Chris Barrow’s Blog

The Dental Business School has worked with approximately 400 dental practices in the last 8 years and we have trained, consulted and coached them in the implementation of 8 key strategies to produce “more profit in less time”.

Quantative results are an average 25% increase in bottom line profits in 20% less working hours for the whole team (whilst maintaining clinical and customer care standards). Qualitative results include happier principals, team members, patients, suppliers and maybe even bank managers!

Earlier this year I wrote an article on team-building in dental practice and shared with you 8 steps to create a “championship support team” – I now want to expand on this theme by looking at leadership as distinct from management – focused on the role of the principal but equally relevant to practice managers and for that matter, all team members.

Firstly, I would like to offer a distinction that has really hit home to me this year.

Managers manage systems – and good managers create, measure, maintain, adapt and improve on effective systems that allow a business to run smoothly and respond quickly to change.

Leaders lead people – and good leaders share their vision, listen to their teams, let go of control and lead by example.

After reading “The 8th habit” by Stephen Covey earlier this year, I realised that The Dental Business School is all about systems – and that I haven’t spent enough time with my clients on their understanding and implementation of leadership – in fact I haven’t exactly been a great leader myself.

2005 so far has been a voyage of discovery, reading further books on the subject, observing myself and my clients, discussing with people I regard as “good leaders” what makes them tick – and beginning to reach some conclusions.

What follows are my initial thoughts and the contributions of some of my clients in dentistry.

The Management/Leadership Matrix

As always, a matrix is a revealing way of measuring the effects that different combinations of performance (management) and behaviour (leadership) have on the principal and their teams:

You can obtain a copy of the PowerPoint slide if you email me at chris@thecoachinggym.com

1. Good manager, good leader = a team that feel inspired and fulfilled in their professional lives;
2. Good manager, poor leader = a team that feel dominated by an impersonal boss who wants the business to run like a machine but doesn’t care about the people;
3. Good leader, poor manager = a team that love the adrenalin rush in short doses but recognise that man cannot live by adrenalin alone – and eventually they tire and die;
4. Poor leader, poor manager = stressed out people looking for another job.

Do you recognise yourself in any of those quadrants? So what must be done?

1. Leadership by direction – in our dental workshops I often ask team members to share with me their knowledge of the principal’s 3-year vision, 12-month plan, 90-day goals and monthly tasks. You can imagine the blank faces I see and I have developed an interesting metaphor – as to whether the team can be likened to slaves on a Roman Galley (down in the dark – just keep rowing) or warriors on a Viking Long-boat (with equal status and a clear knowledge of their objectives). Leaders know where they are going and take the time to communicate that to their team, remind them on a regular basis, demonstrate “what’s in it for them” and inform them of the regular course corrections that have to take place in a small business.

2. Leadership by example – it’s no wonder that I have seen staff room doors in dental practices with the sign “backstage” on them. These enlightened leaders are sending a message to their teams that the opposite of “backstage” is “onstage” and that when we are “onstage” we have to suppress our personal feelings and deliver the show to the audience. The same responsibility applies to the leader of the business. If you are miserable, depressed, stressed, angry – any negative emotions – then do not wear them on your sleeve in front of the team – because your mood sets the tone for the whole practice and gives permission for others to copy. Yes – there is a time and a place for the authentic expression of feelings – but that is not “onstage” and during the performance – it’s in rehearsal. Let’s not forget the word “integrity” in this context – your team will be watching you all the time and if your actions are out of integrity at any time, they will lose faith in you.

3. Leadership by listening – your team members (all them) know more about your business than you do. Do you plan time to hear what they have to say? Especially in dentistry, you are locked in a surgery most of your professional life. Profit doesn’t pour out of a business, it often leaks through the cracks – cracks that you will never notice. When my business manager, Barbara Trotter, joined me in early 2004, she was able to identify a small change in our systems that generated an increase in profit that was higher than her annual salary – and yet the clients didn’t mind and I hadn’t noticed. Do you listen to what your team have to tell you about your systems – and listen to what they have to say about your behaviour?

4. Leadership by removing tolerations – the classic example is the affluent patient who is rude and disrespectful, not to you as owner of the business but to your team members. When you challenge that patient, they will either change their behaviour towards your team or they will leave the practice. Either way, you will be a hero. Conversely, if you support a rude patient and vote with them (and their cheque book) rather than with your team, you will undo all the training that has been bought in an instant. Have you removed tolerations around suppliers, patients, other team members and the physical facilities?

