blog

Giving Patients What They Really Want

Wed, 07 Dec 2011 15:17:41 +0000

It has become even more important to understand that the most successful Dentists are not the best clinicians but that they are the best communicators with the best support teams…

Jonathan Fine, Partner, Breathe Business.

Despite these austere times, the press is full of articles on cosmetic surgery including cosmetic dentistry. Just recently, The Times ran an article on the “top” cosmetic dentists and the transformations they achieve. This is great! I’ve waited my entire career for dentistry to emerge from the shadows of “drill and fill” and preventative medicine and become a highly desirable, sexy, must have. At last, dentists and dentistry have become the new rock and roll and the public are lining up for straight white teeth…

Hang on a minute ~ what’s this? Along comes William Leith, columnist in my favourite paper, the weekend Financial Times with a deeply personal, hard-hitting description of his terrible experiences of being treated by a series of bad dentists. This could spoil things, just when we were getting going!

I like William Leith. He’s just turned 50 and he and I share many concerns, confusions and neuroses. Like me, he has spent many hours during the last forty years in a dental chair and like me; his mouth is full of restorations. Unlike me, his experience of dentists and their dentistry has been utterly woeful. And yet, he represents the sort of perfect private patient that many of you are marketing for; he is beginning to feel his mortality, he doesn’t want to lose the last vestiges of his youth (including his teeth) and he has the money to pay for private dentistry. He’s the perfect mixture of a man who: wants to look and feel good, has plenty of dental problems and is prepared to spend enough to have his mouth transformed.

While the articles about cosmetic dentistry continue to extol the many advantages of having your teeth made more beautiful, Leith is like the man in the fable about the king’s new clothes who dares to stand in the crowd and exclaim that he isn’t wearing any. He blows the whistle on the not very well kept secret that not all dentists are the same and that some of them, by any standards, behave very badly.

Here is the link to William Leith’s article.

And here are some edited highlights:

“Oh well, I think, here we go again. I’ve been here so many times before. Let’s hope everything works out this time. Let’s hope for the happy ending that, so far, has eluded me.

I had many different dentists, who undid and re-did each other’s work. So many have disappointed me. Why?

Because they’ve been rough.
Because they’ve been uncaring.
Because they’ve been after my money.
Because they’ve been cheap hustlers.

Somebody I know and trust told me I’d like her. And I do. I’ve been frank about what I want. I’ve been exacting

“That’s good work,” says Katherine. We look, for a moment, at a picture of a crowned molar. It fits perfectly. The work cost me about £750. It was horribly complicated. Fifteen years on, it’s as good as new.

She can tell me that I’ve had lots of bad dentists, a few average ones, and one good dentist. She points out the places where the good dentist has worked

My mouth tells the story of:

· the man who didn’t want to give me a painkilling injection, so when he hit a nerve I jerked sideways, his drill splitting my lip
the man who filled my teeth with a crumbly substance;
the man who re-filled my teeth but left gaps underneath the filling;
the man who tried to replace the old amalgam fillings with early plastic ones;
the man who replaced the early plastic fillings with amalgam;
the speed-merchant who could have me in and out in 17 minutes, having removed and replaced a filling.
The emergency crowns that didn’t, and don’t, fit properly.
The one magical filling created by Tom, who somehow made a condemned, razor-sharp shell of a tooth whole again.

So, I say, can you do it? “Yes,” she says. At this exact moment I look into her eyes. I decide that she’s The One. She does not look like a cheap hustler. She does not look like she’ll be rough. She looks caring. She looks capable. If I shake her hand now, I’ll be spending a lot of time in this narrow, bright room. I’ll be here 15 times over the course of a year. I’ll give her thousands of pounds.

Let’s go for it, I say, and stick out my hand.”

So, before we rush to the moral high ground and polish up our defences, what can we learn from William Leith?

It matters a great deal to patients like William Leith that they perceive that their dentists:

Are competent and do a good job
Do what’s in their best interests, not what are in the dentists best interests
Wont hurt them at any time
Wont rush
Are good communicators
Are affordable and offer good value
Are trustworthy

In reality, as far as the patient is concerned, it comes down to two things, what the dentist says they can do, what the dentist actually does and that the two congruent! What the dentists say will determine whether the patient has the dentistry done and what the dentist does will determine whether they come back! (Remember 33 million people avoid going to the dentist in the UK, quite a statement of how they feel about dentists!). As in all businesses, “the clients perception is the client’s reality” and whatever you or I think, their reality is the only one that counts! There are many who feel like William Leith and it is our responsibility to help them have the treatment they need and want.

I read endless marketing messages on web sites and in practice brochures about: comfortable modern surroundings and state of the art equipment and yet the William Leith’s of this world want to know one simple fact, “Can you do the job well?!”

So how about telling your prospective patients a few things that they really want to hear (providing of course that they are true!).

Such as:

We do good dentistry that lasts.
We wont hurt you.
We wont rush the work
Or use cheap materials
We will always do what’s in your best interests
We will charge you a fair fee
And we will always explain the fee before we do the work

I suggest that a list like this will get your patients and your prospective patients attention. Providing of course that you and your clinical team can deliver it…

Isn’t it time we really gave the patients what they really want? The practices that do will always survive the external economy and those that just pay lip service will, as always, get found out and written about by journalists such as William Leith and good on them for blowing the whistle!

If you would like some help with growing your practice in difficult times by working with a team with a proven track record,

Email simon@nowbreathe.co.uk

Or Call Breathe Business on 0845 299 7209

The Seven Mistakes Dentists Will Make in 2012

Tue, 22 Nov 2011 15:17:41 +0000

Writing this towards the end of 2011, it’s hard to find any good news being forecast for 2012. All our national commentators agree that it’s going to be a tough year for all sectors of the economy and that public demand for goods and services will remain suppressed and may even get worse.

From my daily contact with practice owner’s, it seems that most are reporting a measurable fall in demand in their practice during 2011 and together with rising costs, profits are really being squeezed.

Fortunately there has always been a lot of slack in dental practices and Principals have been able to get away with running their practices badly and still making good profits. So, there’s plenty of room for improvement and many ways in which things can be tightened up to prevent the profitability heading the same way as the recent stock market indices

So, here are the top seven mistakes I think many dentist will make in 2012. Please focus on these areas now in order to counter the real dangers of being in an underperforming practice during a lean 2012.

One. They will fail to harness the power of the web to generate new patients and keep their existing ones. Most dental practice web sites simply don’t work. They don’t attract enough traffic, don’t create enough leads from the traffic they do attract and don’t provide a reason for existing patients to go back to the site except to find the practice phone number or opening hours. They will continue to work with web companies who over promise and under deliver. This is a bit like paying for an iPhone 4 and only using it to make phone calls!

Two. They will fail to measure accurately their:
·      New enquiries
·      New patients
·      Patient attrition rates and
·      Active patient list size

Their teams will fail to collect this essential data and so Principals wont be able to audit their front desk’s performance, understand the need for training and scripts or be able to put a number on the opportunities they have missed! Instead, they will focus on cutting costs rather than increasing their patient numbers. The bottom line is that if they don’t measure it, they cannot manage it!

Three. They will fail to train their team to enable them to optimise their contact with both new and existing patients. Their front desk teams wont have a successful sales process to convert enquirers into new patient consultations In addition, they wont have a process to reactivate dormant patients effectively or manage their data bases in such a way that keeps their diaries full. Instead, their data base will be full of missed opportunities…

Four. They will fail to optimize the way they pay their Associates and Support Teams in order to maximize their performance. They will continue to pay their associates a fixed percentage of their gross and pay their support teams for turning up rather than on their performance. In these practices, everyone still wins except the practice owners. Performance pay is not a revolutionary idea, it is how the commercial world works from coal mining to laser eye surgeons to prostitution!

Five. They will fail to increase the value of their treatment plans, or the rate of treatment plan acceptance. They will continue to look for new patients rather than increasing their treatment plan value and treatment plan uptake by the patients they already have. – It’s easier, nicer, more fun, more rewarding and more profitable to increase the yield from existing happy patients by structuring the follow up, than it is to find a new patient.

Six. They will fail to prepare for the threat from retailers as they enter the dental market place. They will hope that their patient relationships remain strong enough to keep their patients out of Sainsbury and Tesco despite the impact these retailers have had on sectors such as: Financial/entertainment/fashion/petrol/pharmaceuticals/cosmetics/photo processing.

When these businesses decide to take on a category they don’t mess around. And so, this is truly a Titanic moment for the entire Dental profession. Don’t be kidded, in 5 years time the dental landscape in the UK will look very different, If you are aged under 55, be concerned, very concerned.

Seven. They will fail to communicate properly with their patients, teams, fee earners, colleagues and banks. Believing that the old way of working will be good enough in the new reality of cultural and social austerity.

It has become even more important to understand that the most successful Dentists are not the best clinicians but that they are the best communicators with the best support teams…

So, what is to be done if you feel your practice falls short in any of these areas? Well friends and colleagues, you most definitely need a plan to fix it, a business plan even that takes up the slack in your practice, finally in 2012.

If you would like a quicker fix so that you can:

1. Harnessing the power of the web to generate new patients and keep your existing ones

2. Record your:

· New enquiries

· New patients

· Patient attrition rates and

· Active patient list size

3. Training your team to optimise their contact with both new and existing patients.

4. Optimize the way you pay your Associates and Support Teams in order to maximize their performance

5. Increase the value of your treatment plans and the rate of treatment plan acceptance

6. Prepare for the threat from retailers entering the dental market place

7. Communicating properly with your teams, your fee earners, your patients, your colleagues and your bank.

Contact me directly at simon@nowbreathe.co.uk

Or contact The Breathe Business Team on 0845 299 7209

Are you marketing by the seat of your pants?

Mon, 07 Nov 2011 15:17:41 +0000

A very successful and inspiring 2 days: I now have a clear marketing plan and know exactly what I need to do about my website!

Frank Goulbourn – Principal, Bancroft Dentistry

I used to think that marketing a Dental Practice simply involved spending enough money on the “right” tactics. This was re-enforced by the magazine articles I read and the business coaches I listened to. In retrospect, it proved to be pretty difficult to find the “right” tactics because the tactics were always generic and were supposed to work from Truro to Inverness. It was also impossible to know which tactics really worked because we only measured new patient source and new patient numbers…

During the last 10 years, I’ve given a lot of talks to dentists on marketing and what they have always wanted from me was a list of tactics that were guaranteed to work. Then, they could go back to their practices, choose the tactics they fancied (and/or could afford) and simply implement them.

The tactics I recommended used to go in and out of fashion, were usually generic and the list would look, in no particular order, something like this:

Patient Newsletters
Welcome packs
Referral Cards
A Web Site
Glossy Magazine Advertising
Leaflet drops
Special offers
Wedding Fairs
Health and Beauty Fairs
Radio Advertising
Strategic alliances
PR

There is nothing essentially wrong with the list, it’s just the generic, one size fit’s nature of the list that spoils it. The main problem with this way of doing things is simply this;

It risks wasting eye-watering amounts of your precious cash!

Look, anyone can go shopping for patients. If you spend enough money you can fill your practice with new patients! The purpose of a deliberate and effective marketing plan is to buy new patients at the right price. In other words, the cost of acquisition of new patients must be inline with the profitability of the services that you are selling and the value the new patients bring to your practice!

So, there is a better way of ‘doing marketing’. Here’s how it works:

Decide what your long term Business Objectives are (say, 3-5 years).
Get clear about your “Practice Proposition” (because this is the message that you will be marketing!)

