People, Product, and Profit
In the February issue of JCO, I reported on a book by James Collins and Jerry Porras (Built to Last, Harper Business Books, New York, 1994) that contains lessons for orthodontists beyond those of the ordinary management book. The authors sought to discover what allowed some of the older, more successful corporations in the United States to prosper while many of their competitors either disappeared or shrank in size and influence.
Although the companies differed in management emphasis, each of them, without exception, held a set of "core values" that distinguished it from the competition. Core values, according to Collins and Porras, are the fundamental reason for the existence of an enterprise and the foundation of practically everything a company achieves. The authors suggest that the best test of a core value is whether the company would continue to abide by it even if circumstances changed and the business were punished economically or socially for doing so.
This idea caused me to ponder on what would be the core values in my practice, as well as other orthodontists' practices. I concluded that they can be summarized under the headings of people, product, and profit.
People
The smartest and most capable person in my dental school class was an impatient misanthrope who confessed to me, after one year of general dental practice, that dentistry would be fun if he didn't have to work on people. Unfortunately for him, there weren't too many patients willing to pay him for working on typodonts. Dental and orthodontic services have to be delivered by people to people.
Somewhere within our set of core values, there has to be an acknowledgment of our esteem for the patients we serve, as well as for the people who help us deliver our services. This isn't always easy, because occasionally we encounter patients or employees who take an adversarial position. Nevertheless, to allow a few of life's social mutants to discourage us from celebrating our achievements with the rest of humanity would be to impose unacceptable and counterproductive limitations on our professional development. People will always remain the most unpredictable feature of any orthodontic practice, but serving them is the only reason for the existence of our profession.
Product
Whenever I consider the values that characterize the world's best companies--integrity, innovation, reliability, excellence, and friendly and heroic service--I recall some of the clinically superior orthodontists I have admired and learned from over the years. Some exuded warmth and charm, while others were aloof and detached. Some never tired of innovating, while others achieved excellence with a small number of tried and trusted therapies. Some worked with large, talented staffs, while others worked alone.
Despite their differences in personality, treatment philosophy, and management approach, all of these great orthodontists shared an unshakable professional integrity and a vision of clinical excellence for the product they delivered to their patients. The manner of applying their skills varied considerably, but they were unanimous in their devotion to clinical excellence as a core value.
Profit
I recently had an opportunity to talk at length with some orthodontic entrepreneurs who have pioneered a new method of delivering orthodontic care at a reasonable cost. Their technique may or may not prove its worth, but a basic premise that surfaced early in our conversation was that appointments were contingent on payment--that is, without the monthly payment, no new appointment is scheduled. I like the idea of prompt payments as much as anyone, but to make it a core value ignores the possibility of legitimate circumstances that make financial adjustments necessary. All orthodontists should be dedicated to the promotion of their patients' health, not the destruction of it, and when they allow anything to interfere with that fundamental responsibility, they call into question their professional integrity. Increasing shareholder value and return on investment may be reasonable goals for most businesses, but in a health-care business they must remain subordinate to the health and well-being of patients.
After that discussion, it might seem incongruous for me to discuss profit as a core value. However, an enterprise has to remain profitable to continue serving people. In today's orthodontic practice, government mandates, constantly inflating costs of supplies, and competition for competent employees and for patients continue to drive expenses northward. Meanwhile, good professional management methods are often neglected.
Some orthodontists have sought patients through managed-care programs, even when the fees they receive are lower than their cost per patient. That reminds me of the grocer who sold goods below cost, yet expected to make up the losses through greater volume. Such financial arrangements will benefit neither orthodontist nor patient, because they reward the practitioner for neglecting patients rather than serving them. While profit must remain a core value to ensure survival, the professional commitment to excellence must take first place.
So we have people, product, and profit--and probably in that order for an orthodontic practice that is "built to last". We can define, control, and improve only one of these: product. That doesn't mean we should pay no attention to the other two. Let's hope we never give up the responsibility that is peculiarly ours.