In the spring of 1996, I presented a seminar on practice management to members of the Florida Academy of General Dentistry. At that meeting, Dr. James McIlwain and I first met and had an enjoyable conversation about the dental profession. Shortly thereafter, Dr. McIlwain contacted me and asked me to visit his practice and provide my professional assessment of his operation. The engagement was mutually beneficial, especially for me in that I witnessed a first-class operation and came to know an outstanding individual in Jim McIlwain.

Last August, Dr. McIlwain and asked me to contribute articles to this publication in hopes that my experiences would benefit pediatric dentists in the region. I was appreciative, honored, and immediately accepted.

Over the past 20 years I have been serving dentists in the capacity of a business management advisor, assisting them in developing plans, integrating systems, and providing coaching to help enhance their practices. My experiences have educated me in the real world of how dental offices face day-to-day challenges serving patients and the community in which they live and work. I hope my literary contributions will shed some light on solutions to various topics readers of this publication may encounter in their own office.

Over the past few years, recent economic conditions and world affairs confirmed to me that our world changes and challenges us daily. The resulting effects on the business of dentistry can take us by surprise if we're not prepared. In my years of service to the dental industry working with hundreds of dental offices nationwide, I have discovered that plans can be made to prevent business decline in these changing times.

I have been able to witness the effects a downturn in the economy has on practices. Each office I have worked in within the past year has experienced some impact. Granted, my world is small in comparison to the total number of dentists in the country, but it is large enough to gather some generalities.

What was clearly evident is the realization that regardless of how great each dental practice operates, nothing could be taken for granted any longer. Whatever level of patient services a practice strives to achieve, the levels are being tested daily. Doctors and their staff realize they need to put forth even more of an effort to ensure patients and their families understand and embrace the value of excellent dental care.

Many practices have had a drop in new patient volume. Some patients and families aren't readily accepting recommended treatment as witnessed by a decline in case acceptance. The occurrence of failed and broken appointments has risen a bit. These factors are present in all offices; although some are feeling the effect more than others.

I have observed that offices which encountered less of an impact had previously worked hard on customer service and built trustworthy relationships with patients and their families. The trust and confidence of the patients was well established through exceptional service by the doctors and staff. This resulted in steady case acceptance and kept appointment rates. Productivity slipped in offices that took their success for granted. These consequences have forced them to re-focus on what is needed in sustaining patient and family relationships.In my experience, the most important factor in surviving downturns in the economy is relationships.

In order to ensure one has loyal patients in a practice, it is vital to have a solid foundation of fundamentals in dental practice management; a well thought out business plan, a fantastic staff, effective marketing, and superior patient services. I've seen predictable, measurable growth and prosperity in some dental offices during this economic downturn. These offices have prospered because attention is focused on the details surrounding the entire patient process. Each step of the process must be perfected so that treatment recommendations are followed, appointments are kept,services are paid for, and families are so happy with the office that they refer other people to the practice. Walt Disney said, "Do what you do so well so that people cannot resist telling others about you."

These details are difficult to master; it takes hard work and dedication. Education is a large part of the process. One has to realize that learning is ongoing. Not only the doctor but also the entire staff must consider the value of reading books on how to deal with people, and attending courses on negotiation, sales, and/or interpersonal skills. The knowledge gained must be shared with the entire staff, and incorporated into the practice on a day-to-day basis. Without question, these skills must compliment the high level of professional dental care offered in the practice through continuing clinical education.

Unfortunately, I discovered staff in many offices didn't fully comprehend the impact 9/11 and the downturn in the economy had on the dental industry right away. By and large, they didn't perceive that people had changed. The staff began to realize how serious the impact of world events was only after they started seeing the effect on their patients, the schedule, and the slowdown in business operations. For example, a good number of people called canceling their appointments because they were second-guessing if their jobs were stable, if they would still have dental insurance, and if they would have enough discretionary income for dental care. Initially, some patients kept appointments because they were being laid off and they wanted to complete recommended treatment for themselves or their family in time to use up their insurance and while they still had the money. But after that, reality set in and people no longer were scheduling at dismissal because of all the uncertainty about employment and finances.

Overall, there was not a sense of urgency in the minds of many staff members to raise the standards of how they served the patient.

With all this, how does a practice guard against future downturns in their productivity?
The first step is to employ a great staff made up of people who have the following characteristics: honesty, autonomy, integrity, responsibility, self-discipline, enthusiasm, strong work ethic, and accountability. Next, lead them by using principles that are well grounded in moral values and doing what's professionally right. For example,

"The office is great because employees are empowered, motivated, and happy."
"As an employee, I will continually educate myself so that I am able to reach and even exceed my potential as a quality healthcare provider and team member."
"As a dentist, I will continually educate myself so that I am able to reach and even exceed my potential as a clinician and leader."

Finally, train staff to do the job so well that the patient experiences the highest level of patient service and professional dental care. The end result is a strong relationship of trust and confidence that patients have in the doctor, the staff, and the entire practice. There's an old adage that I truly enjoy, "Ideas are a dime a dozen. People who put them into action are priceless."

Sometimes it takes a wake-up call like a catastrophic world event to help us realize that nothing can be taken for granted. It's up to us to improve ourselves and make even more of a commitment to a higher standard of patient care. Raise the bar on all that you do.