The importance of leadership

Last month we explored the notion that dental practice principals must assume a number of different roles, including those of entrepreneur and manager, and should not see themselves simply as dentists. This implies a clear need for leadership within the practice. Leadership isn’t often discussed in relation to dental practice and yet if one’s vision for the practice is to be transformed into reality then staff members must understand that vision, must be motivated and inspired to buy into and believe in it. For this to happen the principal must assume the role of a leader whom others can look upon to set the agenda, establish values and be an inspiring role model – someone who can motivate people to do their best. Unfortunately, because many practice principals only see their primary role as that of dentist (namely the technician role we discussed last month) then all the various leadership tasks tend to fall by the wayside, staff morale slumps and the business suffers. This month, therefore, we are going to look at the vital topic of leadership within the context of dental practice.

It is possible to categorise someone’s leadership style by contrasting their ‘concern for staff welfare’ with their ‘concern for the job at hand’ (see Figure 1 for leadership styles). Taking each of the four boxes in turn, in the lower right you have the type of person who assumes a rather authoritarian approach to leadership. The job is more important than the welfare of the person doing the job. This type of leader is intimidating, demands, even commands, respect and works in an atmosphere of fear and trepidation. Staff might put up with all this for a while but ultimately they will leave. The opposite is to be found in the upper left box. This is someone who tends to lose sight of the fact that work has to be done because he or she is overly concerned with the member of staff. Unlike the previous character type, this person desperately needs to be liked and doesn’t want to upset the apple cart, even if that results in a second rate piece of work. Perhaps the worst of all worlds is to be found in the lower left box. Here the ‘leader’ doesn’t much care about anything, little gets done and people just go through the motions, all of which has an extremely damaging effect on the business. Clearly the ideal leader is one who can balance the need for getting the job done with understanding the needs of staff members and clearly demonstrating concern for their welfare. Such people still gain respect, but this is mutual and is likely to result in staff that are loyal, hard working, proactive and enthusiastic. We all know or can remember people of each personality type and know the damaging consequences of an inappropriate management style. At this point it might be useful to reflect honestly on your own style of leadership in order to see where you think you fit. In the context of dental practice, we believe that a team leadership style is the one that will yield the best results and yet we all know that this isn’t necessarily that common, with many principals mired in one of the other three boxes.

Adopting a team leadership style is important for many reasons. A good leader will inspire confidence among staff that the business is in safe hands, that the person in charge will take care of things in the right way at the right time. It may be subtle but it is always there. A good leader demonstrates concern while at the same time showing that he/she means business. While this is desirable in relation to support staff, it becomes especially important when dealing with colleagues such as associates and hygienists. All too often, principal dentists are fearful of interfering with an associate’s work patterns for fear of upsetting them and rocking the boat. Unfortunately, this leads to what dental practice coach Simon Hocken has described as a ‘covered market’ in which ‘the owner’s surgeries are manned by market stall sellers who build or dismantle his reputation, while selling different opinions and services at many different qualities’. This clearly cannot be acceptable if the principal has an overriding vision of how the practice should operate. A laissez-faire style of management in this situation would see the principal avoiding discussions with the associate, while an authoritarian style would likely end up in confrontation rather than dialogue. The ideal approach is one in which the two parties come together, the principal explaining the need for such things as uniform service delivery, diagnostic criteria, fee structure, etc, regardless of which dentist you see. The result is a business culture that can be summed up as ‘the way we do things’ and which is consistent with the owner’s philosophy, vision and values.

From what we have written so far, it should be becoming clear that in order to exhibit good leadership you must first understand what drives you, your vision and the nature of your own values. There is a growing acceptance in the business world that firms holding a strong set of core values tend to be the most successful and stay around the longest. If your only value is making money, then this is not going to be enough to acquire and then retain the best people and to sustain success over the long term. As an example, consider the stated values of the Walt Disney Corporation. These are as follows:
• No cynicism allowed
• Fundamental attention to consistency and detail
• Continuous progress via creativity, dreams and imagination
• Fanatical control and preservation of Disney’s ‘magic’ image
• To bring happiness to millions and to celebrate, nurture and promulgate wholesome American values.

Disney’s board of directors see the primary role of their management team as ensuring that these values are upheld by everyone in the company, at every level, effectively therefore becoming the company’s lifeblood. Profits are seen as a natural consequence of adhering to these core values.

The subject matter of James Collins and Jerry Porras’ seminal book Built to last is visionary leadership built around a set of such core values as Disney’s. These are ‘…the organisation’s essential and enduring tenets. A small set of timeless guiding principles’. This demands the type of leadership that not only declares an ideology but also one that creates a culture so strong that there is an almost cult-like feel built around that ideology – think Steve Jobs at Apple. Companies with such leadership carefully nurture and select staff based on their fit with the core values. Google, for example, is notorious for its rigorous hiring practices, which are designed to wean out anyone who does not buy into the company’s philosophy 100%. Once core values have been established they can be used to guide staff development and to establish working procedures and practices (see Figure 2 – a model of staff development).

All this may seem a million miles from your own circumstances, but the same principles nevertheless still apply to small businesses as they do to corporate giants. A report complied by Laura Spence of the Institute of Business Ethics states that many owners of small firms are guided by strong principles even though they are rarely formalised into some kind of enforceable code of practice. The report recommends 10 practical rules for good business conduct and these might be a good starting point for appraising your own values. There is certainly very little in the following list that is not relevant to dental practice:
1. Establish your core business values and stick to them or your reputation will suffer
2. Welfare and motivation of your staff are critical to your success
3. Remember that the owner/manager’s business behaviour will be taken as the role model by staff
4. If you need a partner, make sure they share your vision and values
5. Work at your relationships with customers; they neither start nor stop when the sale is made
6. Do not knock your competitors
7. Stick to your agreed terms of payment
8. Record all financial transactions
9. Find at least one way of supporting communities in which you operate
10. If you are doubtful about an ethical issue in your business, take advice.

