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Where Should I Start?

In the fifth chapter of my book, “The Super General Dental Practice”, the reader is directed to email me at [email protected], request an analysis spreadsheet so that they can fill it out and send it along with a current P&L, and a copy of one week’s schedule back to me so that we can evaluate any blockages in their practice and discuss how they can be overcome. It’s important that everyone knows this information as they continue into the book. Hundreds of doctors have done exactly that, and are amazed at how little they really understand about the business and trends in their practices. Over and over, with each doctor, I am asked: “Where should I start?” We just gave them a blueprint of what to do, and how to do it, but 99% of them can’t even begin the journey. This is baffling. I want to take a moment and discuss where I would start first, and why.
In almost every case, the doctor is central to any blockage we find. In any coaching or mentoring situation, the doctor is always the 800 lb. gorilla in the corner of the room that no one wants to talk about. He or she has assembled a team, trained them or didn’t, created a culture that works or doesn’t, and is working at capacity. What they are doing now has been precisely designed to get the results they are getting now. From the call, I can assume that they have had an epiphany and decided that their current results are falling short of the creating the practice they really want. So they call. Now they are most often seeing their practice for the first time the way a consultant or trusted mentor would look at a business. I think the reality of the task is daunting and they need a swift push to get started and move in the right direction. I want to give the 5 top things I would do if you have decided to take the step to re-engage your practice growth for better and more profitable results.

1. A well-crafted policy manual. The reason I would start with the policy manual is that up to this point, you have created a certain “culture” or esprit-de-corps in your office. It is not enough that you just have woken up and desire a change in your office. For years you have been brainwashing your staff to blindly follow a marginal practice strategy. If you hire a consultant or start making changes, you need a contractual template to deal with the day to day running of the office and the human resource problems that might occur with these changes. What I see in most practices is a complete lack of “consequences” for not following the vision, systems, and boundaries you have set via your policy manual. You need a do over button, and the policy manual is the foundation for this new practice you will build. With HR lawsuits hitting an all-time high in frequency and cost, you can ill afford to use some off-the-shelf policy manual that fails to address your particular practice and state laws. I have had a professional policy manual done by CEDR at (602-476-1418). Nine to twelve percent (9-12%) of dental practices will be sued by what they thought was a trusted employee. The payoff for the employee has gotten ridiculous and you are a prime target for every slime ball attorney out there with a fancy car and a big house payment to make. I wouldn’t practice without a perfect policy manual. Keep in mind the protection that the policy manual affords along with the “remedy” it creates as you steer your team to a new level of practice.

2. Job Descriptions. On a day-to-day basis we don’t consult our policy manual about the little routine things we do. Within the policy manual, we need to have comprehensive job descriptions that detail the daily requirements of each job. During a meeting with a doctor who had a continual turnover of staff, I asked the doctor to write down the job description for his assistant and had the assistant write down her understanding of what her job duties were. You guessed it. After they both finished, I looked at the two job descriptions and was amazed at how they had nothing, nothing in common. It was as if they were describing two separate, completely different jobs. Can you imagine how this would create a dysfunctional relationship when the assistant was operating from a completely different set of duties and requirements than what the doctor considered she should operate from? Is there any wonder that the average stay of an employee is about 2 years in a dental practice? It’s almost like playing football without a huddle or plays and expecting the team to successfully move the football down the field and score. So sit down and have your staff write their job descriptions, read them, and add anything they may have left out or you want to add. Then have them go over it again. Here are the actual steps: (Reminder: Job descriptions may be used as checklist to hire and train new employees and also as a guide to write performance appraisals.)
a. Employee compiles a list of responsibilities.
b. Employee daily adds tasks that are not found in the manual until the list is complete.
c. Owner and employee discuss the list.
d. Owner confirms or deletes the tasks on the list.
e. Owner sets priorities for tasks on the list.
f. Owner sets standards of performance for the tasks.
g. Owner writes statement of purpose of the position.
h. Owner and employee review the list annually to see if growth in the practice or growth in the employee mandates a change in the job description.

