep the reviews topic in my ops manual, and I’d like to eventually use scheduled review time as growth opportunities for my staff, but maybe more so for myself. I have to be a good leader, too, just as much as my employees must meet expectations, and part of that is actually leading: teaching, consulting, convening, instructing and communicating. It’s part of my job description.



Donald Murry III, DMD

The No. 1 Reason to Measure Your Patients’ Satisfaction

Recently, I had an interesting conversation with an owner colleague (Dr. Colleague) regarding the various means by which he and his staff solicit patient comments (via comment cards, website, text message, etc.). He was concerned about the number of patients who were moving their records (attrition; aka, churn rate) and figured it must be associated with insurance, patient relocation, changing jobs, big-box dental chains, competitor’s fees, etc. By the way, Dr. Colleague is a talented dentist with excellent clinical skills who has been practicing for more than 25 years. Suffice it to say, his office collections were more than $2,600,000 in 2016, and he is a popular doctor on the speaking circuit. 

Yes, I said, “collections,” not production. As a sidenote, in my opinion, production means almost nothing. It primarily serves as a benchmark from which to measure your collections and also as “bragging rights” for those of us who sit chairside at continuing education (CE) programs and tell our colleagues how successful our business is. Right or wrong, I believe this is where we get some of our satisfaction. After all, we are only human.

With regard to measuring patient satisfaction, a deeper dive into Dr. Colleague’s operation revealed that his team was trained (by a marketing firm who was selling their product) to be selective in seeking customer feedback. Unfortunately, Dr. Colleague’s team only solicits comments from customers who have displayed obvious satisfaction during their patient visit. Prior to dismissing the patient, the employees are incentivized ($1 per “positive” review) to implore the “satisfied” patient to write a review through a third party (marketing product) that is then uploaded into the dental business website.

By the way, I have no issue with team members and dentist asking for reviews or referrals. After all, I was trained in this highly internal marketing concept during my years at Hilton Hotels Corp. It is a powerful and effective way to build a patient base and is simply smart business etiquette. However, in Dr. Colleague’s case, employees were led to believe that positive reviews will offset negative reviews and that little attention should be paid to the poor reviews. This is simply wrong! There are no ifs, ands or buts about it, and no data to support their contention. Indeed, poor reviews can be vetted for the time being. However, is this any way to do business? Meta-analysis, please?

As clinicians with various levels of training and experience, we all have one thing in common. We know what it is like to experience failure (that sunken feeling) during a dental procedure and fall short of achieving the outcomes we expected. The patient or dental assistant may not detect our struggles, but we do. This built-in “feedback loop” has its advantages and serves to help us understand our limitations and/or the areas of clinical dentistry in which we may need CE or mentoring. After all, if we don’t meet the “Standard of Care,” we may have to deal with the U.S. Drug Enforcement Administration or State Dental Board. If a patient files a complaint, for any reason with any dental board in the United States, the dental board has a duty to investigate, and it will. So how does this relate to measuring patient satisfaction? We need to make sure we have a system that invites and allows every disgruntled patient to voice their opinion. Further, we need to acknowledge their frustration and concerns and take action to improve upon our deliverables, including the most important of all: five-star customer service. Without a conduit to voice their displeasure, it is only a matter of time until our patients will take to the “airwaves” (Yelp, Google, social media, etc.) and share their displeasure with the world.

With that said, there is one good thing that can come out of poor reviews. We learn to listen and improve upon everything we do. It won’t happen on its own. Make sure you have a system that invites and solicits comments from all patients — not just the satisfied. We have to know where we are failing in order to learn how to become successful.



Duke Aldridge, DDS, MBA, MAGD, DICOI, MICOI, FMISCH

Vacations: Distant Childhood Memories

Last year, a good friend of mine confessed she had a dilemma: She was trying to figure out where to spend her remaining two weeks of vacation for the year. Wait … what? Remaining?! I asked how many weeks of vacation she had started with, and she casually replied, “Five.” At first, I was stunned. Then, I was jealous. Now, mind you, she has degrees in chemical and mechanical engineering and works for a top pharmaceutical company where important drugs are being developed to combat big diseases. But she doesn’t work on the weekends and doesn’t stay past 5 or 6 p.m. during any typical workday. And did I mention the five-week vacation?

I’m aware of how notorious Americans are for leaving unused vacation on the table, and recent research confirmed that we don’t seem to be thrilled about taking time off. In fact, we seem to applaud the all-work-and-no-play mindset. When I took my rare two-week vacation two years ago (after not taking any more than five days for several years), I received many astonished reactions. True, it’s about economics for many. But imagine if we were able to train our psyches to take a few days off in the midst of a long work streak. I would argue we would have more productive days following those days off, not to mention a more positive work atmosphere and better focus. In other words, we might actually reduce burnout and do our backs and hands a favor.

