The steps I’m outlining here are not a list of transactional procedures. Rather, they are transformational life-changing concepts. My hope is that you will be as courageous and as excited to learn about how to be a better communicator as you are to learn about implants or smile design. If and when you do take the plunge, get ready to work hard and at the same time experience a more joyful and fulfilled life. Everyone in your life will benefit, and your practice will flourish. As I wrote in Part 1 of this blog, as a result of improved communication in my practice, an interesting thing happened regarding the practice income. Instead of “me chasing it, it chased me.”

Take a look at yourself with DISC Personality Assessment.

The first step to developing your communication skills is to take an up-front look at yourself. This can be a difficult step as you dive into investigating who you are and why you do the things that you do. One of the most beneficial things I did to help myself in this area was to take the DISC Personality Assessment. This detailed report helped me better understand myself, my personality style, and my motivation. Not only did it provide me with new information about myself, it gave me hope that yes, in fact, I could learn how to relate more effectively with others.

Gain insight into the personality styles of your team members.

Once I understood my personality style, I was then able to better connect with my team. I had each member of the team take the assessment to help them discover for themselves who they were and how they communicated with each other. This exercise proved to be an eye-opener for all of us.

This new personal insight was like an eyeglass prescription change. Instead of seeing each other’s faults, we were now able to more clearly see each other’s strengths and work together more harmoniously. Honesty, authenticity, and accountability became part of our daily lives. When conflict arose among us, instead of “burying it,” we resolved it.

As a team, we were able to see each other’s “uniqueness” rather than our “strangeness.” At this point, dentistry became more fun and productive; the practice income or “numbers” rose dramatically. Keep in mind that all this growth occurred before tackling the “transactional” details like appointment scheduling or collections.

Get to know and “connect” with your patients at a deeper level.

Next, we set out to better understand our patients: their needs, their wants, their fears, and their desires. We embraced the thoughts of Theodore Roosevelt who said, “People don’t care how much you know until they know how much you care.”

A few things we did to better connect with our patients included: being aware of our posture, our tone of voice, and the words we shared. We had training and developed our listening skills, asking more questions and talking less. Other changes we made included doing a thorough new patient exam and always keep the conversations focused on the patient. As Dale Carnegie would say, we became “interested” instead of being “interesting.”

Collectively, we agreed that we would not talk about ourselves unless the patient asked us. Additionally, we embraced the use of positive language. The phrase “no problem” was banned from the office.

Continually develop your “co-discovery” skills.

As a team, we committed ourselves to continuing education, seeking excellence in both our technical and communication skills. Our desire was to better understand the individual needs of each of our patients with the goal of helping them achieve optimal dental health.

We valued “helping our patients see what we were seeing.” We embraced the idea of “co-discovery” by asking thoughtful questions and involving them more in their dental examinations and treatment discussions. For example, we used the phrase “gum health measurements” instead of gum disease or gum pocket probing.”

We took intentional steps to make sure that our patients felt well cared for and well informed. We worked within our shared values that included timeliness, cleanliness, politeness, and technical excellence. “Inform before perform” and “quality is not a variable” became an important part of our practice culture. And when situations didn’t go as well as we had planned, we talked about it using AARs or “After Action Reviews,” a system developed by the U.S. Army.

Fine-tune systems after learning how best to work together.

Once we figured out who we were as individuals and how we could best work together as a team to serve our patients, we then started to delve into and fine-tune our systems. A sampling of some of the areas we developed included–patient greeting and check-out, telephone skills, collections, scheduling, morning huddles, staff meetings, job descriptions, and a personnel policy manual, to name a few. As we became better communicators, our office became a fun and more productive workplace. And as a side benefit, at the end of our work day, we had energy left to share with our families.

Let everyone know how much you care.

I’m asking you to be contrarian in your thinking. Instead of looking solely at the transactions of your practice, focus first on how you communicate with yourself and with others. And when you do, your life will never be the same. When you become a great communicator, everyone wins–you, your staff, your patients, your family, and your friends. And remember the quote from Theodore Roosevelt, “People don’t care how much you know until they know how much you care.”

On October 1, 2018, I retired from my solo private practice of twenty-eight years in the rural town of Wolfeboro, NH. During my years of practice, I sought continuing dental education from organizations like The Dawson Academy and The Pankey Institute to advance my technical skills. At the same time, I was a student of communication reading numerous books by authors like Travis Bradberry, Dale Carnegie, Stephen Covey, Kerry Patterson, and John Maxwell. In 2009, I received a master’s degree in strategic communication and leadership from Seton Hall University. My story is one of joy, fulfillment, and financial success.