For example, here’s the proposition for a practice we work with in The Midlands:

At Jones Dental Practice,

We offer:

Effective and long lasting solutions to your dental problems
Painless treatment
Affordable treatment
An honest and professional approach
A wide choice of options
A comfortable environment

Decide on what your overall Marketing Strategy will be for the long term. Where will you put your focus.

Create a 12 month Business Plan which includes a 12 month Marketing Plan. The Marketing Plan will include:

Your target groups
The channels your target groups use (e.g. digital media, social media, print media, etc
Longer term Marketing Programmes
Seasonal Marketing campaigns
Marketing Budget
Required return on Investment
Data collection systems
Define what success looks like

The purpose of a” functional marketing plan” is simply to support your business objectives and ensure that you meet them!

For example; You own a 2 surgery private practice turning over 400k. During the next three years you want to turn it into a 3 surgery private practice turning over 650k. You will need an additional 1000 patients over 36 months, (that’s 27 per month, providing you don’t lose any!).

Your Marketing Plan will depend on many factors including your catchment areas: Demographic, Ethnicity, Social mix, Wealth etc.

There can be no generic marketing plans because every area has a unique population and problems who use their own mix of different channels to access information!

It may seem a little complicated, but this is the only way to make your marketing effective and affordable!

So, if you want some help in building your own unique marketing Plan, Breathe Business is running another of its popular Marketing Workshops with places limited to just 6 practices.

More details

Contact me directly at simon@nowbreathe.co.uk

Or contact The Breathe Business Team on 0845 299 7209

Every Patient a Finals Patient

Mon, 07 Nov 2011 15:17:41 +0000

You remember finals don’t you? Of course you do. Your examiners carefully selected a patient(s) for you to examine, diagnose and present your treatment plan. The final’s patients were unlucky enough to have more than one dental problem and you were marked on finding all of them and your ability to create a set of solutions for the patient.

Then most of us headed off into practice and a series of “finals patients” paraded in front of us. These patients willingly pay us now to make our professional judgements, offer them our best solutions and suggest a fee for doing the dentistry!

However, that’s not always what happens, is it?

There’s something that happens in General Dental Practice (be it NHS, Mixed or Private practice) that is rarely spoken about in Dental Magazines or in on-line forums or even at the bar at dental conferences. And it’s this. That many dentists consult-with, examine, diagnose and treatment plan their patients, not in the way that they did for their finals patient, but by applying some sort of filter, a filter that the patients are completely unconscious of. Such filters have several elements and in 25 years of being a dentist and then 10 years coaching dentists, I think I’ve probably heard or seen them all, (I’ve certainly seen the effects they create).

The filter may have some or all of these components:

1. Will the patient like me if I tell them about all of this

2. Will the patient come back if I tell them about all of this

3. Will the patient think I am over prescribing

4. (For returning patients) If I tell them about all this now, will they wonder why on earth I haven’t mentioned it before?

5. Will the patient be willing to pay for all this?

6. If I persuade the patient to have the big treatment plan, what happens if it goes wrong?

7. As long as I make a note on the records, I am keeping myself within the GDC/Legal rules.

The enemy within here is fear, and not the patient’s but the clinician’s! And so the filter gets applied and the patient is offered the treatment plan that the clinician believes is absolutely “necessary” or the one they feel the patient “needs”. Presumably, they leave the rest until it becomes (as they deem it), “necessary” or “needed”. An additional filter (of course) is the one that pushes the dentist towards offering treatments that are well paid or earn the most number of UDA’s.

So, before anyone rushes off to the moral high ground and starts sending me emails beginning, how very dare you… let me run this analogy past you.

Imagine putting your 3 year old. £25,000 car in for a 30,000 mile service. During the course of this the technician discovers that as well as the regular service items needed, your car also has these faults:

2 sets of worn brake pads
Front brake discs are warped
Rear dampers are leaking
2 tyres are nearly at their worn out marks

As a customer, which of these phone calls would you like them to make?

1. The call that lists the faults, your options and the costs for having everything put right?

2. The call that tells you about the faults they think you will want to hear?

3. The call that tells you about the faults that you will be able to see?

4. The call that tells you about the faults they think you will be willing to have fixed?

5. The call that tells you about the faults that makes them the biggest margin when they repair them?

And what will they do about the faults they don’t tell you about? Perhaps, put a ‘watch” on their records and consider telling you at the next service?

Duty of Care.

I know that some of you will be wincing already at my comparison between a clinician and a mechanic but wait, there’s more “mileage” in this analogy still to come!

After paying for just the service, you drive off from the garage with the faults left unreported. A child runs out in front of your car and you fail to stop in time because of the worn tyres/brake pads/discs/dampers. In the investigation that follows, these things come to light and sparks a witch hunt.

A good garage owner dare not risk this and the inevitable damage to their reputation. A good garage must tell you exactly what it finds wrong with your car/ A good garage takes their duty of care seriously.

So what’s really going wrong when a patient leaves a dental surgery with half a treatment plan? In my opinion, this happens because we’ve lost the simple, straightforward, trusting relationship between patient and clinician that we had as a final year student. External circumstances such as: The NHS, the economy, the practice finances and probably most importantly, our lack of confidence and self esteem have filtered our behaviours so that we agree to compromise our professional skill set and integrity in order to be liked, keep the patient or stay within our comfort zone.

So, how does that sound? Not so great from where I’m sitting and let’s not tell the national newspapers! When I left the NHS in 1992, I decided to get rid of all the filters I had acquired and simply show and tell my patients what I could do for them as if they were one of my family and money and time wasn’t an issue.

I’ve used the exactly the same approach in my coaching practice. I was lucky enough to be mentored by some great coaches on the idea that you often do your best coaching just before you get fired (for telling it like it is). And that’s what I do for our clients.

In my view, you have to decide what sort of dentist you want to be. An anxious single unit one tooth at a time type dentist, forever destined to gross a thousand pounds a day whilst complaining that patients don’t want my treatment.

Or a dentist who communicates clearly and straightforwardly with their patients about what they can see in their mouths and the best way to fix it. Thereby giving the patients back their responsibility for their health and leaving the decision about whether to proceed with them.

As Steve Jobs said in 2005,

Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.”

If you would like some help with effective patient communication or improving your self confidence…

Contact me directly at simon@nowbreathe.co.uk

Or contact The Breathe Business Team on 0845 299 7209

Some Recent Dispatches from "The Practices"

Mon, 07 Nov 2011 15:17:41 +0000

Many Breathe practices (with our help) are preparing their business plan for 2012. An integral component of an effective business plan is an up to date knowledge of the market place in order to anticipate the future pattern of demand and provide for it.  With this in mind, we recently asked a group of ten private practices to give us their observations on the current status of their dental market. These practices are located across the UK in areas that include: Yorkshire, Lancashire, Surrey, Worcestershire, Essex and South Wales. I thought you might be interested in their responses pasted below.  Have a look at what they say and rate it against your own experience. At the end I’ll pull together some conclusions from their reports and together we can see how this affects you and your practice for 2012!

Treatments:

1. We are seeing routine treatments such as: composite fillings, single unit crowns in abundance, none are being deferred for financial reasons.  2. Our patients are spreading treatment over longer periods due to their finances. 3. Amalgam is less acceptable 4. Patients are surprised that “mercury” fillings are still used and don’t want them. 5. Pts want old amalgam fillings replaced with tooth coloured alternatives over a period of time. 6. Patients are afraid of the risks associated with amalgam fillings and more patients are requesting alternatives. 7. There are patients looking for safe amalgam removal 8. Tooth whitening still sells, it’s very price sensitive, patient’s expect a discounted offer. 9. There is a lot of TMD and para-function in patients and the majority of patients don’t know they’ve got it! 10. The over 55’s want aesthetically pleasing smiles without resorting to orthodontics. 11. Very few smile makeover or full mouth rehab treatments done over last 18 months but patients are now starting to return for big treatment plans. 12. Specialist referrals for certain treatments eg. Implants, Endodontics or Periodontics are more common and generally accepted by patients when recommended.

Customer Service:

1. Patients are still prepared to pay for good service 2. Patients are dissatisfied with quick in and out service, they want to be listened to and be involved. 3. Patients are always looking for “drill free” “pain free” “impression free” “needle free” dental care. 4. Patients seem to think everything is saveable as they think there always is an alternative to extraction. 5. Patients expect wider opening hours to give appointments after their work hours. Time missed from work is a worry as it means less income for them.

Patient’s Willingness To Pay:

1. Patients are reviewing all their direct debits to cut their costs. 2. Patients are more money conscious and less willing to spend unless they really need to. 3. More finance requests being refused by 0% finance companies. 4. Not as many patients choosing finance options, preferring to use PAYG over a longer period of time. 5. Not much uptake on credit options, patients seem afraid of taking loans in this economic climate. 6. Patients looking to delay treatment for as long as possible. 7. Job worries are making some patients delay non-essential treatment.

Keeping Their Teeth and Implants:

1. Implants are most frequently used method of replacing a missing tooth in the under 70’s with removable partial dentures’s being the second most frequent. 2. I do fewer dentures but those patients who have them are expecting a higher quality result. 3. More patients are aware of implants and don’t expect dentures to be their only option. 4. Patients expect to keep their teeth for life. 5. Patients feel that Dentures are not an acceptable replacement for missing teeth. 6. Patients are fearful of having Dentures.

Attitude to Hygienist Appointments:

1. Patient awareness of Periodontal Disease has increased in recent years and most of our patients see our hygienists regularly. 2. We need to communicate to patients better the value of regular hygiene appointments. 3. Regular patients can see the benefit of regular hygiene visits Parents and Children: 1. Parents are (surprisingly) happy to pay for early, interceptive orthodontics or preventive treatments for their children. 2. Parents seem willing to pay for better treatment for their children and are realising that The NHS doesn’t always provide what's best. 3. Parents are more concerned about their children having treatment, particularly Orthodontics than looking after their own dental health.

Cosmetic Dentistry:

1. Our patients are interested in aesthetics but prefer minimally invasive treatments such as whitening, orthodontics or composite bonding. 2. Most people want to put their dental health first ahead of the appearance of their mouth. 3. People seem more aware of what cosmetic treatments are available and are well informed about what is involved. 4. White, straight teeth still seem to be a priority for most people. 5. The appearance of patient’s front teeth seems to take a higher priority over their general oral health. 6. As far as some patients are concerned, the way they look is everything.

Orthodontics:

1. Straight white teeth are still in demand (although less people consider it affordable) and orthodontics is considered to be a more acceptable way of achieving this (rather than veneering). 2. More adults aged 20-45 are choosing Orthodontics to improve their smile. 3. Parents are sometimes keen for straight teeth after they see the results of their children's Orthodontic treatment, but they can be put off by the cost and length of treatment.

Value of the Dentist Patient Relationship:

1. Most patients prefer to see a dentist that they know or have been recommended to via a friend/relative /colleague. 2. The personal relationship with the dentist has become more important than ever. 3. The personal relationship between the patient and the dentist is still important. Patients like to get to know and trust their dentist and they hate change.

Opportunities:

1. Anxiety and phobia are preventing patients receiving the dental care that they know they need. 2. There are still a lot of nervous non-attendees out there 3. Many new patients have a low dental IQ, ie "not been to dentist in years as I've never had any problems" or "if it aint broke dont fix it".

What does this mean for Private Dental Practices in 2012? Demand in 2012 •

There is plenty of demand for single unit Dentistry, selling higher value treatment will be more challenging.

• Patients will always want a cosmetic solution where possible/affordable.