However, do those things really matter to us when we have packed schedules and can’t even afford to have our assistants call in sick because they have the flu, let alone a quick getaway? Besides, I wonder if my friend can empathize with dental practice owners or dentists with a solid patient base. Maybe she wouldn’t understand that even if we have a backup dentist to take care of our patients when we’re gone, we still keep those patients in the back of our minds regardless of how far away we travel. When I was staring at the Pacific Ocean during my holiday, I’ll admit I had thoughts of a bridge I had just delivered or a surgery I might have done before I left. “I hope the patient’s bite feels good and my stitches are intact …”

Besides, each day away from the office is a loss for the dental business. Practice owners can’t simply unplug from the office mentally and financially, as my friend in the drug industry may be able to.

As the holiday season came and went, I rolled up my sleeves and got to work as dental insurance benefits came to a close, while my dear friend browsed the travel section at the bookstore to plan her final fortnight of adventure for 2016. Lucky gal. 

Zeynep Barakat, DMD, FAGD

Deciphering the Meaning of ‘I Chipped a Tooth’

I know this is something you hear all the time: “I chipped a tooth.” This can mean so many things, especially if it is coming from a nondentist.

“I chipped a tooth” in the posterior can be a chip off the marginal ridge next to a class II restoration that you did five years ago. And if you saw this, you might just say, “It is fine,” or you might just smooth it off. Or a broken tooth in the posterior could mean the ling cusp of tooth No. 12 just broke to the gumline and below.

The question that usually comes up at our office is: How do we schedule patients who call and say, “I chipped a tooth.”

I am a doctor who does not like to schedule a “come in and we will see” visit. I know how difficult it can be for people to take time off of work or get a babysitter just so I can tell them, “Yep, you have a chipped tooth, and we can see you in three weeks to take care of this.”

Sometimes I schedule 50 minutes for a chip on the anterior that you couldn’t see with a microscope, or I might schedule 20 minutes for a “chip” when, actually, a child fell off his bike and “chipped” the heck out of teeth Nos. 8 and 9, to the point where the nerves were hanging out.

Because I refuse to do a “look-and-see” appointment, about a year ago, we bought a smartphone for the office. First, we bought it to be able to send text messages to people to confirm their appointments. We all know that calling someone at home and leaving a message on their voicemail is about as effective as sending a smoke signal (but we tried for 10 years). And nearly everyone has a smartphone these days, and everyone sends text messages (except for Grandma Nel, who we still just call). Now that we have this designated smartphone, we just ask people to send us a photo of the tooth via text message.

It can be a little tougher for a posterior tooth, but we have had tremendous success in the anterior. For example, both of these photos were sent to me by a patient who called reporting a chipped tooth.

    

Looking at these photos, it is pretty comical how people perceive their oral health care needs. Now that we have this technology, we can use it to help patients schedule the correct appointment.

By the way, through my mobile service provider, adding another line to my plan only costs $5 per month. (I think I bought the phone for $99.) So I am not telling you to break the bank here. I thought this was an easy way to make the office run smoother.

Have you found any ways to make your office run smoother that you want to share? Let me know.

John Gammichia, DMD, FAGD

The ABCs of a Successful Dental Practice (Part 3 of 3)

Welcome to the final installment of the “The ABCs of a Successful Dental Practice.” As we close out this blog post series, I want to impress upon the reader that there are approximately 200 key performance indicators (KPIs) that should be monitored and evaluated monthly through dental practice analytics. 

With that said, and as an owner/operator, I am all too familiar with the time constraints we face as professional colleagues and friends. However, analogous to a pilot who is commandeering a beautiful Boeing 787 aircraft, while monitoring critical KPIs (air speed, jet fuel, altitude, etc.) from the cockpit, it is critical for today’s “dental businessperson” to possess the knowledge and business acumen to navigate their operation while soaring to new heights. This begins with learning how to diagnose your business through the use of KPIs and any corrective actions required to stay on budget and meet or exceed your goals and objectives. I refer to this process as “keeping your finger on the pulse.”

The following recommendations are based upon more than 35 years of business and clinical experience as a clinician, owner/operator, project manager, practice management consultant for solo and large-scale dental organizations and five-star hospitality customer service mentor, as well as completion of a rigorous Master of Business Administration curriculum with an emphasis on health care. As I stated in the previous post, these suggestions are more than simply anecdotal thoughts or ideas. They are based upon the science of business.