For twenty-eight years, I practiced dentistry without the influence of dental insurance, never participating with any PPO’s or Premiere programs with set fees. And in spite of that, my practice thrived. Was it because I was good at my craft? Maybe. I attribute my joy, my fulfillment, and my financial success to the deep relationships I fostered not only with my patients, but also with my staff.

An Unhappy Time in My Life

Early on in my career, I admit that I focused too much on the “numbers” or the financial side of my practice. My mood was often like a rollercoaster. When the numbers were “up,” I was “up.” When the numbers were “down,” I was “down.” In addition, patients frequently refused my treatment recommendations. It was an unhappy time in my life, and I was heading towards burnout. I was often angry and frustrated making everyone in my path miserable.

On occasion, my wife would tell me, “I know that in your heart you mean well, but sometimes your delivery stinks.”

I knew I couldn’t continue this way, and so with some trepidation, I set out to change. I knew this self-examination would be humbling as I took a hard look at myself, my poor communication, and my poor leadership. I knew that before I could lead my staff, I had to get myself straightened out.

A New Focus on “We”

In my searching, I learned that “you can’t give away what you don’t own.” Through lots of study and reflection on my less-than stellar communication skills, I was able to change my “me” focus into a “we” focus. Instead of my usual focus on money or “the golden eggs,” I started to focus on my staff and my patients, the “geese that laid the golden eggs.” And as a result, an interesting thing happened regarding the income of my practice. Instead of “me chasing it, it chased me.”

Lots of the practice management courses today emphasize the transactional or money aspects of running a dental practice: scheduling, collections, website design, marketing. There is no question that these areas are important and are necessary aspects of running a dental practice. However, in my opinion, lasting change and growth in a dental practice starts with the dentist’s thinking and his/her ability to communicate effectively.

In Part 2, I will outline some transformational life-changing concepts with the hope you, the dentist, and your team will experience the benefits of improved communication.

It’s critical to have discussions with team members about what behavioral influence entails.

Behavioral conversations are efforts with patients to encourage health. They involve discovering current perceptions and encouraging choices for improved health – especially dental health. Considering today’s understanding of the oral-systemic connection to overall well being, we owe it to our patients to continually offer them the opportunity for health.

Avoiding the BS Trap

As such, it is essential to consider that social conversation is not behavior conversation. I call it the BS trap. Yes, there is a social component to behavioral. Connecting on a personal level is critical.

As Robert Cialdini says in his book “Influence,” people like doing business with people they like. In a relationship-based practice, full engagement with patients is critical. Engagement increases the likelihood of being listened to and influencing healthy behavior.

AND, we must avoid the BS trap. Conversations need to be about them, not us. Conversations to influence values and behaviors need to be about patients. So, how do you know when social conversation has slipped into BS?

Encouraging Meaningful Discussion With Patients

The key is to realize when you are interjecting yourself into the conversation. Avoid personal words: I, me, my, mine, us, we, our, etc. It is not about us – our story – but about the patient, the patient’s story, the patient’s health values, and their objectives.

Avoid:

• “I went there …”
• “When I did that …”
• “My experience …”

How do you shift from social (the starting point in conversations) to behavioral? Have one or two powerful questions to shift the conversation:

• “How are you feeling about your health?” (Perhaps more powerful than: “What has changed in your health?”)
• “What are you doing to enhance your health?”
• “How are you taking good care of yourself?”

Then “Stay in the Question.” Continue to follow the thread they share. Remember …

Their first response is not the answer. It is their first response.

Questions are NOT the key. Listening is. Go below the surface.

• “What else?”
• “What do you feel?”
• “Say more about that.”
• “Do you have any ideas?”
• “Tell me more about …”
• “Yes, I understand.”
• “I’m glad to know that.”
• “Thank you for sharing that.”
• “Is there anything else?”
• “What is your suggestion?”

These questions work both ways. Teaching you to turn the focus onto the patient and teaching the patient to communicate their needs more clearly.

Have you read this article from team behavior expert Mary Osborne on understanding a hygienist’s true expertise?

It was August of 1995 when I walked through the doors of the Pankey Institute for the very first time.

I was attending a course specifically designed for hygienists and was literally in awe of every aspect of my experience there. Not only was the clinical information fresh and new from what I had been taught in hygiene school, I was also introduced first-hand to the philosophy that has since become the corner stone of my own personal and professional life.

