Enabling Your Team to Bring Their Best to Collaborative Problem Solving

One day, several years ago, our dental practice was facing an imminent snowstorm. We could see that the storm would play havoc with our professional and personal schedules. Decisions had to be made about our response. Should our plan be the same as the last time the office had been closed by weather? People were beginning to get nervous about how this was going to play out. A clear decision and well thought out plan were called for, but there was no one right answer. We needed to quickly make a collaborative plan (an agreement) to distribute power and communicate with our patients.

Planning for Contingencies

As in the case of the imminent snowstorm, I believe there are frequently practice decisions to be made for which there is no one right answer – no one strict plan that we can establish ahead of time and not expect to modify. Many variables need to be considered each time as the circumstances of owners, team members and patients change.

Collaborative planning takes “high engagement,” insight and practice. If you have preplanned team agreement on how to handle special events, you are ahead of the curve, but you will find it helpful to visit these agreements periodically, and you can anticipate you may need to collaborate “on your feet” when contingencies arise.

Role-Playing

Last year, at “Inspired Team Facilitation” with Joan Unterschuetz, we did role-playing that helped the team develop a collaborative plan for which every member of the team had buy-in and agreement. Role-playing has helped our team huddle in an emergency to clarify what needs to be done, who can best take the lead on each task, and acknowledge the compelling reasons why we are doing this as a team. It also has been helpful to prepare each department leader to motivate team members who will help them make sure we effectively communicate with patients, assure patients, and shut down if we need to do this swiftly; then in reverse, open up the practice and zero in on what needs to be done to open the schedule and reschedule patients as priority dictates.

Agreeing to Agree

From the earliest time possible, work on building a culture of agreement around:

• Team meetings with high-engagement of all stakeholders
• Understanding problems to be solved and why they must be solved
• Respecting all team members who would be affected by giving them a voice in the planning
• Understanding that department team leaders will be accountable for execution
• Coming to joint agreement and celebrating that fact at the time the agreement is made

The goal of these “coming to agreement” exercises (even about the small stuff) is to set a standard of collaboration that is in alignment with your practice philosophy. When an emergency arises, the team knows from experience that they can quickly collaborate and come to agreement on a plan of action…even when there is no one right answer and you need to kick start action immediately. If your collaborative meeting goes off track, the dentist as practice leader needs to remind everyone of the compelling reasons why they need to come to agreement now.

Can’t Involve Everyone?

Sometimes involving everyone is not possible in a crisis, but the goal is still the same. The goal is to be on the same page and united in decisions. All team members need to be informed of decisions, so if you and your department leads need to quickly create an agreement, the leaders will report back to other team members for implementation and keep them in the loop. Keeping everyone in the loop honors them and combats the human response of making false assumptions and experiencing energy-consuming emotions. In a culture of agreement, there is less opportunity for negative energy to accumulate—less “drama.”

When asked about The Pankey Philosophy, L.D. Pankey famously responded, “What do you mean when you ask me about The Pankey Philosophy? I am not familiar with the document, although I do recall writing an essay entitled A Philosophy of Dentistry by L.D. Pankey.”

Most dentists are comfortable acknowledging that L.D. Pankey was a great philosopher and that he was the first well-known philosopher in dentistry, but most dentists don’t think of themselves in a similar fashion; rather they like to think of themselves as being prototypes of practicality. This is why most dentists never even think about the value of writing a Philosophy Statement.

Just what is a philosophy statement?

A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A great example of a validated philosophy statement was how Wilson Southam and the Group at Cox operated a number of years ago. Cox was a progressive dental equipment designer and manufacturer located in Stony Creek, Ontario. Wilson Southam was an investor, a co-owner, as well as the philosophical leader of the company. Cox had developed a philosophy around which all of its equipment would be designed – a concept is called, “the computerized dental cockpit,” fashioned similarly to how a fighter pilot might operate. And Cox preferred to sell its equipment to only those who understood its philosophy…only to those who understood the “why” behind the “how” and the “what.” Cox believed in this so strongly that it held workshops centered around its philosophy at Stony Creek.

