Articles By Fred

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.

Working to help dentists automate business systems through computer applications, I have come across an unfortunate occurrence that is not only devastating, it is happening far more often than imaginable:

COMPUTER HARD DRIVES CAN CRASH!

When a crash occurs, all the data stored on the computer could be lost. Imagine for a moment, walking into your office tomorrow, turning on your computer and nothing will get your computer working. When you describe what the computer is doing, (or isn't doing), to your hardware technician, the answer returned is enough to make you shudder; "I'm afraid something has gone terribly wrong. Your hard drive has failed. When was your last backup?" Unless you can reply with 100%certainty that your most recent backup was done correctly, your entire practice's data could be gone…forever!

There are actions to take in your backup protocol to assure sound data recovery. The first step in the backup routine is to have a system in place that is carried out on a daily basis, and known by more than one of your team members. Your backup routine needs to be done on a daily basis, regardless how redundant it seems. It is a good idea to have your data backup protocol printed out and kept in your office manual, for the employees responsible for the backup duty to reference.

For years there was only one option for data backup, this involved manually backing up data 'in house' using several different means, such as tape drives, external hard drives or internal hard drives. Now, dental offices have another option, backing up electronically. Whether using a manual system, electronic, or both systems, a visual verification of correct data backup is needed.

When performing manual tape backups, a person needs to be certain the tape is in the correct drive, and the tape is not malfunctioning. The safest way to protect data is to use one tape for each workday, and performing a month end backup, using two tapes for the month end backup, rotating these tapes so that the office data is never more than thirty days out. One must be certain that the correct files are selected, for example; not just the Registry. If the backup does not include all the valid data, the backup may be for naught.

A process that is performed by some offices is a "test data restore". This can verify if the data was backed up. However, using the verification process in your backup software may be a waste of computer time, because of the immense nature of the files being verified. It can be quite time consuming, since the files are verified one at a time, in reverse. It is better to visually inspect the Report Log text daily to be certain of what exactly was backed up. The backup report will inform that the following files were not backed up or the files were busy. Busy files do not get backed up. Most times backing up the busy file is easily rectified by making sure all programs are closed before beginning the backup process. However, sometimes the report will show busy files with all programs closed. This is why it is prudent to have a competent computer hardware technician to rely on for problem solving discrepancies.

Speaking with computer technicians recently, I have learned that even the popular backup program, written by the well-regarded "Veritas," may have a flaw. Veritas may indicate a successful, 100% backup, even though this is not the case. A complete backup should mean that every selected item was copied. However, some files may not have been included in the backup routine. Again, one must check the Report Log that the backup program provides and read the status of the backup routine to determine if any files were not included. If errors were reported, contact your computer hardware technician and describe your findings to determine if there is cause for concern.

When data is assuredly backed up manually, there is another safeguard to consider; keeping the backup tapes, (or internal/external hard drives), secure. The data can still be lost from a variety of other causes, such as damage to the facility where they are stored, theft, vandalism, or viruses that attack your computer. It is best to keep tapes in multiple areas, being certain that HIPAA regulations are followed, and use antiviral software.

Electronically backing up data is a newer option, which could be used as a primary means of backing up data, or as a secondary assurance. A high-speed Internet connection is necessary to transmit the data to an off-site computer storage facility. The high-speed connection is preferable because backups by dial-up modems could tie up phone lines for hours. If using this option, be certain that the information stored is in an encrypted format, and that the company you choose is in compliance with HIPAA security. Transmitting data will be automated and scheduled in the time period you choose. The monthly rate for electronic storage depends on the amount of data you are storing. Typically it costs twelve dollars per gigabyte of data, per month. Most online services offer data compression and filtering. If this option is chosen, one must be certain that the company chosen is reputable, has recourse for lost data, and that all data can be retrieved if the company goes out of business. It is best to ask your computer hardware technician for assistance in choosing an online program.

As much as we rely on computers, they are susceptible to failure and can ultimately ruin what would otherwise be an anticipated day of bliss at the office.

Remember, computers use superb technology, developed and run by humans. Taking charge and being proactive about backing up your invaluable data will save time, money, and help avoid the stress and aggravation aligned with a computer breakdown.

In today's age of modern dental practice management, fundamental interpersonal relationship skills are necessary to help patients and parents achieve the level of health they desire. But it seems that the knowledge of asking questions correctly, listening carefully to the reply, building the person's knowledge through education, presenting treatment options that make sense, and making good financial arrangements may not be enough to gain acceptance to treatment. A key ingredient that may be missing in helping dental offices achieve accelerated practice growth today is PASSION; a passion for dentistry that links all of these skills together into one seamless engagement that helps patients and their parents become as healthy as they desire. A passion that comes from being excited about all the options available with modern dentistry, including esthetics!

