Creating A Relationship Based Life – A True Story

October 15, 2021 Richard Green DDS MBA

New Patients / Patients of Record

Often a dentist or team member can believe: A new patient or patient of record wants to be efficiently informed on two or three things:

  • What do you want me to know about my dental health?
  • What and how do you want me to do “it”?
  • What is this going to cost? Or isn’t dental insurance going to pay for this?

A Story of Dr. R. A. Green from the Past to the Present:


A retired physician of seventy-five years of age was enjoying teaching at The University of Chicago Medical School. At the time of this conversation, I was attending Northwestern University Dental School and working part-time as a Doorman at The Hotel Pearson. The Hotel Pearson was a residence hotel; the physician was a resident of the hotel. The hotel was located where the Ritz Carleton presently stands on Pearson Street, one block East of Michigan Avenue; the time frame was the early 1960’s. That evening, as the retired physician walked out for some fresh air, he engaged me in a conversation, which he had done on previous occasions. I remember asking him about, what he was teaching?

His reply has stuck with me all these years. He said, “I am trying to encourage the young Interns and Residents to slow down and listen.” Slow down and listen, I replied with a question lingering in my voice. He said, “Yes, if I can help them begin to create opportunities for a patient to experience “deep listening” and then stay “present” with and for a patient, the Intern/Resident will notice, in time, a patient will diagnose their own ailment (at least offer enough important information to be able to develop a very accurate differential diagnosis); a wonderful place to start, a beginning!

He went on to say, “If I can encourage the Intern/Resident to continue to listen deeply, a patient can reveal how they want to be treated. And, if the Intern/Resident can listen just a little longer, a patient can initiate a conversation about how they want to pay for the services to be rendered. Deep Listening accomplishes a greater understanding of the patient, which leads to a better diagnosis, and can lead to a more successful practice model than running from room to room, thinking you only have three – five minutes to do all of the above, while not accomplishing any of the above. I am really trying to encourage them to slow down and listen!

Now, almost sixty years later, I am sitting and reflecting on my lifetime in dentistry and work with patients, team, and dentists; I too have been involved with teaching and coaching, myself and others, for over sixty years. While I strive to have conversations concerning many different aspects of dentistry, which surface while being present, with and for others, the bottom-line in a relationship-based life and practice are very similar to that of the retired physicians’ message, nearly sixty years ago.

My response is also altered and influenced, due to an early encounter’s with Dr. L. D. Pankey, soon after I had met him in 1968. In a conversation, he had asked me to tell him about my office and the flow of a day in my office. His response to my description of my usual day was, “Why don’t you Slow Down and become more Affective, you are Efficient Enough!” A similar message, and it had a heightened impact upon further reflection: “I have heard this before and it sounds very familiar!

What is it you do intentionally, on a regular basis, to slow down and become more Affective (Affective Domain), for you too are Efficient Enough?

Hmmm… Isn’t that interesting!

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Richard Green DDS MBA

Rich Green, D.D.S., M.B.A. is the founder and Director Emeritus of The Pankey Institute Business Systems Development program. He retired from The Pankey Institute in 2004. He has created Evergreen Consulting Group, Inc. www.evergreenconsultinggroup.com, to continue his work encouraging and assisting dentists in making the personal choices that will shape their practices according to their personal vision of success to achieve their preferred future in dentistry. Rich Green received his dental degree from Northwestern University in 1966. He was a early colleague and student of Bob Barkley in Illinois. He had frequent contact with Bob Barkley because of his interest in the behavioral aspects of dentistry. Rich Green has been associated with The Pankey Institute since its inception, first as a student, then as a Visiting Faculty member beginning in 1974, and finally joining the Institute full time in 1994. While maintaining his practice in Hinsdale, IL, Rich Green became involved in the management aspects of dentistry and, in 1981, joined Selection Research Corporation (an affiliate of The Gallup Organization) as an associate. This relationship and his interest in management led to his graduation in 1992 with a Masters in Business Administration from the Keller Graduate School in Chicago.

