‘When did we start doing that?’ Has this question ever been asked in your office? Dr. John addresses implementing change within your practice. It can be something small or practice-changing, but implementing the crucial steps will allow the changes you want to happen, avoid resistance and stay for good in order to progress your practice forward! Don’t miss this incredible episode!
“EP51: Magic Happens Outside of Your Comfort Zone” Transcript:
So I'm so excited again for you to listen to this podcast. Let us know what you think. Subscribe. Leave a review. We love to hear from our listeners. If there's anything that you'd like to hear from us in our podcast, we'd love to hear that. So again, this is Katie. I'm here with the Team Training Institute, turning the time over to Dr. John. Enjoy.
So now we have our plan. And so you took all the information from the tools that we talked about this morning and you started looking out in the future: we need this, we need this, we need this, we need this. We figured out the numbers that I just put up there. Right? We figured out who's going to do what by when. And this is generally done as a leadership team, however you define that. If your practice has seven people or less, you can do it as an entire team. But if it's more than that, it's just too many people, becomes too much noise, too much distraction. Hard to move forward. That's why committees always have five to seven members because if you get more than that, they don't get anything done.
So let's talk about our plan execution. So how many of you, your plan was to stay exactly where you are three years from now? Good. So that means when you started out the day by saying, “Okay. If we're going to operate at a different level, we have to think at a different level and we have to act at a different level.” Right? So how do we get our plan executed? We're going to have to make some change. And so one of the things that I have not given enough credit to is how carefully, cautiously we create change. Because if you create too much change, little hinges swing big doors, right? And if you try to do too much change too fast, it becomes very, very stressful for the team and very, very stressful for the doctor. And it doesn't have to be that way if we manage the change correctly, okay. So here are the steps that we suggest for managing change. First is we provide awareness. And that is, we let people know there are some things coming that are going to change, right? And so I don't really think it's a great idea to put every change that might be happening in the next three years in people's laps, but I think the next one is worth giving everybody's awareness to. All right? The next one is buy in And buy in, basically is why? Why are we doing this? So I can tell you that if you say we're going to make this change because if I'm the doctor and I'm going to go into the team and say we're going to make this change because it's going to increase my personal income [laughter]. I can tell you that would not be very inspiring. All right? So when we talk about change, and we're getting buy in, it's always why is this better for the patients? And if it's not better for the patients, why is it better for the team? And hopefully, it's better for both. So we start with that. Why it's better for patients and why it's going to be better for the team. The next thing if we're going to have a successful change, the people that are going to be executing that change will need to have the skills how to do it, okay? So if you think about your hygiene [exposing on?] your hygiene coach came to your office , they follow this, right? So they started out in the morning by saying, “What are we going to do today?” Then they talk about buying. So they talk all about all the science about why this is better for patients, and why all the experts say that our methodology is the right way to do it. So once they've got what we're going to do, they've got why we're going to do it, what's the next thing they talk about? How? Right? So that's the skills, right? This is how you do it. I know you don't think you have time, but if we set the appointment up this way and you have everything you need right in your op, and you have an occasional system that pops in to help you, and now we get the whole team on board with that, maybe something for the front desk. I just have to come back and help probe. That's all right. We'll do it. We'll make it all happen. And the whole team's onboard, right? So the skills. The next thing they do is work on desire, what do they do for desire? They change compensation a little bit so that if more is done, right, and if we're using the TTI bonus systems, right, if more is done, everybody does better. And the next one is the resources. Okay? So what do we recommend for everybody, right? You can't get up to get a curing light. You got to have a curing light right there. You got to have the ceiling stuff. You have to have everything you need to do those same day preventive services in the room at all times. Otherwise, if you got to get up, it's not going to happen very well. So you got to have the resources to do it quickly and efficiently. And then the next is action plan. When are we going to start? So if we miss one of these, if we do all of these, that's why it's so brilliant what Wendy put together for her hygiene explosion. It's brilliant. Because it follows all these change management steps. It's absolutely brilliant. So what happens if we miss one? All right
if we miss awareness, we don't let everybody know at the beginning of the day what this is all about. And people are wondering, “What the heck is going on here?” They don't know, and it ends up being confused. And confused people don't change as well, right? If we don't get buy-in, we can have apathy or, worse yet, sabotage. If we don't have the skills now, you're just making everybody anxious. And when people are anxious, what happens with tempers? They can flare. Right? So now we're biting at each other. That's no good.
