Over the past few months, I’ve had a series of coaching sessions with frustrated dentists due to many of their exchanges with team members not being as effective as they had hoped. The dentists were confident they had been clear about their expectations, and yet there was still lagging or even absent implementation of the anticipated behavioral and system changes.

“Maybe this is not the right team member! How can they not just do what I ask them to do?”

Of course, I appreciate how disconcerting this can be, AND I want to challenge the notion that a single conversation can lead to effective change.

I imagine we can agree that most of your patients are in the midst of their own developmental process, as dental offices have quality systems in place to support this idea. A patient comes in for a hygiene appointment and they are routinely scheduled to return in 3 or 6 months to follow up, monitor for changes, and (hopefully) celebrate new levels of health. We are used to the idea of having a return date, better known as a “recall appointment.” More often than not this system works. Over time, as the recall appointments continue, trust levels increase along with deepening relationships and even case acceptance.

The question I pose is this: How can you as a leader apply this same principle to coaching your team members? I like to call this system a Conversational Recall.

What if at the end of a coaching conversation, even a short one, you create an opportunity to revisit with the team member to assess progress, problem solve any obstacles, and set a time for yet another Conversational Recall? My own experience tells me that sustained change typically occurs by implementing small changes over time. Staying connected with a team member by offering ongoing feedback and support may very well be the difference between you being frustrated by unmet expectations and your ability to celebrate high performance and heightened levels of engagement.

One aspect of leadership is setting each team member up for success. You can do this by investing time and energy, walking alongside them, and committing to following up as a pathway to letting each person know that you care. One of the greatest ways to inspire change is to demonstrate to your team members that you both value what they have to bring and that you believe in them…sometimes even more than they believe in themselves.

Another aspect of quality leadership may just lie in your ability to be congruent in all areas of your practice; do for your team what you do for your patients—if not more. Care for your team like you care for your patients—if not more. The rewards for everyone involved could be incredible!

When I think of the small things my practice does on an everyday basis that have a big impact on patient relationships, patient satisfaction, and case acceptance, the first thing that comes to mind is what we call check-in and debrief.

Early in my practice years, way back when I was practicing corporate dentistry, when I walked into the operatory, the patient already had topical in place and my job was to get them numb. There wasn’t much of an opportunity to have a conversation. Over time, I learned the concept of check-in and debrief, which is really about how you can use the time at the beginning and end of the appointment to influence the relationship you have with the patient.

These are ideal times to build value for what the patient has agreed to do at that appointment and to tie the goals of the patient to the value of the treatment the patient is receiving, or you hope the patient will accept.

Usually, the check-in and debrief each take about two minutes. My assistants participate in this process with me, so they have increased understanding as well.

Previous Conversations Inform Me

I can be mindful and successful with my conversations if previous conversations with the patient were documented. My assistants take notes for me during my conversations with patients. I need to know:

• What is important to them,
• What they are hoping for, and
• What could get in the way of accomplishing what they believe is best for themselves?

My Check-in Conversation

During the check-in, I aim to converse about what we have planned to do and how this fits the overall goals of the patient. Usually, I enter the room and there is a little chit-chat. Then I ask, “What is your understanding of what we are going to do today?” The response helps me gauge the patient’s awareness. Following this conversation, I may ask, “What is your understanding of how this is part of your long-term health plan?” Or, if the patient has a stated a good understanding of what we are going to do, I say, “Yes, and this is how it fits into your long-term goals for your teeth.” They should now have a good sense of why the appointment time is of benefit to them.

My Debrief Conversation

During the end-of-the-appointment conversation, I aim to thank the patient for being cooperative, talk about what they can expect as a result of today’s appointment, and what they can expect as we move towards their preferred future. No matter what happened during the appointment, I want my patients to hear how much we appreciate them being our patients and being there today. When we talk about what to expect from today’s appointment, we can go over any post-op instructions, which are also presented in written form. Lastly, I want to give them hope that we are accomplishing steps on the road to their preferred future and that we can get there with their continued cooperation. I want to see the rays of hope register on their faces.

I believe all of this is of high value to the patient personally and in building value for the practice. It is well worth the time, and for me, it is a standard part of every patient visit.

For years now, I have followed this simple reflective process. I hope it proves to be helpful for you in your personal and professional growth. My reflection BAG contains Blessings, Accomplishments, and Goals. 

