In July 2004, I left the United States Air Force and opened my first private dental practice with a partner in Farmington, New Mexico. The practice was an immediate success and within twelve months we added more dentists, equipment, and team members to keep up with patient demand. At the three-year mark, it was evident that we were going to exhaust the capacity of our ten operatories and four dentists. In October 2008, we opened a second dental practice in Kirtland, New Mexico, located approximately 15 miles west of the flagship practice in Farmington and changed our name to Sundance Dental Care. The growth didn’t stop. In 2009, we added a third practice in Bloomfield, New Mexico and we have added another practice every year since. We are on target to open a seventh dental practice in the fall of 2013.
The last nine years have been a whirlwind and there are lots of lessons that I’ve learned about growing effectively beyond a single office. The two most important things I’ve learned are: the need to create a shared vision and the value of building the right team. These two factors are foundational to any practice and they are factors that will determine the level of success.
The Shared Vision
It is difficult to run a single dental practice well, let alone multiple offices. With a second office the challenges don’t just double, they seem to grow exponentially. A dentist can’t be in two places at once, so there must be something to bring order to the chaos. That something is a shared vision of what the practice is about, what it will focus on and how it will engage its patients. All dentists and team members must be “on the same page” and share the same vision and goals for the dental practice. Early in our expansion, we set a goal to be, “The Leaders in Full Service, High-Tech Dentistry.” Through this short statement, we distilled our philosophy of dentistry to words that we all believed.
We refer very few procedures out because part of this shared vision includes providing full service dentistry in a high-tech, gentle and compassionate manner within the confines of our practice. We were the first in our area to adopt many of the new technologies designed to enhance the patient’s outcome. I was the first general practitioner in Farmington to offer I.V. sedation, and we were early adopters of digital radiographs and electric hand pieces.
Remaining on the cutting edge has been an important aspect of our shared vision. This does not mean that we adopt every new gadget or technology that comes along. Rather, we look at new innovations in terms of their potential to bring enhanced outcomes and experiences to our patients. If a new technology fails to meet the dictates of our vision then we don’t use it. (Incidentally, we were some of the first dentists to adopt and shortly thereafter drop in-office crown milling for many of the reasons that Dr. Jim Downs articulated in his Fall 2011 Aesthetic Dentistry article.). As a result, our patients know that they are always getting state-of-the-art treatments that are focused on their well being. Patients’ perception is everything. They need to know that we are constantly looking to provide treatments that will change their lives for the better. Currently, we are educating ourselves and becoming involved in sleep apnea identification and treatment, and working with Arrowhead Dental Lab and their continuing education courses.
It doesn’t matter how nice your office is, where it’s located, or the technological wonders you can offer if you don’t have the right staff. Building the right team, one that shares the vision when you are not physically in the office is the most critical aspect of a multi-location practice. In the book, Good to Great, author Jim Collins writes about highly successful companies and the need to have “the right people on the bus.” To do this requires the use of organizational management with a focus on empowering the members of that organization.
As dentists, we all know how important it is for a successful practice to have “systems” in place. As my practice began expanding, the need for “systems” became even more important as we moved forward. We needed operational protocols for the front office, the back office, billing, bookkeeping and accounting. Systems, though, are only as good as the people who are implementing them. This has always been an important aspect of Sundance Dental Care. We pride ourselves on identifying, hiring, and maintaining the best team available, which can be difficult in rural or semi-rural communities. We subscribe to the philosophy of “hiring for attitude and then training for skill.”
Building a top-notch organization requires more than platitudes and clichés. It requires competitive pay and good benefits, not minimum wages and cheap fringe benefits. You will attract the right people when you create an environment were they can be a coparticipant in life-changing dentistry. They must have a sense of ownership and a “voice” in making decisions, which requires that they receive the direction and training necessary. To that end, our team members accompany doctors to continuing education courses. Providing world-class training to all our staff allows them to become world-class team members. It’s very rare that you’ll see a Sundance Dental Care doctor alone at a training.