• Patients want straight white teeth and adult patients are wiling to consider having Orthodontic treatment.

• Patients are wiling to pay for health benefits.

• Parents are willing to pay for the best solution for their children.

• Patients are willing to be referred for, “Specialist Services” such as Implants, Implant retained dentures, Endodontics, Periodontics, Orthodontics.

• Patients want implant based solutions, not removable dentures.

Client Journey

• Learn to communicate to patients the benefits of multiple unit dental solutions.

• Patients are more willing to pay if they appreciate the value of the service. Therefore, explain the value of the proposed treatment and what’s in it for them, before explaining the fee.

• Make it easy for the patient to spread the cost or the time over which the treatment is delivered.

• Spend time with patients, they value the relationship with their dentist and this will distinguish your practice from many of the newer market entrants including the supermarkets and retailers.

• Offer appointments outside of the usual 9-5 office hours.

• Explain why the patient “needs” the proposed treatment and use “fear of loss” as a tool to help them to yes.

• Make hygiene visits an essential and fundamental element of your client journey. Learn to communicate the benefits of this service to every patient. Don’t let dentists do “scale and polishes” while the patients are going numb…

• Always offer a cosmetic solution.

• Have plenty of information in your practice (preferably digitally based) on the range of your practice services.

Opportunities

• Offer “drill free” “pain free” “impression free” “needle free” dental care.

• Offer sedation to anxious patients.

• Offer Amalgam free dentistry. This is very attractive to patients and an easily understood message for your marketing.

• Have a special clinic with bespoke solutions for nervous/anxious Patients.

• Diagnose, treatment plan and treat more Patients with TMD and Parafunction.

• Bring Specialists into your practice rather than referring out.

• Have a “Budget” or an “Essentials” range, priced at 25% less than your fees.

• Offer parents alternatives to NHS treatments for their children.

• Offer invisible braces.

• Have an effective and measurable patient get patient programme.

Simon Hocken Director of Marketing, Breathe Business

For more information, get in touch with the Breathe Team on 0845 299 7209 or info@nowbreathe.co.uk.

Is your Practice Half Empty Or Half Full?

Tue, 11 Oct 2011 15:17:41 +0000

So, how’s the traditional new patient ‘autumn rush’ going where you are?

Back at Breathe HQ, the Team are receiving reports from all over the UK and we are seeing little evidence that the rush is happening this year…

However, there are many exceptions; practices whose third quarter in 2011 has been their best ever, practices who have plenty of new and returning patients and practices who are recruiting new fee earners to cope with the demand.

These days, I visit a lot of practices that have plenty of spare capacity. However, there’s a big difference between a practice that is half empty and one that is half full. The first is shrinking and the second is growing.

We are seeing two very different practice situations and (not surprisingly) two very different sets of practice behaviours.

Let me describe the behaviours of some of the practice owners and their teams whose practices are shrinking.

PRACTICE OWNERS

Are scared, nervous, anxious, not sleeping well. Some banks are revisiting their lending conditions (owners are living in dread that their existing loan might be called in).
These practice owners are hoping, with all their fingers crossed, that the politicians will sort it out, that the media will write about something other than the economy sometime soon and that growth and confidence will return to the UK market place, preferably before Christmas.
In these practices, fear stalks the corridors - you can see it in their faces - and one thing I know is that feeling anxious is no way to run a successful business.
Stuck in crisis mentality, there is a tendency to react by reducing their costs. Practice owners have become too reliant on pulling the cost saving lever. They pour over their bank statements looking for standing orders to cancel (including ours!) and interrogate their reps for cheaper materials, whilst holding their long suffering labs to ransom by paying late and asking for bigger discounts.
They have stopped communicating with their teams (except to complain about them).
They have absolutely no idea how to grow their practice in these market conditions… Neither are they willing to invest in doing this.

PRACTICE CLINICIANS AND SUPPORT TEAMS

Are unlikely to offer cosmetic dentistry, preferring to take the clinical high ground by saying it’s not necessary for their patients or that they don’t really believe in it.
They are happy to refer their Orthodontics and Implants out to others even as their days become increasingly gappy.
Their Associates and Hygienists have started to reduce their days and are looking for work in other private practices (often in vain) and end up saying yes to NHS work.
Some of these practices still close their doors at lunchtimes and all day Fridays, seemingly content to let their phones go unanswered or at best answered by a machine!
Their patients can’t get an appointment before 9am or after 5pm and definitely not on a Saturday morning.
The team have poor communication skills and have never been taught how to answer the phone or how to close a sale.
The Team believe and hope that the patients will never leave because they have such a good relationship with them.

PRACTICE FACILITY The clues are all around from the moment you arrive.

There is little to tell you about the practice from outside and the practice is often hard to find. The signage is terrible and there are no clues as to what the practice does or whom it serves.
The decor is tired. The run down waiting area has uncomfortable seating, dreary pictures and lots of notices, Blu Tacked or cellotaped to the practice walls, telling patients how to behave.
There’s a lingering antiseptic smell.
The Receptionist is hidden away behind a glass screen or an imposing counter.
There are scant clues as to what the practice offers; except perhaps some leaflets or posters for branded treatments such as Invisalign or Zoom Whitening.
The Practice is in need of modernisation; it desperately needs redecorating, re-equipping and rebranding. The surgeries are old, the equipment is vintage and there are no patient consultation areas other than the dreaded dental chair.
The Staff room has become the dumping ground (and sometimes serves as an office too).
The loos are plain, cold and empty.

PRACTICE SALES AND MARKETING These practices haven’t got past first base in the marketing stakes.

They have no kerb appeal (I’m not just talking about an uninviting exterior; businesses are now being judged on their online kerb appeal too).
They have no ‘patient get patient’ programme and their website produces very few new patients.
They don’t know how many leads they are getting because they haven’t asked their receptionists to record them.
All their new patients come from word of mouth referrals yet they do nothing to encourage more of them!
They have no Treatment Menus and not surprisingly, their treatment plans are forever small.

PRACTICE PATIENTS

Have been very loyal and many have stuck with the practices for a long time. However, at around £80 a go, they are beginning to ask if they are getting enough value from their 6 monthly check up and scale and polish appointments.
So, they postpone their visits and hang onto the thought that they can pick up the relationship again once the economy brightens up. In the meantime they keep the phone number somewhere safe, in case they get toothache.

I trust you will have realised by now that I have exaggerated (a little) to make the point.

Just because practices like the ones I have described have worked in the past, doesn’t mean that they will ever work again in the future. In my view, they will slowly and inexorably decline. Life has simply moved on.

However, if you recognise any of the above in your own practice, it really is time to stop hiding and hoping it will get better.

HOW TO SHRINK-PROOF YOUR PRACTICE Here are some essential tips to help turn your practice around.

Steps to take NOW:

Make sure your facility is clean and fresh.
Decorate and de-clutter. Get rid of the Blue Tack, the dead light bulbs, the cardboard boxes etc!
Extend your opening hours
Answer the phone at lunchtime
Clean up your database, create an active patient list, and start reactivating your dormant patients
Have some autumn offers
Sort out your practice kerb appeal
Put a banner outside the practice saying that you welcome new patients

BEFORE CHRISTMAS:

Start behaving confidently and inspire your team to do the same
Get a business plan that includes an effective marketing plan.
Create an effective sales process

Go ahead, do something TODAY to improve you business and turn it around.

Simon Hocken Director of Coaching, Breathe Business

If you would like your practice analysed by Simon Hocken, or you're looking for additional information and advice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Smashing the barriers of success

Mon, 26 Sep 2011 15:17:41 +0000

Aim for the sky and you'll reach the ceiling. Aim for the ceiling and you'll stay on the floor.

Bill Shankly

Each month I meet a handful of practice owners for the first time. I travel to their practices and help them analyse their business. Then we look at many ways that they can improve their practice.

Most Principals want to grow their patient numbers and with that their top and bottom lines. However, before I open my practice grow kit of proven strategies and tactics, I must first identity the roadblocks to growth that are often already well entrenched.

Most of the private practices I analyse are shrinking, but shrinking in a way that isn’t immediately obvious. Most good dentists attract around 10 new patients a month by word of mouth recommendation, yet their active patient list size remains about the same and their hygienist books fail to get any busier. So, what’s going on? Here are my explanations:

A significant number of patients are leaving the practice. It’s just that they do so quietly, without any fuss or giving a reason. They simply cancel their check up or treatment appointments, fail to remake them and ignore any follow-ups made by the practice reception team…
A significant number of patients are delaying their check ups and treatment. They are down the rabbit hole and they’ll come back out when the country looks like it’s in better shape and the newspapers start writing about something other than the recession.

However you measure it - active patient numbers, top line sales, bottom line profit - it’s clear that many practices have hit an invisible barrier to success. Through the work I have done with hundreds of practice owners, I have learnt that there are a few key barriers preventing business success. In this article, I want to describe the most common obstacles and how to get around them.

So, what (or who) creates these obstacles, and what you can you do to remove them?

Here are some possible barriers to your success:

The Practice Manager Many Principals have delegated a number of critical responsibilities to their practice manager and then left them to get on with it. This suits the owner and the manager until either the practice starts to shrink or the Business Coach comes along and asks some pertinent questions such as: * How many enquiries do you get on average a month and how many of them agree to a new patient consultation? * How do you decide which dentist to allocate these new patients to? * What is the active list size (not the number of patients on the data base) for each dentist? * How many patients regularly see the Hygienist? * What happens to the ones that don’t? * What are your fixed costs per surgery per day? The problem is that not knowing the answers to these questions hasn’t really impacted on the growth of your practice until now. And very often the attitude of the PM or their receptionists is, Why are you asking me to do this all of a sudden?
The Principal is Unwilling to Invest Enough in Making Changes Making changes takes time and cash.The rewards are seldom instant, rarely guaranteed and usually show up a bit/lot further down the track! Some Principals want an instant, cheap fix and preferably someone else to implement it. 
There are Saboteurs on the Team Sometimes, skilled team members will quietly find ways to resist changing their working practices. They know that there will be little in the way of sanctions if they don’t embrace what the principal has asked them to do. 
The Building/Facility Needs Updating. Have a proper look at your facility with a fresh pair of eyes. Does it need freshening up, cleaning? De-cluttering? A complete refurbishment? How about booking a skip and getting rid of everything from the practice that you haven’t used in the last 12 months. Either bin it, recycle it or store it off site. 
The Team Don’t Know What Is Going On! Because the Principal doesn’t meet often enough with the team to discuss plans for the future. Or possibly, when they do meet, the team doesn’t show much interest in the development of the practice! 
The Team Are Inflexible. For example, they are unwilling to:  Cover new/extended opening hours. Work a shift pattern to keep the practice open at lunchtime. Come in early so as to offer patients early appointments. Call patients out of hours to reactivate them. 
The Principal Is Waiting To See What The Others Will Do. Many dentists like the safety of the herd and are unwilling to try something without the confidence of someone else pioneering the idea (most well-trodden paths lead nowhere). I suspect the supermarkets will have no such nervousness. Tesco are already planning to have a dentist available in their stores for 78 hours a week! 
Fear, We’ve Always Done It This Way And It Has Worked... For many years changes in dentistry happened very slowly. Now changes come thick and fast. Running the practice in the same way, year after year, is no longer going to work. 
Poor Advice From Suppliers of Professional Services. Unfortunately, I meet principals every week whose: web site doesn’t bring in new patients, marketing collateral is inappropriate, computer software back-up hasn’t worked, don’t know how much tax they are due to pay etc. 
Principal Spends All His Time Doing Dentistry. With little time or energy left by the end of the week to make any changes to the way the practice is run!

