The Journey is What Matters

Evaluating the quality of your practice model based solely on patient starts and treatment finishes overlooks the most substantial portion of the care you provide, the patient’s journey. The time spent with our patients throughout is the most impactful portion of the treatment process, yet it often receives the least amount of attention. How your patients’ feel about your brand and what they tell their friends, as well as their desire to do so, is the result of all their interactions with your practice, so delighting patients at every step of the way should be your mission.

An integral part of designing exceptional patient experiences is also considering the appliances and treatment approaches that are used to achieve similar goals. Yet, all too often I hear dismissive statements like “all appliances can deliver the same outcome” and decisions being made on the basis of the doctor’s comfort level with a particular treatment. Experience driven treatment is not appliance drive treatment. It is simply the recognition that appliances should be selected in order to provide the best possible experience for the patient.

To develop a better understand how our decisions impact the patient’s journey, it is helpful to map out the patient’s (and parents’) entire treatment experience and examine what they thinking and feeling throughout the process. This should be based on a real information about their behavior, thoughts, and feelings throughout their journey, paying attention to key “stress points” like an initial phone call, initial appliance placement, repair appointments, etc. A very basic example of what a various treatment journeys might look like for different appliance choices is show below:

On one end of the spectrum you see a treatment approach where the patient’s experience has been exceptional across the board; while on the other end, we see a fairly generic brand experience where uncomfortable, outdated appliances are used, creating a substantial decline in the patient’s experience during the treatment phase. The cumulative differences between the two experiences represent a huge missed opportunity to drive word-of-mouth referrals and better patient motivation.

Ironically, most orthodontists are completely unaware of any problems in their approach because their patients are all on similar treatment arcs and there is little outside perspective. Both the doctor and the patients have simply accepted things as the way things are, and the only way to break the cycle is by actually performing a critical examination of patients’ treatment journeys using qualitative and quantitative measures.

By visualizing their journey in this fashion, the focus can now be on engineering an optimal customer experience that drives value and practice growth. Unnecessary pain points can be identified and eliminated, and investments made to create more positive movements in the patient’s journey. Treatment goals are extremely important, but the patient experience is just as important so it should not be overlooked.

Learning From Failure

Failure is not something we like to consider. But oftentimes, experiencing failure is one of the ways we grow and become better. Making mistakes often means you are trying, and learning from failure is a key factor. We all will experience failure at some point in our lives. It becomes critical to avoid repeating those failures and accept that not all failures are bad.  We should properly learn from such difficulty. Even a genius like Einstein, made many mistakes.

The opportunity in failure is not commonly acknowledged since failure is regarded as always being bad. Certainly there is bad failure, but there is failure that is sometimes unavoidable, and at times a good thing. Developing a process to detect the failure and properly learning from it is not easy.

We should avoid jumping straight into finding blame, and build a learning culture in our practices. Blame prevents failure from being reported, and this is a basic step for your team to learn. A learning culture also offers the opportunity for your team members to take risks. No risk, no reward. In a blame culture, as opposed to a learning culture, team members will avoid experimenting, developing and implementing change. Because change is risky, and can lead to failure, it is often avoided. Change continues to happen all around us, so we must accept failure is bound to happen if we plan to embrace change, adapt and grow.

When considering strategies for learning from failure, Amy Edmondson suggests a spectrum of failures that start with blameworthy failures and progresses to praiseworthy failures. This allows us to see that not all failures are equal:

Let’s consider acknowledging failure and finding its causes. Once we avoid denial and embrace a process of learning from failure, we can stop living behind excuses and work to make our future better.

Campfire Stories

If you love camping, there is nothing like a campfire, or maybe you are more like me and enjoy a fire pit in your backyard and your own bed and indoor plumbing!  Either way, stories shared around a campfire, a fire pit and even at bedtime (for those with small children) are an amazing way to grab attention from a child, friends, and neighbors or maybe even your spouse as you share a compelling story that captures their attention and even their imagination.

Stories help people understand, experience and even imagine themselves in similar circumstances.  Stories bring confidence, self-esteem and excitement especially if they are about them (like the stories I tell my children about their crazy antics when they were younger!)

If I want to keep my teenagers engaged at dinner, nothing beats telling them about the time my older daughter tried to poison her younger brother, or the time my son had fallen down, hit is head and came home 1 hour later with dried blood all over his face (of course he had no clue!)  Another hot topic is my husband telling them stories about his teenage years, which thankfully they have not imitated!

As an orthodontist, I have seen the power of story when I share in a new patient exam how one of our patients started treatment never smiling and with no eye contact or energy. The story goes on to share how the patient’s entire personality and smile transformed over the next 6-12 months.  By the time they had their treatment completed,  they would not stop smiling and strutted into their retainer appointment like they owned the place.  Simply awesome!

