In previous parts of this series we looked at leadership, the self-commitment it requires, and the first of four universal promises of leadership. The first was the promise to set a clear direction and create meaningful work for the organization you lead.

The Second Universal Promise

You will engage all stakeholders and hold them accountable for performance.

Engaging your team members is about the connection with each of them individually and also as a team. Getting to know and understand each person requires intelligent and thoughtful communication. This communication includes asking insightful questions, listening with all of your senses to the language used and the emotions expressed and experienced. This will expand your understanding and communicate significance to each individual in a very powerful way. 

You have heard this expression: ”Getting the right people in the right seats on the bus.” One of the most important functions of a leader is to evaluate the gifts and talents of each person so that you can put them to work in the best position on the team. Facilitating each individual’s understanding of how their work contributes to reaching our destination provides motivation, clarity, meaning, and accountability. ”Coaching as a Leadership Style” focuses much of our work as a leader on the development of the gifts and talents of the individuals in our organization. When this happens, we have really begun to bring out their inherent potential…the gifts, talents, discretionary energy, and passion of the individuals we lead.

From Ordinary to Extraordinary

Ray McElroy speaks on the topic of “To Boldly Go – Stepping Out of the Ordinary to the Extraordinary.” Ray’s background includes spending six seasons in the NFL with the Indianapolis Colts, Detroit Lions, and the Chicago Bears. A native of Chicago and a graduate of Eastern Illinois University, Ray also served as Team Chaplain for the Chicago Bears Organization from 2008-2013.

McElroy says, “Ordinary people with average talent can accomplish extraordinary things.” He urges us to “see where you want to be and work on getting there.” He asks us to ponder these questions:

• What do you know that nobody else knows? 
• What do you see that nobody else sees? 
• What can you do that nobody else can do or will do? 
• We need a team around us in the valley … Who’s your crew? 

I ask you to ponder these questions:

• Who on the team knows things no one else knows?
• Who on the team sees things no one else sees?
• Who can and will do something no one else can and will do?
• How can you best position team members to contribute their best?
• What do you need to do to better lead your crew?

From Compliance to Commitment

When the organizational culture supports people in such a way that they thrive, strive to contribute, and are valued for their contributions, there is a shift from compliance to commitment to the cause, resulting in dramatic increases in individual and organizational performance. It is a 1 + 1 = 3 phenomenon. 

From Values to Accountability

Our deeply held values become our standard of accountability, both individually and collectively. In Part 2 of this series, I provided the example of performing an After Action Review (AAR) in a morning huddle. When we debrief on previous behavior as a team, everyone is invited to reflect on whether we could have performed better to support our foundational values. One of the foundational values of how we work as a team in my practice is to encourage team members to discern and discuss failures to support our agreed upon values. Anyone is welcome to point out violations. We then look at behavior that violated our values and discuss what would have been better behavior. It provides clarity for everyone.  

A primary goal of leadership is helping each individual and the team, as a whole, become clear on the essential vision, mission and values of the organization. If we confuse, we lose. Clarity wins and is a primary driver of performance. 

Until next week and Part 4

When I bought my dental practice in Glendale, Arizona, eight years ago, they were offering patients a choice of flavors for topical anesthetic. I truthfully thought it was silly and that we would stop doing it. With experience, however, I came to realize that giving a choice was valuable for both patients and team members. Today we are still offering a choice of flavors.

When a patient is seated, the dental assistant will say, “As you know, as part of the process for getting you numb, we will be using a topical anesthetic. We have five flavors and you get to tell me which flavor you would like to use today.”

It is really interesting to listen to the dialog, but also to realize what is happening for the patient. The choice gives the patient an opportunity to settle into a conversation and something to focus on other than that they will be getting an injection and the logistics of that.

The process almost creates a fun, quirky conversation, as the patient thinks about the choices. Sometimes patients say, “You choose, and I’ll guess which one it is. Let’s see if it really tastes like that.” When patients pose themselves this challenge, the whole time I am giving the injection, they are trying to figure out which flavor of topical we have used.

Sometimes patients ask, “Which flavor is your favorite?” or “What do other patients like most?” In this case, we talk about it.

We have the mint flavors everyone else has but we also rotate in cherry, strawberry, bubble gum and pina colada. In summer, we offer watermelon. At any one time, we typically have five flavors and they vary throughout the year. A patient who has come in a few times, may even start the conversation with, “Do you have any new flavors for me to try today?”

One of my favorite conversations is whether the pina colada actually has rum in it and how funny it would be if we could just use the rum. An ice-breaker conversation such as this is a great way for us to ease the tension at the front end of an appointment that will require anesthetic. It truly adds an element of fun that has become for us a practice distinguisher.

