The Wednesday pulse: Busy is not a business model

There is a familiar noise coming from dental practices this week.

It is the sound of growth creaking.

New clinicians are arriving. Diaries are filling. Premises are being improved. Services are expanding. AI is drafting procedures before breakfast. On paper, it all looks marvellous.

Then somebody phones in sick, a piece of equipment throws a tantrum and reception discovers that nobody owns the follow-up list.

Suddenly, the principal is back in the middle of everything, wearing clinical gloves, answering WhatsApp messages and wondering why “delegation” appears to involve everybody delegating back to them.

Busy is not a business model.

Across the Extreme Business community, I have seen owners and managers working heroic hours to compensate for missing structure. They are solving today’s problem, rescuing tomorrow’s diary and carrying last week’s unfinished work home for supper.

That can feel like leadership. Often, it is firefighting with a job title.

The good news is that people are beginning to call it out.

Responsibilities are being named. Project boards are appearing. Recall, reception, patient follow-up and reporting are being given to actual human beings, with deadlines and review dates. One recurring task is being transferred properly before another five are thrown over the wall.

That is progress. Slow, unglamorous and absolutely necessary progress, but progress.

Delegation does not mean mentioning something in a meeting, watching everybody nod and then assuming the fairies will finish it by Friday. Somebody must own the result, understand the standard, have authority to act and know when they will be held accountable.

Money is also becoming harder to hide from.

Practices are looking beyond turnover and asking whether clinicians make a proper contribution after materials, laboratory bills and operating costs. Fees are being reviewed. Cash is being watched. Recruitment plans are being tested against reality rather than optimism.

A full diary can still produce a thin bank account. Dentistry has always possessed that particular magic trick.

The numbers occasionally deliver an unwelcome slap. A proposed recruit is unaffordable. A fee rise should have happened months ago. Impressive production has not become profit. Better to discover that now than when the bank manager develops an interest in your hobbies.

There have also been difficult conversations about performance and behaviour. Good. Kind leaders do not allow poor standards to drift because confrontation feels awkward. They prepare the facts, explain what good looks like, agree the next step and write it down.

Avoiding the conversation is not kindness. It is an invoice sent to everybody else.

AI continues to help with knowledge, systems and admin. Useful stuff. But it cannot decide who owns a problem, notice that a manager is close to exhaustion or tell a talented misery-guts to change their behaviour.

That still requires natural intelligence and a backbone.

The comfort of our community is discovering that your chaos is rarely unique. Somebody else has seen it, survived it and can help you choose the next sensible move.

Growth is welcome.

Just make sure the scaffolding goes up before the next floor.