Ultimate Secret of Practice Management

What is the ultimate secret of practice management? This blog is the final installment of my three-part series on how dental practices can learn from the phenomenal success of amazon.com. In the first part, I discussed the need for practice efficiency. The second lesson was about focusing on value, not price.

Another lesson from Jeff Bezos, founder of amazon.com, is a relentless emphasis on customer service. As with the other great tips from Mr. Bezos, however, we need to adapt that lesson from amazon to the practice of dentistry.

Everyone knows that the patient comes first, and customer service is already stressed in most dental practices. I interpret the customer service lesson to be much more nuanced than a general desire to be polite and friendly. Customer service in a dental practice occurs not only because team members have an intuitive sense of how to treat people well, but because they are well trained.

The third—and most important—lesson we learn from amazon is the ultimate secret of practice management—a relentless emphasis on team training. Continual training gives the team the specific tools they need to provide outstanding customer service.

Here are three great ways to train your team:

1. Ask for examples. At a team meeting, ask everyone to give examples of great customer service they have experienced themselves. Don’t ask for service horror stories. Keep the conversation and the lesson positive. Ask what happened, why it was so memorable, and how great customer service has a lasting impact on one’s relationship with a company.

2. Set the standard. In my next blog, I will discuss “sticky situations” that occur in dental offices and how to resolve them. The doctor and office manager need to tell team members what to say in challenging situations.

3. Use outside resources. I have a Team Training Video Series and I also provide training by phone, Skype, and in person. Having a team coach is a great way to keep everyone trained, focused and motivated.

There is another great benefit of team training. It’s the reason team training is the ultimate secret of practice management. Team training feeds the other principles we have discussed in this series. With proper training, practice efficiency soars. Also, when team members have the right verbal skills, they are able to communicate value for the dollar and move past the cost objection.
There is a synergistic effect among the three principles because they are mutually reinforcing and underpinned by the ultimate secret of practice management: continual, relentless, purposeful team training.

Click to access the following resources:

Efficiency: Part 1.
Value, not Cost: Part 2



Asking the Right Questions to Improve Efficiency

Are you asking the right questions? We all want to know what is going to change in the next ten years.  One of most prescient business leaders in the world, Jeff Bezos, founder of amazon.com, says that we should ask another question: “What will not change in the next ten years?”

Bezos, quoted in Peter Diamandis’ book, Bold: How to Go Big, Create Wealth, and Impact the World, says that no one has ever told him that Amazon’s delivery is too fast.  He concludes that in his business, one factor that will not change is the need to improve delivery speed.

Amazon is continually trying to deliver orders faster.  The company pioneered e-books.  No more waiting for a book to arrive; simply click and the books downloads to your Kindle or other device in seconds.  The company is now testing how to deliver tangible products in hours using drones.

There are three critical factors that will not change in dentistry.  Let’s discuss speed and how we can apply the lesson to dentistry.  I will address the other factors in subsequent posts as we continue to explore lessons from Amazon.

In dentistry, there is always a need to make the delivery of dental services faster by improving efficiency.  It is important to note that I am not advocating spending less time with patients.  On the contrary,  I am focusing on finding ways to use your time and the patient’s time more efficiently.

Here are the right questions for your team to discuss.

  1. How can our appointment process by streamlined? How can we spend less time on the phone scheduling and confirming?
  2. How can we make better use of automated confirmation systems?
  3. How can communication between front and back be improved so we can schedule more efficiently?
  4. How can we ensure that we have some openings in the schedule at the ready for new patients who want to be seen very soon, even if they do not have any urgent dental needs?
  5. How can we streamline the check out and fee collection process?

I pose these questions to teams when I consult with practices and challenge the teams to find answers.  While practices do not arrive at perfect answers, they improve these processes, and that is the goal.

To have a substantive team meeting, work through these questions in depth to improve efficiency.  As I always say, you may not have all the answers, but if you have the right questions, you will improve your business.

Next post:  The second factor that will not change in dentistry and how you can improve.



Don’t Text and Drive (Your Dental Practice)

Dental procedures require focus.  You concentrate on the task at hand and you do not want to be interrupted.  However, when it comes to managing the practice, there is a tendency to multitask.  Many doctors grab a few minutes of desk time and then overload their circuits.  They text, read e-mails, go through their stacks of stuff, talk on the phone, and try to carry on a conversation with an employee and make management decisions.

