The Big Picture

March 1, 2001
Defining your values is a crucial step toward developing a vision for your practice, says Dr. Gregory L. Psaltis. He tells you how to create your vision.

by Gregory L. Psaltis, DDS

If you were at my office in Olympia, Wash. and asked directions to the state capitol building, I could easily guide you there. Turn left out of my office, then go west at the 7-Eleven, straight past Ralph's Thriftway and the new fire department. Take a left at the old fire department and head south. These are all familiar landmarks and the directions are completely clear. If you don't live in Olympia, however, you might get lost. In the same way, employees in a dental office may not know how to reach office goals because the directions are clear only to the dentist.

In my own practice, I believe I've specifically stated my vision. I routinely emphasize it during team meetings, as part of individual conversations, and in my daily interactions with clients. Despite these efforts, I've had team members come forward and state that they essentially didn't know what I expected. Somehow, my efforts fell short in providing a clear picture for them. The intent was there, but the impact was not. In short, the picture - so clear to me - was not conveyed to my co-workers. This could be true in your practice, too, and might be holding you back from having the practice you've always wanted.

It isn't possible for any group of people working together to reach goals or to work with specific intentions if the values driving them are not clearly identified. Everyone entered dentistry for different reasons. As we become busy in our work, our original core values become obscured or forgotten, and with them, our purpose for practicing dentistry.

Taking the time to write down the elements of who we are clarifies the purpose of the practice. This is a critical first step, since it is impossible to develop a clear statement without understanding what is important to you. It may also be the most vital link in establishing a dream practice because values represent the blueprint of that dream. This blueprint can evolve into the vision for the practice and provide the tenets by which all systems, policies, and communications will be established.

How can a dentist begin the process of clarifying values? It may be best to start at home. Many dentists' main focus of attention is on their practices. Their families receive whatever time, energy, and emotions are left over. This is usually not popular domestic policy. Initially, it may be important to go back to your predental days and recall exactly what drew you into the profession. While economic gains cannot be ignored, there were probably other factors that attracted you to the field. It may have been independence, the technical aspects, or the possibility of a reasonable income in less time. For others, it may have been an opportunity to be one's own boss, avoid exhausting on-call duty, or be in service to people in a tangible way.

It may be helpful here to illustrate my point through personal experiences, so that the concepts presented thus far might seem clearer. The following is how identified and established values that remain the basis for my practice today.

When I began creating a practice, I sought out the components that brought me the greatest satisfaction. I strove for clinical excellence; yet, the thrill of a stainless steel crown held little interest for me. Witnessing a child's sense of accomplishment, and the parent's amazement and pride at seeing their child succeed in a potentially stressful moment, did and does excite me. It was with this realization that I began a practice that would provide more consistent satisfaction for me and my clients. I identified behavior management as a genuine value. I don't minimize the importance of technical performance; the success of a procedure certainly impacts the child's and parent's perceptions. However, the communication and management aspects are more exciting for me.

It also became evident that seeing my patients return caries-free was far more satisfactory than placing three more restorations. From this insight, I recognized the value I placed on successfullly educating my clients so that they could experience better health. I have always been proud of the profession for having brought the concept of prevention into a realistic and attainable model. To have experienced this in my own practice crystallized its value for me.

I also realized that as my practice grew and became more successful, it held more and more control over me. The tail was wagging the dog! After 11 years of private practice, I finally allowed myself to take a two-week vacation. Until then, it had been nose to the grindstone, partially due to economics, and partially due to a fear that I "couldn't allow myself to be unavailable for my patients." Mostly, it was because I simply hadn't recognized what had occurred. It was surprising when my wife and I discussed those things we didn't do because we couldn't afford them, and which activities we didn't do because we lacked the time. This list was amazingly lopsided in the "no time" category. It became clear to me that yet another of my important values was having time for activities outside of my practice.

These examples are not intended to serve as a specific guide, but rather to provide a tangible example of establishing one's own values. My values list could go on and might include matters as profound, yet as simple, as common courtesy, honesty, and gentleness. It might include a broad generalization that could set the tone for a practice. As someone unlikely to ever seek elected office, I've always felt that my best chance to create an ideal world is to establish one in my office. That world includes humor, sensitivity, communication, and respect. These values can be applied to every person who walks into your physical space - your clients, your co-workers, your vendors, and anyone else affiliated with your practice.

By writing down your values, you can develop a vision - your own "Big Picture." Begin the process of establishing policies, systems, and training to implement these concepts into your practice. The results can be nothing short of astounding - the team will notice, your clients will notice, and your bottom line will notice.

The first step following this identification process is to determine (perhaps with the help of an advisor) how to alter systems, procedures, communications, and co-workers to start implementing your values. Although your "vision" may not be in perfect focus at the outset, it is important to know your own path before training and supporting your co-workers. Write down your values and your goals. Match them carefully. When you can speak of them to your co-workers, you can consistently document the adjustments you are making. Not only will this help your team better understand the change, it will enable them to support it and address it with your clients.

For example, if you have decided that being in your child's classroom on Tuesday afternoons is important, you might implement a change that entails starting the day earlier or taking a shorter lunch break. If your co-workers understand this change is important to you, they will be less likely to resist it. Also, they can convey to your clients why the office hours are changing on Tuesdays. If a client is unhappy about it, you must consider whether you need to change your values to match theirs or if it is just as well to have that client go to another practice. If you've determined that time with your child is a genuine value, losing that one patient won't matter. It's a step toward fulfilling your vision by acting out of your values.

You may have no changes to make, because your practice already reflects your values. The problem instead may be that your co-workers don't know that! In many cases, your employees will come to know you well enough to understand why your practice does things a certain way. However, they might have no clue. By providing a clear statement about your values and the rationale for having clear policies, you will establish a higher level of trust and respect. You will also find that you need not explain every single detail. Your employees will understand a policy simply by understanding you.

Every dentist should literally sit down and put a pencil to paper. Create a list of values, personal and professional. Put the list away and try not to think about it for a couple of days. Then, when you take it out, it may require some adjustments, but you will know far more during your follow-up review than you did when you first wrote it.

Once you are satisfied with your list, share it with your closest confidant - perhaps your spouse, best friend, parent, or sibling. These are the people who truly know you and will give you accurate feedback. Once you have determined your vision - "The Big Picture" created out of your values - share it with your employees as much as possible. This will allow them to help you create the practice of your dreams. Your vision must be clear for others to see it. Like a well-made pair of glasses, it's your vision that will help others see your plan more clearly.

Focus, focus, focus

Many people choose dentistry because of quality of life issues that have as much to do with one's personal life as one's career. The first step is to recall these original values. The second step is to consider the current reality of your life. Have marriage, children, or other interests created demands that can only be met at the expense of the practice? Third, it is important to re-evaluate your current personal issues. Are the same things that were important to you as a student important now ? Have new issues - such as personal health, community commitments, or philosophical shifts - created new avenues for expression in your life? Fourth, how have your dental interests changed? Have specific areas within the field clearly become primary interests? Have root canals lost their luster, children become a bother, or has crown and bridge work or esthetic dentistry taken on a greater part of your continuing education and/or enthusiasm?

These four areas may help focus your attention on the current values you hold in your life. I would suggest anyone in the profession take the time to identify those critical aspects of life that truly invigorate or enliven you. Once identified, transferring these values into your practice will begin the shift toward a focused practice. However, be careful not to identify your values solely through the context of your practice. Narrowing your focus to the workplace only won't help to balance your life, as this could compromise domestic harmony.

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