For support organizations and dental service organizations (DSOs) to scale, they focus on developing a branding patient experience and a predictably profitable business model. They seek to maximize:

• efficiency while serving the needs of consumers,
• provide a wonderful patient experience, and
• increase both their top and bottom financial lines.

Dentists who have chosen the private practice way of life may want to reflect on the following 12 things DSOs strive to do in 2022, and then apply these tactics to their own business model. These tactics have been among the top topics of conversation at DSO meetings in 2021 and 2022 and will sound familiar to those who follow The Pankey Institute. Why familiar? Because they are top topics also discussed among private practitioners and many are addressed within the Pankey Institute curriculum.

1.Monitor more aspects of your clinical and business operations to determine what is working well and what problems need solving. Then solve the problems as rapidly as you can. As the practice leader, open your eyes and ears, and lead.

2. Track key performance indicators and seek growth in those KPIs.

3. Cultivate a positive practice culture and work environment in which employees want to work and patients want to visit. Team members should constantly check in with each other to communicate what is happening “now” and intentionally tune their senses to know how they can help one another. The goal is both a wonderful patient experience and a wonderful team experience.

4. Design systems and protocols with intention, follow them, and assess them for improvement. Make sure team members understand the Whys.

5. Invest in training your clinical and business teams. Especially important in the last two years are to:

• • Realize the potential of each team member and affirm they are valuable to the practice.
  • Educate clinical and front office teams in how to best engage and support patients with special attention to facilitating the treatments patients need. DSOs have targeted implant treatment and doctor-supervised, clear aligner orthodontics as two niches to focus their education efforts on with staff and patients.
  • Educate front office team members in how to appropriately maximize lead conversion, so the cost of expensive digital marketing can be contained. With increased new patient acquisition, reserve more time on the schedule for new patient appointments. In 2022, if new patients must wait, they tend to go elsewhere.

6. Maximize clinical technology to improve the patient experience and increase the efficiency and accuracy of clinical records, diagnosis, treatment planning, dental lab communication, and manufacturing.

7. Maximize practice management technology to improve the patient experience and increase the efficiency and accuracy of business operations, for example, AI enhanced software that automates billing and online collections or reviews insurance claims for accuracy prior to submission.

8. Migrate to a Cloud-based PMS system to ensure the security of your data.

9. Block schedule to do more procedures in a single visit. Patients and clinicians benefit from this efficiency. Maximize spaces in the visit—as you transition from one procedure to another, to enhance relationships with conversation.

10. Deploy a dental assistant to assist in hygiene, for example, to help clean and turnaround hygiene operatories between hygiene patients. This way, the hygienist’s relationship time with patients is not shortened or eliminated in the race to meet clinical demand.

11. Ensure adequate front desk coverage, so there is always time for those personable conversations that ideally occur when each patient arrives and leaves their appointment. Manage your human resources so almost all phone calls are answered live during business hours by a receptionist well versed in optimal conversation with dental patients.

12. Frequently ask, “What is our branding patient experience? What can we do better to meet the desires and needs of our existing patients and the prospective patients we target?”

Looking at this list, I can’t help but think that Dr. L.D. Pankey would smile. Just because you don’t have a corporate support organization helping you run your business doesn’t mean you can’t do these things on a smaller scale and possibly do them better.

When leaves are turning red and yellow and grasses are turning shades of pink and brown, most of us start anticipating the coming holidays. It’s a season to list everything we still want to accomplish by the end of the year…and it’s also a time to think more about others.

Not everyone experiences happiness during the holidays.

It would be wonderful and remarkable if every patient in your dental practice has fond memories of the holidays and has family and friends with whom they celebrate. But proactively working year around to know your patients has provided you with glimpses into what your patients really might be feeling.

Getting to know each patient has revealed recent losses…a spouse, parent, son, or daughter. It has revealed the emotional impact of divorce, job loss, the chronic stress of work or caregiving, and then, there are a multitude of worrisome health problems.

An idea for uplifting these special patients: Mass-printed holiday greeting cards can be turned into something special that touches these patients on a deep level. Some effort needs to go into personalizing the cards with handwritten messages but the message can be as simple as, “We want you to know that we are thinking of you during this holiday season. You are someone we admire and care about.” That special touch…a small act of kind outreach can make a beautiful, memorable impression on special individuals you have come to know, think about, and may be praying for.

