“No point hiring image consultants if your own receptionist is letting you down” says David Hepworth.

I admire David Hepworth as a writer and commentator, I still miss The Word which he and Mark Ellen ran for nearly a decade. I never thought that I would share one of his blog postings on this site but he nails it, as does Lucy Kellaway in her FT piece (sadly behind a paywall).

Here’s his post:

No point hiring image consultants if your own receptionist is letting you down
Piece in FT by Lucy Kellaway about how much you can tell about a visitor from the way they deal with a receptionist. All true. By the same token that visitor can also tell a lot about a company by the way the receptionist behaves.

I regularly sit in reception in a building used by one very high-profile public body and never fail to be amazed by the gossip and parochial whinging the staff seem content to let me overhear.

Kellaway talks about a company who have a spy among their reception staff whose job it is to report on the behaviour of waiting job candidates. Some managements should have a spy among the people waiting. They might find out a few things about their public image that would horrify them.

The Monday Morning Quote #311

“Live as if you were living already for the second time and as if you had acted the first time as wrongly as you are about to act now!”

Vicktor Frankl in Man’s Search for Meaning


The Monday Morning Quote #310

“The secret of success is concentrating interest in life, interest in sports and good times, interest in your studies, interest in your fellow students, interest in the small things of nature, insects, birds, flowers, leaves, etc.

In other words to be fully awake to everything about you & the more you learn the more you can appreciate & get a full measure of joy & happiness out of life.”

Excerpt from a letter written by Jackson Pollock’s father to his son.


Leading by Instinct – Kathy Kolbe spells it out.

kolbeLogoThis posting is from Kathy Kolbe’s blog dated October 6th 2014 – for some reason I missed out on it first time round. One of the things that I explain to people about Kolbe is that there is no right or wrong. I was recently dismayed to read a posting from another dental coach, who should know better, that unless an individual initiates in Quick Start they are doomed to fail, the truth is far from it, indeed there is a risk of chaos with an insistent QS at the helm without balance in the team.

Kathy’s take on leadership in organisations big and small. Full post and a link to her blog, here.

“There is not a Best M.O. among top leaders. Nor is there any M.O. that would exclude you from being a good leader.

My research shows that the best predictor of both productivity and sustainability in complex and complicated environments is the degree of conative or instinct-based diversity among the core leaders in the C-Suite. In smaller organizations, with only a few people at the top of a narrow pyramid, the conative criteria for leadership also narrow.

Instincts in C-Suites

In a large and very complex organization with a collaborative culture, it works especially well to have a CEO whose instinct is to initiate in both the Fact Finder and Quick Start Action Modes, sparking both research and development programs. Another essential part of the conative mix is for such leaders to instinctively resist or just mildly accommodate Follow Thru systems. This is how such leaders keep their organizations from getting bogged down in redundancies or becoming too bureaucratic.

It is essential, that leaders with this M.O. have CFOs, or other cohorts at the top, who deal with the complicated, more linear, financial, legal, and sometimes physical structures. It has proven wise to have a second in command who naturally plays the role of insisting on adherence to Follow Thru regulations -which he or she instinctively creates. It helps a set of such leaders to work in sync with each other if the second person accommodates Fact Finder strategies. When these leaders have equal levels of insistence in Fact Finder, they need to have clearly defined, separate responsibilities or they will end up with dueling priorities. Rounding out the M.O. of the cohort is a resistance in Quick Start, which adds a stabilizing force to the senior management team.

In today’s world, the CEO often serves as the chief PR person in the face of scandals, recalls, attacks, and hackings. I don’t see many resistant Quick Start CEOs surviving through major crises like these. Quick Start energy is required when being a spokesperson dealing with uncertainty (note what happens to the grand orator in Obama when he addresses uncertainty).

Resistant Follow Thrus are beaten up for not finishing what they start, but without their input organizations would stay put. The power of their randomness makes their resistance to sticking with the plan the ingredient that often saves the day. As confounding as it can be to their conative opposites, their natural ability to dodge bullets is a trait that helps organizations land on their feet.

It is the Implementor leader’s insistence on precision and manifestation of ideas that makes this M.O. the most difficult to put in the C-Suite. It is essential, but often better in the field than the executive offices – as long as he or she is empowered to halt processes for quality control purposes. Given the freedom to skip meetings and lead the on-site troops, these leaders will add significantly to the power and quality of products and programs.

