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.

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