Defining Your Practice Culture

Some practice leaders might see leadership in terms of profit margin. Others take a more holistic approach to leadership where business is important but, to function well, the staff and patients must be front and center.

Recently, I had the pleasure of chatting with Geri Gottlieb, a practice coach and dental consultant that I frequently work with, about the components of being a practice leader. Geri is also a close friend. A native of Seattle, Washington (and huge Seattle Seahawks fan), she now calls Palm Springs, California, “home”. Before being a practice coach and dental consultant, Geri had a series of serendipitous events that brought her to dentistry.

While working in retail, Geri met a dentist who invited her to work as a dental assistant in his practice. After noticing her strong skills with patients, the dentist asked her if she wanted to be his practice’s treatment coordinator. Through the years, Geri became an experienced practice manager and patient treatment coordinator in general, orthodontic and periodontal offices. She also knows the ownership side from her years owning a periodontal practice. This allows her a unique perspective to better understand the multiple silos in our industry; clinical, leader, manager and owner. Beyond her personal experience, Geri has worked with ACT Consulting and hundreds of dental practices to improve their practice management experience and outcomes.

Dr. Dennis Hartlieb: Geri, I recently read Patrick M. Lencioni’s book The Ideal Team Player: How to How to Recognize and Cultivate the Three Essential Virtues. I read one story that stuck out to me: there's a conversation between a new CEO and his leadership team. The CEO is talking about bad apples in the practice or bad apples in the business: employees who don't fit corporate your culture. The most unhappy people in a company are the ones who don't fit the culture. And yet we allow them to stay. They know they don't belong. Deep down inside, they don't want to be there. They're miserable. Although we’re talking about the employee. it's really more about the leadership. Because as business owner, we've all been there. We have team members who are a poor fit for the culture and for the organization. And yet we do nothing about it. So, Geri, talk to us about this is one aspect of leadership.

Geri Gottlieb: Well, that's a pretty loaded question. What I will say is this: when you have not clearly defined and communicated what your culture is supposed to be, what you are striving for? What is the vision and what are your core values that you as a team have to operate? How are we going to get to the vision? It's hard to hold someone to a culture that you haven't defined.

Dr. Dennis Hartlieb: So when you are working with dental practices, how often do you find that the culture is not very clearly defined?

Geri Gottlieb: Almost every time. My husband challenged me at one point and said “Why do you need a dentist to tell you his or her culture? You go into the practice and watch and see what the culture is.”

Dr. Dennis Hartlieb: So, almost like an accidental culture versus an intentional culture?

Geri Gottlieb: Correct. What's harder still is when a practice has done the work of defining the culture, they did that with an existing set of team members. So those team members were not necessarily hired or onboarded into a standard and culture that is intentional. So, now they're hearing of this culture that the doctor or the practice owner wants. But that one isn't what they signed up for.

Dr. Dennis Hartlieb: What if a practice manager were to maybe re-interview people based on “I haven't practiced the way I wanted to or the culture of the practice hasn't been the way I wanted to. But now I want it to be the Disneyland of all practices”? And what if this person says “Well, I have zero desire to work at Disneyland”?

Geri Gottlieb: One of the I things I think you're getting to is that sometimes, and not sometimes almost all the time, I will see a team member-- maybe they are an assistant, a hygienist, or administrative team member-- who has really, really good skills. Maybe it’s clinical skills or skills for treating patients or whatever. But they don't fit the culture. They're not Disneyland. They're grumpy. But we allow it. Because the other skills are so strong, and we think we can't do without those. We do not see how destructive allowing this is over time.

Dr. Dennis Hartlieb: I think in my experience, it's been the “fear of the known” versus “the fear of the unknown”, for sure.

Geri Gottlieb: Right, “the devil we know” versus “the devil we don't”. It’s stressful having to find the new team person to replace that team person, given that they're doing a good job for their task or their assignments. And you sort of put it off and say, “Well yeah, she's kind of a pain in the butt. We're all going to sort of deal with her because she does some things really well.”

Dr. Dennis Hartlieb: So now, I have another question. Let's say I have a dental assistant who clinically is really good, but she's just not nice to patients. Now, fortunately I am not currently experiencing this situation, but I have experienced that situation before. I know this person can get the rooms turned over. I know she knows the materials. I know it's going to be a smooth operation. However, my staff and I just have to apologize on her behalf a lot to the patients. So now I have to go and say, “Look, you're not a cultural fit to our practice because we expect you to be nice to people.” We have had conversations about needing to see improvements, but improvements aren’t happening. So now we have to make this difficult decision.

Geri Gottlieb: Right. Well, the quickest way to think of it is “What happens if you take a bruised apple? And put it in a bin with healthy, beautiful, shiny apples.” They all go rotten, right? Does the bruised apple become shiny and beautiful? No, not at all. that's the same exact thing that happens on a team if you want to demotivate and devalue a team. Go ahead and tolerate the bad behavior or behavior this and or and tolerate this at someone on your team that doesn't fit the culture or doesn't values that you want to have.

Dr. Dennis Hartlieb: And that's because people say “If he or she can get away with it, then why am I being held to this level? If they don't have to be held to that level, is that the bottom line?”

Geri Gottlieb: I think that's the bottom line. Whether that's spoken or unspoken or even consciously thought about or not, staffers start to get like you get frustrated. You get frustrated if you're the shiny apple and you're trying your best and you want to be that Disneyland of the practice, if you want all those things and you're working at that and someone else isn't and it's been tolerated. And yet we get talked to about where we have our shortcomings or these other standards, but we still are seeing that there's a tolerance over here. We just think “Why bother?”.

