Alun Rees - Dental Business Coach

Alun K Rees BDS is The Dental Business Coach. An experienced dental practice owner who changed career he now works as a coach, consultant, troubleshooter, analyst, speaker, writer & broadcaster. He brings the wisdom gained from his and others’ successes to help his clients achieve the rewards their work and dedication deserve.

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11
May
0
Posted by on in Guest Contributors

Just say no.

 

I deal with more and more dentists who are close to or have reached burn out one of the causes of problems is of their own making, it’s their inability to say, “No”.

The temptation in any transaction is to say yes. In the hurly burly of the semi-organised practice where the pressures on our time are made worse by a lack of clear guidelines that facilitates people to say, “no” on our behalf we can always be under pressure to answer in the affirmative.

The NHS is constantly telling their professionals that they should be doing more, that activity is the key to everything, (hell they even called the measurement system units of dental activity) and that to turn someone away is wrong, implying that it’s also unprofessional.

Yet we know that to squeeze a quart into a pint pot leads to wastage, a mess and someone having to clean up later. Here we have one of the paradoxes of the NHS, pile high sell cheap and put in long hours but woe betide you if quality should drop.

One extreme of this is in NHS practices with large numbers of high-needs patients who are not motivated enough to attend regularly but who expect to be seen at short notice. Often it seems they expect a better service than they would get from their GMP.

Time is like land, they aren’t making any more of it so use it wisely. It can be a good servant but a hard master.

Many of us have had the pleasure and pain of starting “a book” from scratch. I did it first for somebody and then twice for myself, possibly a definition of business masochism. In those circumstances faced with an empty diary, a phone that rings sporadically, debts and a growing sense of self-doubt, the knee-jerk response to every call is to get the patient in as quickly as possible, it smacks of desperation but who cares?

By the time I did it for the third time I had learned a tip from the restaurant business and gave a “false” date of opening. When the phone rang we implied that I was booked for a fortnight ahead. Emergencies excepted, obviously. The demand levels rose and within two months I was booked a fortnight ahead.

Unfortunately that sense of urgency, of fearing failure and wanting to oblige may lead to subservience and can prevent the dental business from maturing. The result can be a manic, uncontrolled version of Dental “ER” where the appointment book is full of unprofitable sessions.

I met a colleague, Mary, at a local meeting once and asked her if she was going on holiday this year, her reply alarmed me, “Yes but I only ever take a week, if I have a fortnight there are so many patients to see with problems when I get back it’s just not worth it.” Shortly afterwards I needed to replace our receptionist for maternity leave and recruited an individual who had worked as a nurse and subsequently run reception for Mary. When her husband’s job relocated they had moved away for three months until he was promoted and re-relocated.

Within a week my appointment book was a war zone, every patient who with even the slightest problem and then summoned to be seen as soon as possible. Double booked, triple booked, lunchtimes, after closing, it was a nightmare. When I asked her what was happening to my beautifully crafted, session based and above all organised and optimised book, I was told Mary had said you had to see the patient at once, that patients were encouraged to ring whenever they wished and she would always see them, on that day.

Clearly there was a difference of philosophy and opinion, she had no hesitation in telling me that I was wrong and we agreed to part. Control was re-established and I fully understood why Mary had to take early retirement a couple of years later - burnt out by a bonfire of her own making.

Ideally the people answering the phone should only do that, but it’s not always possible or practical. They must be trained to ask the right questions and to have a manner that reassures and doesn’t alarm and that reflects your practice ethos.

Jack Welch the former CEO of GE wrote in his autobiography, “Saying no is incredibly liberating. Try it on anything and everything that is not part of your deliberately chosen work-life plan”

But it’s hard especially if you have built a system on saying yes.

The first step to change is to decide what you will and will not do. Then introduce boundaries which cannot be crossed. It’s not my place to tell you what they are in your case but common ones are working longer hours than feel comfortable, missing important family duties and giving your patients access to an “open book”.

The next is to decide when you work at your very best and concentrate on those times for your most challenging (or most rewarding) work.

Finally zone your appointment book and vary those zones from day to day through the week for flexibilty. I am not naive enough to suggest that you can avoid some early and late working but when and what must be under your control.

Delegate everything that you possibly can. Dentists should only do what only dentists can do.

