Heather: So I get the great privilege of talking to you about really the success that we can find when we get real clarity on what we're trying to accomplish, our goals, and then banding our team together to perform at a higher level, really getting them engaged with the clarity of the expectation. So first and foremost, I want to talk a little bit about what goal setting and performance currently looks like. So I'm going to ask you a few questions and maybe if there are a couple of coaches who wouldn't mind, mic running, that would be wonderful if you could help with some interaction. So first and foremost, I want you to think about who's currently responsible for the setting of goals in your practices. What does that look like currently? Before everything you learned at the retreat this weekend? Anybody willing to share? Yes. I'll just come by you, Dr. Pitts, and then that'll be easy.
Dr. Pitts: Our team leader. So I have a lead assistant, lead front office and office manager, hygienist and myself.
Heather: So you with that leadership team, you collaborate to set the goals and then you communicate that to the rest of the team?
Dr. Pitts: Yes.
Heather: Okay. Very good. Anybody else do something different? Everybody got shy on Saturday morning or tired? Okay, very good. Well, we'll come back to that. And the slides. There we go. So if you didn't say your process out loud, that's okay, but I want you to think about what's working about the current process you're using for goal setting. So we're going to pick on Dr. Pitts because he did say it out loud. So Kelly's right behind you with the mic. What about that approach seems to be working for you?
Dr. Pitts: So in our break room, we have a whiteboard that we tally and keep a running record so we know what the monthly goal is, but as it changes through the month and then the last week's like the fourth quarter, can we do that little extra effort to win the month? And what goals have we already hit? Which ones have we projected? We need one of these or two of those to get us a goal?
Heather: Okay. So those key leaders have then defined the process of making it visual. Making it visual for everyone to see you're tracking it on a month to date basis really where are we at in the month? And then that clarity of performance makes it easier for people to have the desire really to have those bursts of maybe extra effort. Perfect. Very good. So again, for those of you who didn't speak out loud, what isn't working as well about your current process as you'd like to? And we'll just keep picking on Dr. Pitts, unless someone wants to... There we go. Lisa.
Lisa: I'll take you off the hot seat.
Heather: (laughs) Yeah, Dr. Pitts appreciates that.
Lisa: So after going through the office manager bootcamp, we have this fantastic chart, scorecard as we call it, and it has all of the information on there. We have our current numbers for the month and we have our benchmarks on there. So I would say TTI set us up for me, the office manager bringing all of those things together, and I send that out to the leadership team. What I think that our biggest challenges is that we're running very quickly and fast and I don't feel like we get a chance to sit down and really converse about it. They get my little letter that I add with that scorecard, but I feel like it's too much of me sharing the numbers and then not being able to analyze it together.
Heather: Wonderful. First of all, thank you very much for your transparency on that. Congratulations on your excellent implementation because you took what you learned and you started doing it, which is fantastic. What I hear you saying is there's still a bit of a gap between the work you do as the key leader to share the performance statistics and then the opportunity to really digest the performance and then probably strategize what to do. Okay.
So these are common challenges. Either we don't have enough people involved in the process or there isn't enough time to really digest the information, or maybe there's too much information and it's hard to decide what's going to be most meaningful, what's going to give us the greatest return on our effort. So I always feel like as a leader, my responsibility is to figure out how to get the highest level of ownership and excitement from my team about whatever it is that I'm trying to accomplish.
So I want you to think about currently your goals, and if you had to define the amount of ownership and excitement that your team has about the goals your practice has set, what does that look like? Do you think that the excitement is like an A plus? Are you thinking you're a B minus? What's the excitement level and the buy-in and the ownership to the goals look like in your practice would love for? I heard a couple of people say C, but would love for a couple of you to share, your letter grade and then why you feel the way you feel. I heard people talking, it was just amongst themselves. Yes, perfect.
Speaker 4: What we had just said was like, we would agree maybe with the B minus, it's like the intention is good, but maybe we're just a little misguided and we do deal with the same thing where it's just really difficult to get everybody collaborated with us being scheduled every single hour of the day across the operatories.
Heather: Wonderful. So it's not that it's terrible, but there's room for improvement. Very good. Anybody else? Yes.
Speaker 5: I feel that we have probably at a level A or B, because we have a daily goal and with multiple locations sometimes team members are going from one location to another. So having the daily goal seems to be a good idea. And we have the chip draw that goes along with the daily goal. So people are motivated by that chip draw, and people are motivated by keeping up with the numbers for that day, and they'll ask, what's the number? What's our number for today? So that they keep up with it that way.
