The Monday Morning Quote #64

As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.

~John Fitzgerald Kennedy

The Weekend Read – The Starbucks Experience

51P2oJuJdUL._SL125_(This review first went out in More Profit in Less Time in October 2007.)

….I took myself off to the closest bookshop to Rees Acres, that being ‘Waterstones’ in Literature Festival, Cheltenham, bought the book and settled down in the coffee shop within the bookshop. Now this coffee shop is a branch of Costa Coffee (owned by Whitbread plc) and I was able to contrast my experience with the aims contained within the book. Nicky served me my large Latte after a nameless one had taken my order and my money whilst studiously avoiding eye contact.

As Nicky held my cup in her left hand, she went through a routine with her right hand. First she wiped her nose with the back of the hand, then ran the hand across the coffee ground container; that done she straightened her glasses and adjusted her hair before returning to the machinery and turning the tap off, mixing my drink and handing it to me. This all done with neither eye contact, obviously it’s company policy, nor any more acknowledgement of my existence than to tell me that what she was plonking in front of me was “Large Latte”.

My response of “Thanks very much Nicky” seemed to be such a shock that I felt I had somehow slapped her. Still no eye contact though, the training has obviously worked. I sat myself at an empty table and tried to ignore the crying babies and the moaning of the Daily Mail wives. However I was marginally distracted by the pigeons pecking around my feet. Presumably the birdlife is permitted or even encouraged, the crumbs on the floor can’t have all accumulated there in just one morning, in order that the non-smoking customers inside the shop can experience something of the al-fresco atmosphere that the smokers enjoy.

To the book, I haven’t finished it yet but do thoroughly recommend it. The highlights of the first few pages should be enough to persuade you.

From ‘The Green Apron Book’ which tells some of the core “ways of being” that you need in order to be successful at Starbucks:

  • Be welcoming
  • Be genuine
  • Be knowledgeable
  • Be considerate

The Starbucks Experience can be found on two very distinct levels inside the company:

  1. In it’s unique corporate culture. Leaders within the business create a unique culture for employees in which empowerment, entrepreneurship, quality and service define the values of the firm.
  2. In its passing down of these values to its partners. The partners, in turn, help create a unique and personal experience for customers. Understanding these principles and getting to know how Starbucks leadership and partners (the term that Starbucks uses for all its employees) have grown the company offers a powerful blueprint for transforming your ordinary into your extraordinary.

(and yes I do know that John Lewis, another firm that I personally hold in high regard, ‘employees’ are partners too).

The book is split into five main chapters, which identify 5 key business principles that drive the phenomenal success of the company.

  1. Make it your own.
  2. Everything matters.
  3. Surprise and delight.
  4. Embrace resistance.
  5. Leave your mark.

This is a slim volume that I have put down with regret, will finish within the day and will read again immediately. (I did and have re-read it a couple of times since then). I suggest that you do the same.

Available from Amazon here.

The Foundations For Great Achievement – Philip Humbert

From the consistently excellent Philip Humbert who’s weekly newsletter is a constant inspiration. If there is only one newsletter you receive make sure that it’s Philip’s, subscribe at www.philiphumbert.com

The Foundations For Great Achievement

I’ve been studying human achievement for almost 50 years (professionally for over 30 years), and the longer I do this work, the more I see that the “recipe” for achievement is simpler and in many ways, much easier than most people believe. In fact, Socrates described the basics almost 3000 years ago with the simple phrase, “Know thyself.”

I’ve been thinking a lot about ways to create a workshop around this simple recipe, and I want to share some preliminary observations with you.

First:  Know your strengths

High achievement comes from knowing what you do well, what you love and where your passion lies. Mid-level performance comes from people who can “get by” or are doing something “acceptable” but they are not using their talents to the maximum. When human beings do something they love and have some talent for, they are unstoppable!

Think about a teenager learning to drive, play sports or music, or asking someone special for a first date. Or how about your own determination to be a great parent, good lover or successful investor. When we are doing something that “makes sense,” something that draws and excites us, we find ways to get good at it. “First, know yourself” and always go with your strengths, passions and talents!

Second:  Know your weaknesses

We all have blind spots and weaknesses. We have things we don’t enjoy, or don’t want to do, and yet too often we create lives or careers that require us to do precisely that! How dumb is that?

