MAKE your practice shipshape

Looking back on my 29 years in dentistry, I can see with crystal clarity that the greatest successes and crashes dentists experience have a common theme: leadership.

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by Paul Homoly

Imagine that you're hundreds of feet under the polar ice cap, commanding a ballistic missile-equipped, nuclear-powered submarine armed with silos of ICMBs armed with multiple nuclear warheads. Under your command are more than 100 men — officers and enlisted. You've been submerged and on alert status for months. Every action you take and command you give is under a microscope, either by those you lead or by those who monitor and influence the balance of power in the world.

Welcome to the world of Capt. Steven L. Struble, commander of Submarine Squadron Twenty in Kings Bay, Ga. Struble is responsible for the readiness of four ballistic-missile submarines and their assigned crews. I met Struble at the Center for Creative Leadership in Greensboro, N.C., where he and I, along with 20 other senior-level corporate leaders, attended a weeklong, intensive leadership workshop.

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Capt. Steven L. Struble
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My assumption about Struble's leadership style was that he fell into the narrow, stereotypical, hard line, hierarchical military mentality of leadership — "What I say goes." Instead, I discovered he had a much broader and subtler style and polished leadership skills that I believe are applicable to the dental profession.

Passive approval

I asked Struble what leadership principles he uses as a commanding officer that he believes could be valuable to leaders in the professional and corporate world.

He said, "I believe an important aspect of leadership is the example you as the leader set for those who observe you on a daily basis. Your behavior sets the standard. In my work, we have a concept called passive approval. Passive approval is a concept we hold dear to us and train everyone in the group, particularly anyone in the mid- to upper-leadership positions. The concept is, as a leader, what you see and what you do sets the standard. Whether you're overt or not, if you walk past something and you're observed by a subordinate seeing a condition, seeing a behavior, something dirty or broken, something out of place, somebody not performing up to standards — if you notice it and are seen to notice it and move on, whether you intended to or not — you have given approval for that condition to exist.

"For example, let's say you're the commanding officer and you come aboard in the morning and the topside watch is engaged in a conversation with somebody. As you come through, he casually notices you and goes back to his conversation. That would clearly be improper watch-station behavior. His job is to protect and represent the ship and make sure whoever is coming and going is authorized. So if you observe him lax in his duties, if you wouldn't address him on that and instruct him in the proper method, the fact that he saw me walk by and not take action tells him that whatever behavior he was doing was OK."

I asked Struble where the line is between passive approval and being overly directing, micromanaging, and telling team members how to do every detail of their jobs. Is there a point where a team member may say, "Well that's not a big deal."

"Well, yes, you can reach that point, but that's one of the things as submariners that we try to avoid because the little things matter," he said. "To have a high standard of performance, the assumption is that you've got the big things taken care of and you're now able to address the little things. It's the little things that contribute to continuous improvement. If you start thinking 'That's OK' about some substandard behavior or condition and then tomorrow something else is OK, and the day after that something else is OK, pretty soon the overall standard of performance has degraded to the point that you're out of control. So we hold a very high standard in whatever we do. We keep the problems to a minimum and take care of the little things well before they become big things. And we try to do it in a cordial and cooperative manner so we don't hurt people's feelings or lower morale."

I think it's easy to make the connection between Struble's comments on passive approval and its application to our everyday lives in the dental profession. How many times do we as leaders overlook some little things that ultimately come back as big things and bite us? Here are some typical examples of passive approval working against us:

Jill, your office manager, is upbeat and energetic. She's the best person you've worked with because she can get things done fast and right the first time. Judy, your receptionist, works closely with Jill at the front desk. Judy is quieter and less assertive than Jill, and together they handle the administrative processes of your practice. From time to time, you've overheard Jill speaking to patients and have been bothered by her tone. Jill's manner with patients at times seems brusque and cool. You haven't mentioned anything to her because it happens when you're busy and it's not possible to deal with it. After a while you just accept Jill's behavior. One day you get a letter from Mrs. Taylor, a person you've considered to be a star patient in your practice for many years. In it she details several negative conversations she's had with Jill and Judy. Each description of the conversations she's had feels like a hunting knife being twisted between your ribs. The letter ends with very disappointing comments about your relationship with her and a request that her records and those of her entire family be sent to the dentist across the street. This letter is something you just can't ignore and decide to meet with your team and discuss it.

