By Edwin A. McDonald, DDS 

Case Study 1 

Early in my practice I was introduced to a periodontist in Dallas. We began a close working relationship for many years. He was a great mentor to me. His work was superb, and his patients had great experiences. He got to know our patients so well he could guide them to the best treatment decisions.  

One day we met, and he told me that he was retiring. I told him that he couldn’t do that to me! His response was that he had found the perfect person to partner and transition with. He had.  

The most important thing that happened was my mentor took the time and made the effort to communicate with me about what was happening. It made me realize that I was important and significant in all of this. The incoming periodontist, Ron, was a young version of his predecessor with the same meticulous surgical technique, superb results, and great patient experiences. In fact, in many ways he became better.  

Years later, Ron’s office is in the same location, just beautifully remodeled and updated. The hygienists remained for many years as did most patients and almost all referral sources. Ron has been extraordinarily successful. That makes me happy. He makes me a better dentist. 

In this case, the two periodontists were philosophically aligned, clinically similar, consistent in their judgement, and had great ability to build high trust relationships. Those four components created a powerful foundation to move smoothly from the past to a great future. 

Case Study 2 

Unlike the first case study, most transitions have gaps between the old and the new. In addition, often the existing practice needs an infusion of energy, a new and expanded mindset, and a more powerful vision to move toward what is possible. 

I have a friend that bought a very traditional relationship-based practice with tons of potential. He is different than his predecessor in his management style, approach to relationships, and desire to grow his practice. He has more than doubled it in just a few years. He also has had a complete turnover in the team. In this case, he needed a team that fit how he wanted to practice. He hired individuals who were prepared to embrace a new approach to practice.  

My friend needed to become a more effective leader of his team and develop a deeper understanding of how important they are to his current and future success. That meant investing more time and energy into getting to know everyone, communicating his career goals and learning about their career goals as they together cast a vision of the future …a worthy destination that honored the past as it created an abundant future. That meant leaving behind some beliefs, assumptions, and patterns of thinking as he matured and as they matured. 

“All of the stakeholders around a practice transition will embrace the change if they see the incoming dentist and new team members living the values that have kept them connected to the practice for many years, there is clear and frequent communication, there are genuine efforts at building trust, and there is an expressed understanding of what is mutually beneficial to all parties.”
–Dr. Edwin A. McDonald (LineofSightCoaching.com) 

By Edwin A. McDonald, DDS 

It is amazing to me to realize that I have practiced for more than 40 years in a relationship based, fee for service dental practice. Dentistry has become much more complex during that time. What has not changed is the need for human beings to be loved, accepted, significant, understood, and heard. Also, people who have a high value for their health seek high clinical competence and thoughtful patient management.  

Two years ago, I started looking for a partner to continue providing my patients with comprehensive, relationship-based care. (My hands, back, and body had been telling me that it was time to slow down.) My primary goal in this transition was to create a future where the culture of my practice would continue, and the practice would thrive and grow. 

I received a call 18 months ago from my good friend, Dr. Lynne Gerlach. She said: “Mac, I want you to meet Dr. Shawn Luck.” Lynne went on to say, “I interview young dentists every day and I rarely meet people like him.” 

Shawn and I met, and I immediately understood what she meant. After a few more meetings, several phone calls with colleagues that knew Shawn well, and a thorough financial analysis, it was time for “Team Mac” to meet Dr. Shawn.  

Team relationships are critical to a successful transition. Shawn was met with enthusiasm from my team. That meant we could move forward with a detailed agreement that included terms of employment and terms of practice purchase.  

Shawn’s well-grounded character, confidence, enthusiasm, and intelligence were the factors that guided my decision. We both needed what each other had. I needed Shawn’s character, youth, energy, ambition, and strong desire to own a practice. He needed my clinical training, experience, and commitment to be a focused, consistent, and relentless teacher. 

I began communicating the transition with my team and patients a few months before meeting with Shawn. I mailed a formal letter to my patients that said that I saw three to five years of clinical practice remaining for myself. The letter began and ended with a big thank you for their loyalty, trust, and support. It let them know that I was actively looking for a young dentist to partner with who would continue to take care of them. This letter was a huge success with a thank you from almost every patient. A few patients began to schedule pending treatment that had been on their mind. 