If you don’t like detail work, hire a bookkeeper! If you are shy or introverted, don’t go into sales or politics! If you’re a natural born entrepreneur, I wouldn’t recommend a career in the military. Like, duh!

Unfortunately, most of the time our weaknesses are not so dramatic and we find ways to hide or work around them. Then we end up in situations where we can get along, but we “forget” to do the accounting or calculate the budget. We get “bored” with meetings or annoyed with “those dreamers” in the R&D department. It’s important to know what you’re good at, but it’s absolutely vital to know what does not suit you. Acknowledge your weaknesses! Don’t spend your life “trying” to do things that don’t fit! Life’s too short for that! Build on your strengths rather than compensating for your weaknesses.

Third:  Know what you want

We all have dreams and desires. We know what brings us joy, what excites us, what fires us up. Sometimes, we get confused or lose track of our dreams, but they are still “in there.” The trick is to identify and express them!

The winners in life know what they want and they find healthy, productive ways to go after it. They ask, they poke and prod until they “find a way.” Recently, a client expressed amazement that since he identified a particular skill he wants to develop, suddenly he sees people doing it all the time! We’ve all had that experience. My comment was that “when you know what you want, you’re much more likely to get it.”

Fourth:  Know how to express yourself

The final piece is “finding your voice,” your unique way to let the world know you exist. Some do this naturally and become entertainers, politicians or whatever. Others struggle to express themselves, but winners eventually find a way. They speak up. They reach out. They “go for it” and “make waves.” They voice their suggestions, work for their causes, and make a difference in the world.

High achievement starts by knowing who you are, what you want, and going after it. That’s not always easy or simple, but winners keep trying “until” they find a way. “Know thyself and to thine own self be true.” There is no stopping a human being who knows who they are, what they want, and is determined to get it.

Copyright (c) 2009, all rights reserved. U.S. Library of Congress ISSN: 1529-059X
You may copy, forward or distribute TIP’s if this copyright notice and full information for contacting Dr Philip E. Humbert are included. Contact him at: www.philiphumbert.com or email to coach@philiphumbert.com

The Monday Morning Quote #63

“Do the right thing.  It will gratify some people and astonish the rest.”

Mark Twain200px-Mark_Twain,_Brady-Handy_photo_portrait,_Feb_7,_1871,_cropped

Academia v Business

Found this on xkcd.com/664/ some analogies with dentistry I think.

academia_vs_business

The Weekend Read – Mastering The Business Of Practice by Marc Cooper

I first read this book just over 12 months ago and became an instant fan of Marc’s. Dr Cooper has been coaching dentists and their teams for 25 years and understands the Business of Dental Practice from top to bottom. As a qualified dentist and one time practicing periodontist his comprehension of the “sharp end” or “coal face” is absolute.

This book is not a text book nor a “how to do it”; it is written in the form of a questions and answers in a format I recognise from dealing with emails from my own clients.

Divided into sections Ownership, Leadership, Management & Marketing, it deals with everyday problems in an easily read format. I particularly appreciated the fact that the vast majority of case studies transfer to Dentistry on this side of the Atlantic which is rare in US based coaches and consultants.

This is the first of the five books written by Marc Cooper who is the President of The Mastery Company and is a great introduction to his work.

Available from Amazon in the UKAmazon in the US for more information on all of Marc’s books go to The Mastery Company.

Top 10 Things Your Hygienist Thinks You Should Know

From RDH Volume 29 Issue 11 – November 2009

An American journal but relevant here.

This survey was constructed in a two-phase approach. First, I asked the readers in September to email me “things” they thought their doctor/employer should know. The second phase was the compilation of these suggestions into a list of 25 items and then asking the readers to pick their top 10. This was a popularity contest, sort to speak. We did not ask the readers to rank their top ten, only to choose 10 out of the list of 25 “things your doctor should know.”

The results reflect the percentage of hygienists who chose these particular statements. Overall, 1,451 participated in the survey. Thank you! On average, the respondents chose 9.5 answers, so it worked out to very close to what was requested.

Before I get to the answers, I first want to mention that I think there is a lot of information in these 11 statements, and a lot that you, as hygienists/employees can do, no matter what your position is within your practice. You are a team member, people interact with you, count on you, rely on you, and so your contribution makes a difference. And by contribution, I mean, not the work you produce, but also the support, encouragement, loyalty, creativity, and overall value you bring to the table.

