Dr. Rick Steedle offers advice on selecting the right path to a more successful and less stressful practice
What if being more successful was simpler than we thought? What if we could focus all our time and energy on changing our practice in ways that would have the greatest impact on our success and hit the target every time? What if what we thought we wanted—starting more patients, making the day less stressful, or spending less time in the office—could be achieved faster and easier by making only a slight shift in our thinking?
This is the first in a series of articles on “Becoming the successful, not stressful practice.” This series explores why some practices succeed and others struggle, and why even successful practices can become highly stressful. It will show how to focus your efforts on what’s truly important, making your practice more successful and less stressful in the process.
Changing our approach
So, what is this slight shift in thinking that will help us become more successful? The shift is from “crisis management” to “management by design”; it’s from “problem-solving” to “systems thinking,” seeing problems as a symptom of a greater issue.
Whether we have scheduling conflicts, delinquent accounts, or other troublesome issues in the practice, problems are the by-product of our practice systems, the habitual way our staff performs in our office. Attempting to solve complex problems without considering the interconnected network of related issues often leads to unintended consequences. When we create effective systems, however, all the related issues are considered, and the unintended consequences are virtually eliminated.
The three key decisions
Once we change our approach, the best way to begin improving our practice is to model what successful practices do. Although practices come in many styles, all the exceptional ones become and remain successful by making all of the three key decisions:
1. Choose the right direction
Exceptional practices have a clear idea of where they want to be in 1, 3, and 5 years. And by choosing the right direction, they strive to do four fundamental things exceptionally well.
2. Focus on the right priorities
Exceptional practices commit to continuous and never-ending improvement on what is most important without wasting their time and energy on projects that are inconsequential; they focus all their efforts on achieving significant results. This will be discussed in Part 2.
3. Use the right strategy and take the right actions
Exceptional practices have an effective process for making significant changes, not simply by solving problems, but rather by developing highly effective systems to consistently achieve outstanding results. This will be discussed in Part 3.
The four cornerstones of an exceptional practice
So what then is the right direction? Fortunately, to become successful, we need to concentrate on doing only four fundamental things exceptionally well. We must commit to:
1. Excellence in clinical care
2. Outstanding customer service
3. Great interpersonal relationships
4. Sound financial management.
What we want for our practice is usually the by-product of doing well in these four areas. If we concentrate on becoming better in these four categories, the end result will automatically be the outcomes we want—more patients, better collections, and a less stressful, more competitive practice. A well-run practice that executes these four fundamentals exceptionally well will so delight and “wow” its patients, parents, and referrals that it becomes the “practice of choice” for patients and, ultimately, the “employer of choice” for staff.
We can achieve a more successful and less stressful practice by pursuing the following four elements of an exceptional practice.
1. Excellence in clinical care
Our clinical skill and judgment is one of the keys to a successful practice. In private practice, however, our ability to deliver excellent care requires three additional ingredients:
a. A well-trained staff,
b. A well-designed patient delivery system
c. A personal commitment to excellence by everyone involved.
Under this category, we develop systems for better staff training, appointment scheduling, overdue patient tracking, more effective treatment protocols, lab work processing, etc. In doing so, more efficient and productive clinical operations lead to more time for achieving excellent clinical results.
For example, in analyzing our orthodontic practice, we discovered that 15% of our patients were finishing in more than 2 years due to cooperation issues—not keeping and scheduling appointments, not wearing their elastics, not paying their accounts, etc. The solution was not simply finding a way to get the overdue patients out of treatment (problem-solving); rather it was developing a system that consistently had non-cooperative patients out of treatment in less than 2 years and, in a way that the patient and parent were happy with our decision, and the dentist agreed with the decision. We called it the “Happy Deband” protocol.
By redesigning our entire patient delivery system, from that day forward, we were able to complete 95% of full-treatment patients in less than 2 years. Achieving consistently good-to-excellent clinical results in a timely fashion is a powerful practice builder with a significant impact on the practice profits, patient/parent satisfaction, and staff/doctor stress levels.
2. Outstanding customer service
Giving our patients good customer service is no longer considered adequate today. The new standard is fast becoming the “customer experience” —high engagement with our practice while they’re in or out of the office.
