by Dr. James R. Pride and Amy Tuttle-Morgan
Copyright: Gary Buss at FPG International
The link between Pride Institute management techniques and their direct effect on production, collections, and practice success.
This group of articles chronicles the year-long, true story of a practice undergoing management improvement. So far, authors have discussed these topics:
- increases in production
- resolving staff/doctor conflicts
- uncovering the source of a collections problem
- using the huddle as a vital tool for setting the pace and tone of the day
- preblocking significant procedures in the doctor's schedule
- staff salary increases based on increased collections
By the end of the ninth month, doctor production — which had increased by $400 per day over the year prior to management training — needed to rise another $400 per day to hit the final, 12th-month goal of $2,800. To facilitate this, we reverted to a scheduling strategy used earlier in the year to boost production. We again asked the staff to prepare "ideal day scenarios," this time for daily doctor production of $2,800. They composed fictitious schedules with a variety of procedures totaling $2,800 to get a feel for what that kind of day would be like. The staff also completed the timing of the dentist's various procedures, so they could allocate his time more accurately. They brainstormed on the obstacles to achieving this new production level and how to overcome them. Although they were still striving for growth, the staff had been exceeding the total office-production goals all year.
This presented Dr. Johnson with a pleasant dilemma in the final quarter. The total of hygiene and doctor production for the year was definitely going to reach or exceed the goal set in the annual plan. (Although doctor production fell slightly short of the goal, it still represented an excellent gain, and hygiene production was consistently over its goal). The year was going to be a success.
The question arose: Should we try for an even greater mark? The consultant was adamant in not wanting to raise the bar. She wanted the team to experience its full measure of success and triumph. Attitudinal problems arise when a team's performance is never good enough and the dentist always expects more. Teams that have no clearly defined goal line do not get to experience the exhilaration of a touchdown.
Nevertheless, Dr. Johnson's practice was running above goal. With that in mind, his consultant suggested two options:
- Doctor and team could take more paid time off and still reach their year-end goal
- They could strive for a higher goal, which would be "gravy" — an added plus — while still receiving full acknowledgement for hitting the original goal
Dr. Johnson liked the second option, so the "Practice Olympics" was born. It had two levels: the Silver Medal for hitting the original production goal of the annual plan and the Gold Medal for exceeding that goal. The Gold Medal was based on a higher goal set by annualizing the first 10 months of production to calculate the goal they would hit if they continued at their current pace.
As of the 10th month, total production was $501,607, whereas the goal was $473,710. Annualizing the actual production gave a goal of $602,000 for the Gold Medal. The Silver Medal was fixed at $574,000, the original 12 months' goal. (Total production for the 12 months prior to the management-improvement effort was $486,015, already exceeded by $15,600 in the 10th month.)
To create excitement and an incentive for reaching these goals, we designed a major shopping-spree game, similar in concept to the fantastically successful spree held in the third month, which yielded record-high production levels. (Discussed in a previous article, the shopping-spree game involved the doctor placing an I.O.U. for a specific amount, such as $50, in a pot for each day that the team hits the production goal. If the team reaches the goal every day of the contest, the doctor doubles the amount in the pot. The spoils are divided evenly among doctor and staff members, who have one hour to spend it at a mall. Then, they all meet for dinner, showing their purchases and celebrating their success.) We support having these games periodically for short intervals to hone a specific skill. If the game is properly executed, the skill continues into the future without the extra bonus.
Soon after Dr. Johnson began the Practice Olympics, the other option the consultant had presented (extra time off) also looked enticing, so Dr. Johnson took unplanned additional vacation time. Since the staff worked fewer days than called for in the annual plan, they did not achieve the Gold Medal through no fault of their own, but they did achieve the Silver Medal in production and collections. Not wanting his employees to suffer for the extra time off that he elected to take, Dr. Johnson created an award for them between the Gold and Silver levels. Dr. Johnson's practice finished the year with $582,000 in total office production, up by $100,000, or 20 percent, from the prior year. Collections were 97 percent, one point shy of the goal. Hygiene production was 14 percent over goal, and doctor production was 5 percent under goal.
"Overall, we're really doing great," says Dr. Johnson. "It's been a pretty powerful year for the practice and for me. The workshops and exercises really brought us all together."
Next year, his consultant plans to help him fine-tune his treatment planning for more quadrant dentistry. That will enable him to become more efficient and raise production per hour, and it will improve treatment to the patients. Improving the continuing-care system and marketing techniques are also on the agenda.
Here are the Pride Concepts:
Management improvement must be directed with a delicate baton, not a steamroller. It takes finesse and small steps to accomplish great things. For example, we've mainly introduced planning, better scheduling, improved communications, and sound financial policies in the first year. We're only getting into case presentation, marketing, and other areas in Dr. Johnson's second year, yet we've already achieved a $100,000 increase in production in fewer working days and fewer hours each day. And, no, Dr. Johnson has not changed his amiable personality. He still enjoys chatting with patients and being the kind of dentist he wants to be.
Make change fun and exciting for the doctor and staff."A lot of good things have happened to us," says Mary, Dr. Johnson's wife and the practice bookkeeper. "For me, the best thing is looking at everything a year ahead. Before this, neither Bob nor I knew how to look at the numbers. We always reacted to things. Now we know what our expenses are as a percentage of production; therefore, we know that we need to make a certain amount and have a plan and systems in place to achieve our goals. And we know we're taking care of our retirement, so we'll be pretty well off; that's a good feeling too."
By the end of his first year of improvement, Dr. Johnson had worked 108 fewer patient-care hours. His total office-related expenses had dropped from 61 percent to 58 percent. His pretax earnings increased by 18 percent, and he fully funded his pension. Staff compensation rose by $9,800 for the last six months, coupled with an additional $11,404 in the compensation pool for the first six months of the second year's program. That adds up to a yearly staff compensation increase of $21,204. Dr. Johnson did not need the $20,000 we had set aside in his annual plan for leasehold improvements; his success made it clear that he really needed a bigger office, which he is planning to obtain in the near future. Dr. Johnson achieved his goals by focusing on the Pride Concepts presented in this series.
What makes success like this possible? The power of the scientific method applied to practice management. Is management a science? Unquestionably, yes! It is also an art — the art of leadership. Management is not only the art of leadership on the part of the doctor, but also leadership of the staff. Leadership is a behavior that is cognitively learned and then practiced repeatedly in training sessions and on the job until it becomes normal behavior.
Dr. Johnson realized that the secret to his success was the change in his own personal behavior:
- The development of a positive attitude toward goal setting and goal monitoring
- The importance of both what he says to the staff and his body language
- His willingness to communicate his own personal shortcomings
- His persistence
- His focusing as much on managing the systems and behaviors of his wonderful staff as he focuses on his clinical procedures
Dr. Johnson learned that his own personal behavior was the single management concept that would reduce stress in the office and allow him to enjoy the fulfilling profession of dentistry.
Those of you who are flying by the "seat of your pants," feeling stress and underproduction, might want to review the management concepts by which you run your business.
For more information on improving your practice using the methods described in this article, call Pride Institute at (800) 925-2600.