A philosophy statement can also be called a “core beliefs statement.” A good example of a philosophy statement is the Nicene Creed, co-authored after the center of the Roman Catholic Empire was moved from Rome to Constantinople. At that time, Christianity was in a fractured state, with many different sects, and with many different belief systems. The Nicene Creed was co-created by the Roman Catholic leadership with the intention of having it function as a unifying document around which everyone could agree, so that the church could again move forward.  It states, “We believe…. We believe.”

It’s a well thought out basis for behavior.

So, a philosophy statement represents a statement of beliefs, which is so basic and so fundamental that it provides a rational and comfortable basis for you and your care team to determine what it is that each member of a care team should do, as well as what they should choose not to do.

William James was a physician who lectured at Harvard in the late 1800s on Philosophy and Psychology. He is considered to be America’s first psychologist and was thought of as a “pragmatic philosopher.”  In this regard, James said, “There is nothing more practical than having a personal philosophy.” In the case of dentistry, an applied philosophy (validated philosophy) is practical as well, as it naturally leads to an organically-driven team, deep in mission, and high levels of personal autonomy and interpersonal trust.

A philosophically-aligned team is essential for the creation of a philosophically-driven community.

Barkley a year or so before his untimely death in 1977, said during an interview with Avrom King said: “If I had one wish that could be granted, it would be that every dentist would take the time to create a written philosophy statement.” Let’s talk about why Bob would make such a statement.

The creation of a relationship-based/health-centered practice is a perfect example of the creation of a philosophically-driven community, with the word community being used as a reference not only to the creation of a care team, but also to the patients of a practice, its associated suppliers, mentors, and facilitators. All of the members of this community are philosophically aligned through either careful selection, development, or both.

A community of this type begins with the creation of a care team which has co-authored a written statement of philosophy. This is because you cannot have a true health-centered dental practice without a philosophically-aligned care team which listens well, are true helpers, and who facilitate healing in each other, as well in those with whom they come in contact. One or two people acting alone, simply cannot apply a practice philosophy as others, who are in contact with patients, will create too much confusion and mixed messages in the minds of the patients.

A personal philosophy statement starts the ball rolling.

The dentist might begin the process of thinking through a personal philosophy statement by answering these questions:

1. Who am I? (What are my values and core beliefs?)
2. Who do I want to become? (How do I want to see my life unfold?)
3. Why do I feel this way? (What is my personal purpose in this life?)

To develop your philosophy-driven community (care team, patients, suppliers, mentors and facilitators) the dentist next shares his or her personal philosophy with care team members and leads them in co-authoring a practice philosophy statement.

Remember: A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A co-authored and applied practice philosophy statement produces multiple benefits.

Here are four concrete benefits of co-creating a written group philosophy statement with your care team:

1. It will establish a standard of behavior for everyone to live up to and aspire towards.
2. It will allow for that standard of behavior to be used in a situationally appropriate fashion, and therefore not be used dogmatically, as everyone recognizes that every person and every situation is unique.
3. It will function as a centripetal force…as a kind of principle-centered psycho-social glue which will hold the care team together during times of change and challenge.
4. It will function as the foundational document out of which a practice vision (where are we going long-term) and a mission statement (how we will get it done) can evolve.

How many of us have had a patient call who was really upset with us or our office?

The other day, my office manager came to me and said, “Mrs. Jones called and is super upset.” We had just completed an upper and lower reconstruction. Due to the complexity of the case, I opted to place the lowers in permanently, but I placed the upper in with temporary cement, in case there were any modifications that she wanted made prior to finalizing the case with permanent cement.

My office manager continued, “her new bridge is loose, and she said she is going to get an attorney because she paid a lot of money for this and it is already failing.” I told my office manager it was in with temporary cement, and the patient must have forgotten that I told her this, which in fact was the case.

I asked my office manager to bring her in immediately, and I would take care of it. Mrs. Jones presented, and I greeted her with a smile. I said, “I will take care of you immediately.” I proceeded to remind her that the upper arch was in with temporary cement, and she said, “Oh yeah! I forgot about that.”

After allaying her concerns and asking her if she had any difficulties over the last month, to which she said no, I opted to place the restoration on with permanent cement.

I reminded her that there was one other section, which still needed to be put in permanently, but I would do this in the future, since I was unable to tap it off at the time. (Sometimes, when the seal is really excellent, even temporary cement will hold very well.) I reassured her that all should be well and to always remember that “We’re here for you!”

