By John C. Cranham, DDS  

Sometimes you can see clearly where you want to go with your dental practice. I can vividly remember driving my car to St. Petersburg for my first class taught by Pete Dawson. It was 1989. When the class was over, I drove my little car all the way back to my 800-square-foot office in Portsmouth, Virginia, and arrived at four o’clock in the morning. I had just bought the office from a doctor who did mostly silver fillings—maybe only four crowns in the entire year. I remember I could visualize what I wanted to do with “my” practice but deciding the first steps was overwhelming.  

A dental office can be the loneliest place in the world. I had to figure out the attainable steppingstones. We didn’t have the internet back then. Finding mentors and connecting with supportive, sharing colleagues was more difficult. In dentistry today, it’s easier to find those steppingstones. One of the most rewarding things I do today is helping dentists develop. 

I caution dentists to not assume they will achieve their big goals fast. There is a temptation to give up when progress is slow. You’ve got to stay on the path to get to where you want to go. Think about your goals and steppingstones every day but be kind to yourself if it takes more time than you visualized.  

Remember that everyone is different. All your buddies are going to be in different cities, different socioeconomic areas, and different practices. They’re going to have different opportunities. Social media can be your enemy when it comes to self-confidence and determination. There will be certain people that develop faster.  

I can remember being very frustrated the first year or two in my little town of Portsmouth. There were dentists going through the same classes I was and were already doing the kinds of cases that I wanted to do but wasn’t doing yet. During the first two years in practice, I sometimes wondered if I would ever do the kind of dentistry I wanted. But I kept in conversation with my patients, eventually they began accepting treatments, and the floodgates finally opened.  

One of the greatest things about this profession is we can always strive to be great. I don’t think I’m there yet. It’s the striving part—the working at it and seeing things improve that makes it so fun and rewarding. I love it.  

People ask me, why are you setting BHAGs at this stage in your life? You’ve already accomplished so much. Why are you totally reinventing your practice systems? Why are you going fully digital after practicing on analog articulators for 35 years? 

What I’ve been able to do in dentistry is constantly reinvent myself, and I feel like I am growing in what I can do. So, I say it’s because reinvention is awesome. It’s fun. And my staff knows that if I get something working well, I’m going to find a way to make it even better tomorrow. 

By John C. Cranham, DDS 

Even today, after decades into family life, dental practice, and continuing dental education, I sit down every January to outline my BHAGs (Big Hairy Audacious Goals) for the year. I block out the first Monday after Christmas to do this, but for the previous month, I’ve been thinking about what new goals will excite me most. I commonly do this type of thinking while I am exercising and driving.  

It’s during these alone times that I can intentionally mull over the things I could do next. I pay close attention to which possibilities excite me most. Oftentimes, these are goals that I feel will benefit others. 

Successful people have the ability to create daily behaviors that direct themselves towards their goals and take them forward on steppingstones. One of the simplest, yet powerful things I witnessed Dr. Pete Dawson do is how he started each day. He would go to his desk and spend 15 to 20 minutes writing six things on a 3×5 card. These weren’t a To Do list. These were six things that would direct him toward his next BHAG. He would place the card in his breast pocket. He did this day in and day out. 

Two weeks before he passed, Pete came to my lake house on oxygen. When he arrived, I had to help him out of the car and into the house on his walker. I looked at his shirt pocket, and there it was, the 3×5 card.  

We don’t have to use 3×5 cards to make notes for ourselves. We can use our phones. But it is powerful to reflect daily on steps that will take us in the direction we want to go and record those steps to lock them in our memory.  

In dentistry, we need to carve out habitual time to think about our goals and steppingstones. We need to carve out time to take the identified steps. The point is to have a system in place where you are thinking about it every day, because there is so much coming at us all day long that we are at risk of drowning in the noise.  

When we get caught up in the mundane, life is less interesting and less fulfilling. At least that has been my experience. When you sense you are becoming bored, you might just need to identify the next big goal that excites you. The challenge of getting there will bring you back to full life. 

By John C. Cranham, DDS  

Having BHAGs (Big Hairy Audacious Goals) has been important to me for my whole life, whether it was the Ironman triathalon, getting the opportunity to teach with Dr. Peter Dawson, finishing my book, or setting big goals for my practice. The biggest things in my life that were important to me from a professional standpoint started with an idea that got me excited but seemed impossible. 