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Managing Employee Compensation in a Fair & Open Way

August 13, 2021 North Shetter DDS

As a small business owner emerging from the Covid crisis, one of the issues we face is how to manage employee compensation in a fair and open manner. Are we paying our employees a fair wage for what they do in the demographic area that we live in? Often it is not possible to know what the competition is paying.

In our current job market, skilled labor knows that they can be tough negotiators. Under current National Labor Relations Act rules employees have the right to discuss wages, hours and working conditions with others. Pay discrepancies can result in potential claims of discrimination and resentment. A mix of new hires and old hands, in particular, may lead to conflict about wages.

Your Wage Budget & Scenario Analysis

One way to address this as an owner is to create a spreadsheet that establishes the range of wages you are able to pay for various positions based on your requirements and your budget. It might look something like this:

In my case, I need to know not only what I am paying and whether I am competitive to get the best talent. I also need to know how any changes will impact my overall budget. As I am considering changes in my current employee wages and what I can pay a new hire, I need to know my overall business finances.

I also need to not manage my practice revenue to cover the luxury items I want in my personal life but instead to grow and sustain my business. I need a business growth mindset plus the attitude that Dr. L.D. Pankey promoted when he admonished dentists to learn to live on less than they make. Our teams make it possible to be in business. People come first. We’re in a people business.

Professional Guidance & Standards

My state professional association conducts a survey of offices every few years that provides a reasonably accurate picture of wages and benefits based on a number of demographic variables. That information, along with discussion of this issue with my peers, provides me with an idea of what the range of wages should be in my area.

My industry ideal is to keep total overhead for staff as close to 25% as possible, but in today’s economy this is becoming more difficult. I have found it helpful to define the market value of the various positions in the business and to understand the difference between the team members who produce income and those who do not.

Ask & Answer for Yourself a Few Questions

Where are your wages relative to your peer group? Are you underpaying, or overpaying, some of your people, and if so, what will you do about it? Where are your wages with respect to your budget and to what business analysis considers Ideal?

Something Most Dentists Don’t Do

You can take the information from your spreadsheet and share what you have learned with your team on an individual basis.

Each person needs to know that there is a range of pay for what they bring to your business. When they reach the top of the range, often due to longevity, that is all you can offer in wages. You might consider offering additional employee benefits, for example, additional vacation time. But know that what you offer will very likely be shared with everyone else.

Your wage budget worksheet allows you to develop an open and fair discussion of compensation. It helps remove much of the emotion that often gets in the way when employer and employee seek to justify levels of compensation. Your team members need to know you respect and value them, and to grasp that to remain in business there must be a profit and a budget for the business that makes sense for all concerned.

Relationship-Based Dental Practices Have an Advantage

Although recent news and chat forums indicate wages are rising for dental workers and this is putting pressure on dentists to increase their fees, we have much goodwill we can use to counterbalance this. Employees are not apt to jump ship when they like the environment in which they work…where their work is respected, their work is meaningful, they enjoy their co-workers, and solutions are found to reduce stress.

Dentists, who are truly relationship-based in their philosophy of dental practice, offer a totally different working environment than the many dental practices, in which employees describe their workplace as toxic. You can leverage the goodwill of your team members to help recruit the right new employees and stay in budget.

————

In the comments below, I’d love to hear how other private, fee-for-service dental practices are currently mindfully managing hiring and wages.

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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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On Addressing Traumatic Experiences

September 4, 2020 Paul Henny DDS

When we have experienced a deeply traumatic event, such as an emotionally laden death, or the near-death of a family member, what is often left behind is emotional debris with the potential to follow us around indefinitely. Subsequently, we can become haunted by memories of what happened, or what we should have done to make things better. These kinds of recurring thought patterns can easily bleed over into our daily lives and negatively influence our behavior—and our future.

On a neurobiological level, this occurs as our brain is designed to keep self-preservation as its highest priority. Thus, possessing the ability to quickly recall traumatic events protects us from similar things happening in the future. But commonly, this constant re-remembering can lead us into a state of psychological paralysis, depression and/or chronic anxiety, and poor decision-making.

