I hired Kathy as a dental assistant three months after opening the doors to our practice.  She has impressed me over the years as a tremendously loyal, hard-working, infectiously positive contributor to our team.  She embodied so much of what I value in a team member, and I often made my sentiments clear to her, through verbal and written appreciation, bonuses, and the un-official, un-spoken reputation as “head” assistant.  Such a status afforded her a fair amount of deference when decisions needed to be made about changes to the structure of our clinical operations.  If we felt that our endo sponge system seemed antiquated, for example, she would always be in some way involved with the upgrade process.

In the spring of 2013, we held a full-day team meeting focussed exclusively on OSHA and blood-borne pathogens (lucky us!).  A guest speaker from Columbus visited our office for the day, and gave us the latest updates, rules and regulations, and, of course, toured the entirety of our administrative and clinical domains and encouraged us to make changes, not only to maintain legality, but also to offer our patients the cleanest, risk-free atmosphere possible.

Kathy’s discomfort with this process was truly palpable.  As the OSHA specialist perused our sterilization space and made yet another suggestion, it truly looked as though a bowl full of ants were deposited in Kathy’s pants.  At one point, during a break, I was able to catch her alone in our break room, and asked, “so, Kathy, what do you think?”

“This is bulls***.” was her poignant response.

So, there it was.  We were faced with an impasse.  One option was to embrace changes that, while temporarily inconvenient, would result in real improvement in our practice operations.  The other option, of course, would be to simply embrace whatever success we’ve shared by doing things the way “we’ve always done it.”

This impasse, and so many just like it, are what make our lives, as entrepreneurs, interesting.  It is at these moments that we have the opportunity to develop as leaders, to step out of our zones of comfort, take the more difficult road, and risk some pain and difficult conversations.  The other option, of course, is to maintain the status quo.

In order to determine the next step, we must ask ourselves what our values actually are.  This seems easy, but I have found it extremely difficult, not only as a practice owner, but also as a parent, a spouse, and in all the other arenas in which conflict might occur in my life.  My nature (not my value) has always been to avoid conflict at all cost.  Moreover, I have always prided myself in being a pleasant and easy-going individual.  I liked being liked, and following the status quo makes a person tremendously likable.  Upon determining my values, unfortunately, I realized that following the status quo was something that I really could not continue doing.  If we had policies in the office that put patients at unnecessary risk, that unfairly favored the whims of certain team members over others, or made the office, overall, less than the best it could be, those policies simply needed to be eliminated.

How does someone determine their values?  This question is super easy to answer when it comes to stuff like abortion, immigration, and the national debt.  I rarely meet an adult who doesn’t possess a clear identity when it comes to hot button political issues.  How ironic — that we devote our intelligence and energy creating a clear identity towards things that have a vague impact on our day-to-day lives — but when it comes to the values we possess as practice owners, where real people, our families, our patients, and our teams are affected directly and personally by our adherence to such values, our identities are often fuzzy at best.  So, here are some questions that might help you in this process:

1. When an improvement is suggested in your office, how does it become real? Who is in charge of making it real, the owner or the person suggesting it? How is it “sold” to the rest of the team? How are all team members held accountable for its implementation?

2. With respect to question 1, how are dissenters addressed? What about “chronic” dissenters?

3. When conflict arises between team members in your office, what are the steps that should be taken before the issue is brought to your attention? What issues require immediate intervention from you? From the office manager?

4. How would you rank the following characteristics of the ideal team: punctuality, knowledge/ability, good attitude, teamwork? Ideally you can have it all, but which is most important to you?

Answering these questions is important enough, but more important is to actually share your values with you team, and explain that you are committed to them.  Admit to your team that you are on a journey, with many uncertainties and fears of your own, and that you truly need them not only as employees, but as a part of your team.  Even if they don’t completely embrace your values and commitments, they are responsible for being a part of the realization of them.  What will result is not only a greater sense of responsibility from them towards you, but also the realization that the practice that you own, that they work in, is something that they have ownership in.

I wish I could say that Kathy doesn’t secretly grumble every time she walks by the six fire extinguishers or wall sticker in the lab saying “no food or drink.”  She probably does.  What she probably also realizes,  though, is that with all this talk of commitment and values and trust — well, it applies to how we see her as well.  We are committed to her, and we value her, and we are willing to go through temporary inconvenience in order to make that known.

Ankur A Gupta, DDS, after completing a one-year GPR in Cleveland, started a practice from scratch in 2005. Armed with what he considered adequate knowledge, hand skills, and a personable demeanor, he watched as his practice floundered, finances became un-predictable, and his lower back and spirit toward life became worrisome. Rather than continue the trend, he made a guinea pig out of his office, family, and self; attempting any and all personal and professional “experiments” in self-improvement. More than a decade later, he enjoys enviable new patient numbers and case acceptance, a solution oriented dental team; and most importantly, a meaningful and positive identity. He happily shares the failures and successes with dental and community groups throughout the country, always ending his presentations with practical, implementable, step-by-step ways to be better.