A BHAG has a way of motivating you when you think there’s a sliver of chance that you might be able to do it. You set it as a goal and proactively discover steps to work towards it; then you get out of bed each day intent on moving forward.  

People are “wired” differently, but I do think extremely successful people do this. Pete Dawson was like this. He died four years ago, and I remember being with him at my lake house two weeks before he passed away. He talked about a BHAG he was working on–a new book, and he showed me the layout he had in mind for it.  

If you don’t have a BHAG (the next big goal that’s exciting to you), it’s easy to get caught up in the day-to-day routine. I can think of times in my life when dentistry became mundane. 

One of the most amazing times in my life was right after I was invited to teach with Pete Dawson. I was on the faculty before I was the clinical director. After I was teaching there, there was a six-month period when I was a little depressed. I didn’t understand the feeling. One night at dinner with Pete, I told him I was struggling. We talked about it for a few minutes, and then he said, “It sounds like you need a new goal.” 

That hit me like a ton of bricks. Once I have attained a goal, I need a new aspiration to chase.  

BHAGs are our reasons to get out of bed every morning and be fulfilled by our efforts. Even if we don’t quite complete everything we visualize, we still end up in a completely different place. And in my experience, it’s always a better one. 

By Edwin “Mac” McDonald DDS  

Change isn’t just about external circumstances; it’s also an inner evolution. We go on a transformative journey, and our reflections as we go touch upon our intention and legacy, our personal identity amidst the change, and decisions we make as the change unfolds.  

Challenge 1: Intention and Legacy 

When facing change, having a clear intention is like setting the compass for your journey. What legacy do you aspire to leave behind? Aligning your actions with your deeply held beliefs ensures congruence between your intentions and outcomes. But stress may cause you to move away from your most deeply held beliefs. I’ve witnessed this happen, just as I’ve witnessed deeply held beliefs guide what happens. 

Challenge 2: Personal Identity Amidst Change 

The question “Who do I want to be during this transition?” is profound. It invites introspection. Consider how you want to show up for yourself and those around you, especially those who are most important to you. Authenticity matters. 

Challenge 3: Listening and Accountability 

Change often involves decisions. Whose voices matter? Listening deeply to trusted individuals—those who respect and understand you—can provide valuable perspectives. Forming a leadership team of diverse viewpoints helps guide you toward success. 

The Importance of Values During Dental Practice Mergers and Acquisitions 

Many private dental practices are being acquired by large partnerships in 2024. These transitions have tons of potential and profit associated with them. Associated with these transitions are complex changes for the practice owner and team members…expanded ownership, more complex organizational structure, new operational systems, and a distancing of some decision making. They also come with the unknown of who will be your future partners after the next sale of the organization. Are you prepared for all of that?  

Preparing yourself and your team is essential. On the front end, asking every possible question including questions about the partnership’s core values, how they are integrated into the day-to-day operations, and communicating the importance of that to you and your team is essential to long term success. These questions and expressions are an attempt to examine the congruence and compatibility between you, your team, and your new partners. 

I am witnessing several friends transition successfully to one of these new partnerships. The common factor I observe is that each dentist has great self-awareness and received very strong assurance that they would retain autonomy to continue to practice according to the most deeply rooted values. I also observed that the large partnership was very stable with excellent systems and had high quality leadership.  

My father often told me: “The person that you have an agreement with is more important than the agreement itself.” In other words, a person of strong character will find a way to honor the intent of the agreement regardless of the specific circumstances of the moment. Values have longevity. Circumstances come and go. 

I have also witnessed an abandonment of strongly held values as an organization was going through the painful changes of decline. In abandoning their values, stakeholders were hurt and distanced themselves. It intensified and accelerated the decline. Values matter. Character counts. Clinging to our core values in times of change or decline will increase and accelerate recovery. There are countless Fortune 500 case studies to support this idea. 

