Practice success is defined across the four ‘dimensions’ of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the ‘secret’ of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising ‘secret’ perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this ‘secret’ seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored.
Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.
Article
What is success? How important is money?
The ‘secret’ of success in dental practice is to make patient satisfaction the primary focus. Not a very earth shattering or surprising ‘secret’ perhaps! It is hardly a new idea! Newsome, for example, makes the same point eloquently in his publication The Patient Centred Dental Practice.1 As we progress through this series, we will revisit some of the evidence presented by Newsome and further literature confirming this ‘secret’. Additionally, we will explore the evidence for the aspects of our service which are most important in achieving patient satisfaction, and therefore success.
This first article will consider the meaning of success and the importance of financial profit to our success.
What is success?
The Concise Oxford Dictionary defines success as:
‘Favourable outcome, accomplishment of what was aimed at’.
‘The continuous accomplishment of planned objectives which are worthwhile’.
He believes that the journey towards the planned objectives is the vital element of success. As Wendell Holmes, the 19th century physician turned writer, said:
‘The great thing is not so much where we are, but in what direction are we moving’
(Wendell Holmes 1841−1935).
Success may therefore be viewed as a journey in the ‘right’ direction towards one's purpose or one's worthwhile objectives in dental practice. So what is the purpose of a dental practice? Levin3 posed the question: ‘What is the purpose of a dental practice?’. He defines a dental practice as being:
‘A business focused on providing high quality oral care for patients’.
He identifies three key objectives:
To provide an income to the dentist;
To satisfy the employees;
To service customers or patients.
These three objectives are generic and could be applied to any business. If your business was hairdressing then, additionally, your non-generic primary purpose might be ‘to provide high quality hair care’ for your clients. I would suggest that with any business there is a fourth dedicated objective, or primary purpose. In the case of a dental practice this is, in Levin's words, ‘high quality oral healthcare’. The purpose of high quality oral healthcare is to support patients towards optimal oral health. Therefore, four dimensions of success in dental practice will be explored in these articles (Figure 1):
Financial profit;
Oral health (the primary purpose);
Job satisfaction for the whole dental team;
Patient satisfaction (the primary focus).
Figure 1. Successful dental practice, the simple model.
Financial profit as a dimension of success
The fact that any business needs to be profitable in order to survive, re-invest and prosper is so self-evident that no supporting literature is needed. Clearly, it is an essential dimension of dental practice success.
Finance and funding of healthcare organizations has always been a politically sensitive issue. Achieving financial success in dental practice is as important as it is with any other form of business. Without adequate funding, patient care and team development (the other dimensions of success) will be compromised. However, Newsome1 states:
‘Despite being the ultimate business goal, profit isn't necessarily the best measure of how well a commercial enterprise is doing. Answering the question often asked by dentists, namely. ‘How successful is my practice?’ may not be as easy as it seems.’
He logically suggests that profit is closely related to:
Customer retention − which is more likely with….
Customer satisfaction − when patients value care because they have….
Perceived service quality – which is better in practices which achieve….
Employee retention – which is associated with good leadership achieving….
Employee satisfaction – which is consistently higher when….
Internal service quality is high.
He calls this set the ‘Service Profit Chain’. All of these factors can be measured and endorse the selection of our dimensions of success. Newsome suggests that these six factors are better indicators of long term success. Profit focus alone means constantly looking backwards, having a short term focus and potentially poor customer focus as a result.
Julian Richer,4 the founder of Richer Sounds, expressed similar views and wrote:
‘Most businesses make the mistake of measuring their performance in terms of figures when they ought to be measuring it in terms of people. The primary measure of a business's success should be customer satisfaction not profits. Profits are simply an indicator that you are getting customer service right. Anyone can play around with prices to push sales and turnover up. You can mess around with margins and hammer costs to make profits look good. But these are short term ticks. Unless the customer is happy the business will not last.’
Newsome1 points out that, of the 43 ‘Excellent’ companies chosen by Peters and Waterman5 on the basis of such measures as profit and financial growth, only 14 were doing well five years later, and only five continued to prosper ten years later. In fact, once confronted with the long-term results of the ‘Excellent’ organizations, these writers claimed that the essential message of their book, In Search of Excellence5 was:
People (who work in or with the organization);
Customers;
Action.
It was suggested that the book had turned these ‘soft’ factors into ‘hard’ ones when previously the only ‘hard’ factor was ‘numbers’ (or finance). This book sold 3 million copies in its first 4 years and is considered to be one of the most read business books in history. Eight themes common to ‘Excellent’ organizations were identified and these included:
Close to the customer − learning from the people served by the business;
Productivity through people − treating rank and file employees as a source of quality.
This endorses later claims about the book. Perhaps these companies only measured the hard financial numbers and failed to measure the ‘soft’ issues adequately, such as those recommended by Newsome. They perhaps failed to respond early enough to the ‘people issues’ as they declined?
It is not suggested that vital financial budgeting and monitoring of the practice should be neglected. Making profit the primary focus, however, could lead to long-term failure. The evidence suggests that, if the team is happy and the patients are happy, good profits will flow naturally. This is, of course, as long as prices are set correctly to leave patients feeling that they are receiving good value while the practice is adequately funded. Further evidence for the views of Newsome and Richer now comes from the American Strategic Planning Institute.
The PIMS (Profit Impact of Marketing Strategy) project was started by Schoeffler at General Electric in the 1960s. Harvard's Management Science Institute continued the work in the early 1970s. It has been administered by the American Strategic Planning Institute6 since 1975. General Electric originally wanted to know why some of their units were more profitable than others. So, they collected data on dozens of variables in each unit. The research was eventually extended beyond GE to many other businesses. ‘Product quality’ and ‘service quality’ were found to be two of the most highly correlated variables to profitability. The database now contains information about strategy and performance from more than 3000 businesses. It demonstrates that a focus on quality buys businesses the following key advantages:
Stronger customer loyalty;
More repeat purchases;
Less vulnerability to price;
Ability to command high relative price;
Lower marketing costs.
Conclusion
Success is achieved by moving towards your worthwhile purpose.
The purpose of a dental practice is to achieve happy patients, healthy patients, a happy team and healthy finances.
Short-term and narrow focus on profit alone may lead to long-term failure.
Patient satisfaction seems to be the key to success as long as fees are set to balance value for money for the patients with the funding needs of the practice.