You may not be in a formal leadership role, but you can still be a positive emotional leader (the colleague, for example, people go to when they need an injection of positive spirit), a team builder (someone, for example, who makes sure everyone gets heard), and/or an energy creator (someone who sees when a peer needs support and offers it freely).

So as you read the following results, please remember that real change, behavioral change, takes time and may require your own self-reflection and accountability for your actions and to offer others encouragement, give gratitude, and even laugh.

Lastly, I believe it’s everyone’s responsibility to make your work environment more positive, so please remember to read “Survey results: Now what?” for additional tips on the next steps to your positive transformational communication.

Survey Reveals …

Top 10 Things Your Doctor Should Know

1. Compensate me well for my efforts. I help build your practice. 68% selected this answer

2. Say “thank you” when team members work hard, maybe even give them a reward. 65% selected this answer

3. A doctor should back up the hygienist in discussing periodontal recommendations and perio findings with patients. 61% selected this answer

4. (tie) Dental personnel need to be shown they are appreciated! 50% selected this answer

4. (tie) Not all hygienists are created the same. 50% selected this answer

6. A dental hygienist is part of the team. 48% selected this answer

7. (tie) Talk to your team to see where there might be problems. 47% selected this answer

7. (tie) A dentist should treat the staff with respect; many dental hygienists feel that their employers treat them like “they are just making you money” or are “production girls.” 47% selected this answer

9. The dental hygienist should play a key role in identifying and diagnosing periodontal disease. If the dental hygienist isn’t current on this information, spend some money on CE courses as these will be worth it for the office. 44% selected this answer

10. (tie) Reward us just like you want to be rewarded … that’s all we ask. 42% selected this answer

10. (tie) A dentist should not humiliate employees in front of patients. 42% selected this answer

Kristine A. Hodsdon RDH, BS
Director RDH eVillage

www.rdhmag.com/articles/article_display.html?id=370783

The BDA Fights Back

Fresh on the heels of the editorial in the current BDJ come two releases which signify a sea change in the way the BDA will be perceived by the membership and hopefully by the DoH too.

Perhaps as a response to Tony Kilcoyne’s letter to the BDJ the BDA have again asked that the new decontamination regulations be evaluated by NICE. It strikes me that the 60 references apparently supporting this edict are as difficult to find as the evidence behind the WMDs that led us into the Iraq war.

Next a rejection of the “new” version of the 2006 contract, the so called Warburton or PDS+ contract.

BDA calls for NICE evaluation of decontamination evidence base

The British Dental Association (BDA) has today called once again for a full review of the evidence base for the HTM 01-05 guidance document on decontamination in dental surgeries. The BDA has written to the Department of Health (DH) renewing its 2007 call for a National Institute for Health and Clinical Excellence (NICE) review of the evidence, after it emerged that three areas of the guidance have already been amended before the document is even printed.

The three changes to the guidance that have already been made are:

The use of potable water for the rinse stage of decontamination is now permitted. This is a climbdown from the previously intended requirement for reverse osmosis and freshly distilled water, after studies showed low concentrations of endotoxins in England’s potable water supplies.

The period for which instruments can be stored after they have been processed in a validated vacuum sterilizer has been increased from 30 days to 60 days.

The revision of the requirement for two sinks for decontamination to allow the option of two bowls incorporated into a single unit instead.

Concern about these changes has been heightened by a consistent failure by the Department of Health to publish the references that they say form the evidence base for the document, despite repeated requests by the BDA for it to do so.

Calling for the guidance to be referred to NICE, BDA Executive Board Chair Dr Susie Sanderson said:
“It is telling that changes to the content of HTM 01-05 have had to be made already. The changes expose the uncertain evidence base on which the document is founded and will be a cause of great concern to dentists. These doubts can only be exacerbated by the failure of the DH to publish its evidence base for the document.

“This guidance will apply to family dentists and public dental facilities alike, so complying with it will cost both dental practice owners and the taxpayer significant amounts of money. The dental profession is absolutely committed to the highest standards of patient safety and is happy to invest in pursuit of those standards. But the investment has to be in changes for which there is a robust evidence base. To establish that evidence base the BDA believes the guidance must be looked at in detail by NICE.”