Next is desire. You don't find a way to get desire, right, then we're going to have resistance. If we don't have the resources, we're going to be frustrated. I can tell your hygiene coaches after this if the practice doesn't provide them the resources that we talked about in the training, they get frustrated because they can't get everything done that is possible to get done. And they know it, and they want to do better and they want to serve their patients better.
And the last, if there's no action plan, people feel like they're just on a treadmill. Like, “Oh, gosh, we're changing this. Well, when did that start? I don't know when it started. I didn't know we were doing that. And now, oh, there's another change coming up. Oh my gosh. This is crazy. I feel like I'm on a treadmill.” So going back to making change, one of the things that your business coach will help you do is look at the data that we have as related to the practice [success lead?]. So right now, we get all of this data from Dental Intel. Right now, there's various sources for this. So who here is using Patient Prism? Okay. Good. Yes or no? Yes? Yes? Anybody else? Yes? Yes. Yeah.
So I met with Amol, the CEO of that company, two weeks ago. And what we're working on is having a dashboard where this comes up, Patient Prism data is there that you can click on, go to their site, but just the reporting is here. So you can see exactly on one screen what you're doing. So connecting the Dental Intel data on one side, the Patient Prism data on the other side, and I think it's going to be really, really slick because you'll be able to see this one screen– ah. That's it. They'll be benchmarked. They'll be color-coded. So if you're lower in one area than the rest of the practice is in the TTI family, it'll have a certain color. And you'll say, “Okay. That may be a place of opportunity.” Right? Remember though, numbers don't tell you everything, but they do tell you where you need to look a little more. So often the numbers on a benchmark, your number may look different, but it may be because you just lost a dentist and a hygienist last month, and so there's no way you're going to produce what you did the month before. And so now that looks worse, but it's not really worse, it's just situational. Right? And that's what the coaches help you do, is figure out if it's situational or if it's systemic. All right so I talked about case average earlier. So that's collections divided by new patients. And because I get to see so many practices, I get to see the outliers. I get to see the ones that are really high and the ones that are really low, and I get to learn from both of them. So the highest case average office that I am aware of, their case average is $36,000 per patient. Is anybody in the room higher than that?
Yeah. So it's a very fascinating practice. It's in Calgary, and he just sold, so he doesn't own it anymore. But there was five kind of general practices that fed this practice, the kind of cases that he wanted to treat. So they were all complex. Everybody got ortho. And some of things that he did were like– I don't even understand this. I don't even know what this is. So there was holistic dentistry, and there was blood tests and material tests and all this stuff. I don't even understand it. But his patient following was absolutely incredible. And he took on the most complex cases that– he did a ton of facial pain stuff. Which that type category of patient, that is a very, very, very, very tough patient to deal with and to specialize in. So he had this incredibly complex practice, very, very complex. Guy speaks all over the world. So we were at a meeting. It was a small meeting of group practices. And I was coming to the end of the day and I was saying, “All right. Everybody pick out the three things they're going to work on.” And he said, “That's a mistake.” And I said, “Why is that a mistake?” He said, “You should focus on one thing at a time, and just one thing at a time.” I thought, “Hmm. He just may be right about that [laughter].” Right?
So if we're going to do change, we have to first figure out what we're going to change. And we do that by measuring and benchmarks, right? So we measure how we're doing on our practice success wheel. We have data for every one of those circles. We have benchmarking data. We know what's not good, right? And that's what your business coaches are working with you on. So we can pick the thing that's going to be the easiest to do with the least amount of effort, right? Remember our impact ease filter. And we're going to figure out what we can do with what we have right now, right? So that's creativity before capital, right? And we are going to figure out if the change that we're going to do is going to make it better, faster, easier, or cheaper. So we're going to run it through our filters and we're going to decide on what we're going to change, right? So now we have set the goal. Now we create the plan. Now we go to our change elements, right? So we go to these. Now we're with the team. The plan we probably created with the team, because people support what they help create.
