A Question of Style

A Question of Style

In a fictional article that appeared in Harvard Business Review in 1960, Abram Collier postulated a family-owned textile firm--Wickersham Mills--whose founder had just died. A stockholders' meeting was held at which four members of the family presented their views on what strategies and philosophies they would follow if they were chosen as successor to the founder. Their concepts all had some validity, but they could roughly be separated by their emphasis on different aspects of business. Alfred tended to favor production, Benjamin organization, Charles the needs of the investor, and David the needs of the consumer. HBR readers were asked to vote on which of the four should be elected to head the firm. The article was rerun in 1986 and the readers were again asked to vote. Should this company lean toward being product-oriented, company-oriented, bottom-line-oriented, or consumer-oriented?

It need not be argued whether these four positions are mutually exclusive or whether all four are not important to the enterprise. They are. It is a matter of emphasis. It occurred to me that the elements under consideration at the stockholders' meeting might well be examined by orthodontists, who are in a kind of Wickersham game when they elect to emphasize one principle over another in their practice administration.

In that context, Dr. Mason was born and a scenario similar to Wickersham Mills was constructed for a hypothetical orthodontic practice, and published as "Dr. Mason Chooses an Associate" in the April 1987 issue of JCO. Fictional interviews of three qualified candidates were presented with the thrust of each one biased in favor of a particular management approach. Readers were invited to vote for their choice of an associate for Dr. Mason. As was the case at Wickersham Mills, all of the positions are important for effective management. The problem was to present the candidates and their points of view in a way that would not itself bias the reader in favor of one or the other, and I hope that was successful. Consideration was given to whether any of the candidates should be a woman or a member of a minority group, and it was decided that that fact alone could bias the voting away from the merits of the management philosophies. Because the premise of Wickersham Mills and of Dr. Mason's choice of an associate was an examination of management emphasis, it seemed acceptable to eliminate personality and other emotional factors.

Mark's point of view was that the technique work itself was what he liked, what he was trained for, what he did well, and what he considered to be most important for practice success. He would rather delegate management, which he did not like, was not trained for, and did not do well. Carl believed that vigorous practice management and promotion were of primary importance, and he would rather delegate the technical tasks to trained assistants. Alan favored attention to patient relations as the key to patient cooperation and to practice success. So the choice was designed to be among emphasis on treatment management, administrative management and practice promotion, and people management.

Consider how the Wickersham Mills voting actually turned out as a result of the responses from HBR readers--intelligent, responsible business people from companies of all sizes. David won hands down in 1960 and by an even bigger margin--a majority--in 1986. The votes for Alfred and Benjamin were about equal in 1960, with Charles bringing up the rear. However, in 1986 Benjamin held his votes, while now Alfred joined Charles in last place. It is interesting that voters age 60 and over put David in first place by a much smaller percentage, throwing greater support to Charles and Alfred than younger voters did and about the same to Benjamin.

Among Dr. Mason's three candidates, Mark's position was similar to that of Alfred (production), Carl's was a combination of Charles's and Benjamin's (organization and investor), and Alan's was similar to David's (consumer-oriented). How did our readers vote?

It is not remarkable that the vote for the production-oriented candidate was high relative to the Wickersham Mills vote. Orthodontists are trained in and more intimately involved in technical work than most business people. The interesting part of the Mason voting was the high percentage favoring the people-oriented candidate and the low percentage favoring the candidate who strongly emphasized administration and marketing. Orthodontists appear to favor concentration of their practice building on quiet, internal efforts as against more overt marketing both internally and externally.

As with the vote at Wickersham Mills, there was a definite trend related to age. The percentage voting for Mark Randall (production) increased and the percentage voting for Alan Edwards (consumer) decreased as the years in practice increased. The trend among orthodontists related to age may well reflect a more general trend. Businesses and professions--indeed our whole society--have become more consumer-oriented.

Does emphasis on the principles of David and Alan lend itself better to management of a professional practice? As long as orthodontists prefer a fee-for-service, low-volume, high-fee, referral-source practice, and as long as that type of management permits orthodontists to be successful in that practice mode, the answer for most practitioners will be "yes". Catch 22 in this context is that many more overt practice promotion tactics seem to be becoming more acceptable in traditional practices. As competition and other economic factors come to dictate more of management style and methods, will more emphasis be placed on the bottom-line factors and less on the human factors? In a high-quality, personalized health care service it would be regrettable, but there is a reasonable compromise. Orthodontists must accept that all three of the principles of management represented by Mark, Carl, and Alan are essential--and that all three must be accomplished in an excellent manner if an excellent practice is to be achieved in the future.