Becoming the Successful, not Stressful Practice: Part 2 - Focusing on the “Right Priorities”

Dr. Rick Steedle explains how to focus your efforts on what’s most important in order to have a more successful and less stressful practice

In Part 1 of this series,1 we learned that exceptional practices do four things exceptionally well. They choose the “Right Direction” by committing themselves to the Four Cornerstones of an Exceptional Practice—excellent clinical care, outstanding customer service, great interpersonal relationships, and sound financial management. In this article, we’ll discover what can limit your practice and by focusing on the “Right Priorities,” how to overcome those limitations to become a more successful and less stressful practice.

What limits your practice and causes stress?
Our practice will thrive and become more competitive when we choose the Right Direction. In choosing the Right Direction, we’ve seen what makes a practice grow and become more competitive. To focus on the Right Priorities, we must now ask the opposite question: What holds us back? What limits our practice? Why do most practices grow to a certain size and level off? Why do some practices even experience a decline? We can speculate that it’s the economy or competition, but that’s only a partial answer. We need a deeper understanding if we are to explain how some practices can continue to thrive and grow even in a recession or a highly competitive environment.

When your practice is doing well in the areas of patient care, customer service, interpersonal relationships, and financial management, it will grow. Happy patients and satisfied dentists will continue to enthusiastically refer patients to a well-run practice. Up to a point, you and your staff will be able to keep up with the demand and keep and maintain the quality in all four areas at a high level.

As the practice grows, however, there is a limit to the number of patients you can treat without adversely affecting the quality of clinical care and customer service. Furthermore, as we acquire more and more patients, we may also stress our staff with the workload, resulting in unhappy staff and possibly dissatisfied patients and parents. Gradually, overhead and costs may also get out of control. When this happens, we can sense it. We feel rushed at the chair, we have less time to get to know the patients well, we’re constantly pushing to stay on schedule. Parents and patients may be complaining, the staff is bickering; in short, things are not going as well. At this point, the practice is now operating beyond the limit of its capabilities, its “Total Organizational Potential” (TOP), and everyone feels the stress (Figure 1).

Total Organizational Potential (TOP)
Your practice’s TOP is a measure of its ability to maintain high levels of productivity with ease. It’s the inherent capacity of your systems and people to sustain exceptional performance in all areas. Once you have exceeded that limit, you stress your systems, overwhelming the capabilities of your people, and the quality of your care, service, relationships, and financial management begins to decline. At this crucial juncture, your ability to remain an exceptional practice depends on improving the way you operate.

Let’s take the example of patient wait times. Let’s say that your practice is growing, and recently, you’ve made no significant changes to the way you and your staff manage patient flow. Your capacity for serving your patients then is fixed. At some point, you exceed your capacity to get the patients in and out of their appointments on time. A “gap” then develops between your desired level of service and the actual level of service. Patient demand has now exceeded capacity, and waiting times start to rise.

Sooner or later, patient satisfaction declines. Then practice reputation suffers. In time, the willingness of patients and dentists to refer additional patients drops. Eventually, demand goes down until a gap no longer exists, as the patient’s desired level of service comes into equilibrium with the actual level of service.

What we must understand is that the growth of our practice is a self-regulating system based on the reputation generated by patient’s satisfaction. It’s the quality of those “moments of truth” (discussed in Part 1) that makes the difference. This helps to explain why most practices grow to a certain size and then tend to stagnate, unless they significantly improve the way they operate.

Using the orthodontic specialty as an example, according to the JCO Orthodontic Practice Study,2 the size of an orthodontic practice in the United States can vary by as much as 500%. Contrary to conventional wisdom, however, the growth and size of a practice may have more to do with its ability to constantly reinvent itself in order to maintain high levels of excellence, than it has to do with competition and location. By making constant and never-ending improvements, it is not unusual for a new small practice to eventually become the premier practice in an area.

In summary, our practice is ultimately limited by the way we operate, the capabilities of our systems and people—our TOP. If we fail to implement significant improvements in our operations, we will eventually limit our success and go into stress. However, if we’re willing to devote the time and effort into meaningful change, we can become even more productive in a low stress environment (Figure 2).

So how do we increase our capacity to become a more successful and less stressful practice? We do it by focusing on the Right Priorities.

Focusing on the “Right Priorities”
As the leader of our practice, we must devote time to thinking strategically about our practice, spending time away from the day-to-day operations to systematically plan for its future and to focus our attention on the most important ways to improve. Selecting the Right Priorities is a three-step process:

• Identifying the key frustrations
• Engaging in system thinking, not problem solving
• Prioritizing the key improvements using the Four Cornerstones of an Exceptional Practice.

Identifying the key frustrations
Our opportunity lies in identifying and resolving the key frustrations that parents and patients feel when dealing with medical and dental practices. By exceeding their expectations during each “moment of truth” and constantly delighting them with an exceptional experience in our office, we create “raving fans” for our practice.

