The Monday Morning Quote

“Between Stimulus and Response there is a space.

In that space lies our freedom and power to choose our response.

In our response lies our growth and our happiness.”

Victor Frankl

The 2010 Social Networking Map

From Flowtown an up to date “map” of social networking sites.

Funding for NHS dentistry – draw your own conclusions

From today’s BDA Executive Update

Figures highlight mounting expenses of dental practice warns BDA

New figures published by the NHS Information Centre today highlight the increasing expense of providing dental care, the British Dental Association (BDA) has warned. The Information Centre’s report, Dental Earnings and Expenses, England and Wales 2008/09, shows expenses borne by dental practices escalating at a faster rate than incomes were increasing during the period it details. It also highlights an increase in the average self-employed dentist’s taxable income of just £500 during the year.
The average taxable income for all self-employed primary care dentists in England and Wales in 2008/09 was £89,600, compared to £89,100 in 2007/08, according to the report.
The expenses borne by dentists – the costs of providing the building, equipment, staff and materials necessary to provide patient care – increased rapidly during 2008/09. Practice principals saw their expenses rocket by 7.6 per cent from £218,000 in 2007/08 to £235,500 in 2008/09.
John Milne, Chair of the BDA’s General Dental Practice Committee, said:
“These figures underline what the BDA knows from its own research and talking to members: that the costs associated with providing high street dentistry have risen dramatically. Changes in the exchange rate have had a pronounced impact on the costs of equipment imported from overseas and costs associated with compliance with a variety of regulatory requirements.
“Trends in expenses will need to be monitored carefully to ensure that dental practices are properly supported and are able to provide the resources they need to continue providing high-quality care to patients. The Doctors’ and Dentists’ Review Body will clearly need to consider the issue of expenses carefully this year and the BDA will be requesting it does so.”
Notes to editors
1. The report is available at:

DDRB role on GDP pay in England suspended

The Doctors’ and Dentists’ Review Body (DDRB) will play no role in determining the remuneration of independent contractor general dental practitioners (GDPs) and general medical practitioners (GMPs) in England for the financial years 2011/12 and 2012/13, it has been announced. The decision has been taken in light of the current financial climate and the previously announced pay freeze that will affect public sectors workers earning over £21,000 a year.
Instead, the government will determine any gross uplift for GDPs and GMPs directly. It is understood that any uplift will be determined based on the efficiency assumptions government wishes to apply and evidence on non-staff expenses. The government has said it will enter into dialogue with relevant professional bodies about expenses. The BDA will be contacting the Government to take forward that dialogue.
At the time of writing, it is unclear whether the governments in Northern, Scotland and Wales will mirror the decision made by the administration at Westminster.
The announcement comes just days after an NHS information Centre report showing that the 2008/09 financial year witnessed an average 7.6 per cent increase in practice principals’ expenses across England and Wales.

The Monday Morning Quote

“All problems exist in the absence of a good conversation.”

Thomas Leonard

The Monday Morning Quote

“Pain is temporary, quitting lasts forever.”

Lance Armstrong

Are Staff Happy?

Received this recently and thought I’d share it because I believe it is relevant to the owners of all professional practices.

What are you doing to make sure that your team works together and stays together?

Editorial – Are Staff Happy?
By Steve Gold, Editor, Management in Brief

I’ve just got back from not one, but two business shows this week in, respectively, London and Birmingham, and the one thing that struck me was that – behind the smiles to customers – staff were not happy.

When I say unhappy, I mean unhappy with their lot in life as regards business, and judging from the off-guard comments, it all comes down to the managers at the companies they are working for.

Poor management? Quite possibly, so I was interested to see a news story from P&MM Motivation in which John Sylvester, the firm’s executive director, said that keeping employees motivated throughout the recession is “a marathon and not a sprint.”

According to Sylvester, the announcement that the UK `officially’ came out of its recession at the beginning of 2010 may have offered some encouragement of a positive outlook for the year ahead.

However, he says, nobody is really left in any doubt that the end is, in fact, nowhere near to nigh as the UK’s economy remains in its turbulent predicament.

“To see this dim light at the end of the tunnel only for it to be quickly extinguished again, as the patience and resilience of organisations and their employees is tested further, really brings home the truth that maintaining morale through this difficult era must be considered as a marathon and not a sprint,” he said.

Sylvester argues that motivation must remain high on the business agenda throughout 2010 in order to break through the brick wall that marathon runners meet in the final stages of their race.

Continual re-engagement, he says, is required in order to keep employees tuned into the changing company objectives so that they can head enthusiastically onto the next stage.

“Many job roles will have changed over the last year and feelings of job security may also be frail. Take the time to communicate with a workforce and inform them of what the organisation collectively requires in order to get back on top,” he explained.

The P&MM Motivation chief executive says that, on an individual level, managers should redefine each job proposition and set appropriate targets linked directly to the wider company goals.