What’s wrong with this picture?  In their illuminating book entitled The One Thing: The Surprising Simple Truth Behind Extraordinary Results, Gary Keller and Jay Papason point out the fallacy of multitasking.  It turns out that the brain, like any given computer, has a limited amount of computing capacity. When we multitask, we end up doing several things not nearly as well as we could do one thing.  Research shows that distractions are interruptions that slow us down, detract from the quality of work, and ultimately make tasks longer and harder to complete.  That’s why it’s dangerous to text and drive a vehicle, and why it’s also not good for the health of your practice for you to text or otherwise multitask while managing your business.

When management is just one more ball to juggle, it does not get the attention it deserves.  Decisions are rushed or delayed, employees do not get clear direction or feedback, and problems fester.  By attempting to do too much at one time, not enough time and energy are focused on the complex task of management.  The result is that small management problems are easily glossed over and until they grow into large problems that threaten employee morale and practice production.

There are two solutions.  First, management has to be a priority.  When you are making business decisions, you need the same clarity, focus, and sense of purpose that you bring to the task of establishing an accurate diagnosis for a patient.  Second, you need to have an office manager—even in a small practice—who handles administrative matters and calls your attention to important issues for decision making.

At any given time, the one management task that you are trying to accomplish is important.  Focus.  Give it your all.


Taking Problems to Your Boss’s Boss Fraught with Peril

Dealing directly with your boss’s boss can be hazardous to your workplace health, something I know from experience.  I used to work for a very large organization. The CEO was a whip-smart and affable guy. In my first few weeks on the job, I would banter with him on the elevator, but I did not have much direct contact with him. There were many layers of management between me and the CEO.

One day just before closing time, the CEO unexpectedly appeared in my Dilbert cubicle and sat down in front of me. Heads turned. Why was the CEO on this floor? Why was he talking to one of the new hires? Was he going to fire the new guy (me)?

It turned out that he wanted my advice on an issue. We had a five-minute discussion and he seemed pleased with my input. He gave me an assignment that would take me about two hours to complete. I told him I would have it done by the next morning. Always pleasant, the CEO stood up, thanked me, and walked away.

About thirty seconds after that impromptu meeting ended, my boss called me into her office. She was not amused. She gave me a dagger-like stare and demanded to know how I could have had the audacity to “go over her head.” I explained that the CEO had come to me; I had not initiated the meeting.

However, my boss did not believe me, instead implying that there was some conspiracy afoot. She suspected that I had been secretly speaking directly to the CEO for some time in an attempt to subvert her authority. I explained that there was no plot to overthrow her. I was just sitting at my desk when the CEO dropped by. While this explanation did not sound plausible, it happened to be true.

She must have subsequently talked to the CEO because her paranoia later subsided. However, I learned a valuable lesson: appearances count and one must always be keenly aware of the chain of command.

When there is an office manager in a dental practice, employees are often unaware this business etiquette. If they do not like the answer they get from their boss, the office manager, employees quite cavalierly go over that person’s head and ask the doctor the same question, hoping for a different response. The doctor is not an appellate judge who is standing by to overrule someone else’s decision. If the doctor reverses the office manager’s decision, then the office manager no longer has any authority.

To make the system work, employees need to know that going to one’s boss’s boss is not acceptable. The doctor has to back up the office manager almost all the time. When the office manager’s word means nothing, then the doctor has the worst of both worlds: paying an office manager who is not allowed to manage. If the office manager makes mistakes or handles situations inappropriately, the doctor has to coach the office manager to help that person grow, or, in some cases, replace that individual.

The good news is that many dental practices are substantial businesses. With good managers in place who keep the practice running and allow the doctor to take care of patients, the business can survive and thrive.



Hey Dental Team, Who’s The Boss in the Dental Office?

I frequently ask dental team members a disarming question: “Who’s your boss?” Almost all the time I get this unfortunate answer: “the doctor.” It is probably the correct answer but still not a good answer, because in so many dental practices, the doctor wears too many hats: clinician, manager, and CEO. The manager hat has to go.

This problem is seldom seen in medical practices. When a surgeon is in the operating room, he or she is not likely to be interrupted by someone saying that another employee wants Tuesday off and that is not going to work; team members complaining that the workload is not fair; or pleas for help dealing with a patient who insists on coming in tomorrow even though there is just no room in the schedule.

In dental practices the multi-tasking doctor is always under siege. Team members stalk him or her in the hall, the private office, and sometimes the treatment room. Decisions need to be made and only the doctor has the authority.