Instinctive Facilitators are especially interesting to observe as they perform at high levels of leadership in organizations like franchises and health related situations; first, because in those environments leadership involves maintaining systems and second, because it involves maintaining ego-driven relationships – and the caring for a diversity of human beings. Their instinct to bring out the best in others and to build bridges between people reduces conflicts and keeps energy focused on purposes rather than personal issues.

Entrepreneurial Instincts

It is less complicated to diagnose the instinct-based leadership in an entrepreneurial organization. It is all about the naturally born entrepreneur trusting the combination of Quick Start insistent drive and back-up Fact Finder strategies. Without much Follow Thru budget making, a stand-alone entrepreneur needs to use the power of Quick Start persuasion to cut deals, and rope friends, family and vendors into becoming uncompensated co-conspirators. Of course, those who fill the need for creating Follow Thru systems are also essential. When a true entrepreneur builds an organization to the point where it requires the type of leadership team noted above, it is time for him or her to move on – and do it all over again.

Leadership is not just about the use of conative instincts. But, nothing in my experience indicates that leaders, regardless of their M.O.s, initiate problem solving by using processes they have been taught. Their cognitive powers come into the process when they edit their instincts – and certainly when they second guess them. Leaders’ actions, triggered by whatever motivates them, are as tied to their instincts as their best salesperson’s instincts are tied to asking for the order. I do not belittle the power of the cognitive (it is not an after-thought in the Kolbe Creative Process). It’s a matter of what comes first.

Instincts are precognitive. If that weren’t true, we would have no heroes – or top leaders. Having closely observed the creative efforts of thousands of leaders in vastly different types of problem solving situations, I have yet to see an example of solutions being initiated by them during a period of contemplation. The actions that spark productivity are born from the innate, authentic powers of a leader’s instinctive drive.”

To take your Kolbe A assessment visit The Dental Business Coach website

The Monday Morning Quote #309

“…there is an art to flying”, said Ford, “or rather a knack. The knack lies in learning how to throw yourself at the ground and miss.”
Douglas Adams, Life, the Universe and Everything

“The moment you doubt whether you can fly, you cease for ever to be able to do it.”
J.M. Barrie, Peter Pan

Indemnity Fees – Where Is The Ceiling? – Audio

Alun explores some of the contributors to the perfect storm that have led to large rises in dental indemnity fees in the UK.


Indemnity Fees – Where Is The Ceiling?

I have a client who has been qualified as a dentist for 30 years. He is skilled, dedicated, talented and knowledgeable. I would happily be his patient if the need arose.

He accepts referrals from other practitioners for endodontics, implants and tricky restorative cases. He has recently completed an M.Sc. in Endodontics and is currently 2/3rds of the way through an M.Sc. in Implantology, He is doing these higher qualifications not necessarily to improve his clinical skills but to ensure that he is up to date with contemporary teaching and thinking on the subjects.

He is practising dentistry that is way above the average.

Here are his Indemnity charges for the past five years and the current year. There has been no change in his circumstances or prescribing patterns and no claims for at least six years and none that relate to his provision of high value dentistry.

  • 2010  £2,940 58%
  • 2011  £4,656 13%
  • 2012  £5,276.52 26%
  • 2013  £6,628.48 5%
  • 2014  £6,995.56 51%
  • 2015  £10,570.00
    Over the six years the fees have increased 3 and half fold.

He is canny enough to know that he will have to load the figures into his budgets, adjust his fees accordingly, ensure his marketing engine is oiled and efficient and get on with life. He also acknowledges that were he in plastics, neurosurgery or obs & gynae the cover would be far higher.

What has prompted me to write this are two questions:

How has this state of affairs in UK dentistry come about?
Where are we on the road to permanent change?

My thoughts, for what they are worth, conclude that there may well be a perfect storm in dentistry (and possibly the rest of healthcare). The contributors being:

Politicians. This is not an anti-politician rant but it is quite apparent that repeated dabbling in health, education etc have not led to marked improvements. The interference with health started with the Thatcher government in 1979 with reforms and attacks on the professions an example of one small but significant move was the removal of consultants’ dining rooms. In 1990 after a decade of small changes came the internal market giving rise to competition in health care, still hated 25 years on. The mantra that “the market will decide” somehow can’t work with the NHS.

NHS. A football to be kicked about. A pig in lipstick, the colours vary according to which party is in power. A religion (according to one of Mrs Thatcher’s chancellors Nigel Lawson) which must not be criticised. Certainly a source of misinformation and fudging especially with regards to dentistry. Two new contracts in 1990 and 2006 with a third on the way have done nothing to improve things.

