Another good day to bury bad news?

Posted on April 28, 2011 by Alun Rees

One advantage to the government of the plethora of public holidays is that many people don’t have enough time to watch what’s going on. I am reminded of the words of Jo Moore who sent an email whilst the Twin Towers were alight on Sept 11th 2001, saying that it was a good day to “bury” bad news. Whilst Ms Moore lost her job, her legacy being the phrase becoming enshrined in the public’s memory, the cynical way that “Special Advisers” behave has not changed in a decade.

Today’s announcement of an effective pay cut (think CQC fees, the investment needed to make practices comply with the evidence free HTM 01-05 and a host of other extra expenses imposed during the past year) dropped into the pool during a week when most practices are going full tilt to keep up with the run of short working weeks has been chosen to be as concealed as is possible.

At least in private practice there is the opportunity to increase fees to accommodate new expenses, such luxury is not possible for those dentists who have taken the Queen’s shilling and are just gearing up for another year (the seventh, any sign of a serious itch?) of targets and “never mind the quality just attain the width”. How much longer will this farce continue?

Here’s how the BDA have viewed it.

‘Uplift’ is really a pay cut, warns BDA

The Department of Health’s announcement today of just a 0.5 per cent increase in contract values for general dental practitioners in England for 2011/12 is a pay cut that will negatively affect their ability to invest in patient care, the British Dental Association (BDA) has warned. The BDA demonstrated in its evidence to the Department of Health that expenses in dental practice are increasing sharply, but that warning has been disregarded, the BDA has said.

Dentists are also being asked to implement new best practice guidance for preventing oral disease in children in support of the Government’s aim of reducing levels of oral disease in younger patients. Where it is considered appropriate, parents will be offered the opportunity for their children to have fluoride varnish applied to their teeth.

John Milne, Chair of the BDA’s General Dental Practice Committee, said:

“The level of this uplift is simply not enough. Dentists across England are working really hard, through a period of uncertainty, to deliver high quality care to their patients. They are contending with a growing mountain of pointless bureaucracy and escalating costs on top of the effects of the efficiency savings imposed last year. They need help to address those problems.

“While we support this prevention-focused activity to improve young people’s oral health, the costs of providing the extra fluoride varnish to children have not been recognised by this uplift. The NHS rightly seeks to improve the quality of dental services and to increase the emphasis on disease prevention, but this cannot be done in an environment where not only are dentists incomes frozen, but the continued failure to reimburse expenses puts practices under severe financial pressure.”

Ends

Notes to editors:

The British Dental Association (BDA) is the professional association for dentists in the UK. It represents 23,000 dentists working in general practice, in community and hospital settings, in academia and research, and in the armed forces. It also includes dental students.
For further information, please contact the BDA’s media team on 0207 563 4145/46 or visit http://www.bda.org.

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Practice Managers’ Retreat

Posted on April 27, 2011 by Alun Rees

A review of the Retreat held in Wydale Hall recently – to reserve your place on the next retreat go Joanna Taylor’s website.

Practice Managers’ Retreat

Wow, what an amazing two days!

Wydale Hall in North Yorkshire is a beautiful 18th century country house set in 14 acres of gardens and woodlands.  It is the retreat house and conference centre for the diocese of York.  With warm spring weather and the odd April shower, it was the perfect setting to escape the rigors of daily life for busy dental practice managers.  Three of the delegates stayed at the hall, arriving on Sunday evening for dinner and a restful night to set them up for the interesting two days ahead.

We started on the Monday morning as five individuals who were wondering what a retreat was all about. By the end of the first session we had discovered we had so much in common & found a bond between us, none of us were in this alone, we shared common stresses, highs and lows in our jobs and we all had a great enthusiasm for our teams and practices.

Our trainers and guides for the retreat were Joanna Taylor and Alun Rees.  Joanna is a Clinical Hypnotherapist, NLP Master Practitioner and an INLPTA Certified Trainer and most important of all a busy dental practice manager!  Alun is a dentist and business coach and is married to a busy dental practice manager!  We knew from the start that we were in good hands.

Joanna and Alun provided a safe environment for us to be honest with each other and ourselves. We learnt techniques that will enable us to grow not only as individuals and but also as practice managers.  There was an abundance of time and space to discuss individual issues and to acquire tools and skills to help us cope with a variety of aspects of dental practice management.

We learnt about how we communicate, how we can’t not communicate and how our communication affects us and those around us.

Joanna talked about the functions of the mind and that we have a conscious and unconscious part to our brains.  The conscious mind equates to approximately 5% of our brain and is responsible for making decisions and thinking and processes small “chunks” of information for us.  The unconscious mind is the other 95% and this is where our habits, beliefs, values, emotions and “automatic pilot” reside. It can process millions of “chunks” of information.