Another Example of Values in Transition from My Life 

Finally, I want to leave you with a case study from my church, The Village Church. We had become a multi-site church in response to the demand of many people attending our main campus. As it grew, our leadership became painfully aware that it was not fulfilling our mission and it was not consistent with our closely held values of community and individual relationships. Over a period of several years, each church was given the opportunity to vote on becoming independent. They all voted around 95% in favor of the change. We gave away around 40 million dollars of real estate, equipment, furniture, and other assets to all of the churches.  

Today, the new independent churches are thriving as is our main campus where we attend. The decision was in conflict with everything that is happening in our business and church worlds where there is constant consolidation and scaling. However, the decision was consistent with the values that drive the purpose of the church. The change created multiple thriving churches that are serving their specific communities and growing people and their impact on our world. 

By Mary Osborne, RDH 

How much time do you schedule for a new patient, non-emergency visit? Is your priority efficiency or effectiveness? Is your goal to gather as much clinical data as possible, or is it to begin to build a relationship of mutual trust? Both are possible if you see the new patient visit as more of a process than an event.   

Too often new patients are rushed through an assembly line: brief conversation, clinical exam, diagnostic records, and treatment presentation! Is that really the best way to help people make choices about their health?  

There is no one right way to schedule a new patient. Different practices are successful with different models based on the values of the practice, practice growth, and the personality and skills of doctors and team members. The most important determinant of success is our ability to meet each patient where they are and join them on a journey to health. I am not suggesting we should be without practice standards of care.  We have a responsibility to decide what we need before beginning treatment. Our challenge is to guide patients to understanding why we need what we need, and why that is relevant to their unique situation.   

We may anticipate that patients will resist this type of experience, but if we make it truly about the patient and are flexible, I have found that patients are more than willing to participate in an individualized process that best meets their temperament and circumstances. 

I remember seeing a new patient that I was told was a “very busy attorney” because his secretary said so when she made the appointment and his wife said so when she confirmed the appointment. I anticipated that he would be a driver and prepared to efficiently move him through his appointment.  

As I explored his health history with him he expanded on the specific answers to questions. Soon, he was leading the conversation. When I remarked that I wanted to make sure we were making good use of his time. He said, “Mary, what’s this about time?” I replied that I knew he was very busy. He said, “Mary, this is about me. I have time for me.” 

His statement has stayed with me because I realized that if the conversation had been about me going through my check list and not listening to him, it would not have been a worthwhile experience for him. It also wouldn’t have been a worthwhile experience for me. 

I have learned that when the patient feels in control of the process they are willing to give that time to themselves. A lot of aha moments occur as they learn about themselves while speaking. When patients feel like they are on an assembly line being moved through our system, they have every right to be resistant.  

Empowering patients to lead the process is both an attitude and a learnable skill. When we can lose ourselves in the moment, really listen, really encourage, and really care about the patient’s thoughts and feelings, it is easy to make connections to the next step we recommend.  It is my experience that I can more quickly become a trusted health advisor when I intentionally share control with my patient. 

Most patients are willing to invest more time in the process when they see the connection between their needs and what we recommend.  These are typically patients who have or have had complex health issues and are seeking to improve and retain health. They perceive the value of the extended process and how much value you place on spending in-depth time with them.  

The entire team’s communication can deliver the message that everyone in the practice is keenly interested in them, and their appointment is uniquely planned to meet their needs.  

What has been your experience? Are you open to scheduling more time for conversations that typically garner trust and appreciation earlier in the relationship? 

Laura S. Harkin, DMD 

I’m the owner of a third-generation dental practice. My father was a special person who cared for his patients as much as he did his dentistry. One important piece of advice that he gave was to make sure that my patient records were always complete and pristine. He said, “Anything that you are sending to the laboratory or to a specialist, even down to how you write your lab script or note, must be precise. And the reason is not only to minimize adjustment at the end but to also set an expectation for the same level of care returned by the lab or specialist.” 

As a team, we have spent time evaluating our models and photos to discuss how they can be improved and to recognize our highest standard. Recently, I became a little concerned about some of the radiographs we’d taken in the office. I encountered a few bitewings in which I was able to see the bone levels or the image wasn’t anterior enough to check the distal of the canine. So, as a team, we set aside time to review current x-rays and discuss the diagnostic qualities that we seek to achieve in each type.  

