Elements for Elevation

Helium and hot air balloons? Michael Jordan and a new pair of Nikes? Nope. We`re talking about steps you need to make to take your practice to the next level.

Helium and hot air balloons? Michael Jordan and a new pair of Nikes? Nope. We`re talking about steps you need to make to take your practice to the next level.

Cathy Jameson, MA

"I have a good practice, Cathy. But I want to take it to the next level. I`ve done everything I know how to do. But I think I need a coach if I`m going to go any further."


"I love doing cosmetic dentistry. I have gone to some great courses, lectures, and hands-on courses. I know how to do it. But I`m just not doing as much of the kind of dentistry I love. How do I go to the next level? How do I build the cosmetic aspect of my practice?"


"I feel good about my practice. I`m happy with what we are doing, but I feel we are stagnant. We`ve been at the same level for a long time. I just can`t seem to find the formula for crossing over into that next level. Can you help me?"

These statements and questions are common during or after one of my courses, following one of my articles, or after a doctor has read one of my books. They`re good questions and I`m proud to hear them. Why? It is my hope that each and every one of you will not become complacent and be satisfied with the "status quo." There is no such thing as status quo. The day you think you have "made it" and have no further to go is the day you probably need to put down the handpiece.

I have the privilege of lecturing at some of the best "hands-on" courses in esthetic dentistry. I teach the management aspect, including marketing, communication, case presentation, and financing. During one of these courses in Florida, I was asked how to take a practice to the next level. These questions came from doctors who had new practices, mature (extremely successful) practices, and everything in between.

On the flight home from Florida, I wrote this article. I thought to myself, "What are the key elements that a team must consider to `take the practice to the next level?`"

The following five things represent the first half of items that I think need attention. Sure, there are others, but I believe that these factors deserve close attention.

1. Establish or revisit your vision. Clarity of vision is foundational to practice development. When Andrew Carnegie commissioned Napoleon Hill to study the productive people and companies of their time, he wanted to discover the main characteristics of these people. Why were they more productive than anyone else? How had they learned to harness (or set free) their creative talents?

The result of Hill`s 25-year study was the masterpiece, "Think and Grow Rich." If you haven`t read it, do. If you have read it, dig it out, and read it again. Napoleon Hill discovered that there were 17 "Keys to Success" dominating the lives of the 500 people that he studied. But the characteristic that stood above all else and infiltrated the lives of all of the productive people and companies was a "definiteness of purpose," or a clarity of vision.

You must see the vision of your ideal practice so clearly in your mind`s eye that your actions will follow that direction. Your vision must be so strong and so clear that when you ask yourself, "If we make this decision, if we hire this person, if we go to this course, if we adjust this system, and so on, will it help us to reach our ultimate mission? Will this take us closer to realizing our vision?" If the answers to those questions are "yes," then you are probably making a pretty good decision. If the answer is "no," then you need to step back, look at it again, and reconsider your actions. Your vision needs to be so clear that even when you are pulled "off course," your vision will snap you back into alignment. You may have some adjustments to make. But the vision will be your guiding light, your director, and your benchmark.

Notice that in the previous paragraph I referred to "your ideal practice." Why not? Why should you accept anything less than your ideal? You shouldn`t. Remember, "your ideal practice" is just yours and no one else`s. It doesn`t matter what anyone else wants. Their practices are their practices. What matters is that you have the practice of your dreams. One of the reasons why 33 percent of dentists say that they wouldn`t go into dentistry if they had it to do over again is that they have settled for less than their ideal. It may not be dentistry that they are dissatisfied with, but rather their own lack of commitment to working toward their ideal practice. The result is frustration, lack of enthusiasm, stress, dysfunction, and lack of fulfillment in the profession.

2. Analyze all of your management systems and be committed to improving each and every one of them. If you already have a good practice, going to the next level is delightful, but challenging. Why? Because you wouldn`t have a good practice if you weren`t doing a lot of things right.

And so, you have a challenge. Look at the things that are going well, and pat yourself and your team members on the back to solidify that excellent performance. "That which is rewarded is repeated" (LeBoeuf). But also look at every one of the systems in your practice and ask yourself the hottest question of the end of this century, "How can we do this better?" The time to sit back on your laurels is not now.

There are approximately 25 management systems in your practice, ranging from scheduling, handling broken appointments and no shows, financial arrangements, accounts receivable control, and so on. We have never been in a practice where these systems could not be improved. Without question, we`ve been in some excellent practices where many of them are working very well, but we`ve not seen perfection to date.

If you improve each of the 25 systems by 1 percent, that will make a 25 percent positive difference for you. Taking a highly productive practice and making a positive 25 percent difference is significant, to say the least.

