The Hidden Reason Your Practice Feels So Hard to Run w/ David Maloley

Eight out of ten employees show up disengaged. The other two are doing all the work in your practice.

In this episode, Dr. David Maloley explains what's really driving attrition and why a paycheck doesn't cut it anymore. You'll find out which outside forces are quietly commoditizing your practice, the burnout triggers already built in, and how to create an employee experience that holds your practice together.

Topics discussed:

(00:00) Introduction

(03:19) David’s dream practice that turned into a nightmare

(06:29) What hiring an office manager can't fix 

(09:18) The forces commoditizing dentistry

(18:25) What a bad employee experience looks like

(20:10) Three levels of a value-fluent team

(21:16) What's really driving patient attrition

(23:09) Burnout triggers built into dental practices

(25:30) What happens when you stop chasing numbers

(30:10) Why vague leadership creates attrition

(36:28) The Trust Triangle decision framework

Take the Commodity Threat Assessment:
https://assessment.irreplaceablepractice.com/

Listen to more episodes with Dr. David Maloley:
https://www.buzzsprout.com/2311108/episodes/14424320

https://www.buzzsprout.com/2311108/episodes/14423936

This episode was produced by Podcast Boutique https://www.podcastboutique.com

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Transcript

Why Dentistry Breeds Frustration

Paul Etchison 1:09

Hello and welcome back. We have got a really, really good interview here today. And it just got me thinking so much after I completed this one. Today we got on Dr. David Maloli, and he's an awesome dude, awesome dentist, great leadership speaker, has an awesome story. I mean, just an unbelievable story. And what we discuss in this interview is relevant to everybody, no matter where you are in your dental practice journey, because we discuss how dental practices are almost perfectly designed to create frustration as practice owners. I mean, we work in tight spaces, we're under a constant time pressure, we're dealing with anxious patients that don't want to be there. Our schedules are super unpredictable. And our team, their work is really dependent on one another. So as a doctor, we're trying to focus on patient care. We're trying to focus on production and the front office is doing their own thing and the clinical team's trying to stay on time and everyone's working hard. But if we don't have that shared understanding of what matters most, good people can still begin to pull in different directions and not the same way. So today we're going to talk about how to build a practice where the team is connected by a shared purpose, how we can make decisions from the same set of principles, and how we can work together instead of against one another. Now, you're listening to the Dental Practice Heroes podcast, where we help dentists build practices with stronger teams, better systems, and more freedom by creating businesses that work for the people inside them, not against them. Now, I'm your host, Dr. Paul Atchison, practicing dentist, author of two books on dental practice management, dental coach, and the owner of a large group practice, collecting nearly $6 million a year. And the longer I do this, the more I believe that the best practices are not just in themselves more productive. They are more aligned. They're more human, they're more intentional about the experience that they create for the team and the patient. And today, like I said, Dr. David Maloli, he's the host of the Irreplaceable Practice Podcast. He's someone who spent years, I'm talking about years studying leadership, human performance, burnout, and what it takes to build a practice that can thrive in a changing dental landscape. And if you're in the landscape now, you know that it's changing. All right, let's dive in. David, welcome back to the podcast. So excited to have you back on.

David Maloley 3:26

Paul, it's an honor, man. I can't believe it goes so long in between sessions, but it feels like we can just pick up wherever we left off. So I'm stoked to talk to you today.

Paul Etchison 3:36

It really does, man. But here we are. And tell the listeners, I mean, we want this to be actionable for the listeners. And I think it will be. And I think sometimes we get turned off by leadership principles or we talk about burnout. But I love where you come from because your story is awesome. You come from, you know, somebody that leadership didn't come natural to. You had a lot of problems in your practice that you accepted and took accountability for and you learned your way through them. But then you also went and deeply studied a lot of stuff about high performance and came back full circle. And you weren't always helping other dentists. And you took a little break from that, but now you're back doing it again and from just a completely different perspective. And I'd just love if we could share all that in a nutshell. I don't know how we do it with the listeners, but let's start with talk about your story as a dental practice owner, because I think that's really important for the listeners to know.

