Culture Fit Versus Culture Add 

Robyn Reis, Dental Practice Coach 

When you are hiring team members, you are likely thinking about how those you interview will fit into your practice culture. Do their values align with yours? Do you share similar backgrounds and philosophies? A business’s culture is a system of shared values, beliefs, and behaviors that influence how people dress, act, and perform their roles. Most practice owners work hard to have everyone get along, support one another, and work as a team to give every patient a wonderful experience. So, it’s only natural to want to find someone who fits into that culture when a position opens up. 

In the HR world, recruiters have a different approach – they are moving away from “culture fit” towards “culture add.” What does this mean exactly? A great mentor of mine, Sheri Kay, says it best, “People come together in their similarities, but they grow together in their differences.” 

On the pages of Harvard Business Review, Forbes Magazine, Fast Company, Inc., and Entrepreneur, you will read that more and more companies are moving away from the traditional culture fit that creates a monoculture where everybody has shared similarities and there is no growth. Instead, they are recreating a culture that is open to new ideas, open to conversations where people poke holes in traditional ideas and say, “Hey, what if we did this? This is what we think we want to do. Now let’s figure out why it will or will not work.” 

In recruiting a hygienist for a client, one of the candidates stood out to me. In addition to her clinical hygiene education, she also had a financial background which represented a “culture add” for this particular practice. She had a greater understanding of goal setting, the finances of the business, and how to create a profitable hygiene department. She ended up being a fantastic and productive member of their team. 

When you are in the hiring process, do you think about adding to your culture? Diverse backgrounds correlate with more diverse problem-solving and decision-making processes. In studied corporations, diversity leads to increased profitability.  

In dentistry, diverse backgrounds can lead to the attraction and retention of diverse patients. Diverse backgrounds can fill in operational holes in your business model. Does a candidate have a background in psychology, finance, education, customer service, computer IT, office administration in another industry, or marketing? Does a candidate speak a second language that will be an asset in your community? Is a candidate artistic, an exceptional writer, a community volunteer, or actively participating in other activities? 

During each interview, seek to learn what the candidate could add to your practice culture in addition to culture fit. After talking about a candidate’s resume and interests, talk about situations that occur in the practice and current needs. Ask if the candidate has ever been in similar situations and how they handled them. Do the answers indicate personality traits and strengths that will add to (complement) the team? Ask the open question, “Based on your personal experience, what insights could you add to this situation?” 

In today’s competitive market for talented team members, consider what a new hire with additional skills could add to your culture and what these new contribution possibilities could be for an amazing patient and team experience. Happy hiring! 

Upstream Thinking in the Dental Practice 

Leigh Ann Faight, RDH 

In my years of working with dentists and teams, I have noticed that leaders tend to address what is directly in front of them. They are simply too busy to notice that the issues of today will likely be back tomorrow, and the next day and so on if they don’t find the root cause and build systems from there.  

My favorite book on this subject is Upstream by Dan Heath. I was so impressed by it that I named my dental coaching company Upstream Dental Practice Coaching. The idea of the book is to help us stop reacting to problems and instead look for ways to prevent them in the first place. 

In the book, Dan Heath recalls a quote from Paul Batalden: “Every system is perfectly designed to get the results it gets.” I love this quote; it is as exact as it is simple and begs the follow-up question: Are your systems working to get you the results you want? 

I’m not writing this with just dentists in mind. I recommend that all dental team members appraise together how well your systems are working and think about where the lack of systems is causing stress. As you meet as a team and pull back the layers of your processes, do you discover barriers that get in the way of moving upstream? As a team, you can intentionally rebuild your systems to remove the barriers and prevent them from rolling back into your stream. 

Fixed thinking gets in the way.  

As I coach, I see three behaviors that get in the way of improving the many systems operating in dental practices. 

Problem Blindness 

This is the belief that negative outcomes are natural and inevitable. We treat these problems like we treat the weather, as something out of our control. We normalize problems and even stop seeing them. Teams tell me, “That’s just how it is here.” This finite thinking is one of the first challenges we uncover when I work with teams on intentionally “going upstream.” 

Lack of Ownership 

If an issue arises and no one claims ownership for fixing it, the problem will persist. To really develop upstream thinking you need someone who will say, “Even though I did not create this problem, I will lead us to find a solution.” 

To create a culture where teams have ownership over decisions, leaders must trust the team to make decisions on behalf of the group. On the flip side, the team must choose to take charge of issues as they see them.  

Tunneling 

Tunneling is exactly like it sounds. You focus on short-sighted problems and have reactive thinking. You get stuck in a routine of short-term decision-making and are unable to move forward. You think, “I can’t deal with that right now.” 