The entire practice team can help in listing the few dozens of patients who would benefit most from personal notes. Everyone can pitch in to write messages. Everyone can sign the cards. Social wellbeing among your team members will be elevated by creating an open afternoon on the schedule to do this as a “family” of compassionate caregivers. Add lunch or snacks to make it a team party.

Tip for a Thriving Team from Gallup’s Wellbeing at Work: Operationalize your mission. You will clearly communicate your mission of genuinely caring for patients when you demonstrate to your team that you do care by investing personal effort. Doctors, this means writing personalized messages right alongside your team—and with enthusiasm.

Many patients become hyper busy during the holidays.

Cancellations and lateness occur more frequently in December. Despite best intentions of keeping their dental appointments, some patients overbook and overextend themselves. My personal thoughts are to be patient with them and do four things.

1. If your practice is large with many patients coming through your door daily, it may not be your regular practice to make confirmation phone calls. In December, make the extra effort to follow up text messages with personal phone calls. Have team members organized to make as many calls as possible.

2. Build value for December appointments via a Happy Holidays newsletter that sparks enthusiasm for your practice. Include a digital photo of the holiday decorations in your reception area and remind your December patients that you look forward to wishing them Happy Holidays in person.

Here’s an idea: What if you were to put together oral health care gift bags for a local group home or shelter and communicate to your patients that those coming in for appointments in December will have the opportunity to put their name on a card in a gift bag? You would spread community awareness, the spirit of health, and giving back to your community as a wider dental family.

3. Update your wait list of patients who might come in on short notice. Have those names and numbers at the ready.

4. When open time occurs in your schedule, have a mindset of gratitude: “Wow, I guess we won’t feel so pushed today. We didn’t expect we would have this time to breath and catch up a little.”

Your patients want to know what to do if they have a dental problem over the holidays.

Have a clear plan that you and your team members can engage around to respond when patients have emergency or urgent needs over the holidays. Tell your patients via your media (recorded phone message, newsletter, Facebook page, website blog, etc.) what to do if a dental problem occurs. Clear communication from you tells them that you are thinking of them and want to make it easier for them to manage life’s exigencies…even during the holidays.

Here’s to a season of doing our best and thinking of others!

In 1999, I participated in the writing of a 500-word bio of Dr. Lindsey Dewey Pankey, Sr. for his posthumous induction in the Pierre Fauchard Academy International Hall of Fame. Although he was born over a century ago, his legacy has impacted many thousands of dentists and millions of patients.

Sharing this abridged bio with you 20 years later means that the asterisked number of dental professionals instructed by The Pankey Institute has greatly grown. Nevertheless, I offer this to you in its original words to make his abridged biography more widely known.

From the Pierre Fauchard Academy International Hall of Fame of Dentistry, 1999

Dr. L.D. Pankey, Sr. Was born on July 31, 1901. He received his Doctorate in Dental Surgery degree from the College of Dentistry at the University of Louisville, practiced in New Castle, Kentucky for one year, then relocated to Coral Gables, Florida, where he practiced dentistry until 1969. In 1932, he became a member of the Florida State Board of Dental Examiners and served 12 years, including his term as secretary and chairman. Concurrently, he was a member of the American Association of Dental Examiners, serving as Vice President in 1942 and President in 1943.

Throughout his professional career, Dr. Pankey was an essayist, lecturer, and student.

Having made presentations before countless local, state, national and international dental groups, he was best known for his seminars on “A Philosophy of the Practice of Dentistry.” In 1956, his Philosophy lectures were organized into three-day seminars. Subsequently, a curriculum was developed whereby practicing dentists would attend a series of once-a-year classes over a three-year period. In these classes, Dr. Pankey helped dentists find fulfillment through building relationships with patients about the benefits of optimal dental care. He helped his colleagues seek a balanced life. And he inspired them to do their personal best for every patient.

Dr. Pankey also developed a procedure for occlusal rehabilitation. In collaboration with Drs. Arvin W. Mann of Ft. Lauderdale, Florida, and Clyde H. Schuyler of New York city, he developed a teaching manual. In 1959, they began giving seminars, attracting dentists from throughout the United States and many other nations. Their occlusal rehabilitation procedures became known as the Pankey-Mann-Schuyler Technique (PMS). He was acknowledged by the dental profession for this work by being elected President of the American Prosthodontic Society.

