For the last few articles we have discussed assessing your results, making decisions, and acting to improve your culture and systems to maximize your results. We even discussed the nine areas that can doom a practice to mediocrity. With this in mind, I want to explain a little discussed topic that can literally take the procrastinator and propel him or her past indecision. It can automatically force team members to redesign and improve the systems and protocols by which they work. It can also take an average practice into the top 10 percent area without creating undue stress. Good practices will leap past a plateau into another level of practice. This little discussed gem will surprise you and at the same time you will instantly understand the why, when, what, and how. It is as close to a miraculous healing as you will ever see. The downside is that you will be kicking yourself for not already understanding the brilliance of the strategy and the simplicity of logic that drives it.
The title, while simply “Forced Change”, is deceptive in its actual meaning. Literally you would think that it means you are coerced into making or doing something different. Like I am putting a gun to your head and giving you no choice but to do my bidding. As you will learn in a moment, the word “forced” is actually a noun. Normally you would think force is the cause of change and not the change itself. In this case you will soon realize that “forced change” is the result of putting into motion an action that has a ripple effect on every aspect of your practice. It will change the culture, the finances, number of patients, and alter your limited beliefs to the point of irreversible improvement. Its result is remarkable in the number of things it impacts, as well as in the way it affects everything in your office. You will see that most things it touches, it changes for the best. It predictably improves every aspect of your practice while building consensus with your team and patients. It creates synergism so that what used to take many steps, now takes just a few and produces double the result. If I were you, I would be thinking that Mike’s about to sell me some snake oil. I can’t conceive any circumstance or action that I could take that would have that sort of effect on my practice. You would be wrong. In an effort to intrigue you and get you to consider the impact this will have I need to cover a couple of things more before we introduce this example of “forced change”.
This overlooked strategy has a downside. It will directly confront the number one thing that will hold you back: Limited beliefs that have become truths to you. The second area is that it will require a financial investment and also a time investment. The good news is that initially the cost of doing this is almost zero. It is not until you start seeing the results of increased production, new patients, and profit, that this strategy’s investment will cost anything. At that moment, it won’t matter what the cost is because you are past seeing this an expense and realize it is an investment where you can spend a dollar and get a return of $3 to $10 dollars. Pretty much a no brainer. This return on your investment will also come at a time where you have cut the chains of your limited beliefs and embraced the excitement of growth and empowerment.
Let’s take the limited belief first. Each of you need to understand when a limited belief is the thief in the night that is stealing your growth and happiness as opposed to a real blockage that is holding you back. All real blockages, like not enough ops or staff, always have a black and white solution. There is always an action or change that will diminish, if not totally eliminate, this challenge. With a limited belief, it will always look unsurmountable and there never looks like there is any substantive solution to the problem. When it seems like it is an unbeatable foe, it is always a limiting belief. The challenge here is that fear is driving your inability to accept the fact that, for all these many months and years, you have looked at challenges that were not real. Certainly this conundrum was truth to you, but it is not real. There is a solution. There is always a way out. They existed only in your mind. But they have paralyzed you to think that you were different. That this is an unsurmountable obstacle and no one else is dealing with what you are dealing with. Fear is false evidence appearing real. Invisible chains that are holding you back. Houdini only failed to open a locked door one time. It was a jail cell in the Bahamas and after two hours of trying, he, exhausted, gave up only to find that the door was never locked as he collapsed and leaned against the door and it swung open. He only failed to turn the handle to escape his confinement. The image that he was locked in and could not escape blinded him to the fact that all he had to do was open the door. Nothing held him back but his limiting belief that he was securely locked in.
As we get to any “forced change” strategy, most of you will think or say: “We’ve tried that and it doesn’t work. I don’t have the time. I can’t afford to do this. It’s different where we practice”. Ad nauseum. This is that limited belief talking and by repeating your excuses, you have given it power over you. You have given up and given in before the contest begins. No one wins with that attitude. It’s almost like some doctors enjoy wallowing in their made-up disasters and unbeatable foes. They take the victim mentality over becoming accountable for their results and actions. Their circumstance justifies their inability to save themselves. Right now, you need to lose your excuses if you ever want to find your results. You need to let me partner with you and show you the way to act on this strategy of forced change to put into motion an overwhelming result that will right your practice, undo your lack of leadership or systems or hiring and put you on the road to consistent growth. Sadly, there is no real learning without application. Hearing is not doing and doing is the only thing that has a chance of transforming your practice.
This “forced change” can come in many forms but I want to take just one and walk you through how it can transform your attitude so that you will be able to integrate several other “forced change” systems once you see how quickly it pays dividends. While these dividends will be in the form of money, overhead, staff stability, and culture, the most important benefit may be that it changes your attitude towards dentistry and your practice. It just might have you looking forward to working again. A real attitude “turn around”.