The more problems you are juggling at once, the harder it is to solve them all. If you can’t solve problems systematically you will stay in an endless cycle of reaction, because tunneling begets more tunneling. Compound tunneling with stress and scarcity, and you get stuck. 

“Getting Unstuck” is the name of the game. 

You might want to take your team offsite for a day to talk about what isn’t working in your dental practice. What are the big problems they and you see? Talk about the common human responses of problem blindness, lack of ownership, and tunneling. Talk about upstream thinking and proclaim, “Today is the day we become unstuck.” 

In helping teams find ways to make their systems more successful, I have often found that small changes can make a big difference. If you add target metrics to your systems, “the team” will more likely see and remove barriers that have gotten in the way, redesign systems, and work as a united group to improve the outcomes.  

In the Pankey course held February 2024 — The Pankey Hygienist: Where Clinical & Behavioral Science Unite – The Pankey Institute, we focused on “the flow” of the hygiene-restorative partnership, leading patients toward higher comprehensive care, and getting clarity around the why and how of optimal behavioral and clinical methods. We took a critical look at the habits and assumptions we have developed. We applied upstream systems thinking with the goal of collaboratively achieving with our patients greater oral and systemic health.

What I Brought Back from Napa (and it wasn’t wine!) 

Robyn Reis, Dental Practice Coach 

A while back, I made a business trip to Napa Valley. I was enjoying lunch on the patio of the Ottimo Café which is attached to a shop featuring wines, gourmet provisions, and culinary tools. It was a lovely day, and I was out in the beautiful California sun by choice. A nearby covered area provided shade, and there were multiple diners inside the shop waiting for those shaded tables. 

The maître d’ had given me a choice of tables and made sure I was comfortable. The food, wine and service were excellent. 

A family of four wandered over and sat down at an empty table in the sun. One of the waiters approached them and must have told them there was a line inside because they got up and went into the building. A few minutes later, they came out escorted and sat with menus at the same table they had left. There was obviously a system in place and it was working. Not long after, the two children became unhappy sitting in the sun. 

Being a parent myself I empathized with the parents as they struggled to keep the kids entertained. The little boy put his shirt over his head to block the sun, and I watched the dad looking at the covered area to monitor those shaded tables. As people from the shaded area got up, the tables were cleared, and the maître d’ seated more people.  

There was a lag between one table being bussed and people being seated because in a flash, the family left their table and sat down at a shaded table. The maître d’ approached them again. The family was speaking a different language and the father was using hand gestures. Obviously, communication was difficult. Ultimately, the family remained seated at the shaded table. There was no doubt that “good” customer service for this family was out of balance with “good” customer service for the people inside waiting to be seated. 

It was fascinating to observe the maître d’ having a conversation with the waiter who had been serving the family. My guess is that he was saying something like, “Hey, stay alert to maintain the seating system.” The waiter only nodded. It reminded me of a dental practice where you may have a patient in the hygiene chair and think to yourself, “Oh, it’s a small filling. Let’s go ahead and take care of that today.” Unbeknownst to you, someone may have walked in the front door hoping to be seen, and the front office thinks the walk-in can be accommodated based on the schedule.  

In both situations, it’s best not to make assumptions and communicate, communicate, communicate! In the back, check with the front to see if that filling can be done now. In the front, check with the back to see if the walk-in can be accommodated now. And in the case of a scheduled patient waiting in reception, you don’t want to keep them waiting unless it is really unavoidable.  

Sometimes we’re going to disappoint someone, however, we want to plan our schedule so no one is left waiting. We’re not in the restaurant business where customers are willing to wait in line for a seat at our table. Despite a fine reputation, if you cannot see new patients within a reasonable timeframe, they are going to call elsewhere.  

Look at your own schedule and converse with your team. Do you have an adequate number of new patient appointments available? Are you allotting sufficient time for each type of procedure? How good is your back-to-front and front-to-back communication? Do you keep patients waiting? 

My meal and business trip were a success in Napa. And while I didn’t bring back any wine, I did bring back the importance of having systems in place to ensure a great experience for every patient at every visit. 

Are You Prepared for Your Next Hiring Challenge?

Most dentists hire during a crisis because a vacancy created for various reasons drives a need to fill a position immediately. This high-stress, time-sensitive situation often undermines the dentist’s ability to hire more strategically and therefore move their practice up to the next level. In other words, dentists tend to re-create the status quo out of desperation, rather than strategically evolve their practice over time based on how they hire and develop team members.  