Over 7,000 dentists attended the occlusal rehabilitation and philosophy classes taught by Dr. Pankey. The dentists who attended these classes formed the nucleus of support for establishing The L. D. Pankey Foundation, Inc., and creating “The L. D. Pankey Institute.” The Pankey Institute was the first advanced dental education organization of its kind in the world. It opened the doors to its first class in Miami, Florida in 1972. The curriculum was organized into what has become known as “The Continuum,” a series of one-week classes taken at a pace that is convenient and pertinent to the growth of the participant.

Well beyond simply honoring its namesake and continuing his teaching, The L. D. Pankey Dental Foundation, established a higher mission for dentistry “to bridge the gap between what is known and what is practiced.” Since 1972, The Pankey Institute has instructed over 17,000* dental professionals from many nations of the world, affecting the dental outcomes and well-being of millions of patients. Dr. L.D. Pankey, Sr. was deeply committed to the Institute’s success, participated in its development, and lectured at the Institute up until the time of his death in March of 1989.

Dentistry, our beloved profession, is better because of the man we recommend for induction. The Academy is privileged and honored to induct Dr. Lindsey Dewey Pankey, Sr., into the PFA International Hall of Fame of Dentistry.

Why Patients Want Early Detection

For more than a decade, there has been an increase in the occurrence of head and neck cancers in the United States. According to the American Cancer Society, over 53,000 people in the United States will be diagnosed with oral or oropharyngeal cancer in 2020. Worldwide, new cases of oral and oropharyngeal cancer exceed a devastating 640,000 people per year.

Head and neck cancers include those occurring in the lips, mouth, tongue, and throat. These cancers are often referred to as oral cancer or oropharyngeal (back of the mouth and throat) cancer. There are two distinct pathways by which most people develop these cancers. The one most familiar is through the use of tobacco and alcohol, and the other is through exposure to the HPV-16 virus (human papilloma virus, version 16). HPV-16 is a more recently identified etiology and the same one that is responsible for the vast majority of cervical cancers in women. In less than 7% of oral cancer cases, there is no known cause, and it is believed that these cancers are related to a genetic predisposition.

While oral and oropharyngeal cancers are still considered uncommon, The Oral Cancer Foundation reported in 2019 that approximately 132 people in the US are diagnosed each day and one person dies from oral cancer every hour of every day. This sobering statistic has not improved in many years. The most recent statistics reported by the American Cancer Society indicate there has been an ongoing rise in cases of oropharyngeal cancer linked to HPV infection in both men and women.

Oral cancers have an 80%-90% survival rate when found at early stages. Unfortunately, the majority of oral cancers are found in the late stages and this is the reason for the very high five-year death rate of 43%. Late-stage diagnosis is said to be a result of many complex conditions including a lack of public awareness and a lack of professional screenings in dental and medical offices.

Automatically Include Cancer Screening

Within your exam fee, I urge you to include a thorough oral cancer exam. Make sure your patients know the screening is automatically included in your new patient and regular exams. While performing the screening, talk about what you are doing and why. Patients are becoming more and more proactive about their health and are more than pleased to know about the inclusion of the screening. This is a health-centered benefit of your practice that will distinguish you. If your patients are aware that you are doing it, they will mention it to others and their confidence in you will grow.

If you find you and your team are struggling to implement this, you can reach out to OralCancerCause.org for ideas and coaching.

Another Opportunity to Engage New Patients

My friend Linda Miles, co-founder of Oral Cancer Cause, says, “During the last few years of my teleconsults, I encouraged each dentist to develop a strong relationship with their local oncologists, radiologists and ENT specialists so that he or she would become the go-to dentist to do dental clearances for all cancer patients especially the head and neck cancer patients. In order to start radiation or chemo, all pending dental treatment must be completed. This ranges from hundreds to tens of thousands of dollars per patient to the practice. Dental Oncology is a growth path many should develop.”

Every one of you knows from your own experience with care providers that you want to have complete trust in them before accepting their recommended treatment. Your dental patients are no different, and that trust is affected by their entire experience with everyone on your care team. The dental experience in relationship–based practices increases this desire, because listening well to others is one of your priorities. Patients become at ease confiding their concerns with you and celebrating high points in their life with you. In your dental practice, listening well and acts of kindness generate positive emotions and positive memories of their dental experience.  

