The Dr. Dick Barnes Structure

Feb 24, 2018 No Comments by

3 Steps That Move You Forward.
If you are not moving forward, you are moving backward. This saying is applicable to many things in life—especially dental practices. It means that there’s no such thing as simply maintaining the status quo. If you aren’t actively moving forward, then by definition you are going backward, because everything around you constantly moves ahead.

If you aren’t actively moving forward, then by definition you are going backward, because everything around you constantly moves ahead.


Think about it: the price of doing business goes up each year. If you aren’t taking steps to increase your business, then you will slowly fall behind—day by day, month by month, and year by year. However, decline is not inevitable. By taking action and moving forward, you can reverse the momentum and achieve new heights.

Dr. Dick Barnes became my friend and mentor many years ago. From Dr. Barnes I learned a three-point structure that I taught to dental practices for many years as a Practice Development Trainer for the Total Team Training seminars with Arrowhead Dental Laboratory and the Dr. Dick Barnes Group(DDBG).

Before I retired in 2016, the structure that I taught helped dental practices for years—and it still works in 2018. How do I know? Because I have friends from dental offices who continue to implement this proven structure. Occasionally, they check in with me and their numbers amaze me! I am pleased that so many dental practices that I worked with are still going strong. I was asked to write this article to share with you the proven structure that has helped these dentists surge ahead.

Dentistry Today
Since 1984, when I started working in a dental office in Fort Smith, Arkansas, general dentistry has come a long way. And today, as Peggy Nelson writes in her article, “Beyond Drill-and-Fill,” the dental market is more competitive than ever. General dentists can no longer afford to offer just fillings, extractions, crowns, bridges, partial dentures, and dentures.

For years I listened to the concerns of dental practices and offered solutions to them. It is one thing to identify problems, but it is quite another thing to find solutions to them. The DDBG seminars offer solutions to a variety of common concerns from dental practices.

Common Concerns
The top concerns I encountered were the following:
• an unproductive schedule that did not meet practice goals
• a high accounts receivable
• a lack of new patients
• high overhead
• patients cancelling at the last minute and/or breaking appointments
• an unproductive hygiene department
• an insurance-driven practice
• poor case acceptance
• a lack of patient retention
• a lack of camaraderie among team members
• stagnation

How did dental practices turn things around? First and foremost, the dentists who really wanted help were teachable. They were open to learning new things and implementing a proven three-point structure. The dentists who succeeded learned that being busy did not necessarily mean they had a profitable business. Instead, they learned how to schedule patients in a way that made sense and increased profitability.

The dentists who succeeded received advanced clinical training and learned how to expand their practices to include advanced dentistry—full arch and full mouth restorations, dental implants, TMD treatments, sleep medicine, and practice development training.

The dentists who succeeded learned that being busy did not necessarily mean they had a profitable business.


The dental practices that still thrive today have team members who focus on helping patients get what’s important for them—good function and less pain. Along with that, they deliver beautiful smiles that give their patients more confidence and better self-esteem—all of which benefits the patients.

Whether it’s turning a practice around, or stopping the slide backward, change takes work and commitment. As the dentists I consulted with began to expand service provisions for their patients, the dental teams were also challenged with learning new processes and structure. Again, who succeeded? The ones who said “Why not?” instead of “Yeah, but . . . .” Team members, too, became very teachable.

Phases of Change
Ultimately, both dentists and dental team members must embrace change in order to be successful. Albert Einstein said, “The significant problems we face today cannot be solved at the same level of thinking we were at when we created them.”

To enact change in any group, there are four phases to the process. They are as follows:
1. The Excitement Phase. This is when an office has hope that the new ideas and processes are going to work. When dental teams hear about the Dr. Dick Barnes structure, they get excited. Why? Because the structure offers real solutions to their concerns.

2. The Hard Work Phase (this is when the average person quits). Implementing change is difficult. Things are challenging because with the new skills, team members have to think before they speak or act. During this phase, the team is in the process of adopting change, but change hasn’t become part of the everyday routine yet.

