In times of disruption, small changes can have a large impact. Follow the 5 P’s and see where Proper Planning to Prevent Poor Performance leads you.

Those of you who experienced the joys of boot camp may remember the 5P’s: Proper Planning Prevents Poor Performance. Since we are all stuck waiting to get back to the office, now is a great time to work on plans for a preferred future.

Although we will be opening in a disrupted world and the market we left has been transformed by forces outside our control, good business principles and practices remain valid. Here are some key performance indicators adapted from Roger Levin’s 2019 article about the KPI’s every dentist should know.

Production, Collections and Profit

Review your production, collections and profit for the last 12 months. Levin points out that the trend on each of these items should be up. Sounds simple but it is not. Dig in and analyze deeper. Start with monthly figures and look for trends, then weekly and daily. What are your most productive procedures, days, time of days? When was your last fee increase? Analyze your outstanding accounts. You should be collecting 98% with only a small percentage over 60 days outstanding. How much are you writing off due to insurance mandates? How profitable are you? Have you set any goals? Understand that any item in your practice that is not true overhead is profit. Now you are ready to start working “on” your business.

What percentage of your active patients is currently scheduled? Nobody should every leave your office without another appointment. Your goal should be 98% of active patients are scheduled for some form of care. What is your case acceptance rate? Are you tracking patients with planned treatment that is not scheduled? What is your average production per patient? What is your average production per new patient? It should be at least two times greater than existing patients. What is your hygiene cancellation rate? If you are not happy with what you are learning, now is the time to be planning for better outcomes.

Overhead

Now is the time to carefully assess every item included in your overhead. If you have a practice generating a million dollars, a 2% decrease in overhead is $20,000 directly to profit. Levin Group tells us that general dental practices should have overhead at 59%. Very few practices meet that goal. It is very likely that new mandates from the government will be coming for PPE and testing. Now is the time to get lean and mean in this area.

Patients

Are you tracking your monthly new patient growth and your patient attrition? With all the media attention to aerosol spreading of Covid-19, it is likely there will be resistance to treatment and dentistry in general. Knowing your current situation is important. It is imperative that you use every means available to help your current and new clients understand that you are concerned for their health and safety as well as to emphasize that deferring treatment will only lead to future more difficult and expensive problems.

Staff Costs

The elephant in the room…staff costs in a general dental practice should be 25% of collected production. Your team members are the most expensive and most important part of your business. You may want to share your homework with your team – or even involve your team in the exercises above.

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

More than 31% of solo practicing dentists today are 55 years or older. Since most dentists have traditionally retired between 60 and 69, retirement is a “hot” topic.

Future Financial Need

Goal setters who have planned for retirement since the beginning have accumulated five times what a non-planner has saved. Yet, baby boomers (now mid 60’s to 70’s) have reinvented each phase of their lives, never matching what has been customary. An ADA survey indicates dentists save 10.6% of their income which is below the federal limit of 15% contributions to a qualified pension fund.

Financial advisors think you will need from 70 to 90% of your current net income in retirement. The average dental net in 2019 was nearly $200K. In retirement planning, eighty percent of that is $160K, which is $13,350 a month. If you retire at age 60 and live another thirty years, you will need $4.8M from interest and savings.

Retirement Choices for Today’s Boomers

The figures are staggering for the slightly unprepared. What are the choices for today’s boomer dentist? Sale? Partnership? Associateship? Retire as you go? Or, will you up your game plan for 5 more years? Let’s investigate.

Sale: A sale is currently worth about 24 months of net income which is then taxed. Beware. A sale is final. You are no longer a dentist in that location. There is no going back. The book is closed.

Partnership: Partnerships in retirement have their own pros and cons. By reviewing what motivated you to enter the profession, you may find independence and freedom on your list. Selling half your practice to an unknown partner means you have surrendered your freedom and half your net income in exchange for about nine months of net income. The staff will still look to you for leadership.

Associateship: Becoming an associate after thirty years of private practice could be successful if you have the qualities to be an employee. Will you be happy doing dentistry for someone else? Do you have the qualities to be a team player under someone else’s leadership and rules?

