March 1, 2002
by Steven J. Anderson
Over the past five years there has been a lot of talk in dentistry about “systems,” including those related to quality dentistry and case acceptance. When systems are discussed, a man frequently quoted is Dr. W. Edwards Deming, who has been called the ‘father of quality management’.
Those who know of Dr. Deming, know he is world-renowned for his work with the Japanese after World War II. His teachings provided the foundation on which the Japanese reconstructed their very successful post-war economy. One principle that he has consistently proven to himself and to all with whom he has worked is that 94% of success is ‘in the system’.
What you do and how you do it must have as its foundation, value and integrity, or it will ultimately fail. It must be based on truths about human behavior and the practice of dentistry that are valid. If there is an error in the “truths” that you subscribe to, there will be errors in your system that will cause it to be inconsistent and unpredictable in its results.
What follows are some commonly held “truths” that are really half-truths or mistaken certainties at best that are associated with systems for treatment acceptance. Study them with care. Ask yourself to what extent you believe in these dental “truths” that aren’t true. How you feel about them impacts your effectiveness with your patients and their acceptance of your treatment recommendations.
Truth #1 that isn’t always true: Educate your patients and they will do what is best for their mouth and their health.
It is widely taught and advocated that just educating patients will motivate them to accept the recommended treatment. It is true that if patients don’t know the facts, they are not likely to agree to treatment. Patients must be aware to understand and must understand to agree. But understanding alone does not guarantee agreement. If knowing always led to doing, there would not be any fat physicians who smoke. For those who don’t change there is some other motivation beyond the facts.
By the same reasoning, just educating patients does not guarantee that they will act on what they know. There may be some other motivation that keeps them from doing what seems to you to be logical.
The real truth is that people make decisions based on emotion and then attempt to justify their emotional decisions with logic, not the other way around.
If you need additional reinforcement for this principle, think about the last car you bought. Did you read Consumer Reports and realize that your car needed to have the latest brake system, an improved power steering mechanism, and improved gas mileage? There may be some who put a priority on these things, but more often it is a case of liking the appearance, the comfort and thinking about what the neighbors will think when they see this car parked in your driveway!
All of this considered, is it rational to think that when patients sit down in your dental chair, they are going to change the way they make consumer decisions? Not likely. If this were true, the car dealer would only give you the facts about long engine wear, acceleration, braking distance, etc. The secret to gaining acceptance is supplying the clinical information that is desired by the patient and appealing to what the patient really wants… emotionally.
And what are the emotional wants?
Here’s the psychologists’ list:
Obtain social approval
Attract the attention of potential admirers
Be seen as superior
Have freedom from fear and danger
Provide for loved ones.
Those who are wise will provide what information they think a patient wants according to his/her decision making style and provide ample emotional benefits that the patient is looking for and that the treatment will provide.
Truth #2 that isn’t always true: You can motivate patients to do what you want them to do.
Have you ever wondered, “How can I motivate my patients to do what they really need to do?” You could start with a simplified version of basic human motivations and generalize with two-everyone wants to gain pleasure or avoid pain. It is certainly true that helping people gain pleasure or avoid pain will provide a significant source of motivation. This proposition becomes a “truth” that isn’t true, however, if you fail to realize that one man’s pleasure may not be the same as another’s and especially not the same as your own.
A validation of the impact of emotions vs. practical knowledge occurred when an attempt was made to convince college students to quit smoking. The health appeal didn’t make any perceivable change in behavior. At college age most students think they are immortal. But when the approach was changed to “Keep your breath kissing sweet,” close to 50% of the smokers kicked the habit. The image of the girl of their dreams saying, “Yuck, tobacco breath” was the perfect emotional combination of “gain pleasure or avoid pain.”
Another common mistake in trying to motivate patients is to think that what motivates you also motivates your patients. That’s not always true. The key to making this half-truth really true is to discover the pleasure the patient wants to experience, or the pain the patient wants to avoid. People do what they want to do for their reasons, not yours!
Truth #3 that isn’t always true: Build it and they will come.
You will remember this phrase from the movie “Field of Dreams.” The owner of the farm heard the voice repeating “If you build it, they will come.” The voice the dentist hears is, “The greater your clinical expertise, the more your practice will grow.” Those who believe in this half-truth go from clinical course to clinical course expanding their clinical knowledge-which is a good thing. But the trap is thinking that the knowledge alone will lead to a successful practice.
Ever since I have known him, another mentor who has been my business partner for the past 12 plus years, Walter Hailey, has quoted a scientific study conducted at the Carnagie Institute of Technology wherein it was discovered that only 15% of success is due to technical skill and job knowledge. The remaining 85% of success comes from people skills, or the ability to deal with people successfully.
For example, it was found that for every person who loses his/her job for lack of job skills, there are two who lose their jobs because they lack the ability to get along with the other employees and the customers (patients). The typical case is the dental team member who has the technical knowledge, the proven ability to do what he/she is hired to do, but constantly upsets the whole office and a fair number of patients. If the people skills are not present, there will not be adequate opportunity to demonstrate the technical skills.
Too many dentists have completed the best technical courses in the country thinking that patients will come to them because of their great clinical expertise alone, only to become frustrated because patients are shocked and turned away by the treatment proposals made by these same very skilled dentists.
Interestingly enough, the only direct statement that Dr. Deming ever made about dentistry is on this subject. It is found in his popular book, Out of the Crisis. Here is his statement:
How many dentists do magnificent work? The question is impossible to answer for the simple reason that there has never been a definitive study of quality in the dental profession; nor is there likely to be one. This is partly because dentists tend to work alone, they resist the idea of being evaluated, or even observed by others. And because inferior dental work may not be discovered until years after it is performed, patients are seldom in a position to make informed judgments.
Every day we see many technically trained but frustrated dentists before and after they have learned the valuable lessons and true laws of case acceptance and then implemented them in their daily practice of dentistry. When they combine their newly acquired people skills with their excellent technical knowledge, their practices soar.
In addition to knowing how to provide high quality dentistry, it is important to understand the principles, the techniques, and systems that will open the minds and the hearts of patients to accept the clinical work you know how to do.
So, before you jump into any system, go to its foundation and look for the truths upon which it is based. Ask yourself if they are truths or half-truths, similar to the ones we have discussed. Never forget that when there is an error in the premise, there will always be an error in the conclusion.
Steven J. Anderson is president and co-founder of Dental Boot Kamp seminars and services that give dental teams the systems to combine people skills with technical expertise to help patients accept total treatment.