The Monday Morning Quote #126

The most dangerous phrase in the language is, “We’ve always done it this way.” 

Rear Admiral Grace Hopper


FT on ethics.

It’s unusual for the FT to run a piece by a Bishop, rarer still for me to reproduce it. I have been giving a lot of thought recently to the subject of values, from that come issues of morality and behaviour.

Michael Wise taught me that “the measure of a (dentist) is what they do when nobody is watching“.  Michael’s quote is a variation on a statement by the man who enjoys the marvellous name of Julius Caesar Watts, better known as  J.C.Watts:

“Character is doing the right thing when nobody’s looking.  There are too many people who think that the only thing that’s right is to get by, and the only thing that’s wrong is to get caught. “

What, I wonder, would have happened if 100% of UK dentists at any time in the past had said to a man/woman “this system means that we can not treat patients to the very best standards that we know are available”? Instead, the short term philosophy that has bedevilled both business and politics for the past four or more decades has grown within dentistry.

The acceptance and embracing of the “never mind the quality feel the units” contract (if anybody can show me how there are incentives for long term quality in the contract I’ll happily change my mind) in 2006 has resulted in a state where the important thing is the churn of UDAs, the attainment of the contract, the let’s keep the PCT off our back no matter what approach.

The article is about the oath that MBA graduates from Harvard swore in 2009. So if the products from that cauldron of capitalism can consider the morality of what they are doing so should all of us. I recently posted a piece about a “modern” Hippocratic oath – I think this works as a companion piece.

Here’s the link.

Here are the words:

MBA oath provides an ethical foundation

By Barry Morgan Published: February 7 2011 00:02 | Last updated: February 7 2011 00:02

People expect the Church to talk about moral values but it is fascinating to observe that the world of business also uses spiritual, even religious, language. Businesses talk about the need for “vision” and having a “mission plan”. They are concerned about the “well-being” of their employees and emphasise “service” for their clients. Businesses often have documents that speak of their spiritual architecture.

There is more emphasis on the need for ethical behaviour in business today than ever before. While companies often speak about the values that underpin their philosophy and social purpose, recent events in the banking sector in particular have caused many to question whether businesses do behave ethically. We seem to have a financial system without adequate controls and the impression is sometimes given that some companies are run for the benefit of their top employees, who have enormous freedom to indulge in self-serving behaviour.Too often, talk about ethics – about how we should live our lives, the kind of people we ought to be and the way we would like our communities to function – is regarded as irrelevant, pious or even weak. It is not seen as “businesslike” in a world where competition reigns and financial growth is the only marker of success.

That kind of dissonance between theory and practice has led to a public debate about ethical behaviour in the world of business. Simon Longstaff, from the St James’s Ethics Centre in Australia, working with Australian individuals, businesses and institutions, says six questions need to be asked:
● Would I be happy for this decision to be on the public record?
● What would happen if everybody did this?
● How would I like it if someone did this to me?
● Will the proposed course of action bring about a good result?
● What will the proposed course of action do to my character or the character of my organisation?
● Is the proposed course of action consistent with my espoused values and principles?

Meanwhile, in 2009, MBA students at Harvard Business School committed themselves to behaving ethically and responsibly by taking an oath, pledging that their purpose is to serve the greater good of society.

Two hundred and fifty business schools worldwide have also expressed an interest, which, at the very least, shows that many students feel there is a kind of moral gap at the heart of their business courses and, therefore, in businesses as a whole. Their feeling is that it is not enough to do an MBA without studying the principles on which a business ought to be run.

It is encouraging that those starting their careers are asking fundamental questions about principles and values.

Companies are social organisms, with a social purpose and corporate social responsibilities. These values affect everyone connected with the business. There has to be consistency of message and behaviour across the organisation for its mission to be effective. Often, however, in trying to increase productivity and hence profits, maintain a skilled workforce, remain competitive and anticipate trends in the market, this can take second place and sometimes be forgotten altogether.

But it ought to be a fundamental given that institutions are created for people, not people for institutions. The mechanics of an organisation are obviously important or there would be no business to run but the key component must be the development of a culture, customs, traditions and an ethos where people are valued. This means that the exercise of responsible, ethical leadership is crucial.

The questions proposed by Mr Longstaff and the principles of the MBA oath need to be taken seriously because they offer business an ethical foundation and framework for decision-making.

If adopted, an ethical perspective could become as second nature to executives as an economic outlook. That would make a radical difference to the way in which we conduct business because, in the end, conventional regulations cannot cure moral blindness or human greed.

Dr Barry Morgan is Archbishop of the Church in Wales





Denplan release new survey on consumer attitudes

I have always admired Denplan’s involvement in both future gazing and examining where the market is now. I remember reading in 1996 the Demos publication “Open Wide” co-authored by the wonderfully named Perri 6, in which Denplan were active participants.

If you’re interested to see in how right or wrong they were about 2010 you can download the book here –

Now there’s a new survey on Consumer Attitudes, it’s not as daunting a read as Open Wide but it’s an interesting snapshot.

Access the survey here –Denplan Survey



“Tales from the Troubleshooter #5”

As published in Dentinal Tubules here’s the fifth instalment of Jimmy’s story.