Continue Your Own Practice by Retiring as You Go: Continuing to practice beyond the average retirement age is a viable alternative. The real advantages to keeping your own practice viable are the continued net income, ability to deduct expenses such as continuing education and a leased car, and the psychological rewards of feeling needed, serving others, and your earned status in the community.

Continuing your own practice can be done on your own terms. You can design your ideal practice days, plan your continuing education around travel adventures, and attract staff to work your schedule. You may want to work three days a week for three weeks and take the fourth week off. If you can continue to work on your own terms and have a substantial income that does not require using your retirement funds until you choose, count the advantages and your blessings.

Continue Your Own Practice by Upping Your Game: Another viable choice is to “Up Your Game” and actually make an extra $2M by increasing net in a five-year plan. This can cause a $900K increase in the eventual sale price. We have a number of very pleased retired dentists who upped their game in their 60’s. They can’t believe how much more enjoyable practice is again.

Upping your game means increasing your dental skills and your treatment offerings, installing strong systems of block booking to produce more in fewer days, solid sales conversations for an increased level of patient care, and having an accountable accomplished team marching with you. Because you have upped your skills and are focused, you can actually take more time away as you increase your net. 

Which Choice Is Right for You?

Examine your financial needs. Examine why you enjoy dental practice? Examine your options and spend time thinking about which retirement option feels most comfortable to you. We can help. Many of our clients have chosen to stay part of dentistry, and we have observed that when dentists keep up with continuing education and become skilled at working with new materials and techniques, they gain more than an enhanced income stream. They feel a rebirth and rejuvenation about their profession.

Covid-19 is a true Black Swan event for everyone around the world. Suddenly all dentists are banned from practice, except for emergency care, for at least several weeks. We are all feeling the impact of this strange new virus. How we choose to respond will make a significant difference in the long term impact of this crisis on our lives and our practices. Here are some ideas and information that may be of some help. 

Stay Positive 

Yes, your office is closed, and your team members are not working. There is legislation in the works that will allow you to pay your team with funds from the government. Sit down with your team and reinforce that this situation will not go on forever. Life will return to a more normal scheme. You are not going out of business, and they will have a job.  

Tell the Truth

Most of your team are hourly workers and this is really scary for them. Be honest about what you can and cannot do for your staff. Communicate openly with your staff and patient base. Make sure patients have access to you or a designated team member 24/7 if they need urgent care. Prepare your office totally for the event of having to care for someone with proper protocols and all the needed PPE. Take time to discuss what is happening with your family. Since church will not be an option for the near future, this might be a good time for some family prayer time. This is an opportunity to grow together and support one another and to demonstrate and ask for accountability.  

Take Advantage of the Time Off

Are there projects that you have been putting off at home or the office? Could some of your team be doing a deep cleaning or re-organization at the office? Could you be setting up some additional team training that can be done within the parameters of safe spaces or by video? Doctor, how about taking advantage of some of the video and other CE at The Pankey Institute that is online? 

Collaborate with Your Peers

Pick up the phone and call your friends. Share the information from the IRS. It is a big deal for your bottom line. Discuss putting together some group events when you can gather again. If you know of someone who needs a helping hand or some cheering up, just do it. 

Look at the current situation as a learning experience in coping. Keep the big picture in mind. There may be lines in stores and some folks with a “me first” attitude about toilet paper. However, we have power, water and food. Let’s do what we need to do to get past this and move on. Stay safe, wash your hands and pay it forward. 

It may not be this week. It may be next before you have a practice continuation plan in place and have communicated fully with your team and patients. When you do find you have some time, I encourage you to sit back and think about everything you have experienced over the last month and what new learning you have discovered. Then reach out to colleagues and talk over your learning. Continue sharing with each other throughout this time of social distancing. 

I am mindful of a quote from Carl R. Rogers: “The true wonder of learning is discovering for yourself.”  

Starting out in my career, I felt well trained technically, yet I must have subtly believed I was a “hardware” salesperson. Or, maybe it had to do with my tendency to be introverted. Whatever the reason, I found it easier to talk “hardware and technique” than to listen well and then help patients clarify their health objectives and the benefits they were seeking in their dental health care experience.  