How much of Mrs. Taylor's complaint (big problem) is a direct result of your passive approval of Jill's manner when you first noticed it (little problem)? What standard did Jill set for Judy relative to speaking to patients? By not addressing Jill's manner, you tacitly endorsed it for Jill and Judy and anyone else who witnessed it and did nothing about it. Chances are excellent Mrs.Taylor witnessed your passive approval of Jill's behavior and it ignited her fury.

Another typical scenario where passive approval occurs is in vendor relationships. Tony, your dental supply rep, has been calling on your office for years. In fact, 13 years ago, he introduced you to the original owner of your practice. You associated with the practice for years and eventually bought the original owner's interest. Throughout the transition, Tony was there. Your team likes Tony, and he's good at remembering people's names and occasionally leaves a box of Godiva chocolates on the table in the staff lounge. What he's not good at is following through on details. Several times he's promised to follow up on back-ordered items and it never seems to happen. Lots of little things slip through the cracks with Tony, but everyone, including you, finds it hard to tell Tony, who is such a nice guy, that his service is lacking.

The day comes when you decide to add a fourth operatory. You need chairs, units, headpieces, and all the high-tech (and high-priced) goodies. You have Tony and a competing rep bid on the project and decide to go with Tony's competitor, largely out of your fear of Tony's perpetual inability to follow through. When Tony learns that you bought from a competitor, he confronts you.

Tony says, "I just don't understand why after all these years and all the work that I've done for you, how you can just disregard it all. I've always felt that I've earned your loyalty. Apparently you don't think as highly of me as I thought of you."

You say, "Tony, you have a hard time following through on things and we have to follow up on you to get what we need. It's been a big problem."

"A big problem?" Tony replies. "Nobody has said anything to me about it. If it was a problem why didn't you say something? I would have been glad to make things right."

You can tell from the look in Tony's eyes that things will never be the same. Your intention was never to betray Tony, but in fact, betrayal is exactly what he feels. You, your team, and Tony all feel the loss.

Tony's poor follow-through or any vendor's chronic poor service is often a result of passive approval. Accepting poor service from a vendor communicates to the vendor that such service is acceptable. It's true that Tony missed a few little things. What you missed is your leadership responsibility to not accept poor service and instruct Tony on the standards you expected. Because you didn't instruct Tony, your team followed your lead. Did Tony fail you or did you fail Tony? Either way, the little problems you had with Tony's service led directly to the big problem of a severed relationship, and passive approval was the fundamental leadership flaw.

Forceful backup

Another military leadership skill Stuble thinks is important to the corporate world is the concept of forceful backup.

"Forceful backup is another tenet in the submarine force in that we charge everyone with the responsibility for getting things done right," Stuble said. "Regardless of where you are in the chain of command, everyone aboard a submarine has training and experience. The leaders value your eyes, your opinions, and your thought processes. Whenever there's a situation where there's some doubt or you feel there's a better approach and you don't speak up, you have let down your crewmates because, in fact, you may have been right. Whenever someone comes on board, we tell him to speak up if he thinks something is not right.

"In response to that, there's a covenant here between the subordinate and the senior. The senior agrees that when he hears a recommendation from a subordinate, he's going to stop and listen. The covenant provides that the provider of the information will get an explanation of why or why not his recommendation is acted on, for the benefit of his own training. The senior may or may not take the advice offered, but he will still positively reinforce the provider of that information. This covenant reinforces the behavior of people speaking up when they experience something that they think may not be right. This way we have many sets of eyes looking for problems instead of just one."

Have you ever discovered that a problem existed in your dental practice and everyone knew about it except you? How many problems exist in your practice that you don't know about because your team members don't speak up out of fear of how you will react, or because they don't have the verbal skills, or have been negatively reinforced in the past? It might be a good time to sit down with your team and create the covenant Struble has between him and those he leads. There are lots of problems in the dental office, many of which you have not seen. It pays to have many sets of eyes looking for problems instead of just one.

The lessons from Struble are good ones — lead by example to set the standard, and create a covenant with your team where their contributions are expected and honored. Do it and make your practice shipshape.

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