Even though hundreds of books describe how to give outstanding customer service, customer experience management all comes down to four basic principles:
1. Managing the “moments of truth” —and exceeding their expectations in that moment
2. Systematizing service - so that we can deliver a high level of service every single time
3. Having great recovery plans—to make it right when occasionally we don’t measure up
4. Committing to constant and never ending improvement—by constantly innovating to meet the changing needs of our patients
Managing the “moments of truth”
Every time someone interacts with us or our staff, or we have an opportunity to form or change their opinion about our practice, it’s a “moment of truth.” They either come away from that experience feeling better, feeling worse, or feeling about the same about our practice. Our reputation with that parent or patient, and ultimately our reputation with their dentist and the community, is entirely dependent on those individual “moments of truth.”
For example, research on banks shows that there are three key ways that customers measure whether the bank teller was friendly, personable, and treated them like person rather than a transaction. They reported a positive experience when the teller would:
2. Use the customer’s name
3. Talk about something other than the business at hand.
With this information, we can manage the “moments of truth” in our practice by training our staff to always incorporate those three things into every interaction.
But why are these “moments of truth” so important?
Reputation ratio (4-0-11)
Research results show that if a customer receives good service that exceeds their expectation, they, on average, will tell approximately four people about that good service.
On the other hand, if a customer receives the expected level of service, they will tell no one. It’s not news. But, if a customer receives poor service, which is below what they expect, they, on average, will tell 10 to 11 people about it, and 13% of them will tell more than 20 people
That means that every time our practice doesn’t deliver the kind of service our parents and patients expect, they will tell, on average, roughly 11 people about it. Therefore, we’re going to have to provide an exceptional experience to three other patients, just to get back to even!
Our reputation in the community then depends on managing these “moments of truth.” The positive or negative “word of mouth” about our practice can be calculated by the formula: 4 ´ “raving fans” - 11 ´ “dissatisfied people” = Our reputation
The “Titanic” percentage (96%)
Other research shows that only 4% of customers who receive poor service ever complain about it to the business-- a 25 to 1 ratio. The other 96% may be unhappy, and each will tell approximately 11 people about it. That amount of negative “word of mouth” is the iceberg hidden beneath the surface that can sink our plans for success.
So when a staff member tells us that Mrs. Smith was complaining about how her daughter was treated by our new chairside assistant during the last appointment, the complaint needs to be taken seriously. We now know with certainty that there are probably 24 more “Mrs. Smiths” out there who had the same experience with the new assistant and didn’t complain.
Because no patient dissatisfaction is minor, it’s essential that we “systematize service.” We can’t leave outstanding customer service to chance. We have to create nearly foolproof systems to deliver exceptional service during every “moment of truth” —when the parent calls for an appointment, when our chairside assistant works on a patient, or when our insurance person helps a parent who calls about their new policy.
For example, the new patient experience is critical to practice growth. A possible goal in this category might be to design our new patient process from first call to starting treatment in such a way as to impress the patient and family.
Developing excellent service protocols and training our staff to execute them well can turn the good people we have into extraordinary performers, delivering a result that consistently exceeds the expectations of our patients and parents. Going from merely good to outstanding service has the potential to generate such “raving fans” for our practice that our reputation grows and more patients are referred.
Great Recovery Plans
Even with our best efforts, occasionally, we don’t deliver the service we wish to. Possibly the wrong primary insurance carrier was filed, or the extraction request didn’t get sent on time, or the front desk mis-scheduled an appointment, or the assistant forgot to give the patient more elastics. When this happens, we must have “great recovery plans.”
Everyone in our office has to be trained to handle the situation well and exceed expectations in the recovery process by:
1. Responding promptly
2. Apologizing sincerely
3. Going the extra mile to make it right.
To recover well, for example, the extraction request and radiograph will be emailed immediately, an assistant who lives near the patient will drop the elastics at the house on her way home, the insurance person will re-file the insurance immediately, and send the parent an email confirmation.
Often, when we recover well from a mistake, the disappointed person ends up having a higher opinion of our office because we were so responsive. They now know that they can count on us even when something occasionally goes wrong.
Constant and never-ending improvement
Finally, every time we fail to give outstanding service, we must commit to never-ending improvement, constantly tweaking our service systems or improving training so that what happened this time will be less likely to happen in the future.
Great practices are not complacent and are constantly improving their service systems: How they answer the phone, how they get patients in and out on time, how they schedule their patients to have a stress-free clinical day. For example, by redesigning our scheduling system, we were able to consistently seat 93% of our patients within 10 minutes of their appointment time.
3. Great interpersonal relationships
Exceptional practices are also built on great relationships with referrals, patients, parents, and the community. Fostering and improving those relationships must be a top priority. And, like outstanding customer service, it can’t be left to chance. We must have a strategy and a plan for building and strengthening those relationships.