I went to a workshop led by Carl R. Rogers titled Client-Centered Therapy. This workshop was significantly different than any of my previous educational experiences. It was a participatory experience. It took some time for me to assimilate his educational concepts into my life and practice, and I noticed right off that I had retained more from a workshop experience and could apply my understanding of what I had learned. When I returned to my office, I attempted to create a participatory learning experience for my patients. I learned from these early attempts more about learning and witnessed behavioral changes in myself and my patients.  

I sought out many other workshops at this time in my life. One was Parent Effectiveness Training, facilitated by a local devotee of Dr. Thomas Gordon. Then, I became reacquainted with Dr. Karl Olson, the retired President of North Park University where I had done my undergraduate schooling prior to going to Northwestern University Dental School.  

Olson had joined forces with Bruce Larson and Heidi Frost of Faith-At-Work and created The Leadership Training Institute, which focused on discovering your leadership potential through three separate weeks of “experiential learning.” The first week was focused on Know Yourself, the second-week focus was Know Yourself in a Small Group, and the third-week experience was focused on Designing Small Group Experiences for Others. Each of these three weeks was separated by six months of intentional application and reflection, which created a powerful learning period of discovering myself.  

From my point of view, there is nothing more rewarding than a learning experience in which one can become aware of one’s own learning in “the moment” or upon reflection. So, now that you have been thrust into participating in Knowing Yourself, your practice, your team, and your patients on a new level where there is a concern for everyone’s safety and wellbeing on an elevated scale take time to reflect on what you learned in “special moments” of the past month.  

Are any of your discoveries blog-worthy to stay in communication with your patients? They will appreciate your personal “touch.” 

Making a comment in response to this blog is one way you can encourage a “continuing conversation” of Pankey participants’ “new awarenesses.” 

Being efficient with your time increases profitability. 

Life is busy and everyone is trying to find a better balance between work and time off. If you could produce the same amount of dentistry in three days as you did in four, how would your team react?

Efficiency is a mindset and can become part of your practice culture. Producing more in less time does not mean running around like chickens or being hasty with patients. We can learn the art of using time better for our patients. Focusing on the conversation rather then multi-tasking is one example. Being prepared is the Boy Scout motto and fits perfectly here. Most patients would prefer fewer visits to your office.

Being prepared for any possibility allows your team to feel confident.

Having enough tray set-ups for any opportunity that presents itself is a start towards efficiency. Having a team completely cross-trained allows the team members to shine by being prepared and results in greater efficiency.

More time is created when the practice culture is to offer a complete exam on patients. When there is a comprehensive plan, this moves a practice beyond patching and emergency care. There is a reason why patients come to you, and most want to know you have a plan for them. Along with this, at the end of every appointment, team members need to ask the doctor, “Is there anything else we can do at the next appointment?” It is a signal to the doctor to maximize every appointment. 

Combining treatments can be a measure of efficiency.

Always combine crown prep and endo, or any other treatment. If there are fillings and a crown, do the fillings first as you will complete the crown prep in the allotted time. This works well with CAD/CAM as there is downtime available during milling and baking time.

In Hygiene, collect the fee at the time of service. “Yikes,” say the hygienists, “We’ve never done that before.” Patients love it, and once the hygienists do it, they like the connection, too. This eliminates the line at the front desk and allows more concentration on phone conversations.

Follow Nordstrom and Apple examples. Clinically, encourage hygienists to do full mouth debridement at one appointment.  It saves the patient time, and the result is a healthier mouth.

Become completely paperless.

Operating two systems is a waste of time.  New patient forms are on your websites, and all patient records are digital. To be paperless, just start one day at a time, and don’t waste time putting people in digital who have not been in yet.

Efficiency starts over the phone by asking questions to eliminate the 30-minute “look-see” emergency appointment. With the patient records on your computer, ask, “Is this broken tooth one the doctor had already recommended for a crown?” From the records, ask if there are any other previously diagnosed teeth in the same quadrant needing treatment. Ask, “Would you like to have all three of these taken care of at the same time? I can make arrangements for that.”

The team is accountable for an efficient schedule.

Phone training is a big part of making days efficient and profitable. You can save a lot of time for the doctor and patient, practicing phone scripts for different scenarios that occur in your office on a regular basis.

