Conclusions. By applying general business management principles, dental practices can develop a logical, systematic approach to the management of a professional services business. For many dental professionals, these concepts were not learned in an undergraduate dental educational program and need to be mastered after professional school.

Practice Implications. Ideally, each dentist will establish a philosophical course that provides direction to the practice of dentistry. For a private dental practitioner, part of his or her goal is to create a tangible, transferable asset and a solid business plan that can benefit the practitioner in the present, as well as in the future practice transition.

	DEVELOP A VISION

TOP ABSTRACT DEVELOP A VISION DELIVER QUALITY SURPASS EXPECTATIONS CONCLUSION REFERENCES

 
At completion of an undergraduate dental education, the new dentist faces many choices. He or she can enter the domain of a general dentistry practice, train for a full-time life in academia, develop a private practice as an associate or owner, join the military dental corps, be involved in a managed care clinic, join the public health service, go back for specialty training or consider numerous other options. Regardless of the direction chosen for the practice of dentistry, new dentists need to establish a philosophical course as early as possible.

For example, decisions and commitments need to be made regarding continuing professional education (ideally, a commitment to lifelong learning), support of professional organizations (local, national, international), membership in study groups, involvement with other interdisciplinary specialists to provide more complex treatments, and the development of professional mentoring relationships. It is through involvements such as these that professional growth is enhanced and professional vitality is renewed.

Establish a governing philosophy. For example, if a dentist wanted to establish an esthetic and reconstructive dental practice, it would be important to have a clear vision of the governing philosophy for that practice. A written philosophy might be summarized as follows: "XYZ dental practice philosophy: provide the highest quality interdisciplinary care to meet the patient’s esthetic, functional, biological and psychological needs in a supportive and educational environment that promotes long-term oral health."

Once this philosophical direction has been established for the practice, other decisions become easier. For instance, if the XYZ practice is located in a large medicodental center, it could develop beneficial working relationships with interdisciplinary specialists, ultimately forming an interdisciplinary orofacial team. Further, if the surrounding community is considered to be affluent, it is likely that patients will be able to seek the highest levels of oral health care, thereby providing a sufficient pool of patients for the specialized practice.

The practice can achieve additional value when the owner/dentist lives and works in the same geographical area. Our hypothetical owners, by living in the community in which their office is located, have convenient access to the office, as well as natural social contacts that will help them build their business. The practice issues mentioned create synergy, and continue to strengthen the overall business foundation.

The owners can expand their model further to meet the practice philosophy by aiming at a niche market—the dental patient who seeks esthetic and reconstructive treatment in a fee-for-service practice delivering a high-quality product with superior service. To further develop their skills in providing esthetic rehabilitative care, the practitioners in this hypothetical practice have received advanced education and have become teacher/clinicians. The owners also decided to combine their international teaching experience with the experience gained from clinical practice, by customizing their practice to incorporate a commitment to teaching through a nonprofit teaching and research institute. The owners of XYZ practice have established a unique professional balance, which combines private practice, teaching and research in their day-to-day responsibilities as dental professionals.

Part of the vision for a private practice should be to create a tangible transferable asset.

Need for customized balance. The ability to direct one’s own practice to meet individual desires is one of the exciting benefits of being an independent dental practitioner. Some dentists may look at this XYZ practice mix of professional choices and feel that they also would enjoy the variety and stimulation created by this type of practice. Others may feel that this would not be their ideal environment and would design an entirely different pattern for their private practice. The objective is to create a lifestyle that is balanced in three important areas of life: professional time, family time and personal time. Regardless of one’s sex, it is critically important to have supportive relationships when making quality-of-life decisions that affect one’s business and home life.

Timing. One consistent issue in life is timing. When should I open my own practice, go for advanced education, move locations, have children and make numerous other decisions? At times, these important decisions are delayed or not made at all owing to a "paralysis from overanalysis." Sometimes, the best advice is not to overthink things. Make the best decision based on the facts and your passion for the project, and proceed with the plan. Reassess as you go along, and make any necessary modifications if they are indicated. The important concept is not to stagnate, but to blend one’s intellect and emotions regarding major decisions or directions in life.

