The Big Picture

Gregory L. Psaltis, DDS

If you were at my office in Olympia, Washington and asked directions to the state capitol building, I could easily guide you there. Turn left out of my office, west at the 7-Eleven, straight past Ralph’s Thriftway and the new fire department, left at the old fire department and head south. These are all familiar landmarks to me and represent completely clear directions. If you don’t live in Olympia, you might be lost. In the same way, employees in a dental office may not know how to reach the office goals because the directions are clear only to the dentist.

In my own experience of private practice, I feel as though I have specifically stated my vision of what I want the practice to be. This has been during Team Meetings, during individual conversations and in my daily interactions with clients. In spite of my best efforts I had Team members come forward and essentially say that they didn’t know what I expected or wanted. It was at those crystallizing moments that I recognized that my efforts had fallen short in providing a picture for my Team members. My intent was there, but the impact was not. In short, the picture that was so clear to me was not conveyed to my co-workers. This could be true in your practice, too, and might be holding you back from having the practice you’ve always wanted.

It is not possible for any group of people working together to reach goals or to work with specific intent if the values driving them to those goals are not clearly identified. Everyone entered dentistry for different reasons. As we become so busy in our work, the original core values that drive the practice can be obscured or forgotten and with that loss, the purpose of being there is gone. Taking the time to write down the elements of who we are is an exercise in clarifying the purpose of the practice. This is a critical first step, since it is impossible to develop a clear statement of the meaning of the practice without knowing what is important to you. It may also be the most vital link in establishing the practice of your dreams because the dentist’s values represent the blueprint of that dream. This blueprint will evolve into the Vision for the practice and provide the values by which all systems, policies and communications will be established.

How can a dentist begin the process of clarifying values? It may be best to start at home. I find that some dentists’ main focus of attention is on their practices. The family receives whatever time, energy and emotions are left over. This is usually not popular domestic policy. Initially, it may be important to go back to pre-dental days and recall exactly what drew you into the profession. While economic gains cannot be ignored, there were probably numerous other aspects that attracted students into the field. It may have been independence, the technical aspects of the work or the possibility of a reasonable income on less time. For others it may have been an opportunity to be one’s own boss, avoid exhausting nights of call or be in service to people in a very tangible way. Many people chose dentistry because of potential quality of life issues that have as much to do with one’s personal life as one’s dental career. The first step is to recall these original values. The second step is to consider the current reality of your life. Have marriage, children and/or other interests created demands for time that can only be met at the expense of a dentist’s attention on the practice? Third, it is important to re-evaluate your current personal issues. Are the same things important now that were important as a pre-dental or dental student? Have new issues arisen, such as personal health, community commitments or philosophical shifts that have created new avenues for expression in your life? Fourth, how have your dental interests changed? That is, can one identify specific areas within dentistry that have clearly become primary interests? Have root canals lost their luster, children become a bother or has crown and bridge or esthetic dentistry taken on a greater part of your continuing education and/or enthusiasm? These four areas may help focus your attention on the current values you hold in your life. I would suggest that anyone in the profession takes time to identify these critical aspects of life that truly invigorate or enliven you. Once identified, transferring these values into your practice so that it will support you will begin the shift toward a focused practice. If you attempt to identify your values only through the context of your practice, the narrowing of the focus down to the workplace will probably not result in a more balanced life, in particular domestically.

It may be helpful here to illustrate through my personal experiences so that the concepts presented thus far might seem clearer. The following is an accurate rendition of my own way of having identified and established values that remain the basis for my practice today.

When I began my path toward creating my current practice, I tried to seek out the component that I felt brought greatest satisfaction to me. While I strive toward clinical excellence, it was not the thrill of a stainless steel crown that held my interest nearly so much as witnessing a child’s sense of accomplishment and the parent’s amazement and pride in seeing her/his child succeed in a potentially stressful moment. It was this realization that started me toward establishing a practice that would provide more consistent satisfaction for me and, I felt, for my clients. I had identified behavior management as a genuine value of mine. This is not to suggest that I minimize my technical performance. Ultimately the success of the dental procedure would impact the child’s and parent’s perceptions, but the communication and management aspects were more exciting for me. It also became evident that seeing my patients return caries-free was another experience that was far more satisfactory for me than placing three more restorations. From this insight, I recognized the value I placed on successful education of my clients so that they could experience better health. I have always been proud of the profession for having brought the concept of prevention into a realistic and attainable model. To have experienced in my own practice crystallized its value for me.