This can be one of the greatest statements you can make to a patient. So often they feel “discarded” once their work is completed, and you “have their money.” Or they feel like they are being bothersome if they contact you to make any adjustments. They feel that any issues they are having will work themselves out, or they will just get used to it.

I remind them that we are always there for them and want to make any needed adjustments or corrections to the work we’ve done before any other problems arise. We want to be proactive in taking care of their issues and not be reactive. Often it is a very simple correction.

Letting a patient know “We’re there for you” can go a long way to creating a patient missionary and can be one of your greatest practice builders. “We’re there for you” is one of my favorite messages to convey to my patients, and I repeat it often.

The steps I’m outlining here are not a list of transactional procedures. Rather, they are transformational life-changing concepts. My hope is that you will be as courageous and as excited to learn about how to be a better communicator as you are to learn about implants or smile design. If and when you do take the plunge, get ready to work hard and at the same time experience a more joyful and fulfilled life. Everyone in your life will benefit, and your practice will flourish. As I wrote in Part 1 of this blog, as a result of improved communication in my practice, an interesting thing happened regarding the practice income. Instead of “me chasing it, it chased me.”

Take a look at yourself with DISC Personality Assessment.

The first step to developing your communication skills is to take an up-front look at yourself. This can be a difficult step as you dive into investigating who you are and why you do the things that you do. One of the most beneficial things I did to help myself in this area was to take the DISC Personality Assessment. This detailed report helped me better understand myself, my personality style, and my motivation. Not only did it provide me with new information about myself, it gave me hope that yes, in fact, I could learn how to relate more effectively with others.

Gain insight into the personality styles of your team members.

Once I understood my personality style, I was then able to better connect with my team. I had each member of the team take the assessment to help them discover for themselves who they were and how they communicated with each other. This exercise proved to be an eye-opener for all of us.

This new personal insight was like an eyeglass prescription change. Instead of seeing each other’s faults, we were now able to more clearly see each other’s strengths and work together more harmoniously. Honesty, authenticity, and accountability became part of our daily lives. When conflict arose among us, instead of “burying it,” we resolved it.

As a team, we were able to see each other’s “uniqueness” rather than our “strangeness.” At this point, dentistry became more fun and productive; the practice income or “numbers” rose dramatically. Keep in mind that all this growth occurred before tackling the “transactional” details like appointment scheduling or collections.

Get to know and “connect” with your patients at a deeper level.

Next, we set out to better understand our patients: their needs, their wants, their fears, and their desires. We embraced the thoughts of Theodore Roosevelt who said, “People don’t care how much you know until they know how much you care.”

A few things we did to better connect with our patients included: being aware of our posture, our tone of voice, and the words we shared. We had training and developed our listening skills, asking more questions and talking less. Other changes we made included doing a thorough new patient exam and always keep the conversations focused on the patient. As Dale Carnegie would say, we became “interested” instead of being “interesting.”

Collectively, we agreed that we would not talk about ourselves unless the patient asked us. Additionally, we embraced the use of positive language. The phrase “no problem” was banned from the office.

Continually develop your “co-discovery” skills.

As a team, we committed ourselves to continuing education, seeking excellence in both our technical and communication skills. Our desire was to better understand the individual needs of each of our patients with the goal of helping them achieve optimal dental health.

We valued “helping our patients see what we were seeing.” We embraced the idea of “co-discovery” by asking thoughtful questions and involving them more in their dental examinations and treatment discussions. For example, we used the phrase “gum health measurements” instead of gum disease or gum pocket probing.”

We took intentional steps to make sure that our patients felt well cared for and well informed. We worked within our shared values that included timeliness, cleanliness, politeness, and technical excellence. “Inform before perform” and “quality is not a variable” became an important part of our practice culture. And when situations didn’t go as well as we had planned, we talked about it using AARs or “After Action Reviews,” a system developed by the U.S. Army.

Fine-tune systems after learning how best to work together.

Once we figured out who we were as individuals and how we could best work together as a team to serve our patients, we then started to delve into and fine-tune our systems. A sampling of some of the areas we developed included–patient greeting and check-out, telephone skills, collections, scheduling, morning huddles, staff meetings, job descriptions, and a personnel policy manual, to name a few. As we became better communicators, our office became a fun and more productive workplace. And as a side benefit, at the end of our work day, we had energy left to share with our families.