Timing your procedures is a great way to evaluate your efficiency. We can learn great lessons from efficient assistants. We call this “Ruth’s Rule” as a tribute to one of those fine assistants: Use one bur or instrument, do what you need to do, and then move on. That bur does not appear again for that patient.

Efficient scheduling in blocks has a profound effect on efficiency and profit. 

For example, booking alike procedures at the same time eliminates the team having to shift gears both mentally and physically. Blocks of two hours with a production goal forces the team to focus on better scheduling.

For example, if your goal for each two-hour block is $3k, don’t schedule “look-see” appointments during this time. When you produce $6k in the morning, you are on track to efficiency and more time away from the office to rejuvenate.

Drs. Blatchford are America’s leading dental business coaches. Their book, Bringing Your ‘A’ Game 2.0 is now available at Blatchford.com (888) 977-4600. Blatchford Coaching results in less patient contact days, greater net, more focus on what is important to you.  

According to Markus Zusak, author of The Book Thief, he had to rewrite his book 150-200 times until he was happy with it. And he began by imagining the end of the story, then the beginning, then the chapter headings, then the writing…over and over again. In the end, Markus had a New York Times Best Seller, with 8,000,000 million copies sold and a movie deal. 

One might be tempted to view Markus Zusak as an overnight success but knowing what I have just told you allows you to understand that’s not the truth.

So too is the case with relationship-based/health-centered dentistry. The creation of the practice takes years, starting much like Zusak’s book—beginning with the end in mind. From there, each aspect is assembled from finding and forming the right care team, to developing them, and to finding better and better ways to connect with patients: truly hearing them, understanding their struggles, and sensing their desire to feel better about themselves. 

Along the way, you will make mistakes, have misunderstandings, and outright fail. This will prompt you to rethink, revise, and redo. This is the true nature of success. We learn and move upward with better understanding. 

It has been said that the main difference between a vision and a dream is the work involved.

The later requires none. The former’s work never ends. A true vision is a principle-centered thought capsule aching to be validated by reality. It has an inherent truth built into it which must be realized. And as with Zusak, if it takes 200 revisions to make it happen, then it takes 200 revisions. So be it! 

The simple secret to success is the willingness to be flexible and to accommodate new understandings combined with a sheer force of will and perseverance that only a few are willing to make. 

Dental graduates frequently say they chose dentistry because they liked science and working with their hands. Many thought medicine was their path, but in medicine, they saw the lack of control and time away from family. Dental graduates also say they were attracted to dentistry due to the monetary return they could get for their efforts.

When practicing, profitability can be elusive. You can feel like your child’s hamster trying to outrun your overhead. You can feel like dentistry is #1 in your life and there really is no other life for you, but you are frustrated because your dream was to be farther along in your debt reduction and wealth growing. You are putting in the hours but not receiving the return.

Many things and decisions can get in the way of profits.

We want to convey positivity here, not rehash the problems. You can have a profitable practice. A larger net return can be yours.

Let’s have a frank discussion about you, the leader, THE one who wants very much to win in the game of profitability. The keys to profitability involve YOU–your attitude, your team’s attitude which comes from you, and systems you need in place to be more efficient.

YOU are the key to opening the profitability gate. What is your current attitude about life, your success, and your situation? This is a challenge as you are slightly prejudiced. Do you have a family member or a really good friend who can assess your attitude (your positivity about yourself)? Years of negativity can be a challenge.

How do you feel about the future?

Here are some questions to help assess your present attitude about yourself:

• What are your goals five years from now?
• What are you looking forward to?
• What do you want most out of life?
• What do you like best about yourself?
• What do you feel motivates you?
• Do you have any personal power in your life?

At Blatchford Solutions, when we work with dentists and teams, we ask them to assess various life choices, such as the place they choose to live, and the friends, marriage partners, courses and schools they choose, even cars, vacations, restaurants and more. We all have a Comfort Zone for each of these areas and when pushed out of your comfort zone, you reply, “I would never go there, do that, try that, spend time on that”, and more. Our comfort zones have a floor and a ceiling.

