Five P’s for a Better Future

November 12, 2020 North Shetter DDS

In times of disruption, small changes can have a large impact. Follow the 5 P’s and see where Proper Planning to Prevent Poor Performance leads you.

Those of you who experienced the joys of boot camp may remember the 5P’s: Proper Planning Prevents Poor Performance. Since we are all stuck waiting to get back to the office, now is a great time to work on plans for a preferred future.

Although we will be opening in a disrupted world and the market we left has been transformed by forces outside our control, good business principles and practices remain valid. Here are some key performance indicators adapted from Roger Levin’s 2019 article about the KPI’s every dentist should know.

Production, Collections and Profit

Review your production, collections and profit for the last 12 months. Levin points out that the trend on each of these items should be up. Sounds simple but it is not. Dig in and analyze deeper. Start with monthly figures and look for trends, then weekly and daily. What are your most productive procedures, days, time of days? When was your last fee increase? Analyze your outstanding accounts. You should be collecting 98% with only a small percentage over 60 days outstanding. How much are you writing off due to insurance mandates? How profitable are you? Have you set any goals? Understand that any item in your practice that is not true overhead is profit. Now you are ready to start working “on” your business.

What percentage of your active patients is currently scheduled? Nobody should every leave your office without another appointment. Your goal should be 98% of active patients are scheduled for some form of care. What is your case acceptance rate? Are you tracking patients with planned treatment that is not scheduled? What is your average production per patient? What is your average production per new patient? It should be at least two times greater than existing patients. What is your hygiene cancellation rate? If you are not happy with what you are learning, now is the time to be planning for better outcomes.


Now is the time to carefully assess every item included in your overhead. If you have a practice generating a million dollars, a 2% decrease in overhead is $20,000 directly to profit. Levin Group tells us that general dental practices should have overhead at 59%. Very few practices meet that goal. It is very likely that new mandates from the government will be coming for PPE and testing. Now is the time to get lean and mean in this area.


Are you tracking your monthly new patient growth and your patient attrition? With all the media attention to aerosol spreading of Covid-19, it is likely there will be resistance to treatment and dentistry in general. Knowing your current situation is important. It is imperative that you use every means available to help your current and new clients understand that you are concerned for their health and safety as well as to emphasize that deferring treatment will only lead to future more difficult and expensive problems.

Staff Costs

The elephant in the room…staff costs in a general dental practice should be 25% of collected production. Your team members are the most expensive and most important part of your business. You may want to share your homework with your team – or even involve your team in the exercises above.

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About Author

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North Shetter DDS

Dr Shetter attended the University of Detroit Mercy where he received his Doctor of Dental Surgery degree in 1972. He then entered the U. S. Army and provided dental care at Ft Bragg, NC for the 82nd Airborne and Special Forces. In late 1975 he and his wife Jan moved to Menominee, MI and began private practice. He now is the senior doctor in a three doctor small group practice. Dr. Shetter has studied extensively at the Pankey Institute, been co-director of a Seattle Study Club branch in Green Bay WI where he has been a mentor to several dental offices. He has been a speaker for the Seattle Study Club. He has postgraduate training in orthodontics, implant restorative procedures, sedation and sleep disordered breathing. His practice is focused on fee for service, outcomes based dentistry. Marina Cove Consulting LLC is his effort to help other dentists discover emotional and economic success and deliver the highest standard of care they are capable of.




Building a Culture of Agreement

July 10, 2019 Denison E. Byrne, DDS, MAGD

Enabling Your Team to Bring Their Best to Collaborative Problem Solving

One day, several years ago, our dental practice was facing an imminent snowstorm. We could see that the storm would play havoc with our professional and personal schedules. Decisions had to be made about our response. Should our plan be the same as the last time the office had been closed by weather? People were beginning to get nervous about how this was going to play out. A clear decision and well thought out plan were called for, but there was no one right answer. We needed to quickly make a collaborative plan (an agreement) to distribute power and communicate with our patients.

Planning for Contingencies

As in the case of the imminent snowstorm, I believe there are frequently practice decisions to be made for which there is no one right answer – no one strict plan that we can establish ahead of time and not expect to modify. Many variables need to be considered each time as the circumstances of owners, team members and patients change.

Collaborative planning takes “high engagement,” insight and practice. If you have preplanned team agreement on how to handle special events, you are ahead of the curve, but you will find it helpful to visit these agreements periodically, and you can anticipate you may need to collaborate “on your feet” when contingencies arise.


Last year, at “Inspired Team Facilitation” with Joan Unterschuetz, we did role-playing that helped the team develop a collaborative plan for which every member of the team had buy-in and agreement. Role-playing has helped our team huddle in an emergency to clarify what needs to be done, who can best take the lead on each task, and acknowledge the compelling reasons why we are doing this as a team. It also has been helpful to prepare each department leader to motivate team members who will help them make sure we effectively communicate with patients, assure patients, and shut down if we need to do this swiftly; then in reverse, open up the practice and zero in on what needs to be done to open the schedule and reschedule patients as priority dictates.

Agreeing to Agree

From the earliest time possible, work on building a culture of agreement around:

  • Team meetings with high-engagement of all stakeholders
  • Understanding problems to be solved and why they must be solved
  • Respecting all team members who would be affected by giving them a voice in the planning
  • Understanding that department team leaders will be accountable for execution
  • Coming to joint agreement and celebrating that fact at the time the agreement is made

The goal of these “coming to agreement” exercises (even about the small stuff) is to set a standard of collaboration that is in alignment with your practice philosophy. When an emergency arises, the team knows from experience that they can quickly collaborate and come to agreement on a plan of action…even when there is no one right answer and you need to kick start action immediately. If your collaborative meeting goes off track, the dentist as practice leader needs to remind everyone of the compelling reasons why they need to come to agreement now.

Can’t Involve Everyone?

Sometimes involving everyone is not possible in a crisis, but the goal is still the same. The goal is to be on the same page and united in decisions. All team members need to be informed of decisions, so if you and your department leads need to quickly create an agreement, the leaders will report back to other team members for implementation and keep them in the loop. Keeping everyone in the loop honors them and combats the human response of making false assumptions and experiencing energy-consuming emotions. In a culture of agreement, there is less opportunity for negative energy to accumulate—less “drama.”

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About Author

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Denison E. Byrne, DDS, MAGD

Dr. “Denny” Byrne graduated from the University of Maryland Dental School and has been in restorative practice in Baltimore for 40 years. He is a member of the Pankey Faculty and Co-Director of Pankey Learning Groups. In addition to being the husband of a dentist, father of a dentist, and grandfather, he is keenly interested in facilitating small group learning, golfing and sailing. He enjoys cooking and is a fan of C.S. Lewis.