In this blog post, we will focus on the letters “R–Z,” presented in the hopes that each respective reader will glean a pearl or two.

Recall: A well-designed dental recall system will ensure that at a minimum, 85 percent of active patients (active is defined as any local patient who is seen in your office within the past 18 months) are scheduled for continuous treatment somewhere within your dental practice at all times. Yes, 85 percent (the national average is 42 percent). In other words, each respective patient should have an appointment in your office at any given time, hygiene or restorative. The most successful marketing and greatest potential to grow your business is through your existing patient base and by learning to ask for internal referrals. People buy from people whom they like, and they also refer their friends and colleagues to people whom they like.

Your patients have already chosen you and/or your associate, and now it is up to you and your excellent and highly trained team to maintain this relationship. Every dentist should know how to access the number of active patients and percentage scheduled from their practice management software. If not, ask your front office staff to show you how. This is a critical metric that should be monitored monthly. If we can’t diagnose the problem, we can’t treat it.

Scheduling for your success: Maintaining a consistent and smooth flow of patient appointments while meeting daily production goals (dentist and dental hygienists should have daily production goals tied into an annual budget) is one of the most challenging issues that your front office personnel encounters. By incorporating 10-minute blocks of time, required time per procedure (based upon your top 25 Code on Dental Procedures and Nomenclature procedures), per clinician, a short-call/VIP list and learning to schedule to 70 percent of daily goals before lunch is at the heart of developing predictable and consistent patient schedules that ensure financial health for your business, while decreasing stress for all. There is no quicker way to burn out a team, destroy employee morale and induce anxiety than to “put the patient anywhere in the schedule.” Remember, being busy does not translate into being successful. Scheduling for your success is an art and science and should be respected as such.

Treatment planning: One of my mentors, Dr. Bill Robbins, taught me to call it the way I see it, and that there is no such thing as “we will just watch it.” In other words, do not pre-judge your patients, and try to evaluate if they can afford your proposed dental treatment. Call it the way you see it! Your treatment plan is predicated on the condition of the patient’s oral cavity, not yours, and seldom are there two patients who present with the same needs.

In today’s dental economy, it is my experience that the most successful way to gain patient acceptance to your proposed treatment is through the use of intraoral cameras and by involving the patient in what is commonly referred to as “co-diagnosis.” For example, ask your patient, “Mrs. Jones, what do you see?” as you display a fracture or an area of occlusal decay on 42-by-50-inch screens at the 6 o’clock position of your treatment room. Then listen and say nothing. Let the patient answer. Silence is golden. Then, send the patient home with pictures of his or her teeth, soft tissue, calculus accumulation, etc. By the way, most patients will gladly accept your treatment recommendations because you are no longer having to sell your services. Now you need to have your financial coordinator provide financial options so he or she can convert the case right? Excellent systems are the key.

Uniformity: Providing a consistent product and service that creates value for each and every patient is one of the biggest challenges facing any business. As dentists, we are the primary revenue producers, and unfortunately, we seldom serve on the front line and interact with the patients when they are paying for our services. Your financial coordinator or whoever collects monies on your behalf needs to be trained and supported with proven financial systems to protect the financial health of your business. If the patient deserves continuity of care, then the business owner deserves uniformity of payment. However, without proven systems, your financial health will be jeopardized.

Voicemail: National data suggests that 80–87 percent of new patients who call today’s dentist and are greeted by voicemail will hang up and go to the next dentist on their list. That means that you will lose 80 to 87 of every 100 prospective new patients if your practice’s unanswered calls go to voicemail during regular business hours.

We need to teach our team members to smile, answer the telephone within two to three rings, and make all patients feel welcome and believe they have called the finest office in their community. Case conversion begins with the first patient touch point, and that is usually the telephone. Two weeks ago, a colleague of mine called his office nine times and informed me that on all nine instances, his call went to voicemail. Enough said?

Website: The days of expecting patients to call to make an appointment or walk in your dental office are gone. Print media is on a continual decline and is expected to continue. Print media that promotes your services based upon price only serves to promote dentistry as a commodity, which leads to patients believing a dentist is a dentist is a dentist. There is a place for print marketing (your best patients, approximately 20 percent of your business). However, after tracking hundreds of clients’ data sets, it is minimal at best. When today’s consumer needs a dentist they will find them through referral (from a friend, family member, coworker, employer insurance, etc.) or turn to the world wide web.