The Power Of Development

Looking back over my shoulder at the past 24 years I realize that none of my learning or growth could have occurred if my “boss” had not invested in me. What I didn’t realize early on was that his investment was not just so that I could be a better hygienist. What happened was that I grew to become an incredibly high performing, deeply engaged, missionary and change agent for our practice. I learned that my thoughts, ideas, feelings, and questions were not only welcomed, but invited and encouraged each and every day. I become a perpetual student and my hunger for personal and professional development was fed and nurtured by the culture that we had intentionally created in our practice.

Today I have the opportunity to work with dental teams across the country, and my mission has evolved from being able to serve individual patients to supporting entire teams as they navigate their own growth and challenges. You see, my own experience as a team member was so powerful that I find it imperative to create my own version of Quid Pro Quo.   Yes, it’s rewarding to help practices learn and practice skills that can enhance every aspect of the patient experience, and even more rewarding to know I’m supporting each Dr and team member to be become the very best version of themselves.

What Does It Mean To Create A Healthy Culture?

Experience tells me it’s where each person is seen, heard, valued, recognized, and appreciated. Of course, it’s important to develop and implement systems, define clinical protocols and establish business operations. I ensure you that when team members feel a part of something bigger than themselves and connected to you and each other, a sense of accountability and responsibility to these standards increase exponentially…as does the presence of positive attitudes. And just in case you’re interested, I’ve also found that every single practice will ALWAYS have challenges, conflicts, and competing values to work out. The highest performing teams will be the ones who consistently push themselves to work ON their issues and work THROUGH their differences.

It was one of the greatest honors of my coaching career to be invited to work with the in-house team at the Pankey Institute last week. I left the building after our meeting filled with more pride than ever in the Institute’s commitment to excellence, and to their team. Your Pankey leadership team is continually helping each person find their voice, serve each participant, “walk the walk and talk the talk” of what it means to be in service and an agent for positive change.

Let me leave you with this question: What is the kind of culture that you want to have in your practice, and who are you willing to invest in to get there? I’m here to tell you, it’s worth the effort!

Once you want to be a leader and you know yourself well enough, you’re ready to move on to helping others effectively. We have already taken a look at the first two parts of Dr. Rich Green’s leadership definition:

“A leader is a person…

Willing and Able

To influence behavior;

Their OWN FIRST

Then others

To a preferred future.”

-Rich Green, DDS

Leading Others

Building on our willingness and ability to influence behavior (our own first), now we will talk about leading others. It is by leading ourselves well that we “earn the right” and have the highest capacity to lead others.

I’m going to use the four essential areas I discussed in the previous blog as a framework for discussing our leadership of others.

Let me start by saying that we can train someone to assist us or do a great job greeting our patients, or to do stellar financial arrangements, etc. But when we hire, what we really want to look for is someone who has similar values and is inspired by our vision and purpose.

If we are clear about our own values, vision, and purpose/mission, which means we have done our own work to get clear, we will know if our prospective employees are a good fit by asking questions.

If we already have employees and are in transition, meaning we are changing our practice and/or doing work to get more clear on our values (what the practice is about and where we’re headed), we have an opportunity to be in constant conversation with those around us.

The people around us – in this case our team, specialists, lab technicians, and patients – want to know what we believe in and what we stand for. People are hungry for connection on that level.  

Influencing Others

Now let’s look at the four areas I discussed previously and how they help us in our ability to influence others:

1. Our competency and skills.

What we are doing and how we are doing it models for our team what we expect and what we are about. When our team feels competent and skilled, they feel confident and pleased about the quality of their work.

Especially in a high level practice, taking our team to CE and taking the time to work with them on their technical skills as well as communication skills is vital to their success. Most of us know this and probably do this pretty well already.

2. Knowing how we are wired helps us understand how others are wired.

The patterns, beliefs, and behaviors are not the same, but knowing that we have all been programmed and that this is part of the human condition helps us have compassion and a deeper understanding of how people tick.

Remember, most of this programming we were either born with or was “installed” from 0-7. In some way, even if it doesn’t make sense, we all do what we do in order to feel safe, loved, competent, and a sense of belonging. Knowing this gives us compassion for why people do what they do. 

3. Emotions

Being able to be with our own emotions allows others to be with theirs. As we model this and help our team learn it, they will increase their capacity to be with their own emotions and those of others.

Empathy is one of the most important skills to have as a healthcare provider. We have the opportunity to be the leader of this in our practice and in our life. When we work with humans, we work with their emotions and experiences (whether we like it or not).