The Golden Rule 

Under daily situational stress, personal psychological stress, and oftentimes lingering physiological stress from the day before, preoccupation with internal concerns gets in the way of being truly present for the patient. The benefits of discussing this occasionally within team meetings foster a continuing positive culture of everyone striving to intentionally apply the Golden Rule with patients.  

When that aspiration is sustained and everyone on the team “takes care of” patients by “treating others as you would want to be treated,” the emotions experienced by patients are positive and support treatment acceptance. And, the genuine care you give others has a way of stepping down your own stress with the release of oxytocin.  

I’m speaking to all team members from the front to back when I say, “Practicing being truly present for patients until it becomes a natural habit is one of the greatest things you can do for them, yourself, your fellow team members, and the business.” 

A Few Extra Minutes  

If appointment times are increased by five to ten minutes, the clinical care team has more opportunity to converse with patients without stress developing, and in just a few more minutes a lot can happen. Conversations between care team members and patients help establish trust. These conversations also disclose patient feelings, concerns and unanswered questions. The sharing of this information with other team members can be used to create an optimal patient experience in this and future appointments.  

It takes just a minute more to share this information appropriately in handoffs to tee up the doctor-patient conversation about treatment and to support scheduling the next visit before the patient leaves. By the latter, I mean the business team at the front and the patient always need to be prepared for the end of the appointment when the follow-up treatment fee is presented and scheduled. This preparation includes communicating the why behind the treatment and true concern for the patient’s welfare.  

Same Page, Same Language 

Patient confidence grows when every team member is on the same page, is aware of the patient’s expressed goals and concerns, supports the treatment plan with why it is recommended and enthuses about the expertise of the practice. Using the same language helps too.  

In a relationship-based practice that focusses on these details, this is possible, and more treatment is accepted. If team members stop occasionally to ask themselves, “How was that handoff,” you will discover ways to improve how everyone “takes care of” patients through shared knowledge, empathy, and language. And knowing the Pankey community as I do, I see in my mind’s eye care teams around the world coming together at the end of the day to say, “Nailed it!” 

Patients gravitate toward and stay loyal to dental practices in which the dentist and care team love what they do.  

When you are enthusiastic about your work and how you do it, you can’t help but talk about it, can you? You can’t help but show it.

This enthusiasm affects patients in multiple ways. 

• Your happy office is a delight to visit under most circumstances. 
• The confidence you exude makes potentially stressful visits more comfortable and allows patients to trust in your care.  
• Their curiosity in dentistry and what you can achieve together is peaked. They ask more questions. This, in turn, sparks the patient’s desire to make changes in their health and smile. 
• Because your happiness has spread throughout your care team, the support patients receive throughout their experience is exceptional. 
• You surround them with so much positive energy they feel free to get to know you too. 
• Consistent happy experiences lead to patients feeling like they are among family and friends. 
• And, you’ve all seen this. Patients want to emulate your happiness in their own lives. They want to be like you. 

What is happiness anyway? The definition that I like is “the ability to feel satisfied with your life, to enjoy yourself and others, and to have fun in the present.” This certainly is what your patients enjoy when they visit. 

So, what brings about happiness in dental practice? Perhaps, you’ll agree: 

• Doing what you love to do most of the time, applying your talents and strengths 
• Being outwardly focused on the well-being of others 
• Effectively motivating and leading others to optimal health 
• Being true to your own personal values 
• Ever be it dynamic–Pursuing your own vision of practice (in the case of the dentist) and a coherent practice vision to which you contribute (in the case of team members) 
• Working in a care team that is high functioning with high EQ 
• Effective systems that facilitate doing what you love most 
• Ability to successfully problem solve and adapt with confidence 
• Patients who appreciate what you do together  
• Continuously mastering higher standards of care 
• Multiple moments of true connection with others every day 
• Understanding of yourself and others 
• Satisfaction with your life outside the office 
• Optimism and gratitude 

When it comes to diabetes, let your patients know about the impact oral inflammation can have on their health. Explain what you can do to help them and what they can do to help themselves. Clarify what they can do to take control so that they can live happier, longer lives.

Give your patients optimal assistance.

Include questions in your health interview about whether the patient has been diagnosed with diabetes, has been counseled about being at risk (prediabetic), and/or has a family history of diabetes. If your patient affirmatively answers to any of these questions, inquire about what they know about the link between gum inflammation and systemic diseases, such as diabetes.