A team huddle provides built-in time and a safe place to do something like this. While reviewing the images, it became very clear that the team knew how to take vertical and horizontal bitewings. They also had a clear visual for how the images should look. Sometimes, however, a team member was shy about retaking an x-ray for they worried that a patient would be uncomfortable with the process. Other times, I imagine, they felt pressed for time and hurried to move down their checklist. 

Our review of images reinforced the level of care we collectively aim to achieve in all facets of our clinical day. Just as we strive for beautiful, mounted study casts, we take our x-rays with intention for our ourselves, our referral sources, and, above all, our patients. Consider taking a team meeting to share each other’s tips and tricks for taking x-rays in patients with difficult anatomy, a gag reflex, or missing teeth. Our own team members have a wealth of knowledge that sometimes doesn’t move from one treatment room to the next! 

By Pina Johnson, Professional Certified Coach, and Edwin (Mac) McDonald, DDS 

B.F. Skinner, a noted 20th century behavioral psychologist, conducted an intriguing and provocative experiment using laboratory mice. Using behavioral conditioning he was able to condition one group of mice to believe that through their actions they were able to determine their fate. Using the same methodology, he also succeeded in conditioning another group of mice to believe that there was nothing they could do to alter their fate. 

He then placed the first group of mice, the ones that believed their actions mattered, into a large tub filled with water. As anticipated, this group of mice, when placed in a life-threatening situation, acted instinctively and began to swim to the side of the large water-filled tub. Upon reaching the edge of the tub the mice were able to crawl out to safety. 

The second group of mice, the ones that believed that their actions were meaningless, when placed in the tub of water, simply sank to the bottom and drowned. Appropriately, the lack of responsiveness displayed by the second group of mice was termed “learned helplessness.” 

Culture Lifts or Sinks Ambition 

Belief that our actions and choices matter is essential to “making things happen.” 

According to Edgar Schein, an icon of modern leadership thought, the primary function of leadership is to create an organizational culture. The culture that we choose to create will influence every aspect of our organization and ultimately determine our dental practice’s success or failure. 

Value-based leaders understand the power to alter the course of the organization does not reside with a few; it is shared by many. Organizations with cultures based on shared beliefs and purpose are higher performing. Leaders of the highest performing organizations foster cultures rich in collaborative decision making and a profound belief that everyone has influence. 

Counter Learned Helplessness by Empowering Self-Confidence 

We have come to recognize that good-old “self-confidence” is a learned competency, and effective leaders create organizational cultures that promote and teach self-confidence to each individual team member. This is accomplished by empowering teams through collaborative decision making and ensuring each team member has been given the knowledge, skill, support, resources, and appropriate authority to accomplish each task required to meet the shared goal. 

Unleash Teamwork and Creativity 

In organizations with shared leadership cultures, human self-confidence is unleashed beyond saving oneself to act in the best interest of the organization. Knowing that our individual actions will have some effect on our organization’s future (and thus on our own future and the future of others we value) compels us to want to take actions that have positive benefit for everyone. This is “meaningful” for the individuals within the organization. This raises their engagement in the work and simultaneously generates a sense of wellbeing.  

In our dental practices, “We are serving others with empathy and care to ultimately improve their wellbeing.” This is a form of love. It begets appreciation and reciprocity. When the slings and arrows of daily life initiate negative thoughts of being out of control of a situation, remembering our purpose and prior successes enables us to see disappointments and frustrations as opportunities to create a new type of approach and carry on. 

The goal for effective leaders is to allow all of this to happen in a psychologically safe environment in which our staff need not fear repercussions for their well-intended actions even if the outcome of these actions is less than ideal. By creating organizational cultures that are psychologically safe, we draw out our organizational creativity which is often stifled by the psychological repression found in command-and-control cultures. 

Creative thinking is considered to be one our highest-level cognitive functions and has been found to be a distinguishing characteristic of exceptional organizations. The wise leader understands that their organization is best served through shared power, collaboration, and utilization of their organization’s collective creativity. 

By Mary Osborne, RDH  

The late Dr. Bob Barkley said your dental degree gives you the right to practice dentistry, but you have to earn the right to influence your patients. How do we earn the right to influence? How do we get that invitation we need to be invited into influence? 