Growing a practice means making changes, sometimes a lot of changes and it’s worth revisiting an old saying in coaching: “Keep on doing what you’re doing, keep on getting what you’re getting.” Or, in the case of Dental Practices:  “Keep on doing what you’re doing and get even less of what you have been getting!”

So, to summarise, don’t let barriers stand in your way. Stop focusing on the external factors that are inhibiting your success (politics, economics, the competition); things that are largely outside of your control. If you are serious about breaking through your invisible ceiling, have a close look at either the things or people around you who could be holding you back.

Make no mistake, removing barriers takes guts. It takes a strong commitment from the top, but it also requires participation and support from your entire team.

Removing these internal blockages won’t guarantee success if you have misjudged your market, pricing or demand. However, the exciting news is that recognising and tackling these barriers will set you back on the path of long-term, sustainable growth.

Simon Hocken Director of Coaching, Breathe Business

If you would like your practice analysed by Simon Hocken, or you're looking for additional information and advice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Are you delaying having the practice you want in order to keep the practice you have?

Wed, 07 Sep 2011 15:17:41 +0000

“After all is said and done, more is said than done.”

Anonymous

Talk, they say, is cheap. Go to any dental conference, stand at the bar and you will be amazed at all the things that your colleagues say they will be doing when they get back!

After many years of doing this work, I’ve discovered that really successful clients consistently take a lot of action/get a lot done/embrace change and that everyone else is either:

still getting around to doing it, or
hasn’t decided yet exactly what it is they will get around to doing!

Simply put, the gap between the practice you have and the practice you want lies in the things that you are not doing.

And most often the reason that you are not doing these things is procrastination. There are other helpful and less pejorative names for this habit as well. Steven Pressfield, in his excellent and helpful book on this subject, calls it, ‘Resistance’ and in Kolbe, the psychometric test that we often use with our clients, it's known as ‘lack of Follow Through’. Unfortunately, if you live your life with procrastination, resistance or lack of follow through, your success is likely to be at best sporadic and at worst non-existent.

So, here are some of the more common symptoms likely to be experienced by those folk who have yet to find a way past their habit of putting things off:

The people around them (team and family) get really stressed at trying to get a decision/answer.
Their unanswered email box is getting bigger.
They often forget the basics such as birthdays, hair cuts, taxing the car etc.
They are immobilized by wanting to get it right/needing to know what is the right thing to do.
They often start things but rarely finish them.
They sometimes wake at 0430 in the morning thinking about all the things they haven’t done
They never get around to doing the things they really want to do because doing everything/everyone else steals their time.

In dental practices the most likely things to get put off by the practice owner includes:

Having staff contracts and whole team appraisals (including associates and hygienists) and getting rid of ineffective / dysfunctional team members.
Sorting out front desk team to behave in a way that supports getting new patients and keeping existing ones!
Having a functional website in place that brings in substantial numbers of new patient leads.
Getting hold of their important numbers / management accounts and meeting key team members to discuss and take action from them.
Working with associates and hygienists who are highly effective clinically and in creating long term relationships.
Having a practice manager truly manage the practice and do more than just run the operations.
Creating and recruiting large numbers of patients onto an effective Membership Scheme.
Following a researched, effective Marketing plan with a known cost for patient acquisition and a demonstrable return on investment.
Leading a team that can all communicate the benefits of what the practice can deliver to anyone and everyone.
Holding effective, regular, enjoyable practice meetings!

So, what are the best tactics for freeing yourself from the energy sapping and progress slowing chains of resistance? Well, first and most important is a bit of self-reflection (self-honesty) about how much of this behaviour you actually allow yourself? Go on, be honest, how guilty are you and what are the real and actual effects this is having on slowing the development and success of your practice?

Try asking yourself these questions in order to shift into a more effective habit of getting things done:

Which of the items on my list would make the biggest difference if I were to get it done?
What is the best use of my time right now?
What are the top three things I must get done this week?
What are the common displacement activities that I find to avoid the things that really need doing?
What is the cost to me, my family and my team of me not getting them done?

Of course, truly successful entrepreneurs recognise that there aren’t enough hours in the day to do it all by themselves. They're also often very poor at follow through, so in order for this not to inhibit their success, they have found the perfect solution. They hire a completely trustworthy assistant with excellent follow through to ensure they get everything done.

Mobilising their resources allows them to achieve far more than they would be able to do alone and enables them to focus their efforts on the bigger picture. Delegating may feel uncomfortable at first (especially if you've built your practice up yourself), but the more you delegate, the more effective you and your team will become.

Remember, really successful practice owners concentrate on their main goals and objectives. They are focused. They don't get sidetracked. They don't procrastinate. They make a lot of decisions and therefore get a lot done!

So, have you started yet?

Simon Hocken Director of Coaching, Breathe Business

If you would like help starting, building, growing and managing your practice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Make More Profit: The First 10 Tactics

Mon, 15 Aug 2011 15:17:41 +0000

These days there are many people who will tell you (some for a fee) how to run your dental practice. They may elaborate at length on many ideas to transform your business.

And they have a receptive audience; unfortunately, in the current economic climate, many practices are going backwards in terms of gross fees, patient numbers and new patients.

Travelling around the country, visiting dentists and their teams, it’s clear that many more practices are looking for new solutions to solve the problems of their shrinking practices. However, many are ignoring simple, obvious and proven tactics.

So, in this article I thought I would reiterate the 10 tactics that every practice should have fully implemented before they start to look at more esoteric and sophisticated solutions. In other words, forget the fads, get back to basics and don’t do anything else until you have done these!

FINANCE

1. If you don't measure it, you can't manage it! Set daily and monthly gross fee targets for all fee earners with their knowledge and cooperation.

Use a day-book to have your fee earners monitor their own daily gross fees and meet monthly to discuss their results.
Reward your fee earners (and their support teams) who exceed their targets with a generous bonus.
Have your senior receptionist actively manage all your fee earners diaries so that the right balance of work is booked into them and so that they can reach their target gross fees with ease.

2. Control your costs. High costs can kill your profits as quickly as a low gross. Run your practice lean and mean and don’t tolerate profligacy and waste. Set a maximum spend on fixed costs that is in line with your current turnover and stick to it. Only increase this figure if your spending will increase your turnover!

3. Set a profit target every month. Take into account your costs and the performance of your fellow fee earners and then set a target which is a stretch but attainable. Measure your progress towards the target, day by day and week by week.

MARKETING AND SALES

4. Get a website that works. Many dental business coaches and consultants would have you believe that Internet marketing is a black art. It isn’t.

Have a website created by an experienced digital agency (not a man working in his spare room), one that clearly states your proposition, is simple to navigate, with a call to action - and your practice phone number - on every page.

Have it optimised so that you appear on page one of Google when folk search for what you do in your area! Your website must attracts traffic; that is, 300 or more visits per month. Once you have this level of traffic, your website has to convince 5% of the visitors to contact your practice; these are your leads. Then it is up to your reception team to turn them into patients.

5. Get a front desk team that works. During these last few months, the Breathe Team have been mystery shopping a lot of practices and the results have, in the main, been awful!

Your receptionists are your front line sales team. They have to know exactly what you expect of them when dealing with potential, new and existing patients.

Use role-play and scripts and have them practice a lot. Then monitor the results by having an experienced professional mystery shop your practice and report back to you.

6. Check your Kerb Appeal. Go and stand outside your practice and take a look at it as if for the first time. Prospective clients will make all kinds of assumptions by what they can see. That’s great, you can control their assumptions by making sure they get a positive visual impression!

Have trees pruned so they don’t obscure your practice. Make sure your garden and car park is tidy and swept.
Use signage like a retailer. Be specific and obvious about what your practice does.
Put up a colourful banner that makes prospective patients an offer. Change this regularly.
Make your entrance, impressive, representative, clean and professional.

Then be just as critical inside.

Get rid of all clutter.
Don’t display other businesses marketing materials!
Get rid of blue tac and minimise the number of notices you display. Put the must-have notices in frames or better still on digital screens.
Make sure that all patients and visitors can easily find out about all the services you offer!
Ban gossip, the radio, mobile phones, staff hanging around the front desk etc.
Make sure all your team arrive and leave looking like professionals. No jeans or trainers!

7. Create an effective Patient Get Patient programme. We all know that the most effective and reliable route to getting new patients is to have our existing patients recommend us to their friends, family and colleagues. These folk make great patients as they are pre-sold, willing to buy and trust you and your team from the off.

You can increase this trickle of new patients to a rush by actively seeking referrals. Create an effective patient get patient programme, utilising targets and incentives for the entire team.

You should be aiming for 7-10 new patients per month per dentists from an effective programme.

OPERATIONS

8. Hire the right people. When Richard Branson was asked how he found the right people, he said that he, ‘failed fast and fired often’. Getting the right team starts with the recruitment process; list both the skills and the behaviours you are looking for remember that behavior is more important than skills. Then, properly induct, train and appraise. Don’t pay people just to turn up, use performance pay. Find people who can:

Build relationships
Communicate well
See their glass as half full

And, don’t tolerate low grossing associates and hygienists who are trying to save your patients money whilst not fixing their periodontal disease!

9. Have many regular meetings. Unless you congregate with your team, you can’t explain to them the strategic objectives you have for your practice and how your team can help you achieve them. This is the time that you get to show up as the leader.

Hold the meetings in clinical time (not at lunchtime) to underline their importance.
Start and finish them on time and don’t let them turn into moaning sessions.
Use them to ‘rally your troops’ and run them very professionally.
Don’t tolerate people not attending or not doing what they agreed to do in these meetings!

10. Open at hours that suit your clients. Make sure that your hours suit your catchment. You will probably need to offer some appointments:

Before 0830
During lunchtimes
After 1800.

Don’t let your phone ring more than 5 times, don’t ever switch your phone over to answerphone between 0830 and 1800 and if your lines are busy, use an answering service not an answerphone.

In Summary:

Focus on these tactics first and you will definitely raise the performance and profit of your practice quickly. In 2011, in this trading environment, you have to play the game at the right level.

Simon Hocken Director of Coaching, Breathe Business

If you would like help starting, building, growing and managing your practice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

You Get What You Measure!

Mon, 15 Aug 2011 15:17:41 +0000

One of the most common issues I currently hear dentists commenting about is their concern over the number (or lack of!) new patients and how to keep the practice above water in these austere economic times.

At this point, I would love to be able to wave my magic wand and bestow upon dentists and their teams the golden key that will unlock the door to practice prosperity and success, but alas, it's not that simple!

We can all get lost in profit and loss accounts, cashflow or fixed versus variable costs and become confused by jargon about creating a marketing proposition, or carrying out business process reengineering. After all, how can we be expected to be qualified accountants, expert marketeers and professional management consultants, as well as qualified, expertly skilled dentists with an excellent chairside manner?

The answer is we can’t, so it is necessary to have professionals around us to support our business. However, we all need to do a bit of groundwork if we wish our business to (a) function and (b) make a profit. It takes more to manage your business than to simply check the bank balance at the end of the month and hope that your year-end set of accounts will be adequate, with enough money left to pay the tax bill.

I believe in keeping that groundwork very simple so that I, and everyone supporting me, understand it. This way I’m much more likely to make it a priority rather than something I dread and relegate to the bottom of my “To Do” list where it never gets done.

One thing I have noticed recently relates to a small core of dentists I work with who have struggled in the last year to run their practices profitably. They are now telling me that they have “just had a run of three months in profit” or “just had my best month for over two years”. Could there be a common denominator as to what these practices are doing differently that is reversing their negative trend of practice profit?