Dr. Dennis Hartlieb: You know, again, in this book, The Ideal Team Player, the author points out that often good players will leave the team because they get tired of the bad players being accepted. And it makes their job harder and harder to make up for them. They say, “Adios out of here!” And then you hire new people who are influenced by the bad apples. Then your culture is shifting because a new people you're hiring are now influenced by the people stuck around instead of getting rid of the bad apple.

Geri Gottlieb: Yeah. That's a real challenge. I think that happens all the time and almost every practice. There's usually one bad apple or maybe a couple. You have about a certain percentage of employees that want to be great. They are happy and energetic and want to feel good about the work that they do. Then you have a certain percentage that's on the other side of the fence: nothing's ever going to be right. Nothing's ever going to be good enough. And I call those “still people”. They are still complaining. Still not happy enough. Still not making enough money. Still not fulfilled enough. Still, still, still. Then there's the people on the fence between being a bad apple or a good apple. But it's just like the apple analogy. If you are on the fence, we would think that this healthy side, the Disney side, is where you're going to want to fall to. However, what the brain and what neuroscience tell us is that we actually are more easily pulled to the negative side. It’s more interesting than the positive side.

Dennis Hartlieb: I also see this when you allow that team member to stay on the team. In some cases, it's a leader like an office manager. If your leader has a negative or on the fence attitude, that is going to set precedents for everything. What's allowed there?

Geri Gottlieb: The really great employees or employees with potential are those want to learn and grow. They become really oppressed. When I watch an owner or a doctor finally realize “I actually can't keep this in the practice anymore. I don't care how good the schools are because we can train skill.”
When that person is released to a different future or to a different place. It's amazing to watch other team members all of a sudden rise up and flourish.

Dr. Dennis Hartlieb: Yeah, that's interesting. I've seen that my own practice.

Geri Gottlieb: I just went through that very same thing with a clinical lead assistant with 25 years of experience that the dentist thought he could not do surgery without: “Yes, she's emotionally low intelligence. Yes, she fusses with the team all the time. Yes. We have to have the same conversation with her about how to behave and how to engage and how to talk. But she's so good here. I don't know if I could do that without her.” Finally, his team went to him. I don't advise team members to do this per se, but they did go to him with an ultimatum, which was “You can keep her, and we'll all free up our futures to go somewhere else.” They weren't angry about it. They just demanded change.

Dr. Dennis Hartlieb: It's funny. It takes that to force a leader, an owner to recognize what they already know and then to act on it. It’s not uncommon though. I think that it may not be that that visible, but I think very commonly you have people on your team that are coming to you over and over, like, “Why are you putting up with this crap and why do we have to deal with this?” Yeah, we know. And we just we play it off, right?

Geri Gottlieb: Right. Because it's hard.
It goes back to the very thing that you and I talk about so much and what you talked about: it’s what most of you don't want to have to deal with. You just want to do dentistry and not manage the team sometimes.

Dr. Dennis Hartlieb: It's interesting. One of the things you hear, dentistry, was “Faster hire and slower to fire”. My old college roommate who's in corporate management said it's not just dentistry. It’s everywhere. It is hard to replace people because of the fear of the unknown. So, it made me feel better because I worry that because I'm a dentist, I'm going to be a bad leader. But the root of this problem is throughout management.

Geri Gottlieb: We need to reverse that. I want you to be slower to hire. And even then, we're not guaranteed that the person that we're hiring, no matter what process we have gone through, even if we are clear on our culture, clear on the values, clear on the expectations that we're hiring a right fit.

Dr. Dennis Hartlieb: So, one of the cultural things Zappos does after 90 days that the employees have been with them, they give the opportunity for a for the employee to go away. They will give the employee a check, and the employee can take the check and leave. Or they can rip up the check and stay with the corporation. It’s sort of like a decision tree to see how much the employee fits in with the culture. They could be acting within it for 90 days. They could be playing the role. But inside, they might be thinking, “Oh, this is just a bunch of crap, you know, but I'm getting a paycheck.” But that is one way they have found that helps those who aren't a good fit for the culture to move on. And I've always thought that's a good thing. We've never done that, but I've always thought that's a good, interesting way to sort of shake out the bad apples.

Geri Gottlieb: Absolutely. I think Ritz-Carlton or the Four Seasons have a very similar process as well. It’s a great way to say, “No harm, no foul. Here's a check. You know, if a you're not a right fit for this culture or if we're not a fit for you.”

Dr. Dennis Hartlieb: It totally struck me after twenty-eight years in dentistry, how important culture is. It’s like “You're all exceptionally smart. You wouldn't be here. You wouldn't be dentists.” We all can talk about strategy. We can talk about marketing. We can talk about finances. We can talk in all of those things. But if they don't have the foundation of a healthy culture, of a behaviorally healthy team and leadership the rest of this stuff actually doesn't matter. Because businesses, whether it's dentistry or otherwise, don't go out of business because they're not smart.

Geri Gottlieb: Say that again.

Dr. Dennis Hartlieb: They don't go out of business because they're not smart. They go out of business more because they're not healthy.
I think people can recognize it. Don't you? You can walk into a business that is culturally healthy and actually feel it.

Geri Gottlieb: Oh, absolutely. And I think the more we learn about it, the more we recognize it, which is why they have a culture and core values to guide them and how they hire and fire. You could maybe walk in a business and sort of feel that. You didn't put your finger on it. Like you're not quite sure what's going on here, but you can tell it's not quite a good culture. And then you could walk into somewhere else and be like, “Oh, my goodness, you know what's different here?” and not necessarily put words to it. But when you start to pay attention and do work yourself and dig it into what you want your own culture to be, you can see how culture affects business health. In our next post in the “Dental Leadership” series, we will talk more about how you can define your practice core values to support your culture. Stay tuned!