By Edwin “Mac” McDonald DDS  

Effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. In Part 1 of this series, I described Phase One: The Ending Zone, the time during which a team is feeling the loss of the familiar and coping with uncertainty. In Part 2, I described Phase 2: The Neutral Zone, the time when a team is learning to embrace the change. Let’s look at what is likely to happen in Phase Three as a team continues to transition through change. 

Phase Three: New Beginnings  

During the third phase, the grieving is now passing or gone. This is when you and your team begin to identify yourselves (your culture) with “the new”—whether that be a practice ownership change, addition of more team members, merging with another dental practice, moving to a new office, updating your technology, adding a new niche service, dropping PPOs, or changing your operational systems (how you do things). The change is affecting their daily work and interactions with patients and each other. Adding to this burden is the tendency for patients to ask questions about the change. They also want to know about and feel connected to the change. Time and energy go into that additional communication. 

But, wonderfully, uncertainty is gone and things are clearer to the team members. Commitment becomes high again, and things start to feel “normal” again. People’s sense of competence is greater, they are able to easily identify the practice’s values to what is happening and how they are personally connected to them. When leaders and team members get to this stage, they can focus on the quality of the patient experience, and a new sense of commitment is felt. 

Strategies for Managing this Phase 

• Continue to talk with your team and individuals about how they are feeling about the change. 
• Acknowledge team members that have contributed to the changes. Doing this publicly cultivates trust and gives an example for others to follow. 
• Give individuals a part to play in sustaining the change and ensuring that it becomes the way of working or operating. People need to feel as though they are a part of it. Some leaders who have a hard time with delegating may need to practice letting go. 

Keep in Mind 

• Ultimately, the leader’s ability to communicate effectively will be the leading success factor in managing transition. 
• Approach other natural leaders in your practice – these are the people that others tend to follow or listen to , so get their buy-in early in the process. This will provide more support for you during the process. 
• Expect people’s performance to drop during the process and give grace to those that are not at their highest and best. Eventually, they will reach the other side and so will you! 

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. 

By Mary Osborne, RDH 

How much time do you schedule for a new patient, non-emergency visit? Is your priority efficiency or effectiveness? Is your goal to gather as much clinical data as possible, or is it to begin to build a relationship of mutual trust? Both are possible if you see the new patient visit as more of a process than an event.   

Too often new patients are rushed through an assembly line: brief conversation, clinical exam, diagnostic records, and treatment presentation! Is that really the best way to help people make choices about their health?  

There is no one right way to schedule a new patient. Different practices are successful with different models based on the values of the practice, practice growth, and the personality and skills of doctors and team members. The most important determinant of success is our ability to meet each patient where they are and join them on a journey to health. I am not suggesting we should be without practice standards of care.  We have a responsibility to decide what we need before beginning treatment. Our challenge is to guide patients to understanding why we need what we need, and why that is relevant to their unique situation.   

We may anticipate that patients will resist this type of experience, but if we make it truly about the patient and are flexible, I have found that patients are more than willing to participate in an individualized process that best meets their temperament and circumstances. 

I remember seeing a new patient that I was told was a “very busy attorney” because his secretary said so when she made the appointment and his wife said so when she confirmed the appointment. I anticipated that he would be a driver and prepared to efficiently move him through his appointment.  

As I explored his health history with him he expanded on the specific answers to questions. Soon, he was leading the conversation. When I remarked that I wanted to make sure we were making good use of his time. He said, “Mary, what’s this about time?” I replied that I knew he was very busy. He said, “Mary, this is about me. I have time for me.” 

His statement has stayed with me because I realized that if the conversation had been about me going through my check list and not listening to him, it would not have been a worthwhile experience for him. It also wouldn’t have been a worthwhile experience for me. 

I have learned that when the patient feels in control of the process they are willing to give that time to themselves. A lot of aha moments occur as they learn about themselves while speaking. When patients feel like they are on an assembly line being moved through our system, they have every right to be resistant.  

Empowering patients to lead the process is both an attitude and a learnable skill. When we can lose ourselves in the moment, really listen, really encourage, and really care about the patient’s thoughts and feelings, it is easy to make connections to the next step we recommend.  It is my experience that I can more quickly become a trusted health advisor when I intentionally share control with my patient. 

Most patients are willing to invest more time in the process when they see the connection between their needs and what we recommend.  These are typically patients who have or have had complex health issues and are seeking to improve and retain health. They perceive the value of the extended process and how much value you place on spending in-depth time with them.  

The entire team’s communication can deliver the message that everyone in the practice is keenly interested in them, and their appointment is uniquely planned to meet their needs.  

What has been your experience? Are you open to scheduling more time for conversations that typically garner trust and appreciation earlier in the relationship? 

For support organizations and dental service organizations (DSOs) to scale, they focus on developing a branding patient experience and a predictably profitable business model. They seek to maximize:

• efficiency while serving the needs of consumers,
• provide a wonderful patient experience, and
• increase both their top and bottom financial lines.

