What can you tell us about your background?I grew up in southern Orange County and earned a bachelor’s degree in biology at San Diego State University in 1983. There I met my future wife, Kim, at the...
Focus on family, patients, friends, growth, and community
What can you tell us about your background?
For as long as I can remember, I wanted to make people smile. I always loved getting the class laughing in grade school. Looking back, I am sure...
Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice
What can you tell us about your background?
I was born and raised in Seattle, Washington, and lived there until I was 13 years old. My family relocated...
Dr. Robert Slosberg facilitates accurate mapping and obturation of the resportive defect with CBCT imaging
AbstractA patient presented with advanced internal root resorption of tooth No. 9. The prominent location of this tooth...
Drs. Brian Shaughnessy, Margaret Jones, Ricardo Caicedo, Joseph Morelli, Stephen Clark, and Ms. Jennifer Osborne review the occurrence of teeth presenting with condensing osteitis and their associated pulpal diagnosis over a 2-year period.
Dr. Andrei Zoryan dispels some of the common myths surrounding carrier-based obturation
Carrier-based gutta percha
Carrier-based obturation (such as Thermafil®, GT® obturator, ProTaper® obturator [Dentsply Tulsa Dental Specialties]) is one...
Dr. Robert Fleisher ruminates on how to prepare for retirement
There are so many articles about everything that you become pretty much overwhelmed and can never expect to read them all. So you pick and choose. You like to learn about the latest and...
Dr. Roger Levin presents the 10 top ways to help create a perfect dental team
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John Bednar helps avert problems coming down the pipe
If your office currently has a hard-piped filtered water system, now is a good time to consider if and when you should change to a self-contained bottled water system. A hard-piped filtered water...
Dr. Rick Steedle offers advice on selecting the right path to a more successful and less stressful practice
This is the first in a series of articles on “Becoming the successful, not stressful practice.” This series explores why some thriving practices can become highly demanding. It will show how to focus your efforts on what’s truly important, making your practice more successful and less stressful in the process.Making the three key decisionsAlthough practices come in many styles, all the exceptional ones become and remain successful by making three key decisions. They all:1. Choose the right directionExceptional practices have a clear idea of where they want to be in 1, 3, and 5 years, while striving to do four fundamental things exceptionally well.2. Focus on the right prioritiesExceptional practices commit to continuous and never-ending improvement, focusing all their efforts on what is most important. This will be discussed in Part 2.3. Use the right strategy and take the right actionsExceptional practices use a five-step process for making significant changes and implementing them. This process will be explained in Part 3.Choosing the right directionFortunately, to choose the right direction, we simply need to concentrate on doing four things exceptionally well. We must commit to:1. Excellence in clinical care2. Outstanding customer service3. Great interpersonal relationships4. Sound financial management.What we want for our practice—more patients, better collections, and a less stressful, more competitive practice—is usually the by-product of doing well in these four categories. 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.So how can we achieve a more successful and less stressful practice by pursuing the four cornerstones of an exceptional practice?1. Excellence in clinical careOur clinical skill and judgment is clearly 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 staffb. A well-designed patient delivery systemc. 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, we discovered that 15% of our patients were taking more than 2 years to finish due to cooperation issues—not keeping and scheduling appointments, not wearing their elastics, not paying their accounts, etc. The solution 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, and the dentist agreed with the decision. We called it the “Happy Deband” protocol. 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 serviceGiving 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.Although hundreds of books describe how to give outstanding customer service, customer experience management all comes down to four basic principles1:a. Managing the “moments of truth”—and exceeding their expectations in that momentb. Systematizing service—so that we can deliver a high level of service every single timec. Having great recovery plans—to make it right when occasionally we don’t measure upd. 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, we have a “moment of truth” – an opportunity to form or change their opinion about our practice.2 They come away from that experience either feeling better, feeling worse, or feeling about the same. 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 in banks shows that there are three key ways that customers measure whether the bank teller was friendly, personable, and treated them like a person rather than a transaction. They reported positive experience when the teller would:• Smile• Use the customer’s name• 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.Reputation ratio (4-0-11)These “moments of truth” are so important because when a customer receives good service that exceeds his/her expectations, 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 usually tell no one.But, if a customer receives poor service 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.3That means that every time our practice doesn’t deliver the kind of service our parents and patients expect, they will tell approximately 11 people about it. Therefore, now 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 “Titanic” percentage (96%)Other research3 shows that only 4% of customers who re-ceive 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.Systematizing serviceBecause no patient dissatisfaction is minor, it’s essential that we “systematize service,” never leaving 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 with their new policy.For example, because 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 and increase case acceptance.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 plansEven 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 misscheduled 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:• Responding promptly• Apologizing sincerely• Going the extra mile to make it right.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 improvementFinally, 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 always improving their service systems: answering the phone, getting patients in and out on time, scheduling their patients to have a stress-free day. 3. Great interpersonal relationshipsExceptional 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 in this area 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.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.44. Sound financial managementAnd finally, exceptional practices are well-run businesses. They meticulously manage their finances by concentrating on:• Monitoring the key practice indicators• Making great strategic decisions• Spending their money wisely• 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, 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 future, spending money strategically to increase productivity, satisfaction and revenue.Finally, great practices look first to improving staff productivity before they consider additional hiring. If they feel a need for more staff, they first ask, “Is this a problem 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 there is a need for better work organization, more effective systems, or additional training.ConclusionsPractices 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. 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.5Rather 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 decide to address 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. The Disney Institute & Eisner MD (2001) Be Our Guest Perfecting the Art of Customer Service. Disney Editions, New York.2. Carlzon J (1987) Moments of Truth. Ballinger Publishing Company, New York.3. From The White House Office of Consumer Affairs, Washington, D.C.4. Steedle JR (2010) Leading an all-star staff. J Clin Orthod 44(8):487-494.5. Senge PM (2006) Fifth Discipline: The Art and Practice of the Learning Organization. Doubleday, New York.
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