Understanding what you need and want to create ahead of time (skills and values that are non-negotiable in a person) is key. Hopefully, this article will prompt you to think about this truth as well as prepare for the next hiring challenge. 

Seek These 8 Personality Attributes 

According to Avrom King (and my own experience), there are eight personality attributes that must be predominant within a care team for it to prosper over time: 

1. Optimism: Despite all the craziness in today’s world, team members routinely demonstrate a hopeful and positive attitude toward adversity and others.
2. Involvement: Team members actively pursue problem identification and resolution. They are caring and committed to seeing the practice function at an optimal level.
3. High Self-Regard (not to be confused with high self-esteem): Team members feel competent, capable, and worthy of success. They believe that their lives make a positive difference in this world, and they demonstrate it every day.
4. Missionality: Team members are committed to living clarified personal values. This commitment goes far beyond themselves. They see their life as an integral part of a greater whole and congruent with the mission of the practice.
5. Energetic Curiosity: Team members are stimulated by their curiosity about people, things, and challenges. Consequently, their positive energy is contagious, and their problem-solving ability is high.
6. Resilience: Team members are flexible and able to adapt in a healthy and functional way to routine day-to-day stressors. Consequently, they don’t avoid conflict. Instead, they approach conflict maturely and with the intention of positive resolution.
7. Self-Control: Team members know who they are, where they are, and where they want to go. They also know what they are doing – or are in the process of finding out. In other words, they are effective self-leaders with the ability to delay gratification.
8. Relationship-Oriented: Team members prosper via long-term open, honest, and hidden-agenda-free relationships. Consequently, they’re able to seek out and effectively propagate opportunities for commitment in others through those relationships.

Conduct Behavioral Interviews and Assess Emotional Intelligence 

The bottom line is that our hiring process must be behaviorally sophisticated to predictably assemble a highly symbiotic team of emotionally intelligent individuals. Conduct behavioral interviews and make use of emotional intelligence and personality assessment tests. Behavioral hiring interviews ask candidates questions about how they handled specific situations in the past and the candidates are urged to provide somewhat detailed answers about their role, actions, and results. You may ask how they feel about the experiences and what they learned from them. Knowing what they know now, what would they do differently? Don’t shy away from asking them about their life goals and what appeals to them about working in a dental office. Are they enthusiastic about teamwork and making a difference in the lives of patients? 

One of the things that I take the opportunity to do every year in January is evaluate my fees. I am disciplined about this because the cost of doing business goes up every year.  

Whether it is a low inflationary time when the cost of doing business has gone up 1-1.5%, or it is more like the recent period when the cost of doing business has gone up 7-10%, our profitability is going to decrease if we don’t adjust our fees. When profitability decreases, usually the dentist’s compensation decreases.  

The Fee-by-Fee Way 

We can go through our fee schedule, fee by fee, and raise them individually. Dentists who do this are concerned that they will lose patients if they raise certain fees, for example, their fees for regular recall exams and dental cleanings. Dentists who take the fee-by-fee approach tend to believe patients are less price sensitive to the cost of restorative dentistry and appliances. Some dentists cover the increasing costs of Hygiene by increasing the fees for their restorative procedures. 

The Global Way 

Alternatively, we can do a global fee increase that raises every fee by the same percentage. This is my preferred way. To select the rate, I will look at my 2023 end-of-year profit and loss statement (from my accountant) and compare it to my 2022 end-of-year profit and loss statement. Did I make a profit in 2023? Was it higher or lower than in 2022? I don’t want to make less profit year to year.  

I will also look hard at my practice’s operating expenses in 2023 compared to 2022. I expect 2023 will be significantly higher because we have gone through high inflation in 2023 that none of us could have reliably predicted at the end of 2022.  

For example, if overhead was 65% in 2022 and jumped to 68% in 2023, I must increase my fees by at least 3%, plus a percentage I anticipate will cover overhead increases in 2024. If my profitability decreased in 2023, I also would want to compensate for that loss in the future. (Our “healthy business” goal each year is to maintain and hopefully increase profitability.) 

To arrive at the final percentage that I will raise my fees across the board, I will factor in the raises I want to give my team and myself in 2024, and the other expenses I know (or anticipate) will go up.  

The Global Way Is Easier 

If we do piecemeal fee increases, it becomes a complicated set of mathematics to determine if we will recapture last year’s decrease in profitability, cover next year’s increase in overhead, and hopefully increase our profitability over the next year. If you want to be cautious, you can blend the two approaches. Do a global increase and then go back and look at the price-sensitive fees you are concerned about and lower just those. This is the Modified Global approach. 