Part of the vision for a private practice should be to create a tangible transferable asset. Because the private dental practice typically is the most important business asset of a family, or at the very least represents a significant portion of a dentist’s collective net worth, the dentist should develop an achievable business development plan. A solid business plan requires monitoring on a daily, monthly and annual basis for dentists to reach goals and for the practice to deliver a reasonable profit.

Asset-building will center in part on the physical facility that the dentist occupies. Investing in one’s surroundings will pay off in the short-term with increased patient satisfaction and patient referrals. Well-maintained facilities also will bring a long-term return to the dentist’s investment when others look to join the dental team or buy the practice (Figure 1). An office philosophy that is understood by the team creating an effective office culture, with systems to turn the office philosophy into reality, also is of value when the dentist transfers the practice to another owner (Figure 2).

View larger version (92K): [in this window] [in a new window]   Figure 1. Part of the vision of the private practice is reflected in the physical facility’s style and layout.

View larger version (90K): [in this window] [in a new window]   Figure 2. An effective office culture is created when dental team members understand the office philosophy.

– where one wants to live and practice;

– the ideal practice economics (for example, highest quality, slower patient flow);

– the desired area of expertise (for example, esthetic dentistry, geriatric dentistry, general practice, family practice).

Once these decisions are made, it is easy to lay out the physical characteristics of the dental facility: square footage, design, number of operatories, technologies appropriate to the practice, amount of space dedicated to patient education and treatment coordination, and room for growth.^1–3

For the more comprehensive esthetic and prosthodontic dental practice, the foundation of patient care consists of three pillars: a thorough and comprehensive clinical examination process on the patient’s entry into the practice (Figure 3), a systematic patient education and treatment coordination program, and a delivery system that is able to create a high-quality product combined with a pleasant experience for the patient.

View larger version (99K): [in this window] [in a new window]   Figure 3. A thorough and systematic examination and charting are key to effectiveness in a comprehensive esthetic and reconstructive practice.

To provide the highest quality care, the dental professional must constantly improve and expand his or her skill level.

	DELIVER QUALITY

TOP ABSTRACT DEVELOP A VISION DELIVER QUALITY SURPASS EXPECTATIONS CONCLUSION REFERENCES

 
Appropriate staffing. To deliver quality care to patients, dentists need to address several areas. Of critical importance is appropriate staffing. In today’s environment, in which there can be a shortage of qualified dental support personnel, this goal can be a challenge. Dentistry, however, shares the same business principles with other successful companies as they relate to employee retention; therefore, dentists can learn these principles from other business fields. For example, the Walt Disney Company has a reputation for customer and employee loyalty that, according to Connellan,⁴ the company believes is based in part on its commitment to watching the details, which translates into a quality experience for guests and staff.

The more that the dental team member feels he or she is a part of an organization that considers the patient’s needs to be of highest priority and provides quality care, the higher the staff retention level will be. Providing a quality product instills pride in the dentist as well as in staff members. Some important characteristics of staff members include maturity (regardless of age), a caring personality, orderly work habits, a professional appearance, a positive attitude, a career orientation, an ability to accept responsibility and a good work ethic.

Importance of continuing professional education. In addition to developing staff members’ abilities through in-office training and continuing education courses, dentists must continue to refine their own professional skills. To provide the highest quality care, the dental professional must constantly improve and expand his or her skill level. When staff members and patients observe a commitment from the dentist to continuing professional education, this builds confidence in and loyalty to the practice.

Some guidelines for building technical skills are the following:

– learn from the best in the field;

– take hands-on courses (Figure 4);

– do not take shortcuts to quality;

– invest in oneself;

– invest in dental and business equipment;

– be a committed and passionate lifelong learner.

View larger version (95K): [in this window] [in a new window]   Figure 4. At the Newport Coast Oral Facial Institute, Newport Beach, Calif., hands-on courses can assist the dentist and staff members in heightening skills and continuing their professional growth.

Develop management skills. Dentists also can develop and refine management skills.⁵ One should begin by knowing one’s own personal management style, then establish systems within the office that are logical, organized and consistent. Dentists should monitor the results and make sure they understand the financial profile of the practice. Be fair, ethical and consistent in treatment of patients and staff members. Do not "major in the minors" in management. If something is minimally important (such as telephone bills), leave it at that level.