They should, he observes, offer incentives for reaching these targets, as this approach to `sharing the fruits’ of success will be well received in an environment where pay freezes are the norm.

“All things going well, the need for further redundancies is less likely this year so employers are tasked with assuring staff of their job security,” he said.

The key to all of this, he says, is `recognition’ as this will help to ensure that employees feel valued and rewarded for the extra hard work, commitment and contributions that the current situation demands.

Sylvester claims that, if these efforts are not properly recognised, staff will quickly lose their enthusiasm and begin to set their sights on leaving once the recession has subsided.

In fact, he says, CIPD figures suggest that over a third of workers intend on seeking new employment as soon as the recession has subsided.

If managers can pre-empt this negative attitude by looking after valued staff now, they will weather the storm, as he quite rightly observes – the marathon is far from over.

I think he’s right too. As my experiences at the two business shows I’ve attended this last week clearly show, junior and mid-ranking staff in a large number of organisations are not happy with their employers.

We all have to pay the rent or mortgage, which is why most of choose to work as we do. When this recession ends, you can expect large-scale staff movements between companies.

As some companies will discover to their cost, when their most valuable staff start jumping ship.

Have a good business day.


“Reducing Dental Errors Using Pilot Safety Protocol”

I have a client who is both a dentist and a pilot, on his recommendation  I read a book called “Air Accident Investigation” which examines (as you would gather) air accidents. My client has long been a fan of checklists in his practice in order to practice preventively, in this case to prevent mistakes. He’ll be pleased to see this article and I think a lot more surgeons and their teams could benefit from taking note of the principles.

Pilots and dentists have more in common than one might think: Both jobs are highly technical and require teamwork. Both are subject to human error where small, individual mistakes may lead to catastrophe if not addressed early.

A dental professor at the University of Michigan and two pilot-dentists believe that implementing a checklist of safety procedures in dental offices similar to procedures used in airlines would drastically reduce human errors.

Crew Resource Management empowers team members to actively participate to enhance safety using forward thinking strategies, said Russell Taichman, U-M dentistry professor and director of the Scholars Program in Dental Leadership. Taichman co-authored the study, “Adaptation of airline crew resource management (CRM) principles to dentistry,” which will appear in the August issue of the Journal of the American Dental Association.

Airlines implemented CRM about 30 years ago after recognizing that most accidents resulted from human error, said co-author Harold Pinsky, a full-time airline pilot and practicing general dentist who did additional training at U-M dental school.

“Using checklists makes for a safer, more standardized routine of dental surgery in my practice,” said David Sarment, a third co-author on the paper. Sarment was on the U-M dental faculty full-time before leaving for private practice. He is also a pilot and was taught to fly by Pinsky.

CRM checklists in the dentist’s office represent a major culture shift that will be slow to catch on, but Pinsky thinks it’s inevitable.

“It’s about communication,” Pinsky said. “If I’m doing a restoration and my assistant sees saliva leaking, in the old days the assistant would think to themselves, ‘The doctor is king, he or she must know what’s going on.'” But if all team members have a CRM checklist, the assistant is empowered to tell the doctor if there is a problem. “Instead of the doctor saying, ‘Don’t ever embarrass me in front of a patient again,’ they’ll say, ‘Thanks for telling me.'”

At each of the five stages of the dental visit, the dental team is responsible for checking safety items off a codified list before proceeding. Pinsky said that while he expects each checklist to look different for each office, the important thing is to have the standards in place.

Studies show that CRM works. Six government studies of airlines using CRM suggest safety improvements as high as 46 percent. Another study involving six large corporate and military entities showed accidents decreased between 36-81 percent after implementing CRM. In surgical settings, use of checklists has reduced complications and deaths by 36 percent.

Many other industries: hospitals; emergency rooms; and nuclear plants look to the airline industry to help craft CRM programs, but dentistry hasn’t adopted CRM, said Pinsky.

For the next step, the co-authors hope to design a small clinical trial in the dental school to test CRM, Taichman said.

Laura Bailey
University of Michigan

More brickbats than bouquets?

Yet again a new government in the UK sets its eyes on the NHS.

Why is it that change in the NHS has to be dramatic and so, so, expensive both in financial and human terms?

Is it really the case that having had to concentrate on the cold war for all those years politicians have to justify their existence on what they perceive to be the “biggest challenge” facing the country?

If the NHS is such a sacred cow why do successive health ministers insist on trying to apply such radical surgery with no scientific base?

In their dealings with health care why do politicians seem to have to let dogma dominate their policy far more than they do in any other sector?

Why do they listen so little to the individuals at the sharp end?

Why do they introduce changes that are untried and untested?

Why is there no science in their actions?

I would suggest that in Health (and the country’s involvement in Afghanistan, but that’s way beyond my area of expertise) they take note of George Santayana’s words:  “Those who cannot remember the past are condemned to repeat it.”