So here's what I know. You go through all these steps. You come up with your plan. Here we go. So here's how we execute this. Number one, you set a start date. Has this ever happened in your office? “When did we start doing that?” Has that question ever happened in your office? Yeah. So we set a clear start date and we monitor the results closely. And we do it day one. So when the hygiene coach comes to your office and they go through all those steps of change, right? On day one, if there is no change, is there likely to be much on day two? No. Day one is everything, right? So day one is everything. So we're monitoring the results. And we're doing it on day one. So this is what I got from him– was that if you've got multiple change things going on all the time, it's hard to have the day number one focus on all those things, right? So if we have some that do really great day one, we are going to have a huge celebration about that in public. At the morning huddle, high fives, gifts, crowns for the day, right, diamond pins– like the hygiene diamonds pin, like the hygiene diamonds pin, not a real diamond. That might be what we're doing it a little bit, okay? And we're going to publicly celebrate the early adopters, the ones that jump on and do well day one. We're going to privately engage the ones that didn't. Now, the ones that didn't go along with the change or improve, what's happening? What are some of the things that might be happening? They don't agree with it, right? So their philosophy is different than the practice's philosophy. So they don't agree with it, so they're not doing it. What else? They don't understand it. They don't understand the why or they don't understand the how, right, okay? What else?
Fear of loss.
They don't want to– fear of loss. Say more about that.
[inaudible] fear of loss.
Okay. Say that one more time because that was good. That was really good. They're all good, but–
Thanks. I'll hold it up there. We have resistance when–
You can hold that note for a long time. That was amazing [laughter].
Yeah. What a voice you have. You should sing for Nashville.
No. I'm terrible at that. We have resistance when we– when there's change. And typically, the resistance comes from a fear of loss. And it could be because we don't know what our moorings are. So we don't kind of know where we're standing or we can have a fear of loss because we're feeling uncertain. And any time we're in an uncertainty, there's a likelihood to be a fear. And then, there's going to be resistance. So it's about understanding the core reason why they're fearful, and then looking for ways in which we can help to bridge that gap.
Very good. Awesome. Nice throw. What else? Okay. Fear of rejection or afraid the patients won't like this change and they're going to hear from the patients. And that doctor– I'm sorry. The doctor who decided to make that change– he's not going to hear about it. I'm going to have to hear about it. Blah, blah, blah, blah, blah, blah, right?
Okay. I'll speak as a 62-year-old because we have–
Yeah, I am [laughter].
Is that right?
Yes, that's right.
Anyway, we have [laughter] staff that are– their age are a little bit younger. And I think they really just don't want to learn anything new or do anything new. They're kind of wanting to ride out into the sunset like they yep. So there is an unwillingness to change, right? And human beings are habitual creatures. The longer we've been doing something in a certain way, the harder it is for us to change, right? So that's part of it. All right. So here we are. We've got day one. We've talked to all the– we've high-fived the superstars, so excited, woo-hoo, right? We've counseled the ones that are struggling, to try to figure out which of these reasons is why they aren't making the change. So we're going to go back. We're going to re-cover the why, right? We're going to re-cover the how so that they know how. And one other reason that I didn't mention why sometimes you'll have team members that don't do this is because we've had change attempts in the past that stalled out. And they're waiting it out to see if this is really going to happen or if this one is going to stall out too, right?
Okay? So that's why day one is super important, is that you make it clear that, “No, this is happening. We are going to do this, and you're going to do it too. And it's going to be awesome.” And I know it's going to feel a little awkward [inaudible] while you give them support and empathy.
So what's the next most important day besides day one?
Day two [laughter]. Because what are we going to do on day two? We're going to celebrate the hyper-performers. We're going to celebrate anybody who made progress. And we're going to privately counsel the ones that haven't made any movement. This is how change happens. Okay? So what happens if you are just unwilling, you're not going to do this, you think it's the wrong thing to do, and you're getting counseled every day in this way?
You're going to move on.
You're going to move on because you don't fit the culture of the office, yeah. And not that you want that to happen, but it sometimes has to happen. But I can tell you that's so rare when you handle it this way. When it's always soft. There's no upsetness, there's no anger, there's no looking down on anybody. You're really just trying to do what all of us should do as employers and leaders. We're trying to help people become more successful. That's all we're trying to do. And we're talking to them in that way, respectfully, kindly, empathically. And so it's rare that we can't get people to budge.