There is a powerful tool you already have in your practice that can enhance your relationships from the initial visit through continuing care: a Health History. The Medical History forms most offices use are designed to efficiently gather information from patients about existing and previous conditions and diseases. Patients quickly check boxes. But it can do so much more. If you use health histories as opportunities to begin a dialogue with your patients you can also connect with them in the context of a mutually interesting topic — their health! 

I might begin a conversation with a new patient by saying “In this practice we believe that the health of your teeth is related to your overall health. I know you filled out this health history form and we can talk about the specifics of that, but I wonder if we could begin by taking a few minutes for you to tell me a little bit about your health in general.” Beginning with a conversation in that way it takes us out of focus on disease and opens the door to talking about health; what they know about their health, how they feel about it, and what they do to maintain health. Similarly, when a patient comes in for a hygiene visit instead of asking if there are any changes in their medical history, I might ask, “How has your health been since I saw you last?”  If we listen carefully to their stories about health, we will gather important clinical data, and we will also begin to understand their values. We will begin to co-discover what is important to them. 

The concept of co-discovery is frequently seen as having to do with helping the patient see current clinical conditions that we see. In that way, it’s a very useful tool. But I’d like you to begin to also think about co-discovery as a way of being in relationship with your patients. When you take a few minutes to have a dialogue about health you learn about your patients, as they learn about themselves. It is an opportunity for you to learn about their experiences, concerns, and perceived barriers to health—and it’s also an opportunity for patients to learn about themselves. 

In her book, “Kitchen Table Wisdom,” Dr. Rachel Naomi Remen says, “When you listen generously to people they can hear truth in themselves, often for the first time.” If you’ve had a conversation like this you know the magic that occurs as a patient realizes things about themselves they’ve never thought of before. As they speak out loud they hear themselves for the first time. I have found that if I show up as an understanding fellow traveler with a desire to learn, it opens the door for them to begin to see me as a trusted advisor. 

Paul A. Henny, DDS 

Oftentimes, perspective is everything. Our thoughts influence our emotions, and then our emotions influence our behavior. How we view our situation as challenging but surmountable, impossible and insurmountable, or somewhere in-between, influences the outcome itself. 

When challenged with a difficult situation, for example, chronic intra-staff turmoil, how we view the problem makes all the difference in the world. A conclusion of “That’s just the way people are and I can’t change it,” yields a very different outcome than “I’ve got to do something about this right now, because it is holding my practice back.” 

In 1960, Bennet Cerf made a $50 bet with Theo Geisel. Bennet, the founder of Random House Publishing, bet Geisel, already a well-known author, that he couldn’t author a successful book that only had fifty different words. 

Bennet lost the bet because Geisel saw the imposed limitation as a creative opportunity. The outcome was a book that would sell over 200 million copies. He titled it “Green Eggs and Ham.” 

It’s old news that dentistry is rapidly changing—and in some ways not for the better. But if we focus on the negatives, we automatically shut down the creative solution-oriented side of our brain. 

When we are locked into a glass-half-empty mindset, we think the glass will surely be even more empty soon. Einstein, Jobs, Edison, and Tesla avoided such thinking. That’s why they just kept on creating and overcoming seemingly impossible odds along the way.  

Thomas Edison said, “Opportunity is missed by most people because it is dressed in overalls and looks like work.”  

Putting on our overall and going to work is precisely how we should approach our challenges. We need to stop ruminating over what we think can’t be accomplished, because chances are quite good that they can be. Failing to do so will cause another day to be lost spinning our wheels instead of moving forward. 

Looking for inspiration and examples of creative opportunities in dentistry? My CoDiscovery book—available on Amazon and in the Pankey Institute’s online store, is full of them. 

By Bill Davis, DDS 

When Dr. L. D. Pankey was developing his Philosophy, he studied with many early American business authors and teachers. One such person was Napoleon Hill (1883 -1970). Hill was considered one of the earliest producers of the modern genre of personal success literature.  

Hill’s Early Life 

He was born in a one-room cabin near the town of Pound in the Appalachian area of Southwest Virginia. Unfortunately, his mother died when he was 9 years old. At the age of 13 he began his writing career as a “mountain reporter” for his father’s local newspaper. Later, he moved to Pittsburgh to work for a big city newspaper as a reporter. 