We sent a second letter four months later to announce Dr. Luck. We began communicating about his arrival in person with enthusiasm and emailed a digital copy. The main takeaway here is that the transition immediately benefitted from consistent, focused, and abundant communication with all practice stakeholders about what we were planning and hoping for.  

We are in the middle of year one and I am focusing on mentoring Dr. Luck. We are hoping to play the infinite game as we create and pass on opportunities to the next generation. 

My hope for my Pankey Institute colleagues is you will surround yourself with great people that make you better. Build partnerships with them. Build trust at a deep level. Build community. Serve one another. Seek opportunities to pass on the values of relationship-based practice to the next generation. If you invite young dentists into a relationship and repeat the mentoring you received, we can all play this forward. Dr. Shawn Luck has already captured the spirit of wanting to do just that. 

By Edwin “Mac” McDonald DDS  

Effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. In Part 1 of this series, I described Phase One: The Ending Zone, the time during which a team is feeling the loss of the familiar and coping with uncertainty. In Part 2, I described Phase 2: The Neutral Zone, the time when a team is learning to embrace the change. Let’s look at what is likely to happen in Phase Three as a team continues to transition through change. 

Phase Three: New Beginnings  

During the third phase, the grieving is now passing or gone. This is when you and your team begin to identify yourselves (your culture) with “the new”—whether that be a practice ownership change, addition of more team members, merging with another dental practice, moving to a new office, updating your technology, adding a new niche service, dropping PPOs, or changing your operational systems (how you do things). The change is affecting their daily work and interactions with patients and each other. Adding to this burden is the tendency for patients to ask questions about the change. They also want to know about and feel connected to the change. Time and energy go into that additional communication. 

But, wonderfully, uncertainty is gone and things are clearer to the team members. Commitment becomes high again, and things start to feel “normal” again. People’s sense of competence is greater, they are able to easily identify the practice’s values to what is happening and how they are personally connected to them. When leaders and team members get to this stage, they can focus on the quality of the patient experience, and a new sense of commitment is felt. 

Strategies for Managing this Phase 

• Continue to talk with your team and individuals about how they are feeling about the change. 
• Acknowledge team members that have contributed to the changes. Doing this publicly cultivates trust and gives an example for others to follow. 
• Give individuals a part to play in sustaining the change and ensuring that it becomes the way of working or operating. People need to feel as though they are a part of it. Some leaders who have a hard time with delegating may need to practice letting go. 

Keep in Mind 

• Ultimately, the leader’s ability to communicate effectively will be the leading success factor in managing transition. 
• Approach other natural leaders in your practice – these are the people that others tend to follow or listen to , so get their buy-in early in the process. This will provide more support for you during the process. 
• Expect people’s performance to drop during the process and give grace to those that are not at their highest and best. Eventually, they will reach the other side and so will you! 

By Edwin “Mac” McDonald DDS  

Effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. In Part 1 of this series, I described Phase One: The Ending Zone, the time during which your team is feeling the loss of the familiar and coping with uncertainty. In Part 1, I also listed communication strategies to help them cope. Let’s look at what is likely to happen as you and your team continue to transition through change. 

Phase Two: The Neutral Zone 

During this transition phase known as the “Neutral Zone” or “Chaos Zone,” team members grapple with the loss of the old ways and the unfamiliarity of the new. Competency levels vary, and individuals may feel consciously incompetent or consciously competent. What do I mean by that? 

Some may feel they now know what they didn’t about the change and understand the value of it. They are ready to navigate the change emotionally. Others may feel they are starting to “get it” and deal with it. And others have become champions of the change and model confident competence in making the transition. Others will still experience confusion, stress, doubt or skepticism. This is when leaders need to step up and put on an encourager and coaching hat. 