I recently helped a principal who was close to breaking point, his private practice was so busy that he wasn’t able to take a holiday and was missing out on his family life. He had the tiger by the tail not daring to let go but losing the strength to hang on. It took a few hours of questions, of analysis of his business and some questioning to show that his beliefs were not really truths.

Once that was established, the tiger was slain he took a filleting knife to his schedule keeping what only he could do and delegating everything else, including some of his more straightforward implant cases. Sanity was established but more to the point he felt that he was in charge of his life rather than the other way round. He could see the choices, and was able to take them.

No is a wonderful word and might just save your health.

 

 

©Alun Rees, GDPUK Ltd 2017
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0
11
Apr
3
Posted by on in Guest Contributors

I was not an outstanding student. I had a very full 5 years at Newcastle but was not famed for my exam grades. Past form being no guide to a cup final I passed my finals.

This was before vocational training, whether voluntary or compulsory. Most of my year headed into general practice within days of graduation and kept their heads down for the next 35 or more years. If they were spared.

Inspired by MASH the movie and dreading being stuck in one place I spent two and a half years as an oral surgery resident, dealing with inpatients, impacted 8s, smashed faces and bleeding sockets. I learnt skills that would help me through my clinical career and life, once you have had to cope with gunshot injuries and Le Fort III fractures not much phases you. I coped with warring consultants, departmental politics and green-gowned theatricals but not with primary FDS. General practice was next and, like everyone else, it was in at the deep end and sink or swim. I bobbed about keeping my head above water, unsure what I was doing for many years.

The hospital service had made me open books, read journals and attend regular study days. There were no such expectations in practice, indeed any day long courses were frowned upon, as you “would not be earning”. The limit to my being mentored in practice was a dressing down when I missed caries, “you could have earned another £X here”.

Post Graduate Education (later CPD) was dominated by what was put on at the local PG centre with Section 63 and BDA section meetings, plus the very occasional trip to London for a day at the RCS.

To cut a long story short, one evening with Philip Greene changed my life and I realised that I had to know more about perio. That’s where my CPD proper started and much of it was beyond “approved by the NHS”.

Occlusion with Higson and the full BSOS year experience, with visiting speakers from the US opened my eyes wider. This coincided with my starting my first practice and nothing had prepared me for that! I found the people on the courses stimulating company who cared deeply for their patients, always looking for better ways to treat them. These people further opened my eyes to a philosophy of prevention. “What you need to remember, Alun, is that you don’t cure caries with a turbine” came as a shock, I was a dentist and I drilled teeth didn’t I?

BUOLD took me back into (mostly) university led teaching which was sometimes undergrad+ but led me to think about solutions. A week on the MGDS course made me remember how much I hated exams. Then came several years of tutelage and discipline of Mike Wise and eventually a spell with the Open University Business school MBA course that helped me to get to grips with my expanding and floundering business.

VT was a great idea but it came after my time. There was something to be said for my ad-hoc, buffet style of learning but I know I could have done it a lot better with a mentor. However VT / FD is facing major problems. Many good trainers have been forced out of a pile high / sell cheap system regretting the regular opportunity to pass on their skills and experiences but unable to square the commitment with the imposed system. The majority do not do it for the money, those who have done are left disappointed and their trainees disillusioned.

New graduates and young dentists face a changing world and it’s about time we looked to the future with a clean slate instead of reacting to the present. The department of health / NHS has responsibility for postgraduate training. The NHS is falling apart and has never taught dentists, dentists teach dentists. Is dental education really one of their priorities?

No other profession has such a poor career pathway. It’s not going to happen unless some enlightened and altruistic dentists make it happen. An independent VT system is an idea whose time has finally come. The last time it was mooted there was some enthusiastic support but the project was savagely crushed under the jackboots of Whitehall.

To take Covey’s axiom and start with the end in mind, what skills will a dentist require beyond 2030? How can these skills be learned? How can the very best be encouraged to deliver the very best care that they can and to properly lead skilled teams?

Here’s what I am starting to see in the switched-on practices. The principal has a set of values and standards that they share and instil in their associates. They help the associates to build a rolling personal development plan where, over a period of three years or so, they not only attend courses that will educate, enthuse and encourage them but also are able to put those new ideas and skills into practice. The idea is to provide a bedrock for their next 20 or more years and to imbue good habits. The associates earn reasonably well, possibly less than they would delivering UDAs but they work with great support staff, the pressures they will feel are the ones associated with doing a good job and they have no quotas to fill.