Blessings  

List all the blessings you are grateful for; family, friends, satisfying work, freedom to worship, health, warm home, living in America, etc. Give thanks for the blessings of life. Gratitude is essential to the journey, and too frequently in our “push” to “get ahead”, we forget our core blessings. Compared to these Blessings, getting ahead isn’t the most important thing. INVOLVE YOUR FAMILY THIS YEAR…even your two-year-old will feel the gratitude. 

Accomplishments 

Summarize all things you accomplished throughout the year. This is such an important step to write down because it never ceases to amaze me, when I reflect, just how much I have accomplished. I always need my calendar for this one because I find I forget all the little things I did do throughout the year. The journey can be so (apparently) slow and frustrating, that seeing how far you progress each year is very important. 

Goals 

Now that you are grateful for the mess you have gotten yourself into, write down your goals for the coming year. Come up with 20-30-50 ideas. Many times, the “best” ones are the last few that pop into your head. Remember the Pankey Cross and plan in all areas, Work, Love, Play, and Worship. Know Yourself, Know Your Patient, Know Your Work, and Apply Your Knowledge (this is a part of that). Spend as much (or more) time and money on the behavioral - communication aspects of care as you do the technical aspects of dental care. Plan to integrate Joy, Wonder and Relationships into your work. 

Set Aside Quiet Time to Reflect

Please set aside quiet time to do this. The first time it may take several struggling hours. I reflect several times a year and still set aside a few hours, but it has become almost like meditation for me and is one of the most important things I do for myself. I do this to continually refocus my efforts and to enhance gratitude. This has become part of my personal Peace process.

Thinking Beats Regurgitation

Throughout our education process we dentists are taught to memorize and regurgitate…not to reflect nor to think (I believe, at times, thinking is beaten out of us). We look to others to provide us the “answers” we might be missing that will guarantee our passing the tests (success). Sometimes we glance at someone else’s success and, thus, we let others define success for us — and we all are obsessive enough to bust our butts for an “A” to please someone else. If we just miss being perfect, we feel like such a failure. And for those of you paralyzed by needing to be perfect…Perfection is a disease. The goal is excellence, not perfection. John Wooden said it best:

“Success is the self-satisfaction in knowing you did your best.”

When we have experienced a deeply traumatic event, such as an emotionally laden death, or the near-death of a family member, what is often left behind is emotional debris with the potential to follow us around indefinitely. Subsequently, we can become haunted by memories of what happened, or what we should have done to make things better. These kinds of recurring thought patterns can easily bleed over into our daily lives and negatively influence our behavior—and our future.

On a neurobiological level, this occurs as our brain is designed to keep self-preservation as its highest priority. Thus, possessing the ability to quickly recall traumatic events protects us from similar things happening in the future. But commonly, this constant re-remembering can lead us into a state of psychological paralysis, depression and/or chronic anxiety, and poor decision-making.

At the present time, many patients live in fear of going to the dentist, because they believe there is too high of an infection risk. Concurrently, they consider the process of addressing their dental needs as being a lower life risk. These shadows of fear can remain strong in their mind, particularly when they have a family member who is in a high-risk category. Simultaneously, some dental team members have made the decision to leave dentistry for similar reasons. However, both challenges are happening at significantly lower rates within relationship-based / health-centered dental practices, as these practices have already built strong, enduring bridges of communication within their patient pools.

The Shadow

A contagious virus is a concept most people understand. The level of anxiety this virus has generated world-wide is something many cannot successfully manage alone. We have all had patients whose past dental experiences were so negative and their thinking about it so distorted they cannot recall why certain situations trigger their dental PTSD. Carl Jung referred to the source of these recurring thoughts as “the shadow.” Buried memories and their emotional associations can be so strong that they take complete control over a person’s behavior.

Letting Go

The brain does not stop maintaining its focus on traumatic memories until it has come up with a rational explanation for why they happened and a plan for how to avoid them in the future. On this, Jung stated, “Until you make the unconscious conscious, it will direct your life and you will call it fate.”

CoDiscovery was designed to address the influence of the shadow’s influence on current behavior patterns, in much the same way as psychotherapy facilitates the exploration of the past and associates new meanings with those memories. It is intended to help patients associate new meanings with what they are learning about their dental past.