This first forced change I am referring to is an unlimited number of new patients through rarely used marketing strategies. Let me explain what I mean. Keep in mind that nothing will change in your practice without patients showing up and buying treatment. Secondly, every practice is working at capacity because everything you do is precisely designed to give you the results you are getting. Let’s assume that everything in your practice needs some changing. Some big changes, some small, but everything needs to be different or you will keep struggling. Let’s also assume, like most doctors, you agree there have to be changes but you don’t really know where to start. You might not even know what to do or you’re not really aware of all the areas that would need to be changed. This sets the stage for “forced change” driven by overloading all of your systems at one time by increasing your new patients. Increasing them until nothing really works in your practice. Double them, triple them. Imagine this as a funnel that overloads your capabilities to cope. If we can do this, the ripple effect will be that each and every team member is trying to cope. Things are busier. Each day is different and challenging in a good way. Each member of the team is trying to win at this newfound windfall. What they are currently doing or have done in the past won’t work now. They are drowning in happy new patients and they have to deal with it. Maybe for the first time they try to short cut what they have always done in order to keep the patients and you happy. They make small changes and large changes but they are forced to make a lot of changes in order to compensate for this new capacity challenge. It is at this point that you will start to see the office radically adapt in order to accommodate and thrive in this unfamiliar territory. If you are among the procrastinators and “Yes but” type of doctors, it will be right at this point that you start sweating a bit. Your mind is spinning because we are up against those limiting beliefs that have held you back so for. Don’t worry, just do what I ask and ACT. It will be a bit scary, but remember you have everything to lose if you don’t blindly act. Also keep in mind that this is not really going to cost anything to do this. As you will soon see, we are going to deal with internal marketing that takes little or no money, will take the few patients that are coming to your practice and turn them into raving fans that will tell everyone they know to pick up the phone and make an appointment with their remarkable dentist.
When we, as dentists, think about marketing, things like Google ads, Facebook, radio, billboards, signage, etc., quickly come to mind. I want to take a moment and suggest that many of us miss the obvious marketing ploy in the clinical arena. This type of marketing can be huge and in addition to the traditional marketing outreach, we can literally create a marketing faucet that will guarantee you as many new patients as you can handle. I take that back. We are going to create a marketing funnel that will go far past what you can handle. So far in fact, that you will be forced to change in order to keep up. It is an overlooked area that corporate marketing companies don’t know. The great part here is that it costs little to nothing to do and these raving fans will change the face of your practice. Image having every patient you stick with a needle leave your office and tell everyone they know how great you are.
Marketing is really being able to tell a story that inspires a consumer to find urgency and a need to give you a call and make an appointment. The trouble with this simple description is that it leaves out what needs to happen after the call. Good marketing gets them in, but Great marketing keeps them coming back. Clinical marketing is one of those areas that is often times non-existent in the “average” dental practice.
One of these is how to stage your clinical practice in such a way that you consistently have “painless” procedures and countless patients telling everybody they know about how different you and your office is from every other “wanabe” dentist in your zip code. Below you will find a fast and furious list of the top things we did for over four decades to be considered the best dental office in town. Strategies that literally brought in 250-300 new patients every month. It is with this list that you can elevate you and your practice to appear “remarkable” when compared to all of the other practices in town. Truly, most dental practices don’t make the effort to be remarkable and this is a huge oversight that leaves them vulnerable. The good thing for you and me is that this bar set by other practices is extremely low. If you just start this strategy, you can, in 60 days, change the perception of most of the consumers in your area so that in a few months you become the “it” practice. You will start to become THE DENTIST in your area of influence.
We were always on time. I don’t mean 90% of the time; I truly mean every patient was seen on or before their scheduled time. We were obsessive about meeting and exceeding our client’s expectations, and this is a huge one. If you run late, you show a complete disregard for the person you are about to work on. The neat thing for me is that most of you do run late. Be on time and give them a reason to tell the 200 people they know on social media how awesome the entire office was.
Premed patients with two Ibuprofen (600mg.), and two extra strength Tylenol (500mg.) and get the same efficacy as Vicodin. This will smooth them right out if they don’t have any issues with their stomach.
Nitrous Oxide on every patient. I could probably count on one hand the number of patients that we did not use nitrous on monthly, because there were so few. It was a rare occasion indeed that someone in my practice did not use it, and no, we did not charge anything for it. It even became commonplace for patients to request it in hygiene and again, no, we did not charge for it. Keep in mind that you can’t pay for the positive word of mouth promotion (WOMP) that being on time and being painless will create. In fact, if I didn’t use nitrous, I almost felt like charging them more. Using nitrous meant they were calmer, time passed more quickly for them, they were more relaxed and felt less, and in some cases had a sort of “amnesia” to the clinical details. It created a better environment for both the doctor and patient. We always added headphones and dark glasses to further insulate them from the clinical environment. I can’t understand why everyone doesn’t use it. I can truly say that patients on nitrous thought I was smarter, funnier, better looking, and painless. They had never seen a dentist that compared to their experience with us while on they were on nitrous.