In Part 1 of this series, I introduced you to a discussion about leadership and four universal promises of leadership. My next goal is to discuss the first of four universal promises of leadership.

The First Universal Promise

You will set the right direction and create meaningful work.

Each of us needs structure to live and lead effectively. Setting the right direction requires you to be clear on what your destination is. What story do you want your life and your life’s work to tell? Is it a story worth telling? Will it inspire other people to want to go with you? What will it take to get there? How and where do you start?

Clarity Will Transform You

The structure of destination and meaning comes from your vision, mission and values. Your vision is critical to communicate a clear picture of your destination. Your mission is critical to understanding what you must overcome and connecting each person’s role to it. Values guide us from deep within.

The process of clarifying your vision, mission and values sets into motion self and organizational transformation.

Your vision transforms you into an Inspiration Maker.

Your mission transforms you into a Meaning Maker.

Your values transform you into a Behavior Maker.

Vision is the inspiration maker for the organization. It is the destination that the organization is traveling to. Jason Bourne’s vision was to get his identity back from the evil CIA unit that stole his identity. His mission was the very dangerous actions that he had to undertake in order to get rid of the bad guys and get to the truth.

Mission is the meaning maker for the organization…It is about the conflicts, barriers, and work that must be overcome to reach the destination. In a Nike commercial, the athletes are pushing their physical limits in training (Mission) to become a champion (Vision).

Values are the rules of behavior for everyone in the organization, including the leader. They are the boss. When anyone violates the values that they have agreed to, it becomes obvious to all. The leader makes himself/herself accountable to the team and asks for them to confront him/her if he/she violates them. Values are grounded in our most deeply held beliefs and often integrated to the framework of our faith.

In other words, vision-mission-values are for the benefit of the organization. And, yes, the leader must become them as well.

When your vision, mission and values saturate your organizational culture, you begin to enjoy the rewards of that effort. The shared mental model provides structure for thinking with one mind, speaking with one voice, and feeling with one heart. Your energy and effort are channeled into one powerful coherent force that is aligned at all levels and moving in the direction of your destination.

After Action Reviews

Here’s an example of how in my dental practice we routinely review whether we are on course to our destination in alignment with our values. Recently, in our morning huddle today, we did an After Action Review (ARR) of our performance as a team on the previous afternoon. It was a routinely busy day that got pushed in the last two hours with several important emergency appointments.

An AAR examines the performance of the entire team and asks key questions:

What did we intend to do?
What did we actually do?
What were the results?
What would we do next time?
Were our actions consistent with our values?

I started the discussion. Quickly, several key team members expressed their thoughts and emotions that our performance as a team did not produce the results that we want and were not consistent with “Who We Are” and “Who We Hope to Be” at our best. It was a difficult but very productive conversation…and I think essential to creating better future performance.

These kinds of conversations invite every team member to have a voice in the critical moments of how we perform as a team, which increases the meaning of their work and recognizes the value of their contributions. It also allows us to evaluate if our behavior and performance as a team is moving the practice in the direction of our vision. Clarity wins. These conversations clarify.

Until next week and Part 3

Warren Bennis, in his book, On Becoming A Leader, says, ”Becoming a leader is synonymous with becoming yourself. It is precisely that simple, and it’s also that difficult…First and foremost, find out what it is that you are all about, and be that.”

In other words, leadership development is about developing yourself. As appealing as that sounds, it is one of the most resisted journeys that any human being can attempt to make. One of the most extraordinary writers, thinkers, and influencers I have ever read is Auschwitz survivor Victor Frankl. He said, ”When we are no longer able to change a situation, we are challenged to change ourselves.”

Changing ourselves can appear to be a daunting task, but it is the work required to become a great leader.

Self-Deployment

My favorite definition of leadership says that Leadership is about the deployment of self into circumstances. But which of your selves is deployed? Is it your best self that shows up with clarity, conviction, courage, and compassion as the essential qualities of a great leader? Or is it some other less powerful version of you? The performance of the organization that you lead will be in large part determined by how you show up to the most important people that you have been given the gift of leading. That organization ranges from your family, to your community, as well as the business organization that you lead.

Four Universal Promises

When you decided to become a healthcare professional, you decided to become a leader, whether you knew it or not. That role as a leader comes with four promises that are universal. We will examine those promises in this blog series, and you will get the opportunity to determine how well you are keeping them. Your future and the future of the organization you lead depends upon it.

1. You promise you will set the right direction and create meaningful work.
2. You promise you will engage all stakeholders and hold them accountable for performance.
3. You promise you will ensure that your strategies, systems and processes facilitate focus and execution.
4. You promise you will lead effectively by maintaining relationships of trust to achieve and sustain results.