Several examples of strategic goals may be: a yearly marketing plan for our practice, effective communications training for our staff, a regular pattern of lunching with our referrals, patient appreciation events, and “lunch and learns” with other offices (so that their staffs can have confidence in referring to us).
Also, having a great relationship with our staff (building our All-Star Team) is essential to delivering exceptional levels of customer service and clinical results. It’s our competitive advantage. Having a staff that can handle the operations and management of the practice reduces our stress and frees us up to address more important practice issues. It’s also the only way we can consistently achieve the highest levels of performance without overwhelming us personally. The details of how to build that team are explained in a related article.
4. Sound financial management
And finally, exceptional practices are well-run businesses. They meticulously manage their finances by concentrating on:
1. Monitoring the key practice indicators
2. Making great strategic decisions
3. Spending their money wisely
4. Improving staff productivity before hiring.
Successful practices monitor the key practice indicators and use them to make great strategic decisions about the practice. They don’t wait until a short-term negative trend becomes a long-term serious problem. For example, if referrals from a particular dentist drop off, supply costs begin to rise, or the number of patients seen beyond the estimated completion date increases, do they want to know about it only at year-end? No, they want to monitor that information monthly so that they can take immediate steps to rectify the situation.
As they monitor the numbers, these practices pay close attention to keeping expenses in line, having effective collection systems, maintaining great inventory controls, negotiating the best discounts for materials and supplies, keeping overhead within acceptable parameters, and therefore, generating great income for the doctor and staff. They set financial targets, meet them, and closely monitor the production, collections, and expenses, quickly adjusting if necessary.
Exceptional practices also spend their money wisely, controlling expenses while still investing for the future. They make the distinction between an expense, which is generally recurring and delivers a short-term benefit (e.g., supplies) and an investment, which is not as frequent (e.g., a new office, better equipment) and offers long-term benefits. Some practices are overly focused on every check written and stifle their long-term financial health by spending too little. Successful practices invest in their practices, spending money strategically to increase productivity, satisfaction and revenue.
Great practices look first to improving staff productivity before they consider hiring someone else. If they feel they may need more staff to do the job well, they must first ask, “Is this a question of staff number or of staff productivity?” If staff costs are in line with the averages, then they may need to hire. But if hiring someone will result in higher-than-average staff overhead, it may indicate that they need better work organization, more effective systems, or additional training.
Practices are not “things” that can be fixed, but “patterns of interaction” among the people in the practice. Those patterns, the systems, are the habitual way everyone does their job and what happens (or doesn’t happen) each day is a by-product of those systems. So when problems arise, we must take a broader view, allowing us to identify the systemic causes and leading to the development of more effective solutions.
Rather than managing all the crises, the first step for practice improvement is “Choosing the Right direction.” And the right direction for all successful practices is to constantly improve in four areas: clinical care, customer service, interpersonal relationships and financial management. But once we choose these areas of improvement, where do we start? In Part 2,we’ll learn what limits our practice and, by “Focusing on the right priorities,” how to break through those limitations to become a more successful and less stressful practice.
J. Richard Steedle, DMD, MSEd, MS, received his dental degree with honors and a masters degree in Dental Education from the University of Pennsylvania. He received his masters degree in orthodontics at the University of North Carolina at Chapel Hill where he was awarded the Morehead Fellowship in Post Graduate Dentistry and an NIH research training fellowship. After orthodontic residency, he served on the faculty of the Wake Forest University’s School of Medicine, Department of Dentistry, for 4 years before entering private practice. During the next 20 years, he and Dr. Bruce McLain built a three-office orthodontic practice with a staff of more than 25 employees near Winston-Salem, NC. In 2005, Dr. Steedle joined the part-time faculty at the Department of Orthodontics in Chapel Hill. Since then, he has developed a 3-year curriculum in Practice Management for the residents, complementing the work of Dr. Robert Scholz there. Through their joint efforts, UNC now has one of the most comprehensive Practice Management residency courses in the country. He can be reached at
1. Senge PM (2006) Fifth Discipline: The Art and Practice of the Learning Organization. Doubleday, New York.
2. The Disney Institute & Eisner MD (2001) Be Our Guest Perfecting the Art of Customer Service. Disney Editions, New York.
3. Carlzon J (1987) Moments of Truth, Ballinger Publishing Company, New York.
4. From The White House Office of Consumer Affairs, Washington, D.C.
5. Steedle JR (2010) Leading an all-star staff. J Clin Orthod 44(8):487-494.
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