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 your team is feeling the loss of the familiar and coping with uncertainty. In Part 1, I also listed communication strategies to help them cope. Let’s look at what is likely to happen as you and your team continue to transition through change. 

Phase Two: The Neutral Zone 

During this transition phase known as the “Neutral Zone” or “Chaos Zone,” team members grapple with the loss of the old ways and the unfamiliarity of the new. Competency levels vary, and individuals may feel consciously incompetent or consciously competent. What do I mean by that? 

Some may feel they now know what they didn’t about the change and understand the value of it. They are ready to navigate the change emotionally. Others may feel they are starting to “get it” and deal with it. And others have become champions of the change and model confident competence in making the transition. Others will still experience confusion, stress, doubt or skepticism. This is when leaders need to step up and put on an encourager and coaching hat. 

Strategies for Managing this Phase 

• Discuss Strengths Utilizations: Encourage team members to identify how the change allows them to use their strengths differently and explore new opportunities. 
• Open Conversations: Lead them in conversation and empower them to create solutions as issues of the transition arise. Foster teamwork and purpose as you converse with them, so they feel vital to the practice. Encourage them to talk among themselves and lean on one another as a team because you want to retain that team. Express your appreciation for them navigating and embracing the change. You can take them outside of the office for a social meal that does not feel formal and they can feel connected even outside the office.  
• Provide Support: They will feel the need for information in order to feel secure. Ensure communication networks are open. Bringing in a transitions coach helps. Consider what HR resources you can make available to support individuals during this challenging phase. 

Remember, effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. 

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 can we make recommendations for care without fully understanding what the patient aspires to? The patient’s goals are the context or should be the context for recommendations that we are going to make as their partner in health. Too often, context is the missing piece in our conversations with patients.  

I’ve heard that Dr. Bob Barkley would say to his patients, “You know, Mrs. Jones, if I had taken X-rays of you every six months since you were born, we would have 80 sets of x-rays. And if I stacked them one on top of another and then thumbed through them, I would have a movie of the health of your mouth for the last 40 years. We would see how your teeth changed from health to the degree of breakdown we see today. We can’t do anything now to change that movie. That movie has already been made. But, if you like, you and I can work together to create the movie for the next 40 years. Is that something you’d like to do?” 

If we get agreement from the patient, “Yes, I’d like to work together with you to plan for the next 40 years,” that’s not a specific goal, but it begins to create a context for our recommendations. Instead of the provider setting the expectations of the patient, it becomes more of a mutual agreement to long-term planning, so that there’s a buy-in by both parties in the relationship. That’s moving toward a partnership.  

When we set a general mutual goal during the preclinical consults, it fits in well with our not knowing what we will uncover during the clinical piece of the appointment. Dentists and hygienists can be direct about it, and I think there is value in saying, “I’d like to come to a mutual agreement that we work together to understand what is going on in your mouth, and based on the circumstances we find, come up with the best solutions for you. Is that something you would like to do?” 

We can set expectations by saying, “As we go through this process, I will be asking for your input. We’ll take it slow and be thorough. We’ll discuss what you and I discover, and together we can think through the next steps you may want to take. How does that sound to you?” 

I think it is essential to this process to invite the patient to be in shared control by asking, “Would you like to proceed with the clinical examination? Do you have any questions for me before we begin?” 

When we come to the conversation as fellow travelers with the attitude that “the two of us can work together,” we open ourselves to working toward mutual agreement about what it’s going to take for this particular person to achieve the level of health to which they aspire. Starting as partners with the goal of improved health is a low-stress way of being in a relationship that is comfortable for both parties. 

By Edwin “Mac” McDonald DDS  

Change isn’t just about external circumstances; it’s also an inner evolution. We go on a transformative journey, and our reflections as we go touch upon our intention and legacy, our personal identity amidst the change, and decisions we make as the change unfolds.  

Challenge 1: Intention and Legacy 

When facing change, having a clear intention is like setting the compass for your journey. What legacy do you aspire to leave behind? Aligning your actions with your deeply held beliefs ensures congruence between your intentions and outcomes. But stress may cause you to move away from your most deeply held beliefs. I’ve witnessed this happen, just as I’ve witnessed deeply held beliefs guide what happens. 

Challenge 2: Personal Identity Amidst Change 

The question “Who do I want to be during this transition?” is profound. It invites introspection. Consider how you want to show up for yourself and those around you, especially those who are most important to you. Authenticity matters. 

Challenge 3: Listening and Accountability 

Change often involves decisions. Whose voices matter? Listening deeply to trusted individuals—those who respect and understand you—can provide valuable perspectives. Forming a leadership team of diverse viewpoints helps guide you toward success. 

The Importance of Values During Dental Practice Mergers and Acquisitions 

Many private dental practices are being acquired by large partnerships in 2024. These transitions have tons of potential and profit associated with them. Associated with these transitions are complex changes for the practice owner and team members…expanded ownership, more complex organizational structure, new operational systems, and a distancing of some decision making. They also come with the unknown of who will be your future partners after the next sale of the organization. Are you prepared for all of that?  