Until next week…

As I watched the pandemic unfold from my vantage point in New Jersey, somehow the innocence of a child passed through my mind as I thought, “That won’t happen here.” As the pandemic got a death grip on the New York Metro area, the stark reality of “It happened here” came into full view. At first, we spread the patient visits with gaps for safety and eventually just closed our doors except for emergencies. As the weeks have turned into months, the economic impact and the sense of isolation has started to metamorphosize into a NEW reality. The phrase of “epic proportions” and “uncharted territory” were thrown around on every news cast.

Is this journey really uncharted?

Are we really cast to a horizonless sea? Haven’t we been preparing for this type of event through our education, study clubs, reading, and conversations within the community we call the “Pankey Family?” These examples come to mind:

After reading Gene D. Cohen’s book The Mature Mind, I learned that I’m resilient. I survived the big “C”, a 300-year flood in Havasu Falls, and my wife’s health issues. I realize “I’ll be able to get through this.”

Through the Gallup’s Strengths Finder and the leadership program with Dr. Richard A. Green at Gallup, I learned that my strengths are Ideation, Strategic, Learner, Communication, and Maximizer. Today I trust that the ideas and strategy will come to me. I have leveraged the Strategic strength over and over again.

The book How to Think Like Leonardo DaVinci by Michael J. Gelb tells us that when DaVinci was faced with challenges such as these, he trusted the answers “would appear.” He trusted the challenges would “seed the unconscious” to find a solution.

Waiting for the Unconscious…

While waiting for solutions to challenges, I’ve learned to free my mind and spirit by “chopping wood and carrying water”—TAO! So, when my practice closed normal operation, I went to Home Depot and bought paint…a LOT of paint. On day two I started painting my office. At first, I thought I would paint just the reception room, but as time went on, I had time to paint the entire office. I know myself, and I was doing all I could not to jump onto the “downward spiral” that I learned about in The Art of Possibilities: Transforming Professional and Personal Life by Zander and Zander.

Staying in Community

As the weeks went by the first solution to pop up was creation of a protocol for dealing with virus containment. If a patient did need to come in for emergency care, I needed to have a strategy. Joan Untershuetz and Denny Byrne presented new information last year at their Inspired Facilitation workshop about how the brain needs community. So, I formed a Zoom account and started weekly team meetings. We discussed what we were each doing to stay safe. This piqued my curiosity to wonder what patients were doing to stay safe and could they help me develop a protocol that would help them feel safe?

I recalled Dr. Irwin M. Becker lecturing in C1 on first steps to integrating this new way of practicing. He challenged us to select patients that trusted us already, and he called them “friends of the practice.” I asked my current team to list those they consider to be friends of the practice—those who put smiles on our faces when we see them on the schedule. The list was formed. The ball started to roll. I facilitated my first ever Patient Focus Group and asked two simple questions:

What have you been doing to keep your home safe from Covid-19?

What would you need to know in advance of an office visit in order to feel safe?

New Dimensions of Individualized Care

The focus group responses helped me understand that the protocols they were following at home ran the gamut from washing hands and taking off shoes to something resembling a chip manufacturing plant. I realized that individualizing the protocol could be another level of “values-based relationship-driven” individualized care.  I learned that my patients had high trust in my ability to forage through the regulations and come up with a safe protocol, and they thought it would help them to know the what, how, and whys before they came to the office.

Thanks go to several colleagues who helped by reviewing and critiquing my office protocols as they developed. Much thanks to Joan Untershuetz, Richard Green, Rolando Cibischino, Christine Shagaki and Dennis Stiles for letting me bounce ideas off of them and for their in-depth critiques.

Something else I did to stay in face-to-face contact with patients was to implement a form of “teledentistry.” After watching a presentation by Laurie Owens from DevDent at one of the ACT Dental CE online CE days, I set up an account with Doxy.me and now have regular telehealth hours. I get a push notice when someone is in the “waiting room” to have a tele-dialogue.

A Journey? Yes…Uncharted? No

There are boundless opportunities to put our best Pankey training to masterful use. We were all taught to slow the practice down and be more intentional. We were taught about personality styles and values. Open dialogue and full transparency can be the threads we hold with our patients to deeper levels of trust and appreciation. I feel poised and ready to bring my best self forward in these times that hold endless possibilities for values-based, relationship-driven, uniquely individualized care.

Emotions can flare up rather unexpectedly. When it comes to our patients, we need to have our antenna up and help them step out of their fight-or-flight mode and dial into a better perspective. 