Strategies for Managing this Phase 

• Discuss Strengths Utilizations: Encourage team members to identify how the change allows them to use their strengths differently and explore new opportunities. 
• Open Conversations: Lead them in conversation and empower them to create solutions as issues of the transition arise. Foster teamwork and purpose as you converse with them, so they feel vital to the practice. Encourage them to talk among themselves and lean on one another as a team because you want to retain that team. Express your appreciation for them navigating and embracing the change. You can take them outside of the office for a social meal that does not feel formal and they can feel connected even outside the office.  
• Provide Support: They will feel the need for information in order to feel secure. Ensure communication networks are open. Bringing in a transitions coach helps. Consider what HR resources you can make available to support individuals during this challenging phase. 

Remember, effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. 

By Edwin “Mac” McDonald DDS  

Change is inevitable, and dental practices often experience significant shifts. Whether it’s practice acquisitions, personnel changes, or technology updates, leaders must navigate these transitions effectively. Here are some key strategies: 

Clear Communication: Effective communication is crucial during change initiatives. Prioritize clear and frequent communication with your team. 

Recognize Transition Phases: Understand the different phases your team will go through during transitions. Recognizing these stages helps you address their needs appropriately. 

Feedback Matters: Despite its challenges, providing feedback is essential. Avoiding it can lead to decreased morale, reduced productivity, and increased stress among team members. 

Remember, effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. 

Phase One: The Ending Zone 

In the first phase of change, you are saying goodbye to the old and how people either individually or as a whole identify with the familiarity of it. People may experience denial, numbness, or resistance. The way each person feels and copes is likely to vary. 

It might feel like a significant loss to someone, so it is important that the leader understands how many people are affected at varying degrees of uncertainty and resentment due to the “loss” of what is no longer. Uncertainty and resentment create an environment in which team members may expend energy but not get much done.  

Recognize that this will be a time of loss and grieving for most. The key element that has the biggest positive impact is communication. I have walked several practices through ownership changes. One of them was a privately owned practice that was being acquired by a very prominent corporation. The initial response and reactions from the team members ranged from denial and numbness to resistance. Some employees who had been there the longest felt betrayed. These reactions varied from day to day, and week to week. What helped was constant communication. 

Before a change starts to happen, before the team sees signs of a transition coming, it is important to start communicating why and the transition that is likely to occur. Making employees feel secure and hopeful will reduce uncertainty and resentment. The more certainty you can give them about what will transpire and the future benefits they can expect the easier everyone will move forward, being productive and carrying forward the positive relationships you have invested in over the years. 

Strategies for Managing this Phase 

1. Explain the rationale for the change and the benefits of it. If you are able, elaborate for each team member or department. There needs to be a venue to express concerns or gain support to bring about the closure. People need to know that you care about them as individuals. 

1. Be transparent. Describe in detail what will change and also what will remain the same. Transparency is vital to cultivate trust. 

1. Describe and celebrate the success and values of the previous ways of working and identify how they will be enhanced by the change. 

As long as we, the leaders, recognize their feelings, we have the opportunity to effectively help our team move to the next phase, so they do not stay in the ending zone too long. 

By Edwin “Mac” McDonald DDS  

Change isn’t just about external circumstances; it’s also an inner evolution. We go on a transformative journey, and our reflections as we go touch upon our intention and legacy, our personal identity amidst the change, and decisions we make as the change unfolds.  

Challenge 1: Intention and Legacy 

When facing change, having a clear intention is like setting the compass for your journey. What legacy do you aspire to leave behind? Aligning your actions with your deeply held beliefs ensures congruence between your intentions and outcomes. But stress may cause you to move away from your most deeply held beliefs. I’ve witnessed this happen, just as I’ve witnessed deeply held beliefs guide what happens. 

Challenge 2: Personal Identity Amidst Change 

The question “Who do I want to be during this transition?” is profound. It invites introspection. Consider how you want to show up for yourself and those around you, especially those who are most important to you. Authenticity matters. 

Challenge 3: Listening and Accountability 

Change often involves decisions. Whose voices matter? Listening deeply to trusted individuals—those who respect and understand you—can provide valuable perspectives. Forming a leadership team of diverse viewpoints helps guide you toward success. 