A multi-location practice is not just another dental practice. As you expand, you will have to consider more than just the typical staff member positions. There are obvious positions such as hygienists, dental assistants, front desk personnel, etc. However, have you considered the need for a dedicated billing and accounts receivable manager, accountant, H.R director, marketing professional or even a general contractor?
At Sundance Dental, we employ a graphic designer, print ad photographer and videographer, a commercial contractor, and a communications director either on staff or on a monthly retainer. I could not have imagined that the staff of a dental practice would ever include these positions. However, the financial and logistical requirements of a growing multi-location practice dictate the necessity for these roles. They are valuable team members and they offer specific skill sets that I, as a general dentist, quite simply do not have.
Organizational management isn’t something you just have or put into place—it must be something that you continually evaluate and improve as you move from one to multiple locations. A guideline to keep the level of service in line with our shared vision is to add a team member when someone is functioning at 80 percent of his or her capacity. Anything over 80 percent and you run the risk of employee burnout and a resulting decrease in the level of service for the patient. The “take away” is that an organization must be managed, particularly when moving beyond a single location and management must fill several roles with individuals who possess the right expertise and have a balanced workload.
Empowering the Team
All great teams are empowered. No dentist can be at the front desk answering telephones, in the consultation room discussing treatment plans and financials, working in the operatories cleaning teeth, performing dental procedures and everything else with each and every patient.
The true power of a team can only be experienced when each member is empowered to bring the full scope of their talents and abilities to their job. In the past century, dental practices evolved from the solo practitioner with one or two “jacks of all trade” assistants to highly skilled team members with highly specialized duties and scopes of responsibility. At Sundance Dental Care, we average six to eight team members per doctor in the practice.
Early on, I recognized that being involved in every decision and every patient interaction was not only impossible but also exhausting. Each member of our team is now trained and empowered to handle the patient interactions that fall within their respective realms of responsibility. Employees are guided by the shared vision that puts the patient as a central focus of our practice. This interaction with patients is always being refined and improved upon by our team members because they feel empowered to suggest and implement iterative improvements in all aspects of the practice.
One of the keys to our success is that every morning we have a team “huddle” twenty minutes before we start seeing patients. We discuss our challenges and our achievements and highlight individual patient interactions and team member performance. We also take the opportunity to share key metrics with the staff in these huddles. I believe firmly that the only way for the team to know how they are doing is to “know the score.” We share with our team members our collections, production, and the number of current and new patients. Some doctors get nervous to share metrics with their staff. I feel it is imperative. Why keep them guessing? We use these numbers to set goals and reward the team for achieving goals each month with profit sharing. If you are concerned with sharing these numbers, then also share with them the overhead numbers and how profits and losses are determined. Rarely, if ever, do I have team members who are critical of the practices’ success and feel that they are not compensated fairly.
A couple of months ago, I started focusing on the patient trackers that are part of the Total Team Training program with Tawana Coleman and the Dr. Dick Barnes Group. I not only do this, but I also track each new patient and existing hygiene patients and share the information with my dental assistants, Jason and Jenner. We know what treatment has been proposed, the quoted fee, and if it has been accepted. If a patient has not accepted treatment, Jason and Jenner call them personally during “down time” or during the times I am booked for longer, solo procedures. This results in greater monthly production and collection numbers. The number of “no shows” and holes in my schedule has decreased exponentially as a result of empowering Jason and Jenner with patient trackers.
Another aspect of practice expansion that is helpful for my team is the opportunity to progress within the organization and gain internal promotions. In most stable, mature dental practices, a glass ceiling can exist. Promotions stop because the position of advancement may not be available unless someone quits or dies. This can result in frustration and can be the reason that many great team members leave unexpectedly and join a competing dental practice. With constant growth and expansion, there are always new opportunities for advancement and this creates excitement within the team.
Practice growth and expansion is exciting and important. A practice that does not grow may wither away and die. We can no longer take for granted the success of our dental practices. The landscape is becoming more and more competitive and mega-corporations are becoming more and more active in locations throughout the United States. If you are entrepreneurial and feel that more locations may be on your horizon, empower your team and share the vision!