One other reason that we didn't mention that people don't make a change like this is they don't have the confidence to do it, right? So maybe they get confidence to do it if it's a change in hygiene. For instance, using the caries risk assessment. We know that if people use the caries risk assessment, fluoride acceptance, sealants acceptance goes up dramatically, right? But it's awkward. You haven't ever done it before. So sometimes role-playing to raise someone's confidence that they can have this discussion naturally and easily with a patient, if they do it a few times with one of their colleagues, maybe that would get them over that confidence hump. But part of engaging the struggling is show them that you have confidence in them. “You can do this. This isn't that hard. Let's practice it together. You can do it can make it happen. So we make sure we have done what we can to get by in have the skills, the resources, they understand the plan, and we continued to monitor for progress. So at some point, you're going to have the feeling that you care more about the change than the– you feel you are trying harder to help that employee succeed with this change than the employee is. You're working harder at it. You care more about it. You're upset more than they are that it's not happening. That's the point at which we have to ask, “Are they willing?” Right? And if they're not willing, what are our options at that point? So free up their future is one. What else? What's another role in the office they could play? Maybe this person is in the wrong seat. Maybe we should find a different role for them. But sometimes, we can't find the right seat and they're unwilling. Sometimes we don't have a choice, but that's the last resort. Okay? So what was the big lesson from the change management? What are some of the things that you took away that you're going to think about differently now? Dr. Joe?
I think to understand that grid was really genius as you said. Because when you look at desire or resources, if you see what's happening with your team, you know where it went wrong. And then you can go in and say, “Okay. I'm going to talk to them about their desire or I'm going to talk to them about their resources,” instead of just thinking, “Why aren't they doing this?” and banging my head against the wall – which is why I have this hairline by the way [laughter].
I can think of incentives that we put in for employees and we didn't see any change and it confused the daylights out of me. Why in the world isn't this changing? Only to learn that they didn't understand the incentive. Hadn't been explained clearly enough. They didn't understand it. And just that one thing turned the desire and now it changed.
What else is a lesson that you learned from this?
Focusing on one thing at a time.
Very nice. Well done. That's an important one. That's good. Alright. Anybody else? Yes, Triva?
I'd say framing it so that during this change it's good for the patient and the team. Sometimes I think, “Oh. Is it we're only interested in raising production and collection.” Really making it aware to me that it's really a benefit for all.
And we can't depend on people connecting those dots, right? This is something that you verbally have to do to guide them along the path. Because it's really quite easy for us to think everybody understands where we're coming from. The old expression that goes without saying. Well, there really isn't much that should go without saying because that's how miscommunication happens, right?
I was just going to say that the number-two dot there, monitor results plus– I'm sorry the number-three dot, publicly celebrate the early adapters. I think that the squeaky wheel gets so much attention, usually, that your superstars– I think we take for granted that the superstars are just going to automatically do it. And I think real praise for superstars is probably lacking more in any practice than anything to tell you the truth.
Reading a very interesting book right now – and I can't even think of the name of it – by Dan Ariely. And it's about how we demotivate people without realizing how we demotivate people. So that's going to be at our next retreat and I'll have a presentation on that. It's fascinating. The research on it is so fascinating. And you read it and you think, “Oh. That's so true. Why didn't I know that? Why didn't I think that? Why don't behave in this way so that I'm not demotivating people accidentally?” Dana?
This goes along with the fear thing we talked about before. Sometimes I– is it on? Sometimes I don't think it's fear, I think– well, it is a form of fear, but team members tend to want to make a whole decision around something one patient might say. And I've tried to start really bringing that into change management is, what if one person does? What about the other 99% of those people?
The other thing I see, guys, is that we're very comfortable. Sometimes we get real comfortable. And comfort is knowing, when you go in, exactly what you have to do, right, on a patient and being in a pattern and breaking that pattern. I was 29 years in the same pattern, right? Breaking that pattern is very difficult. You don't want to move out of your comfort level because uncomfortable is unknown and it doesn't feel good at the beginning. So I think comfort, being comfortable and settling, right, is a big part of it too.
Yeah. For sure. Magic happens outside of your comfort zone. [music]