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Beyond Management

Most ailing organizations have developed a functional blindness to their own defects. They are not suffering because they cannot resolve their problems but because they cannot see their problems.     John Gardner

I find that far too often as a consultant that I end up teaching management as if it were leadership because you can’t really “teach” leadership. You can model it, or give examples of it, you can even learn to be a leader, but if someone just does what an author or speaker says to do, or you just copy the behavior of a great leader, you lose your authenticity. It just doesn’t work. I guess my excuse is my own fear that most doctors can’t handle the truth about a lack of leadership. I hope I’m not wrong this time. As I look at most dental practices I would have to say that something is missing: Results. At its essence, leadership exudes simplicity and is reflected in your results. From my perspective and admittedly short time with you in your offices or over the phone, I’m seeing a few things that will hinder you in finishing your dental careers well.

In most MBA programs, you consistently here the phrase, “The culture of the business is the “shadow of the leader”. You can’t be special, distinctive, and compelling in the marketplace unless you create something special distinctive, and compelling in your practice. The leader’s beliefs and character are at the heart of your practice “culture”, and the reason practices fail to grow or keep pace with what patients want.

Like it or not, as the leader, your core values have more of a direct impact than you might think in your office’s culture. The smaller the business, the more personal leadership becomes. There is a transformational impact of effective leadership that I see might be lacking. In great dental practices, the doctor’s authenticity must become the driving force when you embrace a values-based leadership.

Consider that we all face times when we are either burned out or teetering on the brink of not being engaged in our practices. It’s not enough to go through the motions of drowning our staffs’ in meaningless paper, busy work, and systems resulting in poor morale. If I could take inventory of what I most often see when a doctor enters this zone, it would have to be a:
1. Lack of energy.
2. Loss of clarity and focus.
3. Loss of passion.
4. Lack of creativity.
5. Emotional absenteeism.
6. Negativity.

We as doctors are the reason our offices do well, and therefore its greatest asset, but we are also the greatest limiting factor. I truly believe that results based management (Management by Statistics) falls far short of true leadership. I realize that Summit Practice Solutions spends a great deal of time on encouraging our clients to know and monitor certain indicators in the process of helping our clients to another level of productivity, but management, even done well, is a still nowhere close to leadership. Currently I see a culture with a fear basis that is stifling your staffs and keeping them from really engaging in order to give you what you really need and want.

You have good practices, and good practices can be managed, but great practices must be led. You may have heard this before, but a mature well defined practice culture allows us to move beyond the management of people to the management of process. Absenteeism, bad attitude, or a lack of motivation does not exist in a well led mature culture because they would not be tolerated. What we all want are highly committed staffs that need only to know the desired end result, and they will give it to us.

There is a common misconception that by monitoring our systems we are somehow fulfilling our leadership responsibilities, when in fact, leadership has nothing in common with systems management. Rigid systems stifle creativity and spontaneity which are the critical precursor to teamwork. Currently you have a “group” of people working together, but you don’t have a true “team”. Most of you have “good” practices, and good is the enemy of great, and systems management is a perfect example of why it is not great yet.

I’m looking for leadership goals where:
1. A committed staff needs only to know the desired end result.
2. There is no need to manage the people.
3. As the leader and doctor we only observe and manage the process.
4. As the leader we remain part of the team.
5. We realize that we cannot mold people, but we always provide a clear vision.
6. Managing the process requires energy for creativity.

Embracing this type of leadership in my own practices has increased productivity and profitability through a consumer driven process. I noticed that my management problems decreased and found that staff issues, not clinical issues were my number one cause of stress. John Maxwell constantly stresses that the number one job of a leader is to define what is core or define reality. One of the problems with this is that change has become a constant in any healthcare practice. Secondly, more and more practices introduce non-core things as core. In dentistry our number one job in any dental practice is “serving” the patient, not servicing them. In most offices, I see non-core things becoming core in order to deflect an ever increasing short fall in leadership and engagement by the doctor. Consider that most “problems” that doctors think they have are merely “symptoms” of far more insidious problems. An example might be that they have a symptom, not problem, with not having enough new patients where the problem stems from a lack of meeting potential patients wants or needs. As clarity increases, ambiguity decreases when leaders communicate their practice culture’s core ideology.

Cultures with clarity of purpose and values are always self-policing.

You should find that this change in leadership style will improve staff retention and recruitment: You and your office will become a magnet for exceptional talent.

This more fulfilling environment needs to be driven by adequate pay, a working bonus system, and recognition and appreciation. Money is a poor motivator and rules and regulations are a poor substitute for values and purpose in a practice culture. Results-based culture fosters compliance rather than commitment creating low morale and constant turnover. This is currently what exists in most of your practices.

Currently most offices operate on “transactional leadership” which is based on quid pro quo: Where the staff provides a service in exchange for a reward. This system establishes mandatory compliance with regulations. In your offices it is death by paper and overlapping systems that are sapping the creativity and motivation from your staffs. In contrast “transformational leadership” implies change by compelling staff to align their needs to the needs of the practice. This creates synergism through commitment and fulfillment based on shared purpose and values.

