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

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.

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.

What to do when…..a Corporate Opens Nearby – Part 1

What to do when a corporate opens nearby. From Private Dentistry…

Part 1 of 2

“You’ll never guess what has happened now!” said Dr Jim Misery, one of my less upbeat clients, “GleamDent, has opened a 5 surgery practice round the corner.”

“Where Dr Shocker was until he died?”

“Yes, that’s the place, they have opened up the whole house, put in new surgeries, thrown loads of money at it and there’s a big sign out the front, saying, “New branch of GleamDent opening next week! Free whitening offer!”. “What are we going to do? They’ll take all our patients, I just know they will! I should have sold out when I had the chance.”

It hadn’t been a great start to the week for Jim, he arrived at the practice to find a letter from Julie, his senior receptionist, telling him that she was handing in her notice and taking the two weeks holiday leave that she was owed, starting that day. The letter concluded by saying she was going to be working at GleamDent’s new branch in Smith Street – about 150 yards away.

During the rest of our call I concentrated on calming Jim down and getting him to focus on a plan that would resist the unwelcome neighbour. He hadn’t had to cope with anything like this before, fortunately I had. Here are the lessons.

1 Don’t Panic!

Avoid the temptation to despair or to take any rash decisions. It’s understandable that you feel threatened but treat the presence of a competitor as a wake-up call. Take this time to ask yourself why you came into dentistry in the first place and what you really want. Now is your chance to operate on your own terms, to express your authenticity and finally have the practice you wanted.

This is a huge opportunity. All those ideas for change, all the tolerations you have been suppressing, now is the time to examine them and, where appropriate, to introduce them.

Concoct a plan. You are the David to the corporate Goiliath. Include flexibility and the opportunity to amend things quickly should you need. You can be light on your feet, can innovate and respond rapidly to threats and react when things are not working as you wish.

The only constant is change, accept it and become the change you want to see. Not at an indecent rate, all change should be gradual, controlled and measured, but appropriately.

2 Concentrate on your own game.

Be aware of your competition but remember, you can’t undo anything that has happened in the past or anything that they will do – that’s their business – you can only control what you do.

Start with a SWOT analysis of your business. Strengths and Weaknesses are internal elements, Opportunities and Threats are external. 

What is working? What do you do really well? Why? What could you do better?

What doesn’t work as well as it should? What are you going to do about improving?

What could you do more of? What do you need to start doing? How are you going to go about that?

Finally, what external elements are threatening to slow or stop your progress?

3 Get some help.

Use an external coach or consultant to take a long hard look at what you’re doing, how you’re doing it, to interview your team members and to act as a sounding board for your thoughts and ideas and then welcome their thoughts and plans. They have done this before and will know what works. Fortunately Dr Jim had me and I had been there and done that before.

Ask a few friends and family members (or even a professional) to “mystery shop” them asking about prices, treatments and availability. Then get those same people to do the same to your practice. How do you shape up?

4 Take a look at the new kids on the block;

….and every other kid around whilst you’re at it. Examine their online presence, is their website any good? Does it do anything that yours doesn’t and does that matter? What can you learn. One old mantra for success is to “Adopt, Adapt & Improve”, keep it at the front of your strategies.

Walk the streets, literally. Go and have a look at the other practices in the vicinity. Then take a good look at your own. Take photographs or video of you and them and examine them on a big screen. What do you see? What can you improve quickly and easily?

5 Differentiate yourself.

Get absolutely clear about what it is you do, what it is you offer, what makes your practice unique. This is the core of your marketing.

I can hear Dr Jim sighing, “not marketing again”, that’s because he still doesn’t get it. He thinks that marketing is about advertising, about promoting yourself as something that you are not. He’s wrong. Marketing is about being yourself and sharing that. It’s about discovering what’s at the core of you doing what you do and letting the world know.

Everybody in every business should be marketing themselves and the business for every minute of every day. The chances are the corporate will have the same paint job as the other practices, the same signage, the same website, price list, uniforms and ways of answering the phone. Almost certainly the people who work there will have been taught what to say when they answer the telephone, a script memorised. It’s unlikely they will be trusted to speak their own words with the same meaning or they will have been encouraged to be their own authentic selves.

This is where you start to make inroads, where you stand out, where you become the distinctive “Jim Misery” brand. (Jim gets self conscious when I say these things but trusts me enough to go along with it because he knows it works).

Part 2 tomorrow

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