Gently, explain why you are concerned.

Even if it is slight, gum inflammation is harmful when chronic. Let them know that among other health problems, persistent inflammation exacerbates diabetes and development of diabetes. It would help to tell them a story about an anonymous dental patient whose blood sugar decreased over a matter of six months and improved again within a year due to the elimination of gum inflammation.

Invite your patients to begin a new oral health regimen.

Let them know that you will partner with them to track their compliance, evaluation, and improvement. Inspire them with a story about another anonymous patient whose oral health and diabetes was improved by starting a healthier regimen.  They too can experience the healing power of making healthy choices and developing healthy habits throughout their life.

Your patients will start to report to their physicians, family, and friends about the conversations you have had with them. They will all be able to see the efforts you are making to control inflammation in their mouths, and the evidence of improved health. You might begin to see referrals from these patients and their doctors start to follow.

A patient’s feeling of comfort and trust is increased when you demonstrate you appreciate your team.

Showing appreciation to your team in front of patients demonstrates you respect the people who support you in serving patients. This only raises their opinion of your quality of care.

• When patients witness you calmly moving through moments of stress with instructions to your team delivered in a calm tone, a smile, and thanks, it speaks volumes to patients who are eager to have confidence in their care.
• When you spend time informing team members well and empowering them with knowledge of “the why” of your diagnoses and treatment plans, they naturally and appropriately prepare patients for your case presentation, answer questions, and encourage patients to move forward. Expressed gratitude for this support is a positive affirmation that creates growing team confidence, competence and job satisfaction. And this fosters a happy work environment and employee retention. Patients are highly attuned to team happiness and are relaxed among your loyal team members they have come to know. Again, this increases trust.
• A team’s feeling of appreciation will be undermined, and individuals easily become stressed when they are chronically overworked or asked to perform tasks they are not well prepared to do. Be alert to lead them through stress with assurances and demonstration that you care enough to take measures that will restore work balance and comfort.

There are multiple situational stresses that occur every day in your practice that produce the flow of stress hormones, 112 of them to be exact. And when there are stress hormones building up in the bloodstream, the physiological and psychological consequences are noticeable to patients. Fortunately, PankeyGram readers and participants in Pankey Institute courses and study clubs receive a constant flow of fine examples of colleagues showing appreciation for their teams. Showing gratitude doesn’t always have to be done in a big way or at great expense. A positive spoken affirmation in any given moment is going to release some oxytocin. And that’s what we want!

Janet Hagerman’s book, Selling Dentistry – Ethically, Elegantly, Effectively, presents a provocative and compelling analysis of how sales opportunities are missed by the entire dental team. Filled with practical solutions for how to feel good about your treatment recommendations and build your practice at the same time, Janet’s book focuses not only on how to be effective in your sales communications but also how to be elegant in your approach.

Selling Dentistry – Ethically, Elegantly, Effectively was born from a need, a cry for help from dental teams says the author and dental practice coach Janet Hagerman. Dental teams kept asking her how to stop dentistry from walking out of their doors and how to reverse the trend, so more patients would say yes to dental treatment.

In her book, Hagerman uses real-life examples and stories that come from her years of experience helping dental teams succeed.

According to Hagerman, dentists want to know how to sell dentistry. Their teams want to know how to sell dentistry. They want to move beyond an aversion to the “S” word to embracing the “E’s” of selling. Selling does not need to be controversial, says Hagerman, it’s about better serving patients and building trustful relationships, so patients accept the care they really need.

It comes down to surpassing external marketing and focusing on internal conversations with patients.

You are accustomed to consulting with patients about the association of TMD with craniofacial pain, but the link to sleep disorders should now be on your radar. Your patients want to know that you can help them sort out whether their frequently occurring headaches are the result of TMD, obstructive sleep apnea (OSA), a combination of the two, and/or other comorbidities.

Because research evidence suggests up to 50% of individuals suffering from morning headaches have OSA, every dentist likely has some sufferers they can detect, educate, diagnose, and refer or treat. If you are not already an expert in Dental Sleep Medicine, The Pankey Institute’s immersive Dental Sleep Medicine course is one of the best in the country.

A preclinical interview that includes questions about headaches will get you started with a co-discovery diagnosis for OSA related headaches and set you and your patient on the path for the most appropriate diagnostic testing and treatment.