Speaker 1 4:31

Yeah, of course. I went to dental school on an army health profession scholarship. And so I spent the first five years in the military. And I came from Nebraska. So having the experience of living in Germany and Italy completely changed my worldview. And that's really when I got into this idea of lifestyle design because it was so different than growing up on a farm in Lexington, Nebraska. And so when I started looking at practice opportunities, having that sort of vacation in my backyard became really important. First, I didn't think it was realistic. It was seemed like the delayed life plan where you'd worry about that when you get in your 60s. And the more I thought about it, I'm like, why wait? And so I started a practice from scratch in 2009,

David’s Scratch Start Reality Check

Speaker 1 5:17

right at the base of Beaver Creek. I can walk to the gondola right from where I sit right now and had this big dream. But the big dream quickly turned into a nightmare. I had to quickly learn marketing because my ad spend was like 10 grand a month in 2009. Ad costs were really high. I had to learn how to turn one patient to two with referral systems. I had to learn how to attract team members and get them on board very quickly because there's a lot of natural churn in these resort areas. And so it felt like every lesson that I needed to learn, I learned in a very difficult way. And it really came to a dark and challenging point in 2013. If you listen to my show, you know that I walked into my office down the hall and found my wife face down on her laptop computer. And she had to be Medevac to save her life. She had a dissected internal carotid artery, had a stroke, blood on the brain, looked pretty bleak for a long time. I had a three-year-old at home. And as you might imagine, scratch start practice in year three, just starting to get some traction, good team, still not as leadership savvy as I should have been in hindsight. You have nothing left to give your practice. And so I hired, it was kind of a Hail Mary. I hired an office manager to relieve some of the tension, and he only compounded it. And about seven months after I lost three of my team members all in one week. And that's when I realized that I was doing it the grit and hustle way, uh, hence the name Relentless Dentist. It's what I learned on the farm. But there had to be a better way. And so I started looking at the science of performance. And when you don't fight biology, it literally feels like you go from paddling upstream to turnaround and following the current. And that's been my fascination ever since is what does that look like when done and done well in the workplace?

Paul Etchison 7:25

Now, you had a crisis in your practice.

Speaker 1 7:28

Fair to say, yeah.

Paul Etchison 7:29

With your wife working there, Kara. And so you needed to be more present for her. I love that you say it's the Hail Mary. You bring this office manager into your practice, which a lot of people would look at this and say, you know, I've always thought about that. And I feel like it's the classic thing where anyone who's talking about opening a restaurant, there's always somebody that chimes in and goes, Well, you'll be there every Friday, every weekend. They go, Not if you get a good manager. And we sometimes believe that's the same thing in dentistry. Like we can find this office manager. So we put the ad out and we see office management experience. And often it's just like the most experienced front desk person is the office manager. Looking back on that experience, I mean, where do you think that went wrong? And how long did it take you to realize it?

Speaker 1 8:10

It took me about a year. I mean, after the mutiny uh kept him on because I was like, there's a lot that he's doing that I don't, I just can't take over myself. Kara was sometimes that person that would fill in and a pinch. She didn't have the capacities to do that. So it was probably a full year to really realize that management and leadership are very different things. And managers are usually good at managing, but managing assumes they're working on a thing. And if people were going to be led, in my opinion, especially in a practice like mine, 1100 square feet, four ops, fairly high producing for its size and the amount of days we were open, I needed to be the point of first contact from the team members. Their allegiance needed to be to me and my vision. And I've also helped a lot of clients almost demo office managers and say, like, they're really good at this lane, but this one-on-one conversation, this team meeting conversation, department meeting, whatever it looks like, really needs to belong to you because they have no skin in the game. And there are office managers that know how to lead. I don't mean to say that, but it's a difficult thing, even for somebody who is fully invested, whose name's on the door, whose license is at risk. And so that's the thing that I really had to learn is the distinction between management and leadership and how savvy you have to be as a leader to get things done in the right way and sort out the drama and get people pointing towards a shared goal. It's not easy and it requires real dedication.

Paul Etchison 9:51

Yeah. And I think us we're so often just so we just think we're supposed to show up at the office and do the dentistry. And, you know, we run the business on the side and it requires a little bit more intentionality, which you and I have discussed on previous podcasts. And I would say for the listeners, man, go back and search David Maloli. I'll put in the show notes what the previous episodes were. But man, uh, they were some of my favorites. And Dave, last time you came on, we just riffed for like Totally. It was so long, but it was it was one of my favorite. I think it might have been my it may be my favorite episode. And I promise you, I'm just saying I'm throwing you compliments, but I've just got so much respect for you, man. So looking back on all your experience, I mean, you sold your practice, you moved into a different direction, you've you got a lot more training in performance coaching, moved into coaching, helping other dentists. What do you think is the big thing? What is the big shift that we need to make? And are there certain market forces in dentistry right now that are almost requiring this shift?

