Good to Great: What Elite Practices Do Differently

Jim Collins’ best-seller, Good to Great, graces almost every top-10 list of best business books of all time. If you haven’t read it, you should (and no, we are not on commission). I remember reading the book years ago when I was working with Dr. Gordon Christensen on publishing our study, The Business Side of Dentistry, and thinking, “I wonder what set of factors separate top practices from the underperformers.” What is their secret sauce?

After enrolling at Harvard Business School, this question was still burning within me, and I decided to team up with a classmate, Matthew Lingenbrink to figure it out. Matt was a management consultant at Bain and Company for the past four years, where he worked with executives from Fortune 500 companies on operational improvements and strategy. Over the past year, we interviewed practices across the country and are

What is Their “Secret Sauce”?

happy to share with you what we have discovered.

What is a Top/ Elite Practice?

We define an elite practice as one that

fulfills the following three criteria: (1) it produces more than $1.5 million in revenue per dentist; (2) its employees score at least an average of 9 out of 10

Josh Turnbull, DDS

on a Satisfaction/ Promoter Score1; and (3) it is highly profitable (with a minimum of $500,000 net income per dentist annually).

Matthew Lingenbrink

Josh Turnbull, DDS and Matthew Lingenbrink Power To Succeed

employee loyalty to their organization, motivation to do their work, satisfaction with their lives and a sense of unity and esprit de corps. Companies with strong corporate values outperform those without – generating four times the revenues, seven times the job creation, twelve times the stock price and 750 percent improved profit performance2. Vision statements are typically developed by the founder and owner of a company (i.e., the dentist). Mission statements and core values are often developed together with the members of a team. We have seen practices take a staff trip or dedicate an evening in the practice where they order in food to hash out and share ideas to create their mission statement and core values. Involving the staff in the creation process is crucial, because they feel like they own it. We recently witnessed one of these meetings and found it to be a very energizing, teambuilding exercise.

Although each practice was very different, we identified the following five factors that are clearly noticeable in elite practices and are often missing from underperformers:

1. Vision/Mission Statement A vision statement describes your company’s long-term goal. A mission statement describes what you stand for. All great companies in the world are guided by a vision/mission statement. Top practices understand this and are much more prone to invest the time to develop one and make it an active influence in their practice. They understand that vision/mission statements inspire patients and motivate staff to invest themselves in the practice. They imbue both patients and staff with a greater sense of pride in their association with the practice. And they set the strategic direction, define the culture and underpin the systems and processes that help the practice stay on course.

Creating a real, breathing vision/mission statement that has a sustained impact on your practice can be challenging. Followthrough is critical. We have seen the following from top practices:

Top practices are also much more likely to have a clear set of core values. Research has shown that shared values create increased

Select a core value to focus on for the week and read it in morning huddles. Provide an award in the Monday morning meeting to the employee that best demonstrated that value the prior week. • Post the practice vision/mission statements and core values somewhere visible for staff and patients to see – in the waiting room for patients, in meeting and break rooms for staff, and on the practice website for the general public. • Read customer reviews in morning huddles and highlight how they reflect core values. 2. Great Leadership Dentists of top practices are not always energetic, gregarious and charismatic, but they are very good at motivating their people. Here are three ways in which we saw them do so:

a. Pride and Impact: Top practices

have very distinct cultures that flow from their vision/mission statements. They have high standards of excellence and people feel fortunate to be a part of them. There is also a very innovative spirit about these practices and a focus on continuous improvement. People are expected to bring their best ideas and there are systems to encourage and reward the behavior. b. Rewards and Recognition: Com-

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education (CE) courses. They also regularly sponsor staff throughout the office to attend CE courses.

3. Constant Focus on Goals and Metrics It has been said, “Goals that are not written down are just wishes.” Although each practice differs in the metrics it tracks, the top practices have a much sharper and consistent focus on measuring and following up on goals and metrics. However, it is very important to point out that the top practices we observed have all been in business for over a decade and have put patients before profits. As such, their goals do not affect the way they treat patients. They simply help push them to work more efficiently, market more effectively, etc. Here are some of the goals/metrics top practices set/track that underperformers often do not:

of a company (i.e., the

dentist).

pensation is necessary to keep your employees around, but not to keep them motivated. In fact, even wellpaid employees can be unhappy if not properly recognized. Top practices are very good at regularly recognizing their people for achievement and effort. From our interviews, we found that personal recognition was a much more powerful motivator than financial bonuses or rewards. c. Professional and Personal Devel-

Production: Yearly/monthly/daily production. Also, production per hour for each provider. This latter metric is one of the most significant because it measures efficiency and helps identify variability by provider. • Marketing: New patients, source of patient referrals, ROI from each method. • Utilization: Cancellation/no show rates, percentage of patients with appointments scheduled.

opment: People need to feel stretched, even when they do not realize it. Doctors of top practices set the expectation that their staff continually improves in their profession – encouraging them to read the latest dental literature, share their learnings in team meetings and pursue the latest continuing

Clinical Treatment Planning: Treatment acceptance rate, SRP treatment percentage. Top practices are very good at identifying trends, diagnosing holes and dips and working hard to constantly exceed goals and improve.

1. Clear Roles and Responsibilities It’s no secret – dentists are not good at holding their staff accountable. Part of this stems from the fact that they are unsure what people should be accountable for. Top practices have very clear roles and responsibilities and typically have regular performance reviews (at least semi-annually). Great dentists at top practices strike a good balance of rewarding employees when they exceed expectations and being willing to let them go if they are chronically underperforming.
2. Exceeding Patient Expectations The little things mean a lot to patients. The after-hours phone call to see how they are doing after a difficult or long visit to the practice. The hand-written thank you

1 A Satisfaction/Promoter Score measures employee motivation and satisfaction. Employees are asked a series of questions, which include: “On a scale from 1 to 10, with 10 being the highest, how likely would you be to recommend a friend or colleague to work here?” and, “On a scale from 1to 10, how likely would you recommend someone to get be a patient and get treatment here?

We are convinced that

if practices focus on these five principles,

they will move the needle from average or

good to great.

2 Kouzes, James, Posner, Barry. (2007). Leadership Challenge (4th Edition). San Francisco: John Wiley & Sons. (pp. 79-80).

card for referring a friend. The extra time spent on a new patient exam to get to know the patient and address her chief concern. Greeting the patient by name and with a smile. Remembering things in his personal life. These are the things that patients do not expect – and love. These things convert them from passive patients to evangelists for your practice.

These five principles were common themes apparent in many top practices. We are convinced that if practices focus on these five principles, they will move the needle from average or good to great. These principles are powerful and will bring a greater sense of excitement and purpose to you and your staff. ■

Matthew Lingenbrink: Consultant at Bain and Company, the world-renowned consulting firm, where he helped leaders of Fortune 500 companies with strategy and operational improvement before attending Harvard Business School. He also graduated magna cum laude with a masters degree in Accountancy from Brigham Young University.

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