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

Part 5. People – Asset or Liability?

The Seven Pillars of Dental Practice Management© are:
Financial Controls

Accountants show equipment as an asset and the wages owing to staff as a liability. I am not qualified to argue over the strict definitions but any practice owner knows that a dental chair that has failed to operate on a fully booked Monday morning is a liability. A receptionist who can call all the patients whose appointments were booked several months ago and then confirmed by text to explain, apologise and rebook leaving them feeling sorry for the owner is a real asset.

In Jimmy’s practice there existed a hierarchy of staff. The “practice manager (PM)” and “head nurse (HN)” were part-timers who considered themselves to be a cut above the remainder of the team which comprised two full-time and one part-time dental nurses and a full-time receptionist.

There was little or no communication between PM & owner or the rest of the team.   The PM started work at 8am and left at noon thus avoiding any opportunity to have regular conversations with Jimmy. She was responsible for initiating and transmitting claims – she wasn’t all that good with the software so I estimate that tens of thousands of pounds of claims were not made.

PM & HN were the only people allowed to do any ordering, unfortunately they had no idea of efficient stock control or just in time ordering. The result was that there were huge outstanding bills with some suppliers, with large amounts of  the ordering seemed to be done on an arbitrary basis and there was certainly no budgeting.

They (PM & HN) had betrayed the trust show in them by giving themselves a 50% pay rise 12 months earlier, whilst giving the rest of the team 3%. They bought luxury tea for their own use and had bought a special coffee maker that only they were allowed to enjoy.  These two were definitely a liability.

Staff meetings were irregular and usually consisted of Jimmy having a moan about something or other and telling everyone to “shape up or ship out”.

I could go on but I’ll stick to the problem of dealing with their control. The HN jumped ship within a week of my coming on board, the PM was not quite so easy. In spite of supervising and controlling the appointment book so that a shortfall of 14.5% was achieved requiring a 10% clawback from the PCT, we were not able to sack her for negligence. Jimmy, in his frustration, had written several notes to her exercising the language of his native Glasgow so any attempt at dismissal would have resulted in an employment tribunal. Therefore we had to go down the redundancy route – this was done with excellent legal support, took a month or so to accomplish and was expensive but necessary.

Then we were able to get to the work of improving the rest of the team.

The first step was to introduce weekly staff meetings where everyone felt safe to say what they thought. Contributions were invited and new ideas were welcomed. The two full-time nurses had been at the practice for more than five years and were full of suggestions to make things run better.

That was immediately followed by a pay increase for everyone.

Next came a programme of delegation and education resulting in an increased involvement with and awareness of the practice as a business.

  • The nurses were given a budget for purchasing.
  • Appraisals were introduced, much to the initial apprehension of the team. Once they got to grips with them and realised it was a non-judgmental exercise they really enjoyed the experience.
  • They were all told that they were expected to reach and, if possible, exceed the GDC requirements for CPD and as much assistance as possible was given so that their personal development plans could be realised.
  • Training in software use and impression taking meant that they became far more involved in patient care.
  • The receptionist took on a number of administrative duties that had previously been closely guarded by the PM – and took them in her stride. The result was clarity about several stages of the patient journey.
  • Every team member became responsible for monitoring a variety of performance indicators.
  • Conversion of the PM’s office to a room for discussion with patients and parents meant that the nurses were able to communicate better. The result was an uptake in private treatment and better motivated patients with fewer failed appointments.

The past twelve months has seen an increase in morale, a decrease in absence and a team that is starting to behave as a team rather than a collection of bullied individuals. Patient complaints have reduced – they were running at one or two a week at one point. The biggest challenge has been to get them to believe that they are all valued. They still have a tendency when asked why they do something in a particular way to reply, “because “X” (the PM) said so” – old habits die hard.

One challenge that remains is getting Jimmy to get out of the way of his team, having abdicated rather than delegated for five or more years, leadership of a small team hasn’t rested easily on his shoulders.

So, to answer the question that’s in the title of this piece, all people can be an asset if they are treated properly and bad ones are a liability if you tolerate them becoming such.

The Monday Morning Quote #125

“People will forget what you said,

people will forget what you did,

but people will never how you made them feel.”

Maya Angelou

European Dental Trade (Market Trends)

Just come across this on the Stockdale-Martin blog, interesting reading, the blogpost is here.

The Federation of the European Dental Industry (FIDE) recently released its 2011 Survey on the European Dental Trade (Market Trends). Co-designed by ADDE, the Association of Dental Dealers in Europe, the survey gives an insight into dental industry demographics, manufacturing and marketing behaviour across 12 European countries, including France, Germany, Russia and the UK. Among other things, it revealed that:

• 263,756 dentists currently practise across Europe, of whom 29,294 practise in the UK

• There are 12,200 active dental offices across the UK, as well as 2,370 dental laboratories

• 5,776 dental hygienists and 7,044 dental technicians are also currently active in the UK

• 1,301 new dentists graduated from UK training institutions in 2010

• The sales value of all dental products across Europe (excluding metal implants) is worth an estimated €5,897 million (approximately £5,134 million), while the UK market is worth some €427 million (£372 million)

• 59 dental dealers operate in the UK, 7 of which sell exclusively via mail order, telesales and catalogue

• 19% of UK dental manufacturers supply directly to dentists

• 46% of dental retail purchasing by dentists in the UK is conducted online

• 82% of dental offices use computers in-surgery.