Speaker 1 10:46

Yeah. So I started the podcast in 2013. And a lot of it was a documentation of my journey and my ajas and my insights, and where I was kind of led astray by conventional information where I had to kind of figure it out myself or from uh mentors outside the industry. And during that journey, I became more interested in dentists than dentistry. And it became this pursuit of knowledge of human behavior. And the further I got down that rabbit hole, the more interested I got. And I already had a client base due to the podcast. So it was a pretty natural pivot when I had the opportunity to sell my practice in 2019. And the more I understood human biology and organizational psychology, the more I realized like we are engineering our dental practices to create burnout, to create patient attrition, to create team drama. And it's because we're not using the human mechanism in the way that it's designed. And I almost was forced into that sort of a high in my own practice because I couldn't fight the current anymore. I literally had to find a better way. My dad had a heart attack that threatened his life in his 40s. And I got to the point, Paul, where I literally assumed like the defib unit in my office might have to be used on me. And I know the stats on that is are pretty high for the dental office. So I kind of resigned myself like this place might kill me. In order to be the parent that I wanted to be for Bennett and create the lifestyle that I moved here to create, I had to find a better way. So there was a very true forcing function. And then I worked with clients. I saw their cognitive biases leading them in a less than effective way. And when I brought them back to the first principles of team dynamics and leadership biology, then we could have the breakthroughs because we weren't fighting

The Office Manager Leadership Trap

Speaker 1 12:47

the force that always wins, which is human biology. So today, the forces that I really see compressing the people that I advocate for are usually very well trained, coy, spear, big name institutions. But then they're compressed by PPOs, is the obvious one. Another commoditizing force would be a DSO, where it's kind of blurring the lines. Is a dentist just a dentist? That would be at the commodity level. If you're a little bit better, you'd be a product or a good. If you're a little bit better, you could be a service. But until you become an experience, you're fighting kind of the dentalization of dentistry because I don't think we've done a good job of differentiating ourselves and saying, like, I'm not only better, I'm different. And you have a completely different experience here in my practice because most websites look like pretty similar, same stock photo, same. We take care of patients like family. So DSOs are one, PPOs are one. I think the unknown, the X factor right now is clearly AI. I would suspect that we're like, I remember when I sent my first email in college and I was like, it was novel. It was like, that's cool. Uh, but you can only send it to somebody else at the University of Nebraska. But you didn't think like the internet was going to take over everything. I think we're still at that what's going to happen stage of AI because our minds can't predict exponential curves very well because we live in a pretty linear world. 2027 will look a little different than 2026, but not much. And technology used to double every two years. Now it's like every six months. So, what does that look like when we have a force that's truly scalable, truly disrupting? Uh, no one can predict. So I don't really think there are AI experts right now, because it's anyone's guess how this synergizes with humans. And people have kind of overshot and laid a bunch of people off. And humans still want to talk to humans. So I think it's an opportunity to hyperhumanize our practices so that we are even better at those value points, those little inefficiencies that we can build in. I think it can free us up for that. So we have DSOs, PPOs, AI, consumer behavior is significantly different. The trust that we have for doctors is going down. Most 73% of patients will check at least three sources before making a decision. One of those is AI, one of those is social media, one of those is somebody who's gone through a similar situation or procedure. So now we have this sea of conflicting information, and 54% of patients now don't know who to believe. So that's a real case acceptance issue. And patients are starting to compare our services with the Carvana's, the apples, and the Amazon. So if we're introducing friction into that system, people won't tolerate it. We're not going to become those things. I think intentionally we want to introduce some friction into the system so it's not this treat them and street them thing. But still, the the contrast and comparison is there and the loyalty is decreasing. And probably the biggest issue right now is shifting employee expectations. And that's where I spend most of my time because if you can't create a talent magnet, I don't know how you create a exceptional patient experience or referrability in your practice. So when all of those forces are converging at once, we don't have a choice but to get better as a dental practice owner.

Paul Etchison 16:32

Wow. Dude, like you really laid it out there. And I think it's I'm a little sad, Dave. I'm a little sad for our industry. Because you don't, you know what's interesting is like you think about it. So like in 2012, like when we we shifted from like a phone call culture, like text was just like this thing. It was kind of cumbersome and it took a little long time. And then eventually became like we've been shifting into this like less relational, less personal. But I love how you say it. It's the friction because the consumer won't tolerate the friction. You don't have online schedule. And essentially anything, friction is something that's not automated and requires a human-to-human contact, but that's what's missing. And you're so right. That is what's bringing makes all the dental offices more or less the same. You take out that personal component. So, like, in your opinion, is it even possible to I mean survive? I mean, if you look at what you know about leadership biology and where we should be and how to feel good as a dental practice owner, is that practice model feasible in this day and age?