Preparing yourself and your team is essential. On the front end, asking every possible question including questions about the partnership’s core values, how they are integrated into the day-to-day operations, and communicating the importance of that to you and your team is essential to long term success. These questions and expressions are an attempt to examine the congruence and compatibility between you, your team, and your new partners. 

I am witnessing several friends transition successfully to one of these new partnerships. The common factor I observe is that each dentist has great self-awareness and received very strong assurance that they would retain autonomy to continue to practice according to the most deeply rooted values. I also observed that the large partnership was very stable with excellent systems and had high quality leadership.  

My father often told me: “The person that you have an agreement with is more important than the agreement itself.” In other words, a person of strong character will find a way to honor the intent of the agreement regardless of the specific circumstances of the moment. Values have longevity. Circumstances come and go. 

I have also witnessed an abandonment of strongly held values as an organization was going through the painful changes of decline. In abandoning their values, stakeholders were hurt and distanced themselves. It intensified and accelerated the decline. Values matter. Character counts. Clinging to our core values in times of change or decline will increase and accelerate recovery. There are countless Fortune 500 case studies to support this idea. 

Another Example of Values in Transition from My Life 

Finally, I want to leave you with a case study from my church, The Village Church. We had become a multi-site church in response to the demand of many people attending our main campus. As it grew, our leadership became painfully aware that it was not fulfilling our mission and it was not consistent with our closely held values of community and individual relationships. Over a period of several years, each church was given the opportunity to vote on becoming independent. They all voted around 95% in favor of the change. We gave away around 40 million dollars of real estate, equipment, furniture, and other assets to all of the churches.  

Today, the new independent churches are thriving as is our main campus where we attend. The decision was in conflict with everything that is happening in our business and church worlds where there is constant consolidation and scaling. However, the decision was consistent with the values that drive the purpose of the church. The change created multiple thriving churches that are serving their specific communities and growing people and their impact on our world. 

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? 

By Barry F. Polansky, DMD  

An excerpt from Spare the knives…save the dental souls! published in Dental Economics, March 1, 2002 

For many in our profession, the daily onslaught of difficult procedures, rejected treatment plans, assistants who just don’t get it, the end-of-the-month cash-flow crunch and other office “fires” can lead to a fate not unlike the victims of the Chinese torture. 

The ancient Chinese employed a form of slow execution called “The Death of a Thousand Cuts” in which the victim was sliced repeatedly with a knife. Each individual wound was superficial and nonlethal, but the accumulation of hundreds of cuts proved fatal and caused much more pain and suffering than one sure stroke. 

Henry David Thoreau said, “The mass of men lead lives of quiet desperation.” I’ve come to believe that, in dentistry, there are a higher proportion of people in that category than normal. We start our dental practices to give ourselves more life; yet, inevitably, our practices slowly suck up the lives we have. 

Ironically, it wasn’t the dentistry that caused my distress. It was the “business” of dentistry that devoured my soul. All things being equal, I love the clinical side of my profession. But all the problems that confronted me in my practice—social, financial, and physical, during the normal day-to-day routine were overwhelming. The business of dentistry is hard! Unfortunately, I didn’t quite recognize that at first. 

Like many people, I studied philosophy at college, enjoying the sense of order that a well-constructed framework of ideas could bring to an otherwise indecipherable argument or problem. So, when faced with such a myriad of problems in the early days of my practice, quite naturally, I began to search for a philosophy of dentistry that would help me make sense of the issues at play. 

I looked to successful dentists to find my mentors, and, at the time, there were some great ones—Pankey, Dawson, Reed, Becker, Barkley. What I learned was a real eye-opener! I thought the antidote to my woes would be advanced clinical skills; however, these dental gurus were talking just as much about staff management, financial control, and the philosophy of running a business as they were about how to cut a great crown prep! I was surprised, but it made sense. I put these ideas into effect, and my practice turned the corner from that time on. 

By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

Kelley Brummett, DMD 

Recently, I completed growth conferences with everyone on my team. The beauty of a growth conference is that it’s all about growth. It’s all about effort. It’s all about meeting each other and becoming more aligned with the mission of the practice. If I have something I want to share with a team member that’s a concern or something new I would like them to achieve such as mastery of a new skill, I think about how I’m going to communicate it. And as I do growth conferences with the individuals on my dental team, I am cognizant that they are likely to want to receive feedback differently as individuals.  

I’ve discovered that if I ask my employee upfront how they like to receive feedback, they pause to think before responding. I wait patiently for their response because I know the response will save both of us time and energy. For example, there are some team members who want the short and skinny of it—“Give it to me straight now.” They don’t want you to hold back. There are some team members who need to be gently warmed up before they can hear the message and require thorough explanations of why. 

I’ve discovered it helps to frequently ask the “how do you like feedback” question of my team to get their buy-in of my feedback. The beauty of “feedback” is that even criticism can be framed in a positive way as the next identified step in working towards a goal.  