5. Leadership by genuine appreciation – I work for the money and the money is good – but at the end of a training day or the end of a busy week, one client who thanks me for “the difference you have made” is worth more than the money. People just love to genuinely appreciate. Do you spontaneously say “thank you” for a job well done and is there a standard of mutual courtesy in your business at all times?

6. Leadership by training, consulting and coaching – training is showing people how to do things, consultancy is showing them how to apply the training to their own circumstances, coaching combines a shoulder to cry on with accountability. Do you have robust training systems and protocols so that people can find out how to do their job properly? Do you have ongoing supervision so that they can get better – and do you create an environment in which they can regularly check on their own progress?

7. Leadership by extreme self-care – if you are exhausted and unwell then the whole team will suffer. If they see you burning out they will become demoralised and fearful for their own job security. If they see you falling behind on attitude, skill or knowledge then they will slow down and coast – why shouldn’t they if you don’t seem to care. An effective leader looks after herself physically, mentally and spiritually. Do you take enough time off? Do you enjoy a balance between your professional and personal life?

8. Leadership by inspiration – good leaders are those who inspire one to commit to something greater than one’s self. In doing so, leaders ask people to take advantage of their own skills and abilities, and to stretch and grow. Within my own client base I have witnessed examples of dentists creating environments where their people become very motivated and inspired to live life more fully. Leadership is about providing real hope for the future.

9. Leadership by innovation – dentistry is in a state of constant change both clinically and operationally, so the ability to research and respond to those changes will further inspire your team that they are working with a real pioneer in the profession. Conversely, an attachment to outdated methods and “machinery” in your practice demonstrates a lack of enthusiasm for the future.

I asked a number of my current and former clients to offer their own perspectives on leadership and on my “9 characteristics”. Firstly, we hear from Stephen Hudson, based in Chesterfield and author of a popular newsletter at www.gdpresources.com :

“Many people blame the NHS fee scale for creating a “Treadmill effect” in NHS practice, but this is not the case. The Treadmill is not a creation of the system, but a creation of how the dentist works in the system. The main problem here is that the classic treadmill dentist is not a leader; he is a manager doing a very poor job in all aspects of dentistry, especially the management. To be a leader you first have to look at yourself and say, “what about what I am doing is right, and what can I do better?” Many dentists don’t do this; they simply try and work harder, and only find themselves deeper in a hole of their own making, and cannot figure out how they got there. They fail to take a step back and go “Hold it, this isn’t working”. Leaders don’t manage. To be a leader, you actually have to lead, effectively and consistently, and forget about managing. You cannot do this if you are micromanaging every aspect of your practice, working six days a week, and killing yourself seeing 50 patient a day.

The leader builds systems that the managers then incorporate into the practice. Yes, you have to write the systems, but the implementation and running of said systems are best left to management, with the understanding that the mangers know what the leaders are trying to achieve. Your systems must be built with the cooperation of the staff, and should reflect the fact that situations change, usually daily. They should also reflect EVERY aspect of your business. This way you can turn a dental practice into a turnkey business that operates effectively even when you are not there. And every system should point to and reflect the vision that your leadership is trying to achieve. Without written systems for everyone to relate to, the staff has no solid foundation for what you are trying to achieve. “That’s rubbish, I want my patients to be dentally healthy, and I don’t need systems for that”. Really? Well tell me:

* What do you mean by dentally healthy? How do you monitor and record this?
* How does your staff know you have achieved this?
* What do your patients get out of this, and how do they know they are dentally healthy?
* What do the staff get out of it?
* How does someone come in and reproduce what you do? Your systems must be reproducible. You must be able to take them from practice A and put them in practice Z and have them still work.

It is the preparation, through your leadership, the training and the constant refinement of the systems that will make your practice profitable. And then you can sit in your surgery and do what you do best without being constantly interrupted. Ah bliss.”

Stephen Hudson BDS, MFGDP, DRDP

My second contributor (with the addition of views expressed by Robert Nixon) is Dr Stephanie Houseman DDS, a dentist based in St Louis, Missouri who sold her practice to become a personal coach to dentists in the United States from 2004.

“Often when we discuss things like leadership we talk about things like style and method, but if we can admire different leaders for different reasons or with different styles, there must be some common factors which are identifiable in all good leaders.

I think there are three characteristics that are always evident in good leaders or managers, which enable them to gain respect and the desire within others to follow them.

* Experience
* Consistency
* Clarity of Purpose

Good leaders or managers (because you cannot be a good manager if you are not a good leader) display these traits whichever style they use.