The Importance of Values During Dental Practice Mergers and Acquisitions 

Many private dental practices are being acquired by large partnerships in 2024. These transitions have tons of potential and profit associated with them. Associated with these transitions are complex changes for the practice owner and team members…expanded ownership, more complex organizational structure, new operational systems, and a distancing of some decision making. They also come with the unknown of who will be your future partners after the next sale of the organization. Are you prepared for all of that?  

Preparing yourself and your team is essential. On the front end, asking every possible question including questions about the partnership’s core values, how they are integrated into the day-to-day operations, and communicating the importance of that to you and your team is essential to long term success. These questions and expressions are an attempt to examine the congruence and compatibility between you, your team, and your new partners. 

I am witnessing several friends transition successfully to one of these new partnerships. The common factor I observe is that each dentist has great self-awareness and received very strong assurance that they would retain autonomy to continue to practice according to the most deeply rooted values. I also observed that the large partnership was very stable with excellent systems and had high quality leadership.  

My father often told me: “The person that you have an agreement with is more important than the agreement itself.” In other words, a person of strong character will find a way to honor the intent of the agreement regardless of the specific circumstances of the moment. Values have longevity. Circumstances come and go. 

I have also witnessed an abandonment of strongly held values as an organization was going through the painful changes of decline. In abandoning their values, stakeholders were hurt and distanced themselves. It intensified and accelerated the decline. Values matter. Character counts. Clinging to our core values in times of change or decline will increase and accelerate recovery. There are countless Fortune 500 case studies to support this idea. 

Another Example of Values in Transition from My Life 

Finally, I want to leave you with a case study from my church, The Village Church. We had become a multi-site church in response to the demand of many people attending our main campus. As it grew, our leadership became painfully aware that it was not fulfilling our mission and it was not consistent with our closely held values of community and individual relationships. Over a period of several years, each church was given the opportunity to vote on becoming independent. They all voted around 95% in favor of the change. We gave away around 40 million dollars of real estate, equipment, furniture, and other assets to all of the churches.  

Today, the new independent churches are thriving as is our main campus where we attend. The decision was in conflict with everything that is happening in our business and church worlds where there is constant consolidation and scaling. However, the decision was consistent with the values that drive the purpose of the church. The change created multiple thriving churches that are serving their specific communities and growing people and their impact on our world. 

Change can be difficult even when it has benefits for everyone.

Some people are simply averse to any kind of change. As a result, we may encounter pushback from staff while attempting to initiate changes in protocols, practice policies, or practice systems. Anticipating and preparing for potential negative feedback is the best way to defuse staff concerns and smooth the way for needed change.

There are two prerequisites to navigating change successfully. First, the staff must believe that we have their best interest in mind. This is a matter of trust that is developed over time. Secondly, the staff must feel safe in offering unfiltered feedback before and during the change initiative. As the leaders of our practice, we are responsible for creating a practice environment that makes both of these essential prerequisites possible.

The following suggestions will prove helpful in developing a change strategy.

1. Be prepared.

Before introducing any change initiative, we must have clarity regarding the necessity and advantages of the proposed change. Painting a clear picture for the staff that includes the specifics and anticipated benefits is an essential first step. Anticipating the staff’s concerns and potential questions as well as our response will help in creating a smooth presentation. Set the expectations for how everyone might feel throughout the different stages of the transition, for example: resistance, frustration, skepticism, excitement, relief, and high energy.

2. Seek early adopter support.

Identify those people that are likely to support your ideas and seek their help in moving a change initiative forward. Most likely, these will be the leaders of the clinical and administrative staff. Collaborate with them in creating the best possible change model. By allowing them to contribute their input, they are much more likely to buy into the concept.

3. Present the change Initiative with humility and transparency.

“My way or the highway!” is the worst possible way to present any significant change. We gain acceptance by being as transparent as possible and patiently addressing staff questions and concerns. Seek collaboration and request input. Be more coach-like by using open-ended questions to draw out their underlying concerns, for example, “What concerns you about this?” and “What would need to happen for you to feel better about this change?”

4. Ask for their help.

There is something about asking for help that creates buy-in. Let your team know that you cannot achieve the desired result without their help. If the intended change is experimental in nature, let the staff know that it is reversible if the desired results are not achieved. Ask them how they think that they can positively contribute and re-affirm how important their role is in the process.