True Story… 

Recently, I was in Lowe’s and in the “returns” line ahead of me was a man who was attempting to exchange a Sears socket head for his Craftsman socket wrench he had purchased years ago. (Lowe’s has an agreement with the makers of Craftsman tools now that the Sears empire has collapsed, and you can buy Craftsman tools at Lowe’s featuring the same lifetime warranty.) 

The man wanted to exchange his worn-out socket for a new one, in the way he had done in the past at Sears. The socket head likely costs less than $5.00. The dutiful Lowe’s staff started up their standard exchange routine, wherein they attempt to gather personal information so they can track inventory and justify the exchange. The man refused to cooperate and give any personal information. He just wanted an exchange with no questions asked and no receipt required.  

The pitch in his voice rose, as he said, “I’ve got tools older than I am, and I’ve never had to do this before. Are you trying to accuse me of stealing this socket head?” Those of us in the line looked at each other and started to wonder how this happened so fast over such a small item. 

The cashier wasn’t particularly masterful at managing the awkward event. He responded by coldly reciting the store policy. The man then grabbed his socket off the counter and said, “Just forget it. I won’t be buying all that lumber over there on that cart or shopping here ever again.” And then he stormed out.

Everyone working that morning just shrugged and acted as if it never happened, apparently quite adapted to this type of customer behavior. I went on and returned my item and then purchased a few other things, but I couldn’t help but think about what had just happened…why and how it might have been managed better. 

Where Did the Breakdown Occur? 

Oftentimes what we see isn’t what is driving the situation. I think the socket might have been a symbol to this man of the breakdown of his great relationship with Sears. In other words, his anger at Sears for abandoning him was displaced onto these Lowe’s employees.  

Our culture has become coldly transactional, and this was a clear symptom of it. We’ve all seen patients figuratively fly off the handle for small and insignificant things. Back in my insurance involvement days, people wanted to argue with us over having to pay a $5.00 copay. 

Most people who come into our offices are somewhat overwhelmed and over-stimulated, and it is easy for them to conflate and draw the wrong conclusions about what is happening around them. When this happens, we need to quickly help them relax enough to get what they came for.  

What Would You Say? 

I keep thinking about what the Lowe’s cashier could have said to make a difference. Perhaps, “Aren’t those Craftsman tools amazing? How long have you had this socket? Wow! And I’ll bet you use it all the time! We’re so fortunate to carry these amazing tools now that Sears has gone out of business! Can you help me out? My boss needs me to track the store inventory, even when we do exchanges like this. I know this is an inconvenience, but can you share with me your name in case you ever have a problem with this new one?”  

…Thinking on our feet while chairside can be difficult when caught by surprise. I’m grateful that in my relationship based mode of practice, I can amend my policies on the fly, so people come first.   

Every one of you knows from your own experience with care providers that you want to have complete trust in them before accepting their recommended treatment. Your dental patients are no different, and that trust is affected by their entire experience with everyone on your care team. The dental experience in relationship–based practices increases this desire, because listening well to others is one of your priorities. Patients become at ease confiding their concerns with you and celebrating high points in their life with you. In your dental practice, listening well and acts of kindness generate positive emotions and positive memories of their dental experience.  

The Golden Rule 

Under daily situational stress, personal psychological stress, and oftentimes lingering physiological stress from the day before, preoccupation with internal concerns gets in the way of being truly present for the patient. The benefits of discussing this occasionally within team meetings foster a continuing positive culture of everyone striving to intentionally apply the Golden Rule with patients.  

When that aspiration is sustained and everyone on the team “takes care of” patients by “treating others as you would want to be treated,” the emotions experienced by patients are positive and support treatment acceptance. And, the genuine care you give others has a way of stepping down your own stress with the release of oxytocin.  

I’m speaking to all team members from the front to back when I say, “Practicing being truly present for patients until it becomes a natural habit is one of the greatest things you can do for them, yourself, your fellow team members, and the business.” 

A Few Extra Minutes  

If appointment times are increased by five to ten minutes, the clinical care team has more opportunity to converse with patients without stress developing, and in just a few more minutes a lot can happen. Conversations between care team members and patients help establish trust. These conversations also disclose patient feelings, concerns and unanswered questions. The sharing of this information with other team members can be used to create an optimal patient experience in this and future appointments.  

It takes just a minute more to share this information appropriately in handoffs to tee up the doctor-patient conversation about treatment and to support scheduling the next visit before the patient leaves. By the latter, I mean the business team at the front and the patient always need to be prepared for the end of the appointment when the follow-up treatment fee is presented and scheduled. This preparation includes communicating the why behind the treatment and true concern for the patient’s welfare.  

