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The Proactive Practice: why "change" doesn't work

March 1, 2008
You attended a seminar on Friday and are excited to implement what you learned on Monday.
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by Gary Kadi

You attended a seminar on Friday and are excited to implement what you learned on Monday. At your Monday morning meeting you share this new “flavor of the month” while your team is looking at you and thinking, “He must be smoking some good CE again.” Your motivation doesn’t even make it to lunch.

Change doesn’t work. We have plenty of evidence to support this. The more we try to change, the more things stay the same. In this article, I will share with you 14 years of research that has collectively yielded billions of dollars in increased collections, has resulted in many worry-free years of time spent out of the office, and thousands of happy, driven team members.

I know I’m being a bit harsh here because I know most of you have made changes that have made a profound difference for your patients, your team, and for you and your family. I’m going to suggest that what you actually did was make a transformation. Most of the time change happens with one or two individuals at different times. Everyone committing to change at the same time is vital for change to stick.

The magic in creating the Proactive Practice lies in transforming each individual on your team and then aligning the group collectively to a common cause.

Seven blind spots hindering sustained change

Blind Spot 1: If you can’t see the outcome, you cannot achieve it.

So often we focus on tasks and activities and not on the result. Do more to have more. Do,do,do,do,do,do … all you get is “do-do” and the more you do the worse it smells. It is like being on a treadmill with no “off” switch.

When we observe practices, (most) everyone is working hard and is very busy. The challenge here is that the team is focused primarily on the means, not the end, and on activities rather than results.

The essential shift starts with the leader. When my firm asks a doctor why he or she wants to hire us, the answer usually goes right to more money, better systems, happier team, patients who comply. My next question is, “Why do you want this?” This question forces him or her to look beyond the immediate desires. The usual delayed response is, “I never thought about that.”

Getting to the “why” or source of motivation or intention drives the journey from the inside out. We never do things because someone on the outside tells us to. Consider the quest to quit smoking. How many people have you known who continue to smoke after a heart attack and the demand from their cardiologist?

Take it to the Next Level action:Start with the end in mind. Write up a one-page description: “My Ideal Practice and My Ideal Life.” Find a quiet place without distractions where you’ll feel comfortable creating. The key is to have an area of open space to help expand your mind — on the beach or on your patio, for instance. Next, disconnect from your considerations, justifications, and the reasons you’ve been telling yourself you can’t. Visualize yourself retired and playing with your great-grandkids (or golfing) full time. What do you want to be known for and why? What do you want for yourself and the generations to follow? Now take yourself a decade prior to that outcome and capture what this time in your life looks like, what you are doing and experiencing, then back up decade by decade until you get to today. Notice how you feel. Does the journey you just created seem possible and real to you? If not, start over and repeat the exercise until it does.

Blind Spot 2: One move is connected to at least seven others.

So often we want to make changes and do not think things through. In my studies, there is an average of seven things that need to be addressed with each change that is made. This is because the things we want to change are symptoms of a root cause. If you’re are trying to change a symptom, all you’re doing is “band-aiding” it. This is why scripts do not work. For example, the root cause of why there are broken appointments in your schedule is because those patients never really agreed to the treatment, let alone the cost associated with it. We think they agreed because they “scheduled.” When they don’t show up, you really believe they must not be feeling well. Sometimes they call, but most of the time they just drop out of care and enter the inactive purge file. Then you invest in more marketing to obtain more patients. Again, another example of symptom band-aiding.

Take it to the Next Level action: Pick one area in your practice where you want to make a change. Apply this four-step process: 1) Trace the symptom back to its source, 2) Co-create a plan with your team to address the challenge, 3) Get agreement from the entire team of accountabilities and actions to be taken, and 4) Measure, monitor, and course-correct as needed until it becomes habit.

Blind Spot 3: The past is collapsed into present and future.

Here is where change meets “transformation.” Trying to resist, change, or avoid the influence of the past keeps us focused on it. We are reluctant to leave the past behind; disinclined to let go of the hold it has on our present lives. Not doing so results in an endless treadmill of trying to live in a “now” that is littered with smaller thinking from our past. Consider that up until now, your past has collapsed onto your present, which gives you your future. We are all trying to create big futures by what we have experienced in the past, which is virtually impossible. This is why I asked you to do the exercise on detaching from the past. This is also why we typically grow in smaller gradients rather than quantum leaps and why change doesn’t stick.