4. Knowing and owning our truth.

This is an empowered and empowering place to stand. When we own and are clear about our truth, our desires, what we stand for, and what we are about, we can lovingly set boundaries and make clear decisions.

This also helps us honor others as they stand for what they believe. Once we are clear about these things for ourselves, we have an opportunity to share them with our team so that we are all moving toward the same preferred future, which we’ll talk about in the next blog.

Stay tuned …  

I have heard many dentists say in one way or another that they are not leaders or don’t want to be. It feels to many of us like a big responsibility. Some would rather abdicate this responsibility as leaders in the dental practice (or life) because it can be hard.

Leadership & Growth

My favorite definition of a leader is from Dr. Rich Green:

“A leader is a person…

Willing and Able

To influence behavior;

Their OWN FIRST

Then others

To a preferred future.”

I started my own practice from scratch, owned it for 20 years, recently sold it, and now work in the practice part time. As the primary leader for so many years and now as a co-leader for 4, I know how hard it is.

We have a lot of other urgent and/or important things pulling for our time and attention. Even though growing and practicing our leadership is vitally important, it is seldom urgent, so it’s easy to put seemingly urgent things ahead of it.

But I would assert that leadership is ultimately the single most important tool we have to help us achieve success and happiness.

Willing and Able

As Rich says in his definition, a leader is a person willing and able to influence behavior.

The definition of willing is:

1. Ready, eager, or prepared to do something.

2. Given or done readily.

The definition of able is:

1. Having the power, skill, means, or opportunity to do something.

2. Having considerable skill, proficiency, or intelligence.

Let’s be honest, these definitions are a little bit daunting. Here’s the thing, leadership is a commitment that we “live into.” 

Feedback and Action

We learn leadership as we go. We will likely never feel 100% ready, eager, prepared, skilled, proficient, and intelligent at it. We shouldn’t constantly comparing ourselves against some ideal.

We must notice where we are and make strides toward where we want to be. We must also keep showing up, leading, and getting feedback about what’s working, what’s not, and where we had the impact we intended to have and where we didn’t.

It’s not as important what the feedback is as what we do with it. Many of us who were born, bred, and raised perfectionists have learned to focus mostly on the negative feedback. Then we beat ourselves up with it and defend or make excuses about why we did what we did.

Feedback can be really hard to hear … Part of being a great leader is learning to hear the feedback and looking to see what feels true and what doesn’t. We have to to see what created that result, even if it’s something we said and/or did (all without beating ourselves up).

And then, if there’s something that needs work, do the work to shift it so that things are better next time. We’ll be talking more about that in my next blog. Another part of being a great leader is to notice, acknowledge, and own even small improvements and to really celebrate when we (and others) do something well. So, are you willing and able to influence behavior? Even when it’s hard?

If we want to be intentional and impactful as leaders, it definitely takes willingness and effort to grow our ability. I have found that it is the most rewarding work we can possibly do!

We’re actually influencing all the time anyway, so wouldn’t it be wonderful to do so intentionally?

The ABCs of dental office organization tell us how to prioritize our time, energy, and resources so that we can provide the best care possible. In Part 1 of this series, I discussed the definition of the three main ABCs: administrative tasks, behavior tasks, and clinical treatment.

Read on for how to implement an understanding of these principles into your practice efficiency protocol:

Dental Office ABCs: Prioritizing

How can you get better at organization and adherence to the ABCs? Here are three steps – 

1. Ask each team member to list all possible administrative tasks. This includes tasks they do not need patients to be present for or where they need uninterrupted time for maximum efficiency. You should generate your list as well.
2. Next, have them create a list of behavioral tasks.
3. Finally, have your team members delineate their clinical processes. This should lead to discussions on tray/room set-up, treatment preparation, and efficiency.

These lists can be developed by each person in the office prior to a staff meeting. Then, in a team meeting you can discuss each person’s “top 3” and consider periods in the schedule throughout the week where each team member can carve out A – B – C times.

A Productive Daily Conversation

For example, our business associate at my dental practice sets aside Thursday morning for uninterrupted “A” time to catch up on delayed insurance claims, payment calls, etc. This means our relationship coordinator/primary chairside rotates to handle incoming calls and our assistant chairside rotates to chairside duties. Everyone loves the cross-training and variable challenges.

The coordinator answering the phone does not need to be under pressure. If a call comes in for the business associate, they simply state, “Sue is busy right now. May I have her return your call in an hour?” or some such reassurance.