So what are some of those key frustrations for parents? An excessive appointment wait time has to be at the top of their list. Everyone is so busy these days. You’ll win major points with parents if you can get them or their child in and out of the office on time. So for our practice, developing a schedule that was smooth, stress-free, and on time became a top “outstanding service” priority. This effort resulted in seeing 93% of our patients consistently within 10 minutes of their appointment times.

What are the key frustrations for your patients? The chief complaint has to be not getting their braces off when expected. So for our practice, completing 95% of our full treatment patients in less than 2 years became a top priority. Setting the goal to have highly trained assistants, efficient treatment protocols, and a disciplined monitoring system to track active patients enabled us to deliver “excellent patient care” and improve “interpersonal relationships.”

What are some key frustrations of the referring dentists? Their list would include patients not returning for periodic dental exam visits, poor communications about developing problems, excessive treatment times, and mediocre clinical results. Developing an excellent communications system, efficient clinical treatment protocols, and consistent tracking to encourage follow up appointments with the general dentist can only contribute to your reputation as a place for “excellent patient care.”

We have internal “customers” too—our staff. For example, we can address the key frustrations of our financial staff by developing a collections system that greatly reduces the distasteful job of calling and managing delinquent accounts. In our practice, it was possible to transform an old collection system that achieved 97%-98% collections with great effort to a new system that collected 99.5% with significantly less effort. This seemingly small percentage change actually resulted in a 90% reduction in delinquent accounts. Putting that system in place in our practice significantly reduced our frustrations in the area of “sound financial management.”

Engaging in “system thinking”
Problems rarely occur in isolation. Whether we have scheduling conflicts, delinquent accounts, or other troublesome issues in the practice, problems are usually the by-product of our practice systems and the habitual way our staff performs. Attempting to solve complex problems without considering the interconnected network of related issues is doomed to failure.³

Therefore, once we have identified the key frustrations, we must see each problem as a symptom of a greater issue. We must shift our thinking from “problem-solving” to “system thinking,” from “crisis management” to “management by design.” We must meet with key staff, exploring any problem thoroughly to recognize the full scope of the issue and coming to a shared understanding of why the problem exists. Then we can decide on a course of action that doesn’t simply solve the identified problems, but transforms our systems so that similar issues do not arise in the future.

The quickest and most effective way to replace an inadequate system is to use the CASE principle—Copy And Steal Excellence. Find a practice performing well in the area you wish to improve and learn their system. Then modify and adapt it to your specific situation. Many other exceptional practices have already successfully resolved the issue; there is no reason to “reinvent the wheel.” Instead, spend your precious time on training your people to execute the new solution in your office.

Prioritizing the key improvements
Once we have identified the key systems that need improvement, how do we keep from overwhelming everyone in our practice with all that needs to be done? The best way is to use the Four Cornerstones of an Exceptional Practice to focus our efforts on two to three key projects, making those changes our top priorities. To narrow our focus, we ask: What one system change will have the greatest impact right now in each of the areas of clinical excellence, customer service, interpersonal relationships, and financial management? The answer in each category will yield our top four priorities. For example, a practice might conclude that the top priorities are: (1) implementing a new clinical procedure; (2) creating a grid schedule that can help achieve on-time appointments; (3) developing a yearly marketing calendar for all the key referral sources; and (4) implementing a better collection system.

Once we’ve selected the projects that will have the greatest positive impact, the next key question to ask is: Do we require a new system or do we simply need to remove the bottlenecks in our present system by devoting more resources, providing more training, or changing one part of the process to get a better result. We must allocate time to meet for strategic planning with our staff during this entire process. Often, we’ll discover that the practice’s key issues are usually the key frustrations of our staff as well. This is fortunate because we can’t expect to make significant progress without their commitment to the change. For each project, those who will implement the new procedure or are affected by the new system are included in all of the meetings. With a voice in the decision-making, commitment will be higher and the chance of success, greater.

Conclusion
Exceptional practices focus on the right priorities by committing to continuous and never-ending improvement in the things that will have the greatest impact in each of the four key areas. They constantly break through their limitations by addressing the key frustrations of their patients, parents, staff, and referrals, creating systems that work consistently and exceptionally well. In doing so, they take their practices to even higher levels of clinical care and customer service, while improving interpersonal relationships and establishing sound financial management.

In part 3 of this series, we’ll explore how exceptional practices don’t leave excellence to chance in any area. They have an effective strategy to plan and execute these improvements. They follow a five-step process for significant and lasting change, not simply by solving problems, but by developing highly effective systems to consistently achieve outstanding results.

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 This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References
1. Steedle JR (2011) Becoming the successful, not stressful practice. Part 1 – choosing the right direction. Orthodontic Practice US 2(2):45-47.

2. Keim RG, Gottlieb EL, Nelson AH, et al (2009) 2009 JCO Orthodontic Practice Study. Part 3: Practice growth and staff data. J Clin Orthod 43(12):763-772.

3. Senge PM, Kleiner A, Roberts C, et al (1994) The Fifth Discipline Fieldbook – Strategies and Tools for Building a Learning Organization. Doubleday/Currency, New York.