The Monday Morning Quote #582

Success or Failure depends more upon attitude than upon capacity, successful men people act as though they have accomplished or are enjoying something.

Soon it becomes a reality.

Act, look, feel successful, conduct yourself accordingly, and you will be amazed at the positive results.

William James

Oh the places I will go – Part 3 – Bounceback

Part 1 – The World at my feet

Part 2 – The World at my feet – in pieces

18th March 1993

My 40th birthday and a very significant date in the life of my practice. In the wake of the 1990 NHS contract and subsequent clawback of fees a group of dentists in Gloucestershire “held hands and jumped” to remove our dependence on the NHS. Several of us had things in common, we were of similar age, had big loans and couldn’t see how we could square the circle of carrying on providing our best for patients and continue to make a living.

With the assistance of the fledgling group, Gloucestershire Independent Dentists (GID) and supported by each other, in the words of Judith Cameron, we leapt and the net appeared. Some practices changed overnight, I was more cautious and transitioned over a 12 month period, giving all my adult, non-exempt, patients one last NHS course of treatment. This enabled me to have a conversation about the why, how, when and who of the changes. In those days Denplan was just about the only game in town and Gloucestershire became “Denplan county”.

I dreaded making the change, I anticipated wholesale rejection, arguments, insults and my hard work unravelling in minutes. I couldn’t have been more wrong. Because I changed gradually, and every patient received a letter ahead of their next visit plus good PR from GID, the word had got round. I allowed time to talk to explain my motives and to offer alternatives. The overwhelming feeling was one of acceptance, some begrudging, some cancelled their appointments “on principle”, some disappeared and then reappeared. More patients that I expected just said, “I’m surprised it has taken you this long, you have been giving private service since you opened.”

Instead of it being a catastrophe it was a tiny bump in the road. At the same time I started studying with the Open University on their MBA course which was really useful but due to circumstances beyond my control I was never able to complete. I also enrolled with Dr Mike Wise’s year long restorative course which also made me raise my game.

So I found myself with a largely private practice. There was still a significant NHS commitment because of the number of children we had attracted, which took a lot of management but worked extremely well and became a model for others to follow.

Things were looking up, I had managed to get a mortgage after a couple of years of banks not wanting to touch me with a bargepole, had remarried and our son was born in early April.

Life was good and the challenges were under control. The work was no less hard but the road was looking smoother.

What to learn from aircraft??

Earl Weiner

Among them:

  • Every device creates its own opportunity for human error.
  • Exotic devices create exotic problems.
  • Digital devices tune out small errors while creating opportunities for large errors.
  • Invention is the mother of necessity.
  • Some problems have no solution.
  • It takes an airplane to bring out the worst in a pilot.
  • Whenever you solve a problem, you usually create one. You can only hope that the one you created is less critical than the one you eliminated.
  • You can never be too rich or too thin (according to the Duchess of Windsor) or too careful about what you put into a digital flight-guidance system (Wiener).

Wiener pointed out that the effect of automation is to reduce the cockpit workload when the workload is low and to increase it when the workload is high. Nadine Sarter, an industrial engineer at the University of Michigan, and one of the pre-eminent researchers in the field, made the same point to me in a different way: “Look, as automation level goes up, the help provided goes up, workload is lowered, and all the expected benefits are achieved. But then if the automation in some way fails, there is a significant price to pay. We need to think about whether there is a level where you get considerable benefits from the automation but if something goes wrong the pilot can still handle it.”

The Fish Rots From The Head

“il pesce marcisce dalla testa” – The Fish Rots From The Head

The final quarter of 2018 saw me speaking throughout the UK on “Leadership and Management”. In preparation I examined the characteristics of both, the differences between them and where they overlap. This exercise meant that I had to take stock of some of the theories that I had espoused and taught over the past 20 years. 

Whilst our knowledge evolves, certain core principle stay the same and one of these comes with the snappy phrase, “The fish rots from the head”; allegedly derived from the Italian, “il pesce marcisce dalla testa”.

What this means is the leadership is the root cause of any organisation’s failure. If the culture of your business is broken, only the leadership can repair it. If the leadership doesn’t establish and maintain a healthy culture then a vacuum is created within which an unhealthy culture will grow and the rot will spread.

I see this happening in many dental businesses. Although the business was healthy at one point, change has meant that the leader has taken their eye off the ball. Often they have believed that by “delegating” work to a practice manager they don’t need to put their energy into leading. What has really happened is abdication not healthy delegation.

Every business large or small must have clear leadership from the top with clarity, guidance and adherence to core values. Without regular examination and renewal, stagnation and disease will occur. The resulting drop off in health means that changes have to be made. 

It is only the leadership that can eliminate disease, remove any necrotic tissue and then make the changes to ensure that the standards it sets are maintained in the future. Unfortunately all too often the cure and remedial treatment is more painful than was needed if business health had been maintained.

(first published in Dentistry.co.uk 22nd January 2019

The Monday Morning Quote #577

You know what (that) strategy is?

1. Decide what you want.

2. Compare that to where you are.

3. Write down the steps that you need to take on a piece of paper to get you from where you are to where you want to be.

4. Do the work.

Anon

Sleep isn’t for Wimps.

I had a nickname in my first year at university – “The Midnight Rambler” – I didn’t sleep very well and used to wander around the halls of residence looking for people with their lights on to share a coffee and have a chat. (I suppose the coffee was a clue…)

I finally got around to reading “Why we sleep” by Malcolm Walker and wish it had been compulsory reading 40 years ago, I might have had a more productive life rather than a more manic one. I grew through a period where it was considered macho to go without sleep, I remember the plastic surgery firm at Withington Hospital boasting at 11pm how they had been in theatre all day and were just about to go back there. I always said that I needed less sleep than others – in hindsight I was wrong.

Walker talks about productivity and the effect that sleep (or its lack) has on it. He quotes this article and makes the point that KPIs in most companies are measuring things that are easy to measure – revenue, goals accomplished, profit, new customers etc. Most of these are affected by employee traits creativity, intelligence, motivation, effort, efficiency, effectiveness, sociability, emotional stability and honesty. All of these are systematically dismantled by insufficient sleep.

Would you let a surgeon who had only had 4 hours sleep operate on you? I wouldn’t. 

Would you let a woman who only slept for four hours a night run a country? I wouldn’t do that either.

It’s a great book that will frighten you and convince you to make an early night and sufficient sleep a part of your routine.

Buy it HERE.

 

The Monday Morning Quote #571

“Nothing is so useless as doing things efficiently that should never have been done at all.”

Peter Drucker

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