Success breeds confidence. You can believe in something all day long, but until you do it and achieve it, you will never truly have confidence in it.


3. The Beginning-of-Success Phase. Dr. Barnes always used to ask dentists and team members the following question: “Which comes first—confidence or success?” Usually, team members are quick to say, “Oh, it’s confidence!” But actually, it’s not—success comes first. Success breeds confidence. You can believe in something all day long, but until you do it and achieve it, you will never truly have confidence in it.

4. The Internalization Phase. During this phase, the process of change becomes internalized—a part of the routine. Team members can do things the new way without having to think twice about things. And once change becomes internalized, teams never do things the old way again.

The DDBG offers tangible solutions to common concerns, and the highlight is the three-point structure. The Total Team Training course starts with tips on getting patients in the door, because many dental practices need to perfect those skills. The class can help dental practices get patients into the practice. Sometimes it just involves reassuring a new patient on the phone by saying, “You have called the right office. We can help.”

I. The New Patient Exam
Once patients are at the practice, the first part of the structure can be implemented—the new patient exam. Dental practices can’t skip this part; it’s the very first thing that dental teams should do when a new patient comes in the door.

A new patient experience includes meeting and greeting new patients, gathering new patient information (through the new patient interview), and communicating that information to the clinical team before handing off the patient for the exam.

The new patient experience is all about building good relationships. The importance of good relationships cannot be overstated. In the 1982 book In Search of Excellence: Lessons from America’s Best-Run Companies, Tom H. Peters and Robert H. Waterman wrote, “When one talks about customer service, nothing is more important than the word relationship. The relationship is everything.”

Dr. Barnes has always said, “Patients will do business with people they like and trust.” Building relationships of trust is critical, and it all starts with the new patient experience.
The new patient interview is for all new patients. It’s for anyone who has never been a patient in the office, including emergency patients, shopper caller patients, and new prophy caller patients. Conduct a brief interview that covers some of the patient’s health issues and concerns. This really is a way to introduce the new patient to the practice and vice versa.

The new patient interview is a way of gathering information from the patient, but it also sets the practice apart as a unique and caring place. It’s a time of co-discovery with the patient about what treatments are important to them and why.

The new patient interview also gives team members an opportunity to deliver key messages about the practice (for more information on the messages, see my article “Create an Uncommon Practice: Five Messages for New Patients,” in the November 2015 issue of Aesthetic Dentistry). The result is dental team accountability. Once teams deliver those messages to a patient, it’s time for accountability from dental team members.

For example, one of the suggested messages to deliver is a financial one. If I asked a patient if he or she was concerned about the finances required to return their teeth to excellent health, and the patient said “yes,” then I would respond, “Well, you will be glad you’re here, because you will always know about everything in advance—before we do any treatments. In this office, there are no surprises.”

After delivering that message, the dental team is accountable to follow through with that promise, remembering that their integrity is at stake.

More than anything, the new patient interview offers dental teams a chance to make a good first impression to their patients. Successful dental practices learn how to listen to their patients and co-discover what the patient’s values are regarding treatment.
Dental teams should become expert listeners, both with active listening skills and with reflective listening skills. Then they can learn to do a new patient interview in a reasonable timeframe—no more than ten minutes.

II. The Diagnosis/Financial Arrangement Appointment
The second part of the structure is the diagnosis/financial arrangement appointment. Successful teams learn how to present treatment and then help patients find the money to pay for it.

Successful teams learn how to present treatment and then help patients find the money to pay for it.


Instead of focusing completely on the tangibles such as crowns, veneers, implants, fillings, etc., co-discover what is important to a patient from the very beginning. After the discovery process, case acceptance will grow. The focus changes and the dental procedures become a means to an end, rather than the end in and of itself.

It starts with dentists realizing that they are changing their patients’ lives for the better through the world of dentistry. The crowns, veneers, and implants that they place help patients by eliminating their pain and discomfort, providing them with better function, and giving them smiles they can be proud of—ultimately leading to greater confidence and improved self-esteem.

