Clinical freedom in a time of austerity.

First published online in Dentistry Blog on 8th April 2019. Full article.

Clinical freedom is becoming an aspiration rather than reality.

I regularly have to straddle a line between what principals need and what associates want, whilst attempting to keep both sides happy.

Often this involves money and the phrase ‘clinical freedom’.

Amongst the things they never teach you at dental school is that you must cover your costs before you can take anything out for yourself.

Increasing overheads makes this hard.

For instance, a 13% increase in CQC fees to ‘better align the cost of regulation’ must be borne by business owners.

As far as NHS practices are concerned, the minimal rise in fees during a decade of austerity have been swamped by rising costs.

Where contracts are fixed and consume a week’s full-time work to achieve them, there is little or no room for increasing productivity.

Associates, who have the dubiously privileged position of being self-employed, must take their share of the repeated squeezes on practice owners.

Either earn more (difficult with a fixed contract) or cost less.

Because previous generations earned a bigger slice than you, unfortunately does not mean that there is any divine right.

In any profession it is time and expertise for which people pay.

The third party fee setter (the NHS) took a set of fees from a decade and a half ago and continues to run with them.

This ignores the flexibility and evolution that existed in the dental contracts for nearly six decades, which helped practices stay agile in order to remain profitable.

Sometimes these money pressures are manifested in a reduction in quality of working conditions; for instance equipment might not be maintained, materials and laboratories are chosen on cost and choice is limited and staff might be ‘bargain basement’.

As the first casualty of war is truth, so clinical freedom can become an aspiration rather than a reality.

It ain’t what you do, it’s the way that you do it.

The recent CIPD research in partnership with Simply Health was completed in November 2018 and covered more than 3.2 million employees across the UK.

The top causes of long term sickness were mental ill health & stress with 59% & 54% respectively.

 

 

The top three causes of stress related illness are:

  • Workloads / volume of work.  62%
  • Management style.   43%
  • Relationships at work. 30%

Your style as a manager needs to vary depending upon the different environments and employees. Management styles can be categorised as autocratic, democratic and laissez faire. What do you think your’s is?

If you need help with either your own management style or your managers’ style then drop me a line at alunrees@mac.com – it’s what I’m here for.

The full report is available here.

CIPD’s Top tips to support managers to minimise stress in their teams is available here.

 

 

Patient? Customer? Client? What really matters.

An interesting conversation in a practice about what the people that are treated/served/cared for should be called. I have been around the block a couple of times over the past 30 odd years and have returned to, and will remain with, patients. But that’s my opinion, you use whatever is comfortable for you.

“We sometimes make assumptions based on our opinions about a customer’s Patient’s wants and needs.

It’s hard to be objective about our ideas when we are invested in the outcome.

But that shouldn’t stop us trying to stand in our customer’s Patient’s shoes for long enough to understand how he feels.

Our opinion is immaterial if it doesn’t align with the story the customer Patient believes.”

Adapted from Bernadette Jiwa.

If you’re in Dublin on March 2nd

My maternal grandparents would be proud of me being selected for Croke Park. I’ll not be gracing the hallowed turf with my prowess with sliotar and hurley. Instead I’ll be up on level 5 in the Hogan suite on the 5th Floor with a Taster session of “The 101 Things They Didn’t Teach You At Dental School”.

Herb Kelleher – Cheap can be cheerful

Herb Kelleher was the co-founder of Southwest Airlines, he died earlier this month. He had many attributes that I admire, not least of which was introducing a culture to the company where Southwest’s employees took themselves lightly but their jobs seriously.

 

Kelleher had a simple philosophy, “A motivated employee treats the customer well. The customer is happy, so they keep coming back. It’s not one of the enduring mysteries of all time; it is just the way it works.”

An article in the FT Michael Skapinker which celebrated Herb, contrasted his outlook with a recent email from a disappointed British Airways passenger. Skapinker concluded with this statement, “few people come to work intending to be unhelpful. If they are horrible, it is usually because their bosses are horrible to them, or they prioritise sticking to the rules, or cutting costs, over keeping customers happy.”

In 1987 Michael O’Leary (of RyanAir) visited Southwest Airlines and Herb Kelleher to learn about the airline industry. Although there were plans for them to meet again, O’Leary never went back to complete his tuition.

