4 Factors Key to Improved Performance of Your Multiple-Location Dental Practice (Part 1)

Published on September 2, 2018
(This is the first of two articles, by Trude Henderson, on the lessons regarding performance learned for multi-location dental practices. Please stay tuned for the second half of this article and more on managing CX in multiple offices at once. – Ed.)
One of the takeaways of ToothFairy’s pilot study regarded inconsistencies in performance between the offices of multiple-location dental practices. Operating multiple satellite offices in addition to a main office is becoming increasingly attractive, especially among orthodontists. They see opportunities to minister to a geographic location that was previously under-served, as well as to boost their bottom line.
The example set by High Reliability Organizations (HRO’s) tells us that, if we wish to improve performance, including the customer experience, and maximize reliability, we must reduce system variability, including the variation that exists between locations. Careful thought, planning and accountability are needed to ensure that all your offices function with minimal system variability (e.g., procedures, communication, guiding principles and training,) because otherwise, you might face unwanted consequences, like higher overhead, an increase in employee turnover and the loss of patients.
During a baseline assessment prior to our 3-year pilot study, we conducted both employee engagement and customer experience feedback surveys of dental practices in the Western United States. The baseline provided invaluable insights and established a basis for comparing the situation before and after our operational excellence intervention. We would like to share with you 4 key lessons learned in the process, in addition to High Reliability Organizational tools and techniques we implanted, all of which helped reduce variability and promote the improvement of the overall brand. They are as follows:

1. Substantial variabilities in the customer experience between locations can constitute a significant threat to your brand. After collecting thousands of data points, carefully analyzing them and then problem-solving utilizing an operational excellence/ HRO approach, we can tell you first hand that the sooner you take steps you align your customer service across locations, the sooner your brand will improve.
   
   One example that we would like to share with you involves a pattern that we noticed when we examined patient feedback from one practice with two different locations during our pilot study. Patients from the satellite office complained that when their local office was closed, they called the main office, as instructed. They reported that the front office staff there did not treat them with the same level of attention and respect as the staff at their local office. Local office staff were immediately briefed and the issue was resolved.
   
   What we find most interesting in this episode is the fact that the same behaviors surfaced in employee engagement surveys – employees revealing how they felt demeaned and talked down to when they communicated with other employees at the main office. The lesson to be learned: be mindful of behavior-related trends, good or bad, because their effects on your customers are likely to spill over to your employees, and vice versa. Remember: “The customer experience is about how you make people feel!”
   
   To help avert developments like this, we recommend that you begin with the following:
   
   1. Examine your practice across the board and pinpoint what you have been doing when you are at your best. Then make a list of the “ideal-behaviors” (we refer to these as “True North” behaviors) that you can implement, and hold staff and doctors accountable for consistently modeling them. Be sure to model them yourself and become the process cheerleader! Utilize these behaviors to recruit, hire, promote, reward and discipline employees (referred to as aligning your guiding principles with your practice systems). Be sure to list them in your employee handbook along with your mission statement, and ask employees to acknowledge with their signature that they have received a copy.
      
   2. Don’t let variances in the customer experience or local issues go undiagnosed or unresolved. Utilize a real-time customer feedback e-survey platform designed to measure the customer experience ‘locally’ at each office, all year long. Be sure to examine the results locally rather than across the organization and then take immediate action. Marketing expert John H. Fleming, the author of Human Sigma: Managing the Employee-Customer Experience, says, “This is critical because customers experience variation, not averages. The variability within a company easily dwarfs the differences between competitors” (from “Why Consistency is the Key to Profitable Customer Service,” Gallup, August 10, 2006). This scenario is diametrically opposed to what you want to accomplish. Your goal should be to widen the gap, so that your practice stands out as the ‘cream of the crop’, so to speak. This is critical in today’s hyper-competitive market!
      
   3. Cross-pollinate employees. By this we mean assign your satellite employees so that they periodically work in the office(s) with the people that you believe are the best models for your ‘True North’ behaviors. This strategy provides learning opportunities for all employees.
      