On the other hand, if you do not feel that any of your systems are as clean, smooth, or flowing as they should be, then you have a lot of work to do. But you also have a tremendous opportunity for boundless growth.

Step back. Humble yourself. Look at your practice with wide-open eyes. Commit to making every aspect of it better. Not only will you be more productive, but you will also be more profitable and will obtain control of stress that is caused by systems that are not working succinctly.

EXERCISE: Refine each of your management systems. "Tweak" each system. Find ways to make each system a bit better. This may be a good time to have your practice evaluated by a management professional. A third-party set of eyes is effective when determining where your practice can be improved. Coaches are appropriate for everyone who is interested in continuous improvement.

3. Uplift your customer service. Ask your clients/customers/ patients what they want from you. Take the time to find out what services they appreciate the most, along with which ones you are doing well and which ones need improvement. Accomplish this through:

(a) Questionnaires: Develop questionnaires that ask about your customer service and how you can improve it. Also ask questions about goals for their mouths, teeth, and smiles. Let them know that you continually want to add services/ treatments that meet their needs. In order to do that, you are surveying your patients to gather relevant information.

You need to focus on areas that are going well and areas that need improvement, as well as open the door for cosmetic possibilities. If you ask these questions, don`t forget to pay attention to the answers.

(b) Patient information sheets: Upgrade your patient information sheets to include questions relative to things your patients want to receive from you, both in terms of customer service and treatment options. Again, if you ask these questions, pay attention to the answers.

(c) Communication: Reach out to your patients through quarterly newsletters or through special mailings about events you have attended or about a new procedure you are offering. Send them articles you have written or articles that are relevant to your procedures. Let them know about the great opportunities in dentistry today. People will not come to you asking questions unless you open your own doors. So, be in constant contact with your client base, and remember the importance of education.

(d) Patient Education: Schedule enough time into your hygiene and clinical appointments for education. The main reason that people do not proceed with recommendations is a lack of dental education. Therefore, make a commitment to do a better job of educating by:

- Using brochures to give visual credence to recommendations and to educate people about new techniques and procedures.

- Using the intraoral camera on almost every patient to show him/her areas of concern, dentistry diagnosed but left untreated, periodontal concerns, and to open the door for cosmetic possibilities.

- Using patient-education programs on the computer or self-supporting systems, such as CAESY. These need to be a part of almost every appointment. Most learning (83 percent) takes place visually. Use visual aids.

- Showing before-and-after photography of your dentistry, using photo albums and/or the intraoral camera/computer. These can help people learn about the features of the recommended treatment, the benefits of that treatment, and provide proof that you can produce these results.

- Making sure that your practice`s hygiene-retention system is flawless. Don`t let people fall through the cracks faster than they are coming into the practice. The vast majority of your restorative and cosmetic dentistry should be coming right out of hygiene. Nurture that patient family which you already have.

(e) Ask questions: Don`t be afraid to ask your patients what things they appreciate about your practice and what kinds of things they would like to see changed. Don`t become defensive about this feedback. Listen. Evaluate. Decide whether or not if what they are ask- ing for fits your vision. But, while doing this, keep your "ideal practice" in mind.

Ken Blanchard, the author of "Raving Fans," says, "In today`s business world, having satisfied customers isn`t enough. You have to do all that is expected of you and more. Then, and only then, can you create `Raving Fans,` customers who come to you, stay with you, and refer others to you."

EXERCISE: List 10 things that you do in your practice to create "Raving Fans." Identify ways you can improve on all 10 of these customer-service areas. Then, brainstorm three new customer-service concepts that you can put into effect in your practice. What will you do? Who will do what? When will you start?

Once you have placed these new customer-service processes into action, evaluate how they are working and how you can improve them.

4. Improve your communication skills. I truly believe that communication skills are the bottom line to your success. Regardless of your role in the practice, how you communicate makes all the difference in the world. Throughout your entire lifetime, I encourage you to work on improving your communication skills.

Most problems (and most disgruntled patients) are a result of ineffective communication or a communicative "glitch." Clarity of discussion, whether clinical or managerial, can offset problems and help to create those "Raving Fans." On the other hand, being able to listen may be one of the greatest assets you can bring to your practice. And yet, listening is not easy. It takes special training and lots of practice.

"Listening is a natural process that goes against human nature," says Kevin Murphy, president of CDK Management and Consulting Associates. Why? There are many reasons: interruptions, noises, biases, language barriers, assumptions, time, etc. However, the art of listening can be improved through study, coaching, and practice.

Communication skills are just that, skills. They can be learned and certainly improved. I have taught communication skills since 1975, but I still go through 50-60 hours of communication skills training every year. Again, be committed to continuous improvement.

