December, 2000

Don’t Believe Everything You’ve Believed

En Español

Suzan Bekolay

What’s the one thing about orthodontic practice that you always believed but don’t believe anymore?

• Perhaps you believed a specialty would be easier than general dentistry.
• Perhaps you believed that being an excellent clinician with integrity, strong ethical and moral fibre you could prosper, be successful and be happy.
• Perhaps you believed that post-graduate training, such as gnathology would differentiate you from others.
• Perhaps you believed that a high degree of efficiency, fiscally and organizationally, would provide the economic base to practice in an ideal way.
• Perhaps you believed that you could be an orthodontist for your whole life and never tire of it.
• Being an orthodontist would allow you to enjoy other qualities of life such as making your family a priority.
• Perhaps you believed that having philosophy and mission well in hand, you would solve the challenges of running a profitable practice.
• Perhaps you believed that if you invested time with people, to really ‘care’ – it would pay off.

There seems to be general agreement that a large number of North American orthodontists, and many other health professionals, are struggling with at least one ‘value’ equation. On one side is the investment of time, energy and money to practice. On the other, is the calculated return on those investments in terms of health, joy and happiness.

Beneath all of the valuable theories of strategic management, financial management, team management, and organizational structure lies the fundamental need of all orthodontic practices – to produce revenue through case fees.

This article explores the reasons why orthodontists may struggle with the aforementioned values equation and examines the breakdown of the fundamental need of practice – people choosing you to do their orthodontics.

How is behavior different for an orthodontic client?

You have an advantage over other health disciplines including general dentistry. Why is it that only 21% of people seeking orthodontic care ‘fall out’ compared to much as much as 70% to 98% in other health disciplines?

The majority of people entering a dental practice are not aware of potential changes that would improve their health. In the behavioral change spiral, they are in a stage called pre-contemplation. They aren’t ready to change. They deny that change would be advantageous, are unaware or are not yet interested.

When people call your practice, 100% of them are already in the second stage of the change spiral – contemplation. They are thinking about orthodontics. They know what you do, basically, and they are interested. That is your advantage. And that is where orthodontists often drop the ball.

The next stage of change is ‘preparation’ which leads to ‘action’. There are additional stages that influence behaviors during orthodontic care, including dropping out literally or through non-compliant behaviors, but they are not the focus of this article. Influencing the transition from one stage to the next is the challenge, not only of starting cases but maintaining them to completion and often into restorative stabilization. But having people choose you over someone else, pay what you ask and refer others is the challenge.

How do you influence behavioral change?

Knowledge does not change behavior! Eventually, it may have some influence but its effect is limited. What we witness in most practices is ‘case presentation’, which is some form of preaching, teaching and attempted conversion. While well intentioned, the effect upon the client is a ‘glazed look’ as they tolerate your enthusiasm and passion for clinical results. That is, of course, if the client manages to get through the records portion, which if not insurance supported, may not go further.

You may have noticed the growing number of consultants and organizations prepared to infuse you with ‘sure-fired techniques’ to get your clients to say ‘yes’. They are usually manipulative, often heavy handed, and can be harmful to the intended outcome. Moreover, they usually don’t feel good to clients or to the professional.

The merits of teaching versus manipulating is arguable as to which is most effective or which is most ethical. With either method, or some combination thereof, some people submit, some lose interest – causing withdrawal at the start, during or towards the end of treatment. In all instances there is considerable risk of unenthusiastic referral by the client or through feedback to the referring professional.

Neither enhances the quality of relationships between people. Neither addresses the common desire of professionals towards gaining health, joy, happiness and fulfillment by ‘working with people they enjoy calling friend’. Both poorly address fee sensitivity where cost and value are constantly weighed against each other and where only insurance support effectively sways the decision to do. That is not to say there will be no success, but it is limited.

We are valuing, conceptualizing beings who constantly seek to make sense of our world and ourselves by linking sense data with frameworks. The sense data is our, more or less, reliable measure of “reality”; the frameworks are our values and perspectives. Moreover, our sense data (what we think are facts) are affected by the conceptual framework we have adopted. People are the captains of their own values and perspectives (perceptual field). My values dictate how I invest my personal resources of time, energy, money, gifts and opportunities.

Most everyone knows what changes behavior. It’s not complicated. Focus on all things positive or, the pros of changing behavior. Here is where the simplicity ends. The problem is that professionals have little or no training in the art of formulating questions that inspire a client to re-examine their values structure. Add to that, they have difficulty assessing readiness for change, and propensity for health. Part of preaching and teaching involves the imposition of values during the ‘case presentation’ – you do by my set of standards. It often fails, leaving both parties frustrated. Sometimes longer presentations attempt to cover every possible reason of which very few ‘click’ with individual clients and may result in loss of attention or misunderstandings. Then comes objection handling evidenced in questions such as “Will my insurance cover it?” or “Can we come in evenings, Saturdays or after school or work?”