We gave some time to thinking about our own beliefs and values and how these affect our bodies and how we behave.  We learnt to pay attention to our body signals of stress and tension and to notice any negativity.

Very usefully both Joanna and Alun helped us discover ways to deal with awkward situations and people.  Alun gave us an overview of Transitional Analysis and introduced us to the concept of Parent, Adult, Child which rang familiar bells with all of us!  He recommended the book ‘I’m OK, You’re OK’ by Thomas A Harris for further reading.

Another useful topic covered was the management of change – both for the practice and for individuals. Successful practices can and do adapt to change; very successful practices anticipate and manage change in advance. We looked at Robert Dilt’s model, Neurological Levels of Change that provides a useful framework for deciding at what level it is appropriate to work to achieve the desired outcome and to manage the change.

Some time was spent on the second day looking at our personal goals.  We looked at six areas of our lives: career or professional, family, relationships, personal growth, health & fitness and spirituality.  We explored which areas we weren’t achieving the results we wanted.  Joanna suggested some powerful questions to ask ourselves, which would help to identify beliefs that were limiting our success in gaining those results.

Most interestingly we learnt techniques in self-hypnosis where Joanna took us slowly through the processes that would be useful in different situations and we were able to practice no fewer than five different methods. Self-hypnosis is a naturally occurring state that virtually everyone, with practice, can learn to use for achieving goals that otherwise might be too difficult to achieve.  Self-hypnosis can help with many issues including stress, resolving problems and achieving goals, such as smoking cessation or improving emotional health and life balance.

Joanna’s skills at storytelling proved invaluable in reinforcing the learning whilst Alun’s vast experience of dental practice meant that everything stayed relevant.

These two days were of great value personally and professionally.  By the end of the second day we were looking forward to taking our experiences back into our real worlds.

The retreat gave me time and space in lovely surroundings to take stock of my life and work and to face future challenges with more confidence in myself and my abilities.

I thoroughly recommend this course to anyone involved in practice management.

S.H.

To reserve your place on the next retreat go Joanna Taylor’s website.

 

 

 

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Often quoted but ever read?

Posted on April 27, 2011 by Alun Rees

The Hippocratic Oath is frequently referred to during discussions about medicine, and by extension dentistry. Portions are quoted but I never knew whether they were taken in or out of context. To my knowledge nobody ever discusses the full words and meaning of the statements, attributed to Hippocrates, some two and a half millennia ago with students and new graduates. So when I came across this article recently I thought I would share the contents.

I was fortunate to visit the impressive plain tree on the Island of Kos which is said to be the site where Hippocrates sat and taught his pupils. Whether the concept of sitting at the feet of a master still exists in these times of “Problem Based Learning” I am not sure, but it impressed me that I was able to enjoy being in a place where fundamental concepts of medicine were defined.

First up is a “modern” take by Louis Lasagna. Then the original.

HIPPOCRATIC OATH: MODERN VERSION

  • I swear to fulfill, to the best of my ability and judgment, this covenant:
  • I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
  • I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
  • I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
  • I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
  • I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
  • I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
  • I will prevent disease whenever I can, for prevention is preferable to cure.
  • I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
  • If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

HIPPOCRATIC OATH: CLASSICAL VERSION

  • I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
  • To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
  • I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
  • I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
  • I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
  • Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
  • What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
  • If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

Unfortunately in 2011 the phrase that comes to mind is: “You pays your money & you takes your choice.”

 

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26th TC White Symposium – Surviving Dentistry

Posted on April 26, 2011 by Alun Rees

There’s an acknowledgement of the presence of stress, both mental and physical, and the damage it can have on dentists and their teams in the TC White Symposium to be held at the Royal College of Physicians and Surgeons, Glasgow on the 13th of next month.

(It’s difficult to write the next bit without looking as if I’m waving my own flag so apologies but I’m the meat in the post-lunch sandwich.)

Featuring speakers from different backgrounds it’s a good looking programme and I’m looking forward to both listening and contributing.

The full details are available from the College website.


 

 

 

 

 

 

 

 

 


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The Monday Morning Quote

Posted on April 25, 2011 by Alun Rees

“I have learned never to underestimate the capacity of the human mind and body to regenerate – when when the prospects seem most wretched.”

Norman Cousins

from

Anatomy of an Illness


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The Power of Words

Posted on April 20, 2011 by Alun Rees

I am indebted to Marc Cooper for introducing me to this film.

Marc will be in the UK on May 12th & 13th to run a course on “Ownership and Leadership” at 38 Devonshire Place. Take a look at Marc’s website here and the details of this and other seminars here.