Although it took me years to recognize, I ultimately came to realize that as my practice became more and more successful, it held more and more control over me. It was quite a shock to realize that the tail was wagging the dog! In my eleventh year of private practice, I finally “allowed myself” to take a two week vacation. Up until then, it had been nose to the grindstone, somewhat because of economic need, somewhat because of fears that I “couldn’t allow myself to be unavailable for my patients,” but mostly because I simply hadn’t recognized what had occurred. When my wife and I discussed which things we failed to do because we couldn’t afford them and which activities we didn’t do because we lacked time, it was surprising how lopsided our list was toward the latter! It became clear to me that one of my important values was having time for activities outside of my practice.

These examples are not intended to serve as a specific guide for any other dentist, but rather to provide tangible examples of establishing one’s own values. The list of my values could go on and might include matters as profound, yet simple, as common courtesy, honesty and gentleness. It might include a broad generalization that could set the tone for a practice. In my case, I have always felt that as someone unlikely to ever seek elected office, my best chance to create my ideal world would be to establish it at my office. That world includes humor, sensitivity, communication and respect. These values can be applied to every person who walks into your physical space—your clients, your co-workers, your vendors and anyone else affiliated with your practice. Again, it is most helpful to write these values down so that they are not continually swirling around in your head. From this list, you can develop your Vision (the Big Picture). Then you can begin the process of establishing policies, systems and training to implement the concepts into actual practice. The results can be nothing short of astounding—the Team will notice, the clients will notice and your bottom line will notice.

The first step following this identification process is to determine (perhaps with the help of an advisor) how to alter systems, procedures, communications or co-workers to start implementing your values. Although the entire picture (your Vision) may not be in perfect focus at the outset, it is important to know your own path before training and supporting your co-workers. Write down your values and your goals. Match them up carefully so that when you speak your Truth to your co-workers, you can illustrate with an adjustment you are making to your practice. Not only will this help your Team understand the change better, it will enable them to support it and address it with your clients when you are not present. For example, if you have identified being in your child’s classroom on Tuesday afternoons, you might decide to implement a change that entails starting your day sooner, taking a shorter lunch break or ending earlier. If your co-workers understand that this change is the result of something important to you, they will be less likely to resist it. Also, they will be able to tell your clients why the office hours are changing on Tuesdays so that your clients will be more likely to support it. If a client is unhappy about it, you must consider whether you need to change your values to match theirs or if it is just as well to have that client go to another practice for care. If the time with your child is a genuine value of yours, losing that one patient will matter little and you will have taken a step toward fulfilling your Vision by acting out of your values. This one idea is merely a tangible example of a change you might make.

You may have no changes to make, because your practice already reflects your values. The problem may be that your co-workers don’t know that! In many cases, your employees will come to know you well enough to understand why your practice does things that way it does. However, they might have no clue. By providing a clear statement to them about your values and, therefore, the rationale for having clear policies, you will go far in establishing a far higher level of trust and respect and you will find that you need not explain every single detail. They will already understand a policy simply by understanding you.

In summary, I would suggest that every dentist literally sit down and put a pencil to paper to create a list of values, personal and professional. Put the list away and try not to think about it for a couple of days then take it out and see how close you have come. It may require some adjustments, but you will know far more during your follow up review than you did when you first wrote it. Once you are satisfied with your list, share it with your closest confidant—perhaps your spouse, best friend, parent or sibling. These are people who truly know you and will be able to reflect back to you how accurate they feel your list is. They will separate the values that are genuine from the one that simple “sound good.” Once you have established your values, use them as the blueprint for creating your vision in your practice. Be creative and massage your practice in ways that will support your values. Once you have determined your vision, which is the Big Picture created out of your values, share it with your employees in as great of detail as possible. This will enable them to help you to create the practice of your dreams. Unless your vision is clear, though, others will never be able to see it. Spend your time on the focus of your values first, then develop a vision out of them. Just like a well made pair of glasses, your vision will help others to see your plan much more clearly.

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