Those of us in dentistry know that sometimes we move fast, but there are times that we need to sit back, think through what somebody gave us information about, and then come back and have a conversation. Mary Osborne has guided us to have conversations with patients that allow us to slow down and learn more about them so they can think, hear themselves speak, and learn about themselves. I’ve decided the feedback question is also a good question to ask patients. “How do you like to receive information? Would you like to know all the details or for me to summarize?” 

I’ve learned from Mary and experiences with patients that “staying in questions” helps them grow. Staying in questions also helps team members grow. Staying in questions helps us providers grow. So, feedback—how do you give it? How do you like to receive it? How do you handle it? I encourage you to think about this. 

By Michael (Mike) Rogers, DDS

Close to my office there is a small strip center that includes a realty group and a small church. At one end, there is no sign to show what it is, but it has a drive-through window. Every day there is a significant line of cars going up to that window. Cars line up waiting their turn, and the line is so long the cars snake through the parking lot, out into the street, with hazard lights flashing. 

I have a friend who loves to create stories about what is going on in strangers’ lives. Why is someone driving so fast? What meal are they going to create with food in a shopping cart? Why are two people arguing?  

Fantasized from some level of observation, my friend has captured what this drive-through is all about. He believes that because the drive-through is adjacent to a church, you can pull up to the window and are given a donut along with a prayer. It’s a small ministry for people to have a better day. That’s not a bad narrative but no real basis for the story. I say that as the line of cars grows longer, the prayers gain power. I get a warm feeling of their impact on others. 

I find we make up stories in my office as well. We make them up about why someone didn’t show up for an appointment, why someone didn’t move forward in care that has been advised, or why someone won’t pay a balance. Our tales are based on some level of observation, but they are tales none the less. 

I try to remember to look at these moments in three ways. 

• What do I know? 
• What do I think I know? 
• What do I want to know? 

We practice this in our office. I encourage my team to not live in “what I think I know.” This state of mind too often leads to creating stories that reflect a judgement. If I hear a team member begin to create a narrative based on a circumstance with the phrase “I think…,” I try to politely make them aware of what they are doing. They most certainly recognize when I do it and politely let me know. I just grin to hide my disappointment in myself. Maybe someday, I’ll say, “thank you.” 

In relationship-based practices, we have such marvelous opportunities to help people be healthier. Asking questions about what we’d like to know and sometimes creating self-discovery for the patient as well. We often get repeated moments to connect and learn with each other. The need to make up stories is dissolved when we get to hear their story. Sometimes that story is fun, other times hard. We get to walk along that story with them. What a gift to live a life in that connection! 

Recently, a member of the realty group on one end of the strip center came in to see me. I couldn’t resist asking what the line of cars is about. It turns out it is an Ignition Interlock site for people that have had a recent DUI. You go up to the window for your installation time of the small handheld breathalyzer to prevent your car from starting after drinking alcohol. 

I haven’t shared that with my friend. I like his story better. 

Paul H. Henny, DDS 

Trust is commonly thought of as a firm belief in the reliability, truthfulness, and capability of another. But trust is about vulnerability . 

The more a person trusts, the more they are willing to allow themselves to be potentially hurt. They make a risks-benefit analysis, and when they feel they are ready, they decide to throw the dice.  

Conversely, when a person isn’t willing to trust, they have strategically chosen to minimize their vulnerability.  

Think about the times when you were personally unwilling to let someone into your life—when you were feeling too vulnerable. 

It’s easy for us to project our values without sensitivity to others’ often hidden concerns. When a patient says no to x-rays, to allowing us to proceed with a proper restoration, or other appropriate procedures, they don’t trust us enough right now. And when that occurs, it’s easy for us to instinctively respond by projecting our values onto the situation.  

A better strategy is to empathetically explore why a person responded to the situation the way they did—try to understand the situation from their perspective, and then focus on finding common ground in shared goals and values. Hopefully, with the right questions and empathy, we can build a bridge of trust and help our patients cross over to a place of more information on which to make the appropriate decisions for themselves. 

“No” often means “not yet,” as in “You haven’t convinced me yet that I should allow myself to be that vulnerable around you.” 

Co-Discovery requires a leap of faith on our part—a belief that most people will eventually do the right things for themselves. If we are unable to trust our patients on that level, then we’re going to struggle emotionally, demonstrate frustration, and to some extent inadvertently manipulate patients into doing what we want them to, a behavior that drives emotionally sensitive patients away. 

We need to trust our patients will make the leap as well. We need to willingly take the time and energy to continue in and trust the Co-Discovery process during which the patient starts to believe that we are the best resource to help resolve their problems and achieve their goals. When we allow our patients the time to make decisions based on what they think is in their best interest, they usually make healthy choices and appreciate the services we provide. This is how we succeed in helping them (and us) have a healthier, happier life. 

For an in-depth look at Co-Discovery and multiple essays on patient-centered dentistry, you are invited to read my recently published book: CoDiscovery: Exploring the Legacy of Robert F. Barkley, DDS, available at The Pankey Institute and on Amazon.