The BMJ recently asked a range of commentators from clinicians to academics to comment on the white paper on health Equity and excellence: liberating the NHS. Has the NHS become “a huge laboratory for some dodgy experiments,” in the words of one commentator; will the white paper divide the medical profession, as another claims; or will it simply empower doctors?

I’m grateful to my brother who is far more involved in both health & education than I for sending me this article and for pointing out what I agree is the best comment on the white paper. It’s by Jonathan Waxman, professor of oncology, Imperial College London who says:

The white paper is a finely written piece of prose redolent with allegory and metaphor that comes straight from a copywriter’s posterior. It proposes joined up, radical change to the way the NHS is managed and will empower the professionals . . . well some of them, the GPs. The trouble is that the white paper doesn’t seem to be written by an empowered joined up professional, and so lacks insight into the way the NHS works. It shows little understanding that health care is complex and doesn’t just involve one group of doctors, but many professional groups working together.

It seems that the notional cost of introducing these proposed changes is £1.7bn (2bn; $2.6bn). We know that government costing estimates are born in ya ya land, and usually out by a factor of 10 or 100, or whatever. We have seen the £15bn disaster of the NHS computer costs. The primary care trusts were introduced without trialling, and they have been a mess that costs £5bn a year to administer. The NHS is a £100bn business. What type of business introduces change of the order that the government is proposing without trialling? Don’t you think we should think about things before we leap off the white cliffs into the savage sea and on to the razor rocks?

The current white paper sets one group of health providers against another. It claims to be joined up, but it is divisive and potentially destructive. Please minister, think again.

Those words again:

The white paper is a finely written piece of prose redolent with allegory and metaphor that comes straight from a copywriter’s posterior.

……lacks insight into the way the NHS works. It shows little understanding that health care is complex and doesn’t just involve one group of doctors, but many professional groups working together.

Please minister, think again.

I couldn’t agree more.

The Monday Morning Quote

You cannot stay on the summit forever; you have to come down again. So why bother in the first place?

Just this: What is above knows what is below, but what is below does not know what is above. One climbs, one sees. One descends, one sees no longer, but one has seen.

There is an art of conducting oneself in the lower regions by the memory of what one saw higher up.

When one can no longer see, one can at least still know.

Rene Daumal

Thanks to Tony Barton of Red Kite World for introducing me to this quotation & the works of Rene Daumal.

The Weekend Read – The Buddha, Geoff and Me by Edward Canfor-Dumas

Sometime during the days following October 10th 1957 my father delivered my 4 year old self, wrapped in pyjamas and dressing gown, to The Laurels, Huntley. We made the journey because my brother had just been born, a home delivery, and I presume my Mum, whose 86th birthday it would have been today, needed some space.

The Laurels in those days was the home of Bill and Nan Lane and their family, they had 5 children, the youngest of whom Christopher was at least 10 years older than me. The next up was Rachael at that time in the sixth form at Gloucester High School for girls in Denmark Road.

It was during this visit that Rachael taught me to read, I can still remember the patient way she helped me distinguish the shapes and forms of the words and how they made sense. I have never looked back.

I was frequently “left” with the Lane family, who had been a part of my parent’s “courting” days, I loved being there, in what seemed to me to be a huge house in the country. Later on I remember sitting outside the house at the side of the A40 selling plums for  a week or more reading my way through Enid Blyton’s Famous Five novels, I must have been 8 or 9 – what would the Daily Mail say now? (Child left at roadside to peddle fruit, at risk from every passing pervert!).

Books again, so having “got it” my home was a treasure trove, my father worked for William Collins the publishers and so was forever coming home with all sorts of books, I couldn’t tell what was “adult or child” so if it was on the shelf I helped myself and got on with it or didn’t.

I have bought, skimmed, scanned, read or just ignored most of the popular, self-improvement books. It’s my nature, it’s part of being a coach to know what tools to suggest for my clients to use. So when I read in an ezine (ironically I can’t remember whose) someone suggesting this book as a good read I gave it a go.

The story is straightforward, Ed has just split up from his girlfriend, he hates the job he’s doing and his life is generally going nowhere. He bumps into Geoff in the pub one lunchtime, falls into conversation with him, helps him unblock a drain and listens to little of his philosophy. This first meeting leads to many more and follows Ed’s exposure to the form of Buddhism followed by Geoff, through Ed’s devout scepticism of all forms of religion to a gradual acceptance of the teachings of Nichiren Daishonin.

What’s unusual about this book is the effect it had on me, I read it in three sittings and, on completion,  started it again and am more than half way through my second read.

I have problems explaining why it’s so good, it’s well written without a doubt, the author is a highly skilled and experienced writer for TV, both drama and comedy, and advertising. Perhaps the message was right for me right now as I felt it’s a book I had been waiting to read.

Whatever, I urge you to read this book, enjoy the experience and let it weave its spell on you.

It’s available from my Amazon store here.

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