GeneralDentalPractice

Mike Busby

The ‘Secret’ of Success Part 1

Abstract: 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.
Dent Update 2011; 38: 133–135

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
Mike Busby, MPhil, BDS, LDS RCS, DGDP,
FDS RCS(Edin), Dental Advisor Denplan,
Hon Lecturer in Primary Dental Care,
University of Birmingham, St Chad’s
Queensway, Birmingham B4 6NN, UK.
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’.
To succeed is defined as:
‘Accomplishing one’s purpose’.
Turner2 defines success in a
similar vein:
‘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:
1. To provide an income to the dentist;
2. To satisfy the employees;
3. 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).

March 2011 DentalUpdate 133

 GeneralDentalPractice
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:
1. Customer retention − which is more likely
with....
134 DentalUpdate
2. Customer satisfaction − when patients
value care because they have....
3. Perceived service quality – which is better
in practices which achieve....
4. Employee retention – which is associated
with good leadership achieving....
5. Employee satisfaction – which is
consistently higher when....
6. 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.
March 2011

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
Book Review
The Anatomical Basis of Dentistry. By
Bernard Liebgott. Elsevier, 2009. ISBN
9780323068079.
The Anatomical Basis of Dentistry is an
extremely comprehensive and detailed text
relating to gross anatomy and assembled
specifically with the needs of students of
dentistry in mind. It also provides good
electronic resources as useful additions to
the printed matter. The text is organized
predominantly in terms of anatomical region
but Chapters 1 and 8 introduce systemic
anatomical concepts. Chapter 1 also includes
some general, but important and frequently
neglected topics, such as fascial planes and
serous compartments. The final chapter
provides an invaluable aid to students,
providing dental applications of anatomy
including local anaesthesia, clinical imaging
and surgical procedures. Between the first
and last chapters are sections based mainly
on anatomy by region, with emphasis given
to the head and neck in extensive sections on
‘The Neck’ (Chapter 5), ‘The Skull’ (Chapter 6),
and ‘The Head by Regions’ including contents
of the neurocranium (Chapter 7). By necessity,
in a regional approach there is a tendency
for important systemic concepts to become
fragmented between several chapters. Here,
the spinal cord is included in Chapter 2, ‘The
Back’, while its anatomical and functional
continuity with the rest of the central and
March 2011
advantages:
1. Stronger customer loyalty;
2. More repeat purchases;
3. Less vulnerability to price;
4. Ability to command high relative price;
5. 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.
peripheral nervous system is covered in other
chapters. However, the nervous system as a
whole is described in Chapter 1.7 ‘The Nervous
System’ and Chapter 8 is devoted to ‘Systemic
Anatomy of the Head and Neck’, including
cranial nerves and autonomics. Chapters 4,
9 and 10 cover abdominopelvic viscera and
upper and lower limbs, respectively, and may
be considered by some to contain information
redundant to some dental courses, although
the rationale for including them is made clear
in the Preface.
Each chapter has a set
of multiple choice questions for students to
self-test their knowledge and understanding.
In the opinion of this reviewer the means to
accessing answers to these questions was not
immediately obvious as they are not listed
in the Table of Contents (although they were
eventually found on p.489). The illustrations
are simple but skilfully constructed to
demonstrate key concepts, for example by
using colour to emphasize specific structures.
This approach can in some texts lead to an
oversimplification of the true anatomy, but
here, used in conjunction with photographs
of dissected specimens and high quality
radiological images, complexities associated
with ‘real anatomy’ are conveyed. A major
strength of the book is the section on
clinical applications of craniofacial anatomy
and additional clinically relevant examples
are associated with individual chapters
GeneralDentalPractice
References
1. Newsome P. The Patient Centred
Dental Practice. London: British
Dental Association Books, 2001.
2. Turner C. Born to Succeed.
Shaftesbury, Dorset: Element Books
Ltd, 1994.
3. Levin R. The purpose of business.
J Am Dent Assoc 2003; 143:
1118−1119.
4. Richer J. The Richer Way. London:
Emap Business Communications,
1995.
5. Peters T, Waterman RH. In Search of
Excellence: Lessons from America’s Best
Run Companies. New York: Harper
and Row, 1982.
6. American Strategic Planning Institute
(Since 1975). The Profit Impact of
Marketing Strategy.
throughout the book. In conclusion, The
Anatomical Basis of Dentistry is eminently
suitable for undergraduate students
wishing to consult a single comprehensive
text focusing on gross anatomy. It may be
necessary, however, that tutors recommend a
separate neuroanatomy text as the coverage
of this notoriously difficult topic is dispersed
across more than one chapter. Students will
also need to consult a separate text dealing
with microanatomy/histology which is not
covered here in any depth.
Dr Ruth E Joplin and Dr Susan M Davis
College of Medical and Dental Sciences
Birmingham
DentalUpdate 135