In part one of this article, we learned how CarolinasDentist, an eight-location group practice in North Carolina, applied the insights gained from their use of metrics to provide better care while also experiencing record growth and profitability. These results were the outcome of an effort from the entire team to become a data-driven practice. We defined data driven as follows:
“A data-driven practice is one built upon and guided by the facts and meanings relating to key performance indicators. A data-driven practice embraces the insights received from data, even if those insights reveal flaws in leaders or systems. Problems are viewed as exciting opportunities to change and transform into something better. Perhaps most importantly, a data-driven practice is powered by a collaborative, blame-free culture that invites ownership and servant-leadership from all team members.”
In part two, we’re going to focus on the greater challenge of sustaining growth by using data to create a culture of accountability and ownership. In this regard, CarolinasDentist is no different than any other practice. They were subject to all the typical pressures and struggles facing many dental practices as they attempted to navigate the complex waters of providing great patient care and building and sustaining a small business. What helped them move through the hard moments and reach a state of sustainable progress was the healthy, data-driven culture they had worked hard to create.
Now more than ever dental practices must rigorously follow sound business principles, just as you also continually strive to adhere to high standards of clinical care. As this effort to improve unfolds, there will be inevitable roadblocks and dead ends on the journey. This focus on growth is likely to reveal strengths and weaknesses in your dental practice’s culture. Embrace this discovery, or in the vernacular of the day, lean in. Changing the culture of any organization isn’t for the faint of heart. It’s going to be messy and hard and at times even painful. It will also be worth everything it costs you if the result is a thriving team of leaders who take ownership of outcomes. This is the why behind creating a data-driven practice.
Culture is Critical
According to Josey Sewell, vice president of education at Dental Intelligence and former COO at CarolinasDentist, “We just made measuring performance a very normal part of our culture. It was how we talked and what we tried to model as leaders. This was especially important at the beginning, when we were introducing the concept of using data to measure performance to an existing team who hadn’t done this before.” So, how did the CarolinasDentist leadership team go about transforming their practice into a data-driven one?
“We started by helping our entire team connect measuring performance to patient care,” Josey said. “Showing each department and team member how using data would impact our patients made the transition easier. It was still a lot of hard work, obviously, but connecting everyone’s performance to the health of our patients was essential.”
The CarolinasDentist team also found it helped to show team members how practice data would positively impact their performance and opportunities for promotion, or how it could make their job easier. “Rather than picking out the things we didn’t like at first, we really focused on the wins and celebrated effort and progress like crazy, making it super positive and having a lot fun with it,” Josey recalled. “Maybe it’s a little competitive something or other such as ‘Who can do the most this?’ or ‘Every day, who’s going to log in the most?’ or other similar incentives. You can pick what works best, but creating some fun little competition and incentives made it more likely that everyone would engage.”
Leadership is so important in this process. Team members are looking to their leaders to see how they feel about implementing changes and if they really believe in what they are asking their staff to do. In Josey’s words, “I think that one of the most important things to do when you’re a leader or a manager, especially if one of your own metrics is low, is to be open and vulnerable about it with everyone. Pointing it out to them and saying ‘Guys, I had no idea I was so bad at this. I’m so glad I have the visibility. How can I be better? Can you help me be better?’”
When asked about other ways CarolinasDentist helped their team transition into using data, Josey emphasized the importance of showing how data helped in problem solving. For example, they used Dental Intelligence’s recare pie chart to help keep their ten operatories fully scheduled each day with the patients most in need of treatment. Instead of simply calling patients based on when they had last come in, they instead could build the daily schedule around predefined criteria relating to their highest clinical priorities. They did the same with their hygiene department. “We had a terrible cancellation and no-show rate and Dental Intelligence helped us identify that,” Josey said. “Once our hygiene team saw where we were falling short, they quickly took ownership of the problem and went to work resolving it. If we had just said ‘Here’s a big problem and what are you going to do about it?’ the response would’ve been much different. Letting them discover and then determine how they would resolve it was much more effective.”
They also found it was important not to try and fix everything all at once. “We tried to be incremental and patient with our implementation of measuring performance,” Josey said. “This gave everyone the space to really drill down into the problems and to not feel rushed in the process of solving them. You can analyze, manage, lead and empower people so that you’re not having to drag everybody along. But they’re empowered within their own role because people want to contribute, people want to do good at their job and don’t always know how.”
Lead People, Not Systems
Another one of the important lessons CarolinasDentist learned was to make sure owners and managers had a chance to process and understand new tools or systems before they were presented to the entire team. “If the dentist and office manager can go through the training first because they’re the ones who are going to have to field the questions, that can make a huge difference,” Josey shared. “When we first introduced our vision of becoming data driven, we skipped this step and it made for an awkward beginning. As a leadership team, we did a review and adjusted our implementation process so our managers and owners had a chance to evaluate and internalize what we were going to do. This gave them the space to ask important questions such as ‘How am I supposed to behave?’ or ‘How am I supposed to think about this?’ When your managers feel even 1 percent more confident than the team—they don’t need to be completely masterful—they’ll be much more effective in helping team members embrace these changes. We had to slow down to speed up,” Josey recalled. “One of the ways we did this was by having clinicians train other clinicians rather than having a manager or administrator handle this. It’s just one of those unique dynamics in a dental practice.”