They routinely visit and observe specialists working and take part in routine, non-judgemental two-way appraisal / audit sessions. If they find that they want to pursue a further qualification they are encouraged. In addition they are shown the workings behind the practice so that they are able to understand how a successful dental business functions. Their communication and leadership skills are developed and enhanced.

How would it be if these Private trainees were able to rotate through say, 4 to 6 practices, over a three year period not unlike a registrar system and were expected to embark on a Masters degree during the latter part of their training?

There is an irony here in that the “corporates” would be better placed to provide such a system; there would be the opportunity to provide different practices for their trainees to work. Sadly they are mostly wedded to shareholder value, concentrating on servicing NHS commitments in an environment which does not encourage excellence - in spite of what they say.

So what’s going to scupper this?

•   Failure to ensure this is a win/win/win trainees/trainers/patients.

•   Egos.

•   Involvement of medical educationalists.

•   No long term plan.

•   No leadership.

•   Allowing the NHS within a hundred miles of this idea.

•   Not enough people with the vision to make it real.

 

Now who’s going to run with it and safeguard the future?

 

©Alun Rees, GDPUK Ltd 2017
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0
01
Mar
0
Posted by on in Guest Contributors

“The NHS is safe in our hands. The elderly are safe in our hands. The sick are safe in our hands. The surgeons are safe in our hands. The nurses are safe in our hands. The doctors are safe in our hands. The dentists are safe in our hands.”

Margaret Thatcher, 1983.

I remember thinking that when Margaret Thatcher said those words, written by speechwriter John O’Sullivan, that it was thoughtful of a politician to mention dentists. Thoughtful and unbelievable.

The use of the ‘Epistrophe’, the rhetorical tool of repeating of a word or phrase at the end of each sentence was used to echo Churchill’s ‘Anaphora’ of “We shall fight them etc”. Rhetoric has given way to the sound bite of, “The NHS is safe in our hands” which has always been Fake News or as my schoolteachers would have called it “Lies”.

The majority of politicians when given the opportunity have repeated the “safe hands” mantra. I wondered if it was a stock phrase they taught you at MP elocution school along with, “Hard working families” and "Education, education, education”.

“La-La Land” has been defined as “a euphoric dreamlike mental state detached from the harsher realities of life”. Few dentist fall into that category but I believe there are many who may hope: “To think that things that are completely impossible might happen, rather than understanding how things really are”.

A definition of madness is to do the same thing again and again hoping for a different result. Since Mrs Thatcher, governments of every hue have sought to undermine the dental profession by repeated assaults and insults both specific and general.

In the UK, like the majority of countries, most routine dentistry is provided by small businesses with the owners taking the financial risk of failure but also any profits from success. For years there was a 3-way set up, patient, dentist and NHS; the first paid the second the fees that were decided by the third that also set the rules. There was the possibility of competition, expansion and genuine entrepreneurship within the system. 2006 changed much of that.

The 2015 saw the Tories return to government free of their Lib-Dem coalition partners with talk of SMEs (Small and medium sized enterprises) being the “lifeblood of the economy”. Promises were made of more investment in super-fast broadband for entrepreneurs, a review of benefits for the self-employed and a trebling for the start-up loans programme.

A commitment was made by Prime Minister David Cameron (remember him?) to, “slash red tape” and to change employment laws to enable greater competition. One promise that was kept was for referendum, an excuse for any and all procrastination for the foreseeable future.

Cameron not only promised “the NHS is safe in our hands”, but also, “there will be no top down re-organisation” before letting Andrew Lansley set about things like a drunken bull manoeuvring a JCB in china shop.

The (genuine) news that the Inland Revenue’s “Make Tax Digital” (MTD) plans will mean all self employed individuals and small businesses having to make some form of tax return and payment on a quarterly basis hardly bodes well for dentists looking to reduce their costs. It will involve far more time and increase accountancy fees.

Changes in Business Rates will have a profound effect on many businesses, with London rates set to rise by 35.5% over the next two years. The fact is these changes should be made every 5 years but were delayed from 2015 so as not to interfere (i.e. prove unpopular) with the general election is further evidence of interference with the truth. Mrs May quickly promised help, then admitted there is no more money.

For years the GDC said that they could not make any changes and an act of parliament was required. This happened in late 2015, I am not sure that anyone has felt the benefits of “a more streamlined complaints system with timelier decisions, and with appropriate safeguards for both patients and dental professionals”.