Heather: So because you've tied an incentive to it's made it a little bit easier for people to stay interested. But I also know your team well enough to know you have a pretty sophisticated leadership team and commitment and dedication to communicating and creating that clarity around performance. So not surprising to me that you would say an A or a B. So because we spent so much time talking about statistics yesterday at the social networking event, the conversation continued. And I was talking with Dr. Andrew and Dr. Ed Hood about non-dental practice performance. And we actually were talking about, I don't know if any of you followed the College World Series. They were very interested because LSU won of course. But I'm actually from the Midwest, very close to Omaha, Nebraska, where the College World Series is held. And we were talking about, there's a little bar in Omaha that created a contest of teams, fans who buy jello shots in support of their teams. Did anybody see this?
Speaker 6:
Yes.
Heather:
Yes. Okay.
Speaker 6:
LSU won.
Heather: Yeah. LSU won by a landslide. But it was brilliant from the bar's perspective because jello costs like nothing. But anyways, what they do is when a customer buys a jello shot, they have to say what team they support. So then they advertise it throughout the week, and I guess maybe Tennessee or someone was holding the record. And then the founder of Raising Cane's, the chicken place apparently came to Omaha and was like, well, I'm going to make sure LSU wins the jello shot record or whatever. And I think it was like $1 per jello shot, and they spent like [inaudible] I can't even remember what it was.
Speaker 6: The last number I saw was 67,000.
Heather: Yeah, 67,000 jello shots. So what does jello shots have to do with anything I'm talking about? Well, what Hood's and I were talking about was just the way that businesses and leaders will either gamify something or quantify something in a way that becomes exciting and gets more attention and energy and input and follow through. So it was brilliant on behalf of the bar selling $67,000 worth of LSU jello shots. But then we actually started talking about Raising Cane's, and Dr. Andrew said he has a 17 year old kid who lives down the street from him who works at Raising Cane's, and his family was over at their house and he asked him, "How's work going? Do you guys stay pretty busy?" And he said, the 17 year old kid said, "Yeah, we sell x thousand pounds of chicken every week." And Dr. Andrew was like, "How does this kid know or even care," as a 17 year old kid?
So he started asking him, "Well, how do you know that?" And he's like, "Well, they tell us. We record it. We have goals, we have contests." So the fact of the matter is, it's not just dental practices, it's the bar in Omaha. It's Raising Cane's Chicken. We're all trying to find a way to make what we do more meaningful. So that's really what I want to talk about. What can we do to improve the engagement levels around our performance? Because if we remind ourselves that what we're measuring is just 100% a reflection of our patient care and our teamwork, that's a really meaningful thing to measure.
It just so happens it comes out in reports and key performance indicators and all those kinds of things. So for those of you who've known me long enough, this is probably my absolute favorite thing to talk about. It's the concept called the Dimensions of Success. So it was created by a company called Interactive Associates, and they do business consulting with all kinds of different businesses in healthcare, out of healthcare. But what they did was when they started deciding to consult, they started studying really successful businesses.
And what they were able to distill down was that these businesses did a really great job of balancing their focus on these three specific areas. So this is supposed to be an equilateral triangle. And for those of you who took geometry, we know that that means all sides are equal, all angles are equal. And in this scenario, it means all areas of focus are equal. So our ability to get results, our ability to define and follow a process, and our ability to really nurture and maximize our relationships.
So what they found was the leaders who were most consistent at balancing their efforts in these three areas had the most predictable, consistent, scalable, sustainable levels of success. And why I think this is important is because whenever we start talking about numbers, we get really heavily focused on the results. The number is the result of the effort we put in. But if we're not careful, it can be a little bit repelling and maybe defeating the purpose, because people are like, all they talk about is the money or the numbers or what have you. When really the results are a byproduct of us having clarified the most important processes, having trained our people to follow them, having engaged our teams in a way that they even care.
So the dimensions of success to me, is an absolute wonderful visual representation of my hope for what ultimately comes from our measuring of key performance indicators, OKRs, all those kinds of things, whatever we're calling them. So when we're thinking about what this might look like for your team, I always think it's a little bit challenging because the easiest thing for us to do is measure history, the things that have already happened. So we set goals, but really the goal really ends up being the measurement of the consequences of what we've already done. So production. We report on the production from yesterday at the morning huddle, but we can't change it. It's already in the past.