Not only can you share these incredible transformation stories with other patients to help motivate them and get the parents excited about treatment, you can share these stories with your team too.  Have them get really good at telling stories to their circle of influence in their communities.

Build a culture in your practice that is excited about what great work they are doing.  Get your team to tell those stories to friends, neighbors and other people in their circle of influence.

You could even have a “story of the day” in your morning meetings and have different team members be responsible for sharing those stories.

Think of the buzz these stories can create about your practice and provide the needed “fuel” to power those continued referrals into your office.

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HIPAA Compliance

As “covered entities” under the HIPAA Privacy Rule, orthodontists are required to safeguard all Protected Health Information (PHI). Under the law, PHI is defined as individually identifiable health information that relates to the individual’s past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.

Keeping this information secure in the digital age can be quite challenging, especially with day to day communications to patients and between doctors. Fortunately, options like Google’s G Suite have made this easier while also allowing doctors to work with familiar web services like Gmail, Calendar, etc. By using Google G Suite for Business, signing the G Suite Business Associate Agreement for covered entities, and adjusting your account settings according to Google’s straight-forward HIPPA implementation guide orthodontists can very easily remain compliant with all their communications. 

G Suite offers all users access to ‘Core Services’ including Gmail, Calendar, Drive, Google Hangouts (chat messaging feature only), Hangouts Meet, Keep, Google Cloud Search, Sites, and Vault for use with PHI under the G Suite BAA as long as the health care organization configures those services to be HIPAA compliant as outlined in their implementation guide.

‘Non-Core Services’ as well as the Core Services Contacts, Groups, and Google+ (subject to change) do not offer functionality where PHI is ​permitted. ​G Suite administrators can choose to turn on these remaining Core Services, but it is their responsibility to not store or manage PHI in those services. Before switching on or using third party services connected with any of the core G Suite you must verify that the integration is HIPAA compliant.

While everything will be encrypted and compliant within your organization, many doctors ask about how to handle emails containing PHI outside the practice to potentially unsecured email servers that are unencrypted. When emailing patients their information directly, just like we all do with appointment reminders, you simply ask if it is ok to do so and inform them of the possibility that they may be using an unencrypted email service.

If you are sending documents or written emails with PHI to other doctors to coordinate and communicate about patient care, you will need to utilize Google Drive to make sure that all PHI remains on your secure servers (some practice management softwares and paid services offer this same ability as well, though I wouldn’t pay extra if you can just use G Suite). Not all doctors utilize encrypted email servers so it is better not send any PHI in the body or subject of the email and instead simply share access to a ‘Folder’ on Google Drive, where they would then have to log in to access the information securely. Do this by toggling the share settings for a folder to ‘Specific People’ and entering their email of the doctor for whom you want to provide secure access.

Setting a Business Strategy

Any business, orthodontic practices included, should have a strategy in place. Setting a strategy, and incorporating true strategic thinking are critical. A commanding general should have a strategy to go into battle and a coach should have a strategy before playing a game. Otherwise they could suffer heavy losses. Similarly, we must consider strategic thinking as a factor for success in the core competencies of an orthodontic practice.

As a business is developed, a strategic plan should be set in place. These plans begin by incorporating a vision or mission statement. These are the goals set for the business and set the tone for the core strategy. The second component is a list of initiatives that the business will carry out to pursue those goals. These initiatives devise the larger part of a business plan, with a long affirmation of the core competencies. Finally, the planning is rounded out by the financial projections that will set budgets for the business.

The challenge continues in that business strategy is not a static exercise. As a practice grows and years go by, planning needs to evolve into true strategy. A plan and a strategy become inherently different. Where planning looks at cost allocations, strategy focuses on revenue. That focus should incorporate the customers that will affect that revenue. Strategic positions can be based on the needs of our customers, their accessibility, and the variety of the products and services we provide.

Planning can’t and won’t make revenue magically appear, and the effort you spend creating revenue plans is a distraction from the strategist’s much harder job: finding ways to acquire and keep customers.” Roger Martin

Strategic thinking becomes more important since it focuses on long-term goals of growth and revenue creation, versus the short-term goals from planning. Our focus should be on the top line vs. the bottom line in orthodontics. Certainly, planning on bottom line gains are key components in business where revenue can be profitable for that business. But it is strategy that compels customers to give the company that revenue. The trap for strategy makers lies in the way planning and cost management commonly dominate strategy rather than serve it.

Strategic thinking should be considered regularly to maximize the potential of several components of an orthodontic practice. These should include clinical strategy, financial strategy, marketing strategy, strategy in the implementation of technology, and a strategy in maximizing human capital.  Ultimately, who will you target and how will you target them?  Those questions help to set your strategy for success.