Yes, there is! They have started measuring and reviewing key activities in their business using a few, well chosen Key Performance Indicators (KPIs). These particular dentists are almost allergic to numbers and the “S” word (sales), but by keeping it simple they are now able to focus on what is making their business work (or not) and then make changes to keep it on track.

A very dear, wise and astute friend gave me the following advice several years ago and it revolutionised my life:

“Measure what you value, and you get what you measure”

This is exactly what the principal dentists I mentioned earlier have taken on board and made a part of their daily lives. We can apply this motto to both our businesses and our personal lives. For example, many of us make resolutions about losing weight, getting fitter or spending more time doing the things we enjoy. How often do we fail in achieving any of these goals?

I spent years wishing I was thinner, reading lots of books and articles about weight loss and occasionally actually doing something about it. Sometimes I felt good, other times I knew in my heart that I was fooling myself, such as those moments when my jeans seemed to be a tiny bit looser so I thought I must be on track (I wasn't!).

Then I realised, once that advice had sunk in, that I had to:

Value the importance in my life of actually being thinner (I wrote a lot down, which I still refer to regularly five years on and two children later)
Stand on the scales (however painful that was)
Write down my real current weight (and stop trying to stand on one foot to make it less)
Set a target weight that I wanted to reach and when (realistically)
Tell someone my current and my target weight (ouch! Very, very scary as I had never admitted my weight to anyone before!)
Stand on the scales each week and weigh myself, record my weight and tell my buddy the progress (or lack of)
Assess (with the help of my buddy) if I’m losing weight and staying on track, what I’m doing or eating that’s working, and if I’m not losing weight and not on track, what I need to change or stop doing or eating
Continue measuring even when I hit my target weight: keep measuring, reviewing and taking appropriate action regularly to stay on track

It is a natural law of the universe that once you start measuring something important to you, a high percentage of the time you will get what you want. The reason being that the act of measuring and reviewing ensures a focus on the desired outcome, so you are far more likely to achieve it.

So, enough of the magic wands and laws of the universe. How does the losing weight analogy work for running a successful, profitable practice? Here’s how:

Decide what things you need to measure in your business (KPIs) that are important for you to achieve your desired outcome.
Start with a few simple, useful KPIs and evolve
Start measuring your KPIs by collecting the data
Set a target for each of your KPIs that you want to achieve in the next year
Share those targets with key personnel in your business and your coach
Measure your KPIs on a weekly or monthly basis (ie continue to collect the data), as appropriate
Review the data on a monthly basis with your team and coach as appropriate and assess whether or not you are on target to meet your year-end goals
Make decisions and take action. Make changes to ensure that you are on track to meet your year-end goals.

It doesn’t matter how bad those first numbers are, you have taken a major step forward in your business because now you know exactly where you are. This is purely a starting point.

I am still surprised at the number of practices that do not set a forecast with targets and a budget for the year, nor measure and review how they are doing. Without these fundamentals, they are really relying on hope as a strategy (and it didn’t work for me in getting thinner).

In the current economic environment, pure hope on its own is a very dangerous strategy.

Ernie Wright Lead Coach: People & Business Management

For more guidance on how to measure for success, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

How To Make A Small Dental Practice Super-Profitable

Fri, 29 Jul 2011 15:17:41 +0000

We work with a lot of smaller dental practices; that is, practices with a turnover of less than £500k. I have always been fascinated by the variation in profitability of these practices and within our client base, past and present, we have seen practices deliver net profit that varies from 5% to 45% of turnover!

Practices that are bigger than this generally have more critical mass, enabling them to get past their cost base more readily and create a more reliable profit. However, as so many practices in the UK are around this size, I thought it would be interesting to highlight what has to happen to make these practices ‘super profitable’.

So, let me paint you a picture of my perfect £500k turnover general dental practice, which makes the sort of profit that would bring a smile to even the most cynical dentist’s lips!

2 Surgeries.
A list of between 1,600 and 1,800 Adult patients.
Fees set at the equivalent of £200/hour.
12-20 new patients a month.
2 Dentists, each working 4 days per week, 46 weeks per year, grossing a minimum of £1,100/day, that is £200k per year with a occupancy of approx 85%, doing simple, general dentistry.
75% of the adult patients see the hygienist...
Who works 5 days per week, 46 weeks per year, grossing a minimum of £550/day, £125k per year with occupancy of 85%.
The gross fees are therefore, circa £525k.

Now for the costs.

If there are associates, pay them no more than 45% of their gross (and preferably 40% at £1,100/day gross). Pay them a higher percentage if their gross increases. Better still don’t have an associate, have a profit sharing partner.
Pay the hygienist(s) a maximum of 33% of the hygiene gross and only when they are treating patients.
Spend no more on materials, than 8% of total practice gross.
Spend no more on Laboratory bills than 10% of total practice gross.
Spend no more than £14k per month on everything else, that is the fixed costs. Of these, spend no more than 20% of the total practice gross on staff (excluding hygienists).

In this model, the profit will be in the region of £220k to be split between the two dentists. If you want the model to create more profit then:

Increase the daily gross figures of the fee earners
Maintain the same percentages of gross fees for, Laboratory Bills, Materials, and Staffing
Don’t increase the fixed costs

Interestingly, If you were to own a practice like this and not work in it, simply employing associate dentists to do the work and paying them 45% of their gross fees after laboratory costs, the profit will circa £50k. Now that is compelling.

if you were to open 5 of them, you could create £250k/annum profits without putting on a pair of surgical gloves and with plenty of time to do all those enjoyable things that being a dentist has taken away from you!

So, why don’t more dentists either create this model for themselves to enjoy working in, or to own, whilst others work in it? Well, I believe that it’s because they don’t do these simple things:

Practice Financials:

Track all of the numbers I have mentioned. Review at least every month with the core team.
Negotiate hard on all costs.
Don’t work with associates who gross less than £1,100 per day.
Don’t work with Hygienists who cannot maintain in excess of 80% occupancy or who gross less than £550, or who want to be paid more than 33% of the gross hygiene fees.
Keep it simple. Don’t go shopping for too much in the way of new kit or go on too many courses.

Marketing. Focus on:

Word of mouth referrals.
Walk by clients who see your signage. Banners etc.
Website and Internet marketing.
Reactivating dormant clients and dormant treatment plans.

Practice Sales:

Have front desk team scrupulously and reliably record all lead information and new patient information.
Train all team in ethical selling skills and practice these with role play every month.
Set targets for everything, review and reward.

Practice Operations and HR:

Don’t pay people for just turning up, use performance pay to remunerate the whole support team.
Increase the range of your opening hours so that as a minimum you offer early morning, late evening and a Saturday morning.

In summary: A practice that runs this model can create a significant profit (40%) if it is well run! Unfortunately, many practices I visit and talk to fall far short of this and seem unable or unwilling to implement the tactics I have outlined. Many are stuck with a team who simply refuse to embrace change and are frankly poor at what they do.

In the new financial reality that is the UK in 2011, I believe that both small and large dental practices have to change and implement successful strategies such as these, or risk not being around in 2012.

Simon Hocken Director of Coaching, Breathe Business

If you would like help starting, building, growing and managing your practice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Are you One of the Best or One of the Rest?

Fri, 15 Jul 2011 15:17:41 +0000

These days, I spend a lot of time presenting to groups of dentists and their teams. I know that these audiences really like two things:

Tactics that have worked for others and
Success and disaster stories from the world of dental practices.

It’s pretty lonely being a dentist and they want to know what the rest are up to; either to confirm that they are on the right track or to get hold of some new ideas to take back to the practice and try-out.

So far, so good, except most of the ideas never actually get tried out! They sit as notes on paper (or these days on an iPad) providing comfort for the owner who hopes that one day, he might find time to do something with them. They’ve dropped the ball (the ball being focus, commitment, even success).

Over the years, I’ve become increasingly curious about what separates the dentists who implement the ideas from those that don’t and even why some practice owners are still succeeding when, these days, most practice owners are slipping backwards.

So, I want to introduce you to three types of practice owner, examples of which I meet every week. Stereotypes of course, but hopefully a useful model to help you understand the characteristics of the best and those of the rest.

1 The Ostrich (Hope Strategist)

The Ostrich wants a quiet life. They may have fallen out of love with dentistry but remain in love with the lifestyle that it has created for them. Very often, they stumbled into practice ownership years ago, as some sort of ‘natural progression’ from being an associate and these days they often feel somewhat depressed and aggrieved by the increasing demands being made on them such as CQC, HTM01/05, Employment Law etc.

They seek out colleagues who confirm their view that all the fun has gone out of being a practice owner and that the rule-makers are out to get them.

They rarely have much hard data because for many years now, they have been running their practice by: monitoring the white space in their diaries, their bank statements and their annual meeting with their accountants.

They are often micro-managers and have a high staff turnover.

Their practice managers are usually low paid ex-receptionists or ex-nurses who have little experience or training to do the job they are now being asked to do. They often make a competent job of running the operations in the practice, but really struggle with managing the practice's Marketing, Sales Processes and Financial controls, so they don’t!

The Ostrich know that they need to invest in their increasingly faded and outdated practices but they don’t really want to spend their falling profits. If they did decide to invest further, they would struggle to know what to invest in except perhaps a new surgery for themselves.

However, they tell themselves that although the patient list has got a bit smaller and new patient numbers are falling, the old patients still love them and one day - hopefully - it will all get back to the way it used to be. Essentially, The Ostrich would prefer not to implement any changes…

2 The Enthusiast (Information Gathering Strategy)

The Enthusiast loves dentistry and will often tell you that what they really want is to “ just do the dentistry”. They are great fun to be around because their passion for fixing teeth is infectious!

Naturally, they love clinical courses and in their office you will find piles of books, course hand-outs, magazine articles etc, waiting to be implemented. The Enthusiasts spends many hours of the week seeing patients and will fit in running the practice into the gaps during the day. They have made clinical dentistry their hobby and some even visit the practice at weekends in order to fix broken kit.

Often, they are sophisticated, highly skilled restorative dentists and they love clinical courses and trade shows, investing heavily in clinical skills and equipment.

They often achieve high gross fees, which quickly disappear in the (high) costs of their practices. They don’t know much about the numbers because in the past there has always been enough money, although these days the overdraft seems to be climbing.

Most Enthusiasts are naive leaders, trusting their teams to do what it says on their job descriptions. In return, their often-loyal teams appreciate their skill sets and will defend them to the last.

They talk a lot and change their mind often and so none of their team really understands where the practice is heading. They are keen to make decisions to advance their practices and essentially, they will implement such changes as soon as they have gathered some more information…

3 The Implementer (Driven by Objective Strategies)

The Implementers are ambitious and have created a clear set of short, medium and longer-term business objectives so as to develop their practices. In order to achieve these objectives, they have reduced the amount of time they spend treating patients and increased the amount of time they spend working on their practices.

They make a lot of decisions, knowing that some of them may not work out and that this gets things done. They do not get anxious about making decisions.

They are not nervous about investing in their practice and they do this willingly once they have quantified the return they can expect on their investment. This means that their practices are constantly evolving towards their objectives and their whole team is fully briefed on where their practice is heading. They have researched their options (or better still have their business manager help with this) and they have the right information from the best advisors.

They have hired a team that is skilful and that can be trusted to do the job on time, on budget and to the right standard. They achieve this by making very clear requests of their business managers.