5. Consider scheduling more frequent staff meetings during periods of change.

Depending on the nature of the anticipated change, more frequent staff meetings may be necessary to address concerns and problems that may arise. For example, changing practice computer software seems to be problematic and frustrating for both clinical and administrative staff. Allowing more time to address the technical issues and frustrations of the staff has proven to the most effective means of addressing both issues.

6. Check in frequently with the staff:

Although checking in with our staff should be a common practice, it is most beneficial during periods of change. Simple questions like “How is it going?” or “What do you need from me now?” are a quick and simple way of letting your staff know that you recognize and appreciate their efforts in making the change a reality.

7. Celebrate the staff’s accomplishment:

Whenever the change is fully implemented there should be time for celebration. Consider doing something special for the team as a means of recognition for a job well done. An appropriate bonus and/or a special event away from the office are ways of expressing gratitude. Never pass up celebrating a team’s successful effort in achieving change.

All of you have heard me quote the famous proverb: “Guard your heart for it is the wellspring of life.” It is great wisdom. It is also very practical.

To remain healthy and safe, our “hearts” need to be protected. We need rest, downtime, and peace of mind. We need a life that gives energy as well as demands it. We need people around us to remind us of who we really are and what is important. We need to say yes to what is most essential and no to the things that aren’t essential.

In recent weeks I have heard a podcast interview of two people on the other side of burnout and a forced six-month sabbatical. I have had multiple conversations with dentists and dental teams that are overwhelmed and disillusioned. In addition, I have listened to a sad story of a friend who started behaving carelessly and out of character secondary to the fatigue and frustration of unrelenting pressure and career demands. He just wasn’t himself.

Many of you are running full speed, meeting the relentless demands of your practice as well as pursuing teaching and writing opportunities. The question I pose to each of you is “Which opportunities and demands are the most important—essential, to you and your unique life?”

We needlessly increase stress when we compare ourselves to others and think we should achieve what they are achieving. We create pressure on ourselves when we feel we should say yes to others’ requests for our energy and time. In contrast, we honor health when we pause to consider what is best for ourselves and recall our personal priorities.

Our purpose, capacity, energy, desires, loves, dislikes, and circumstances are unique to each of us and unlike those of anyone else.

I have listened to and read about people, who have been through periods when they struggled with their physical health, energy, and emotional state. To recover, they found that vacations were only a part of the solution. They had to find a community of peer support. They had to find ways to make each day healthier and more productive. They had to intentionally create “white space” in their life, place only the most important events on their schedule, and develop a respectful way to say “no” or “not now.”

Saying no is difficult for most of us but is required to live our one short life on purpose. In addition to living on purpose, there are other essentials for wellness. I’m thinking of:

• Resilience—Restoring physical, mental, and emotional strength often requires more rest, exercise, and recreative interaction outside of work with family and friends to reframe perspective.
• Meaningful work—Do what you love at least 50% of the time.
• Energy management—Pace yourself, take breaks, enjoy the “flow” that occurs when you are highly engaged in your work, and respectfully rely on your leadership team to help you maintain a schedule that prioritizes the most important activities.
• A peer-to-peer community of support—We have the human need to give and receive empathy, understanding, wise counsel, sparks of creativity, and encouragement.
• Dedicated time to recreate the self—Think in terms of daily, weekly, monthly, and seasonal-yearly rhythms. Create time to regularly relax, relate, and play outside of dental practice. Like a surfer running to the beach when the waves are perfect, allow yourself some flexibility to embrace spontaneous opportunities.
• Spiritual nourishment and expression—What nourishes the most foundational part of you? Seek the goodness that elevates your soul and feed on those nutrients. Celebrate that goodness with gratitude.

We talk a lot about balance at Pankey, and we do this because it is all too easy for healthcare providers to run out of steam…to run out of oxygen. Like the airline steward says, “Put on your emergency oxygen mask first before assisting others.”

Our positive thoughts, emotions, words, and actions—our joyful hearts, are what make it possible for us to be a wellspring of understanding, compassion, and love. We need to protect our hearts to enjoy our work and improve the wellness of everyone around us.

