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Then came the reduction from 6 to 5 working days, a decision originally made four years earlier, justified by Henry’s son, Edsel Ford, “Every man needs more than one day a week for rest and recreation….The Ford Company always has sought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.

Servant Leadership

I first came across the concept of Servant Leadership in Robert Greenleaf’s book.

Wikipaedia describes the concept thus, “the servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible. Servant leadership turns the power pyramid upside down which puts the customer service associates at top of pyramid; instead of the people working to serve the leader, the leader exists to serve the people. When leaders shift their mindset and serve first, they unlock purpose and ingenuity in those around them, resulting in higher performance and engaged, fulfilled employees.”

In recent times I was impressed by Danny Meyer’s description of his use of the concept in his restaurants described in his excellent book, “Setting the Table”.

Traditional management is “top down”:

But something wonderful happens when you flip the structure:

The leader’s role is to serve and support the layer above them, no matter where or who they are.

You cannot have a dynamic organisation unless you are constantly encouraging people to improve and believing that they can do it.

Does it work? My personal experience says so and Suzanne Peterson and her colleagues showed that when CEOs are servant leaders, tech companies have significantly higher returns on assets over the next nine months, even after controlling for prior returns. HERE

Leadership is a multifaceted discipline take some time and consider this concept, you’ll be glad that you did.


Time to review your associate contract?

A couple of years ago I asked a specialist dental lawyer friend of mine why her firm suggested using the BDA associate contract rather than writing one of their own, she replied that as the BDA contracts are the the mostly widely used they are regarded as the industry standard. She went on to say that the longer and more complicated the contract the more likely it was that there could be challenges and disputes both of which cost money to resolve. (Simplify, simplify)

Times change, bringing changes in the context of contracts, therefore the content needs to evolve.

The BDA has updated their template dental associate contract to reflect these changes; the amendments include clarification around:

  • Practice hours.
  • Time away from the practice.
  • Locum cover.
  • Provision of equipment.
  • Hygienist services.
  • NHS contract requirements.
  • Private fees.
  • Confidentiality and data processing.

I am still surprised by how many associates and principals do not have a formal agreement in place or, where they do, there is no regular formal review of working arrangements. When I visit a practice to carry out a Practice Business Health Check I ask about not only “if” but also “when” contracts are in place and reviewed.

With the self-employed status of associates coming under increasing scrutiny it is important for both parties their contracts are contemporary. 

BDA members can access the relevant updated contracts on the website here: New Contracts


The Seven Pillars of a Successful Dental Business…simplify, simplify, simplify.

There are times in your life when you have to sit down and simplify.

I did it first as a DJ by asking myself what really makes people dance and enjoy themselves and how could I cram all that fun into a short space of time.

I did it 40 years ago during my first job when the pressure of being “on” for 7 straight days threatened to turn me into a blob of jelly and bones.

And again 30 years ago as I became a practice owner, that exercise took place whilst sitting on the floor in Malaga airport enduring a 6 hour delay for a flight to Gatwick. I produced a one sheet marketing plan that proved so practical and successful I used it again when I started my second practice a year later.

I did the exercise once more when I finally changed career from clinician to coach. Here’s the back story.

The Seven Pillars of a Successful Dental Business

In 1995 whilst studying on the MBA course with the Open University I was struggling to reconcile the structure and working patterns of a dental practice with those of the businesses that we were examining. Yes, there were some things that they had in common but there were also glaring differences, so I devised what I thought fitted the business of dentistry. In the dozens of practices with which I have worked since then the definitions have been re-enforced and I have come to rely on them so they are an almost unconscious backbone to my analysis and planning.


The cliche is, “if you don’t know where you are going then you have no idea if you are getting closer or further away.” This is at the heart of my initial work with a client and their business. They need to know what they want, so we work hard at the outset and taking the long term view, perhaps as long as a decade, to discover what direction they need to take and what growth will mean for them. This is real “what is your dream?” area. From there we chunk things down, initially to 3 years then to 12 months, then 90 days and smaller. Classic coaching protocols, not used nearly enough.

Financial Controls

If you are going to have a dream and aim towards it then you must know what your financials are going to look like. I am still amazed that many practice owners only look backwards, even in this age of online banking they wait for their bank statements and reconcile; at some point after their financial year end they wait for their accounts to be produced so that they can discover what they did maybe 20 months or more ago.

So I encourage my clients look to forward using spreadsheets or other financial software (spreadsheets are simpler) in order to see monthly general and cashflow budgets. The advantages are clear, for long term planning, for setting of fees and for the day-to-day monitoring of cashflow.


Let’s get one thing clear – we’re all in sales. Selling can and should be one of the highest form of communication that takes place. It is all about establishing and maintaining a relationship with the patient. I have no time for people who say that you should earn £X from every new patient, in my experience to push new patients before a solid relationship is in place is doomed to failure and frequently results in buyer regret.


I take John Jantsch’s definition as the bedrock of all marketing. It’s simple and effective: “Marketing is getting people who have a specific need or problem to know, like, trust and do business with you and then to refer you others who have the same need or problem.” If your marketing doesn’t do that, at a reasonable cost, then there is little point in proceeding. No amount of money spent on external marketing will replace a good internal marketing system. The biggest crack through which business falls is the failure of the team to ask for referrals.


The recruitment, training and maintenance of a good team takes constant work. First rule, start as you mean to go on, ensure that the new recruit is imbued with the core values of the practice and that their formal induction lets them see and absorb the culture of the business. Next, listen to them through regular appraisals that are a two way street, and respond to the established training and development needs.


Einstein said that things should be made as simple as possible, and no simpler. Unfortunately enforced compliance has overtaken what should have come naturally, the heart of the administrative systems must be your practice manual or “how we do things here”. This should be a living document, constantly being adapted, adopted and improved as the demands on the practice evolve.


Is the practice a place you would want to visit? How does it look, smell and sound? How does it feel? Regularly revisit the physical environment so that you can see things from your patients’ points of view.

How’s your practice doing? Does it need a Health Check?

British Dental Conference & Dentistry Show Day 1

Firstly let me get this comment out of the way, it is not and probably will never be a substitute for the BDA conference. Done.

The numbers were high. When I arrived from the airport at 9.05 the queue to print tickets looked daunting but the stewards kept it organised and the ticket machines were straightforward to use so the wait was minimal.

Every year brings a glut of new businesses to shows and, unsurprisingly, this year’s were those selling GDPR compliance packages. On May 25th the sky will not fall in in the same way that the “Millennium bug” did not bring civilisation crashing down. Last GDPR mention, I promise.

At first glance the lecture theatres were well placed and isolated from the main exhibition hall. There was little or no sound leakage to distract from the content. Less ideal were the theatres situated within the hall, it was clear that anyone doing three or four presentations over the two days would be left with a sore larynx by Saturday afternoon.

One of the justified complaints from the people who pay to make these events happen, the dental industry, is that delegates who come to attend the academic elements don’t visit their stands – with this set up it would be impossible to ignore the goods and services on display.

It was good to see the numbers of Foundation Dentists and Students in attendance something that Closer Still hadn’t welcomed in the past apparently because they weren’t responsible for making or influencing purchases.

No hordes of freebie hunters either.

A very good first day.

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