Remember that great communication equals great production. The bottom line (and I mean the bottom line) can be improved by a commitment from the entire team to study and improve in perhaps the most important of all our skills, communication.

EXERCISE: Find a course on communication skills. Take this as a team. Then, at your regular team meetings, spend a certain amount of time practicing these skills. In addition, decide on a book on communication skills that you would like to study together as a team. Study the book a chapter at a time. Practice the skills relative to each chapter.

5. Develop the role of treatment coordinator. More dentistry is probably sitting in your charts waiting to be done than you have completed as a practitioner. This doesn`t mean you haven`t done a good job. It just means that you have a tremendous opportunity within your own practice. I truly believe that most practices can double from within by nurturing that which they already have.

Most practices spend a great deal of time and effort on hygiene retention, which is essential. However, most practices do not invest the same time and effort in a retention program for dentistry diagnosed but left untreated. Develop the role of treatment coordinator in your practice. In order to elevate your practice, I think this is a must.

The following are some suggestions for role responsibilities for the treatment coordinator. Different practices will develop different job descriptions based on their individual needs and situations, such as:

Y Joins the doctor for the new patient experience

Y Joins the doctor while he/she develops the treatment plan so he/she knows what the doctor is going to recommend and why, how he/she wants to proceed, and any special insights about the case that would help him/her to present or support the doctor?s treatment plan

Y Develops all financial information before the case presentation

Y Joins the doctor for the case presentation, or could make the presentation himself/herself

Y Gives the doctor third-party support and makes sure that all clinical questions are answered before a discussion of money takes place

Y Makes the financial arrangement and gets a signed financial agreement

Y Schedules the first appointment

Y Keeps a close record of all dentistry diagnosed but left untreated and follows up with these patients on a regular basis

Y Sends thank-you notes and before-and-after photographs to patients once treatment has been completed

EXERCISE: Evaluate how much dentistry is sitting in your charts waiting to be done. At your next morning meeting, make sure that you look at all treatment plans to note dentistry diagnosed but left untreated. Have your business administrator calculate the dollar value of that dentistry. Then multiply that times the number of days you work in a year and get a rough estimate of the enormous amount of dentistry waiting to be done.

Then, determine if the role of treatment coordinator would help to get some of this dentistry scheduled and completed. Your answer will be Oyes.O Develop a job description that is just right for you. Develop a plan of action. Then, make it happen.

There is someone on your team, whether it?s a hygienist, a clinical assistant, or a business administrator, who will love this opportunity, this challenge, and this new and fruitful responsibility!

Again, these are the first five steps to elevating your practice to the next level. I encourage you to be proactive. Don?t just read this article. Do something powerful with it. Put these recommendations into action. In an upcoming issue, Part II will outline the next five steps.


Effective team members understand that there is no limit to what they can learn, and the more they know, the more they can contribute to the team. Continuous learning by team members complements and facilitates the ability of a team to function effectively. Talk with the experts. Find yourself a mentor or a role model. Benchmark against the best. Ask a lot of questions. Want to be empowered in this day and age? Empower yourself. Think outside your own self-limiting box to expand your knowledge.

Look at the big picture. The only barrier to lifelong learning is you. Reorganize your time to recognize education as a priority. Get past your own ego and self-imposed restrictions. The resources are all around you. Be willing to tap into continuous learning.

John Murphy, 1998

1. In my mind`s eye, the vision of my ideal practice looks like this:

a. Type of treatment provided:



2. My ideal patient visit:

3. My Team:

a. Business Administrator:

b. Assistants:

c. Hygienists:

d. Laboratory:

4. My facility:

5. My equipment and technology:

6. Number of days:

7. Hours:

8. Vacations:

9. Amount of Production/Collection:

10. Take home salary: (Gross)

11. Reputation in Community:

Now, ask yourself:

1. How do I make this happen?

2. What`s getting in my way?

3. What will I do to overcome my own barriers/obstacles?

4. Who do I need in my life to help me? Who do I need as a resource person or company?

5. What`s getting in the way of me inviting these resources into my life?

6. Why?

7. What do I need to do to overcome my own resistance?

8. What will be the benefits of having resources/coaches/helpers in my life?

9. Will I do this?

10. When?


1. Establish or revisit your vision.

2. Analyze all of your management systems and be committed to improving each and every one of them.

3. Uplift your customer service.

4. Improve your communication skills.

5. Develop the role of treatment coordinator.

Characteristics of a Treatment Coordinator can include:

* - Clinical knowledge

* - Good communication and listening skills

* - Confidence in the doctor`s ability

* - Comfortable quoting TOTAL treatment plan fees

* - Conviction that the patient loses if he or she does not complete treatment. In other words, a treatment coordinator must be passionate about dental care, including cosmetic treatment.

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