Take it to the Next Level action: Hire an independent, third-party expert to meet with each team member. The purpose is to hear them individually to get all the issues they’ve accumulated from the past fully expressed. It is important to deal with any resentments, broken promises, etc. The result you are looking for is to flush out all the misunderstandings and bad feelings so that you can get to a place with each team member where the past is put where it belongs — in the past. The goal is to arrive at a “blank canvas” with which to create a future that everyone can agree upon.

Blind Spot 4: Team willingness

There are three types of team members — the positive/willing, the negative/resistant, and the downright antagonistic. You can only work with the first two to create a lasting change that makes a difference. Once you handle the action step above, you will reach a point where you have an open, willing team. If there is just one bad apple, you are not going to turbo-charge your future. If you did the above steps effectively, the resistant team members have handled their fears and joined the willing — while most of the problem children have run off to their next victims. Be careful, because sometimes they hang on and don’t de-select themselves. You must muster up the courage to knock out the silent killer of your dreams.

Take it to the Next Level action: Confront the antagonist(s) in your practice and let them know their attitude is no longer acceptable. Put them on alert: they have two opportunities to take corrective action — one verbal warning, one written warning, and then the final good-bye.

Blind Spot 5: Wrong target — context vs. content

If you want to have sustained change, you must first shift your practice framework (beliefs and thoughts), not the content (what you do), inside the frame. The framework or context is the container that holds the contents. Your container is made up of your real beliefs and thoughts. If you think that you can only attain $50,000 a month, you will prove your belief is right; and when someone or something threatens your belief, you will consciously or subconsciously sabotage it. Our innate desire to be right is stronger than our wants or results. Therefore, if you cannot play in a bigger sandbox, stay in the one you are in. Doing things better or differently will never work. This is why three-ring binders full of information do not work. First, work with someone who can help you expand your container or comfort zone and install a contextual infrastructure that can hold the capacity you want to create. The pitfall of implementation is that tactics are typically senior to strategy in traditional practice-management systems.

Take it to the Next Level action: Sit down with your team in front of a huge, blank canvas and brainstorm the picture of your practice’s future. Write down phrases and then vote on the priority of each. Then, in a couple of sentences, write up the agreed-upon vision. For example: “Recognized as the best dental office for preventive and restorative care in a comfortable setting. Our office will be applauded for making a difference in the community we serve. We will know we’ve achieved this by establishing more patients than we can handle.”

Blind Spot 6: Leadership

If you missed the half hour when they reviewed leadership in dental school, this would explain why leadership is missing in your practice. Leadership and management are typically collapsed as one. It is important to understand the difference in creating transformation that sticks. Leadership consists of the two “I”s — Influence and Inspire. Once you have your practice vision, your job is to constantly and consistently inspire and positively influence your team.

Take it to the Next Level action: Establish structures for leadership to happen. At team meetings, carve out time to revisit your vision and hold an open discussion on how you are fulfilling your future. In your morning meetings, read an inspiring quote. Visit to register to receive free daily inspirational quotes you can use.

Blind Spot 7: Management

Management consists of what I call the three “M”s — measure, monitor, and make it work. Anything you measure you can monitor, and anything you monitor you can grow. My team and I have invented a tool for you to use that takes the emotion out of management. It is called MBA or “management by agreement.” All upsets in a practice originate from a broken or missing agreement. Think about it — you have expectations of your team, yet they have their own. It is your job to set agreements and expectations for your team and your patients. An example is to create a policy handbook that establishes criteria for timeliness, dress, attitude, etc. Your team leader, not you, is to manage the agreements made in the handbook. As for results, there needs to be an agreement to the minimally acceptable standards of performance — I call these DPOs or “daily primary outcomes.” Everyone on the team establishes an agreed-upon outcome for each day. These are calculated as parts of the total goal for each month, which is then tied to the annual goal. To get a full understanding of how DPOs work, order my book, “Million Dollar Dentistry.”

This is how you shift from a reactive practice that focuses predominately on putting fires out all day to a more enjoyable proactive practice where you stand at the helm of your ship. With controls in hand and your eyes ahead, you’ll be able to predict and troubleshoot as necessary. Your team will be doing the sailing, so you can switch on autopilot until you are ready to port.

Dream big. Life is not a simulator. Play the proactive practice game — the destinations are quite amazing.

Gary Kadi is president of Next Level Practice and author of the best-selling book “Million Dollar Dentistry.” He helps turn dentists’ offices into multimillion dollar businesses. For more information, visit

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