When Josey was a practicing hygienist, she mentioned how much more likely she was to accept information from one of her peers, even if they were in a sales position. “If the salesperson had a background in hygiene, I was much more likely to accept what they were presenting versus someone without that shared connection, even if the information being presented was identical. We’re all more likely to listen to someone we have something in common with.”
This shared understanding also becomes important when using data to provide coaching or correction to a team member. Josey shared an experience of evaluating a hygienist’s performance and noticing she wasn’t presenting fluoride to many of her patients. “After we discussed the science of oral health and the importance of recommending fluoride to every patient, we took a look at her presentation percentage in Dental Intelligence and saw there was a gap there. Because of my background in hygiene, I completely understood what the issue was—most of the patients she was presenting fluoride to didn’t have insurance that covered this treatment. It doesn’t take long for someone to realize they don’t like to keep hearing someone say ‘no thank you,’ so they just stop presenting it. My background as a hygienist allowed me to be direct with her and ask ‘Who needs fluoride? Basically, 98% of the population, right? But looking at 100 of your most recent patients, only 10 of them got fluoride.’ After she had a chance to process that, I then asked her ‘Would you feel like a better hygienist if more people were accepting fluoride?’ ‘Yes, absolutely,’ she answered. ‘Okay, I said. Then let’s talk about the verbiage we use so more of those patients will accept fluoride.’ We talked about scripting and responding to people who reject fluoride because of insurance limitations by saying for example, ‘Research shows that fluoride is important, and this is going to prevent this and this and this. It’s $50, but your insurance doesn’t cover it. But as your hygienist, I would recommend it. What would you like to do today?’”
This all comes back to the culture of your practice. If leaders and team members embrace the importance of measuring performance and see it as a clear positive in their growth, these types of conversations will be perceived as needed and helpful. “Data shows where we struggle in our verbal skills, which can be a hard pill to swallow,“ Josey said. “In our minds we believe we have great case acceptance and then we see the numbers that say otherwise, and think the numbers must be wrong. Then we realize we may have some areas to improve. We have to get through that awkwardness and be firm with expectation. People who don’t like numbers are typically those who don’t like to be held accountable.”
A Team of Owners
As mentioned previously, a data-driven practice is built and sustained on the principles of culture and ownership. When everyone in the practice feels they have a part to play in the success of the practice, you are in a great position to grow. But how do you create an ownership mindset in your team members? Josey and the leaders at CarolinasDentist found this to be one of their most important steps in building and maintaining the data-driven practice they’d imagined.
“One of the ways we found most effective was by tying relevant metrics to the goals each of our team members set,” Josey said. “When we would introduce this concept to someone, there was usually some resistance, which we anticipated. If we provide vision and excitement and support, we would eventually hear something like ‘I know that numbers are great, but I don’t know how to do it.’ We loved hearing this! This moment of vulnerability is a powerful one for both the team member and leader. Tread carefully. After thanking them for sharing something like this, we would then propose a first step and let them personalize it. For example, ‘I want you to download the mobile app and I just want you to start looking at your schedule, look at your schedule and see if there are any holes and start to pay attention to the unscheduled treatment that’s on it. Are you willing to do that?’ Because of the trust we’d built up to that moment, the answer would almost always be affirmative.”
Another element of building this ownership mindset is asking team members several important questions. As Josey recalled, “We would ask things like ‘What are you worried about? What are you concerned about? Where do you feel like it’s going to get in the way?’ And then we’d be quiet and allow them to verbalize what they were thinking and acknowledging the things they were unsettled about. Not just asking for the formality of it, but actually listening and helping them work through that. And then, afterwards, just being able to say, ‘I know you’re nervous, I know you’re worried, but I’m going to ask you to trust me on this. Can I get your commitment for the next 90 days and can you commit to doing this and this and this from just those things? Even if you’re looking at one number a day, can you commit to doing that for me?’ And then when they make that effort, I’m really acknowledging and rewarding that because they’ve made the effort.”
“The hard part is being consistent,” Josey added. “When we were implementing Dental Intelligence into our practices, for example, we talked to everyone about how important it would be for them to begin using Dental Intelligence’s Follow-Ups system, which lets you customize your follow-up interactions with each patient. But rather than just saying to everyone – ‘use follow-ups’ – we would instead have an open-ended conversation with each user. For example, ‘We feel like Dental Intel follow-up calls should be something we’re doing every day and something we track. Would you agree? Tell me about your experience doing follow-ups.’ They would then share ways they had seen success using follow-ups and we would celebrate that. We then would ask them, ‘So, if we can agree these follow-up calls are really important, does that mean there should be a certain number of calls a day? A certain number of calls each week? And not just calls, but what do you want your performance to look like? How do you think we should measure success?’”
In summary, sustaining a data-driven dental practice isn’t complicated. Doing so doesn’t require 15 steps, multiple handbooks, or infinite staff training meetings to achieve. It does require a practice culture built on growth. Team members need to feel they have a say in how success will be measured and ownership toward reaching their goals. Culture and ownership. The building blocks upon which any dental practice can confidently develop and maintain the type of healthy growth they’ve imagined for themselves and their teams. Rome wasn’t built in a day. Creating and sustaining a data-driven practice will likewise require consistent effort, vision and creativity. Embrace the journey.