Orthodontics requires a considerable investment of time, energy and money. Therefore, it is not a spontaneous decision. People are primarily choosing you – their perceptions of you and not simply the orthodontics itself. Usually, they will consult with others, especially other family members, regarding the financial impact. Therefore, wise partnering and conferencing includes your assistance in helping clients articulate their perceived value of orthodontic intervention and why you are the ‘preferred provider’. If their decision boils down to simply cost – an orthodontist is at risk for price shoppers or convenience shoppers and who can blame them when orthodontics seems like orthodontics?

When they ‘click’ with you (the values you represent) above all else, and when their values for health ‘click’ with the choice to do orthodontics, then and only then will people move towards healthy behaviors. From the beginning of your relationship – the phone call, through to the completion of treatment, many things must ‘click’ into place with their values like the tumbler of a combination lock. Relying on a beautiful smile as the end product doesn’t always support a 4 year commitment. For treatment to be clinically successful means that your client, adult and child, owns and supports the decision to do orthodontics. Children should not be excluded from the choice making process. Support and commitment is demonstrated in paying for the perceived value or worth of the service or following through on their part to wear elastics, wear appliances, maintain home care, to keeping appointments, and on to enthusiastically referring others or giving positive feedback to their general dentist.

How does feeling good and being profitable come together?

Orthodontic practices, like many other businesses, are either high volume or low volume. For some, high volume and low profit margin produces market share, but it doesn’t feel good especially without profit. Over time, satisfaction and fulfillment often wanes, even when there is profit. For others, low volume and high profit margins produce great feelings, but perhaps less final profit which offsets the ‘great feelings’.

High volume counts on efficiency, whereas low volume counts on effectiveness. Efficiency is valuable but far more concrete and tangible. Cookbooks and manuals make sense. Methods of measuring, calculating, and tracking serve every practice. They should not be totally ignored.

Effectiveness is the widely ignored part of health professionals’ background. The behavior dynamics of change are complex and intervention strategies are not ‘fool proof’. A golfer is not made by only taking lessons. Improvement occurs through a system of lessons on theory, practice, adjustment, more theory, more practice, and more adjustment. Reaching high degrees of effective communication through sound behavioral psychology, isn’t as easy as 1-2-3 and so, therefore, unattractive to many consulting businesses. Some oversimplify processes dramatically diluting the validity and sometimes creating negative results. Truly effective communication coaching is, by nature, highly customized and requires longer relationships. Professionals are often anxious for ‘quick fixes’ and ‘magic bullets’. Sadly, the real root challenge of health care is ignored. Why is it that people don’t do when they know they should?

The question of philosophy between disease centered or health centered practice is also rooted in behaviors. Thus, understanding behaviors and learning how to appropriately intervene does more than create preferred professional life but impacts mission and purpose for the profession itself. Therein lie reasons for fulfillment.

Have you noticed that you are drawn to certain types of people? Are you more energized and enthusiastic in investing time, energy and money to be with them? How did you learn how they think? How did you learn what they value?

Feeling good and being profitable means serving a meaningful purpose and mission while serving people who share your values and with people (staff) who are in total alignment, possessing more than skills. The journey begins with values identification, learning how to articulate those values to your team, gaining consensus and conveying your core values to clients and referring professionals. Your team congruently represents you and works together with you, to close the gaps in the alignment of values with every aspect of your practice including client candidacy, delivery systems, organizational climate and structure, all non-verbal, pre-verbal and verbal representations to name a few.

What is believable?

• Technology has brought about sweeping changes to our culture. Now, more than ever before, people are seeking a sense of belonging. People seek out places where they feel understood and not where they are taught to understand.
• Dependency on insurance coverage to do orthodontic care is hazardous.
• Opportunity is abundant! Huge numbers of people would benefit from orthodontic care beyond cosmetics. Many general dentists don’t understand the real value of orthodontic intervention relative to bruxism and failing dentistry.
• Effectiveness is a journey requiring vision, patience, tenacity, and commitment to learn about behavior and articulating value. It’s about strategy and not tactics.
• Position is gained as the unique qualities of a practice align with the unique qualities of individual professionals and so, therefore, also provides the distinctive edge to stand out in the crowd. Orthodontics from practice to practice may be the same or similar, but can your clients perceive the ‘value add’? Can referring professionals perceive the value add?

Contributed by:

Suzan Bekolay, Click Coaching
For more information and background visit our web site at www.clickcoachinginc.com. Feedback and complimentary ‘brain picking’ is welcome. Send e-mail to suzan@clickcoachinginc.com