Let everyone know how much you care.

I’m asking you to be contrarian in your thinking. Instead of looking solely at the transactions of your practice, focus first on how you communicate with yourself and with others. And when you do, your life will never be the same. When you become a great communicator, everyone wins–you, your staff, your patients, your family, and your friends. And remember the quote from Theodore Roosevelt, “People don’t care how much you know until they know how much you care.”

On October 1, 2018, I retired from my solo private practice of twenty-eight years in the rural town of Wolfeboro, NH. During my years of practice, I sought continuing dental education from organizations like The Dawson Academy and The Pankey Institute to advance my technical skills. At the same time, I was a student of communication reading numerous books by authors like Travis Bradberry, Dale Carnegie, Stephen Covey, Kerry Patterson, and John Maxwell. In 2009, I received a master’s degree in strategic communication and leadership from Seton Hall University. My story is one of joy, fulfillment, and financial success.

For twenty-eight years, I practiced dentistry without the influence of dental insurance, never participating with any PPO’s or Premiere programs with set fees. And in spite of that, my practice thrived. Was it because I was good at my craft? Maybe. I attribute my joy, my fulfillment, and my financial success to the deep relationships I fostered not only with my patients, but also with my staff.

An Unhappy Time in My Life

Early on in my career, I admit that I focused too much on the “numbers” or the financial side of my practice. My mood was often like a rollercoaster. When the numbers were “up,” I was “up.” When the numbers were “down,” I was “down.” In addition, patients frequently refused my treatment recommendations. It was an unhappy time in my life, and I was heading towards burnout. I was often angry and frustrated making everyone in my path miserable.

On occasion, my wife would tell me, “I know that in your heart you mean well, but sometimes your delivery stinks.”

I knew I couldn’t continue this way, and so with some trepidation, I set out to change. I knew this self-examination would be humbling as I took a hard look at myself, my poor communication, and my poor leadership. I knew that before I could lead my staff, I had to get myself straightened out.

A New Focus on “We”

In my searching, I learned that “you can’t give away what you don’t own.” Through lots of study and reflection on my less-than stellar communication skills, I was able to change my “me” focus into a “we” focus. Instead of my usual focus on money or “the golden eggs,” I started to focus on my staff and my patients, the “geese that laid the golden eggs.” And as a result, an interesting thing happened regarding the income of my practice. Instead of “me chasing it, it chased me.”

Lots of the practice management courses today emphasize the transactional or money aspects of running a dental practice: scheduling, collections, website design, marketing. There is no question that these areas are important and are necessary aspects of running a dental practice. However, in my opinion, lasting change and growth in a dental practice starts with the dentist’s thinking and his/her ability to communicate effectively.

In Part 2, I will outline some transformational life-changing concepts with the hope you, the dentist, and your team will experience the benefits of improved communication.

Lin-Manuel Miranda concludes his iconic musical Hamilton with a piece titled, “Who Lives, Who Dies, Who Tells Your Story.” The song causes the audience to reflect on why certain people in history are remembered, while others are forgotten. It draws them in and includes them in the drama to discover personal meaning through the experience.

L.D. Pankey knew and told his story. Others told it too.

One of my favorite quotes from Peter Drucker is, “The aim of marketing is to know and understand the customer so well the product or service fits him and sells itself… The aim of marketing is to make selling superfluous.” When I first read Drucker, is was a true “a-ha” moment for me; it completely shifted my paradigm about marketing while simultaneously connecting it to L.D. Pankey.

The light came on. L.D. Pankey was one of the greatest marketers in the history of dentistry. And he achieved it by first knowing who he was, and then clearly and consistently communicating it to the world. In other words, he was very good at telling his story, and it was through that narrative that others learned, grew, and our entire profession benefited.

Clarify your story to tell it well.

If we are to thrive in this rapidly-changing marketplace, our own compelling story must be known. Our story must be told by ourselves, by our care team, by our patients, and others. It’s ultimately up to us who will tell our story and what they will say. So, how do we go about telling our story? First, we must clarify our philosophy and vision to the point that they are “in our tissues” … to the point that we can’t NOT talk about them. Put your story out there with enthusiasm. The rest will follow.