Finally on the Fake News front that (new) NHS contract. As the BDA says, “The 2006 dental contract is not fit for purpose. It rewards dentists for hitting government targets for treatment and repair, not for improving their patients’ oral health.

In the 2010 general election, the opposition Conservative manifesto pledged a new dentistry contract. The coalition agreement – struck between the Conservatives and Liberal Democrats – pledged the contract would be introduced by the next election, in 2015.

In August 2016 Lord Prior said, “I believe that we expect the new contract to be introduced fully in 2018.”

And lawyer, John Grant ,wrote after yet another debate on the proposed contract.

At some point there will be a new contract, but at present no one knows at all what this is going to look like.

When it does come in the government – no matter which party is in power – is going to want an awful lot more from dentists and in return is going to pay significantly less.”

If you think things can only get better (see 1997) then you are not only living in La-La Land but still expecting it to win the Best Film Oscar.

©Alun Rees, GDPUK Ltd, 2017.
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0
25
Jan
0
Posted by on in Guest Contributors

If your best friend won’t tell you what do you do? A different problem.

“I’m feeling a little bit under the weather”. Another vague absence. Karen was good team member, a hard worker and, with the exception of a couple of days a month, punctual and reliable. The principal and the practice manager didn’t know what to do; they had tried the usual approaches mixing concern and compassion but had got nowhere.

A recent survey of 10,000 office workers has found that most one-off sickies are due to hangovers with “just hating the job” coming in second. Neither was the case with Karen, she never drank and clearly enjoyed her career.

“Alun, I wonder could you do her appraisal when you’re next visiting the practice? We’re struggling with what to do about her absences.” Sometimes a different face, voice or ear will bring results. This time was a success and I was able to get to the heart of Karen’s problem. I found her to be a sensitive soul, caring and concerned but in the horns of a dilemma.

The practice consisted of six surgeries with one principal, four full and part-time associates and part-time three hygienists. They operated an egalitarian system where, in order to ensure their were no opportunities for favourites or cliques, the nurses moved around on what appeared to be a fairly complicated rota. This way they worked with associates, principal, hygienists, did their turn in the LDU and had a share of being a “float”.

It turned out that Karen’s absences always coincided with her being due to work with Pam, one of the associates. Pam was experienced, had worked in a variety of practices, hospital departments and had also had a spell working in the community. It was acknowledged she could be a bit brusque with both patients and nurses, but her work was good, she ran to time and grossed well. She was recently divorced, had no children and lived alone.

I managed to get to the heart of things when I met Karen. She was under the impression that the visiting Business Coach was there to see her for some sort of disciplinary matter but I soon disabused her of this and she relaxed. We proceeded with her appraisal, which went well, and having gained her confidence I introduced the matter of her absences. She eventually shared with me the fact that Pam suffered from what used to be labelled as “B.O.” - in other words she was smelly. All the nurses were aware of it but for some reason Karen was particularly sensitive and had needed to run to the toilet to be sick the last time that she worked with Pam. She had now got herself into a real state in case the same thing happened again. She had started to believe that she was the one with the problem and hence the absences.

When I asked the principal and the practice manager they both admitted to having noticed Pam’s odour but had presumed that it was a rare event. Bromhidrosis or body odour, is a common phenomenon in post-pubertal individuals and can rarely become pathologic if it interferes with the life of the individual concerned.

So far, so good we had a diagnosis, but how to treat the problem?

As I was there, and Pam was there that day, it was felt that there would be less of an embarrassment if I were to broach the subject with her. Fine I thought, the client is always right and I have to earn my corn. It wasn’t something that I had done before and I am all for new experiences, if it went badly then I would get the blame and could walk away for another three months.

We met after work and I gave myself 15 minutes to achieve the objectives which were, to point out to Pam as subtly but effectively that there had been comments, to find out if she realised that there might be a problem and then work out a way to deal with it.

Her reaction, thankfully, was not one of denial or to attempt to blame someone for “sneaking” on her. She was horrified and visibly upset. It turned out that she had rather “let herself go” (her words) following her divorce and some days it was all she could do to drag herself out of bed and often didn’t get round to showering or bathing. She wore a tunic at work but wore it over clothes and we agreed that a change to scrubs might help. Most, but not all, of the clinicians wore them and as they were laundered by the practice it removed any home washing. An easier conversation than I feared with, hopefully, a positive result.

