The high cost of low implementation

June 15, 2016
Right now, go to your computer and search for "Staff Agenda 2010" in your old files. 
Gary Kadi, Founder of NextLevel Practice

Gary Kadi

Right now, go to your computer and search for "Staff Agenda 2010" in your old files. If you are like most practices, you will find a bulleted list of topics that resemble those on your agenda just last week:

• Increase new patients

• Decrease no-shows

• Fill hygiene holes

• Talk to Brittney about being a "Debbie Downer"

• Motivate the team

It's time for a change. This month, I'm going to give you the godmother of all systems: The Four-Phase Implementation Process. This is your moneymaker. Your celebratory touchdown dance. Your first-class ticket to being financially free and spending more time with the people you love.

The four phases are forget, fail, succeed, sustain. Let's look at each one closely.

Phase 1: Forget

Your brain has two innate purposes: to reproduce and to keep you safe. We are all doing well in the area of reproducing. The population is increasing nicely. Your brain is also doing its job to keep you safe. But to get past your glass ceiling, you have to go beyond the primary purposes of the brain: you have to ignore what the negative voice in your head is telling you.

This is where the rubber dam hits the dental road. We all have ANTs (automatic negative thoughts) that kill off the possibility of thriving. These thoughts show up as procrastination, analysis paralysis, and forgetting. They're the roommates in your head who appear when an opportunity to grow past where you are presents itself. They say, "Don't do it. You know what happens when you do this." But if you want to be in a place you have never been, you have to do something you have never done.

This is where internal conflict arises. As a result, when things get difficult, you "forget" about the problem. Why? Because forgetting is easier than dealing with it.

Once you have this awareness and can confront your ANTs, you have to deal with the next army of "forgetters," your team. They don't consciously forget. It is just built into the natural makeup of being non-business owners. It's risk aversion. Their fears of losing their jobs if they fail are 10-times stronger than their desires to risk failure and seize opportunities for gain.

I learned this when we would go into a practice and exuberantly share with the team that we were going to implement a "triple-win bonus system." I could read their body language as they were saying, "Get out of here, Mr. Consultant. We are fine here." What they were telling us is that they would rather keep things the same and be safe. Not doing something wrong or making a mistake, which meant they could keep their jobs, was a bigger payoff than getting more money. Instead, they wanted to make more money without being or doing anything different, which didn't work for the dentist-owner.

This is why having an accountability partner to maneuver this phase is essential. Building a practice model that tracks daily outcomes by position and setting up your office manager as team leader is the key to moving you through this phase. Very few go past here and move on to the next phase. This is why it seems only 5% of dentists retire financially free.

Phase 2: Fail

Notice I didn't say "failure." This phase is not personal, but we all take failing personally. When you put in outcomes by position that are tied to your annual income, it allows you to have factual control and it takes the emotional, "I feel like I had a great day today" off the table. When operating on the basis of facts, you and your team know if you are succeeding or failing each day-not at the end of the month or year when it's too late.

Every team member has a DPO (daily primary outcome) that is calculated by taking your annual goal of, say, $1 million for a one-doctor, one-hygienist team working four days a week and taking off four weeks a year. You then need to collect $85,000 per month and $5,500 per day. Your target DPO is $4,500 per doctor per day. Your appointment coordinator fills your schedule to $4,500 and the hygienists to $1,000 per day. Your hygienist produces at least $1,000 per day and your treatment coordinator closes at least $4,500 per day.

Now that you have shifted your team from trading time for money, you have a new control metric that tangibly lets you know if they are succeeding or failing on a daily basis. If they are not hitting their numbers, it sends off a personal and practice "failing alarm" and brings attention to the "fail." "Fail" in this context is the alert that something is missing from the proven system that they are responsible for consistently implementing. "Fail" allows your office manager to locate the missing element. It does not mean that a staff member is bad or wrong. This is where your office manager proactively diagnoses the system and holds up the mirror for team members to see for themselves what is missing, not what is bad or wrong. This approach is vital in keeping implementation moving and for the rest of the team to observe how this is handled. When this is handled in a safe manner where jobs are not being threatened, vulnerability decreases. Implementation becomes safe and gains momentum because most team members don't want to be left behind.

Phase 3: Succeed

Once you get implementation momentum and your staff leaders are creating a gap between those who are on board and those who are just hanging out, you might need to have a "crucial conversation." This crucial conversation is with those who are hiding out or holding on for dear life, or who may even resent the success of others. This conversation has five steps:

1. Acknowledge: "Leslie, thank you for your years of service."

2. Share what you see: "It is my experience that you may not be on board with the changes we are making. Is there something you need to share with me?"

3. Set expectations: "Leslie, starting now I'm asking you to be an active participant in moving forward, and this is what it looks like . . ." (Be specific.)

4. Get agreement: "Do you agree?"

5. Measure, monitor, make right: Set a meeting in one week and circle back with Leslie. Bring facts to the meeting to show progress.

For those who are on board, highlight their measurable success and have them share at team meetings what they are doing and why it's working. We have found that when you become a teacher, you move from success to sustainability. The ability to speak about something allows for understanding on a whole different level.

Phase 4: Sustain

To sustain this process, you must take a deeper dive into steps four and five in the crucial conversation. By creating a culture where your team understands that agreements are tangible and factual, you will have people who honor their word and hold others accountable.

OK-go implement! You now know that the minute you learn something new, you are going to forget about it and fail. Here is to failing fast so you can enjoy the fruits of implementation.

If you ever have questions, I invite you to e-mail me. Send me a message at [email protected]. I'll fill in the blanks and help you avoid the high cost of low implementation.

Gary Kadi is CEO of NextLevel Practice. He created NextLevel Practice to implement the Complete Health Dentistry™ business model, where teams willingly embrace and implement change, patients respect their treatment regimens and invest in their health, and doctors enjoy practicing the way they envisioned when they graduated from dental school. The high cost of low implementation

About the Author

Gary Kadi | Founder of NextLevel Practice

Gary Kadi, founder of NextLevel Practice, is on a mission to help dentists beat the odds. While most dentists now don’t retire until age 69, and 96% of them aren’t financially free, Kadi has developed the strategies and methods to empower dentists to retire on their terms. The more than 6,000 practices he’s worked with generate over $1 billion in combined collections. Kadi has helped them discover true freedom—becoming time-free, debt-free, and frustration-free.

Updated July 14, 2023

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