It’s critical to have discussions with team members about what behavioral influence entails.

Behavioral conversations are efforts with patients to encourage health. They involve discovering current perceptions and encouraging choices for improved health – especially dental health. Considering today’s understanding of the oral-systemic connection to overall well being, we owe it to our patients to continually offer them the opportunity for health.

Avoiding the BS Trap

As such, it is essential to consider that social conversation is not behavior conversation. I call it the BS trap. Yes, there is a social component to behavioral. Connecting on a personal level is critical.

As Robert Cialdini says in his book “Influence,” people like doing business with people they like. In a relationship-based practice, full engagement with patients is critical. Engagement increases the likelihood of being listened to and influencing healthy behavior.

AND, we must avoid the BS trap. Conversations need to be about them, not us. Conversations to influence values and behaviors need to be about patients. So, how do you know when social conversation has slipped into BS?

Encouraging Meaningful Discussion With Patients

The key is to realize when you are interjecting yourself into the conversation. Avoid personal words: I, me, my, mine, us, we, our, etc. It is not about us – our story – but about the patient, the patient’s story, the patient’s health values, and their objectives.

Avoid:

• “I went there …”
• “When I did that …”
• “My experience …”

How do you shift from social (the starting point in conversations) to behavioral? Have one or two powerful questions to shift the conversation:

• “How are you feeling about your health?” (Perhaps more powerful than: “What has changed in your health?”)
• “What are you doing to enhance your health?”
• “How are you taking good care of yourself?”

Then “Stay in the Question.” Continue to follow the thread they share. Remember …

Their first response is not the answer. It is their first response.

Questions are NOT the key. Listening is. Go below the surface.

• “What else?”
• “What do you feel?”
• “Say more about that.”
• “Do you have any ideas?”
• “Tell me more about …”
• “Yes, I understand.”
• “I’m glad to know that.”
• “Thank you for sharing that.”
• “Is there anything else?”
• “What is your suggestion?”

These questions work both ways. Teaching you to turn the focus onto the patient and teaching the patient to communicate their needs more clearly.

Have you read this article from team behavior expert Mary Osborne on understanding a hygienist’s true expertise?

Once you want to be a leader and you know yourself well enough, you’re ready to move on to helping others effectively. We have already taken a look at the first two parts of Dr. Rich Green’s leadership definition:

“A leader is a person…

Willing and Able

To influence behavior;

Their OWN FIRST

Then others

To a preferred future.”

-Rich Green, DDS

Leading Others

Building on our willingness and ability to influence behavior (our own first), now we will talk about leading others. It is by leading ourselves well that we “earn the right” and have the highest capacity to lead others.

I’m going to use the four essential areas I discussed in the previous blog as a framework for discussing our leadership of others.

Let me start by saying that we can train someone to assist us or do a great job greeting our patients, or to do stellar financial arrangements, etc. But when we hire, what we really want to look for is someone who has similar values and is inspired by our vision and purpose.

If we are clear about our own values, vision, and purpose/mission, which means we have done our own work to get clear, we will know if our prospective employees are a good fit by asking questions.

If we already have employees and are in transition, meaning we are changing our practice and/or doing work to get more clear on our values (what the practice is about and where we’re headed), we have an opportunity to be in constant conversation with those around us.

The people around us – in this case our team, specialists, lab technicians, and patients – want to know what we believe in and what we stand for. People are hungry for connection on that level.  

Influencing Others

Now let’s look at the four areas I discussed previously and how they help us in our ability to influence others:

1. Our competency and skills.

What we are doing and how we are doing it models for our team what we expect and what we are about. When our team feels competent and skilled, they feel confident and pleased about the quality of their work.

Especially in a high level practice, taking our team to CE and taking the time to work with them on their technical skills as well as communication skills is vital to their success. Most of us know this and probably do this pretty well already.

2. Knowing how we are wired helps us understand how others are wired.

The patterns, beliefs, and behaviors are not the same, but knowing that we have all been programmed and that this is part of the human condition helps us have compassion and a deeper understanding of how people tick.

