Dental Explorer | Fourth Quarter 2009 3

Exploring: Practice Philosophy

PRE-PLANNINGThis term is redundant but we use it anyway to emphasize that planning for each appointment must be done well ahead of time. Lack of pre-planning will be evident any time the doctor walks into an operatory and has to wonder what will be done today. It is unbelievable how much production time is lost by failure to have everything ready to go for every appointment. That means all materials, instruments, and patient preparation ready. The process won’t work however without a very clear treatment plan because the staff won’t know what to prepare for. I also advocate a separate sheet in the record for noting what is to be done at the next appointment. This includes any special material or prepara-tion that must be done before the patient arrives. “Next appoint-ment” sheets are checked by the chairside assistant one week ahead and one day ahead to make sure that everything will be ready at appointment time. If your practice management software doesn’t allow for the addition of a page in the records, it is worth the effort to create a hard copy and keep it in the patient’s record like the good old days.

MONITORS AND STATISTICSThe most exciting thing we’ve learned is that anyone who really wants to follow a few basic rules can make dramatic improvements in any practice in a very short time. I’ve always believed that any practice, no matter how good or how bad, could be improved, and now I’m totally confident that those improvements can be major. It’s almost unbelievable what can happen when the doctor starts to look at what is going on and is willing to accept a more structured approach to office management.

Monitors are necessary for control. They are a way of measuring results, and it is axiomatic that what we measure, we improve. In monitoring a number of practices, it has become apparent which goals are achievable in well run offices, and the results achieved for many different monitors can be compared in order to discover what makes the difference. We now have some solid data on every aspect of production, collection percentages, salaries, and other costs. We can tell if fees are too low or any expense item is too high, and we can even monitor how long it should take to

complete each administrative task so we can tell if the staff person responsible for that task is efficient. By having such a clearly defined structure for office administration, it becomes more practical for an office manager to keep control of all the administrative tasks and it makes it simple for the doctor to analyze the effectiveness of the entire operation.

Productivity per hour (average) is the ultimate measurement for analyzing the effectiveness of treatment planning and the coordi-nation of scheduling. It is affected adversely by ineffective pre-planning and inadequate quality control. When this important monitor is analyzed and compared with productivity averages from other offices it can be a very real focal point for managed improve-ment.

Establishing a Practice Philosophy of Patient Care How You Can Put Your Practice In The Top Ten Percent…

By Peter E. Dawson, DDS

The most exciting thing we’ve learned is that anyone who really wants to follow a few basic rules can make dramatic improvements in any practice in a very short time.

Exploring: Practice Philosophy

4 Dental Explorer | Fourth Quarter 2009

It should always be considered an “absolute” that productivity should never be increased at the expense of quality care. Further-more it doesn’t have to be. Increased productivity is the payoff for better management of the doctor’s time.

STRUCTURED MANAGEMENTThe wrong kind of structuring can definitely stifle creativity, and that is why it is so important to have the right concept before making changes. First let me say that there are very few offices that wouldn’t see immediate and substantial benefits from bet-ter organization of the administrative part of office management. Better organization starts with clearly defining every task that must be accomplished to make the office run smoothly while increas-ing profitability. If tasks can be matched to a simplified method of performing and monitoring each administrative objective, it actually permits more time for creativity where it counts – in the interaction with patients and in creative scheduling. Tasks can be divided into daily, weekly, and monthly, and even yearly tasks, and the format for completion of each can be directed by the computer program. A good system makes it a requirement to get each day’s work done. It doesn’t allow procrastination. This is the kind of structuring from which every practice can benefit.

Structuring of the administrative office has many other advan-tages too. In a well-organized, task-oriented system, loss of a team member does not have to be a disaster because a new staff person can be trained to perform the clearly defined tasks. The new team member’s performance can also be monitored and compared with standards for task completion.

PEOPLE SKILLS For many Dentists, the people skill component of the triad of skills is the least comfortable and most troublesome. Managing the team is a responsibility that falls squarely on the doctor’s shoulders, and success in this arena will only occur with open, honest, direct communication. Often times a dentist will let a problem with a team member fester rather than address it in a timely manner. Just like a dental problem, no personnel problem ever gets better by watching it. Swift communication about the problem is always the best approach.

Start by clarifying your expectations. Typically whenever there is disappointment in a relationship it is rooted in the lack of clarification of expectations. It is the doctor’s responsibility to paint a picture with words of what he/she expects from each team

member. Be sure that the desired outcome of every task is mutually understood. Describe what a successful result will look like to you. Determine if the individual shares the same vision of accomplish-ment and give specific feedback, positive and negative, as soon as the work is completed. Keeping the focus on the task, rather than the personality, is the key to reducing the emotionality that often accompanies performance feedback.

As the leader, establish early and often that the primary reason each person is employed by the practice is to serve the needs and expectations of the patient. The secondary reason is to help the doctor be more productive. Dentistry can be practiced without any team members. It’s not efficient, and typically not practical, but it is possible. If a team member is not enhancing the patient’s experience and the practice’s productivity, question the need for that individual.