Our staffs will commit to shared purpose and values but will only comply with rules and regulations. We all want commitment, not just a group of people that work together complying in order to get paid. Please go back and read about the “Staff Owned” practice in previous articles we have written.

The Theory of Cognitive Dissonance states that stress is created when there is a difference between our ideal selves and our real selves: The greater the separation, the greater the degree of discord. This in turn creates a lack of transformational leadership that insure increased uncertainty, difficulty in making effective decisions, focusing on unimportant things, and a lack of creativity and motivation in our employees. Leadership has to begin with a hard look at ourselves, adjustments, and a new dedication to doing whatever it takes in order to realize a different result. To grow and prosper, we have to become a better us. Excuses and lack of attention to leadership will sink even the most motivated office.

I love this quote from Jim Clemmer: “Reputation is what people think I am. Personality is what I seem to be. Character is what I really am.” Our goal as leaders of our practices should be to blur the lines between the three until they are the same.”

The prerequisite for leadership has to become: Trust and Credibility. The problem is only our staffs get to vote on this. It doesn’t matter what we the leader thinks. If someone considers they are a great leader, and looks over their shoulder and finds no one behind them, then they are just taking a walk.  We need to remember that we are 100% responsible for our communication with others. What we mean to say is irrelevant, what is heard is truly relevant. The message delivered and the one received should be the same because Perception is reality. There often is a direct contradiction between words (rhetoric) and actions (reality): Rhetoric-Reality Gap. It is our actions rather than our words that provide meaning to the experience. It is not a matter of saying things right; rather, it is a matter of consistently saying and doing the right things.

I see two basic types of leaders: Leaders with a “scarcity mentality” and those with an “abundance mentality”. The “scarcity mentality” exudes a sort of zero sum philosophy where there is a finite or winner and loser and is not compatible with effective leadership. It’s almost like their role is to identify weaknesses in others so they can create a lose-lose scenario by judging others. You could say there will be an overall negativity permeating the practice with a need for control and a general lack of creativity. The number one thing I see in this type of office with a leader who by omission or commission leans toward a scarcity mentality is that the staff members are always afraid to make decisions or try new ideas, because failure in itself will be viewed by the doctor as a weakness and dwelled upon. It’s like recognition is so coveted by the doctor that they just can’t share it with the staff.

On the other hand we see the “abundance” mentality of leadership where it becomes not a philosophy but a lifestyle. These doctors actually operate like the universe is infinite. They demand a win-win conclusion to almost every interaction. This type of leader understands we all have weaknesses and strengths, but judge others based on their strengths. This always creates a culture of accomplishment and empowerment where the doctor attributes achievements to their staffs and will always be the first to accept the blame for failures.

When you create an environment where your staffs truly participate, you don’t need control. They know what needs to be done, and they do it. And while they devote themselves to your cause on a voluntary basis, a willing basis, the fewer control mechanisms you really need. Without trust, leadership is at best ineffective or lacking demonstrating a downward spiral in staff morale and productivity. Values are then replaced with stringent rules and regulations piled in the corner of every office held in three ring binders. This strategy will never work over the long haul of a career in dentistry.

As I understand that you would like to change the culture in order to take your practice to a different level than what you currently occupy. Looking at most practices I see a “profit paradox” where if the practice isn’t profitable it will not serve any other purpose. Dental practices that exist only to produce a profit don’t last too long, while practices that don’t pay attention to profits can’t exist to fulfill their long term purpose. Somehow we need to find the middle ground here.

I wish I could remember where I read this, but over twenty years ago I jotted this down about creating priorities to create this middle ground:
1. Priority 1: Purpose is what
2. Priority 2: attracts the right people to our practice.
3. Priority 3: Equipping our people with the knowledge, skill, and resources to be successful
4. Priority 4: in order to make our organization profitable.

Creating purpose in order to attract the right people so that we can equip them with the knowledge, skill and resources to be successful means our practices will always be profitable.

Once again, monitoring our systems does not mean we are fulfilling our leadership responsibilities, in fact; leadership has nothing in common with systems management. Every time you see “rigid systems” you will find stifled creativity, and spontaneity, which I see as the critical precursor to teamwork.

Imagine what life would be like if nothing that you did mattered? How would you feel if your words or actions were so inconsequential that you were disregarded by others, and you became powerless and unable to alter your existence? Now consider what we do when we micromanage our staff. Micromanagement is compensating for our deficiencies as leaders. All of us should instead partner with our staffs and build a better practice culture.

I know that this was pretty long, but there has always been an 800 lb. gorilla in the corner of the room that no one wanted to talk about or acknowledge in dentistry: Leadership. So leadership in a whole different form needs to permeate your office in order to get where you said you wanted to go.

I would recommend involving your staffs in an intentional planning session that would direct their efforts away from micromanaging and paper overload to a clear vision of what the next few years should look like. Make 2013 a year in which you commit to learning the tools of leadership.


Michael Abernathy, DDS
[email protected]