Unfortunately I can’t join Marc and the delegates as I shall be speaking in Glasgow at the T.C.White Symposium.

And whilst we’re on the subject of words in Glasgow…(did you see what I did there?)

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“Tales from the Troubleshooter #2”

Posted on April 19, 2011 by Alun Rees

Tales from The Troubleshooter – Case 1. Jimmy’s story.

Part 2.Where are you going?

The Seven Pillars of Dental Practice Management© are:

  1. Vision
  2. Financial Controls
  3. Sales
  4. Marketing
  5. People,
  6. Environment
  7. Systems

Last month I told the story of how Jimmy had got into a situation where he had a high income but was losing money and had no way of stopping himself sliding further into debt. That was an illustration of the second pillar “Financial Controls”.

This time I’ll go back to the first pillar “Vision”. If you don’t know where you are headed how on earth will you know when you get there? Or even when you’re half way there? The concept of a vision is a fundamental to every successful person.

Like a lot of dentists Jimmy had fallen into his path in life, putting one foot in front of the other and rarely if ever looked up to see where he was going. School led to A-levels which resulted in five years at university. In company with the vast majority of dentists of the pre-VDP generation an associateship in general practice was the next step. Marriage then children meant a need for an income to support a family. An opportunity to buy a run down practice presented itself so further debt came from an ever eager bank.

Absorbed as he was in the sheer busyness of life his 30th then 35th birthdays came and went before he knew it. With 40 looming he had a minor heart attack and decided to relocate away from his home city. This was an example of someone reacting instead of responding to a situation. Unfortunately this coincided with the realisation that he and his wife had never been really suited and they parted, she stayed in the family home with their children.

He found himself several hundred miles away starting again in a new practice and soon with a new wife and more children. Fortunately he was a very hard worker, a personable soul and a good clinician so the new venture flourished.

A road accident made him (probably for the first time in his life) take stock of his situation and he decided to sell his general practice and to concentrate on his first love, orthodontics. He was then aged 52 and he threw himself into the clinical elements of the business with relish and enthusiasm, building a “successful” practice for the third time in his career.

However, just like a soap bubble held in the palm of your hand disappears when you try to hold it, so it is that success, unless founded on sound principles, can prove to be an illusion that disappears before you eyes at the point when you most believe it.

What are the definitions of success? Well they are different for every single one of us. Each individual has their own buttons which, when they are pushed, brings them to the point of Maslow’s self- actualisation. It is never my place as a coach and consultant to decide these things for my client rather it is better for all concerned for me to help them to make the big decisions on their own.

The metaphor frequently used for life’s “journey” (a word devalued in recent times by association with Simon Cowell’s proteges) is a sea voyage and I’ll use that here.

Frequently when a client approaches me they say, “I don’t know what to do, tell me where I should be heading” I can give them the tools and I can help them build their boat, I can teach them navigation but I can’t decide for them where they are going to sail.

When you set off from home port you are affected by the wind and the currents and you’re immediately off course. With a good compass, regular readings of latitude and longitude (or these days a GPS) you can keep yourself on track. If you haven’t got a vision or a series of goals of where you’re heading then all you’re doing is pottering about in your boat which can be pleasant but it doesn’t take you anywhere.

With Jimmy, the crisis in the business had led him to the point of despair about the rest of his life and what he should do with his still young family. I encouraged him to take some time by himself to examine every aspect of his life, as you can not take “work” in isolation.

The suggested sectors are:

  • Career
  • Family & Friends
  • Money
  • Partner
  • Physical Environment
  • Health
  • Growth & Spirituality
  • Fun & Recreation

Try this for yourself, using the topics above sit down and write as if you are 3 years in the future and imagine where you will be and what will have happened to you for you to have made the most of the time. Then decide on the steps you have to take to get there. I am grateful to my first coach Chris Barrow for teaching me this technique.

When you have decided what it is you want share it with as many people as possible, particularly your partner and your team. This will make it real, make you accountable and will help to make it happen.

My friend the ocean rower Roz Savage (www.rozsavage.com) used another exercise where she imagined herself listening to a choice of orations being given at her funeral. The first one was how it would be if she stayed as she was; with the second one she visualised how her life could be if she grasped all the opportunities that were available to her. The result is that she is no longer a well paid management consultant  and rows oceans in order to bring attention to environmental causes.

Back to Jimmy. He has now made some very hard decisions about his future, a decision to sell the practice to his associate and, to allow a period of evolution rather than revolution, to remain as a part-time associate until the new owner finds their feet. They plan a return to closer to where he and his wife feel their roots to be in order to enjoy a quieter pace of life.

These days he still works very hard but now knows where he is heading. His vision and the steps he must take are clear.

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