Link to press release here.

Dental access contract still unsuitable as changes do not go far enough says GDPC

The unnecessarily complex contracts for dental access funding make them risky and inappropriate for dental practice, despite some changes made by the Department of Health (DH), the BDA’s General Dental Practice Committee (GDPC) has said today.  The final version of the ‘PDS+’ agreement developed for the current round of dental access procurement has been published today by DH.  It runs to nearly 50 pages and 17 schedules.

John Milne, Chair of GDPC, said:

“Although it must be an individual business decision, we advise dentists to think very carefully and seek advice before taking on one of these contracts as the dangers of breach are rife, and the consequences of breach may be very damaging to practices.”

The GDPC, advised by specialist lawyers, has spent more than four months explaining in detail to DH why its proposed contract was unsuitable, one-sided and unsafe for practitioners. The first version, based upon a medical model, was wholly unacceptable and we advised members not to sign it.  While DH has made some significant changes, we still do not feel that the contract is acceptable.

The main reasons are:

  1. The requirements are one-sided, leaving all the risk of a complex and untried payment mechanism with the dentist.
  2. Fundamental new provisions, such as the payment mechanism, the need to comply with new key performance indicators and the ‘dental care assessment’ of patients should have been developed and piloted in conjunction with the wider profession through the implementation of the Steele review.
  3. The contract is over-specified and a large majority of the controlling provisions remain, leading to intrusive micromanagement. Practices will need to devote considerable resources to managing the contract and ensuring that the requirements are met.  For most practices, this will require a dedicated contract manager and for the contract value to reflect the risks and extra work required.

Members are advised to take specialist advice if considering bidding for access contracts.  The contract, which DH says is not actually mandatory for PCTs to adopt, is on the BDA’s website here. BDA guidance notes are available here for BDA members.

Link to the press release here.

BDJ Editorial – Well Said Stephen Hancocks

These are strange times in Dentistry. Government apparatchiks have dabbled with NHS dentistry since 1990 and none of their changes have improved much, if anything, for the poor patient. Persistent interference and change has led to a dental work force that is low on morale, and even lower in confidence in politicians. Since 1997 there have been increasing attempts to bring the dentists to heel, at my most paranoid I wonder if Dr John Reid saw the an opportunity to do to the profession what Mrs Thatcher had done to the miners.

Amongst this the British Dental Association, trying to represent the interests of every dentist in every branch of the profession is an easy target for those who want to snipe. The fact is that dentists are such a disparate bunch with such a panopoly of opinions that the BDA would sometimes be better off trying to herd cats, bottle smoke or nail jelly to walls.

Through these times the editorial of the BDJ remains a refreshingly independent read and the current edition is no exception. I have been a member of the BDA since student days and still serve as a section officer, I came close to resignation in 1990 when there was a complete failure of leadership  but I preferred to remain within the tent. I suggest you read this piece by Stephen Hancocks.

British Dental Journal 207, 405 (2009)
Published online: 14 November 2009 | doi:10.1038/sj.bdj.2009.1008

The artful science of politics
Stephen Hancocks, OBE1

Editor-in-Chief
Send your comments to the Editor-in-Chief, British Dental Journal, 64 Wimpole Street, London W1G 8YS e-mail: bdj@bda.org

Introduction
The current controversy over the sacking by Home Secretary, Alan Johnson of the chairman of the Advisory Council on the Misuse of Drugs, Professor David Nutt will doubtless pass fairly quickly into the history book of minor public skirmishes. Apart from the significance of the Professor’s view of the classification of drugs the other notable aspect was the vehemence with which the decision was defended. It serves to highlight the serious disconnections that exist between scientific fact (evidence base) and political dogma, the assessment of risk and the application of policy, and the practice of defensive public strategy. Such inconsistencies are well known to us in dentistry.

It was Professor Nutt who caused earlier controversy by suggesting in a comparison of relative risks that drug harm can be equalled by other aspects of life that involve risk-taking behaviour; likening the dangers of taking ecstasy to those of horse-riding. Howls of indignation went up at that time from the then Home Secretary Jacqui Smith (perhaps statistically, losing a job as Home Secretary is a greater risk still) declaring that the claim trivialised the dangers of the drug. Yet I suspect it was the social gradient of the comparison that caused political correctness to come into play. The sordid drama of collapse through ecstasy, tinged with crime, in a sweaty inner city night club probably seemed more immediately socially relevant than the trauma from a riding accident in a leafy country setting, despite both being tragic in their own terms.

