Ep 149: Production Isn’t Everything… Or Is It?

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Dr. John Meis (00:01.746)
Hey everybody, welcome to this episode of the W Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. How you doing, Wendy?

Wendy Briggs (00:09.547)
I'm doing amazing, Dr. John.

Fantastic. All right. Well, we've got an interesting topic today and it has to do a little bit with how we think about production, how we think about money and how we get our heads in the right place so that we can be successful. So shall we start out with I'm hearing less of this than I used to. And I think because the financial pressure on practices is so much greater now than it used to be. But

I used to hear from lot of dentists that focusing on production was all about greed. And yeah, so let's talk a little bit about that.

Right. Yeah, we used to hear it from team members too. In fact, there still is a lot of chatter about that on some of the team channels, right? Both hygiene, office manager. When someone will post a question about, our practice has decided to change to this. Does this sound familiar? Is anybody else doing that? And some of the comments inherently are greed, greedy doctors, greedy, greedy, greedy, greedy. This is why they're doing it. Instead of really taking a step back and saying,

Yeah. Yeah.

Is it the right thing for patients? Right? So sometimes it still is somewhat prevalent, although we might be hearing it less than in the past. There still is that negative connotation that exists sometimes, a mindset that if we focus too much on the production, the staff will think we're greedy, the patients will think we're greedy, and it's a negative thing.

I think one of the things that gets people thinking about it being greed is that we measure production in dollars. And really it's a reflection of the amount of care given. And I wish there was a different measure that was meaningful that people would understand because it is wanting to be as productive as possible, meaning helping as many people and as high a level as we possibly can is, I think, quite noble. know? Yeah. So, but unfortunately, the way we measure it is in dollars. And I think that's where the greed comes in. Yeah, right.

That could be a little bit off putting to some people, know, and also when we talk about increasing case acceptance or a focus on case acceptance, sometimes there's again that negative connotation that we're talking about diagnosing unnecessary or unneeded care and that has nothing to do with it. You know, it really is a higher level communication. There's so much opportunity in every single dental practice. You know, in the early days, Dr. John, if you remember one of the first reports we would run when we were doing a practice audit was unscheduled treatment plans report.

Yes. Right.
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Because we wanted to see if their case acceptance process was effective or not. And literally, every practice, even those that are like, we have no work, all of our patients have been restored. When we pull up that report, there's millions of dollars sitting there in unscheduled treatment.

Yeah, that's so true. That's so true. You know, years ago, practices rarely failed. Right. But that's not the case anymore. Practices do fail. I was just I was in Virginia a couple of weeks ago working with a couple of big group practices and one of their doctors had been in a practice and the practice had failed. That's how she ended up there.

And so it is somewhat a matter of survival. If we don't produce enough, then we shut the doors and then nobody is served, right? The patients aren't served, the team isn't served. Yeah. And what about the rural practices, you know?

Right. As you mentioned, there's a tremendous risk there if we don't have enough cash flow coming through. I mean, every single person listening to this podcast has experienced this in the last few years when we have the COVID crisis that nobody could see coming. Some practices were very well prepared because they had plenty of cash reserves, but many practices didn't because that's just not how it's done in dentistry. Our overhead is high. Our costs are high. Our startup costs are incredibly high.

Right.

So we have young doctors that have mortgages to kingdom come, high high school debt. And so it does become a matter of survival for those circumstances, even in normal day-to-day operations. But then you throw a curve ball at them, like COVID. We have had other doctors that we've worked with over the years that have had some pretty significant unexpected curve balls thrown their way. And production and cash has determined their survival.

Yeah, yeah. that's right. So in our CEO group, which is the group that we help doctors go from single location to multi location, multi doctor, and we guide them through that process, we have an exercise called cash confidence. That is, know, dentists don't think about having working capital on hand, have no idea how much they should have. And it's just a tool to help them think through in their particular situation how much they should have.

Yeah, know, interestingly enough, Dr. John, let's give our listeners just a couple examples, right? So one of your CEO doctors, longtime TTI client and friend, Dr. Ed Hood, he spoke at our summit a couple of years ago about what happened with the, you thousand year flood in Denham Springs and overnight, a couple of his locations flooded and were destroyed. And the cash that he had built up through that process and through some other strategies he'd been really focusing on the last few years actually saved him through that.

Yep, yep, no, that's true. Yeah, gosh, we can go down the list. Dr. Herron, Rob Herron, had a health issue and he was able to manage that because of the same thing, same process as making sure that we had adequate working capital. And so when we get back to production, one of the things that I've been taking some heat about over time is I talk about the concept of diagnostic assertiveness.