Evaluate Your Fees Early in 2024 

Annual evaluation of our fee is a must-do, and I don’t think there has ever been a better time to raise fees in all the years I have practiced. We live in a time when everything costs more. Patients understand that our overhead costs have increased. They know we are running a business and want us to stay in business to be there for them. 

I encourage you to use a system of thinking to figure out which fees you will raise and how much you will raise them. I advocate for the global approach or the modified global approach. Ask your accountant to give you profit and loss statements for 2022 and 2023. If you need help with your evaluation, ask your accountant or practice management consultant to assist you. 

I’m sure there are many aspects of your work that are really fulfilling, and I’m sure there are aspects of your daily work that you wish could be easier, maybe even less stressful. What about your work brings you joy? What would it take for you to provide your best work? What would it look like? What would it feel like?

I took an informal survey of dentists and hygienists about what they would need to have an ideal day. When I examined the dentists’ answers, I realized the answers would resonate with every member of a dental team.

The top five answers from dentists were:

1. Having the appropriate instruments to provide excellent care.
2. Opportunity to gain knowledge and skills.
3. Excellent performance/execution of their work.
4. Opportunity to implement new learning.
5. Working with patients who are grateful for their care.

All hygienists desired “time to provide appropriate care for each patient.” Specifically, they asked for:

1. Time to select and sharpen instruments for each person and for the specific procedures they will be doing.
2. Time to properly assess each person’s unique periodontal condition, including time to accurately measure gum pockets and recession, minimal attachment/thickness, and to assess bleeding (blood thickness, how much bleeding, and where it is coming from—is it systemic or localized?).
3. Time to explore possibilities with patients regarding their current condition, past condition, and potential future.
4. Time to debrief and collaborate with the doctor to explore the next steps for the patient.
5. Supportive teamwork across the practice to provide the best care.

Speaking of collaborating with team members, I invite you to ask your team members what their ideal day would include. Discuss, as a team, your shared ideals, and expectations. Consider where expectations do not match and discuss why this is and what must change to meet shared agreements.

Understanding and affirming the needs of others will have a positive impact. The exercise of writing down what works, what could be better, possibilities, goals, and a pathway towards implementation of superior supportive teamwork is likely to increase your practice joy factor.

In recent years, dentists, physicians, and the public have become highly aware of the interrelationships among occlusion, oral inflammation, airway problems, and systemic health. As dentists, we’ve stretched our care domain to coordinate patient care across all settings of care. Often, we are dismayed at the growing prevalence of chronic diseases among our aging patients. We want to help improve their lives. We know of ways to do this.

To do our best for our patients, it does matter if the patient has diabetes, cardiovascular disease, sleep apnea, gastric reflux, or poor nutrition. It does matter if we want to be master problem solvers in collaboration with our medical colleagues. Looking for oral and systemic health interrelationships every day with every patient is a basic element of many dental practices. Collaboration with physicians is a basic element of my practice.

Has your approach to patient care extended into at least the first phase of integrative dental medicine? This is the phase of sincerely asking the Why questions and searching for solutions. While I was in practice with Dr. Pete Dawson, for 40 years, I heard him say, “We’re going to ask why about problems until we don’t have to ask why anymore.” He called this “finding a better way.”

The 3 Pillars of Integrative Dental Medicine

In 2019, Dr. Shanley Lestini and I published a book titled The Shift: The Dramatic Movement Toward Health Centered Dentistry. In this endeavor, we were fortunate to have the support and input of two of the world’s most preeminent clinicians and educators, Dr. Peter E. Dawson and Dr. Bradly Bale. It was our goal to influence dentists and medical physicians toward fostering solutions together for their mutual patients in three pillar areas of integrative dental medicine:

1. TMD and Occlusion
2. Inflammation & Infection
3. Breathing and Sleep Disorders

Finding a Better Way Is Up to All of Us

My goal in this essay is to fuel your passion for operationalizing what we all know will make us better doctors – that which will enable us to be truly health-centered dentists. It comes down to relentless curiosity about the causes of diseases, the modalities for eliminating those causes, and how our best “individualized” efforts with a patient will have the greatest positive impact on the prevention, elimination, and management of health conditions that adversely affect their quality of life.

“We’re going to ask why about problems until we don’t have to ask why anymore.” – Peter E. Dawson, DDS

In this era of heightened awareness surrounding the intricate connections between oral health, overall wellness, and the growing prevalence of chronic diseases, we, as healthcare providers, find ourselves at a crossroads. It is our commitment to improve the lives of our patients that propels us forward. Embracing the principles of Integrative Dental Medicine (IDM) beckons us to explore the “Why” questions and seek innovative solutions. Don’t miss your chance to embark on a journey that redefines the boundaries of healthcare with the upcoming course “Integrative Dental Medicine: Creating Healthier Patients & Practices” – for more information visit the course page.