You need to know if your “Deserve Level” allows you to be profitable. You can sabotage your success if you feel you deserve less. You can modify your Comfort Zone (Deserve Level) with a clear vision, strong determination and possibly some outside help.

What is profitability to you?

Put some numbers down; spell it out for yourself at this time. Is a net of $500K unreasonable for you? Do you deserve to have 60% overhead on $1.2M collection? Is a net of $750K unreasonable for you? Is a net of $1M something you deserve? Do you deserve to be debt-free? What would change in your life if you were debt-free?

Your Deserve Level also affects the quality of team members with whom you choose to work, the building and area in which you choose to practice, the continuing education courses you take, and so many non-dental activities, too. Our goal is to help you realize you can be as profitable as you feel you deserve. Dentistry is not just about your clinical excellence. It can also be about your excellence in the business of profitability.

A patient’s feeling of comfort and trust is increased when you demonstrate you appreciate your team.

Showing appreciation to your team in front of patients demonstrates you respect the people who support you in serving patients. This only raises their opinion of your quality of care.

• When patients witness you calmly moving through moments of stress with instructions to your team delivered in a calm tone, a smile, and thanks, it speaks volumes to patients who are eager to have confidence in their care.
• When you spend time informing team members well and empowering them with knowledge of “the why” of your diagnoses and treatment plans, they naturally and appropriately prepare patients for your case presentation, answer questions, and encourage patients to move forward. Expressed gratitude for this support is a positive affirmation that creates growing team confidence, competence and job satisfaction. And this fosters a happy work environment and employee retention. Patients are highly attuned to team happiness and are relaxed among your loyal team members they have come to know. Again, this increases trust.
• A team’s feeling of appreciation will be undermined, and individuals easily become stressed when they are chronically overworked or asked to perform tasks they are not well prepared to do. Be alert to lead them through stress with assurances and demonstration that you care enough to take measures that will restore work balance and comfort.

There are multiple situational stresses that occur every day in your practice that produce the flow of stress hormones, 112 of them to be exact. And when there are stress hormones building up in the bloodstream, the physiological and psychological consequences are noticeable to patients. Fortunately, PankeyGram readers and participants in Pankey Institute courses and study clubs receive a constant flow of fine examples of colleagues showing appreciation for their teams. Showing gratitude doesn’t always have to be done in a big way or at great expense. A positive spoken affirmation in any given moment is going to release some oxytocin. And that’s what we want!

I’d like to tell you about my neighbor up here on Bent Mountain. His name is Mike Stockton. He personally designed the house we live in. He drew every line of it and then supervised, as well as participated in its construction. Mike had no formal training in architecture or construction. He just loved it and then studied it long enough to master it. His history is that of an artist.

We are all born with certain gifts and talents.

The key is to discover them, develop them, find ways to connect them with others in a fashion that they will be valued, and then to share them. Of course, applies to dentistry as well. We will only be willing to invest the time, energy, and attention necessary to master something if it brings us joy and satisfaction. That’s the pay-off—the ability to step back and say to ourselves, “That was pretty good, but next time I think I’ll try this instead and see if I can make it even better!”

But that’s not enough to be successful. To be a masterful and successful dentist, you also must be able to connect and inspire others to become better versions of themselves. And that, of course, includes team members and patients alike.

What else do you need?

You need to be able to promote yourself. You must be willing and able to share what you know and can do with others in a way that they feel it will be helpful. And there’s a word for that. It’s called “marketing.” Marketing is not a dirty word if it’s done from your heart and you deliver on your promises. No, let me correct that. You over-deliver on your promises.

When you go into that private coffee shop and they take a moment to create a heart in the froth of your latte, that’s marketing too. That’s caring enough about what you do to take the extra steps that demonstrate you sincerely care about what you are doing and how other’s feel about it.

So, now we have five key things:

1. Gifts and Talents

2. Mastery

3. Inspiration

4. Communicating What You Can Do to Help Others

5. Extra Steps that Show You Care

How others perceive how well you do these five things, will determine your financial future, because people will give you their money in exchange for your gifts, talents, skills, and caring when they perceive that you do the above five things exceptionally well and they benefit significantly as a result.

Passionately practice these things, and you will have a bright future ahead!