Alliance with dental technicians. Closely related to the delivery of a quality dental product is a close working relationship with a dental technician or technologist. Whether this alliance is within one’s own office or located remotely within a dental laboratory is not critical. What is critical is the quality of the technical work provided. It is only by associating oneself with a highly skilled dental technician or technologist who understands the esthetic, biological, functional and bio-engineering aspects of constructing prostheses that dentists can deliver high-quality care consistently to patients (Figure 5).

View larger version (96K): [in this window] [in a new window]   Figure 5. A close working relationship with skilled dental technicians ensures consistently high-quality care.

Alliance with interdisciplinary specialists. Creating a high-quality practice also requires strong alliances with colleagues in different specialties. Finding the talent needed for an interdisciplinary team approach to patient care brings excellence to comprehensive care. The various specialties—such as periodontics, orthodontics, oral and maxillofacial surgery, and endodontics—provide an opportunity to enhance treatment results through collective treatment planning. Dentists need to choose specialists for their specific talents in specific areas.

The specialty of periodontics serves as a good example to illustrate this point. Some periodontists are most interested in periodontal plastic surgery and have developed expertise in this area beyond that of some of their colleagues. Other periodontists may choose to focus on controlling periodontal disease. Dentists should be familiar with the specific talents or areas of expertise of the specialists with whom they work and choose the best interdisciplinary team member or members to achieve the best results for the patient. Optimal interdisciplinary teamwork can be achieved by focusing on a shared philosophy of quality patient care, as well as on frequent and thorough communication to keep treatment goals consistent.

	SURPASS EXPECTATIONS

TOP ABSTRACT DEVELOP A VISION DELIVER QUALITY SURPASS EXPECTATIONS CONCLUSION REFERENCES

 
Practice success comes from a focus on surpassing expectations at all levels. Dentists should adopt a goal to surpass the expectations of patients, staff members and even themselves. Patients’ expectations of a dental experience can be surpassed if dentists treat everyone with utmost respect, provide service with a smile, meet special requests and needs, give patients enough time so they do not feel rushed, and always do their best. If these services are delivered consistently, patients will develop a sense of loyalty to the practice and dentist, and they willingly will pay the fees that are justified by this high level of service.

A similar set of goals also applies to one’s staff. Dentists can surpass staff members’ expectations by treating them with respect, rewarding them for excellence, creating a caring environment at the workplace, and listening to their ideas and concerns.

Dentists may surpass even their own expectations if they develop high but reachable goals, allocate time for family and friends, and set aside time for themselves to stay healthy and become emotionally rejuvenated.

	CONCLUSION

TOP ABSTRACT DEVELOP A VISION DELIVER QUALITY SURPASS EXPECTATIONS CONCLUSION REFERENCES

 
We encourage every colleague to dare to dream and create his or her ideal practice profile by following the formula discussed in this article. By removing personal glass ceilings, dentists remove the false limitations that keep them from reaching their potential as dental professionals. It is helpful to find someone who has accomplished what one wishes to achieve and turn to him or her as a role model or mentor.

Ultimately, it is important to take intelligent risks. An often-expressed regret of people in their 80s and 90s when asked what they would do differently if they had their lives to live over is this: they wished that they had taken more risks in life. If one starts with a clear vision, works hard to deliver quality dental care and establishes a goal of surpassing expectations, the results will be astounding.

View larger version (147K): [in this window] [in a new window]   Dr. Paquette is a prosthodontist in private practice in Newport Beach, Calif., and is co-executive director of the Newport Coast Oral Facial Institute, Newport Beach. Address reprint requests to Dr. Paquette, Newport Coast Oral Facial Institute, 360 San Miguel Drive, Suite 204, Newport Beach, Calif. 92660, e-mail "jmpaquette{at}ncofi.org".

View larger version (135K): [in this window] [in a new window]   Dr. Sheets maintains a private practice in Newport Beach, Calif., is co-executive director of the Newport Coast Oral Facial Institute, Newport Beach, and is founder of The Children’s Dental Center in Ingle-wood, Calif.