Implementers are quiet and competent leaders who understand the value of time spent planning. They always prioritise their action lists highlighting the actions that will create the biggest differences and set time scales to have these actions completed. Their teams are motivated, well paid and willing to go the extra mile.

Essentially, The Implementers understand two things: that talk doesn’t count, only actions make a difference and secondly, that progress is more important than perfection.

in summary:

What type of practice owner are you? No matter which category you fall into, I'd be willing to bet that you still want more patients, increased profits and the freedom and flexibility to enjoy your ideal lifestyle. Yet only only one kind of practice owner is achieving all this. It is self evident that information, tactics and ideas are of no use to you unless they get implemented!

I have highlighted the attitudes and behaviours that the most successful practice owners exhibit. Decide on what you want right now. If you want a quiet life, keep burying your head in the sand or continuing to gather information. But denial and inaction won't build a solid business foundation.

Choosing the right attitudes and behaviours will be more important to your success than choosing the right tactics.

Simon Hocken Director of Coaching, Breathe Business

For more guidance on running a successful practice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

If you want what the 1% have, you have to do what the 1% do

Wed, 29 Jun 2011 15:17:41 +0000

We all know the problem for Dental Practice owners: They have to do the dentistry as well as lead and oversee the running of their business.

And because their fees are important for practice cash flow, doing the dentistry tends to get the priority time and priority energy, and running the business may come a distant second.

In order to help our clients disconnect from their everyday routine and reconnect with their business (and themselves), the biggest call we make on their time is to ask them to spend a few days with us in November.

One of the ironies of my job is that very often my meetings with clients, be they telephone or face to face, get squeezed into the downtime between them seeing patients! Our Client Account Managers (Nicola and Claire) spend many hours trying to find appointments that don’t interfere with earning fees such as: before dentists start work, after they finish work, in their lunch breaks, between patients etc etc. This is rarely a good time to discuss the serious business of making a dental practice successful. Better suited to the much less serious business of filling teeth. (I’m not knocking it, I just remember that when I owned my practices, the patients and the dentistry were the easy bit, successfully running my practices was much more difficult...)

So, what do the 1% do?

Well, they have many successful strategies in common but one of the most powerful is that they schedule regular time to work on their business. This includes taking regular time every year to create, review, revisit and update the long and shorter term strategic plans for their business. Because of this, they get really clear about how their practice is going to perform in 5 years time, 3 years time, in 12 months time and within the next 12 weeks.

The problem for many dental practice owners is that they are too busy doing dentistry to work on their business, let alone create 5 year, 3 year and I year business plans which inspire them and their team to move their practices forwards. So they bumble along making decisions based on their next best guess, rather than following a considered and well-researched business plan. Paradoxically, this has worked for some dental practice owners for the last 20 years. However, it is obvious to all of us that since the banks fell over, the game has changed and that having a BDS no longer guarantees a ticket to profitability.

So, every November, we facilitate a workshop in the peace and quiet of South Cornwall to enable our dentists and their partners to create:

A 3-5 year strategic business plan
A 1 year functional business plan
A set of actions that will ensure the functional business plan is implemented for the next 12 weeks and the right people are/will be in place to carry out these actions.

These plans then power their practices forwards until they need to be revisited and revised. At the same time we also encourage them to rebalance their time and their personal finances in order to remove the commonest cause of stress for dentists, not enough time and not enough money! It’s fair to say that the clients who have invested in doing this work have more success and achieve it faster than those who haven’t.

For me, the real value in having a detailed plan to take your practice forwards is that the plan will create a series of waypoints over time and this makes it simple for you to measure your progress. For example the waypoints will tell you when to target and measure your progress against indicators such as:

1. Turnover 2. New Patients 3. New services, 4. Profit 5. Net Worth

Regardless of what you are measuring, all of us love to feel that we are making progress towards a goal. This progress enables us to feel good about ourselves and boosts our self-esteem. Making progress against measurable goals makes the whole team feel better about their work and themselves.

Dental Practice owners who don’t have the luxury of a strategic business plan tend to experience challenges such as these:

1. They don’t know where to invest their time to make their practice more successful. 2. They don’t know where to invest their money to make their practice more successful. 3. They don’t know who to hire next. 4. They don’t know where to expand their services. 5. Their teams have no idea what they are working towards and what’s in it for them. 6. They won't know when it’s finished. 7. They have no idea who might buy their practice when it is time to realise their asset.

The second crucial area we address during our November workshops is the area of leadership. Very few Dental Practice owners know how to lead, inspire, motivate and acknowledge themselves, let alone their teams. This means that very often, their best laid plans inevitably fail as they can’t do it all on their own!

So, if you are serious about taking your practice to the next level, particularly during this economic cycle, I believe that you had better start doing what the one percent do!

Simon Hocken Director of Coaching, Breathe Business

To learn more about how we can help you and your business move to the next level, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Riding the Avalanche of Change

Thu, 16 Jun 2011 15:17:41 +0000

Recently, a client asked the Breathe team to analyse the data of 39 private practices in order to compare their turnover and profit in 2010 to that in 2009. The results were shocking:

Average fall in turnover: 12% Average fall in profit: 37%

It is currently a difficult time for some principals to own and lead a dental practice, and many of them are (rightly) concerned by:

Gappy books and low numbers of new patients
Patients leaving and list sizes shrinking
Patients shopping around on price
Patients putting off treatment, especially check ups and hygienist appointments
Falling profits and increasing overdrafts
Shrinking practice gross fees
Increasing personal tax bills

For some practices it is becoming harder to continue trading at the same level as in 2009. This pressure combines with substantial and complex new compliance and regulation including:

2010, HTM01/05
2011~ Care Quality Commission Registration
2012/13~ Revalidation

The increased cost of running a practice and the fall in turnover has considerably reduced the profitability of many dental practices. This is reflected in the valuations that private practice owners are now receiving from experienced agencies.

Growing expenditure and further constraints on profit are also coming from within the world of dental business. Factors include:

Difficulty locating skilled, profitable associates There is an oversupply of newly qualified, inexperienced dental graduates with insufficient technical and/or interpersonal skills to gross high enough fees.

Unsustainable pay demands Associates, therapists and hygienists continue to have unrealistic expectations about how much practice owners can afford to pay them.

Lots more competition Competitors include retailers, corporates, dental tourism, the Internet, new squat and re-invented practices, which means that practice owners have to increase their marketing presence and marketing costs.

The necessity to obtain new and increasingly complex skills Acquiring new skills incurs training costs, in addition to the funding of necessary additional equipment.

The result of this unusual combination of circumstances is that:

Practice costs are going up
Practice gross may be going down
Practice profits are falling
Private fees are unlikely to be rising fast enough to keep pace with all these new costs

As ex-Chairman of the BDA, John Renshaw, said on the dental website www.gdpuk.com in late 2010, when addressing some of these issues, “Colleagues, we are on borrowed time.“

However, despite this avalanche of change occurring alongside a political and economic environment where the recession, austerity budgets, public service cuts, increasing unemployment, rising oil prices, falling house prices and so on continually adorn the front pages of our national media… there are plenty of opportunities for dental practice principals to grow their practices.

In the 1990s during the last recession, Tesco and Sainsbury managed to grow their supermarket businesses by around 30%! In 2010, Dental Market analysts (Source, MBD June 2010) forecast that by 2014 there will be:

A 21% increase in the size of the private dentistry sector (in real terms)
A 12% increase in the size of the NHS dentistry sector (in real terms)

I believe that the increased demand for dentistry will occur across a whole range of dental services, but it will be most keenly felt by practices that are able to offer:

Cosmetic Dentistry
Quality Affordable Family Dentistry
High Street Retail Style Dentistry
Boutique, Business Class Dentistry
Specialist Dentistry (Implants, Orthodontics etc)

I do not believe that average practices doing average dentistry and providing an average service will benefit from this uplift in demand. Neither will they continue to benefit from a decade or more of rising demand for cosmetic dentistry. They will have failed to notice that: 60 is the new 40, that the media continue to help dentists sell cosmetic dentistry, that the Internet makes information on cosmetic treatments freely available to prospective patients and that these patients demand a sophisticated response from their dentists to their enquiries.

Riding The Avalanche The avalanche of change will bury average practices. Successful principals will ride these changes, growing their practices and benefiting from bigger, more valuable and more profitable businesses. In order to ride the avalanche, successful practices are learning how to ‘play the game at the right level’. This means they are very serious about:

How they clearly differentiate themselves from other practices
Regular, effective marketing campaigns with a measurable return on investment
Having a team that can sell new patient consultations and treatment plans!
Their client journey
Collecting and analysing data that measures their success

The are adept at:

Providing exceptional customer service
Looking after their existing clients as if they were old friends
Having most of their regular clients commit to their practice by joining a compelling membership scheme
Adding value to everything they do
Providing opening hours that suit their busy clients
Being passionate about what they do
Not hurting, upsetting, or annoying their clients
Making it easy for their clients to pay
Offering a wide range of services
Recruiting a team who are willing to be lead and embrace change

In summary, dental practice principals have a ‘double whammy’ that they must deal with effectively and quickly. They have to trade in a market that has become much more difficult over the last two years, whilst implementing a raft of changes in order to satisfy the rule-makers. Fortunately, the demand for good quality dentistry offered in a professional and comfortable environment is increasing, together with the competition for these clients. I suspect there will be some spectacular winners and many losers.

Probably the single most relevant indicator of future success in this rapidly changing market will be the attitude of the practice principal. A positive, ambitious, can-do attitude will, this time, win out over all those who are still complaining!

Simon Hocken Director of Coaching, Breathe Business

For more advice call the Breathe Team on 0845 299 7209 or info@nowbreathe.co.uk.

Turning Bad Press into New Patients

Fri, 03 Jun 2011 15:17:41 +0000

Another year, another media hatchet job on Dentists in general practice. Channel 4’s Dispatches programme and the associated Saturday Times full-page article were full of righteous indignation as well as being, at times, simply wrong.

This time, the broad complaint against dentists was that of “gaming”. As I understand the term, it means exploiting the system to the advantage of the dentist and to the disadvantage of the patient. The sacred cow that the naughty dentists were exploiting was, of course, the NHS. This generates, as it always does, comparisons between NHS patient charges (now more opaque and nonsensical than ever) and private pay as you go fees. Already an apple and pears style comparison.

However, my intention in this article is not to prove the programme researchers wrong but to try and understand why Dentists keep attracting this media derision and how to turn this around to your advantage.

Most high street dentistry in this country is provided on the NHS. Around 18 million courses of NHS treatment last year compared to around 10 million courses of private treatment. Many more patients receive “mixed treatment”, that is a mixture of NHS and Private fee per item treatment and relatively few patients’ benefit from true private practice.

So, in order to understand the root of the problem the media has with dentists, lets get a few facts out of the general dental practice cupboard and into the spotlight:

On average it costs around £450 per surgery per day to open a dental practice before the dentist who works in the surgery gets paid.
Most dentists in general practice earn on average £425/day before personal tax. This means that they have to gross around £1,000/day.
So, whoever pays the fees, (NHS, Denplan/Capitation Private pay as you go) the clinician has to gross around £1,000/day to cover the surgery costs and meet their income expectations.
However, £1,000/day gross can be earned in many different ways. Here’s three examples:  - NHS UDA’s/hour at £22/UDA - NHS UDA’s/hour at £22/UDA plus £66/hour in private fees - £132/hour in private fees
In the examples I have given above; example one probably entails treating around 40 patients per day, example two probably involves treating around 30 patients per day and example three probably involves treating around 20 patients per day.
It is undoubtedly true that the patient’s experience, as one of 40 patients per day, will differ to the patient’s experience as one of 20 patients per day.
It is also likely that the type and quality of the clinical dentistry will differ in these examples in that it is hard for clinicians to do difficult clinical dentistry quickly.
Those that deliver the dentistry could make this situation clear to the patients before they receive treatment. Generally, they don’t.
Which means that often patients are confused as to what their choices really entail and some clinicians and their support teams hide behind this confusion.
Which leads to TV and Press expose’s on the provision of dentistry in the UK…

Full circle then.