However, just having a website is not sufficient. Today, consumers (including new and existing patient base) are glued to their smartphones, tablets and laptops. The typical user is continuously checking their email, updating their social profiles, searching for a destination (your office) and, on average, spending five to six hours per day navigating their device. According to Pew Research, 64 percent of American adults now own a smartphone of some kind, up from 35 percent in spring 2011. The ability to “stay in touch” has changed from a luxury to a necessity for all types of users. We are truly a people “on the go.” Patients expect you and your website to be great. If you don’t have a website, you don’t exist, and if you have a website and the consumer doesn’t like what they see they will bounce (bounce rate) right off of your page and move to the next.

X-rays: A full-mouth series of X-rays (FMX) and a panoramic X-ray, or cone beam computed tomography, for new patients are still the standard of care. I see more and more colleagues failing to order the appropriate images (because insurance won’t pay for it) necessary to evaluate the head and neck area for which we possess tremendous knowledge. The panoramic X-ray has fantastic value, and when displayed and presented to the patient on large screen monitors, it serves as a wonderful education tool that builds rapport, value and trust. The ability to evaluate the patient for intra-osseous pathology, elongated Styloid processes, internal carotid plaque, temporomandibular joint disorders, sinus pathology and much more warrants acquiring a beautiful panoramic X-ray. With respect to FMX or bitewings, we need to hold our team accountable for acquiring diagnostic images so we can do what we do best. I see hundreds of images that would not pass the test in dental school for either the dentist or dental assistant.

Yearly budget: As we close 2016, there is no better time to prepare your annual or yearly budget and start off the new year with clear financial goals and objectives. I am fortunate that I had the pleasure of developing budgets for years with Hilton Worldwide global hospitality company, and so I am accustomed to same. With that said, and if you need help, reach out to someone who can help you (a bookkeeper, certified public accountant or colleague who is experienced in preparing a realistic budget). Creating a well-thought-out budget is the first step to accomplishing your financial goals while creating a blueprint for 2017.

Zest: Dentistry is a profession that enables each of us to serve our patients and colleagues, as well as give back to our community and family. Let your zest be the inspiration that helps lead your team to a successful and happy new year in 2017.





Duke Aldridge, DDS, MBA, MAGD, MICOI, DICOI

Three Tips for Establishing Trust in the Workplace

The foundation behind every relationship is based on the principle of trust. Not only am I talking about in personal relationships, but also in our workplaces as well. If people trust you, they believe in you. Even if you make a mistake or act in a negative manner toward them, they won’t hold that action against you because they “know you.” They would understand that is not typical of your behavior and most likely try to help you with whatever the problem was. 

On the flip side, if someone doesn’t trust you, everything you say and do will be under scrutiny. Behind all your actions, there will be doubtful motive, and until the trust is established, there is no relationship at all.

As dentists, we are leaders in our offices, and leaders must be trusted. If you have a team member who is doubtful of your intentions, he or she will not implement your practice ideas and philosophies. He or she instead may say negative things behind your back to other team members — and even to patients. You can imagine the cascading, detrimental effects this can have on your business. If you don’t have a trust-based relationship with your patients, they will most likely not move forward with any treatment recommendations you may have; and if they do, they likely will find fault in your work, even if it was done pristinely.

Trust is a core concept that every successful business attains. Here are three ways you can establish a trusting rapport with your team and patients:

1. Never overpromise. At times, people have the best intentions and try to do more than what is within their realm of capability. We allow ourselves to be talked into things because we want people to like us, and we want to help, or sometimes we just may carry too much bravado. Regardless, if you are not sure you can do something — don’t do it! In fact, I always tell my team under promise but try to over deliver.
2. Say what you mean. When you talk, communicate clearly and accurately. Sometimes people tell “white lies” because they feel they will avoid offending someone or confrontation. Maybe they will embellish a story to make it seem more glamorous and exciting, or to try and gain more credibility. Life is just way too busy to try to keep up with these fallacies. Eventually, you get caught, and then feelings get really hurt, and you lose all your credibility.
3. Honor your word. If you say you’re going to do something, make sure you do it. Once in a while, you may legitimately not be able to do what you said you would. Make sure this is discussed with those affected, and reschedule. If you don’t, you will lose trust with people, and you will begin to lose faith in your own integrity. If you can’t keep your word to yourself, this will eventually have a heavy negative impact on your everyday sense of happiness and overall well-being.

The bottom line is: Be true to your word, to yourself and others. If you believe in yourself, you will have strong core values that can help you build strong relationships with people that will bring success in every aspect of your life.





Pamela Marzban, DDS, FAGD