Experience

People will not follow someone who knows (or they suspect knows) less than them. This does not mean that leaders must be experts in every subject, but people instinctively know if someone is experienced enough in managing people to ask the right questions of the right people in the right way at the right time. (It is experience in leadership we are talking about, not crown and bridgework…. a concept that very few dentists seem to grasp)

Consistency

“Tracy, who the hell double booked me? I am sick of telling you, don’t double book patients! Oh by the way Jim from the golf club will be coming in sometime this afternoon, I said I would stick his crown back on for him”.

Clarity of Purpose

In every aspect of life people seek direction and guidance. This is why even in adulthood you still find people saying “I’ll ask my Dad” or “I wonder what my Dad thinks” Why? Because in that world of uncertainty which is childhood, the one constant was (if you were lucky enough) your father. Dad would tell you what to do with certainty.

Why do soldiers follow some officers into what, to any rational person, are situations of extreme danger. Because they have total confidence in the decision he has made.

Different leadership styles may be appropriate to different groups but without exception I think these characteristics are always there in good leaders. Pick any one you want (and some of them were utter despots) but as leaders they had the ability to mobilise whole nations or transform industries – through their experience, consistency of behaviour and unwavering clarity of purpose.

So many of us dentists are so analytical and caught up in the daily grind of doing our thing in people’s mouths that we forget about the people part, let alone being a leader. We just want to go to work, do our thing and be perfect and go home (and hope the day went smoothly).

I have observed and listened to many dentists and their teams over the years and I can usually pick out the ones who have it together. They know who they are and what they want, have communicated this with their team, and their team is on board. Their practice is a win-win for everyone and they are givers, not takers. There is mutual respect in the practice and they like one another.

Dr. Stephanie Houseman

www.7steps2abalancedlife.com

An update for 2006

In June 2006 we held our first ever “Leadership Intensive” inviting clients to invest 2 days in a Bristol hotel, discussing their challenges around leadership and suggesting solutions. A total of 19 guests attended, including principals, their spouses and some practice managers.

The track we were to run on was only vaguely defined before the event began as we were enrolling our guests as an R&D team on the subject of leadership. As things turned out, we followed the steps outlined here:

• The Discomfort Zone – why it is necessary to face uncomfortable truths about ourselves before we can learn

• The finish line – what has to be achieved for each guest by the end of the Intensive

• The 15-minute life story – personal introductions by the guests

• The Management/Leadership matrix – a description of the points made in this article (originally written a year earlier)

• Which quadrant are you in? – personal identification by each guest of which quadrant they occupied

• Leadership Evolution – the journey around the Matrix – following dental principals as they journey from one quadrant of the matrix to another

• Distinction between M & L – the distinctions between management and leadership

• Unique Ability – identifying each guest’s “great work”

• What’s in the way? – identifying what is “getting in the way”

• How to control your mood – controlling emotions

• How to delegate – effective delegation

On Day 2 we began to construct a list of the characteristics that would have to be displayed by a truly great leader – the PowerPoint slides are also available if you email me.

Acknowledgments

I have been helped in the preparation of this article by all of the dental practice owners and their team members who have attended our workshops over the years and shared their personal experiences and feelings. My clients in The Dental Business School are my R&D team and never fail to supply new material.

I especially want to thank the group of coaches and dentists who read a first draft of this article and added their thoughts and suggestions, some of which helped me create the “9 characteristics”, some of whom added a sentence of two and especially Dr’s Stephen Hudson and Stephanie Houseman, who made a major contribution from the “cliff face” of running their own practices.

My final thanks go to my good friend and fellow coach Dr Simon Hocken www.jumpcoaching.com whose encouragement and preparation were the cornerstone for the success of our Intensive. Simon truly “made it happen.”

Dr Chris J Williams fangpranger@eurobell.co.uk

Dianne E. Dawson, M.A. dianne@dawsonresources.com

Pat Byrne orthodonticce@btconnect.com

Zarine Jacob www.passionfruitcoaching.com

Michael Ames mike.ames@crimson.co.uk

Alan Stafford www.coachingfordentists.com

Brad Swift www.lifeonpurpose.com

Robert Nixon robertnixonwetheral@yahoo.co.uk

Roy Baylis roybaylis@winwin-solutions.co.uk

Geoff Hinsley Geoff@GeoffHinsley.com

Viv Whittle inspire@mentormedia.co.uk

Chris Hutchinson chris@trebuchetgroup.com

Charlie Lang progressu@netvigator.com

Stephen Hudson sad@decker.demon.co.uk

Dan Lee dan@dannylee.com

Lorrie Kazan lorrie@lorriekazan.com

David E C Huggins david@andros.org

Stephanie Houseman stephanie@7steps2abalancedlife.com