After practicing dental hygiene for more than twenty years, I went to work in the office of Dr. Doug Roth who was attending courses at The Pankey Institute. He had a copy of Dr. Bob Barkley’s book, Successful Preventive Dental Practices. Reading that book was a revelation for me. Although I never knew Bob Barkley, his work so resonated for me that I had the feeling he had read my thoughts about working with patients.

I had believed for some time that more was possible in dentistry. I had worked with good dentists and felt as though I took good care of my patients in the time I was allowed to spend with them. We were kind, thorough in our exams, and conscientious in treatment recommendations. Sometimes they took our recommendations, and sometimes they did not. I did not think there was much we could do to change that.

As a result of Bob Barkley’s book and the courses Doug was taking at the Pankey Institute, we incorporated a new model for bringing new patients into the office. Instead of moving patients quickly through an exam and treatment recommendations, we invested time and attention to get to know patients in a different way before we recommended significant treatment. I had no idea of the depth of connection we could have with patients, and the impact we could have on their health and well-being!

We spent “engaged” time with patients over a variety of appointments. We came to understand that the clinical tasks we had to accomplish were a small part of caring for patients. We began to see every interaction, with every patient, as an opportunity to get to know them and what was important to them to help them make healthy choices.

Over time we discovered with our patients:

• The status of the dental health
• The challenges of their current conditions
• The implications of these conditions if nothing was done to intervene
• Interventions they and we could do to change the trajectory of disease.
• A possible preferred future of choice
• Considerations involved in various treatment choices.

When we met patients where they were instead of where we thought they “should be” we found that some were ready sooner than others. We stopped giving patients solutions to problems they did not yet own. We came to understand that if we gave patients the time and attention they needed to own their existing conditions they were more curious about what Dr. Barkley called their “Probable Future” and more likely to pursue a “Possible Future.”

Without this spirit of collaboration and intentional patient development, we cannot do our best work.

Our influence develops throughout a process in which the patient is learning, in touch with their body, and engaged in thinking about the implications of the various aspects of their oral health. Because the conditions we discover today and our patient’s choices will impact their future health, we have a moral obligation to share what our experience tells us is likely to happen (the probable future) if they do nothing or if they choose a stop-gap treatment.

It is also our responsibility to help them see a preferred future that is possible for them when they are ready.

By engaging them in the exam process, creating opportunities for them to experience learning about their health, and welcoming them into collaboration, we enable them to partner with us in shaping their future. We must help them understand the implications of any choice they might make including its limitations, so they are fully informed to make true choices.

We have been trained to be efficient, and most dental clinicians have pride in their efficiency. But by prioritizing being “effective” over being efficient we make better use of our time and theirs. We experience an increase in trust, in our patient’s confidence in their decisions, and a more comprehensive view of treatment. Patients begin to see dentistry as a vehicle to create optimal health, function, and esthetics. Patients are more likely to keep their appointments, follow through on suggestions, and pay for our care with gratitude.

When we invest time in the early stages of our relationships, everything down the road flows more easily.

Enabling Your Team to Bring Their Best to Collaborative Problem Solving

One day, several years ago, our dental practice was facing an imminent snowstorm. We could see that the storm would play havoc with our professional and personal schedules. Decisions had to be made about our response. Should our plan be the same as the last time the office had been closed by weather? People were beginning to get nervous about how this was going to play out. A clear decision and well thought out plan were called for, but there was no one right answer. We needed to quickly make a collaborative plan (an agreement) to distribute power and communicate with our patients.

Planning for Contingencies

As in the case of the imminent snowstorm, I believe there are frequently practice decisions to be made for which there is no one right answer – no one strict plan that we can establish ahead of time and not expect to modify. Many variables need to be considered each time as the circumstances of owners, team members and patients change.

Collaborative planning takes “high engagement,” insight and practice. If you have preplanned team agreement on how to handle special events, you are ahead of the curve, but you will find it helpful to visit these agreements periodically, and you can anticipate you may need to collaborate “on your feet” when contingencies arise.

Role-Playing

Last year, at “Inspired Team Facilitation” with Joan Unterschuetz, we did role-playing that helped the team develop a collaborative plan for which every member of the team had buy-in and agreement. Role-playing has helped our team huddle in an emergency to clarify what needs to be done, who can best take the lead on each task, and acknowledge the compelling reasons why we are doing this as a team. It also has been helpful to prepare each department leader to motivate team members who will help them make sure we effectively communicate with patients, assure patients, and shut down if we need to do this swiftly; then in reverse, open up the practice and zero in on what needs to be done to open the schedule and reschedule patients as priority dictates.

Agreeing to Agree

From the earliest time possible, work on building a culture of agreement around:

• Team meetings with high-engagement of all stakeholders
• Understanding problems to be solved and why they must be solved
• Respecting all team members who would be affected by giving them a voice in the planning
• Understanding that department team leaders will be accountable for execution
• Coming to joint agreement and celebrating that fact at the time the agreement is made

The goal of these “coming to agreement” exercises (even about the small stuff) is to set a standard of collaboration that is in alignment with your practice philosophy. When an emergency arises, the team knows from experience that they can quickly collaborate and come to agreement on a plan of action…even when there is no one right answer and you need to kick start action immediately. If your collaborative meeting goes off track, the dentist as practice leader needs to remind everyone of the compelling reasons why they need to come to agreement now.

Can’t Involve Everyone?

Sometimes involving everyone is not possible in a crisis, but the goal is still the same. The goal is to be on the same page and united in decisions. All team members need to be informed of decisions, so if you and your department leads need to quickly create an agreement, the leaders will report back to other team members for implementation and keep them in the loop. Keeping everyone in the loop honors them and combats the human response of making false assumptions and experiencing energy-consuming emotions. In a culture of agreement, there is less opportunity for negative energy to accumulate—less “drama.”