Meanwhile, back in your practices, I expect the media storm in the teacup has passed and that it’s business as usual. Or is it? Actually, I believe that very often, dentists get the press that they deserve and as long as they keep behaving as they do, the press will continue to produce programmes and press articles like these. The press are simply echoing the public’s dissatisfaction and discomfort with how (some) dentists behave. Remember that 33 million people in the UK don’t go to the dentist, a pretty damming judgement.

It’s easy to discover what people dislike about Dentists and Dental Practice; any party-goer will willingly tell you if you let slip you are a dentist!

Here’s my top 10 public dislikes about dentists and dentistry. They:

Are afraid it will hurt.
Don’t like injections.
Find it difficult to get to the practice for treatment during working hours.
Are concerned about the cost.
Are unsure whether the treatment they are receiving is NHS or Private.
Are worried that they might get treated for something that doesn’t really need doing.
Feel out of control during the treatment and feel terrible afterwards unable to eat or drink in polite company.
Are not sure how to select the best option from the choices presented to them.
Have often had bad experiences in the past, which they want to avoid having again!
Feel the fees are hard to understand and represent poor value for money

After many years of listening to patient complaints, I’m confident that these are the most potent dislikes! I believe the challenge and also the opportunity for any dentist who really wants to step outside of this paradigm is to re-write these dislikes by meeting them head on and providing a service that challenges all these negative connotations of high street dentistry by actively turning them around!

For example, imagine working in a practice that:

Makes a promise that it will never hurt its patients!
Uses local anaesthetic techniques (such as The Wand), which means that local anaesthesia is comfortable and effective at all times.
Offers appointments to suit their patients busy weekday schedules.
Has flexible ways to pay and is positioned to offer high quality at moderate prices.
Has clear communications about what treatment is covered by The NHS/Dental Plan etc and which treatment they will have to pay for.
Uses modern digital imaging technology to help patients understand where and why they have dental pathology.
Allows patients to stay in control during their treatment keeping treatment times as short as possible and managing the patients expectations of what they will be able to do afterwards.
Gives freely to patients, time, information and advice on treatment options.
Acknowledges to patients that dentistry has provided tough times for patients historically but that such experiences are now history.
Offers real value for money (as judged by the patients rather than those that work there).

If you were to market this as your proposition rather than another practice offering, “State of the art equipment in comfortable modern surroundings…” then I believe you would truly begin to address the public’s very real objections to having dental treatment. The media with all their inaccuracies are just the voice of this public discontent.s

Simon Hocken Director of Coaching, Breathe Business

To find out more about creating a 'proposition' to grow your practice, promote customer loyalty and drive sales, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Retail is detail

Fri, 06 May 2011 15:17:41 +0000

Attention to detail can turn an average dental practice into an outstanding dental practice from the patients’ perspective.

Ask any retailer from ASDA to Agent Provocateur and they will confirm that one of the principal key drivers in retailing success is getting the detail correct.

From the opening hours signage to credit card processing, from the team’s uniform to the vernacular sales assistants use when speaking to customers: it all conspires to generate a successful purchase.

As customers, we are continually collecting and simultaneously evaluating information. We are searching for clues that either reinforce our buying motivation or, just as critically, reduce it. Curiously, we often experience a huge sigh of relief when we discover that the retailer is not living up to our perceived understanding of their proposition. The sense of relief is driven by the fact we can stop processing the vast amount of multi-level information (sight, sound or scent) we are being hit with and simply accept the fact that this particular retailer is not right for us. We are quite pleased to move on.

How many times have you been motivated by a real need, marketing, or simply opportunity and entered a new retail environment with an expectation that has been shattered in a matter of seconds by a dirty or foul smelling environment, slovenly staff, poor lighting, or perhaps vast amounts of threatening signage?

These are the obvious conditioners to our perception of the retailer and will have a massive impact on buyer behaviour. However, in all honesty, these types of problems belong to a retailing world of the 1970’s and thankfully these types of conditions would be most unusual to come across today. The conditioners that affect buyer behaviour today tend to be subtler.

Typical Conditioners

The location of the unit: next door to an Indian takeaway as opposed to next door to Boots.
Signage and packaging: how well does the signage communicate the retailer’s core proposition to its target customers? Do customers understand what is being sold?
The welcome: how easy is it to find the entrance and how welcoming is it? What are you presented with first in terms of smell? Many supermarkets pump a chemical into their air management system that makes the air smell of baking bread, which research tells us makes us hungry (hungry shoppers buy more) or the universal fact that every supermarket’s first aisle is fresh fruit and vegetables, designed to communicate a halo of goodness and freshness over the entire 65,000 different products that are sold in a typical large supermarket.
What can you hear? Have you ever sat in a hotel dining room and listened to some screeching female vocalist belt out a love song in an extreme American accent whilst you are trying to eat breakfast? It’s incongruous, but worse it really spoils breakfast. Or how about PA systems operators in regional airports?

So how does this detail translate to the world of dentistry?

Are dentists indeed retailers? Is it important? The accepted view is that UK dentists are becoming very retail-savvy. There are countless examples of the so-called ‘dental spa’ with very un-dental type names being over represented in certain segments of the dental market. Make no mistake, dentists are and will become skilled retailers, however the detail point goes way beyond the ‘packaging’ of the practice.

Take 10 minutes out to try this little 10-point test. Put yourself in a prospective new patient’s shoes, visiting your practice for the first time:

Kerbside appeal: how does the practice look? Cold and clinical, or warm and inviting? How do you want it to look? First impressions really count.
Does the signage communicate the type of dentistry you provide (eg pain free, no needles or cosmetic, etc)? Does it say new patients are welcome? Does it tell you the opening hours and does it tell you where to park?
On entering what can I hear? As a new patient I am naturally stretching to see if I can hear the dreaded drill. Instead, I hear a soundtrack from some birds tweeting gently in the background, along with some running water.
How do the people who work in the practice look? Could it be a tanning parlour, a Toni & Guy or an NHS waiting room? Not uniformed or uniformed, or maybe in scrubs? What is your overall conclusion of the team: frumpy, happy, young, senior, mainly female, gentle, professional, sloppy, dim, exciting..?
Does the receptionist step out from behind the counter to welcome the new patient or does she simply look up and say, “Hello, where did you park? Please fill your registration number in here” (which is what my expensive dentist’s receptionist always does).
How are the toilets? Check them out at about 4.30pm, you might be shocked. Dirty toilets translates as dirty dentist, transmitting disease.
What is the range of magazines and how thumbed are they? People are perpetually thinking about cross-infection.
How is the clinical team addressed by staff? Is it Dr Brown or Gordon? Both could be correct depending on your practice’s positioning, but that is not always the reason first names are used. The captain of a BA 747 is always referred to as ‘captain’ by cabin crew, as it is critical his leadership is never compromised through familiarity.
What items are sold to me in a passive way through point of sale devices as I am waiting to see my dentist?
What happens when the treatment session is over? How is payment handled? Do I feel like the value has been reinforced so I leave contented?

Not applying the retail is detail rule to your practice will hurt your bottom line. In fact, you will find that applying this rule plays a vital role in keeping your team focused on who is the most important person in the practice... the patient.

Jonathan Fine Director of Marketing

If you would like some help with effective marketing:

Contact me directly at jonathan@nowbreathe.co.uk

Or contact The Breathe Business Team on 0845 299 7209

Users Guide to... Reactivating Cancelled Appointments (Part 1)

Fri, 06 May 2011 15:17:41 +0000

It is likely that all the work that you need is sitting un-booked in your patient files and in the mouths of the patients that do not have an appointment to return to your practice. Having an effective re-activation strategy will also help increase your patient loyalty as they will realise that your practice cares that they haven’t come back!

The best tactic to re-activate the patients that have cancelled appointments and have yet to rebook them is to have your reception team telephone these patients. However, this tactic has to be implemented very carefully.

Don’t:

Let patients leave saying they will call the practice to make an appointment. If they insist on this, have your reception team arrange a time to call them later the same day!
Write letters, they don’t work!
Leave messages with a third party.
Leave messages on the patient’s voicemail.
Let your junior receptionists ring a list of patients at two in the afternoon and leave voicemail messages for most of them asking them to contact the practice. They won’t.

Do:

Have someone on your reception team, who is trained and effective in making sales calls, contact these lost patients.
Call at a time when patients are likely to be in. Good times are: 1730-2000 weekdays, 0900-1100 Saturdays.
Keep an up to date active patient list. Choose a cut off time; for example, include patients on this list who the practice has seen within the last 15 months. Have your team keep it accurate and up to date.
Keep an active patient list per dentist. This will enable your team to allocate new patients to the dentist who needs them most!
Keep the rest of the patient data in a dormant patient file for reactivation.

For more advice on reeling patients back in, call the Breathe Team on 0845 299 7209 or info@nowbreathe.co.uk.

Associates, Carrots and Sticks

Fri, 06 May 2011 15:17:41 +0000

I visited a lovely practice this week, which is typical of many. The principal earns around 70% of the gross fees despite working with two associates and two hygienists. Without the principal’s contribution to the gross, the practice is simply unviable as a business. This puts an enormous load on the principal and in many cases (including this one) they earn far less of their gross than if they worked as an associate...

Many principals I meet feel that their associates are simply:

Not pulling their weight in terms of how much clinical dentistry they produce.
Receiving a disproportionate amount of pay for the dentistry that they do produce.

And that’s not all. Paradoxically, the associates are often unhappy too, many of them feeling undervalued, uninformed, out of the loop and unappreciated. This is not a formula for a successful, happy, profitable practice and in these straightened times, some practices are being brought close to the edge of the financial cliff by these behaviours.

Owning a dental practice means that you have the opportunity to grow a great business, earn a great income and create a valuable asset that you can sell. Working as an associate in a dental practice should be both fun and very well paid. So, how is it that I meet so many principals who are dangerously stressed because, despite having one or more associates to help increase both the practice turnover and profits, the success of their practice is still too dependent on the volume of dentistry that they diagnose, treatment plan, sell and produce.

There is a better way and many practices that we work with are very profitable with (relatively) relaxed principals and content associates. So, below I’ve summarised the 10 most effective strategies and behaviours that you and your associates must demonstrate in order to create long term, rewarding, win:win working partnerships:

The Top 10 Ways To Have Happy, Profitable Associates!