So oftentimes what we're reporting on is an end result or an outcome, and there's nothing we can do to influence what's already happened. So sometimes we think that the only way to improve the end result is to talk more about the end result. So I'll work with teams and they'll say, "Well, we haven't been meeting our daily production goal." And I'll ask them, "Well, what are some of the things you're doing to improve that?" Well, we hung up a whiteboard, which I am not saying any of these things are bad. So these are really good things to do. But they'll say, "Well, we hung up a whiteboard and now we write the daily goal on it every day, and we just talk about it more." Okay, that absolutely is a perfectly great strategy. "Have you seen improvement from it?" "A little bit.". Everybody's more aware of what the goal is. So that helps a little bit. But still can't necessarily change the outcome just by improving the way we measure it.
So what I'm most concerned about is helping people understand the activities that led to the end result. That's what we as team members have the greatest amount of influence over, and that's what I find people get most excited about because it's as closely connected to them and the patient experience as possible, as opposed to printing out a report, which we still need to do. But key performance activities ultimately end up driving key performance indicators, results, whatever you want to call it, outcomes. But the activities are real time. So at any point throughout the day, I can change the way I'm doing a current activity. I have the opportunity to influence the future outcome.
So if we can get really good at identifying the key performance activities and get better and more consistent at those, there'll naturally be an improvement in our key performance indicators and outcomes. So the ability to identify those activities I personally like by role, helps create clarity and consistency for the people responsible for those activities. And then it helps you to be a little bit more confident in being able to predict the outcomes. So for instance, I'll give you an example.
Let's just say one of our key performance indicators is your number of AR days, which it is. It's on your practice success loop. But when we report that together at the end of the month, and let's just say your AR days is 25, because that's the goal, 25 or less. When we report the AR days for the month of July at the beginning of August, I can't change what happened in July. But what I can do is start talking to you about the process you're using to improve the outcome of the AR days. So are we working outstanding claims on a daily basis? Are we sending daily statements? Do we make sure that all of our claims are clean before they're sent out? Whatever it is, we can start talking about the activities. Which of those are working well? Which of those have the greatest room for improvement?
And then if we're improving the activities, the consistency, the clarity of the activities, when I'm measuring August results in September, the outcome hopefully has improved. But really what we usually do is we spend so much time on reviewing what we measured, which has already passed, and we don't really always spend as much time talking about how we're going to influence it moving forward.
Let me back up here real quick. I got a little click happy. One thing I like to remind people is that our actions, ultimately are really just the byproduct of our overall vision, culture, values, all of those kinds of things. So at the end of the day, the activities or the actions that we decide to have are really just agreed upon behaviors that represent who we are, what we say we are, how we want to operate.
So actions really drive key performance indicators, and then they really impact critical success functions, OKRs, whatever you want to call them, which are usually a byproduct of the objectives, the strategies, the vision, the plan you created for yourself. So a lot of times we'll start with a three-year vision, a one-year plan, a 90-day action plan. But usually then that's where we stop and we set key performance indicators there. In the next 90 days, I want these to be our outcomes. What I challenge us to do is take it a step further and say, "What are the actual activities? What are the actions that we have to change and improve and influence every day to get that end result?" So that's what we're going to talk about for the next 10 minutes before I wrap us up.
So first and foremost I believe that if you can make goal setting more of an all team sport, you're naturally going to have more predictive results. People support what they help create. So if I have the ability to give input on what our goals should be, I have an automatic increased level of ownership and accountability to the outcome of those. The other thing is a lot of times when I say that to people, people usually go, "I can't just leave it up to my team to set the goals. How will they know how to do that?"
Well, history is a really good gauge for future performance. If everybody knows what we've been capable of, they're pretty comfortable figuring out what we can be capable of in the future. So if you've done a good job of being transparent and sharing results, it's pretty easy for them to help figure out what performance should look like moving forward. What tends to happen is that we underestimate what we're capable of in big picture timelines, and we overestimate what we think we can do in short timelines.
So someone will say, "We took an Invisalign course. We're going to start doing Invisalign." And I'll say, "Well, what's your goal?" "We're going to do 25 starts in 30 days." That's completely awesome if you did that, but seems a little bit unrealistic if you've never done any and now you're going to go to 25. So sometimes we need a little bit of help putting up the guardrails. And I might say to someone, "Well, what do you think you can do in the first six months of being Invisalign certified?" Then you'll hear someone go, "25." The same group of people might think 25 is doable in 30 days and in six months. You have to help give the guardrails.
But making sure that you're clear about what you're trying to accomplish is really all you as the leader need to do to set the path to let them create the plan. So sometimes it might be as simple as saying, "Hey, you guys, I want to make sure we're always growing within our existing practices. I want to make sure we maximize what we already have before we're adding new. I think it's realistic to assume we could grow by 10 to 15% every year. What do you think?" You're still going to let them take the lead, but you're putting up the clarity of expectations.