Use IV Sedation on those folks that don’t want to be there. Sure, oral sedation is easy. But because of absorption and titration it can be more dangerous for the patient. In IV sedation we can knock them down and wake them up instantly. Faster, more predictable, and truly those who need sedation really don’t want to be there. If you don’t want to do or can’t, just hire someone to do it for you and market it everywhere.
Profound Topical Gel: Steven’s Pharmacy www.edgepharma.com , Costa Mesa, California or [email protected]
DBG: Topical gel in 30 and 45Gram tubes (could cut soft tissue with this by itself. Works great.)
DYC: Liquid for rinsing in 480- and 960-ml bottles: Helps with scaling and gaggers on impressions. This stuff is amazing. Use it as a topical, numb baby tooth, use it in a Centrix syringe with mop head, wipe on and numb for deep pocket scaling. Use their Cyclone DS for gaggers.
Use Septoject needles from Septodont with their tri-beveled edges and siliconized metal needles there is nothing as smooth, quick, and painless. Be sure to use a 30 gauge. (Yes, you can aspirate with it). Use Articaine from Septodont.com for anesthetic. Great, profound, fast acting and lasts long enough to do anything you want.
Use X tip or Stabident for those hard to numb patients, for kids, and for folks where you need profound anesthesia or a lack of peripheral soft tissue numbness. It makes you faster and everyone will compliment you on the profoundness and lack of any sensation from your dentistry.
Use Vibra-ject ITL for painless injections. It attaches to any syringe and makes you look like you walk on water.
Use a Carpule warmer and add a PH chemical to your anesthetic to diminish any sensitivity to gradients of PH or temperature during the injection. It will also speed numbing and increase the profoundness of anesthesia.
Always use a medium mouth prop with clinical procedures. It diminishes postoperative TMJ soreness, creates consistent working arena for the dentist, allows the patients to relax, and speeds the procedures with improved visibility. If you have a little more money to spend, the Isolate system is awesome. Great visibility, ergonomics, light, and suction.
Chlorhexidine: Every prep should be cleaned with Chlorhexidine. I don’t get it. Dentists don’t incorporate even the simplest most tried and true systems to minimize bacterial encroachment, and postoperative pain and sensitivity due to bacterial growth at the interfaces and surfaces of their crown and operative preps. I would never place a filling or crown without using an antibacterial scrub to eliminate the bacteria, smear layer, and desiccated dental tubules.
Use Hema-Glu on every filling and crown prep to desensitize and increase bond strength. You will become the painless dentist.
Use glass ionomer for bases, pedo fillings, and buildups to eliminate sensitivity and recurrent decay. We all know about the effect of the fluoride release but also remember that this is a dual cure material with almost no shrinkage compared to any type of composite. Mix it up and bulk fill, hit it with the light, prep or finish and you are done. No sensitivity, decay, or postop problems.
Use Accufilm for occlusal adjustments. There is no thinner carbon paper on the market. The thick stuff does not work and you will eliminate all contacts if you don’t switch.
Dexamethasone: Every filling or crown receives a buccal injection following the appointment of Dexamethasone 4mg/ml. It is a steroid and will eliminate almost all postoperative sensitivity and pain or swelling. Works great for extractions (Oral Surgeons use it in their IVs). This is the single best thing I have done for over 20 years to create a reputation of no pain with my patients. The only contraindication would be Insulin dependent diabetics: It throws off their dosage.
Medrol 4mg tabs: The use of Medrol 4mg at about three a day as a prophylactic or after the fact anti-inflammatory to eliminate the general tenderness or slight discomfort following any procedure. Works great, and you look like a miracle worker without prescribing a bunch of narcotics.
Use a little Polysporin powder placed in any extraction socket prior to having the patient bite on a moistened 2×2 gauze. You will stop almost all dry sockets. Got this one from my first job from a dentist who was in his late 80’s. Say goodbye to dry sockets.
Terrific Patient card: Give every patient your cell number after any appointment that you numb for. It will make you look like a saint and they will never call. Write a “Terrific Patient” card to every patient that you numb, every day, all day long.
I usually just hand write a note that says:
“You were a great patient today. If you need anything at all, just give me a call on my cell at 972-523-4660. Don’t forget to send me two more patients just like you.”
It goes in an envelope and goes with the assistant to the front desk who addresses it and mails it that same day. http://www.abbottcards.com/prodinfo.asp?number=PA301W
Forced Change is the simplest way to initiate a rapid response to poor results. Without much training, these strategies become a plug and play, never miss strategy that pays huge dividends. Create a strategy that, when implemented, creates a ripple effect on every system and team member. It will literally rewrite your culture while transforming your results. The biggest pay off is that once implemented, it even drags the reluctant doctor along to another level of practice.
Michael Abernathy DDS
[email protected]
972.523.4660 cell
PS. You have probably heard or seen this before, but Albert Einstein (a pretty smart fellow) is credited with giving this definition of INSANITY: “Doing the same things over and over while expecting a different result.” Another twist on this that I have heard is this: Keep doing what you’ve always done, and you’ll keep getting what you’ve always gotten. (MG)