The Power of Saying No
Setting nonnegotiables can help dentists stay in their wheelhouses and protect their patients and businesses
Randy Leininger, MBA
In June 2021, I launched a business plan that I had developed as my MBA capstone project. The plan was for a dental laboratory that only accepts digital impressions, only provides posterior zirconia units, and only offers three shades—nothing more, nothing less. Our first phone call was from an office telling us they had a case for us to pick up (a VPS impression). It wasn't for a posterior unit or in a shade that we offered, so it didn't fit our business model in any way. Unfortunately, I told them, "I'll be down to pick up the impression ASAP!"
I won't bore you with the details, but over the following 2 weeks, we had to remake the case twice, which didn't wow the patient or the practice and ultimately lost us money. What's worse is that we lost any future opportunity with that office. When they called us the first time, the best thing that we could have done for that practice, their patient, and ourselves would have been to say, "Sorry, we don't do that."
Most of us are familiar with the phrase, "in my wheelhouse." When dentists are in the wheelhouses of their practices, they are providing their patients with care that is arguably unsurpassed in their areas. However, dentists are also humans, and a host of siren songs can tempt them to leave their wheelhouses when their businesses and patients would be better served by them saying no.
This siren song coaxes clinicians toward the "rocks of productivity" and influences them to provide treatments that they otherwise would have referred out if the schedule was full. From the Bible's Proverbs 16:27 admonishing that "idle hands are the devil's workshop" to the band Styx's 1981 hit reminding you of the calamity of having "too much time on (your) hands," there is plenty of justification for the discomfort that dentists feel when there are holes in their schedules. When a dental practice is idle, it's burning cash, and the heat from that fire can cause doctors to say yes when they should be saying no. Holes in the schedule can also tempt them to add treatment to an already full day because the patient can't come in when there is an opening.
The Excitement of Something New
Several years ago, a dentist friend asked me if he should spend tens of thousands of dollars on an in-office milling setup. I could tell that he was excited about the technology. I asked if he wanted my "practice manager" answer or my "supportive friend" answer.
"I want the supportive friend to answer," he replied. "I just think that the technology is so cool. It would excite me to come to the practice and know that it was there to use. It just looks fun." Unfortunately, over the last 10 years, the fun has worn off, and now the new toy is just a piece of deprecated equipment that must be regularly repaired and updated at his ongoing expense.
Keeping Up With the Dr. Joneses
It's easy to feel left behind when you see other general practices in your area offering orthodontics, implants, endodontics, dentures, in-office whitening, free whitening, sleep appliances, same-day crowns, and even Botox treatments, foot massages, and other treatments. Imagine all of the additional revenue! Imagine not having to tell a patient no when asked, "Do you folks do (whatever) here like Dr. Jones's office?"
Providing an outstanding patient experience is more important than ever in a world where nearly all patients have a digital platform to share their opinions about their dental practices. When a practice attempts to provide customer service that is outside of its wheelhouse, it is often reminded that "no good deed goes unpunished."
A prime example is when practices attempt to "verify" what portion of the treatment cost the patient's dental plan will cover. Unless you have a dental plan expert in the front office or are using a third-party insurance processor, providing any degree of certainty about what a plan will or won't cover is leaving the wheelhouse. I don't know of a practice that hasn't ever been burned by providing an estimate that ends up being wrong and results in a greater out-of-pocket expense for the patient. I also don't know of a practice that hasn't ever written off the difference to calm an upset patient. The good news is there are ways to answer this question (and others) without leaving your wheelhouse.
Staying in Your Wheelhouse
What steps can we take to make sure that saying no becomes a strength and that we avoid the pitfalls of feeling the pressure to say yes?
Step 1: Set Your Nonnegotiables
The concept of setting nonnegotiables is something that I use on a daily basis in many aspects of my life outside of business. The concept is simple: what actions or situations are always a "hard no" when presented? As the captain in the wheelhouse of your practice, you need to determine what is nonnegotiable. Decide which treatments you perform and which treatments you refer to specialists. Decide which dental plans you accept and which ones you do not. Decide how much time is blocked out for which procedures and when you will see emergency patients. Create a nonnegotiable practice model and stick to it.
Step 2: Great Expectations
Your nonnegotiables are useless if they only exist in your mind. They need to be communicated to your team and your patients. To help manage patient expectations, you should put everything in writing. It's also a good idea to put it on your website. To help manage employee expectations, create job descriptions for team members and have them sign a copy to confirm that they understand what is expected of them. In addition, get in the habit of having patients sign documents to acknowledge that they have received treatment and cost information. I love when practices have a form to set expectations for possible variances in dental plan coverage estimates. A simple statement such as, "Coverage estimates are provided as a courtesy, and any additional treatment cost will be your responsibility," can help to avoid misunderstandings.
Step 3: Public Executions
After setting and communicating your nonnegotiables, be very vocal and firm about their enforcement. If you have a nonnegotiable team meeting that starts at 7:30 am each morning, don't make an exception for the team member who can't get there until 7:45 am. By allowing an exception, you are communicating to all of the other team members that the start time of the meeting is negotiable. If they perceive that the start time of the morning meeting is negotiable, then they may perceive that every other item on your list of nonnegotiables is also. Team members and employees who refuse to respect your nonnegotiables should be separated from your practice.
Step 4: No Personal Exemptions
You must also hold yourself accountable for your nonnegotiables. If a close friend calls and says that he or she needs to get in this afternoon for a quick root canal, post and core buildup, and same-day crown, unless you have an open block of operative time in your schedule, the answer is no. If you want to move a patient in the schedule because you need to get on the internet to try to buy Taylor Swift tickets, the answer is no. It can be more dangerous to make exceptions for yourself than for you to make them for your team or patients because of the leadership position that you hold.
Step 5: Annual Enrollment Period
Your nonnegotiables are allowed to change as your needs and the needs of your team and patients change. If you want to offer additional services or treatments at the practice, take the time to work out the bugs of implementing them before you start saying yes. It's OK to periodically go back to step 1 and amend your nonnegotiables. If you do this, you will also have to repeat step 2 and then commit to steps 3 and 4 for the new iteration. It may be beneficial to set a quarterly or annual review of the nonnegotiables and, if possible, incorporate input from your team and patients. This process will be much easier if you stuck to your guns regarding your initial nonnegotiables because you will have had more consistent experiences on which to base your amendments.
It has been 18 months since I brought my little MBA project to life, and I have gotten much better at saying no to current and potential clients during that time. However, after 12 months of doing business as a team with input from our customers, we changed our nonnegotiables in the interest of adding services. Once we worked out how to add these services to our wheelhouse, we began offering them to practices. We still say no to requests that fall outside of our wheelhouse, but we keep track of them, and in our quiet moments, we consider ways that we could meet these requests in the future, provided that we will be able to do so in a way that wows our dentists and their patients. Ultimately, learning to say no will get you more yeses at your practice.
About the Author
Randy Leininger, MBA, is the founder of Troutberry management consulting and the CEO of Just Crowns dental laboratory in Boise, Idaho.