Hire associates who share at least some of your values. This will mean that you fundamentally understand each other and just as important, like each other! Don’t hire anyone that you wouldn’t want to get into a lifeboat with!
Share your vision for the future of your practice with your associates and ask for their help in putting this into place. Tell them what’s in it for them.
Hire a different and complementary skill set to your own so that you both bring clinical strengths to the practice patient base by cross referral.
Coach, mentor, consult and train your associates. Good associates can get even better by watching and listening to their principals, particularly when they are working in surgery. It is rare these days for associates to sit in a principal’s surgery. As a young dentist, I did it a lot and learned some valuable skills, both clinical and patient management.
Find plenty of time to communicate with each other! Many principals find it impossible to have meaningful conversations with their associates and vice versa. Discuss, disclose and share your personal agendas. Find out what’s working for one or both of you and what isn’t working. Talk about money and whether you feel you both are getting paid enough!
Use a sliding scale (35 to 65%) to reward high earners and protect yourself from low earners. Set targets for everyone (including the principal, make them available to the whole team and have the whole team help in achieving the, with a bonus for going beyond the targets.
Learn together. Go to conferences, courses, cpd evenings together, try something new together and compare results. Go into each other’s surgeries a lot every day. Resist the biggest threat facing all dentists - boredom!
Use praise a lot. As a generalisation, principals are quick to criticise and slow to praise. Everyone on the team needs praise from their principal that they are doing the right thing. We are all longing to be lead.
Zone all of your dentists' diaries to create the right mixture of high earning, hourly rate and below hourly rate dentistry into every day, so that every day is a good day.
Have a contract so that everyone knows what the rules are. In particular, agree the amount of time that your associates spend in your practice, including the hours they will be available in the day (no going home early because there wasn’t a patient) and the precise amount of holiday and cpd. Agree all this and timetable it for all clinicians, a year in advance.

It’s not enough to be the practice owner and the lead clinician. Principals have to be skilled in leadership and the 10 points I have highlighted are mainly leadership skills. As the leader, you have to be inspiring and motivational, a great communicator, empathic, a good listener and walk all of your talk. You have to be clear where your practice is going and surround yourself with people who want to help you get there.

Now, does this sound like the kind of principal you would like to be?

Simon Hocken Director of Coaching, Breathe Business

For more guidance on running a successful practice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

The Black Art of Fee Setting!

Wed, 06 Apr 2011 15:17:41 +0000

Since hanging up my surgical gloves in 2003, I’ve worked as a coach, covering the length and breadth of the country, and one thing continues to surprise me. In all corners of the UK, with the possible exception of London’s West End, private practice fees are really very similar.

I have a theory that Principals must be consulting with some centralised (government run) fee-advising agency, responsible for keeping the lid on private dental fees! What really surprises me is that the fees bear so little relationship to the actual practice’s costs which, unlike fees, vary wildly in different practices.

Fee setting appears to be a black art and when I question Principals on how they arrived at their fee scale, very few of them seem to really know. On reflection, I think this must be how it happens:

They:

Ask colleagues what they charge
Mystery shop their competitors’ fees
Believe what dentists say about their fees in the bar at conferences
Choose an hourly rate that sounds ‘about right’ (say, £150-£250/hour)
Create a fee scale - many use the old NHS item of service list - by applying the hourly rate to how long they estimate the treatment will take.
Sometimes create an aide memoire; before computer software became ubiquitous in surgeries, a laminated card, now more likely to be software driven. This is a set of treatment times, from 5 minutes to 3 hours, in 5 minute intervals, which multiplies the hourly rate by the time allocated to achieve a fee, with the addition of a lab bill where appropriate…

This is the ‘Solicitor model’, who often charge an hourly rate divided by 6-minute increments of time. Their practice hourly rate often varies dependent on the skill set and the seniority of the solicitor you hire. I believe this method is inappropriate for a dental practice and here's why:

Some treatment items are delivered at no fee or at a low fee.
Some treatment items require more skill and more skilled chair-side support than others.
Some treatment items require more costly materials than others.
It is impossible to charge for every 6 minute segment of a 7.5 hour clinical day.
On an hourly rate basis, some fees appear (to the patients) to be expensive and some fees appear to be not high enough.

So, here are my suggestions on how to set your fees in a way that truly reflects your costs and the profits you wish to make.

First of all you must:

1. Understand exactly what differentiates your practice from the others You and all of your team need to be able to explain this in language that every new patient will understand. It is not enough to promise “personalised dental care in modern, clean and relaxed surroundings. State-of-the-art equipment, the latest techniques and outstanding customer service to bring you dental care of the very highest standard.”

The true value of your practice lies in this differentiation from your competition and it is this differentiation that will help determine the right level of your fees.  2. Be able to describe in detail the sort of patients you wish to attract What do they want from a practice like yours and how much will they pay for these services? How do they assess the quality of what you and your team provide? This will not be about your crown margins but the quality of their experience in your practice.

3. Understand your business model You will have to know:

1. How much profit you wish to make.  2. How much your practice costs to run. 3. How much turnover your practice has to achieve in order to create your planned profit.

Once you know what your turnover objective is you can start to attribute a share of this turnover to each of your fee earners, to include: Yourself, Associates, Therapists, Hygienists etc. Consider, how many patients each fee earner looks after and how many new patients your practice attracts. Also, are there new services you believe your patients might welcome and buy?

4. Understand what position in the market place your practice occupies It helps to consider how retailers position their businesses, for example, consider these four well known retailers: Harvey Nichols, Selfridges, John Lewis and Debenhams. Where do they sit in the market place in relation to each other and how do their environments and client journeys differ? Their pricing will reflect this.

Do you wish your dental practice to appear: Boutique, Expensive, Middle of the road or Inexpensive? Where do your local competitors sit, what do they charge and how do you want to position yourself in respect to them?

5. Once you have considered how your Differentiation, Prospective Patients, Business Model and Market Place Positioning affects your pricing, then:

Set a base hourly rate that truly reflects your costs. In my experience, your fixed costs will be in the region of £350/£500 per surgery per day.
Consider setting a higher hourly rate for advanced treatments.
Use these hourly rates to calculate a mathematical fee for every treatment based on time. Add a lab fee if required.
Adjust every fee to reflect the demand and the value perceived by the patient for each treatment. Some fees will adjust downwards, some fees upwards. This will calculate the actual fee charged for one item of treatment.
If you supply more than one of these items (three fillings, two crowns etc) calculate the fee by multiplying the number of items by the actual fee.
Don’t discount by more than 5% to reflect the saving in time.
Understand that these high hourly rate items will merely compensate you for the hours in the day when you will under-achieve your hourly rate.
Sell items of treatment, not time.
Know what your margin (profit) is on every service.
Assess whether this will achieve your profit target?

In summary, there is a world of difference between the fees you charge and the perceived value they represent to your patients. With this in mind, your fees and the value they represent have to be congruent. It is fine to charge high fees if you are confident that your patients will consider them good value. Even low fees, if charged for poor treatment or in a poor environment or accompanied by a poor client journey, can still represent poor value to patients. The worst-case scenario can be when a practice charges high fees, supplies high quality clinical dentistry, but for reasons of poor environment or poor customer service their patients still perceive the fees as representing low value.

As you know, your patients will ultimately judge the value of what you and your team do by using a completely different set of criteria to those you might apply! In my experience, private dental fees have hardly moved upwards at all during the last decade, whereas inflation has been increasing the real cost of providing dentistry on the high street. This alone will significantly reduce your profits.

Isn’t it time you set your fees in such a way that genuinely serves both you and your patients?

Simon Hocken Director of Coaching, Breathe Business

For more guidance on setting fees and other proven ways to grow your practice, contact the Breathe team on 0845 299 7209 or info@nowbreathe.co.uk

Get ahead of the curve

Wed, 23 Mar 2011 15:17:41 +0000

Consumer markets, of which dentistry is one, always follow a pattern that is firmly based on two fundamental marketing principals.

The first principal is that all consumer markets change over time, nothing stays the same. Change is largely driven through innovation, fear and uncertainty, entrepreneurial flair or indeed all three. Think of Ryan Air, B&Q, Amazon or the CO OP funeral service.

The second rule is based on the principal that if you listen carefully and truly understand what the consumer wants, you can change their traditional buying behaviour over time by leveraging innovation, accessibility, perceived value or remarkable service levels. There are countless examples of this, from the sale of fashion products through supermarkets (George at ASDA) to the sale of car insurance (Direct Line) through the telephone and then latterly online.

We have all witnessed the dramatic changes in the UK optics business over the last 25 years. Relaxation of advertising rules, new competition, and the abolition of the NHS eye test for all made for challenging times. Yet amidst this upheaval, the birth of Specsavers was one of the industry’s great success stories. Husband and wife team Doug and Mary Perkins seized the opportunity to change the optical care industry after deregulation in 1983, with a mission to provide quality eyecare at affordable prices clearly, simply and consistently. It is now the largest privately owned optical company in the world, with more than 1,350 stores throughout the UK, Ireland, Europe, Australia and New Zealand, and a turnover of £1.2billion.  Today 70% of the UK market for contact lenses and spectacles is in the hands of just 4 groups. So how did this happen and, more importantly, what impact did the change have on the UK’s 40,000 independent Opticians in 1990, when the large companies began taking ground? The inevitable first defensive position to take if a multiple opens next door is to take your proposition and positioning ‘up market’, clearly distancing your business from the ‘value for money’ end of the market. The problem with this defensive strategy is that everyone thinks that there's nowhere to go but ‘up market’, so there are 20,000 other business owners thinking the same thoughts and all attempt to move to the same market position. Some will execute it well, carve out a successful niche and build a robust business as a premiumn niche operator as a result. However the majority of independent opticians vaporised over a 10-year period, ask yourself why?   So what does this mean for the dental practice owner in the UK? Due to the non-invasive nature of optics it is often dismissed as a less skilled procedure requiring less patient confidence, therefore it could be argued that it has little in common with dentistry. Perhaps, but try putting yourself in the customers’ / patients’ shoes. A brand that you have known and trusted like Boots or Tesco opens a state-of-the-art dental practice within a 12 minute drive of where you live offering easy parking, 7 day opening and speaks to you in a language you understand; demystifying the world of dentistry, talking about a pain free, relaxed experience at value for money pricing. It’s going to get your attention and serious consideration, particularly if your current dentist is unremarkable and perceived to be expensive.

Change is coming, if not directly to your catchment near it. The ripple effect will have consequences; if all the independent Dentists adopt the traditional defence of moving ‘up market’ then it is going to get crowded very quickly. Stay ahead of the game by applying the earlier mentioned two principal marketing rules to your practice:

Rule #1 Embrace the change, don’t become a victim. Look at your catchment, evaluate your competitive set, establish what they are not doing well or simply not doing, find the gaps and monetise them.   You may discover that you've chosen the wrong market - the perceived need for what you offer isn't strong enough, they aren't willing to pay what you need to charge, or the size of the market is too small. In this case, it's time to position yourself for an entirely different market. Don’t just think of the somewhat hackneyed spa practice format, consider a ‘Saga’ type practice, or opening a ‘Tesco’ before they do (Tesco won’t open in your town if there is a dentist doing the same thing as there are just too many open points!)  Rule #2 Find out what your customers and non-customers really want by asking them [(it is important to use a third party to do this); you might be very surprised. You may find that by opening at 6am daily and serving a light breakfast to all your business executive clients, you keep them for life, whatever Boots is offering. Be innovative – you need to think outside the box to be able to make a success of a business in tough times.  Keep your eyes open for change before it happens - so you've already thought through how you're going to make critical adjustments before it's too late. In tough times like these, only dental practices that are nimble, resourceful and above all, innovative, will survive and thrive.   Get ahead (and stay ahead) of the curve now whilst there is time and you could be in for a substantial growth in your business.

Jonathan Fine Director of Marketing, Breathe Business

Start thinking like a strategic marketer. For a chance to learn more about which marketing methods are best for growing your practice, come and meet Jonathan at our intensive two-day Marketing Workshop in April. We promise no-nonsense advice on how to put sales and marketing strategies in place to generate new business for your practice.

To find out more contact the Breathe Team on 0845 299 7209 or info@nowbreathe.co.uk.