Remember, most of this programming we were either born with or was “installed” from 0-7. In some way, even if it doesn’t make sense, we all do what we do in order to feel safe, loved, competent, and a sense of belonging. Knowing this gives us compassion for why people do what they do. 

3. Emotions

Being able to be with our own emotions allows others to be with theirs. As we model this and help our team learn it, they will increase their capacity to be with their own emotions and those of others.

Empathy is one of the most important skills to have as a healthcare provider. We have the opportunity to be the leader of this in our practice and in our life. When we work with humans, we work with their emotions and experiences (whether we like it or not).

4. Knowing and owning our truth.

This is an empowered and empowering place to stand. When we own and are clear about our truth, our desires, what we stand for, and what we are about, we can lovingly set boundaries and make clear decisions.

This also helps us honor others as they stand for what they believe. Once we are clear about these things for ourselves, we have an opportunity to share them with our team so that we are all moving toward the same preferred future, which we’ll talk about in the next blog.

Stay tuned …  

The ABCs of dental office organization tell us how to prioritize our time, energy, and resources so that we can provide the best care possible. In Part 1 of this series, I discussed the definition of the three main ABCs: administrative tasks, behavior tasks, and clinical treatment.

Read on for how to implement an understanding of these principles into your practice efficiency protocol:

Dental Office ABCs: Prioritizing

How can you get better at organization and adherence to the ABCs? Here are three steps – 

1. Ask each team member to list all possible administrative tasks. This includes tasks they do not need patients to be present for or where they need uninterrupted time for maximum efficiency. You should generate your list as well.
2. Next, have them create a list of behavioral tasks.
3. Finally, have your team members delineate their clinical processes. This should lead to discussions on tray/room set-up, treatment preparation, and efficiency.

These lists can be developed by each person in the office prior to a staff meeting. Then, in a team meeting you can discuss each person’s “top 3” and consider periods in the schedule throughout the week where each team member can carve out A – B – C times.

A Productive Daily Conversation

For example, our business associate at my dental practice sets aside Thursday morning for uninterrupted “A” time to catch up on delayed insurance claims, payment calls, etc. This means our relationship coordinator/primary chairside rotates to handle incoming calls and our assistant chairside rotates to chairside duties. Everyone loves the cross-training and variable challenges.

The coordinator answering the phone does not need to be under pressure. If a call comes in for the business associate, they simply state, “Sue is busy right now. May I have her return your call in an hour?” or some such reassurance.

When done well with open respect of each person’s priorities, this can evolve into a daily conversation. For example, the relationship coordinator may ask for uninterrupted time to call a certain patient about emotional support or a referral to a specialist. The business associate may request time to call an insurance company.

Have fun with it. Your approach will evolve and remember that mistakes are the fruit of great progress. Celebrate/laugh at them. Keep at it and the ABCs will change your practice.

Every successful dental case begins with a conversation. 

A Case of Great Dental Expectations

“So what should we do next?” my patient asked. I rolled my chair beside him, excited about the challenge of achieving his preferred future.

I looked him in the eye. “Do you really want to know?”

“Yes!” he said.

I responded, “I don’t know right at this moment. However, may I take some models, photographs, and study your mouth? Taking time to study your mouth with this information will allow me to develop viable options for you to decide what you would like to do next.”

This conversation came after my patient lost #12 and had an implant placed. He had never asked this question before and his past dental history was single tooth dentistry.

Once the records were gathered, I spent some time in my office lab opening up his vertical according to the principles that Mike Fling teaches in his worn dentition course as well as the Pankey restorative footprint and clinical sequence taught in our Essentials 3 curriculum.

From my patient’s diagnosis, I discovered that he had two options: ortho plus restorative treatment or restorative treatment without ortho. Space was needed and form and function would definitely improve with improved space. We met for a conversation.

We looked at photos and models, then discussed the options. He explained to me that he would prefer to do the restorative plan without the orthodontics. My team and I invited him to experience a mock-up of the potential outcome from a wax-up by our own John Lavicka of Dental Ceramics. The patient immediately replied, “Let’s do it!”

Even though the patient understood why I wanted to do the orthodontics, he wanted to attempt treatment without it. I was happy to move forward with a restorative-only treatment with one agreement: If it did not work, I could initiate orthodontics. He agreed.

To be continued …