If you are a practice owner/principal you must think seriously about the underlying principles upon which you want to build your practice. Once you have thought carefully about, and established, your own values then you have a basis for explaining to other people what you expect from them. Strange as it may sound though, you may not be entirely sure just what your values are. They aren’t something that we often verbalise or write down. This is probably as good a time as any then to start thinking about them and to try to understand what really matters to you.

In an article that appeared in the Journal of the American Dental Association in 2008, Marc Cooper observed that: ‘Without core values clearly and solidly established at the heart of a dental practice, performance will always be limited.’ Cooper surveyed 1,000 dentists, asking them to list their core values. The results were as follows:
• Integrity (selected by 72% of dentists surveyed)
• Excellence (39%)
• Honesty (37%)
• Compassion (30%)
• Responsibility (29%)
• Respect (26%)
• Caring (26%)
• Commitment (25%)
• Service (23%)
• Doing the right thing (21%).

One dentist in Cooper’s paper explains how such core values translate into ‘how things are done’ in his own practice:
• Integrity – we are honest, we do what we say we will do
• Courage – we have the courage to do the right thing simply because it is the right thing to do
• Respect – we treat our patients and each other the way we would like to be treated
• Excellence – we strive for excellence in all we do; good enough is not good enough
• Improvement – we strive to get better at what we do every day
• Service – we are here to serve our patients at a level higher than they have ever experienced
• Profit – it is absolutely necessary that we are profitable because without profit we can serve no one.

This particular dentist’s entire business, leadership and management structures are built directly upon the foundation of these core values.

Clearly most practices don’t have the luxury of starting from scratch when choosing staff members, and it may well be that some existing employees just do not ‘fit’ with the practice philosophy. Under these circumstances the tough decision has to be made to let such people go and to take on people who are more closely aligned to practice values. Clearly this is not a decision that can be taken lightly and, while due consideration must be given to the various legal implications of such an action, it nevertheless remains a fundamental principle that a dental practice cannot achieve true success unless staff operate as a unified, motivated team. For that to happen everyone must sing from the same proverbial sheet of music, which means that they must, in essence, share the same basic values. Good leaders establish those values from the outset and then continually reinforce them.

Ron Dennis, MD of McLaren, recently explained the secret of his long success in the ultra competitive world of Formula One. He said ‘You have got to be true to your own values, so think about what you truly believe in.’

Every issue we are recommending one book that you might wish to read to give you a better insight into the topic under discussion. This month we suggest that you read Rob Goffee and Gareth Jones’ excellent book Why should anyone be led by YOU? Goffee and Jones assert that anyone who aspires to lead must understand that the power of leaders stems, ultimately, from their followers and that people who assume leadership (and that, without question, includes dentists who assume the role of owner/principal) must understand something about the complex nature of that role. A leader is much more than a figurehead. A leader is the person who makes the big decisions about where the business is going; the person who decides on the big issues, the issues that will make things happen that are different from the things that are happening now.

To finish with, look at Table 1, which lists some of the qualities of good leaders. By and large these can be learned and we do not believe in the widely held theory that good leaders are born and cannot be made.

Table 1: The qualities of a good leader

Vision – if you don’t have one, get one! Make sure it is achievable otherwise your staff will quickly become demotivated.

Clarity – you must be crystal clear on what you believe to be the important issues and then demonstrate an ability to break these down and explain them in a way your staff can understand. You need to be direct and straight with them and not ‘go round the houses’ to make your point.

Passion – you must have a passion for what you do but remember passion isn’t always enough. TV presenter and former boss of Granada, Gerry Robinson, says that: ‘Passion in the hands of those who lack judgement is the most dangerous thing I have ever come across, and it is far better to do nothing with a business than lead it passionately down the wrong path.’
Your passion has to be aimed at a target that makes sense.

Courage – being an owner, the boss, in charge of everything is quite frightening. You are usually risking your own money and often your family’s future. It is not for the fainthearted and real courage is required to see it through.

Rallying the troops – good leaders aren’t shrinking violets. This is not to say you have to be dripping with charisma, but you do need the ability to tell your staff that you are all in it together and make them feel that they would rather be with you than working somewhere else. People do actually want to be led, they want to respect the leader and they need to feel excited about the future. Remember, you set the tone that others will copy; your attitudes and behaviour will, eventually, permeate the entire company.

Consistency – this should speak for itself. Leaders cannot afford to be moody, dealing with one thing or one member of staff in a particular way one day and then adopting a completely different stance the next. As hard as it often is, you must take control of your reactions and strive to be level-headed, honest and decent in your dealings with everyone. Similarly, be consistent in your goals. People have to feel that the way ahead is clear and not constantly changing tack.

Delegation – you cannot do absolutely everything yourself. Good leaders identify what they are and are not good at and then hire the right people to take over those latter tasks. Don’t be frightened of letting go.

So there you have it. No one is saying you have to suddenly become Winston Churchill or Richard Branson in order to run your practice more effectively, but please give some thought to the notion of leadership and we are sure that the effort will repay you handsomely.

Further reading
Goffee R, Jones G (2006) Why should anyone be led by YOU? Boston: Harvard Business School Press

Collins JC, Porras JI (1997) Built to last: successful habits of visionary companies. New York: Harper Collins

Cooper MB (2008) Core values and practice success. J Am Dent Assoc 139: 1405-6

Spence L (2000) Priorities, practice and ethics in small firms. London: Institute of Business Ethics

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