Ancient wisdom has taught us that as “Iron sharpens iron, so one person sharpens another.”

I love education and learning. As a long-time student and faculty member at The Pankey Institute, I am challenged by and learn from all of my colleagues every time that we gather for an educational event, whether in person or online.

Some of that learning is from the program. Much of it is from one another as we discuss and share what is pertinent in our practices and careers and how we apply what we are learning. In short, these experiences improve my performance as a dentist, leader, and practice owner.

The grid of improving performance according to Todd Herman, performance coach, looks like this:

1. Observe & measure past action (Data from yourself & others)
2. Reflect on that data and the feedback from other key trusted people
3. Reflect / Visualize on the future, especially with key trusted people
4. Design Future Action (Experiments) & Acclimate to this new behavior
5. Repeat

This formula for change is almost always best done with other likeminded people who are on similar journeys. They can give you encouragement, feedback, perspective, resources, & connections.

Even more importantly, it can be very therapeutic to hear the stories and experiences of others to realize that you are not alone in your challenges and the ups and downs of attempting to do something difficult. It is simply reassuring to come face to face with the humanness of friends and colleagues that you respect. It makes our own human frailty much easier to accept and can give us the courage to try again and again.

Keep in mind that every thriving and durable organization has gone through countless failures in route to accomplishing their vision.

The highest performing individuals in any endeavor are working in a team of likeminded individuals who are seeking to accomplish similar things. Those individuals have a much-expanded capacity to understand one another’s challenges and needs. This expanded capacity is often the difference between success and failure.

Isolation is the enemy of progress. Don’t let it determine your possibilities.

Seek out ways to include shared experiences in your personal and professional development by joining like-minded groups like Pankey study groups, group masterminds, and group coaching programs. You even can create groups of your own to surround yourself with positive energy.

Once you have experienced the power of shared experiences like these, you will see the difference from working in isolation.

In previous parts of this series, we looked at leadership, the commitment it requires, and the first three of four universal promises of leadership. The first promise was the promise to set a clear direction and create meaningful work for the organization you lead. The second was the promise to engage all stakeholders and hold them accountable for performance. The third was the promise to ensure your strategies, systems and processes facilitate focus and execution.

Now we will look at promise four.

The Fourth Universal Promise

You will lead effectively by maintaining relationships of trust to achieve and sustain results.

Why would someone want to follow you? The answer is trust. In order to keep the first three promises of leadership, you must value the priceless currency of relationships built upon trust.

Trust is one of the most difficult concepts for sociologists to describe and define. Two exceptional thought leaders on trust in our culture said this:

Steven M. R. Covey: “Trust lives at the intersection of character and competence.”

Rachel Botsman: “Trust is a confident relationship with the unknown.”

Becoming Trustworthy

Because trust builds confidence and frees up hearts and minds to commit, it forms the basis for a thriving practice culture and draws out the inherent potential of your team (their individual talents, energy and passion). Traditionally, I focused my energy on building trust.

Rachel Botsman proposed that in creating a culture built on trust, we would be served better by focusing on becoming more trustworthy. Rachel’s idea hit me hard. It was spot on. Trust demands the best that we have to offer. Perhaps, it demands all that we have to offer. It is the secret sauce of why people decide to surrender themselves to the great vision you offer.

If you take one thing away from this, take away a renewed devotion to becoming a more trustworthy person. You will likely find that your aspirational identity shows up with more clarity, courage, conviction and compassion.

And So, Back to Clarity

People follow leaders they trust by surrendering to a compelling vision that engages their hearts and minds. Others will trust your vision if you are clear, courageous, have conviction, and are compassionate. These are the building blocks of a shared (collective) style of operation and leadership in which each individual in the organization contributes, benefits and leads. This is relevant to your patients (clients) as well as the team you lead.

As I end this series, I leave you with my belief that developing and elevating your leadership competencies is the best investment you can make. Effective leaders who deliver on the four universal promises of leadership create strong cultures that outperform average cultures by multiples, not percentages, in every measurable dimension over time.