Practice gutsy dentistry

Feb. 1, 2003
Learn from Jack Welch and practice gutsy dentistry. Bust through limiting boundaries and take your practice career to new heights!

by Janet Hagerman, RDH, BS

Jack Welch's business biography, Jack: Straight From the Gut, became an instant bestseller. As CEO of General Electric for 20 years, Welch was outspoken, innovative, and controversial. His management style was often criticized and considered unfair. However, during his tenure, Welch built GE's market cap by more than $450 billion dollars, while also increasing the value of its products and services to the American (and eventually worldwide) consumer.

Welch's fascinating book intrigued me. My father was an engineer with GE for over 25 years. Figuratively speaking, GE put me through college and paid for my dental hygiene education. I wondered what lessons Jack might have for us in dentistry. Here's what I found.


One of the first things Welch did when he became CEO was to introduce his differentiation vitality curve. The curve sorted A, B, and C employees. According to the curve, "A" players are passionate about their work and committed to making things happen. "B" players are good employees who lack passion, but are coachable and can become "A" players. "C" players don't get their job done. They procrastinate and drain other people's energy.

Each department manager was responsible for monitoring the performance of its team members. Periodically, the bottom 10 percent of employees (the "C" players) were given opportunities to find employment elsewhere. This created a constantly evolving pool of high achievers.

Welch's differentiation system was considered by many to be unfair and cruel. You may think so, too. But think about nature and the natural selection of the species. The weakest animals, unable to hunt, die of starvation or get eaten by stronger animals. This increases the quality of the species and ensures its survival.

Anthony Robbins, peak performance coach, says, "The best study in life is how it is, not how you think it should be. You may not like gravity, but if you jump off a cliff, it will still hurt you!"

In dentistry, how often do you clean sweep and clear out the bottom 10 percent of performers? Never! Would you? Could you? Probably not! You're too compassionate. Plus, "It's so hard to find good help these days!" Sound familiar? How many of you know of someone (not you, of course) who has put up with a mediocre (or worse yet, downright unacceptable) employee for weeks, or months, or even years?

Take a lesson from corporate America. Start acting like you're going to get fired unless you step up and become a top peak performing "A" player! How do you do that? Sigma Six Quality.

Sigma Six Quality is a statistical term referring to quality of performance. A sigma is a standard deviation on a bell curve. The fewer the system defects, the higher the sigma. Sigma Six Quality translates into a level of 99.998 percent perfection. Welch used this concept to take a new look at the quality of products and services provided by General Electric. GE had always been known for "good" quality. But Welch wanted to take quality to a new level. He knew that, in the existing economy, if every, single GE department and subsidiary company did not rise to be in the top 2 percent, then the company would capitulate to competition and fail in the marketplace.

Sound familiar? Sure, your dental quality has always been "good." But what do you do to make yourself really stand out? In the face of managed care and massive advertising, what makes your office shine among the many? Sigma Six dental quality would be a highly profitable practice that consistently delivers outstanding and relentless levels of patient care. Some characteristics might include the following:

Growing services

After the disaster of Three Mile Island, Welch correctly predicted a drastic decline in contracts for new nuclear plants. So, he strategized a way to create business by vastly increasing the service GE provided to the already existing plants, focusing on safety. Welch's "after market" concept placed an equal focus on servicing the original equipment. His continuum concept enabled customers to get longer lives from their investment.

In dentistry, how can you help your patients get longer lives from their investment? Their investment includes the money they spend for dental restoration, cosmetics, prevention, and maintenance. It also includes their investment of time and trust in you to oversee their dental health and cosmetic options. How do you commit to protecting your patients' investments?

• Recommend adult fluoride. We now know that topical fluoride benefits adults with existing restorations, gum recession, and patients taking any "anti" (dry-mouth causing) medications. Most patients fall into one or more of these categories.

• Maintain current radiographs and six-point periodontal documentation.

• Commit to 100 percent continuous patient care and maintenance. That's a 100 percent recare rate. Pre-appoint all patients. When making reactivation calls, come from a place of concern for your patients and their dental investment, not with a focus on trying to "fill the book."