      You must always remember: your culture is a mirror image of your brand. Surprisingly, offices just a few miles apart can be miles apart in culture – some to such a degree that they appear completely different practices. We recognize that every office has an ideal patient, and that the advertising needed to attract and retain this ideal patient varies between offices, but this shouldn’t be confused with the ideal behaviors and guiding principles required to build your brand – globally. Our pilot study involved some practices in which the doctors and staff together spoke as many as half-a-dozen different languages, and although their ideal patients came from vastly different backgrounds, and thus they had to take this diversity into account to properly interact with them, their guiding principles remained the same.
      
2. The fact that you already have high-performing offices in place can prevent you from sensing the urgency for action to improve the performance of underperforming offices.
   
   We suggest:
   
   1. No matter how busy you are, make it a priority to set aside time with supervisors each month to review and discuss metrics generated via your practice management software, feedback survey results and social media reviews of all offices (to encourage greater transparency), including the low-performing ones, so that the problems stay top-of-mind. Use visuals to paint an accurate picture. To encourage team as opposed to silo culture, be sure to include supervisors from all offices.
      
   2. Conduct daily huddles in every office and include the voice of the customer, via feedback reports and social media reviews. Encourage a free and open environment where employees feel comfortable, feel encouraged to view challenges as opportunities and free to offer innovative solutions. Make the topic of your conversations more about the customer experience and problem-solving rather than production. When your team masters the customer experience, production will speak for itself!
      
   3. Don’t be afraid to change your leadership strategy related to a decision you made months or years prior. Things change, people change (including your ideal customer) and technology changes daily – so something that was once good enough for your father is probably not good enough for you.
      
   4. Resist the temptation to accept “simple” explanations for problems. We all are busy and hear a lot of excuses, but don’t settle for it. Ask a lot of questions and challenge long-held beliefs so that you can arrive at source identification and underlying causes. Be aware that when it comes to asking questions, the trick is in your approach. Make this a routine part of how you address concerns, as it will appear less likely that you are pointing fingers at individuals. Look for system flaws rather than placing blame on individuals. If you detect a problem in one department, investigate other departments and offices to ensure they too don’t share the same or similar flaws. Collect as much feedback about the problem as you can prior to deciding on its source and/or cause.
      

These are some factors that you, the practice leader or manager, should remember when you set about the task of reducing the number of inconsistencies in your multi-office enterprise, with the goal of improving your brand and bottom line. Hopefully our non-traditional approach to dental practice improvement, comprised of Operational Excellence and High Reliability Organizational Concepts, has given you a lot to think about. We will give you an opportunity to digest it, and discuss the points remaining in our next blog.
Works CitedBabcock & Wilcox Technical Services LLC. (2008). High Reliability Operations; A Practical Guide to Avoid the System Accident. Amarillo: U.S. Department of Energy.
Fleming, J. H. (2007). Human Sigma: Managing the Employee Customer Experience. Gallup Press.
Fleming, J. H. (2017, August 25). Gallup.com. Retrieved from Business Journal: http://www.gallup.com/businessjournal/23953/why-consistency-key-profitable-customer-service.aspx
Jon M. Huntsman School of Business. (2012). The Shingo Prize for Operational Excellence: Model & Application Guidelines. Logan: Jon M. Huntsman School of Business.

For more information about High Reliability Organizational concepts, read our previous blogs
Ten Steps You Can Take Right Away to Improve the Reliability of Your Dental Practice
High Reliability Concepts: Insights of Value to any organization.
Trude Henderson is the co-founder of ToothFairy, a startup elective dental and medical practice improvement software company which delivers an unparalleled customer experience that inspires delight, loyalty and positive emotional connections to improve the lives of patients and the practices they visit. In 2016, she was the first to introduce High-Reliability Organizational Concepts to the dental industry. For questions, contact her directly at Trude@GetToothFairy.com. Follow Trude on LinkedIn:  https://www.linkedin.com/in/trudehenderson/ (no email required).
Go to ToothFairy's website: www.ToothFairySoftware.com.