The “Rogerian” therapy model of unconditional positive regard, congruence, and non-judgementalism is an ideal format for patients to safely explore their fears, beliefs, values, and priorities. And that’s why Bob Barkley and Nate Kohn, Jr., Ph.D., leaned so heavily on Carl Rogers’ work. Bob Barkley put this re-experiencing process under an umbrella he called, “Three Phase Adult Education,” and the rest became history.

The Future

As optimistic as the future appears to be regarding the successful management and treatment of COVID-19, this pandemic experience has reshaped our thinking—our “shadows,” forever. How we manage these memories, conscious and subconscious, will have a lot of influence on our success going forward. If we demonstrate we are on the same side as our patients in preventing COVID-19’s negative impact, we create yet another strategic advantage we can leverage against our transaction-oriented competition. On the other hand, if we allow our patients’ fear-driven “shadows” to drive their decision-making, we will rue the day we allowed this proverbial cart to be placed in front of their psychological horse.

Bob and Nate had it right. CoDiscovery is the pathway to deeper understanding, hence better decision-making. And better decision-making is exactly what our profession needs right now.

In previous parts of this series, we looked at a definition of leadership, the commitment it requires, and the first two of four universal promises of leadership. The first promise was the promise to set a clear direction and create meaningful work for the organization you lead. The second was the promise to engage all stakeholders and hold them accountable for performance. Now we will look at promise three.

The Third Universal Promise

You will ensure your strategies, systems and processes facilitate focus and execution.

Selecting the strategies, systems and processes that serve your vision best is a leadership function. Execution of the systems is a management function involving the entire team, including you, the dentist.

Strategies are designed to fit your destination. Strategies, systems and processes efficiently channel actions into results. The ongoing results create feedback for refining your focus, systems and processes. This promise of leadership is about keeping the team (and yourself) focused on execution and minimizing distractions.

Focus Versus Distractions

Practice owners are flooded with messages that distract them. The entire dental industry targets them with promotions for things, services, and behaviors. They are told many versions of what they should buy and should do in order to succeed. Other distractions come in the form of emotions and self-doubt that become barriers to living out their dreams. Those “should” messages, emotions and self-doubt serve as continuous distractions from everything that is important.

Leaders sometimes break the third universal promise of leadership by:

• Not providing or managing their critical resources.
• Allowing distractions that diminish their focus or lead to inaction.
• Ineffective or inadequate processes.
• Becoming addicted to the process rather than results.

Here are two examples:

• One of those distracting messages leads you to buy the latest and greatest technology. It uses up your capital resources, and you then hesitate to purchase the fundamental instruments, equipment and materials that your organization needs to perform at its best. If you were to live this all over again, you would have made a different decision. If you are clear that your strategies and budget are designed to get you to your destination, you can discipline yourself to refrain from such impulse purchases in the future.
• You read an article or talk to a colleague who is trying the latest hottest strategy for practice building. It is in conflict with everything that you have said that you believe in and hope for. You wonder if you are doing the right thing. Your doubt leads to team confusion and disillusion. This is getting you nowhere. Now you find you have to go back and clarify your vision, mission and values to reset your strategies, systems and processes as aligned steppingstones to your destination. With determination and hope, you can and will refocus and get back on track!

Keep Hope Alive

Breaking promises is exhausting and energy stealing. It builds resentment and degrades hope.

Our organizational brand and our effectiveness as a leader are about the promises that we make and keeping them. I firmly believe the first and last task of a leader is to keep hope alive…the hope that we are finding our way to a better place. That place is the destination we call our vision!

Until next week and Part 5

Life is a lot like a game, it’s a series of physical, emotional, and financial interactions with our environment and others. Sometimes we “win,” and sometimes we “lose.” And sometimes all we can do is just learn, so that the next time a similar situation comes around, the outcome will be more favorable for us. In this context, we can also view life as a series of negotiations… negotiations with ourselves, negotiations with others, and negotiations with our environment.

On this, psychologist Jordan Peterson, Ph.D. states: “You can’t negotiate from a position of weakness. You need to understand that if you want to advance your career and yourself you must negotiate with others. And this is because, even if you are competent at what you do, but you remain silent, you will be ignored. So, in the grand scheme of things, what you can do will not even be considered. You will just be a part of the background which is keeping everything functioning for everyone else.”

To develop ourselves, and to become successful, we must, therefore, be both competent AND strategic. We must be able to say to ourselves and to others (directly and indirectly), “This is who I am. This is what I believe. This is what I can do to make your life better, easier, or more fulfilling.” But that kind of posture, that kind of clarity, and that kind of purposefulness, is only useful within the context of a helping relationship, where the meaning of “better,” “easier,” and “more fulfilling,” can be discussed and negotiated.