• Share your complete menu of services. Never assume the level of care your patients desire. Always offer them ideal care. Distinguish your products from over-the-counter items found in retail stores.

• Take a shade-guide reading at each preventive appointment and document it in the chart. Whitening is the gateway to cosmetic dentistry, and this is a great way to introduce patients to "wants"-based dentistry.

What additional patient services can you think of, above the basics, that make you stand out from the crowd? It is enticing to focus on the latest dental services for your patients, especially in light of all the new and exciting cosmetic and restorative products constantly emerging on the marketplace. By coupling that attitude of excitement with extraordinary patient care, you help your patients protect their "original equipment" (their teeth), ensuring longer lives for their dental investment. At the same time, you expand your service past needs-based dentistry.

Measured and reported results

One of Welch's favorite tools was innovative charts and graphs to illustrate progress. We know that production is a specific way of measuring progress and reflects the success with which we serve our patient base. Are you monitoring your results? Is your team aware of production goals?

Measuring results by monitoring production creates accountability for success. Studying production reports helps staff members to understand the costs of doing business and to take more responsibility for running their department like a partner in practice, rather than a time-clock-punching employee. Production monitors keep the team constantly aware of progress and provide the ability to make immediate corrections.

Other systems you can utilize to monitor production are preappointing, reactivation, treatment enrollment, and overhead. You can monitor any system, and doing so is vital to progress. Measure your results. Monitors make money!

Highly visible rewards

How do you reward your team when you are on track and those monitors are jumping with improvement? Jack Welch used salary increases, stock-option grants, and role-model recognition at company meetings. He felt it was vital to reward people for their effort and achievement, not simply because they had managed to remain in the same position for a long period of time.

What is your reward philosophy? Do staff members want a raise because they have "been here the longest"? Does your team participate in profit-sharing, or a bonus program? Staff members have an incentive to work harder when they know they have a piece of the pie.

Use salary increases to reward outstanding performance, not just job longevity. Create incentive programs via bonus and/or profit-sharing systems. Recognize and acknowledge individual team members or departments for excellent work at staff meetings.

How else can you acknowledge and show appreciation for your team achievers? Restaurant and movie treats, flowers, retail-gift certificates, trips, shopping sprees, a day at the spa — these are all fun rewards! For more great ideas, read 555 Ways To Reward Your Dental Team by Dr. Joe Blaes and Dr. Nate Booth.

Another reward that benefits the doctor, as well as the staff achiever, is complimentary continuing education. At the office of Dr. Debra King, DDS, Atlanta, Georgia, all staff members have access to, and regularly use, their extensive library. This includes books, tapes, articles, and newsletters covering subjects ranging from clinical to motivational topics. By committing to constant professional improvement, each staff member benefits by becoming a more valued employee, while the office is rewarded with higher production and increased patient care. This is a win-win system for everyone.


For a technically-oriented engineer, it was surprising how long Welch resisted jumping on the Internet band wagon. But once he saw the light, there was no stopping him. Today, we can hardly imagine a retail business or professional organization, regardless of the type, that does not offer customer sales and service via computer.

Like it or not, electronic business is here to stay. New York CPA Pat O'Rourke estimates that 68 percent of all business people use email on a daily basis. Are you confirming patients by email yet? What a great way to reduce broken appointments! Many offices already are collecting email addresses from their patient base in anticipation of this trend, even if they are not using it yet. Hint: Ask patient permission to contact the patient by email.

The Internet also is an excellent way to distribute messages to your existing patients, as well as market to potential patients through newsletters and your own Web site. There are some great companies you can hire to handle this for you. You supply your patient mailing list and the information pertinent to your office that customizes your message. They do all the work of putting it together. The result is polished and professional. One excellent company is Roadside Multimedia, ( or (360) 568-6254 by phone). Specializing in electronic newsletters, announcements, brochures, Web-site design, and targeted search-engine positioning for Web sites, this company can keep you on the edge of e-business. Roadside's Chris Mackey says, "Just as important as having an online presence is marketing that presence through search-engine positioning. You want your Web site easily available to people in your geographical area who are likely to use your service. We help leverage your Web site so that potential patients with a desire for your service can find you."

