How many Managers does a Dental Practice need? (And how to afford them)

This is a “how-long-is-a-piece-of-string-type-question”! It depends what the practice owner wants to achieve. And, in reality, it depends on the practice owner’s willingness to fund more non-fee-earning team members and the practice owner’s willingness to (make time to) lead them.

Actually, that last sentence encapsulates the difference between successful, well managed, growing dental practices and well, everybody else!

All dental practices have to manage their operational needs (surgeries, stock, rotas, compliance, HR etc) in one way or another, because they have to get through the week. In many old-fashioned practices, the person tasked with this is an untrained, “practice manager” who has come through the ranks and has often been a loyal employee in the practice for many years. These people usually manage adequately through familiarity with the tasks required and ensuring that all the day-to-day trouble-shooting is sorted. In these practices, there are rarely any written processes and “the knowledge” remains (and sometimes leaves) with the practice manager.

When we are asked to help a practice such as this develop, very often our first blocker to progress is their “practice manager”. To turn a practice like this around and get it onto a growth path, we have to help the owner create a resource that can:

• Make various projects happen
• Do the things that, left undone, will stop the practice from developing
• Measure the results of the changes made and then feedback to the owner (and us!)

This is too big a task for the existing manager who is operating a juggling act managing the status quo. Unfortunately, and I suppose inevitably, the in-situ practice manager feels threatened and bamboozled by the rapid influx of tasks that need doing and new people (both inside and outsourced by the practice owner) that are probably disrupting their previously “quiet” and cosy-but-busy life! This, together with the rapidly-becoming-apparent gap in their management knowledge, leads some PM’s to push back or leave. (They don’t need to: they have an important role).

As the saying goes, “You can’t make an omelette without breaking a few eggs” and change, like making omelettes, is messy. And I can already hear you practice owners whispering already, “Even if I am convinced I need more management, how can I afford it?”.

This is a perfect chicken and egg situation. A two or three surgery practice grossing £500-800k can only afford to pay for more management from existing profits or by making efficiency savings (unlikely, as these practices are already very lean in terms of operational spending in order to maximise the owners’ profits!). However, a practice that is growing will naturally have more profits which can fund better management which in turn will lead to more profits. This is not about increasing practice costs, this is about making your practice grow and become (possibly a lot) more profitable.

The real leap of faith for practice owners is that they need their increased management resource in place before the growth can properly get underway. In other words, better management is an investment that pays off (handsomely) further down the track. In our experience, the more willing the practice owner is to invest in better management, the faster the practice will turnaround and grow.

In order to develop a practice and have it grow consistently and long-term, a practice owner will need people who can actively manage and improve ALL of the areas of their practice listed below. To many practice owners, this will seem like a long list, and if they were to tick the areas which are addressed currently by their PM, they would only manage a handful of ticks. (Probably, operations and, sometimes, book keeping.) All I can say is that amongst our portfolio of practices, those making significant progress are addressing all of the following areas of their business:

1. Operations:
   1. Compliance
   2. HR
   3. Surgery upkeep
   4. Reception
   5. Facility including: equipment servicing and upgrading, fabric, cleaning etc
   6. Stock
   7. Rotas
   8. The Christmas Do
2. Business Development/Growth:
   1. Business growth strategy
   2. Project Management
   3. KPI’s
3. Financial Command and Control:
   1. Forecasting and Budgets
   2. Book keeping
   3. Financial KPI’s
4. Marketing:
   1. Campaigns
   2. Online Collateral:
      1. Web Site
      2. Web Site Support (SEO PPC Blogs etc)
      3. Social Media
   3. In house, word of mouth referrals etc
   4. PR, Print etc
   5. Marketing KPI’s
5. Sales:
   1. Patient Journey Management
   2. Diary Management
   3. Treatment Coordination
   4. Telephone Call-Backs
   5. Patient Reactivation
   6. New Patient Handling
   7. Target setting
   8. Sales KPI’s
   9. Training

Some of these tasks have to be done in-house, however many of them can be outsourced to businesses keen to support dental practices such as forward-thinking accountancy practices, marketing businesses, call handling centres, recruitment agencies etc. It goes without saying that outsourcing can be cheaper and less of a risk than recruiting and employing a new team member. Shrewd practice owners know which skills they need in-house and which skills they can outsource.

Of course, many practice owners just pick and mix from my list above and choose a slower growth path. They usually do this in order to manage their own anxiety. In reality, going slowly is a false economy! (as I have explained in a previous Simon Says, see: https://www.nowbreathe.co.uk/2017/06/going-slowly-will-cost/).

I suppose what I’m really talking about here is the transition from the old way of managing a dental practice to the new way of doing so; in order to develop, grow and future proof your practice. It can be a rocky and anxiety-making path for practice owners. So here are my Top 10 most common mistakes to avoid when improving the management of your practice:

Simon’s Top 10 Dental Practice Management Mistakes:

1. Having insufficient resources (People, Money, Knowledge)
2. Principal is spending too much time in the surgery and insufficient time leading his/her team and managing his/her managers…
3. Principal is doing some of the management tasks (badly, such as book keeping…)
4. The dentists (and sometimes hygienists) in the practice (including the principal) refuse to be managed
5. Principal doesn’t lead, preferring an ineffectual collegiate approach where everybody on the team has their say
6. Principal doesn’t spend sufficient time in meetings with their manager(s)
7. There are few or even no written processes for the team to refer to
8. When a team member refuses to implement a process there are no sanctions deployed
9. The KPI’s are not acted on or shared with the team
10. Some/all of the team need more training and role play

When I analyse a practice which has stalled (by any measure), I find often that it is their lack of effective management that is holding them back. This is probably the most common glass ceiling for small to medium sized dental practice in the UK. And my top tip is this: look outside of dentistry when you are looking to employ an operational manager or a business manager. And my bonus tip is: be prepared to pay enough to get the skills and experience that you need!

If you would like some help in sorting out your practice management and getting your practice onto a growth path, contact me for a chat. (By the way, we also help turn practice managers in to happy, successful business managers. Contact us to find out more).

Best wishes,

Simon
m. 07770 430576
e. simon@nowbreathe.co.uk