It is revealing that the organizational chart of most dental practices consists of the doctor at the top, with a flat line listing of all employees below. Everyone other that the doctor is on the same level on the chart. In business parlance, this means that the doctor has many “direct reports”—a small army of employees who need to get the attention of the boss/doctor throughout the day.

The solution is for the doctor to designate a true office manager, someone with the authority—not just the responsibility—to manage the practice and make day-to-day decisions. The office manager reports directly to the doctor, who of course oversees decisions, but the rest of the team all report to the office manager. In this way, the doctor can focus on treating patients while the office manager handles administrative matters.

No practice is too large or too small for a manager. Whether the practice has four, forty, or four-hundred employees, there needs to be a designated office manager to rescue the doctor from most managerial tasks and ensure that the doctor is kept busy cranking out dentistry, which is the way the business generates revenue.

Too many management tasks sap production time and wear down the practice’s greatest asset—the doctor. Years ago, when the pace of life was slower, offices were not bulging with technology, and patients were not in such a hurry to get back to their over-scheduled lives, the doctor could run the business and treat the patients. Now, however, the practice of dentistry is becoming more complex by the day and the overhead monster is threatening to eat the profits. To ensure continued practice success, the doctor needs to concentrate on dentistry, while the office manager does the rest.

For many practices, particularly small ones, having an office manager is a change of culture, and I help often practices with this transition. When the organizational chart is redone and team members are trained in new roles and responsibilities , everyone benefits from a more logical distribution of duties.

Next week: The political clash that occurs when team members want to go around their boss (the office manager) to talk to the “real boss” (the doctor).


Killer Interview Questions to Help You Hire the Right Person

Killer interview questions help you hire great team members  Start using these questions now.

I also suggest that you ask applicants to write a cover letter explaining their special talents or abilities. Applicants who do not include a cover letter should not be considered because they failed to do their very first assignment. You can learn so much from cover letters—including the applicant’s level of sophistication, their command of English, and the strengths they choose to emphasize.

Here are the questions:


Why are you applying for this position?


What special aspects of your work experience have prepared you for this job?
Describe one or two of your most important accomplishments.
How much supervision have you typically received in your previous job?
Why are you leaving your present job? (or, Why did you leave your last job?)


Everyone has strengths and weaknesses as workers. What are your strengths?
What would you say are areas needing improvement?
When you have been told, or discovered for yourself, a problem in your job performance, what have you typically done? Can you give me an example?
Do you prefer working alone or in groups?
What kind of people do you find it most difficult to work with? Why?
What are some things you would like to avoid in a job? Why?
In your previous/current job, what kind of pressures did you encounter?
What would you say is the most important thing you are looking for in a job?
What were some of the things about your last job that you found most difficult to do?
What are some of the problems you encounter in doing your job? Which one frustrates you the most? What do you usually do about it?
What are some things you particularly liked about your last job?


What special aspects of your education or training have prepared you for this job?
What courses in school have been of most help in doing your job?


What is your long-term employment or career objective?
Who or what in your life would you say influenced you most with your career objectives?

What would you most like to accomplish if you had this job?
What might make you leave this job?


What kind of things do you feel most confident in doing?
Describe a difficult obstacle you have had to overcome? How did you
handle it?
How would you describe yourself as a person?
What do you think are the most important characteristics and abilities a person must
possess to become successful in this position? How do you rate yourself in these areas?
Do you consider yourself a self-starter? If so, explain why ( and give examples).
What things give you the greatest satisfaction at work?
What things frustrate you the most? How do you usually cope with them?
What qualities are you looking for in a boss/supervisor?
What have been the sources of stress in your work history?
How so you deal with work related stress?
What was the last major problem at work that you were confronted with? What action did you take on it?
What have you done to further your professional development?


What motivates you to do your best work?
Can you give me examples of experiences on the job that you felt were satisfying?

Describe how you determine what constitutes top priorities in the performance of your job.


What are your standards of success in your job?
In your position, how would you define doing a good job?


Do others view you as a leader? Why or why not?
What approach do you take in getting others to accept your ideas?
What specifically do you do to set an example for your co-workers?


While these questions will certainly help you elicit insights from applications, please remember to consult with your attorney to be sure that all your human resources policies, including hiring, are in full compliance with all applicable laws and regulations.

David Schwab, Ph.D.

Marketing Dental Implants: New Teeth or New Car

Dental practices often use car analogies when talking to patients about fees for dental implants. A typical response to a patient who recoils at the fee for dental implant treatment goes something like this: Think about what it costs to buy a new car. Dental implant treatment lasts longer so it’s a better value. This message is good but it needs to be much more specific and cogent to be an effective way tool for marketing dental implants.