In the posture of a helping relationship, we are in a position to make a better offer than doing nothing. Truly helping relationships with our patients require personal power, and personal power is both principle-centered and reciprocal, as the power actually comes from the other person and their belief in us.

In situations where we have no personal power, because we have not or cannot establish a truly helping relationship, we rely on other means to advance our agenda, such as leveraging convenience, emotions, pride, deception, loyalty to a third party, fear, and so forth.When we do this, our principles are lost, as is the greatest potential for the other person to believe in us.

Remember, you have the personal power to continually reassess relationships with patients and choose whether or not proceeding with a relationship in its current form is helpful. Helping the other person have personal power… creating experiences that earn trust… choosing to manage relationships with our patients first… then, offering true help and discussing why it is better… this is the path that positively influences everything else downstream.

In previous parts of this series we looked at leadership, the self-commitment it requires, and the first of four universal promises of leadership. The first was the promise to set a clear direction and create meaningful work for the organization you lead.

The Second Universal Promise

You will engage all stakeholders and hold them accountable for performance.

Engaging your team members is about the connection with each of them individually and also as a team. Getting to know and understand each person requires intelligent and thoughtful communication. This communication includes asking insightful questions, listening with all of your senses to the language used and the emotions expressed and experienced. This will expand your understanding and communicate significance to each individual in a very powerful way. 

You have heard this expression: ”Getting the right people in the right seats on the bus.” One of the most important functions of a leader is to evaluate the gifts and talents of each person so that you can put them to work in the best position on the team. Facilitating each individual’s understanding of how their work contributes to reaching our destination provides motivation, clarity, meaning, and accountability. ”Coaching as a Leadership Style” focuses much of our work as a leader on the development of the gifts and talents of the individuals in our organization. When this happens, we have really begun to bring out their inherent potential…the gifts, talents, discretionary energy, and passion of the individuals we lead.

From Ordinary to Extraordinary

Ray McElroy speaks on the topic of “To Boldly Go – Stepping Out of the Ordinary to the Extraordinary.” Ray’s background includes spending six seasons in the NFL with the Indianapolis Colts, Detroit Lions, and the Chicago Bears. A native of Chicago and a graduate of Eastern Illinois University, Ray also served as Team Chaplain for the Chicago Bears Organization from 2008-2013.

McElroy says, “Ordinary people with average talent can accomplish extraordinary things.” He urges us to “see where you want to be and work on getting there.” He asks us to ponder these questions:

• What do you know that nobody else knows? 
• What do you see that nobody else sees? 
• What can you do that nobody else can do or will do? 
• We need a team around us in the valley … Who’s your crew? 

I ask you to ponder these questions:

• Who on the team knows things no one else knows?
• Who on the team sees things no one else sees?
• Who can and will do something no one else can and will do?
• How can you best position team members to contribute their best?
• What do you need to do to better lead your crew?

From Compliance to Commitment

When the organizational culture supports people in such a way that they thrive, strive to contribute, and are valued for their contributions, there is a shift from compliance to commitment to the cause, resulting in dramatic increases in individual and organizational performance. It is a 1 + 1 = 3 phenomenon. 

From Values to Accountability

Our deeply held values become our standard of accountability, both individually and collectively. In Part 2 of this series, I provided the example of performing an After Action Review (AAR) in a morning huddle. When we debrief on previous behavior as a team, everyone is invited to reflect on whether we could have performed better to support our foundational values. One of the foundational values of how we work as a team in my practice is to encourage team members to discern and discuss failures to support our agreed upon values. Anyone is welcome to point out violations. We then look at behavior that violated our values and discuss what would have been better behavior. It provides clarity for everyone.  

A primary goal of leadership is helping each individual and the team, as a whole, become clear on the essential vision, mission and values of the organization. If we confuse, we lose. Clarity wins and is a primary driver of performance. 

Until next week and Part 4

When I bought my dental practice in Glendale, Arizona, eight years ago, they were offering patients a choice of flavors for topical anesthetic. I truthfully thought it was silly and that we would stop doing it. With experience, however, I came to realize that giving a choice was valuable for both patients and team members. Today we are still offering a choice of flavors.