Stockdale Martin is currently undertaking the first SMi-Dent survey, which will be delving into some of the issues raised in this and previous dental industry reports. For further information or to obtain copies of either report, email or give our offices a call on 0870 7355385.

Dentists – be wary of social media

Hot on the heels of the Nursing and midwifery Council warning Nurses and midwives about the use of Facebook and other social media sites, more here, comes a similar message from the British Medical Association, here.

Doctors warned over using Facebook

By Jeremy Laurance, Health Editor

Wednesday, 13 July 2011

Doctors should not accept Facebook requests from patients, the British Medical Association (BMA) says.

The dangers of breaching confidentiality, damaging their professionalism and risking the doctor-patient relationship are too great, BMA says.

Many doctors and medical students use social media – including Facebook, Twitter and blogs – with no problems. But in new guidance the BMA recommends they adopt conservative privacy settings and declare any conflicts of interest when they post online.

Dr Tony Calland, chairman of the BMA’s Medical Ethics Committee, said: “Medical professionals should be wary of who could access their personal material online, how widely it could be shared and how it could be perceived by their patients and colleagues. Accepting Facebook friends presents doctors with difficult ethical issues.”

There has been a plethora of social media experts working with dentists in recent times, some suggesting that dentists should use Facebook extensively as part of their overall marketing plan. It’s the dentist who falls foul of the GDC never the expert.

I can’t find any mention of the GDC pontificating on the use of social media – yet.


What are “regulators” for?

I have been wondering about the parallels in regulation between dentistry and other professions.

General Dental – front page shows a smiling person doing something to a plaster model on a Tupperware container.

“We are the organisation which regulates dental professionals in the UK.”

General Medical – front page changing images of smiling doctors, patients, students etc

“Regulating doctors – ensuring good medical practice.”

The Care Quality Commision has been thrown over dentistry at short notice without thought, consultation or consideration. Nobody knows how it will work alongside the GDC or even whether it was needed to. Hours of work and a bill of £800. That’s for another day.

Next (in my ignorance) I went to The Law

Strap line “Supporting Solicitors” “The Law Society represents solicitors in England and Wales. From negotiating with and lobbying the profession’s regulators, government and others, to offering training and advice, we’re here to help, protect and promote solicitors across England and Wales.”

So that’s not really the equivalent of the GDC/GMC. The site helpfully tells me that if you have a complaint about your solicitor you have to go to the Legal Ombudsman (picture of Adam Simpson – a real person) which assures you that “we don’t take sides” – not the experience of many who come to the attention of the GDC/GMC.

On the other hand should you have a complaint about a solicitor that has worked for someone else then you need to take the matter up with the Solicitors Regulation Authority (nice smiley young people) who it turns out are the “independent regulatory body of the The Law Society”.

The lawyers are facing changes in less than 3 months to the newspeak of “outcomes-focused regulation” and their registration fee structure was more confusing than GDC/GMC involving individuals & firms.

I was impressed with “Lexcel” which is only awarded to practices that meet high management and customer care standards.

My impression is that the legal profession is one step ahead of the dead hand of government and takes its image of self-regulation seriously.

Accountants are registered with the Institute of Chartered Accountants which has a very helpful website they say that “One of the aims in our charter is ‘to maintain high standards of practice and professional conduct by all our members’. As a professional membership organisation, we are committed to acting in the public interest.” You have to be ACA or FCA qualified to join but I believe you can call yourself an accountant without having qualifications.

Next I looked at the Nursing and Midwifery Council which ” exists to safeguard the health and wellbeing of the public.It has the obligatory “how to make a complaint” button, I’m surprised they don’t flash and say “go on, you know you want to”.

Taking a look at the GDC, GMC & NMC websites I realise that they are all designed along very similar lines and possibly by the same team – not sure whether that reflects s loss of autonomy or what really. The GDC site is the worst of the three by a country mile, it is both patronising and complicated. Far too much information on the pages and not designed with the user in mind, the bunching together of every job in dentistry makes the whole thing unnecessarily complex. Would it be beyond the wit of the GDC to have different coloured pages for DNs, hygienists etc or is this part of the dilution of aspiration by insisting we’re all one great big happy team?

And don’t start me on fees, why is it that to register as a midwife costs £76 yet a dental nurse costs £120.





The Monday Morning Quote #124

“In battle, in the forest, at the precipice in the mountains,
On the dark great sea, in the midst of javelins and arrows,
In sleep, in confusion, in the depths of shame,
The good deeds a man has done before defend him.”

Bhagavad Gita

Training is a waste of time

“We are wasting our money on training” said one board member.

“They are disloyal and lazy people who don’t care about our organization and as soon as we train and develop them, they leave to our competitors.”

A short but heavy silence finally was broken by hesitant voice;

“Imagine if we didn’t train them and they stayed with us?!”.

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