When you can monitor things that are easy to measure, that's always best, but that's not always the case. Depending on your role, it's not as easy. A lot of times dental assistants will say to me, "Well, what will activities should I be responsible for? What should my goal be? Because I'm not technically a provider." So you have to think about, well, what's the best scenario for the person and their responsibilities and their goals and their roles? So maybe a dental assistant is responsible for helping influence same-day dentistry, that's measurable. At the end of the day, you can ask them, "Were you able to help your doctor work in any same day dentistry?" It's a yes or a no. It's an easy way to have feedback and accountability. If the answer was no, it's another question. Did you have opportunities that we just weren't able to take advantage of?
So what we're trying to do is have our conversations and our actions be the forefront of how we spend our energy, because that's ultimately what's going to drive the results. But a lot of times we flip it around and we put a lot of effort into the scorecard, and I do this. So Lisa's probably like, "Well, why'd you send me the scorecard then, Heather?" The scorecard still matters, but what matters even more is helping people get good at the activities that influence the outcome of the scorecard. So anytime you can help people find something measurable that's specific to their role, anytime you can have conversations with them, did you have an opportunity to improve? Didn't you? What stood in the way? What would've made it easier for you to take advantage of improving the activities they're responsible for?
Really what we're trying to do is have an ongoing conversation to increase the level of ownership. That's really all we're trying to do, is make sure that people understand their key activities because they're the ones that have the greatest influence over them. So everybody should know what their key activities are. And some positions are harder to identify the activities than others. So many of you have probably heard me talk about the dental decision tree. And really what the dental decision tree is, is a made up term. There is a concept called the decision tree. If this, then this. If you get to this point, you have a couple of options. If it's yes, you go here, that kind of thing. But I've just lovingly adopted it for dentistry. And what I try to hold myself accountable to doing, I'm going to just flip ahead a little bit here and talk through this. So what I try to think through is, am I wanting my team to focus on production or collection? Are they more of a part of the restorative team or the hygiene team? Do they understand that our greatest opportunity is capacity? Or do they understand we need everybody to help drive demand? Do we need more visits? Do we need to do a better job with the visits we have.
All of these key performance indicator outcomes. What I'm trying to help my team understand is, where there's greatest opportunity for their influence within each. So if I'm looking back, let's just say the month of June, and I missed the mark on our production goal, I want my team to be able to tell me, "Well, did we miss production from the restorative side of the practice or the hygiene side of the practice? Was it one or the other? Or maybe a little bit of both? Did we miss our production mark because we didn't have enough appointment availability, which is capacity? Or did we not have enough input and influence over keeping the schedule flow full, which is flow, which is demand? Did we have more patient visits than we typically have, but we weren't as consistent and effective with the care we delivered? So our productivity per visit went down."
I actually spend a lot of time looking at the past only to be able to help myself predict the future. So when Lisa said she started sending out the scorecard, I still use the scorecard because I want to know if my energy and attention on the actions, the activities is working. So you don't stop looking at the past, but you do a better job of balancing the current and the future so that you can influence the numbers you've been measuring in the past. So what should your strategy be, to get your team to a point where they're really able to predict, are we going to meet our numbers this month or not? I always tell people, I feel like we're functioning at the highest level of engagement with statistics when no one is surprised by how the month ends.
So if I come to your practice and I ask you, "Did you have a good June?" And you say, "Yes," I'm going to ask you, "Well, how do you know? What happened? What made it good?" And a lot of times we're going to just start guessing. We had a lot of new patients. We had really great patients this month as opposed to the not great patients the month before. We do this because we start to just go from a place of feeling or emotion. But the challenge is, it's really hard to repeat feelings and emotions because they might not even be accurate. So I'm going to tell you a very quick story, and I need to go faster, because I don't know James who gives the hook.
But there's a practice that I work with out of New York, and their monthly production goal is $750,000 a month. And for several months they weren't hitting it. And we kept talking about, why do you think this is? And it was all over the board. Well, we did more all on four cases before. We're not doing as many crowns. We didn't have as many Invisalign starts. And I was like, okay, let's run the reports. Let's make sure that our feelings are in sync with the data. No, wasn't Invisalign cases, wasn't number of crowns, wasn't number of all on fours. Okay, what else? What else could it be?
Well, when we used the dental decision tree and started narrowing down where we should focus, what actually ended up happening was they changed a little bit in the way they scheduled. Not a lot, just changed the timing of what felt like shouldn't be anything that was that impactful on the hygiene schedule. But what it did was it ended up shrinking the amount of appointment availability they had available. So their number of visits actually went down quite a bit. So they didn't even have the capacity within their schedule to be able to see the same number of patients that they had historically seen. So naturally then the outcome wasn't going to be 750,000 in production because you shrunk the number of opportunities by, I can't even remember exactly, it ended up being 150 appointments or something like that.