3. Where are you and where do you want to go? If you have filled out the spreadsheet analysis and gone through the discussion with me over the phone, you will have a good idea of where you are and whether or not you fall short of what should be possible. With this clarity, we find that you automatically re-focus you attention on developing the practice you always thought you would have. Without a target to shoot at we will never get better. Analytics, benchmarks, and measured performance are all key to uninterrupted growth and profitability. Here is a short list of a few benchmarks and goals that would give you a target to shoot for:
a. 50-75 new patients per doctor
b. A 50%-60% overhead with compensation being about 25%, facility costs 7-9%, marketing 3-5%, dental supplies 6%, lab 8-10%, and office supplies less than 2%. (For a more comprehensive look at overhead and benchmarks go to and access our link to past newsletter articles.)
c. Production of $20,000-$25,000 per employee per month
d. Production of $25,000-$30,000 per operatory per month
e. Hygiene production comprising 33% of the total production of the office and production at least 3 times what they are paid and the office having 2 times the number of hygiene hours as doctor’s hours.
f. A minimum of 98% collections rate
g. A recall rate of 80% with at least a 50% direct referral rate for new patients.

4. Consequences. The “C” word. There is another “C” that I find far too many practices embracing: Compromise. The time has long since passed when we could just keep marginal people on our teams. Your practice will never go any further than the one staff member with the least commitment to your vision. It’s the weakest link theory all over again. You are as good as our poorest staff person. Keep in mind that none of us is paying individuals to make our life more challenging and miserable. Every person who works for you should be “afraid” of being fired for the “right” reason. With the policy manual, job descriptions, and benchmarks in place, you should now have a very black and white standard for staffing success. We have all read that the greatest enemy of great is good. We have compromised ourselves into allowing less than we are capable of doing. Becoming average or just good guarantees you will fall short of what you are capable of. Dr. L.D. Pankey described the average doctor as the best of the worst or the worst of the best. The same is true for the practice. For me, I am not going to settle for coasting and a mediocre practice.

5. The 360-Degree Job Review. Because we mentioned the 800 lb. gorilla in the corner of every practice, let me now address that scenario. For you to wake up one day and decide to change everything for the better requires a little staging to pull off. Remember that you already hired a bunch of people that you can’t fire because one of them is a family member, another is a mom and daughter, and the last one has something they could embarrass you or threaten you with if you let her go. You have spent the greater part of your career avoiding confrontation with your staff by allowing things to go on without intervention or correction, and now I am asking you to change your spots and become the leader you need to be in order to take you practice to the next level. Beginning with yourself does a lot to help the staff see that you are serious about change, and you are willing to be the example. That’s called leadership. A 360-degree job review allows you to expose yourself to ridicule and performance measurements before you do the same thing with the staff. It creates a “what’s good for the goose is good for the gander” standard of operation. If you would like a copy of our review for the doctor, just email me and I will forward it to you. Once you receive the review, just copy it and give it to each of your staff members. You are going to allow them to fill it in and make comments “anonymously”. You will be surprised at the pent up animosity that they hold for you because of your “double standard” leadership style. This review will give you the ability to see how others view you. Not the “you” that you feel you portray, but the person everyone sees. For most of us, this is a real game changer. Hopefully you can get over yourself and take the review for what it is: A do over button for effective leadership. When we do this for our clients, we collate the information so that the doctor has no idea where each comment came from. If your office is at a point where you feel that your office manager can’t do this for the staff, and then contact me, and I will do it for you. It is important that the staff be brutally honest and feels like they will have 100% anonymity so that you can get the unbridled truth out of them. Shortcut this, or try to control the comments, and you will fall short of getting the results that this can yield. Once the results are in, you will need to print them off and post them in the staff area so that everyone can see them and begin to work on becoming the boss that your staff can respect and follow.

If you have any questions or need a more clarification, just give me a call and we can take the time to make sure that every question is answered to your satisfaction.

Michael Abernathy, DDS
972-523-4660 cell
[email protected]