And that if we brought a patient in and we had 20 doctors do a diagnosis and treatment plan, we wouldn't end up with one treatment plan. We would end up with a range. And one of those would have the most treatment. One of those would have the least treatment. It's not a judgment. I'm not saying one's better than the other. I'm saying if you took those two extremes, it could be bad. But in the typical set of doctors, it's not a bad thing. It's just a thing that is.

And so when I point out that people are or have low diagnostic assertiveness, they sometimes think I'm telling them to diagnose differently. And that's really not what it is. And so I have a slide and actually got the slide from you, but it's a picture of two teeth and they're molars and they have large amalgams in them and you can see cracks in the teeth and you know the one I'm talking about. And so I'll ask the room, all right, what would you do for these teeth? Everybody says crown.

And then I say, okay, if I go into your office, I'm not going to see any teeth like this. Right? I bet I am. I know there was in my practice. And so their standard, what they think should be done is this, but they're not quite performing up to it. And so when I talk about diagnostic assertiveness, it's just perform what you think is the right thing. Just do it more consistently.

100%. And some of that is team support, right? A really interesting phenomenon that we often see is sometimes there will be well-intentioned team members, whether that's a hygienist or an assistant or even at the front desk, that are almost standing between the patient and the diagnosis. And they're trying to save their patient's money by not having to recommend care. Sometimes I've seen, well, we shared a screenshot or a question that we got from a doctor recently that said, the doctor leaves the room, hygienist tells them the care that has just been diagnosed is not needed. How do we handle that? Right? That's a problem. And so offering minimal care to save patients money really is not the ethical option. We've even seen people at different desks, treatment coordinators change the recommended treatment to something less expensive without even really talking to the doctor about that, which again has its own ethical challenges there. But in our world, we love to see

Yeah. Yeah.

patients given the opportunity to choose for themselves. Not everyone's going to choose world-class care, not everyone can, but they should at least have the opportunity to decide. If we look at those patients that we see in hygiene all the time, there's very, very few circumstances where patients wouldn't see a benefit from something. Whether that's a preventive service or restorative service, just about everybody we see could benefit from some kind of care.

Absolutely.

or an additional service. And so in the early days when I would temp or fill in for colleagues, my goal was always to find at least one thing that would benefit the patient, every patient that I saw that wasn't on the treatment plan, that wasn't in the schedule and actually do it that day. And it was amazing how rare that approach was. People were shocked by it. They were stunned by it. And I'm like, this is something the patients actually need. So why aren't we doing it on a consistent basis to your point?

And why would we do preventive services to prevent disease? Right. And what dental problem gets better over time? None of them. They all get worse. Right. So the sooner you treat them, the better. But if you have this break in your head that, gosh, if I tell them about the treatment that they would benefit from, then they're not going to like me or my team's going to think I'm greedy or, you know, that stuff goes on in dentists heads all the time. And it's really destructive to patient care.

Mm-hmm. Yeah.

Yeah, absolutely. And also, we've also seen circumstances where the focus on production can be too heavy. Right? I love your concept of diagnostic assertiveness, because it really is about finding balance.

Yes. Balance, yeah.

And I think focus on production is kind of the same, right? And balance as well, not overall team production, but doctor versus team production or doctor versus hygiene production. All of those things need to be considered with a certain level of balance, because I think, again, if the focus on production's too much, then people feel like they're not hitting their daily target. They feel like they're getting, you always talk about not wanting people to feel like they've been spanked or chastised or guilted or lectured. Nobody wants to feel that way. They want to feel encouraged and supported.

And so I think having too strong of a focus on production can also be a negative thing. So finding balance is where it's really critical. And I would say as well, often hear from, practices will hire us often.

And we begin with a focus on hygiene. Because in our world, that often is an untapped area of potential in the practice because all of the preventive services that we've mentioned. But again, because of that focus on hygiene, sometimes the hygienist can feel almost unfairly targeted. So you've got to be careful about that and make sure there's balance. You sometimes the hygienists are like, okay, we're tired about having our production be why we're not hitting goals or why we're not doing the things that everybody wants us to do. But then the doctors really aren't growing their side. So it can become a little bit of a conflict point if we're not careful with how we manage it.

Yeah, for sure. One of the common complaint we hear from team members about morning huddles is when the morning huddle is all focused on production and really money. At the end of the day, that's the major focus, not that it doesn't have a place there, but it has just a place. It's not the entire thing. It's not the entire focus. It's about getting your team ready to have an amazing day and do amazing customer service.

Yeah, and I think there too, Dr. John, how we talk about it matters, right? Making sure that everyone understands that in our practice, production isn't necessarily the goal, but it's the result that comes. We take the best possible care of our patients. And so when we approach it from that angle, everyone understands, like you said, that production is just how we measure. And we wish that there was a different metric other than the dollars, because we don't want the dollars to be the key focus. We don't want to come across as being focused only on cash flow.

But really, production is the representation of how well we're serving our people. And our people deserve the very best care. And so when we focus on production, the angle or the approach really should be celebrating production when we hit targets is because our patients are receiving excellent care. And that's something that should be important to everybody.

Yep, sure. And then sometimes it's helpful to remind team members that production, if there's enough of it, leads to profits. And profits are where all the good stuff comes from, right? It's where all the new technology comes from. It's where bonuses come from. It's where raises come from. It's where we get to take time off and we get to go to great meetings and that's where it comes from. And without it, those things just don't happen.

Right. On a recent podcast, Kellie Black and I were talking about incentives and how to keep the team fired up and motivated consistently. You know, production really helps us do that too. Right. So they are linked together and inspiring the team. We love a few years back, actually, interestingly enough, during COVID, we had an event planned that was called, "Reach for the Beach". Right. We were going to have our retreat in a tropical location. It was supposed to be on a cruise ship, which, you know, I guess the universe didn't want us to do that. But it's a good thing we weren't on a cruise ship when that all happened, because man, I'll tell you what, some of those poor people, those stories were wild. the whole point with that was, OK, what did we do last year? Can we set an ambitious goal and give the team something to reach for? Let's reach for the beach. Let's see if we can earn this amazing CE event on the beach.

You know, a lot of our practices will do that with our retreats and things. They'll set a goal and say, hey, if you're able to hit this target, then you can join us when we come to the next TTI growth retreat, because they're really fun meetings and they learn a lot, they take a lot away, and it's a really great opportunity for teams to bond. And so having a target, something like that that the team can reach for, we have seen that to be a very effective strategy as well over the years, besides the things like activity bonuses and things that Kellie and I were talking about.

Yeah. And you know, when we, we set goals, it certainly makes sense to have the team involved in setting goals. And when we set goals, ambitious goals, we also have to have a plan because goals without a plan is very, very frustrating with teams. So if we're going to have a 20 % growth, where's that growth going to come from? You know, how much of that's going to be from hygiene? How much that's going to be from doctors? What's hygiene going to do differently than they've done in the past that is beneficial to the patients? What's doctor going to do differently than they did in the past?

And so, making sure that we have that plan in place, that people know that we are keeping with the win-win-win philosophy. And that is any change that we make has to be a win for the patient. That's the first win and the most important one. And if we don't have a win there, we shouldn't be doing it. Second is a good win for the team. So how is the team going to benefit from it? Reach for the beach, that's a pretty good one.

Yeah, in comparison with the message that I saw recently where the entire team hit their goal. They had a same day goal of about $20,000. Now granted, it was a multi-doctor practice, multi-hygienist practice. And the reward that the team got was a $5 Starbucks card. And it was pretty much a won, won. You know, we're all killing ourselves to accomplish this. she's like, it doesn't even buy my drink.

Yeah. Yeah.

You know, that doesn't even buy one beverage in today's world. so in a way, you know, I love that that approach, the patient wins, but the team needs to have a significant win. And we should have the win be commensurate with the effort. You know, we always say if there's a return on effort, the effort will continue. And what gets measured improves. And so having a way to reward that effort is important for consistency and sustainability of whatever it is we're trying to accomplish.

They do, yeah. In our high impact dentist course, we teach a change management process where you think through the three wins. Here's a change you're going to make. Okay, let's think through the three wins. Think we're going to communicate this to patients, how we're going to communicate it to the team. And it's just a very, very good leadership skill to be able to do that. And when we do that, we are much more likely to have a successful change.

Awesome. Well, again, all things production. Production is not always a bad thing, right? That's the thing that we always hear. Production isn't everything or is it? It can be, but the right approach will really determine your success as you focus on things you can do to serve patients better. That's what it's all about.

Yep. A friend of ours walked around a dental meeting not that long ago with a t-shirt that said people over profits. Without profits, if there's no margin, there's no mission, right? We cease to exist. But putting people, putting your patients, number one, the number one win, number two win is the team, putting people over profits is the way to go.

All right. Very good. So anything else on the topic? Let's get our heads in the right place. Profits aren't bad. Production isn't bad. It's just taking care of patients.

Right, we love it. Go out and have a great week.

Yeah, that's right. All right, everybody. That's it for this episode of The Double Your Production Podcast. We'll see you next time.

Bye bye.

Ep 149: Production Isn’t Everything… Or Is It?

Ep 149: Production Isn’t Everything… Or Is It?

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