Evidence exists – if required!

It does leave one wondering about the government’s attitude to decontamination. We have had the imposition of single-use endodontic files because of a ‘theoretical’ risk of cross infection control by prion proteins, yet no scale of evidence has been forthcoming to allow a judgement on how theoretical or otherwise the risk may be. We now also have the edicts of HTM 01-05 which require the use of, amongst other things, washer-disinfectors in primary dental care and an assurance in a letter to this journal by the Chief Dental Officer of England that it is evidence based.1 Somewhat disingenuously one feels, the letter also states that ‘over 60 references to the published scientific and clinical literature were used in its compilation. A list of these references is currently being compiled for publication if required.’ If required? Surely this is in jest? If they are already published how long does it take to compile a list? No research paper submitted to this or any other reputable journal would be considered if it arrived with a statement that the references would follow in due course ‘if required’, let alone one which had such far reaching practical and economic consequences as HTM 01-05. Despite a promise to the BDA, at the time of writing the elusive list has still not been received.

We therefore have to take someone’s word for it. It might, of course, be sensible guidance but how are we able to judge? Without our knowing it might also be politically expedient guidance based perhaps on the defensive premise that if it isn’t enforced and a patient contracted an infection as a result of dental treatment the government might be culpable. Yet how many cases of MRSA, for example, are traceable to dental practice as compared with hospitals? We are not told but the belief is none. In contrast, the recently published report from the National Creutzfeldt-Jakob Disease Surveillance Unit2 makes interesting reading. It details that between 1995 and 31 December 2008, a total of 167 cases of definite or probable vCJD had been identified in the UK. Devastating for those individuals and families involved but hardly what one could term a public health crisis. Comparisons might be odious and possibly inappropriate, but by the time you read the next issue of the BDJ two weeks hence, about the same number of people will have been killed on our roads in a fortnight as contracted CJD in 13 years.

So what am I trying to say? In the first instance I am asking for some honesty about whether an evidence base exists or not, and if it does some further educated discussion about the seriousness of the risks. But I believe that we also need some clarity in thinking between the application of science, the estimation of risk and the formulation of public policy. Cost benefit is always a harsh term to introduce when health is concerned but to put the argument back into a road safety context, the likelihood of eliminating fatal accidents at railway level crossings could be achieved by building a bridge over each and every one in the country; but at what price?

No one would ethically suggest that we abandon cross-infection control, or indeed expose our patients, our teams or ourselves to unnecessary risk of microbiological contamination. However, equally, no one in practice for the public good should be compelled to implement guidelines, the evidence for which has not been published in the accepted way, that have not been openly risk assessed and that smack of a political expediency removed from the reality of that which other evidence suggests is prudent. It takes at least two parties to cross-infect, the same number as it does to establish trust.

References

Cockcroft B. A legislative requirement. Letter. Br Dent J 2009; 207: 303. | Article | PubMed | ChemPort |
The National CJD Surveillance Unit. Seventeenth Annual Report 2008: Creutzfeldt-Jakob disease surveillance in the UK. Edinburgh: NCJDSU, 2009. www.cjd.ed.ac.uk

James Hull – ups and downs.

As David Brent famously announced to his office staff – “one day you’re the pigeon, the next day you’re the statue.”

James Hull 13th October 2009: news.bbc.co.uk/1/hi/wales/8303743.stm

James Hull 15th October 2009: business.timesonline.co.uk/tol/business/industry_sectors/health/article6917214.ece

I have never met James Hull, I respect what he has done, no matter how you define success he has achieved it. I applaud his efforts, the wealth he has created and the energy and drive he has brought to dentistry. I am sure that there are people who will revel in the story of his removal from (his) office, they are usually the people who happily kiss backsides and then enjoy stories of others’ fall from grace whilst rarely creating anything original of their own.

So don’t dwell on the words of the odious Brent but on Kipling:

If you can meet with Triumph and Disaster,
And treat those two imposters just the same.

I have no doubt that James Hull will return.

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