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.

The Binge Listen #1 – Don’t Tell Me The Score

I came across the “Don’t Tell Me The Score” podcast a week or so ago and have listened to the eleven episodes whilst wrestling with wood over the past couple of days – one great advantage of the ear protectors that I employ whilst using the chain-saw is that they both isolate me and keep my headphones in place.

The premise of this BBC Radio 4 podcast is that sport can teach us a great deal about life. Presenter Simon Mundie interviews at length his guest, who has direct association with sport as a player, coach, writer, or scientist. I particularly enjoyed Ben Ryan on Motivation, Mike Brearley on Leadership and James Kerr on Legacy. There are lessons to be learned from each and every episodes and I thoroughly recommend it. More books to read! If they are as good as “Legacy” then I’m going to enjoy myself.

Available from all good podcast sources and the BBC website.

PS – One small criticism – Simon I do wish you wouldn’t keep mentioning England winning the Rugby World Cup in 2003 as if it was the greatest achievement in history – or indeed a surprise. Whilst it sticks in my craw to say it they were the best team both in the tournament and during the year leading up to it, so victory was deserved.

 

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.

Little by little – Happy Winter Solstice.

Happy Winter Solstice! Don’t worry I’m not going off on a Pagan kick just taking sometime to enjoy the bleak midwinter.

Today, December 21st, is the shortest day of the year. Where I live the daylight will last for 7 hours 49 minutes and 18 seconds. As I used to tell my son, before he could scientifically argue back, today is the day when the sun packs its suitcase and starts heading northwards and Summer is on the way.

Tomorrow there will be 7hr 49min 19s of daylight, the day after another 7 seconds and on January 1st we can enjoy all of 7hr 55min 21sec presuming we’re awake by 8.02am , by the time we reach the Summer Solstice there will be 16hr 38min 48sec.

It reminds me of the one sure way to achieving and continuing success, small constant increments. Many of us start by presuming we will experience the “big bang” at some point and finally reach success will be ours. The truth is far more ordinary, small incremental changes for the better is the way to attain success. Read about Dave Brailsford’s work in cycling, look at the vast majority of successful enterprises and you will see that little happens overnight rather it is the gradual progression that gets results.

Progress does occur, there will be setbacks of course but by focussing on making every day better than the one before then you will move forward into your particular sunshine. One where we are not obliged to head backwards after June 21st.

Take some time over the holiday period to ask yourself what you want your changes to be this year. What’s your 2020-Vision? What are the steps you must start making?

 

Tech stasis?

John Naughton writing about last week’s “Apple Special Event”.

“But maybe we’ve arrived at what Charles (Arthur) calls — “a sort of tech stasis”. Many of the things we have are now Good Enough, and so despite Moore’s Law and the wonders of computational photography, etc. we don’t need to upgrade them every year, or every two years.”

 

Hours down. Productivity up. Nothing new.

Sculpture of a Ford car in his father’s village in West Cork.

“Reduce your hours and watch your productivity increase.” I tell my clients that they need to focus on the the three Es by becoming, “Efficient, Effective and Economic.” This does not mean cutting corners or scrimping to save, rather ensuring that you are doing the best you can for only as long as you need – and no longer. Most dentists spend far too much time doing work that is undervalued, under rewarded and ineffective.

When my team & I stopped working 5 clinical days per week, our income and profits rose and team morale increased. Unfortunately there is still a macho thing about being booked “X” weeks ahead, it’s more likely to kill you than make you happy.

My daily calendar tells me that today in 1926 Henry Ford introduced the 5 day, 40 hour working week. I have an interest in Ford, not least because his father was born a few miles from where I am writing this in West Cork and my grandfather had some involvement with the Ford factory in Cork. I wondered how the hours change came about and why we seem to have stuck there or, in some cases, moved backwards in 94 years.

It seemed that Ford’s decision was one of several that put the company’s workers first. In 1914 with a background of unemployment he increased wages from $2.34 to $5 for a nine hour day. This move, doubling the industry norm, shocked many who said it would not succeed. Instead it was “a stroke of brilliance”, it boosted productivity and helped build a sense of company loyalty and pride.

Then came the reduction from 6 to 5 working days, a decision originally made four years earlier, justified by Henry’s son, Edsel Ford, “Every man needs more than one day a week for rest and recreation….The Ford Company always has sought to promote an ideal home life for its employees. We believe that in order to live properly every man should have more time to spend with his family.”

Henry said, “It is high time to rid ourselves of the notion that leisure for workmen is either ‘lost time’ or a class privilege.”

Ford also saw a bigger picture. Give people Saturday off and they can shop and have leisure, thus spending the money they are earning.

…and we think the “gig economy” is progress?

Yerkes-Dodson is still relevant – if you want to enjoy your clinical career

Why should a “law” described first in 1908 be relevant to everyday Dentistry (and more)?

Robert Yerkes and John Dillingham Dodson described their tests with rats that could be encouraged to complete a maze when stimulated with slight electrical shocks. When the strength of the shocks was increased however the rats just ran about looking for an escape. They concluded that arousal levels helped to focus attention and motivation on the task at hand but only up to an optimum point and after that point fatigue appeared and performance declined.

Research has found that different tasks require different levels of arousal for optimal performance. For example, difficult or intellectually demanding tasks may require a lower level of arousal (to facilitate concentration), whereas tasks demanding stamina or persistence may be performed better with higher levels of arousal (to increase motivation).

The first image shows the classic inverted ‘U’ shape of a difficult task (placing implants, molar endo, treating some children are examples that come to mind). It also shows a continuation without decline of more simple tasks which can be maintained for longer without reaching a point influenced by fatigue (examinations, routine restorations on well adjusted patients).

 

 

The second image shows the typical “stress curve” where performance takes a while to peak if we are under too little stress, then goes through a short period of optimum stress before reaching too much and heading down through exhaustion to burn out.

The reason that I have written about this is that we need to look at the time periods that these curves represent from the short (an hour say) to long (months or even years). There are different challenges that dentists face with differing solutions.

Firstly of course there is the fatigue that comes from trying to do too much challenging work in a short period of time. This results in high stress levels and possibly poor performance on a daily basis. Often there are time management issues where we are obliged to match our performance to the patients availability. This can see a clinician “coasting” by dealing with the relatively straightforward whilst at their peak in terms of readiness and responsiveness but then having to find reserves of energy when the patient “demands” treatment at later times in the day. I have never understood why dentists are reluctant to tell the patient exactly when and why they would like to see them. My own experience in a practice with large numbers of children was to insist on seeing under 11s for any treatment (examinations excepted) first thing in the morning. For the most part when people have reasons explained to them and can understand that it is for their benefit then they will comply with your wishes.

Also to consider are the long term problems of fatigue that arise from the day after day, just doing it without time off. Even in the best time managed (at a relatively micro level) practice if there is often not enough time spent away to unwind, recharge the batteries and recover, then burn out will creep up on you. The prodromal signs are a lack of efficiency and, more importantly, effectiveness.

Dentistry is still a macho occupation for many who seem to get a perverse enjoyment from overwork. It’s sad but true that for many there is an opportunity to build the life they want but put obstacles in their own way as if frightened of taking control.

Time management on both micro and macro levels is hugely important, ignore it at your peril. Get help if you need it.

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