Dentists who have chosen the private practice way of life may want to reflect on the following 12 things DSOs strive to do in 2022, and then apply these tactics to their own business model. These tactics have been among the top topics of conversation at DSO meetings in 2021 and 2022 and will sound familiar to those who follow The Pankey Institute. Why familiar? Because they are top topics also discussed among private practitioners and many are addressed within the Pankey Institute curriculum.

1.Monitor more aspects of your clinical and business operations to determine what is working well and what problems need solving. Then solve the problems as rapidly as you can. As the practice leader, open your eyes and ears, and lead.

2. Track key performance indicators and seek growth in those KPIs.

3. Cultivate a positive practice culture and work environment in which employees want to work and patients want to visit. Team members should constantly check in with each other to communicate what is happening “now” and intentionally tune their senses to know how they can help one another. The goal is both a wonderful patient experience and a wonderful team experience.

4. Design systems and protocols with intention, follow them, and assess them for improvement. Make sure team members understand the Whys.

5. Invest in training your clinical and business teams. Especially important in the last two years are to:

• • Realize the potential of each team member and affirm they are valuable to the practice.
  • Educate clinical and front office teams in how to best engage and support patients with special attention to facilitating the treatments patients need. DSOs have targeted implant treatment and doctor-supervised, clear aligner orthodontics as two niches to focus their education efforts on with staff and patients.
  • Educate front office team members in how to appropriately maximize lead conversion, so the cost of expensive digital marketing can be contained. With increased new patient acquisition, reserve more time on the schedule for new patient appointments. In 2022, if new patients must wait, they tend to go elsewhere.

6. Maximize clinical technology to improve the patient experience and increase the efficiency and accuracy of clinical records, diagnosis, treatment planning, dental lab communication, and manufacturing.

7. Maximize practice management technology to improve the patient experience and increase the efficiency and accuracy of business operations, for example, AI enhanced software that automates billing and online collections or reviews insurance claims for accuracy prior to submission.

8. Migrate to a Cloud-based PMS system to ensure the security of your data.

9. Block schedule to do more procedures in a single visit. Patients and clinicians benefit from this efficiency. Maximize spaces in the visit—as you transition from one procedure to another, to enhance relationships with conversation.

10. Deploy a dental assistant to assist in hygiene, for example, to help clean and turnaround hygiene operatories between hygiene patients. This way, the hygienist’s relationship time with patients is not shortened or eliminated in the race to meet clinical demand.

11. Ensure adequate front desk coverage, so there is always time for those personable conversations that ideally occur when each patient arrives and leaves their appointment. Manage your human resources so almost all phone calls are answered live during business hours by a receptionist well versed in optimal conversation with dental patients.

12. Frequently ask, “What is our branding patient experience? What can we do better to meet the desires and needs of our existing patients and the prospective patients we target?”

Looking at this list, I can’t help but think that Dr. L.D. Pankey would smile. Just because you don’t have a corporate support organization helping you run your business doesn’t mean you can’t do these things on a smaller scale and possibly do them better.

Efficient office organization leads to effective office functioning. It frees team members up to take care of people. It can greatly increase effectiveness – defined as helping people make choices appropriate to their health and improving efficiency of care delivery.

Dental office organization starts with understanding tasks and roles:

ABCs in the Dental Practice

A = Administrative Tasks

These are tasks that can be done when patients are not present. For example, planning next week’s schedule for effectiveness or following up on and processing insurance claims.

More examples:

• Filling the hygiene schedule.
• Working the re-care system.
• Supply ordering.
• Treatment planning.
• Specific treatment pre-planning.
• Review of x-rays, charting, and chart notes. 

B = Behavioral Tasks

These are usually communication efforts with patients. Focused, uninterrupted time is available.

Examples:

• Talking to new patients on the phone.
• Care instructions following treatment.
• Treatment conversations.
• Financial arrangements.

C = Clinical Treatment

Here the patient is present. Ideally, treatment has been organized and so thoroughly thought-out beforehand that care proceeds rapidly and efficiently.

I have heard it said that treatment can be fast and good, fast and bad, or slow and bad. Slow and good is virtually never possible.

Speed and efficiency respects the patient’s time and emotions. This is why effective clinical organization must include pre-planning. 

Understanding Office Roles

If you understand these roles for yourself and each team member, your week can proceed much more effectively. Many dentists do not feel “productive” unless they are chairside spinning the high speed, but this is not always the case.

If you consider your role in the practice as similar to a CEO (vision and implementation) and/or COO (efficient operations) you must consider “A” time important.

If you consider yourself an advocate for your patients, your “B” time – especially quiet time to ponder treatment options as well as learn and grow in communication – is essential.

To increase your dollar per hour productivity, you must practice continual chairside improvement and time management in treatment procedures. This is the only way to accomplish more work in a single day.

