Unwitting Barriers to Care

February 24, 2021 Paul Henny DDS

Few people have worked as tirelessly to advance the thinking of L.D. Pankey and Bob Barkley as Rich Green DDS, MBA. Recently, I ran across some of Rich’s quotes that truly capture the nature of his experience in dentistry.

A behaviorist’s definition of learning is changed behavior demonstrated. As my personal growth allowed, I relaxed and thought more about creating an experience in which my patients had the opportunity to learn something, which would challenge them to change behaviors that had negative impact on their life and health. The more I looked at those “learning moments,” the more they appeared. The learning occurred as I helped patients clarify what was most important to them and what they wanted to learn. As I facilitated a learning process with my patients, they were able to discover for themselves those two things, and then they were able to take their own steps in personal growth…People tend to support what they help to create.

Below Rich is speaking of his long-term work with Don Clifton and The Gallop Organization.

As we studied the uniqueness of individual private practices, one finding was the tendency of a dentist and team to unwittingly create barriers to the patient’s progress when what they really wanted was to create pathways to greater health. The barriers were typically caused by an impatient or judgmental attitude and the “teach and tell” method of attempting to change behavior.

In this last passage, Rich speaks to the central theme Bob Barkley taught across the country following the publication of his book, Successful Preventive Dental Practices. In the mid 1960’s, Bob worked closely with Nate Kohn Jr, PhD to dramatically reorganize how he interacted with his patients. In so doing, he largely abandoned what Rich refers to here as “teach and tell,” in lieu of what Bob called “CoDiscovery.” Because Nate Kohn, Jr. had his PhD in Educational Psychology, he exposed Bob to the latest thinking in learning science – and much of it had been influenced by the work of Carl Rogers, PhD.

It fascinates me that we can now go back and understand how all of this evolved, as well as why Bob chose to do things in a very specific way. Perhaps most important is how it all evolved through the hearts and missions of both Bob and Rich. And this last point is key, because if the motivation behind a person’s use of CoDiscovery doesn’t emanate from their heart, from a deeply sincere desire to help others grow and realize greater health through that growth, it won’t work. Instead, it will be perceived as being manipulative and thwart the desired outcome.

The “unwittingly created barriers” will block the passage of the relationship to the next interpersonal level — the level necessary to establish enough trust to proceed to the needed care. CoDisovery is an intentional practice, born out of a personal philosophy toward life and practice. This heartfelt way of interacting with others sometimes feels slow, but it is the fastest way I know to truly help others.

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Paul Henny DDS

Dr. Paul Henny maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute, and visiting lecturer at the Jefferson College or Health Sciences. Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

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Why People Choose Your Dental Practice (Part 1)

January 22, 2021 North Shetter DDS

In a world where the profession of dentistry is facing commoditization with the development of Dental Service Organizations (DSO’s) and large group practices, those of us committed to private, fee-for-service, comprehensive care are facing increased competition. Over many years in practice, I have observed why people choose us and what we can do to foster this even more.

Our Competitors

  1. DSOs and multi-location groups are on the top of all our minds, as their centralized business services and approach to higher volume scheduling allow them to be profitable while offering extremely low-cost new patient exams and reduced fees for restorative services.
  2. “One-tooth dentistry” dentists in private practice are also a form of competition as they seem to be lower cost to consumers since they only treat “the problem” rather than looking at the whole person.
  3. Smartphones compete for attention. With the entire world’s knowledge lodged in our smartphone, we now find the average attention span in America has shrunk to a meager 9 seconds! Now we are in a world of TMI (Too Much Information) where a less than a 5-star review might eliminate your office from consideration even though it has no bearing on your professional skills.
  4. Nonstop digital advertising for all kinds of desirable goods and services constantly competes for patient dollars.

The Reputation of Private, Fee-for-Service, Comprehensive Care Dentists

It is interesting to note that, throughout the current Covid-19 pandemic people, have continued to visit their dentist. What have we been doing right?

We have a reputation for:

  1. Being sanitary.
  2. Following proper safety protocols.
  3. Being trustworthy.
  4. Treating people with genuine interest, respect, kindness, and thoroughness — one person at a time.

Your Approach to Patient Engagement Is Special

To continue growing our restorative practices with new patients who need and desire our type of comprehensive care, we need to create an environment of mutual engagement between our office and our clients. This is not a “paint by numbers” exercise. Each dentist and care team must create and commit to a philosophy that fits their core values and style. The way you engage with your patients is “special” to you.

Your philosophy of care distinguishes you and allows you to stand out in the marketplace. When your actions are consistently guided by your ideals, patients know it. They value it. They refer other like-minded patients to you. Your special behavioral foundation is why they come to you.

4 Tips for Building an Environment of Optimal Patient Engagement

To execute on this philosophy, we need to build a behavioral foundation that promotes alignment with our team, commitment to excellence, ample time with patients, and mutual respect. Here are some tips that have guided many private practices focused on individualized, fee-for-service, comprehensive dental care.