In our office, we routinely take our patients’ blood pressure, and we have a variety of cuffs. Most commonly, both hygienists use one of the convenient, digital wrist cuffs. A few months back, they noticed a trend of higher BP readings than they thought were appropriate. We wondered if the wrist cuffs were giving us accurate readings. We did a little research and I decided to reach out to my own primary care physician to ask her advice.

I learned two important things about taking blood pressure:

1. My physician recommended that we give our patients three to five minutes sitting up in the dental chair, relaxed, and not moving. While pleasant chitchat to reduce anxiety might help, we were advised to steer away from asking any medical history questions and other questions that might produce a bit of anxiety before taking the patient’s blood pressure.
2. One of the challenges with wrist cuffs is that the cuff is supposed to be at the level of the heart. In a dental chair, the patient is likely to rest their arm on their leg unless we instruct them to do otherwise. She advised that we have the patient take the arm that is wearing the cuff and place it across their chest to hold it at the level of their heart. To be at heart level, the hand shouldn’t come up to the shoulder but be horizontal with the elbow.

My physician asked me if we have arm cuffs that go above the elbow. I told her that we have two digital arm cuffs. She said she prefers using the arm cuffs herself because they tend to be more accurate than a wrist cuff, especially in picking up subtle variations.

This great information has enabled us to take blood pressure readings with more confidence and would be valuable to share with your team members who measure blood pressure. 

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series. 

A quick, easy way to create a mission statement for your dental practice involves your team. Last year, I called a team meeting to discuss what we want the practice to be like each day for ourselves and our patients. I wanted us to discuss what we could focus on.

We sat around the table in our break room. I asked the team members to take turns going around the table throwing out one word, two words, or a phrase that they felt described our practice. After a moment’s reflection, someone started the process. They had words. They had phrases. They developed whole sentences. And the beauty of this was that I didn’t have to say anything. I just sat there and listened.

If you are asking a team to be part of a mission, I think it is important that you allow them to create the mission. By the end of the meeting, we had a mission statement that we wanted to reflect on and revisit. A week later, we had a conversation about the statement. The team changed a couple of words, and then, Voila! We had our mission statement. It was a mission to which everyone had contributed.

Our next discussion was about how we wanted to be reminded of our mission and how we wanted to make patients aware of the mission. The team decided to put the mission statement on the break room wall, where we would see it daily, and to frame it for the reception area wall, where our patients could see it.

We also met to discuss our values. The team went around the table, listing our practice values. After collaboratively sorting the values, the team developed a list of our top values. This list also has been framed and displayed in the reception area.

We want to share our values and mission with our patients because they are like family. Our top priority is helping them understand their health, so they can make better decisions to improve their health.

Curious to know the wording we settled on? Our mission statement follows: “Devoted to impacting our patients’ lives by investing in their health while establishing relationships through our exceptional care in a safe and comfortable environment.”

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series.

A quick, easy way to create a mission statement for your dental practice involves your team. In 2022, I called a team meeting to discuss what we want the practice to be like each day for ourselves and our patients. I wanted us to discuss what we could focus on.

We sat around the table in our break room. I asked the team members to take turns going around the table throwing out one word, two words, or a phrase that they felt described our practice. After a moment’s reflection, someone started the process. They had words. They had phrases. They developed whole sentences. And the beauty of this was that I didn’t have to say anything. I just sat there and listened.

If you are asking a team to be part of a mission, I think it is important that you allow them to create the mission. By the end of the meeting, we had a mission statement that we wanted to reflect on and revisit. A week later, we had a conversation about the statement. The team changed a couple of words, and then, Voila! We had our mission statement. It was a mission to which everyone had contributed.

Our next discussion was about how we wanted to be reminded of our mission and how we wanted to make patients aware of the mission. The team decided to put the mission statement on the break room wall, where we would see it daily, and to frame it for the reception area wall, where our patients could see it.

We also met to discuss our values. The team went around the table, listing our practice values. After collaboratively sorting the values, the team developed a list of our top values. This list also has been framed and displayed in the reception area.

We want to share our values and mission with our patients because they are like family. Our top priority is helping them understand their health, so they can make better decisions to improve their health.

Curious to know the wording we settled on? Our mission statement follows: “Devoted to impacting our patients’ lives by investing in their health while establishing relationships through our exceptional care in a safe and comfortable environment.”