Practice transitions

‘In the middle of difficulty lies opportunity’ – Albert Einstein.

Never has this been truer than in dentistry today. I write this because, firstly, the media is highlighting the political problems affecting the delivery of dentistry and the difficulty in practising quality care for all patients.

Secondly, there is new concern coming from the medical community about a possible link between periodontal disease and other health problems such as heart disease, strokes and bacterial pneumonia. There is also some concern that it may be related to late miscarriage. These are good, sound, honest and logical reasons to change.

We all know it’s in the best interest of the patients to offer them higher quality, more comprehensive and preventive care. We know, too, that there is awareness of and demand for more aesthetic dentistry. Yet there seems to be so much fear about making the change. Fears that patients won’t understand what we’re trying to do, that they’ll think we will try to talk them into extensive, unnecessary treatment, or that we’re greedy and it’s just about the money. Change can be difficult.

But let me ask you some questions:

• How many patients are you seeing a day?

• How productive are those days?

• Do you feel you’re making a difference in people’s lives?

• Do you feel respected, appreciated and rewarded?

• Are you performing the procedures you enjoy?

• Do you feel you have sufficient time for patients and procedures?

• Do you see yourself working this way for the next five years?

Be proactive

Face it, change is inevitable – it will happen whether we like it or not. The current interest in cosmetic dentistry is proof enough and, of course, there will be more changes coming all the time.

The question is, how long do you want to wait to adapt to the changes? You can be proactive and accommodate it, or you can wait for the changes to overcome you and sweep you away. Either way, things are going to have to change.

If all-private practice is the way forward, then a framework for getting there is imperative and it starts with getting past the fear of change. There is a Chinese proverb that says: ‘The beginning of wisdom is to call things by their right name’.

According to William Bridges, an expert on transitions: ‘Change is an event that is situational and external to us. It’s when something old stops and something new starts. It can be work, or a life event… the completion of a project, a merger or downsizing, or the announcement of a new policy.

‘Transition is the experience of the gradual, psychological reorientation process that happens as we respond and adapt to the external change. Transition often results from a change, but it may also be triggered by the news that a change is imminent and, so, start before the change actually takes place’ (Bridges W, 2000).

When change is looming in a dental practice, it affects the entire team. Dentists themselves may fear how changes might affect their own self-image, or whether they will be seen differently by the community or their team. These personal fears must be managed, but are compounded when trying to manage those of an entire team. There is always more control over one’s own reactions. The unknown is how the others will react to the changes, and whether they can make a successful transition.

Bridges goes on to say that there are three phases of transition, and understanding the process can help identify the reasons for the fear and serve as a pathway through change. His three phases are:

• Phase I – endings. Even if a change is for the better, there is a loss involved, a letting go of what was and maybe even who we were in that situation

• Phase II – the neutral zone. A confusing in-between time when we aren’t who we were or where we were, but we’re not who and where we’re going to be either. It may seem chaotic, like being lost or disoriented

• Phase III – new beginnings. We begin to identify with the new situation and become familiar with what will be. We accept the new reality the change brings.

Leadership qualities

Understanding the process of transition can help us deal with change more easily and quickly. But getting there requires leadership, values and commitment. Team members need to know that the changes they’re committing to are positive and in tune with their values. They want their leader to have a strong vision and the right intention, who can articulate ‘why’ these changes will benefit all concerned.

They need to know that offering the highest quality care isn’t about trying to manipulate patients into treatment. It is about helping patients find problems for themselves through the process of self-discovery or co-diagnosis.

Every emergency patient has already done this. They diagnosed that they have a problem because it hurts or is sensitive or feels rough to their tongue, and they want it fixed now. The ability to develop co-diagnosis is an important skill that all team members need to know and believe in.

The process is rewarding because it’s honest and allows clinicians to offer patients the best without pressure. It leads the team to feel confident they are doing something worthwhile – that in making the changes, they are making a difference.

The sad thing is that most dental practices don’t even tell patients about all of their options, they just assume that the patient will want the cheapest, easiest fix. Many people would choose higher quality, longer lasting aesthetic restorations if they knew about them. And those that don’t should have the right to choose compromised treatment if they prefer.

The important issue here isn’t whether the patient chooses ideal or compromised; it’s whether the patient was the one choosing, not us. Our role is just to educate and support.

Yes, these positive changes can increase your profitability, however, I still believe that doing what’s right for the patient is an even more powerful motivating force for you and your team.

There is plenty of mediocrity out there – why not lead the change? Why not feel the fear and do it anyway? Offer the best, be the best and lead the best.


Bridges W (2000) Transition – the personal path through change. Carlson Learning Co. Inscape Publishing, Minneapolis, MN

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