Seema Sharma shares her experience of her MBA and how it changed the way she approaches business development
Like many other dentists, I have learnt the ‘business’ of dentistry on the job, making my fair share of mistakes with strategy, human resource management, budgeting, marketing, time management and team leadership. As luck would have it, I have a wonderful network of friends and advisors, and for many years I was content with running a single large practice in the heart of Docklands.
In recent years, however, I went in search of new challenges, and decided to buy a couple of small (single chair) retirement practices with room for expansion. Such practices tend to have high property costs and low goodwill values, and I was well aware that cashflows would be challenging in the first three years, so my strategy for growth was key to success.
I have always been curious about the world of business and recently I undertook an executive masters in business administration at Imperial Business School, London. My areas of study included financial and management accounting, corporate finance, macro and micro economics, strategy, organisational behaviour, leadership, innovation and entrepreneurship.
There are many things I could share about the transformational experience of doing an MBA, but the real measure of its worth lies in the way it has changed the way I approach business development. For my final dissertation I chose to ‘Create a strategy for sustained growth of my dental practices, by disrupting, transforming and elevating the provision of dental care for a wider audience’.
From the 66-page report that now forms a template for my small group of practices, if I were to pick one thing that stands out for me as a critical success factor, it would be the importance of fostering unity of purpose to make change sustainable.
Unity of purpose
This article focuses on fostering unity of purpose by defining a clear vision. Much has been said about the importance of articulating a business’s vision, and for me the most actionable guidance came from the book ‘Breakout Strategy’ by Finkelstein, Harvey and Lawton. Tom Lawton was one of the teachers on my MBA programme and he showed us how a vision statement is more likely to foster unity of purpose if it encapsulates the value it brings to external stakeholders such as patients, whilst also speaking to the values of internal stakeholders such as clinicians and support staff (Finkelstein et al, 2007).
Our teams commenced formulation of our strategy with the following vision statement below, ‘We provide dental treatment for existing problems to a high standard, then work with you on a preventive approach which keeps you and your family smiling for life.’
Our objective was to put long-term oral health at the centre of our vision whilst addressing four transitions required (Finkelstein et al, 2007) to bring our vision to life, as outlined below.
1. Transitioning our organisation from functional silos to an integrated network
It has been said many times that there is no ‘I’ in teamwork. It is all too easy for dentists to be head down, drill in hand whilst nurses chase to and from the decontamination room and receptionists juggle telephones and queues at the front desk. Use of the word ‘we’ emphasised the whole team’s shared commitment to excellence at every step of the patient’s journey, and use of the word ‘you’ put the patient at the heart of our service. We discovered that de-centralised decision-making fosters innovation and creativity to improve service delivery. This required a redesign from top down implementation typical of hierarchical systems to a more flexible approach, so that action could be enabled by removal of management layers. In this way, functional silos were broken down and the patient experience could be shaped proactively at multiple touchpoints by every individual in the team.
2. Transitioning our culture from productivity to growth
A highly regulated environment has programmed practice managers to seek out and rely on data to predict, plan and endlessly document activities. This creates a comfortable and predictable role for managers in maximally utilised practices, but can leave those working in underutilised ones blinkered to new possibilities and stunt future growth. The desire to evolve from a culture of productivity to meet fixed targets such as those set by the NHS, to a culture of growth, was captured by separating care into short-term ‘treatment for existing problems’ and a longer term partnership commitment to ‘work with you on a preventive approach.’ The word ‘problem’ is still my least favourite word in our mission statement but it speaks to many patients as the main reason for visiting the dentist. Our aim therefore is to initiate behaviour change with a promise of the institutionalisation of on-going personalised care systems (Beer, Eisenstat and Spector 1990). in order to keep patients returning, improve self-care behaviours and translate into a growing patient base.
3. Transitioning our markets from narrow to wide
There are really only two sources of new patients; those who do not visit the dentist regularly and those who visit another practice. We wanted to expand our markets, and it is widely accepted that word-of-mouth recommendations are a cornerstone of successful growth. Bringing ‘your family’ into the vision statement invited satisfied patients to generate further leads for our practice from their own networks. A highly differentiated level of clinical care and customer service will help us to grow a database of loyal patients who trust us and refer friends and family. This has to be facilitated by clinical and communication skills development throughout the team.
4. Transitioning our relationships from transactional to symbiotic
The current UDA system has conditioned us to think in terms of finite courses of treatment, and evidence based guidelines require us to base recalls solely on clinical need. This transactional approach frees up access for as many patients as possible, but does little to foster behavioural change to sustain improvements oral health. Articulating an aspiration to keep patients ‘smiling for life’ communicates our commitment to use a partnership approach which fosters continuous improvement to the value proposition (the ‘promise’) for patients. It also helps us to recognise how hard we need to work at cultivating relationships which patients, team members and all other stakeholders to create an enabling environment and a support network for growth.
Change management is challenging because of the tension between the roots offered by continuity and the possibilities that can come about with change. Unwelcome and competing stakeholder values can hamper progress, but if given the chance to surface they can propel transformations because ‘mutual exploration shapes continuity and change to unfurl’ (Malhotra and Hinings 2015).
The articulation of our vision and alignment of values across our small group of practices has done much to foster unity of purpose across our entire team. I hope this article provides some useful tips for others embarking on growth through change.
1. Beer, M., Eisenstat, R. and Spector, B. (1990). Why change programs don’t produce change. Harvard Business Review, 68 (6), 158-166.
2. Finkelstein, S.; Harvey, C.; and Lawton, T. (2007) Breakout Strategy: meeting the challenge of double-digit growth. New York, McGraw Hill.
3. Finkelstein, S.; Harvey, C.; and Lawton, T. (2008) Vision by design: a reflexive approach to enterprise regeneration. Journal of Business Strategy, 29 (2), 4-13
4. Malhotra N, Hinings CRB, 2015, Unpacking continuity and change as a process of organisational transformation, Long Range Planning, 48, 1-22