Read more about Southwest’s business model here.

 

 

Put down your smart phone…

The more I watch the way people behave with mobile devices the more uncomfortable I become. I was secretly pleased a couple of years ago when my son justified his use of a Nokia (non-smart) phone, “Makes and takes calls, sends and receives texts. What else do I need?”

I have regular conversations with dentists and practice managers who face resentment at best and mutinies at worst because team members aren’t allowed to keep their phones with them (and on line) at all times, on the pretext of “what happens if someone has to get hold of me?” which really means, “but I’ll have to go without Instagram/FB/Snapchat/Twitter/etc.” (Perm any 3 from a multitude).

This comes from The Economist via “Memex” (the blog of John Naughton which I consider to be essential reading).

Distraction is a constant these days; supplying it is the business model of some of the world’s most powerful firms. As economists search for explanations for sagging productivity, some are asking whether the inability to focus for longer than a minute is to blame…..

….Distractions clearly affect performance on the job. In a recent essay, Dan Nixon of the Bank of England pointed to a mass of compelling evidence that they could also be eating into productivity growth. Depending on the study you pick, smartphone-users touch their device somewhere between twice a minute to once every seven minutes.

Conducting tasks while receiving e-mails and phone calls reduces a worker’s IQ by about ten points relative to working in uninterrupted quiet. That is equivalent to losing a night’s sleep, and twice as debilitating as using marijuana. By one estimate, it takes nearly half an hour to recover focus fully for the task at hand after an interruption. What’s more, Mr Nixon notes, constant interruptions accustom workers to distraction, teaching them, in effect, to lose focus and seek diversions.

What to do when…..a Corporate Opens Nearby – Part 2

What to do when a corporate opens nearby. First Published in Private Dentistry…2 of 2

6 Expand your offering.

What is the corporate doing that you could be doing – and be doing better? Now is the time to take those course that you have been postponing. Invest in yourself, your skills and those of everyone in the practice. Where are your “blind spots”? What skills are you, your associates and support team lacking? Get out there and get refreshed, it will do everybody good.

 

7 Up your business game.

Get out of any business comfort zone you may have been enjoying. Set personal and business goals. Make sure your financial controls and monitoring are as good as they can be. Brush up your sales process by ensuring everybody understands the importance of every stage of the patient journey. Refresh your internal marketing.

8 Ride with, and learn to avoid, the punches.

People will leave, the unexpected ones, the ones that you have moved heaven and earth to help. That will hurt; you’re a human being, of course it will hurt. There is a possibility that there will be a fall in new patients calling. Accept it, use it as a chance to look backwards at patients who you haven’t seen for a couple of years and reactivate them.

Beware of getting dragged into a price war with the new business who will be using loss leaders and offers to attract new patients. There’s no such thing as a “free” examination, just a consultation with someone who isn’t qualified to give a full opinion. A price war is a race to the bottom, keep your eyes upwards, make quality your mantra in everything that you do.

9 Wave goodbye / Welcome back

Let patients “leave” with your blessing, they’ll be back. Be understanding, be helpful, offer to share notes and radiographs. Keep them on your database (with permission) so that they get the regular newsletter, the news of the people, the offers, the inside track.

In my experience the best way to drive business to a private practice is an NHS corporate opening across the road. When they come back, and if they don’t return you really do need to take a long hard look at yourself, welcome them, listen to what their experiences have been and what they have learned. Then learn from them. Delight in their return, welcome them home.

 

10 Celebrate your independent success on your terms.

The patients who attend are coming to see you and your colleagues. The help you give is what you think is appropriate not set down and governed by a spreadsheet. The targets you set are your targets, flexible enough to be realistic for your patients.

The history of post-war Britain is for successful small firms to be swallowed up by large ones and for the intrepid owners to move on and start again. You cannot take on the “big boys” on their terms so don’t try to do it. Discover your niche, work at it, celebrate it.

Look at the big picture, you aren’t competing with the corporate you’re competing for the discretionary spend with holidays, cars, gym membership and consumer goods. Put health and individuals at the heart of your business, be honest with yourself, your team and your patients and you will resist this and other challenges.

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