It is no secret that the practice of medicine is under attack, a national debate for years has spawned cost controls and a presidential initiative culminating in the Affordable Care Act. In case you missed it, or for future reference, here is the complete law, all 906 pages (381,517 words) as printed by the Government Printing Office. With an additional reported 11,000 pages of regulations or or 11,588,500 words. Oh, and there was a Supreme Court case about the validity of the Act that you might want to read, someday.
Okay, so physicians have gotten the message, cut costs, if possible. In an article The Team Can See You Now by Laura Landro, a description is provided of the concept and implementation of a team. The team basically divides up what used to be considered a doctor patient visit among a variety of non physicians reserving an actual visit with the doctor. Here is one telling quote, “Winning over patients to team based care can be a challenge. A 2012 survey of more than a 1000 low income people in California by the Blue Shield of California Foundation found that a majority preferred to be seen by doctors.” Imagine what those that are not low income would prefer?
And that is why dentistry will always trump medicine. Dentists and dental specialists see their patients, provide care to their patients and are usually available to discuss care with their patients. In my view, in dentistry the special aspect of the team is to support the doctor patient relationship not change, constrain or undermine it.
We often see Doctor CEOs and staff members that seem “verbally challenged”. Have no doubt they know their clinical area, understand their
duties and responsibilities but just can’t seem to engage with patients. Especially on some topics that have a difficult social message. Like BAD BREATH. The fact is there a lot of people that have it and don’t understand it. The same verbally challenged dental staff we find can do just fine if they have a prop – something that helps them start the conversation. Well, Doctors and Staff you are saved! An excellent article in the May 2013 issue of Scientific American is titled, Good Bacteria for Bad Breath. Our suggestion is to review the article, secure copies for the reception area, and put a commentary on your own blog or web site. The article is not publicly available at this time but you can secure a copy on line at
A yearly practice planning question as well as a periodic staff meeting topic is the question, “Do we set an example?” The answer, of course, is yes, every doctor and staff member is an example, for better or worse, to the patient on the receiving end of a treatment visit. The real question is, “What kind of example do we set?” Great care and attention should be given to discussing and assessing the response. Invariably we have found that going through that discussion will raise every practice member’s attention level and raise performance as well
I often talk to Doctor CEOs about the model of their practice or the model they desire for their practice. In many cases we at Berning & Affiliates act to strengthen practices, clarify vision and mission and help implement a practice transition. Recently I had a doctor indicate that what he wanted was to have an aspiring practice, one that everyone from staff, suppliers, professionals guiding the practice and doctors held one goal, to do their part better. It is a very interesting way to think of what is usually an operational discussion. In this discussion the operations were important to this doctor but not the most important. What was desired was an investment of caring by all involved to continuous improvement. It was a fresh take and one I thought would be interesting to share.
In many practices the bright idea of the moment, week or month rules. By that I mean that the lead doctor interjects some modification or wholesale change and seeks to get all staff on board. It can be exhilarating but also highly disruptive with a jerky feel to the operations of the practice. On the other end of the spectrum is the Doctor CEO that is deliberative. This doctor introduces any significant practice system, administration or marketing change only after investigation and discussion with consultant(s), key staff and other doctors. When approached in this manner the practice has a smooth feel for all involved.
Here is the core of a recent discussion with a Doctor CEO. Rather than staff meetings how about “conversation meetings“? In a conversation meeting the format is to talk about one item that if implemented for practice would impact it significantly. Log jams, more equipment of a certain type, training in a particular area, adding staff or doctors including adding a multi-discipline format, moving the practice and more might bubble up. Whatever it is stay with the topic, digest it together, call a consultant right then and there on a speaker phone or via Skype and get input. To get a start, to see the potential, and get excitement going is the idea behind conversation meetings.
Many Doctor CEOs act to chair, often informally, staff meetings. In other practices the “chair” position will be that of the practice administrator or even rotate between staff members. One question that pops up with some frequency is whether the chair is responsible for the meeting to meet the objectives indicated before or during the start of the meeting. There is no question that a Doctor CEO acting as chair of a meeting can simply inform the staff of a topic and then say, in effect, do it. But such an approach can leave a lot to be desired, including willing participation and engagement. At Berning & Affiliates we encourage that all staff see it as their individual and collective responsibility to help a meeting be productive and achieve its objectives. Try this approach: print at the top of the agenda “It is your responsibility to help us achieve our agenda objectives and to share your insight and suggestions.”
In examining an exceptional practice recently I discovered the roots of its success. The Doctor CEO was known to be totally committed to the education and development of each staff person. This devotion to staff and their participation at an optimal level went far beyond a yearly performance review. It was described as year long ongoing conversation that centered on advancing the capability of each staff person. Perhaps you can imagine how the staff as a whole and each individual responded. If not, I can tell you they were thoroughly invested in the practice and wanted that Doctor CEO and the practice to gain from all they had learned and gave an equal measure of commitment back.
One of the worst leader profiles we see is the Doctor CEO that does not think! Too often Doctor CEOs in the midst of the day-in and day-out practice demands deals only with that days’ demands. Can’t really blame them except when it goes on for months, even years. There are such significant penalties for leading in a reactive way! Here are some I have seen: being reactive means no continuity for staff to understand what is done or why, reactive means no plan for execution by the team and being reactive causes a buildup of messy loose ends causing the leader to run faster and grapple with ever more items. In short, this management style can put the doctor underwater in a big way! We strongly encourage that doctors lift their sights at this time of year and participate in planning the objectives of the practice into the next 2-3 years. It can be a great relief for everyone involved to stop being reactive and move to planned action. When you are ready to state with clarity your practice vision and move to implementation consider our Doctor CEO Practice Planning Day.
Significant attention is being given to two areas by large employers, predictable retention and pay. Screening for a fit between the work and the applicant using talent-management software rose to a reported $3.8 billion in 2011. Very large companies are fueling the growth with carefully developed software. The software is aimed at reducing the gut feel of whether an applicant will be a fit or not by providing an assessment that wipes out the hunches so often used in routine hiring situations. At some point, given the apparent success of the development to date it is likely to be adapted to small and medium size employers. Dentists and dental specialists as CEOs for their practice should be alert to the development in this area since it could be a major aspect of future practice management. For additional information see Meet The New Boss: Big Data WSJ 9/20/12 http://online.wsj.com/article/SB10000872396390443890304578006252019616768.html.