E-business is like learning a foreign language in another country. It's hard, at first, until you get past the learning curve. Then, you wonder how you could possibly live there without knowing the language!


Welch took GE all over the globe. How would "thinking globally" effect your dental practice and our dental industry?

Dr. Michael Koczarski, DDS, in Woodinville, Wash., advertises in airline-flight magazines to attract clients from other states and countries to his practice. Dr. Bill Adams, DDS, of Marietta, Ga., has traveled to Honduras and Bolivia, delivering dental care to indigent cultures. Dr. Ronald Eichel, DDS, of Atlanta, Ga., enrolled his entire office of 20 in "customized for dentistry" Spanish classes. He did this to help his staff to care more efficiently for their increasing Spanish population. Diane Crenshaw, RDH, of Asheville, N.C., is traveling to Brazil taking "Fortune Management" and "Hygiene Mastery" growth strategies to South America.

What can you do to stretch your patient care beyond your local neighborhood? Some doctors and hygienists regularly contribute their services to less fortunate communities. Other offices attract and serve patients from other parts of the world. Do you have a Web site? Can a potential patient from another part of the country find you and learn about your practice?

Thinking globally is a state of mind. It has to do with breaking down the barriers that divide and prevent us from acting and producing efficiently. It means looking at diversity as a means assist our growth and progress, rather than interfering with that progress.

Would thinking globally impact how you regard your state dental practice legislation across the country? As a hygienist in Georgia, I'm envious of my friend, Amy Mitchell, RDH, in Washington state, whose legislation allows her to deliver anesthesia, place restorations, and use soft-tissue lasers to serve her patients. Amy is an absolutely outstanding hygienist practicing in an office and state that allows her to use her finely honed skills to deliver a higher standard of care to her patients, freeing her doctor to deliver even higher levels of dentistry.

Do your state practice acts support you in allowing your staff to deliver the absolute best quality of care and service to your patients? How can we take the best that technology has to offer to impact the most people in a way that provides the highest standard of care?

The ADA and AAP statistics both concur that 75 to 80 percent of our country's population have periodontal disease. Does the periodontal diagnosis and treatment in your practice reflect this? Doctor: How much more perio would you codiagnose with your hygienist if you knew you wouldn't have to anesthetize the SRP patients? Hygienist: How much more perio would you enroll if you knew you wouldn't have to wait for your doctor to anesthetize? Doesn't it make sense to alter our state practice acts, expand auxiliary duties, and train our hygienists all over the country to be able to deliver anesthesia to our patients, relieving dentist stress, saving precious time, and, most of all, increasing patient care? We need to expand our brains to consider a much bigger picture. Think globally! What can we do as an industry to break down the barriers of diversity and, instead, use it as a tool to unite us?

Jack Welch practiced what he coined "boundaryless" operating systems. What boundaries of your operating systems are no longer useful? How can you expand and extend your limits? How can the dental industry continue to raise the standard of care for our patients when we are still divided among ourselves and are inconsistent in our state practice acts? Think about this the next time you vote on expanding auxiliary duties.

Thinking globally can be an exciting approach to the way you practice dentistry. We now know that it is practically impossible to ignore the simultaneous growing and shrinking of our planet. Thinking globally opens up a whole new world of possibilities.

Which of these characteristics do you exhibit and utilize as leaders of your practice, your team, your departments, and your patients? Learn from Jack Welch and practice gutsy dentistry. Bust through limiting boundaries, and take your practice and career to new heights.

Characteristics of a Sigma Six Quality Practice

1. Create annual/monthly, daily financial goals. Make the staff aware of these goals and accountable for them.

2. Consistently upgrade your clinical skills and technology. Use intraoral-imaging on each patient to educate and enroll treatment.

3. Provide a complete head, neck, and oral cancer exam at each preventive appointment, on every patient, every time.

4. Maintain an ongoing chart audit of your files to ensure consistent patient care and an accurate patient base.

The Four E's of Leadership

Jack Welch's business principles were administered under the guidance of his "Four E's of Leadership." They are:

1. A very high energy level.

2. The ability to energize others around common goals.

3. The edge to make tough yes and no decisions.

4. The ability to consistently execute and deliver on your promises.

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