A Career-Making Assignment 

In 1908, the editor of the newspaper assigned Napoleon, who was the papers newest and youngest reporter, the job of interviewing the industrialist and philanthropist Andrew Carnegie. At the time Mr. Carnegie, known for his steel business, was among the most powerful men in the world. Napoleon was warned that Mr. Carnegie did not do interviews. Undaunted, Hill went to Andrew Carnegie’s office and told the receptionist he was a reporter and asked to speak to Mr. Carnegie. When he was turned down for the interview and told again that Mr. Carnegie did not like to do interviews, Napoleon didn’t give up. He came back daily and sat in the reception area. 

Persistence Paid Off 

During the second week of going in and out of his office, Andrew Carnegie asked, “Who is that young man waiting in the reception room.” Carnegie was told it was a newspaper reporter waiting to see him. That evening, at the end of the day, Mr. Carnegie went out to the reception room to see if the young newspaper reporter, who had been waiting quietly for over a week to see him, was still there. 

After they introduced themselves, Napoleon told Carnegie he had been sent by his editor to get a story. Napoleon told Mr. Carnegie he hoped to interview him and other wealthy people to discover a simple formula for success. Carnegie was so impressed that he took Napoleon to dinner to continue their conversation. 

This was the beginning of a great friendship, and over the next year they met regularly to develop the formula, as Carnegie also wanted to know the formula. Carnegie presented Napoleon with a letter of introduction to Henry Ford. Ford, after his series of interviews, introduced Hill to Alexander Graham Bell, Elmer R. Gates, Thomas Edison, John D. Rockefeller, and others. 

Hill’s Bestselling Book 

In 1937, Napoleon Hill published a bestselling book, THINK AND GROW RICH, which emphasized a positive attitude and having good communication skills. After reading the book, Dr. L. D. Pankey was very impressed by Hill’s statement: “Whatever the mind of man can conceive and believe, it can achieve.” Conceiving and believing are just the first steps to achieving your goals. According to Hill, you must take serious action. 

Every innovation, every invention, and every work of art begins with an idea. Long before the Wright brothers ever flew, Leonardo Da Vinci had sketched and designed an aircraft. Da Vinci conceived of mechanized flight, but the Wright brothers believed it was possible, they acted on that belief, and thus achieved flight.  

Hill’s Lasting Impact on Dentistry 

In 1929, L. D. Pankey had the idea that teeth could and should be saved, although at first, he didn’t know how. His belief was strong enough to motivate him to do some research, study what was known at that time, and do the necessary experimentation to make his idea a reality. One of the people he was most inspired by was Napoleon Hill. His model of ambition and teachings about how others achieved innovations spurred L. D. on. Belief in himself and his idea helped L. D. persist despite some uncertainty, blind alleys, and many other frustrations. 

The ambition and growing ability to save teeth was arguably the biggest change ever to occur in dentistry. From this concept, innumerable innovations have been born and are accelerating today. 

Where Would You Like to Go? 

There is an old Chinese saying, “If you do not know where you are going, you are likely to end up somewhere.”  

Too many people end up “somewhere” because they have not clearly defined where they want to go. The first step in moving toward greater satisfaction is to set specific goals. Vague goals such as, “I’d like to be a better dentist,” “I’d like to be happier,” or “I’d like to make more money,” are common.  

Napolean Hill would say that more specificity will take you somewhere purposeful. Perhaps, “I would like to learn about implant placement,” “I want to have more fun with my children,” or “I want to earn 15% more this a year.” Then, be evermore specific and set definite time frames so you can measure your progress. For example:  

• “I would like to begin training in implant placement this coming September and be placing implants successfully in June. Tomorrow, I will begin by investigating continuing education programs in the science of implants.” 
• “I would like to have more fun with my children. At dinner tonight, I will ask my children about ideas they think would be fun activities, and we will start by doing one of the activities each week.”  
• “I would like to increase my income by 15% this year. I will meet with my accountant and a dental practice coach this month to look at ways to increase my profitability. I will also do some more reading in practice management.” 

Believe in Your Goals and Your Ability to Achieve Them 

Once you have conceived your ideas, you must believe it is possible to achieve them. Without the power of belief, you will not take your ideas seriously; nor are you likely to weather the many setbacks and frustrations that will probably come along with you on your journey.