When a patient is seated, the dental assistant will say, “As you know, as part of the process for getting you numb, we will be using a topical anesthetic. We have five flavors and you get to tell me which flavor you would like to use today.”

It is really interesting to listen to the dialog, but also to realize what is happening for the patient. The choice gives the patient an opportunity to settle into a conversation and something to focus on other than that they will be getting an injection and the logistics of that.

The process almost creates a fun, quirky conversation, as the patient thinks about the choices. Sometimes patients say, “You choose, and I’ll guess which one it is. Let’s see if it really tastes like that.” When patients pose themselves this challenge, the whole time I am giving the injection, they are trying to figure out which flavor of topical we have used.

Sometimes patients ask, “Which flavor is your favorite?” or “What do other patients like most?” In this case, we talk about it.

We have the mint flavors everyone else has but we also rotate in cherry, strawberry, bubble gum and pina colada. In summer, we offer watermelon. At any one time, we typically have five flavors and they vary throughout the year. A patient who has come in a few times, may even start the conversation with, “Do you have any new flavors for me to try today?”

One of my favorite conversations is whether the pina colada actually has rum in it and how funny it would be if we could just use the rum. An ice-breaker conversation such as this is a great way for us to ease the tension at the front end of an appointment that will require anesthetic. It truly adds an element of fun that has become for us a practice distinguisher.

In Part 1 of this series, I introduced you to a discussion about leadership and four universal promises of leadership. My next goal is to discuss the first of four universal promises of leadership.

The First Universal Promise

You will set the right direction and create meaningful work.

Each of us needs structure to live and lead effectively. Setting the right direction requires you to be clear on what your destination is. What story do you want your life and your life’s work to tell? Is it a story worth telling? Will it inspire other people to want to go with you? What will it take to get there? How and where do you start?

Clarity Will Transform You

The structure of destination and meaning comes from your vision, mission and values. Your vision is critical to communicate a clear picture of your destination. Your mission is critical to understanding what you must overcome and connecting each person’s role to it. Values guide us from deep within.

The process of clarifying your vision, mission and values sets into motion self and organizational transformation.

Your vision transforms you into an Inspiration Maker.

Your mission transforms you into a Meaning Maker.

Your values transform you into a Behavior Maker.

Vision is the inspiration maker for the organization. It is the destination that the organization is traveling to. Jason Bourne’s vision was to get his identity back from the evil CIA unit that stole his identity. His mission was the very dangerous actions that he had to undertake in order to get rid of the bad guys and get to the truth.

Mission is the meaning maker for the organization…It is about the conflicts, barriers, and work that must be overcome to reach the destination. In a Nike commercial, the athletes are pushing their physical limits in training (Mission) to become a champion (Vision).

Values are the rules of behavior for everyone in the organization, including the leader. They are the boss. When anyone violates the values that they have agreed to, it becomes obvious to all. The leader makes himself/herself accountable to the team and asks for them to confront him/her if he/she violates them. Values are grounded in our most deeply held beliefs and often integrated to the framework of our faith.

In other words, vision-mission-values are for the benefit of the organization. And, yes, the leader must become them as well.

When your vision, mission and values saturate your organizational culture, you begin to enjoy the rewards of that effort. The shared mental model provides structure for thinking with one mind, speaking with one voice, and feeling with one heart. Your energy and effort are channeled into one powerful coherent force that is aligned at all levels and moving in the direction of your destination.

After Action Reviews

Here’s an example of how in my dental practice we routinely review whether we are on course to our destination in alignment with our values. Recently, in our morning huddle today, we did an After Action Review (ARR) of our performance as a team on the previous afternoon. It was a routinely busy day that got pushed in the last two hours with several important emergency appointments.

An AAR examines the performance of the entire team and asks key questions:

What did we intend to do?
What did we actually do?
What were the results?
What would we do next time?
Were our actions consistent with our values?

I started the discussion. Quickly, several key team members expressed their thoughts and emotions that our performance as a team did not produce the results that we want and were not consistent with “Who We Are” and “Who We Hope to Be” at our best. It was a difficult but very productive conversation…and I think essential to creating better future performance.

These kinds of conversations invite every team member to have a voice in the critical moments of how we perform as a team, which increases the meaning of their work and recognizes the value of their contributions. It also allows us to evaluate if our behavior and performance as a team is moving the practice in the direction of our vision. Clarity wins. These conversations clarify.

Until next week and Part 3