  1. Doctor, start by engaging and educating your team to be the best that they can be by modeling the behavior you want to see in them. Commit to high quality Continuing Education for you and your staff. Join a study club and associate with like-minded members of your profession.
  2. Engage your new patients with a patient-centered experience from first contact onward. Make a special effort to create a first visit that includes time for becoming acquainted with one another on the behavioral level and more time for a true comprehensive exam.
  3. Make sure that your patient understands that you respect them as “the expert” in choosing what outcome is right for them at this moment in time.
  4. Make sure your patient understands that your office is “the clinical expert” at determining the various outcomes that are available based on the:
  • Situation they are bringing to you,
  • Findings of your exam,
  • Technology available, and
  • Time and dollars they choose to spend.

More tips will follow next in Part 2.

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North Shetter DDS

Dr Shetter attended the University of Detroit Mercy where he received his Doctor of Dental Surgery degree in 1972. He then entered the U. S. Army and provided dental care at Ft Bragg, NC for the 82nd Airborne and Special Forces. In late 1975 he and his wife Jan moved to Menominee, MI and began private practice. He now is the senior doctor in a three doctor small group practice. Dr. Shetter has studied extensively at the Pankey Institute, been co-director of a Seattle Study Club branch in Green Bay WI where he has been a mentor to several dental offices. He has been a speaker for the Seattle Study Club. He has postgraduate training in orthodontics, implant restorative procedures, sedation and sleep disordered breathing. His practice is focused on fee for service, outcomes based dentistry. Marina Cove Consulting LLC is his effort to help other dentists discover emotional and economic success and deliver the highest standard of care they are capable of.

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The Four Universal Promises of Leadership - Part 2

June 18, 2020 Edwin "Mac" McDonald DDS

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

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Edwin "Mac" McDonald DDS

Dr. Edwin A. McDonald III received his Bachelor of Science degree in Chemistry and Economics from Midwestern State University. He earned his DDS degree from the University of Texas Dental Branch at Houston. Dr. McDonald has completed extensive training in dental implant dentistry through the University of Florida Center for Implant Dentistry. He has also completed extensive aesthetic dentistry training through various programs including the Seattle Institute, The Pankey Institute and Spear Education. Mac is a general dentist in Plano Texas. His practice is focused on esthetic and restorative dentistry. He is a visiting faculty member at the Pankey Institute. Mac also lectures at meetings around the country and has been very active with both the Dallas County Dental Association and the Texas Dental Association. Currently, he is a student in the Naveen Jindal School of Business at the University of Texas at Dallas pursuing a graduate certificate in Executive and Professional Coaching. With Dr. Joel Small, he is co-founder of Line of Sight Coaching, dedicated to helping healthcare professionals develop leadership and coaching skills that improve the effectiveness, morale and productivity of their teams.

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A Change in Behavior Begins with a Change in Belief

July 26, 2019 Paul Henny DDS

Three-quarters of human brain growth takes place in the first three years of life.

And that represents almost everything except the prefrontal cortex, which does not fully mature until around the age of twenty-five. This means that our ability to cognitively process…our ability to understand and respond appropriately to lower brain functioning, and particularly our emotional system, is quite limited early-on. Yet that is exactly when most of our beliefs about the world and how it works are formed and rarely challenged. So, when a person comes into the office claiming that “When I was a kid, the dentist put both feet on my chest to extract the tooth. It was horrible. I hate going to the dentist,” we are actually dealing with a belief and not a fact.

Responding to “When I was a kid…”

It is counterproductive to begin a new relationship with a person by telling them that they are wrong and don’t know what they are talking about. So, we have to begin someplace else, with the goal of facilitating a change in belief over time, and not with a goal of convincing others how much we know and that they should surrender to our intellectual prowess. Start with the understanding that we humans don’t like to be challenged as wrong. Also understand that we’d often rather be wrong than right, simply because it feels better to our ego.

It turns out that the only way beliefs change is through an inside-out process of self-reflection, re-assessment, new realizations, and new assumptions repeatedly confirmed by new experience. Before there is a commitment to action, your patient with negative beliefs about dentistry must go through this. And, I’ll bet you weren’t thinking all of that was going on in your patients’ brains, but it is…every single day. That is why relationship-based dentistry holds so much power and potential.

Truly helping relationships are the only vehicle through which significant personal change occurs in dentistry. L.D. Pankey said, “Know your patient,” not because you can use the knowledge strategically to defeat them on an intellectual level, but rather to help pave the way toward significant change and therefore better decision-making.

We can’t manipulate our patients toward becoming healthier.

In fact, the more we try to manipulate people, the more their lower brain recognizes something is wrong. It doesn’t know what, but at least it’s smart enough to stop listening, and focus on self-preservation—like staying away from people who will likely put “both feet on their chest.”

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About Author

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Paul Henny DDS

Dr. Paul Henny maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute, and visiting lecturer at the Jefferson College or Health Sciences. Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

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