What often is an obstacle in the process of gaining acceptance to treatment is the perception by some who work in the practice that they are going above the accepted norm, or that they are pushing unnecessary treatment. Comments from team members that come to mind are, "I don't like to sell", or "I don't want to sound like a used car salesman."

Perhaps dentists have thought of these questions over time:

• What is the reason why staff feels uncomfortable with "selling" treatment that is prescribed by the dentist?
• Why does staff feel "pushy" when they are asked to discuss treatment options and reinforce dental care that the practitioner feels is important for optimal dental health?
• Do staff members have preconceived notions of what would be the proper care?

In order to overcome the "sales" barrier, empower staff with the knowledge to educate parents about all the available options for their children's care. That may include helping the parent become aware of and excited about treatment that yields a more pleasing esthetic result, even though it may be more expensive. Some team members may have a mental block created from their own personal circumstances that may lead them away from discussing esthetic treatment because of cost. Avoid this by encouraging team members to allow parents to make decisions for themselves based on the knowledge provided during their visit.

The patient process requires determined steps to help patients and parents arrive at the logical and sensible conclusion of accepted treatment. These steps include asking questions that help determine a need or want, educating them to help the person become more familiar with their options, and using communication skills to lead them to the decision that makes sense for them. Injecting passion into this process requires a true belief that the options are exciting and will create an end result that helps address the particular desires of the parent and child.

Getting caught up in the skills of day-to-day operations, such as cleaning and polishing teeth, restoring teeth that are decayed, promoting good oral hygiene at home, can lead our minds away from the real reason why people will pursue treatment recommendations. That is, people who accept and pursue treatment are excited about the outcome because the doctor and staff created a passion about the end result.

In this day and age, people are very conscious of the way they look. We are bombarded with images of beautiful airbrushed models looking perfect. Adults as well as children strive to look their best to fit in to the social norm. Parents may not feel esthetics are as important for the child based on cost versus teeth that will eventually be replaced by permanent teeth or that are hidden from view when the child is smiling.

This summer, my nine-year-old niece was very upset because a boy in her class brought attention to her teeth appearing yellow. After many days of the nine-year-old crying and pouting, her mother responded by buying her whitening strips from the local drugstore. My niece proceeded to covet and show off her new beauty treatment to cousins and neighbors. This started a chain reaction, and now all six other children present, ages five through twelve, feel the need to use the whitening strips to have model perfect teeth. This is the thought pattern of many children, as well as their parents, today. Children have always felt the need to fit in, not to be deviant from the norm, and parents are more willing to give in to the child's perceived needs.

Esthetics in dentistry for children, now more than ever, is necessary to help a child's self esteem, especially when one thinks of actors in movies today. In order to portray a villain or a character lacking intelligence, the actor's teeth are crooked, missing, or chipped. When portraying someone with low self-esteem, the teeth are yellow, gray, or dingy because of poor hygiene. Children internalize this and feel that they are lacking in potential too, regardless of their true appearance.

Dental team members need to be cognizant of how these factors affect children and communicate this to parents. Specifically, they must explain all of the provided options, teach the benefits of treatment, and be aware of how dental treatments will benefit a child not only physically, but psychologically as well.

A practitioner should continually build on staff's knowledge base as to why esthetics is necessary and beneficial to children. As staff becomes more familiar with treatment options, they in turn can more easily explain to patients and parents why choosing more than just the most basic and perhaps less expensive option may not be in the best interest for the child. In essence, the staff member will arrive to the level of getting excited about not only the physical but the psychological impact on the child, as well.

The staff needs to understand that they are not selling treatment to a parent/patient, but providing parent/patient with a solid knowledge base so that the parent/patient can be well informed when making the final decision regarding dental care.
The end result will then most certainly be that the parents and patient have been involved in a process in which they feel educated, comfortable with, and excited about the treatment outcome. They will be convinced that the payment they are making is valuable and worthwhile. They will share the passion for dentistry!

On many occasions, I have come to know practices that are operating extremely well, are profitable, and employ a stable staff. All until…something happens: a spouse is transferred, pregnancy, or a move to (allegedly) greener pastures. What was once a well-run machine now has a wrench thrown in the works. Successful management of this type of event will depend largely on the strength of the practices' personnel management and the leadership abilities of the doctor.