When I checked in with the practice owner during our regular coaching calls Pam had obviously had a bit of an awakening. The odour problem had gone and she had taken ownership of the problem by taking the time to ask each nurse at the start of her next session with them to please tell her if there was any recurrence.

©Alun Rees, GDPUK Ltd 2017.
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0
08
Sep
0
Posted by on in Guest Contributors

I wrote a piece for Dentistry magazine earlier this year about the new Chief Dental Officer who at the time was busy on a “fact-finding” tour of her new territory. Sara Hurley’s tour was without doubt planned as a charm offensive, featuring smiling photographs with some of the movers and shakers of British dentistry. When she made an appearance at the BDA conference in Manchester her ad-lib question and answer session on the BDA stand was very successful and she came across as personable, reasonable and eloquent. “Good”, I thought, “here’s someone who wants to make friends”.

After more than a decade of her successor, Barry Cockcroft, who could not be described as any one of personable, reasonable or eloquent she seemed a breath of fresh air. But, let’s face it, the bar wasn’t set very high.

In my article I reminisced about CDOs I had encountered, I would not claim to have known any of them. I encountered Brian Mouatt when I was doing the MGDS pre-exam course just after the Conservative government announced a new dental contract, which was intended to “sort out NHS dentistry for good”.

He gave a talk on the new contract and promised that he would answer our concerns when he had finished. However having completed his prepared address he muttered something about having a previous engagement and headed for the door, our angry comments and questions ringing in his ear.

I only knew Margaret Seward because she was married to my first boss, Professor Gordon Seward, she was in post for two years and presumably wasn’t able to leave much of a mark on things, people I have met who worked with her spoke highly of her.

The other CDO I met was of course the previously mentioned Dr Cockcroft who was the highly visible mouthpiece for the iniquitous UDA system and became the exception after a line of low profile CDOs.

In view of Dr Hurley’s ease with people and obviously understanding the need for good PR I was surprised to hear that the new CDO had been far too busy to answer questions on Channel 4 in the wake of their damning reports on UK dentistry. If an NHS dentist was similarly booked solid for 6 months it would be mismanagement.

There was something that kept nagging at me and that was the somewhat cynical conclusion we reached after Brian Mouatt’s sudden departure. The CDO is a civil servant and is there to do the government’s bidding. The current incumbent has spent her professional life in the services reaching a high rank, she knows all about chain of command and is used to taking orders.

Her announcement this week at an NHS Expo (whatever that may be) that, “Going to the dentist every six months is unnecessary,” as the Daily Telegraph reported it, only undermines the position of Dentistry.  The other statements attributed to her are more “austerity” fuelled DoH propaganda.

"You don't see your GP every six months so why would you see your dentist?” Dr Hurley said. Well, Sara that is because NHS medicine is an illness driven system that is reactive and gives only lip service to prevention.

“If you go to have your car MOT, and he says, come back in six months, do you blindly adhere to that advice?” Actually Sarah if I’m driving one and a half tons of complicated machinery that I want to be safe yes I do. What does the army do about recalling tanks for servicing at the correct intervals? I would suggest that if you do them “blindly” someone could find themselves being disciplined.

She was joined on the platform by Roy Lilley who described dentistry as  “a rich man’s hobby” as a regular reader of Mr Lilley I know him to be anti-medic, and by extension dentist, who thinks that every ill in medicine can be cured with a “cuppa builder’s and a hobnob”. He criticised improved surroundings for dentistry, perhaps a return to upright chairs, woodchip wallpaper and lino; with queues on the stairs for gas sessions - would this suit him?

It has taken dentistry half a century to get the message across that regular attenders have fewer problems, stay healthier and actually prefer the reassurance. The good practices already tailor their recalls to suit patients and have been doing it for decades. Your statement is irresponsible and only fuels any criticism and scepticism of dentistry. You knew that your words would make headlines and that you were undermining the hard won confidence that most general practitioners face. However as you have never been a GDP how can you possibly understand what that really means?

It would appear that after a year in post gaining the fragile confidence of dentists, the directive has come down to the CDO, “get rid of your camouflage tunic, put on your hard hat and Kevlar, come out into the open and start gunning down your colleagues. That’s what we pay you for, not popularity - oh and Sara don’t forget there may well be a gong in it for you”.

©Alun Rees, GDPUK Ltd, 2016
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