It’s up to the dentist and the dental team members to co-discover with the patient whatever their reason is for moving forward with dental treatment.


Patients must be given a reason to invest money, and the reasons will vary for each individual. However, a patient never walks in the door and says something like, “I’d like to get four crowns and an implant today!” A patient walks in the door and says, “I’d like to be able to eat corn on the cob again,” or “I’d like to have beautiful teeth for my wedding photos.”

How do we know when the patient values the recommended treatment? Here’s a formula that I used: Value = Benefits – cost. Dental teams learn what patients value after they find out how the patient will benefit. Once team members co-discover what their patients want, they can help them find the money to pay for it. It’s up to the dentist and the dental team members to co-discover with the patient whatever their reason is for moving forward with dental treatment.

As you proceed with this part of the structure, remember that dentists and team members can never want the treatment more than the patient wants it. It’s not enough to tell patients, “The doctor thinks it’s urgent for you to get this treatment.” You must clearly explain the benefits for patients in a way that resonates with their values.

Remember that dentists and team members can never want the treatment more than the patient wants it.


Once team members make that joint discovery with the patient, the financial coordinator will stop taking money and start receiving money. He or she will become the patient’s ally, and not the bad guy.

III. Scheduling Treatment
The third part of the structure is about scheduling treatment in a productive manner. To begin, set production goals every day. Next, have resources available to fill the schedule.

Where do those resources come from? They come directly from the diagnosis/financial arrangement appointment. Once you’ve found those resources, you will have what it takes to fill the schedule.

A good appointment scheduler should be in control of his or her schedule, and will never ask a patient, “When would you like to come in?” Instead, the question will be replaced with, “The doctor has these times available for these procedures.”

When it comes to a hygiene schedule, schedulers can ask if morning or afternoon appointments work better, but they should never ask such questions when arranging a doctor’s schedule.

A good appointment engineer learns what are confining procedures for the doctor, and what are nonconfining procedures for the doctor. Now, I know many dentists think they have a special suit under their shirts with a big “S” on it (which, of course, stands for Superman), but teams have to be realistic enough to admit that even the best dentist can’t be in two places at one time—much less three.

Taking Action
When the three-point structure is implemented in the proper order, offices see results. I was always delighted when dental team members would call me to report their successes after a training. However, sometimes offices that really wanted the structure to work for them did not see the results they had hoped for right away. When that happened, I would reach out to the team members and review how they were implementing the structure.

After reviewing their actions, I could help them identify what part of the structure was left out or implemented incorrectly. For example, I worked with a practice that had a chronic cancellation problem. They reported to me that the structure wasn’t helping their cancellation problem. Just that morning, they told me, a patient for a large case failed to show up on the day of his appointment.

When I heard this, I responded, “Tell me about the patient who was supposed to be here at 9 a.m.” The team member said, “He was supposed to bring the money with him today.” I realized that the team member hadn’t helped the patient find a way to pay and/or fit it into his budget.

Once team members make that joint discovery with the patient, the financial coordinator will stop taking money and start receiving money. He or she will become the patient’s ally, and not the bad guy.


If you help patients find a way to fit the treatment into their budget, and co-discover the value of treatment with them, no matter what unexpected events happen, patients will still show up for their treatments.

It’s important to implement the structure in the proper order, as each step builds upon the success of the previous one. As a result of completing the structure in the proper order, patients will be asking, “How soon can I come in?” That phrase is music to the ears of any appointment engineer.

It has been my joy to reflect on all of the dental offices that I have had the privilege to train throughout the years. If you’ll make the decision today to move forward, you won’t ever go back. Every day should be better than the day before. And always believe that “the best is yet to come.”

Best Practices, Winter 2018

About the author

Tawana Coleman was a practice development trainer with the Dr. Dick Barnes Group for more than 20 years. She worked with thousands of dental practices across the United States and Europe. The structure that she taught empowered dental practices to dramatically increase production. For any questions, email Tawana at rtcoleman@cox.net.
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