When Amanda started working for me, I hired her as a dental assistant. I owned one office consisting of two admin, three hygienists, and two assistants. I noticed very early that she seemed driven and ambitious. So I asked her, “What are your goals and dreams?” She replied, “Well, I really love teaching, so I may quit assisting to go work for a local assisting school at some point.” Now, I had been thinking about opening an assisting school for quite some time, but had never found the right person to help me run it. “What do you think about helping me start a school?” I asked her. She was ecstatic. We started the school small and grew it to two locations and, hundreds of employed assistants later, it is a resounding success.

People and the culture you create with them should be at the heart of your business. Without your staff, you don’t have a business. Finding good people who want to work is hard. However, by creating the right culture, staying away from work is the last thing on the minds of your team. Specifically, in the realm of DSOs (in which my business resides), the path to creating cultures is diverse. The culture you settle on ultimately will determine the team members you attract and retain. This will have a dramatic effect on the success of your business long-term. Ultimately, your business consists of three things: product (in my case group practice dentistry), customer (who the product is for), and producer/mover of the product (your staff). If you have two right, but not the third, you’re going to have a rough time! For the sake of this article we will focus on staff. Without a good team culture, your customer and product will suffer.

Fast forward a couple years from the start of the assisting school, Amanda was also assisting for general dentistry and feeling a bit bored. I asked her, “What would you like to be doing?” She replied, “You know, I really like surgery and I wish I could focus more on that.” Fortunately, we had just started a full arch implant center with a prosthodontist. Amanda gladly slid right over and started a full-time assisting job doing just what she wanted: complex full arch surgery all day long!

One extreme of culture is an authoritarian model of leadership. Leaders sit on their perch and bark orders to those below. Teams in these cases do not typically have a say in whether they want to do the thing they are being asked to do. They typically are seen as ‘lower’ than management. When things go wrong, it’s not management that takes the blame, it’s the team who failed to do their job. Also, a level of respect is demanded from lower level employees, regardless of whether it is earned or not. I know of offices who prevent assistants from talking to doctors unless they are spoken to. Division of duties is usually very hierarchical. Anyone above a certain pay grade is not expected to do anything ‘below them’ (such as clean up at the end of the day). Dental offices which operate like this can foster an attitude of fear and compliance in order to maintain order and discipline. The focus is on completing tasks, not on improving the system. McDonald’s is often used as an example of this type of systematization where anyone can plug into a roll and follow a checklist. This only works, however, when there is a corresponding personal mission and value given to the process of following this system.

The U.S. Navy (where I spent the first three years of my dental career) is a good example of this type of culture. It works well because job security is not a huge concern. It’s very hard to lose your job in the military. In private practice dentistry, however, you are really only one day away from walking papers during any moment in time. The culture of compliance and fear gives people a sense of order and discipline but also means it’s hard to feel valued for your personal contributions. This can stifle innovation and personal growth, which could help to grow a business to new heights.

After about a year or two of surgical assisting, Amanda seemed restless again. We decided that she should make a change to work closer to home. By this time I had two other offices in an adjacent town and they needed an assistant. She gladly accepted the position and became their go-to leader, helping that office grow from 250k per year in production when we bought it, to over a million just two years later.

The opposing culture to authoritarianism is where each team member is an asset to be cultivated. In my business, we have a much more nuanced and egalitarian culture which sees no one as above another. I hire more for character and potential than I do pure skill set. When I interview someone, I’m more concerned with whether they are someone who brings 100% commitment to being their best self to our business. My first observations have to do with whether they are who they say they are. When someone is proven to have good character, I ask them what their hopes and dreams are and how I can help them to achieve their goals? This allows the individual to see that they can have control over their own destiny within our business. As they pursue their version of excellence, they bring innovation and ideas to the group. Consequently, leaders are built from within.

One day Amanda pulled me aside and said, “I think I want to be an office manager someplace. Would our assisting school still be good if I worked for someone else? I don’t want to harm our relationship.” I said, “Give me a chance to find you a manager position.” Soon after, we bought and remodeled a practice within a short drive of her new home (she had recently gotten married and moved). The office manager in the practice we purchased decided to step down, immediately saying it was time to retire. “I got a spot for you!”, I announced to Amanda. She was absolutely thrilled and she’s currently helping us implement our standard operating procedures there right now!

When someone struggles in their job, or when someone really wants to grow, we strive to find new jobs for them within our company. With seven offices and an implant center, there is a lot of opportunity for growth. We have repeatedly taken individuals who were performing at a low or mediocre level and elevated them to success by finding them a job they were better suited for. As Gino Wickman says in the book Traction, “the employees have to G.W.C.: Get it, Want it, and be Capable of it.” Since I’ve created a business which is focused on using good talent when I find it, we either find a new position that they ‘GWC’ with, or we create a new position just for them. This enables our company to morph and grow as we strive to utilize the best resource we have: our team members. The next time you have an employee who is about to leave for one reason or another, ask them what their dreams are and use that to grow and expand your business. By taking their concerns to heart, giving them a new role and letting them do what they do best you are ensuring a culture where people know they have freedom and mobility. Your turnover rate and growth will both benefit tremendously!

Christopher Sortman, DDS graduated from University of Michigan Dental School in 2002. He completed his AEGD in Okinawa with the US Navy in 2005. He is currently CEO of Strategic Blue, an emerging west Michigan DSO. He can be reached at Drsortman@sb-dental.com