Dental education seems to have been taken over by the NHS. The preparation for general practice appears to lag a generation behind the reality.

Open borders have resulted in an influx of dentists from other countries in Europe where the situation for dentists is worse – more pressure on the labour market means that associate fees are forced down (see Thatcher & the market).

The TLAs (3 letter acronyms). The GDC has proved itself to be out of touch and overbearing. A generation ago it was viewed with respect and there was a confidence in its abilities.  Now it acts like a cane wielding headmaster whose default position is to flog first, second and third and never to listen. Advertising for business has meant that it has sunk to the level of ambulance chasers and placed itself in the role of an adversary to the people who pay through the nose to keep it in existence. The BDA has done little to truly integrate with its constituents and hides behind committees the decisions of which bear little relevance to the day-to-day existence, challenges and fears of its membership. For too long it seems to have been afraid of its own shadow and has lost years through the distractions of its legal status and constitution. The DoH does things in its own sweet or not so sweet way (see politicians and NHS). Also CQC etc etc. The DPS, DDU & MDDUS are having to play catch up with the numbers of cases that are arriving at their doors, their subscribers fees (remember this started about their fees) having to be hiked to cover spiralling costs. IDH and other corporates have had a significant influence on provision of dentistry, mainly but not exclusively NHS.

Lawyers. It is said that in the 60s large numbers of politicians were economists and the economy went down the pan. Since the Blair government came to power in 1997 there have been lawyers in government by the score and the legal system often appears to have been built for the legal profession rather than its users – or victims. This might not really be new, Jarndyce and Jarndyce was based on a case from 1853.

Health and Disease. The patterns of disease have changed. The flood of rampant caries of the 50s, 60s and 70s seems to have abated. Perio is still not “sexy” either in education or practice. The heavy metal generation of baby boomers who were born and then indulged by parents as sugar came off rationing are able to do something that their parents could not and that is to keep their teeth for life. But like the “full mouth rehabs” of the past their care is costly and limited numbers of dentists are able to perform it with sufficient skill. Without the next generations having the drilled and filled mouths that need to be maintained what will dentists of the future do? Add to this mix the use of higher trained ancillaries hygienists and therapists and stir the pot.

Fashion or fads. From wall to wall veneers, through the cosmetic boom including botox & fillers and on to another TLA, STO or short term orthodontics. Now, it seems that after a weekend course you can become an orthodontist. The practitioners are usually well meaning or sometimes desperate to keep their businesses afloat and are promised much by the purveyors of systems. The suppliers have something to sell and have no responsibility for what is done with “their” appliances when fitted. It is totally understandable that people will make mistakes either through ignorance, enthusiasm or a combination of both. The rise and rise of STO cases resulting in complaints plus those of the far more intrusive techniques of implantology (the last, but continuing, big fad – and I mean no disrespect to those skilled clinicians who place and restore implants, rather the way that the subject is hyped as a “cure-all” for both patients dental needs and practice finances) are threatening to derail completely the indemnity market.

So there you have it. I have no solutions except some that may be unpalatable but are, I gather, being considered within the NHS. This means that there will be tiers of dentists who are limited in what level of dentistry they can provide. It is being done by the NHS for financial reasons without a doubt. But what difference might such an approach mean in private practice? Well perhaps a decent career structure and path rather than the ad-hoc system that now exists would make sense. That of course brings further questions. Who will decide who should join the path? What power will they have? How will proper mentoring happen?

A very big question. Where does the money fit? At the moment an associate 12 months after qualification in the NHS or straight away in private practice is “valued” at the same amount as someone who has 30 years of experience and an armful of qualifications – that does not happen in any other profession. When I raise this subject the responses vary, of course, depending on the circumstances, age, experience and whether the person is a practice owner.

One thing is clear, dentistry needs to get its house in order and by that I mean behaving like a profession that takes responsibility for its actions across the board. However, the attacks from the organisations that I have listed above mean that dentists are disunited, poorly represented, often run their businesses like school tuck shops and persistently act like ostriches with their heads buried in the sand.

Perhaps the market will decide, there may well be widespread unemployment, dentistry will become devalued and will cease to be a career of choice. Whatever happens it will be painful for some. It could be that these indemnity fees are not really large compared with how they will be and that they will continue to rise and be seen as just another cost of doing business that must be passed to the customer.

%d bloggers like this: