Getting Maximum Return from Your Practice’s Most Valuable Asset

By Mike Massotto

The purpose of this article is to outline several of the most vital practice management tools, which when implemented, will instantly transform your office culture and open the way for unprecedented business expansion and growth. Yes, dental practice is a business as many of you may or may not have discovered the hard way. However, the most fundamental and critically important element of a successful practice is often the least understood and most neglected – your people. As practice management consultants and coaches who work exclusively on-site or in small, intimate groups on an intense week–to-week basis, we devote 50% of our time to the personal development, understanding, and handling of staff. Since they drive the practice and make or break whether or not your office systems, procedures, and policies get and stay effortlessly and flawlessly implemented in the service of you and your patients, it is vital that you truly understand and use the following distinctions and tools in the ongoing development of your practice.


The derivation of the word culture comes from the French colere meaning to tend to or to cultivate. Cultivate in this case means to cause to grow by special attention or by studying, advancing, and developing to refinement. Thus, your practice culture is determined by how much attention you put on your people in their training, integration, development, and advancement as individuals in support of your purposes and goals. How effectively you understand, know and can inspire your staff will ultimately determine the level of practice growth you can achieve.

You therefore need to start by simply surveying (and afterwards interviewing) people with a direct, straight to the point questionnaire to get a clear and accurate assessment from their perspective of how they view themselves, their teammates, and you and your associates in relation to the practice. Some sample questions should be: What is your position or what post do you hold in the office? What do you do and what are you responsible for? Does your work interest you? Do the duties you perform align with your position in the office? How do your responsibilities contribute to the practice? What barriers do you run into while doing your job? What works about your job and what needs improvement? What works about the practice as a whole and what needs improvement? Where do you feel you need improvement? What works about the doctor(s) and what needs improvement? What could be changed to make your job easier and help you get your job done more effectively? All are powerful questions, which will assist you in gathering common themes and in the identification of potentially detrimental personal and practice blind spots, which often go undetected. Conversely, this discovery process will also allow you to recognize what is right and working about you and your practice which is just as important so as not to change or deviate from your successful actions as a leader and entrepreneur.

During the survey and interview process you must be sure to create a safe space for your people to be completely honest without fear of repercussion or resentment. The truth may hurt, but without it you cannot make changes. Resisting, justifying, defending, and rejecting your staff’s reality, whether you can readily understand where they are coming from or not, will invalidate them and create upsets and resentment. Sometimes it is just best to shut up and listen – it can be very therapeutic and beneficial in the end.

However, you will never get total candor without acknowledging how you have been in the past, cleaning it up, and giving permission in the present to allow full, uncensored expression from your people. You could position these surveys and interviews as follows: “In the past I may not have been as open as I am now to hearing the truth and to be willing to make changes. I have realized that there may in fact be things about me and the practice that need attention and improvement, and I need your help in handling these areas. So I want you to know you have my full permission to share with me, without fear of repercussion or resentment, what you see needs handling. I want you to know that I value your opinion and I am ready and willing to hear whatever contribution you have to me and the practice.”

Of course, how you deliver this message and whether or not it truly comes from the heart will determine your success. People can tell when you are genuine and sincere, and will make the decision to trust you or not based upon this and your agreement and compliance to confidentiality, if so desired.

Once you get agreement from your team to participate whole-heartedly in this discovery process, set aside a full day to conduct private one-on-one meetings with each individual staff member, including part-timers, when they can openly discuss and elaborate on their survey answers and offer solutions and suggestions. Be attentive and interested, listen, ask for specifics or clarification when needed, and take good notes. Remind them it’s all confidential and okay to share whatever they want if they feel it’s important to the improvement of themselves, the practice, and you. Do not have a stopwatch on them, and acknowledge and thank them for their time and contribution in assisting you in transforming the practice.

After completing this first step toward getting the existing reality of your practice and its culture, you now have the momentum generated to move on to the next steps in creating and maintaining the ideal office culture.


A fact is the truth and can be proven as such. An opinion may have some fact in it but is not always entirely the truth. After conducting your interviews, gathering data, and recognizing common themes, you must decide on what is factual information to act upon and what is not. Through simple observation and further investigation, it should become apparent where you need to focus your attention and efforts toward improvement. Usually if more than one person is giving you the same specific data, it’s probably true. When in doubt, look at where the information is coming from. Is the person cynical, negative, or generally unhappy in life who seeks to criticize rather than contribute? If so, you may need to decide if their viewpoint is accurate and can be trusted.