Excellent people skills are also a critical component of treatment acceptance. I have seen many dentists with the perfectionist personality style wonder why their patients cancel appointments, don’t accept treatment and even disappear from the practice, while a colleague down the street has to delay his patients’ needed treat-ment because he is so busy. Clinical skills in diagnosis and treat-ment planning alone will typically not lead to treatment accep-tance unless the patient feels cared for, listened to and understood. Remember that while we can present all the information about the patient’s problems and the solutions, it is often how the patient was treated that makes the difference in treatment acceptance.

Treatment acceptance is a team effort. If the dentist is proficient in verbal skills and the team isn’t, everything you do and say can quickly unravel if just one person on the team uses the wrong word, inflection, or tone. As the leader, the dentist needs to provide training in people skills for the entire team and set the standard for patient interactions. How patients and team members perceive the dentist has a profound effect on the success of a practice. Daniel Goleman, in his book Primal Leadership, states, “The greatest impact on a company’s bottom line could quite possibly be the leader’s mood”. If a dentist is frustrated and unhappy about coming to work for any reason, those around him or her notice it and the effects are tangible. If that frustration and unhappiness is due to challeng-ing clinical problems that require development of your technical skills, learn the clinical skills needed to achieve predictable, stable, beautiful results. If the frustration and unhappiness results from the pressure of running a business and the managerial and people skill challenges inherent in doing so, learn to solve those issues. The true measure of a top ten percent practice is the joy and fulfill-ment of the dentist and team and all the skills necessary to achieve it are learnable.

ENJOYING DENTISTRYDentistry can be a very frustrating way to make a living if some ba-sic concepts are not understood. If any dentist doesn’t really enjoy

As the leader, the dentist needs to provide training in people skills for the entire team and set the standard for patient interactions.

Dental Explorer | Fourth Quarter 2009 5

practice it will almost certainly be for one of three reasons:1. Lack of predictability.If a dentist has not learned how to diagnose problems accurately he or she must guess at how to treat the patient. This is very unsat-isfactory, both to the patient and the dentist. It is surprising how many problems patients present that could be treated more effec-tively if dentists were better trained. I’m talking about facial pain problems; TM disorders, problems of aesthetic, phonetics, or any number of masticatory system problems. The dentist who learns how to diagnose and treat masticatory system problems effectively has a lot to be excited about. It’s fun to be able to help patients when you know what you’re doing. And dentists can learn – if they stay away from gimmickry and empirical approaches to treatment.

2. Lack of quality control.Without it, we’re going to have to waste an awful lot of time doing work over because it wasn’t done right in the first place. Sadly, the dentists that are in the biggest hurry ultimately end up spend-ing the most time and still don’t get the rewarding satisfaction of beautiful work.

3. Lack of office organization.When an ineffective team member fills the day’s schedule with a miscellany of poorly defined, unproductive tasks, it’s easy to see why some dentists hate their work. All tasks in the practice need to be organized into documented systems with accountability for all results assigned, understood and measured.

One of the greatest joys I get out of teaching is to see dentists come alive and start enjoying life and enjoying their practices. The difference between burnout and loving what you do is often no more than five or six basic things that need to be learned well so all the other details can fall into place, thereby making a better foun-dation for the practice. Any dentist who is committed to learning and practicing those basic foundational blocks can find excitement and joy in the practice of dentistry. I am not saying it’s easy, but I do say it’s achievable if the commitment is there, and our commit-ment is to help every dentist achieve joy, success and excitement in our wonderful profession.

Biographical Outline: Peter E. Dawson, D.D.S.

For more than 35 years, dentists from around the world have been traveling to St. Petersburg, Florida to attend Dr. Pete Dawson’s seminars on “The Concept of Complete Dentistry”. In addition, Dr. Dawson has lectured throughout the United States at almost every major dental meeting, at many universities and study clubs, and in many foreign countries. He is known all over the world for his contributions in the field of occlusion and restor-ative dentistry and for his concepts on diagnosis and treatment of temporomandibular disorders. He is the author of the best selling dental textbook, Evaluation Diagnosis and Treatment of Occlusal Problems, published in 11 languages, and the recently published textbook, Functional Occlusion: From TMJ to Smile Design. He has received many national and international honors in his field, including the Thomas Hinman Medallion Award for Leadership in Dental Progress and the Distinguished Alumni Award from Emory University.

Having grown up in his dad’s dental laboratory, Dr. Dawson has been actively involved in dentistry since age 13 when he went to work as an apprentice technician. One of his principle objectives is to develop and teach better dentist/technician communication, which he sees as essential to master quality dentistry.

He is a Fellow in the American College of Dentistry and the International College of Dentistry. He serves as consultant to the “International Journal of Periodontics and Restorative Dentistry”, and is:

- Past president of the American Academy of Restorative Dentistry

- Past president of the American Equilibration Society

- Past president of the American Academy of Esthetic Dentistry

- Past president of the Pinellas County (FL) Dental Society

- Past president of the Pinellas County Dental Research Clinic

- Past president of the Florida Academy of Dental Practice Administration

- A graduate of Emory University School of Dentistry

Dr. Dawson firmly believes that dentists must accept the role of physician of the masticatory system. For those who do, the next 20 years should be the best years in history to be a dentist.

Any dentist who is committed to learning and practicing those basic foundational blocks can find excitement and joy in the practice of dentistry.