At the present time, many patients live in fear of going to the dentist, because they believe there is too high of an infection risk. Concurrently, they consider the process of addressing their dental needs as being a lower life risk. These shadows of fear can remain strong in their mind, particularly when they have a family member who is in a high-risk category. Simultaneously, some dental team members have made the decision to leave dentistry for similar reasons. However, both challenges are happening at significantly lower rates within relationship-based / health-centered dental practices, as these practices have already built strong, enduring bridges of communication within their patient pools.

The Shadow

A contagious virus is a concept most people understand. The level of anxiety this virus has generated world-wide is something many cannot successfully manage alone. We have all had patients whose past dental experiences were so negative and their thinking about it so distorted they cannot recall why certain situations trigger their dental PTSD. Carl Jung referred to the source of these recurring thoughts as “the shadow.” Buried memories and their emotional associations can be so strong that they take complete control over a person’s behavior.

Letting Go

The brain does not stop maintaining its focus on traumatic memories until it has come up with a rational explanation for why they happened and a plan for how to avoid them in the future. On this, Jung stated, “Until you make the unconscious conscious, it will direct your life and you will call it fate.”

CoDiscovery was designed to address the influence of the shadow’s influence on current behavior patterns, in much the same way as psychotherapy facilitates the exploration of the past and associates new meanings with those memories. It is intended to help patients associate new meanings with what they are learning about their dental past.

The “Rogerian” therapy model of unconditional positive regard, congruence, and non-judgementalism is an ideal format for patients to safely explore their fears, beliefs, values, and priorities. And that’s why Bob Barkley and Nate Kohn, Jr., Ph.D., leaned so heavily on Carl Rogers’ work. Bob Barkley put this re-experiencing process under an umbrella he called, “Three Phase Adult Education,” and the rest became history.

The Future

As optimistic as the future appears to be regarding the successful management and treatment of COVID-19, this pandemic experience has reshaped our thinking—our “shadows,” forever. How we manage these memories, conscious and subconscious, will have a lot of influence on our success going forward. If we demonstrate we are on the same side as our patients in preventing COVID-19’s negative impact, we create yet another strategic advantage we can leverage against our transaction-oriented competition. On the other hand, if we allow our patients’ fear-driven “shadows” to drive their decision-making, we will rue the day we allowed this proverbial cart to be placed in front of their psychological horse.

Bob and Nate had it right. CoDiscovery is the pathway to deeper understanding, hence better decision-making. And better decision-making is exactly what our profession needs right now.

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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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Visit Your Dental Lab

August 26, 2020 Kelley Brummett DMD
Recently I went and spent time at the lab of my dental lab technician. I had heard that this was a good thing to do, but the value I got was far more than I expected when I scheduled the visit.

One of my labs is out of state and one is close by. I don’t frequently visit my labs, even the one that is close by, as I find many reasons not to go. However, whenever I have visited the local lab, I experienced them differently than when speaking with them over the phone. Early this year I set aside some time to visit my local lab.

Chairside Challenges With Patients

We have challenges chairside with our patients… It could be the size of their tongue, how they open, the frequency of how little they open, and just like us, our labs run into problems. Oftentimes, they don’t have the whole picture. The patient isn’t sitting in front of them. They only have an impression, a scan, or a model. So, I went around to each person in the lab and asked them what they are looking for when working with a dentist, their concerns, and the roadblocks they come up against. How easy is it for them to pick up the phone and call us about some of the challenges they are experiencing while working with a case?

The visit accomplished a few things. One, we established a more open relationship. This means I’m going to call them as frequently as I need, and they are going to call me as frequently as they need. Two, we reviewed the case and they assisted me with my wax-up. We had an open and honest conversation in which they helped me understand how I can improve my work. We also got to know each other. This is important to me because I strive to have a relationship based practice. I want to be able to speak honestly with my patients and lab, to laugh, and to celebrate the things that are going well.

Conversations With Your Lab Technician

What you do chairside with your patient can be enhanced by conversations with your lab technician. I know that sounds obvious, but what I heard from my lab is that dentists are so busy, they don’t pick up the phone and reach out. And when the lab calls dentists about the challenges of a case, these busy clinicians frequently don’t want to be interrupted by the call. Typically, they don’t want to redo something.