After compiling the facts, you need to devise a strategy and plan to handle the root causes of cultural and practice deficiency by identifying the “whys.” You should be able to trace all the numerous problems you are having with your people and your business back to several underlying main causes, which will handle all the symptoms when addressed. In other words, stop putting out fires and take away the matches. You can then have a permanent handling of persistent problems and upset. Our favorite analogy to further understand this point is the problem the maintenance crew had with the Lincoln Memorial Monument in Washington, DC.

There was an ongoing problem with bird droppings collecting on the walls of the monument. After months of power washing, engineers decided to further investigate the source of the problem. They brought in a bird expert and found out that there were many insects residing in and around the monument, which were attracting the birds. So an insect expert was brought in and it was discovered that what was attracting the insects was moisture collecting on the roof. Once the drainage problem was handled, away went the insects, the birds, and the droppings. Isolate sources, and recurring practice problems can be resolved once and for all.


Once your have a strategy and plan devised from the identification of the real why’s as generated from your discovery process, you need to roll out to the team what you have learned and realized about yourself and the practice for agreement going forward around your plan to improve and change. This will open up the lines of communication like never before in your practice and lay the groundwork for an ongoing open forum to discuss and co-create your future and fulfill on the needs of your team.

During a roll out meeting with the entire team you need to get total agreement and alignment to your plan by handling any distractions, disagreements, and opposition amongst your people. Ask a question such as “can you tell me how this is not going to work?” If you handle these fears, uncertainties, and any resistance by demonstrating and ensuring how it can and will work, you will get enthusiastic compliance and cooperation as long as you are committed to walking your talk.


Although it defies conventional business logic, the only way your patients will ever be taken care of with the highest level of quality, professional service and care will be when you make your people number one. When your primary focus becomes taking care of your internal customer by ensuring they are happy and fulfilled, acknowledged and appreciated regularly for their service, and given security and constancy by providing them sufficient salary and an incentive or bonus plan in a sane and peaceful working environment, your patients will automatically be made number one.

We believe quality control is an oxymoron. Great quality and impeccable service should not have to be enforced. It should be an automatic byproduct of empowered, happy people working as a team to push forward a common purpose in the care of others. The needs and wants of your team should always be considered first in your executive decision-making. Twelve-hour days may be great for you and convenient for your patients, but overwhelming and exhausting to your people.


Communication lines are the power of your practice. Keep the lines of communication open and flowing on a consistent basis, and you will keep morale up and productivity happening. Have a daily morning and afternoon huddle with a structured agenda. Focus on the game for the day and not just on a review of the day’s schedule. Look for opportunities to fill holes in production and recommending needed treatment. Role-play patient scenarios and brainstorm handling to be proactively prepared for each patient prior to their arrival. Hear your team’s concerns; make sure they are all ready and fired-up for the day, and always inspire and motivate while making it fun.

Additionally, be sure to hold entire team staff meetings no less than twice monthly. Be prepared with an agenda, which should include time for an open forum of issues. Have people come to the table with solutions to problems to keep it from becoming a gripe session. Review policies both new and old, and ensure they are being enforced. Managing by policy and statistics and not emotion will keep staff and patient relations clean and positive. Always end the meeting on a win and with training on some aspect of practice procedure that you feel needs attention and improvement. How you can ensure that new patient intake, financial presentations, hygiene re-care, etc. are going to your satisfaction is to drill and role-play them until they are mastered.

Finally, implement departmental meetings on a regular basis as well. Designate a hygiene, assistant, and administrative team leader to hold short meetings structured around their areas of specialty. These agendas should include not only discussions on technical issues but on team interaction and relationships as well.

These six points if implemented properly will dramatically improve staff relations and patient service. It is important to understand that there is no such thing as business and personal. It is all personal when dealing with human relations. There is no “shutting off” certain aspects of your life and who you are as a person when you come to work. The sooner you realize this and learn how to effectively communicate, interact with, develop, and understand your people and have them recognize the value of doing so with each other, the sooner you will be on your way to profound practice cultural and business development.