Whenever a new employee is acquired and introduced into the practice at any position, careful thought and consideration must be given to the person's skills, ability to meet the qualifications of the job, and personality traits. After checking the new hire's references and verifying skill level, what may be most difficult to ascertain during the interview process is the candidate's personality style.

There are four distinct personality traits. Learning these traits, understanding them, and embracing the fact that everyone is different is the first step towards blending people together as a team. A combination of these traits among the members of the team will help your office relate to a broader spectrum of people who frequent your practice.

Controller or Director
These people must be in charge. They are strong willed, decisive, direct in their approach, and tend to be domineering. They make quick decisions based on what is best for them. They care little how decisions affect others. They are interested in results, not emotions. They are willing risk-takers. They are always in a hurry. They want the straight facts and will quickly decide on a course of action.

Analyzers or Engineers
They must have all the facts before reaching a decision. They will desire every bit of information you have available concerning the job, and they often request more. If you try to rush them into a decision, they will become frustrated. They are unemotional, detail-oriented, and proceed with decisions slowly and methodically. They are definitely not risk-takers.

Promoters or Cheerleaders
They look at the big picture and don't sweat the details. They are fun-loving folks, often storytellers. They make decisions quickly, frequently without benefit of the facts. They tend to be self-centered, to live for the moment, and are enjoyable to be around. They are often most concerned with appearance, and they are definitely risk-takers. They have little interest in the details of the task and will be turned off by such information.

Supporters or Helpers
They are reluctant to make decisions. They work well with people, having tremendous concern for the feelings of others. They are very anxious about how their actions affect others and are intensely uncomfortable with conflict. They go along with other people's decisions easily and are excellent workers. They will also take on more work to ease someone else's job; but in the end may not be able to complete the additional work; they have difficulty in delegating to others.

These personality traits exist today in every dental office among all team members. Despite pre-conceived notions, there's no specific personality trait for each position. Not all excellent administrative or front office workers are "Controllers or Directors"; not all great dental assistants are "Promoters or Cheerleaders".

Consider your own personality. A dentist could have any one of these personality traits and find harmony as well as conflict with other traits. This is true for the rest of your team. And keep in mind; this is true of your patients and their families who frequent your practice.

Blending these personality traits brings into focus the big picture. As a team, you will be better able to relate to a wide variety of people in ways that make them feel comfortable. You will in turn build trust and confidence in their minds for your ability to care for them.

Here are some down-to-earth approaches that you and your team can undertake that will help make use of workplace styles and personalities. Consider first the application among yourselves, then apply them where appropriate to patient services:

1. Understand your differences: Pay attention to feedback, assimilate it and apply it to solving issues or praising for a job well done.
2. Keep lines of communication open: Address any concerns immediately before they snowball.
3. Be Proactive: Develop a knack for thinking ahead.
4. Keep everyone in the loop: People don't like surprises or embarrassment. When things are going well, a short message or conversation, would suffice. When a problem arises, don't hide it; explain and offer solutions.
5. Be a rock: Show up early, meet deadlines and volunteer to help others when you have free time.
6. Don't take criticism personally: Keep an open mind, control your emotions and stand up for yourself, politely, but firmly.
7. Don't play games: Never criticize or gossip about people, and mind your own business.
8. Know people's quirks and accommodate them: Does he/she prefer notes, formal memos, or communication face-to-face?
9. Pitch ideas: Make sure they're reasoned, solution-oriented and will benefit the function of the practice, not just to make your own workload easier.
10. Speak clearly: Collect your thoughts, write down what is needed or be concise when verbalizing your needs.
11. Stay Cool: Avoid losing your temper. Don't be defensive. Control emotions and hold back negativity in self and among the team. Be positive and sensible in dealing with workplace conflict.

Building great relationships with people at every turn is key to good management, and ever more important in today's changing times. A sluggish economy has forced layoffs and other cutbacks in businesses of any size, resulting in high stress, low moral, and concerns about job security. People have fewer options in terms of walking away, and keeping a job has more to do with demonstrating both technical and interpersonal skills. During the late 1990's, dentistry was experiencing widespread growth and prosperity. In comparison, it's more difficult to sustain growth and profit today.

No matter how experienced a person is, it is inevitable that conflict within the work place will arise. It's inevitable because its human nature. Handling conflict in such a way that it creates an alliance, rather than an obstacle, is the result of successful management of people.

Small businesses such as dental offices rely on outstanding people performance. Managing people and personalities are the foundation for retaining patients, keeping an excellent team of people, and sustaining profits.