When done well with open respect of each person’s priorities, this can evolve into a daily conversation. For example, the relationship coordinator may ask for uninterrupted time to call a certain patient about emotional support or a referral to a specialist. The business associate may request time to call an insurance company.

Have fun with it. Your approach will evolve and remember that mistakes are the fruit of great progress. Celebrate/laugh at them. Keep at it and the ABCs will change your practice.

It’s important to consider your hygienists as autonomous skilled professionals independent from your management. Of course, as the leader you must provide guidance, but you should still defer to their training in their specific field.

A Hygienist’s Expertise

This is one of the hardest parts about managing a team – letting go of the reigns a little. But you don’t have to entertain a free for all to provide some freedom. If a hygienist has made it clear to you that they have both clinical and behavioral skills, then it’s your job to open up a dialogue.

You should discuss with them what you will individually bring to an exam. Find out what they feel comfortable recognizing and diagnosing, that way you can both be on the same page. Don’t rely on the antiquated belief that hygienists only know how to recognize. They are also fully capable of diagnostic techniques.

In hygiene school, they will have thoroughly reviewed the signs and symptoms of multiple conditions. But for them, their education tends toward directing them to call the problem to the dentist’s attention.

The key to all of this is to only offer advice in your area of expertise. That goes for both hygienists and dentists. As with most things, individuals vary. Dentists and hygienists will have different qualifications, therefore providing different perspectives in the practice. No matter our level, we must offer our opinions as opinions and be willing to listen to the thoughts of others.

Diagnosing versus recognizing comes down to semantics, while both are very different from the actual treatment planning designed by the clinician. It’s a hygienist’s responsibility to serve the patient’s needs to the best of their ability based on their skill level and judgement.

What do you consider a hygienist’s purview in the dental practice? We’d like to know what you think! 

How you help patients become healthier in your practice is a big question. That’s even more true when the role of your hygienists is unclear. The best method of serving patients well can become hazy due to procedural problems that have nothing much to do with care.

Hygienists in the Dental Practice

For example, there is some confusion over the relationship between the insurance company, dentist, and hygienist. Essentially, what level of care are hygienists allowed to handle and why? This brings up multiple concerns such as their ability to diagnose, who the patient wants to hear recommendations from, and how a periodic exam is charged.

The only way to figure out the right answers to these areas of interest is to take a hard look at your individual dental practice. There is no one perfect solution, no size fits all. You have to decide what is appropriate based on your relationship to hygienists on your team as well as their skill and knowledge levels.

Who Does What?

Clarity is a great motivator. When people understand their purpose, they are better able to carry it out well. The only way you can have clarity around the role of hygienists that will then seep over to them is to separate the expectations you feel bound by from what you actually think is best.

Taking the time to consider the big picture of your practice can go a long way. You can only maximize all the personnel resources at your disposal, including a hygienist’s communication skills, technical knowledge, personal perspective, and time, if you know why you’ve hired them in the first place.

First, determine where a hygienist’s value fits into your practice. What clinical service is your best and what behavioral service is your best? Most importantly: Who provides these services and why?

Where do hygienists fit into your dental practice? Give me a shout in the comments below!

Every successful dental case begins with a conversation. 

A Case of Great Dental Expectations

“So what should we do next?” my patient asked. I rolled my chair beside him, excited about the challenge of achieving his preferred future.

I looked him in the eye. “Do you really want to know?”

“Yes!” he said.

I responded, “I don’t know right at this moment. However, may I take some models, photographs, and study your mouth? Taking time to study your mouth with this information will allow me to develop viable options for you to decide what you would like to do next.”

This conversation came after my patient lost #12 and had an implant placed. He had never asked this question before and his past dental history was single tooth dentistry.

Once the records were gathered, I spent some time in my office lab opening up his vertical according to the principles that Mike Fling teaches in his worn dentition course as well as the Pankey restorative footprint and clinical sequence taught in our Essentials 3 curriculum.

From my patient’s diagnosis, I discovered that he had two options: ortho plus restorative treatment or restorative treatment without ortho. Space was needed and form and function would definitely improve with improved space. We met for a conversation.

We looked at photos and models, then discussed the options. He explained to me that he would prefer to do the restorative plan without the orthodontics. My team and I invited him to experience a mock-up of the potential outcome from a wax-up by our own John Lavicka of Dental Ceramics. The patient immediately replied, “Let’s do it!”

Even though the patient understood why I wanted to do the orthodontics, he wanted to attempt treatment without it. I was happy to move forward with a restorative-only treatment with one agreement: If it did not work, I could initiate orthodontics. He agreed.

To be continued …