But the challenge was it took a few months for them to figure out that's what happened, because we were just guessing. And we all do this. I think it's because we weren't as good at case acceptance this month. I think it's because we didn't have as many same day treatments. Whatever it is, we just start guessing, and then our actions and our activities follow where we guess. And it may or may not actually be the most accurate place to put our energy.
So my real quick example of how our ability to ask ourselves questions can have a really big impact. So another practice I was working with, goal of 45 new patients per month per doctor, but they were currently only performing at 32 new patients a month per doctor. So when I asked them, "Well, what do you think we should do about that?" What do you think everybody said. "We should do more marketing. We just need to get more new patients in." But then when I asked them is, "Let's just say marketing's not an option, and we have to figure out something else, where should we start?" So then they started asking questions. "Well, do we actually even have enough appointment times on our schedule to accommodate 45 new patients per doctor per month?" It's our dental decision tree. "Do we have the capacity to actually accomplish the goal we set out for ourselves?"
We did actually, in this case. "What's our internal referral percentage?" They're questioning this because they want to know, has our patient experience changed at all to make people not as excited about choosing our practice? Well, the great news was it hadn't. They were still having a really great patient experience. "Well, how many phone calls are we getting? Is the phone ringing as much as it used to?" Interestingly enough, it was actually ringing more. "Well, what's our appointment conversion look like?" So my ability to answer the phone and then convert that into appointment.
What we found was that their appointment conversion had actually dropped. Of all the actions or the activities that ultimately could lead to the outcome of new patients, that was the one that had changed. But it took multiple questions to figure out that that was the activity we should focus on. So little hinges swing big doors. And what happened was we realized that on average, each doctor was getting about 80 calls a month. The appointment conversion currently was 40%, which was resulting in 32 new patients per doctor. So we just decided to focus on improving that one behavior, only getting better at converting the call to an appointment. We could ignore everything else. We're just going to try to improve that one activity.
And we only set the goal of improvement to 10%. So it wasn't a great big lofty, ridiculous, unattainable goal. We just said, "What if we could get from 40% conversion to 44% conversion?" Just improving that one behavior by 10% actually changed the new patient flow per doctor from 32 new patients to 35. But what also happened was that even though that was only three more new patients a month, on average, they were producing $2,000 per new patient, and their internal referral percentage was 50%. So for every three patients that came in, they referred another one and a half statistically. So there was actually a compounding impact that happened just by identifying that right behavior, that right activity, that right action.
So increasing our call conversion rate by just 10% actually made the doctor's performance go from 32 to 35 new patients, but then they got another one and a half new patients, because of the referral percentage, $2,000 per new patient. And it was an exponential impact on the practice. And we just had to find the right behavior. But if all we kept doing was just measuring new patients at the end of every month, we probably would've dropped more money in marketing, kept beating our heads against the wall figuring out. The phone would've rang more, but our appointment conversion may not have improved, and we would've been even more frustrated.
So I share all of this with you because I think you'll be tempted, like most of us, this is familiar, I'm not going to go through this. But what I think we're usually tempted to do is all of these things. We just have to get better at all of these things, and that's okay, we do. We do need to keep getting better at improving our patient flow, our effectiveness with patients, our ability to collect the dollars. But what I want us to get really good at is knowing at any moment in time, which of the few activities matter most. Which of the few activities are going to drive the outcomes we're most needing to improve. So with that, I just want to remind you that all of the statistics we've talked about, all of the pieces of the practice success loop, there's a lot of stuff there. It's a great reflection of our patient experience, of our processes, of our teamwork. But sometimes if you try to digest the whole thing, it's overwhelming and it's hard to make progress. So if you can identify the most meaningful activities for each person on your team, at any given time, you cannot underestimate the impact of just one person, one activity, and one small change. It's this ripple effect, which I think is one of the coolest things ever.
So I'd love for you to think about your one thing. Your one thing for each person on your team. What's their activity? What's their key performance activity that's going to have the greatest impact on driving the outcomes, the key performance indicators, the results. Look over your last couple of months and figure out, was there a production gap? A collection gap? Was it restorative? Was it hygiene? Was it a little bit of both? Was it our patient visits? Was it our effectiveness with our visits? That helps you identify the activities and helps you figure out where your energy should go so you're not guessing. Still keep reporting, still use the scorecard, still celebrate and measure those results. But the more clear you can get about the specific activities, the higher the likelihood you're going to be able to improve and influence them, which ultimately drives the results.