The reality is that we are not perfect, and it is challenging for the lab to make decisions when they don’t have all the information. In my relationship-based practice, it is important for me to freely exchange feedback with my lab. We get feedback forms from labs so we can tell them how well they did. I want feedback from my lab, so I can learn how to improve what I do and understand the challenges they had. I’ve never had a lab willing to give me written feedback, but by developing relationships with the employees of my lab, I have learned some things that improved what I do. And it has made phone conversations with them easier to do.

Regular Laboratory Visits

When was the last time you stepped into the laboratory you use? Have you ever asked them how they can help you improve what you do? I urge you to visit your dental laboratory technician and open the conversation.

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Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

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Miracle Makers

May 26, 2020 Paul Henny DDS

As the Pankey community begins to re-open its practices, reports indicate that most patients are responding with high levels of trust and gratitude. This represents a clear indication that the investments we’ve made in building truly helping relationships with others are paying back significant dividends at a most critical moment. Relationship-based / health-centered dental practices are designed to give the kind of meaningful caring and support that relationship-starved people truly need as they venture back out into this brave new world. 

The truly person-centered Pankey practice model aligns well with research which shows longevity and happiness aren’t just linked to healthy diets, habits, and genetics, but also to the consistent presence of positive social engagement. My mother frequently spoke of these types of happy people as being “givers.” She’d say, “They are givers – not just takers, and they pass this attribute along to their children, because, well, that’s just who they are.” 

Abe Maslow called these types of personalities “B-Lovingindividuals—individuals who self-actualize through their unconditional love of others. These are the folks who buck today’s meta-trend of consuming more, contributing less, and living a silo-type of existence. And we look forward to seeing them on our schedules, enjoy spending time with them, and feel a tremendous sense of loss when they finally pass.  These folks are the ones who intuitively know that the loving attention they give to others, no matter how simple or brief, is an ever-expanding positive experience that yields out significant benefits to themselves as well. 

When you add up all of those moments, hour after hour, day after day, year after year, you end up with the smiling and joking Betty or Bob. They’re the ones who are the first to give you a hug when you’ve had a bad day or experienced a personal tragedy. And they’re the ones who alter the course of our lives through a laugh, a smile, by demonstrating strength, courage, and irrepressible hope. In short, they are miracle makers. 

As practitioners of relationship-based / health-centered dentistry, we need to remind ourselves that we’re miracle makers as well, because we’re also in a perfect position to listen intentionally, care more deeply, and help more significantly. But that’s only possible when we choose to see dentistry as being a helping profession and not just about teeth, technology, production – and now PPE! 

On a personal level, I’ve found myself sharing my feelings about what we’ve experienced with my team and patients, and I’m finding myself opening-up on an emotional level more each day. As a result, we’ve ascended to yet another tier of caring as a teamWe’ve used this communal tragedy as an opportunity to strengthen our social bonds through love and understanding instead of allowing fear to drive us further apart.  Abe Maslow would likely say that we’re self-actualizing on the individual, group, and community levels through B-Love. This represents a key realization, because in spite of all the new stress which has been thrown into the middle of our lives, we’ve been able to see the huge practice development opportunity the situation has created for us.   

Those of us who have grown technically, intellectually, and spiritually through The Pankey Institute have “givers” hearts (just go to one Pankey Alumni meeting and you’ll understand exactly what I’m talking about). Consequently, this communal tragedy plays right to our natural strengths, inclinations, and existing practice structures. So, in spite of all of the changes surrounding us, it’s time to confidently step forward and demonstrate principle-centered leadership. And by so doing, we’ll be holding fast to what we already know is true – that the secret to living is in the giving. 

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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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Your Patients Want to Know… All Team Members Care About Them

January 31, 2020 Deborah Bush, MA

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 relationshipbased 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 pageis 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!” 

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Deborah Bush, MA

Deb Bush is a freelance writer specializing in dentistry and a subject matter expert on the behavioral and technological changes occurring in dentistry. Before becoming a dental-focused freelance writer and analyst, she served as the Communications Manager for The Pankey Institute, the Communications Director and a grant writer for the national Preeclampsia Foundation, and the Content Manager for Patient Prism. She has co-authored and ghost-written books for dental authorities, and she currently writes for multiple dental brands which keeps her thumb on the pulse of trends in the industry.

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