By Paul A. Henny, DDS 

In Part 1, we looked at personal boundaries in dental practice. I mentioned scarcity bias and how it is prevalent in undifferentiated dental practices but not so much in dental practices where providers and patients mutually share the values and agenda of the practice. Because scarcity bias is so human, so ingrained in us, I want to discuss two things in Part 2: healthy relationships and also how to address scarcity bias as it occurs in our differentiated dental practices. 

Insight Into Our Boundaries Leads to Healthy Relationships 

Healthy interdependent relationships are only possible through first understanding our personal boundaries (Who am I? What am I responsible for? What am I not responsible for?). That’s critical because psychologically speaking, boundaries are like fence lines with consciously regulated gates.  

The aphorism “Good fences make for good neighbors” prevails.  The same logic applies to the practice of dentistry and the nature of the relationships that we create—consciously or not, within it.  

And Now, We Circle Back to Differentiation  

Healthy interpersonal boundaries lead us toward more interpersonal authenticity, which leads us toward higher-quality communication of our values and purpose. Higher quality communication leads to a more sophisticated level of collaboration and healthy results, including healthy interdependent relationships, self-reflection, self-responsibility, improved oral and total body health, improved mental health, and a constantly growing reputation for your values. That’s differentiation. That’s personal authenticity. That’s success. 

Addressing Scarcity Bias 

Once we understand ourselves well and we communicate consistently with personal authenticity, we still have the challenge of “knee-jerk” scarcity bias in our patients. This is where patience comes in and empathy—understanding and recognizing their feelings. 

People are biased toward the here and now. The mind is naturally focused on meeting immediate needs at the expense of future ones. We procrastinate important things such as dental treatment unless we have an urgent need for it. We fail to make investments, even when the future benefits are significant or the costs of not doing so are substantial. 

When the dentist and patient participate equally in a co-discovery examination process and co-discovery consultations to discuss health history and current findings, and the patient is empowered and becomes comfortable mentioning everything on their mind, we have already begun the powerful process of leading each other through understanding what is happening in the body and what is happening in the mind (feelings and thoughts). We can start to talk about what the patient would like to achieve long term—the patient’s beyond-the-moment oral health goals. We can start to talk about what is possible to achieve together and introduce the notion that we can take steps at the speed that is mutually comfortable for us. 

Inspiration to do “the work” is often planted with just a few words that create a future desirable image in the patient’s mind. If we have the patience to let the inspiration grow, without overwhelming the patient, scarcity bias can dissipate. Often patients come back to the conversation the next time they visit us and say, “I was thinking about what we talked about, and I think I am ready to…”  

Negotiating health goals between two adults starts as an invitation to agree upon common goals. We can start early in the doctor-patient and hygienist-patient relationships by instilling the thought that preventive health care is a partnership. They can’t do it alone and you can’t do it for them. Everyone must play their part responsibly. 

Life is a lot like a game, it’s a series of physical, emotional, and financial interactions with our environment and others. Sometimes we “win,” and sometimes we “lose.” And sometimes all we can do is just learn, so that the next time a similar situation comes around, the outcome will be more favorable for us. In this context, we can also view life as a series of negotiations… negotiations with ourselves, negotiations with others, and negotiations with our environment.

On this, psychologist Jordan Peterson, Ph.D. states: “You can’t negotiate from a position of weakness. You need to understand that if you want to advance your career and yourself you must negotiate with others. And this is because, even if you are competent at what you do, but you remain silent, you will be ignored. So, in the grand scheme of things, what you can do will not even be considered. You will just be a part of the background which is keeping everything functioning for everyone else.”

To develop ourselves, and to become successful, we must, therefore, be both competent AND strategic. We must be able to say to ourselves and to others (directly and indirectly), “This is who I am. This is what I believe. This is what I can do to make your life better, easier, or more fulfilling.” But that kind of posture, that kind of clarity, and that kind of purposefulness, is only useful within the context of a helping relationship, where the meaning of “better,” “easier,” and “more fulfilling,” can be discussed and negotiated.

In the posture of a helping relationship, we are in a position to make a better offer than doing nothing. Truly helping relationships with our patients require personal power, and personal power is both principle-centered and reciprocal, as the power actually comes from the other person and their belief in us.

In situations where we have no personal power, because we have not or cannot establish a truly helping relationship, we rely on other means to advance our agenda, such as leveraging convenience, emotions, pride, deception, loyalty to a third party, fear, and so forth.When we do this, our principles are lost, as is the greatest potential for the other person to believe in us.

Remember, you have the personal power to continually reassess relationships with patients and choose whether or not proceeding with a relationship in its current form is helpful. Helping the other person have personal power… creating experiences that earn trust… choosing to manage relationships with our patients first… then, offering true help and discussing why it is better… this is the path that positively influences everything else downstream.

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…

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!” 

Janet Hagerman’s book, Selling Dentistry – Ethically, Elegantly, Effectively, presents a provocative and compelling analysis of how sales opportunities are missed by the entire dental team. Filled with practical solutions for how to feel good about your treatment recommendations and build your practice at the same time, Janet’s book focuses not only on how to be effective in your sales communications but also how to be elegant in your approach.

Selling Dentistry – Ethically, Elegantly, Effectively was born from a need, a cry for help from dental teams says the author and dental practice coach Janet Hagerman. Dental teams kept asking her how to stop dentistry from walking out of their doors and how to reverse the trend, so more patients would say yes to dental treatment.

In her book, Hagerman uses real-life examples and stories that come from her years of experience helping dental teams succeed.

According to Hagerman, dentists want to know how to sell dentistry. Their teams want to know how to sell dentistry. They want to move beyond an aversion to the “S” word to embracing the “E’s” of selling. Selling does not need to be controversial, says Hagerman, it’s about better serving patients and building trustful relationships, so patients accept the care they really need.

It comes down to surpassing external marketing and focusing on internal conversations with patients.