I believe that car analogies should only be used in certain situations. If the patient has been fully educated about the benefits of dental treatment, including quality of life benefits, and still has a hard time accepting the fee, then a skilled treatment coordinator can talk about the relative value of optimal oral health versus a new car.

The problem is that most patients are unprepared for a large dental fee. The average person may assume that a visit to the dentist for an exam, cleaning and x-rays will be in three figures. Patients also often know ahead of time that treatment for something more extensive such as periodontal disease or the fabrication and placement of one or more crowns will be in four figures. Few patients, however, are ready at the outset to come to terms with a five-figure dental fee.

Once the patient has heard the fee and is wrestling with the cost/benefit analysis, then you can talk about cars. Here is a great message for patients:

The average person in the U.S. buys a new car every six years. The average price of a new car is about $33,500. If we add an inflation factor and subtract trade-in value, the average person will pay over $100,000 for four automobiles over an 18-year period. Dental implant treatment typically lasts for decades. In fact, with proper professional maintenance and home care, many people have dental implant treatment done once and it lasts a lifetime. The bottom line is that dental implant treatment improves the quality of your life and over many years it is an exceptional value for the dollar.

Patients who have dental implant treatment often say that it was money well spent and they wish they had had the treatment sooner. Prior to dental implant treatment, however, it is often necessary to talk about value, and the car analogy has its place in marketing dental implants when explained properly.

David Schwab Ph.D.

Bezos Drives to the Post Office

In a television interview, Amazon founder Jeff Bezos said that in the early days of his company, he collected packages bound for his customers, loaded them into his personal vehicle, and drove them to the post office.   You won’t see Jeff waiting in line at the post office to ship packages these days. By Cyber Monday 2013, Amazon was selling items at the rate of over 300 per second! The company had net sales in 2014 of $89 billion and Amazon is on track for $100 billion in sales in 2015.

Jeff Bezos is an inspirational figure. He started a very small business, scoffed at his critics, and created an empire.

There are start-up dental practices that have few patients. There are doctors in these new practices who are wondering if they can generate enough revenue to keep the doors open.

While the challenges are daunting, there is always a market for excellent dentistry. Every day 10,000 people in the United States turn 65, and our youth-obsessed culture creates a continual market for cosmetic services, even as patients need care for periodontal disease, the replacement of missing teeth with dental implants, and basic restorative services.

The next time you wonder if your fledgling dental practice is going to succeed, think of Jeff Bezos carrying packages into the post office. He started with a vision, understood that people wanted to take advantage of easy, online shopping, and built his business even while the skeptics were wringing their hands. Now consider the latest brainstorm from Mr. Bezos: delivering packages to your front door via drone. It is easy to imagine all sorts of practical problems, not the least of which are drones falling out of the sky and causing hazards, but that vision of drone package delivery will probably also become a wide spread reality.

Entrepreneurs with imagination and perseverance often succeed, a lesson that applies to dental practice management.

David Schwab Ph.D.


Fire in the Trash Can: Dental Practice Management Issue

Quick! There’s a fire in the trash can in your dental office. What do you do?

You could move the trash can to another room even as it sprouts flames and then go back to business as usual. Out of sight, out of mind, you know.

But wait. Do I smell something burning? Of course! The fire is still in the trash can, and it’s spreading! Even though the trash can is in another room, the problem has not been solved, because the fire is not out. In fact, the situation poses a greater danger the longer it is ignored.

In many businesses, including dental practices, the short-term solution to many dental practice management problems is to, as it were, move the fire in the trash can to another room. Just pretend the problem doesn’t exist or hope it gets better without any intervention.

  • There is a problem brewing between two staff members in the office. Let’s change the subject and hope the problem goes away.
  • The number of new patients has been trending down. Let’s talk about that great case we had last week and put off grappling with the new patient issue.
  • One of the computers isn’t working properly. Let’s use the computer in the back while we hope miraculously that the main computer will get better with some rest.

One of the hallmarks of good dental practice management is to face problems squarely and solve them in a timely way while they are still controllable.

You may have gone to dental school and you may not see yourself as a firefighter, but one of your main jobs is putting out fires.   Follow all the rules: prevent dental practice management fires when possible, respond immediately when there is a problem, and put the fire out once and for all so that problems in the dental office do not smolder and reignite.

David Schwab, Ph.D.