To be continued …

There are many reasons to continually think about how you can add more value to patient appointments. First and foremost, though returning patients want to feel comfortable, they will also appreciate small beneficial changes when they visit.

Value is the number one motivator that will keep patients coming in regularly on time without missing appointments. If being at your practice is particularly enjoyable, they’ll be excited to keep their commitment to regular recall appointments. Additionally, if you provide expanded health services, you’ll be elevating your hygiene appointments to another level.

Here’s a value add that’s easy to implement and good for patients:

Hygiene Boost: Taking Blood Pressure

Many patients may see their hygienist more often than their regular physician. That’s why taking their blood pressure at the start of an appointment is so beneficial. Blood pressure can tell you a lot about the state of their general health.

Patients may be surprised at the result gathered from the blood pressure cuff. If it reveals seriously high blood pressure, a recommendation to a physician may be necessary. The hygienist should explain that your practice takes this additional measure so that you can truly provide comprehensive care. It’s part of your thorough screening process, including periodontal assessments and oral cancer screenings.

Your hygienists will also appreciate being able to provide this extra touch of healthcare. They could really be making a difference for someone who had no idea they were experiencing an issue. Most importantly, it’s another relatively inexpensive way to show patients they are cared for. The entire process should take less than two minutes.

For more Pankey fun, check out this blog on our favorite places to eat Cuban food here. The next time you’re in Key Biscayne, you won’t be able to resist.

What add-on services do you provide during hygiene appointments? We’d love to hear your good ideas!

After building my dental practice from scratch, my work life began to get more and more intense. I knew I had to slow down, but I didn’t know how until I decided to take a leap of faith and visit the Pankey Institute.

Creating a Work Life Vision at Pankey

At Essentials One, I was blown away by the faculty to student ratio. It was almost 1:1! The quality of the education was outstanding, but what I found most impressive was the encouragement, mentorship, and passion from all the faculty and staff.

Pankey taught me how to help my patients value dentistry, develop communication skills, and learn co-diagnosis. Most importantly, Pankey helped me create a vision of what I always knew I wanted — a low volume fee for service practice that allowed me to have a good family-work life balance.  

Returning to My Dental Practice Recharged

When I came back home from Essentials 1, I immediately stopped working six days a week. I started some training exercises with my team to show them what my vision was.

One month later, I went out of network with my first insurance plan. This plan was one of my biggest — it made up 25% of my patient base, but I was determined. Six months later, I evaluated our progress. We did not lose a single patient and our revenues had actually doubled. When I saw this, I went out of network with six more plans immediately. We were on a mission.

Today, two years after Essentials 1, I am only in network with one remaining plan. Our practice has continued to grow. We have worked less hours, seen almost half as many patients per day, and our practice revenues have increased.

Additionally, I have also taken more time off every year and taken more continuing education than I have in the past. My team continues to be excited in our journey together to achieving our professional and personal goals.  

My story is nothing special. I truly believe anybody can develop the clinical, leadership, and communication skills to create a successful relationship-based practice. For me, the Pankey Institute provided all the resources I needed. Pankey has changed my life. I hope to give back one day. 

What’s your dental practice story? Join the conversation in the comments! 

One of the gifts of dentistry is that we get to drive our vision and create the practice that engages and fulfills us. There are really very few professions with such limitless possibilities.

If you dream about working three days a week, you can create that. If you want to work from 7-3 or 3-10 you can. Do you love doing endo procedures? Then you can do them. If you dislike doing pediatric dentistry, then you can choose to refer it all out.

How to Practice Dentistry in a Way That Fulfills You

There is no one way to practice dentistry. This is an incredible gift and for me makes dentistry one of the best professions. Having this amount of choice also comes with some challenges and responsibilities.

The first challenge is accepting the gift of choice. Dentistry is full of outside pressures that can drive how we practice if we choose to let them. These pressures may come from other members of our team, other dentists we know, insurance carriers, or our own beliefs.

Along with choice comes the responsibility for choices, their execution, and their outcomes. Creating the practice you dream about may not happen overnight. It will require a thoughtful plan and the commitment to execute it, but it is within your reach.

The place to start is to allow yourself to dream and dream big. Walk on the beach, find a quiet space, and just let go of the constraints of how things are now. Imagine what it would look like to practice dentistry and LOVE it.

As you imagine this preferred future, tap into your emotions. If you find yourself excited, energized, and propelled to action, then this is the path to start to walk down. Refrain from asking yourself “How” you will create it.

Once you have a vision for how you want to practice, now it is time to ask the “how” question and remember anything is possible. The question is what will it take to create it. Begin with a timeline and ask yourself how long from now you want to have the practice you just dreamed about.

On the right hand side of the timeline is that preferred future. On the left hand side is today and how things look today. Then work backwards from the future and place milestones in time and change along the way.

Remember, for everything you want, there will be something to give up or some cost, but it is possible!

How have you designed or wanted to design your dream practice? We’d love to hear from you in the comments!