Same Page, Same Language 

Patient confidence grows when every team member is on the same page, is aware of the patient’s expressed goals and concerns, supports the treatment plan with why it is recommended and enthuses about the expertise of the practice. Using the same language helps too.  

In a relationship-based practice that focusses on these details, this is possible, and more treatment is accepted. If team members stop occasionally to ask themselves, “How was that handoff,” you will discover ways to improve how everyone “takes care of” patients through shared knowledge, empathy, and language. And knowing the Pankey community as I do, I see in my mind’s eye care teams around the world coming together at the end of the day to say, “Nailed it!” 

When the art and science of dentistry are reduced down to primarily being about production and code mining, its spiritual dimension is easily lost. Spend a few minutes on some dental social media sites, and you will quickly see this truth in black and white. 

Dr. L.D. Pankey warned us about this problem.

The key to becoming a truly successful professional isn’t just about mastering the technical skills and endlessly chasing after the siren songs of our materialistic culture. Such narrow pursuits are ultimately hollow and do not represent enough to carry us through life as a fully developed person. And they do not represent enough to carry us through life’s inevitable tragedies and periods of significant suffering.  

Creating a habit of connecting with our patients in deeply meaningful ways, helps us to form the emotional antibodies we will need to carry us through the inevitable not-so-good times, the times when all the money and material possessions in the world can’t solve our problem. These are the times when only love, support, and reciprocated empathy can start the process of healing our wounds. 

Never forget this central truth.

Chasing after the next new and shiny object may not be the best solution for our challenging situation today. The best solution may very well be sitting right in front of us in the form of a deeply caring patient.
 

Every message a person tries to convey to another person has two components to it, the content of the message, and the feeling or attitude associated with the content. Both are critically important, as both give context and meaning to the information being shared.  

In some instances, the content of a story is less important than the feelings associated with it.

In fact, sometimes the content may be a complete distortion or a fabrication. Regardless, the person may believe the story because the story has a specific meaning to the person. Consequently, it is critical that we try to catch the full flavor of meaning underlying the story. 

Do they believe that they are going to lose all of their teeth no matter what they do? Do they believe that it is normal to lose all of their teeth? Do they believe that they are not worthy of investing in themselves through dentistry? Do they believe that all dental work fails and is a bad investment? Do they believe that most dentists are dishonest? Do they believe that their problems cannot be resolved?  

To discover meaning, we must respond to the feeling component of their communication:

“You seem really upset about this, can you tell me more about it?” “I can see that you are really anxious, can you help me to understand why you feel this way?” “You seem really frustrated – even angry about what happened. Can you tell me more about it? Do you think you will ever be able to work with another dentist?”  

We are attempting to discover is what their story really means to them. How do they see this story and their current situation affecting them going forward? How important is it to them that they resolve their current situation? Do they even know what their situation really is? 

Patients gravitate toward and stay loyal to dental practices in which the dentist and care team love what they do.  

When you are enthusiastic about your work and how you do it, you can’t help but talk about it, can you? You can’t help but show it.

This enthusiasm affects patients in multiple ways. 

• Your happy office is a delight to visit under most circumstances. 
• The confidence you exude makes potentially stressful visits more comfortable and allows patients to trust in your care.  
• Their curiosity in dentistry and what you can achieve together is peaked. They ask more questions. This, in turn, sparks the patient’s desire to make changes in their health and smile. 
• Because your happiness has spread throughout your care team, the support patients receive throughout their experience is exceptional. 
• You surround them with so much positive energy they feel free to get to know you too. 
• Consistent happy experiences lead to patients feeling like they are among family and friends. 
• And, you’ve all seen this. Patients want to emulate your happiness in their own lives. They want to be like you. 

What is happiness anyway? The definition that I like is “the ability to feel satisfied with your life, to enjoy yourself and others, and to have fun in the present.” This certainly is what your patients enjoy when they visit. 

So, what brings about happiness in dental practice? Perhaps, you’ll agree: 

• Doing what you love to do most of the time, applying your talents and strengths 
• Being outwardly focused on the well-being of others 
• Effectively motivating and leading others to optimal health 
• Being true to your own personal values 
• Ever be it dynamic–Pursuing your own vision of practice (in the case of the dentist) and a coherent practice vision to which you contribute (in the case of team members) 
• Working in a care team that is high functioning with high EQ 
• Effective systems that facilitate doing what you love most 
• Ability to successfully problem solve and adapt with confidence 
• Patients who appreciate what you do together  
• Continuously mastering higher standards of care 
• Multiple moments of true connection with others every day 
• Understanding of yourself and others 
• Satisfaction with your life outside the office 
• Optimism and gratitude