Speaker 1 17:32

I think so, but it requires a pretty significant paradigm shift. We're moving from the industrial age to the information age. I think now we're in the transformation age. So it demands us to be adaptable. And you can't be adaptable with highly resistant, selfish team members. But there are principles that are undeniable. I spend a lot of time with the Flow Research Collective. And it these principles bring out the best of it in us. It's really attention management in a distracted world. Leadership is now becoming attention management, not only for ourselves, but for our teams and for our patients. And the brain works its best under certain conditions. And right now, most of the conditions point straight towards burnout. And so if we don't appreciate the humanness, I think we're pretty good at the patient experience. I don't think we're so good at the employee experience. And if we don't shift our mind from production first to performance, and there's an old, I'm dating myself a little bit here, but when I was a kid,

PPOs DSOs AI And Commoditization

Speaker 1 19:45

the dynasty was not the New England Patriots, it was the San Francisco 49ers. And much of that coaching tree today stems from Bill Walsh. And he had a principle that the scoreboard takes care of itself. And I believe that when the human conditions are right, then case acceptance becomes much easier because we're in a high trust environment. And then a lot of the profitability and the cost management. Yeah, there's mechanics on the back end, but you don't have to like be heads down as your own CFO for three hours a week to make that happen. You're simply letting the assets, the most valuable assets in the practice, do what they're born to do and play to strength.

Paul Etchison 20:29

You know, I I talk a lot about patient experience, and I I can't say that I've ever given much focus intentionally to the employee experience. So if you're looking at it from the perspective of an employee experience, what does bad look like? What are the things that we might be unintentionally doing that are just shooting ourselves in the foot and just causing us in a bunch of stress in that department?

Speaker 1 20:52

I think we have to appreciate that a top performer, and I I'm not speaking about the bottom third. Oh, I don't think we want those people in our dental practices. I want to attract the top third to the top two-thirds into the dental practice. So when I speak about an employee, I'm talking about somebody that gives a damn and somebody that uh wants to dedicate themselves to work. A paycheck doesn't cut it anymore. They need meaning in their work. And so what that looks like when you're selling that vision to a team member is that you're constantly reminding them like we're changing lives. That patient that you did scaling and root planning on, you may have prevented a preterm low birth weight baby because all of our work naturally drifts to this factory model of next patient, next procedure. It's just who we are as humans. And so we have to keep infusing meaning into the huddles and the one-on-one meetings and your team meetings. So that would be the biggest one is making sure that these intrinsic motivators are alive and well. Dan Pink made three of them very famous. Mastery, which means I'm consistently getting better at my job. Autonomy, I have a sense of control over my domain. It could be the schedule, it could be my hygiene op, it could be ordering. And then there needs to be shared goals where the whole team unifies for that trophy. And then purpose. Like, is something I'm doing today contributing to the well-being of others? And I think you need to look at that at three levels. I call it a value-fluent team. Am I contributing to the patient and the patient experience? Am I contributing to the practice? And am I contributing to my fellow team members? When those three things are in line, I think it makes the patient experience hard to match. And now, to take this to the next level, a patient in a skeptical world, like I kind of mentioned, where they're taking in this sea of disinformation or conflicting information, they're going to believe the messenger, which is the team, and then the message, and then the move. So we can't really get to financial arrangements appropriately or scheduling until their body, their nervous systems, evaluates is this value or is it dangerous? So it's really going back to the biological level of what does an anxious, distracted society but behave like? And what do I do to make sure that they feel like any risk is removed so that they can easily say yes to the next step.

Paul Etchison 23:29

Aaron Powell So is this what you mean when you talk about how we're set up, almost designed to increase, I don't know if it's increased, but to allow patient attrition.

Speaker 1 23:38

I think we have to take it into context. So we're in a very skeptical world. People have been burnt and lied to in so many different ways. And the answer isn't to shout louder. It's to literally say, I see you and I understand you. The commoditization forces make that very difficult. PPO, for example, says, We're gonna pay you less for your best work. So that rewards a higher volume or a higher pace environment, which means less connection. So that's just one example. Disenged employees would be the other big one. Right now, the data from Gallup is like eight out of ten people are disengaged. Yeah. Which means 20% of the of your team is doing all the work. The worst, the more scary statistic is 12% of them are actively disengaged, which means you're paying them to sabotage the organization. So with those stats, it's a wonder we get anything done because it's a it's literally defining a tug of war. And that's in an average practice. I mean, there's 50% of the practices that are below average where that those statistics are even more alarming, where they're constantly hiring or bringing on temps. And that just leads to a broken dentist who cannot connect with patients. And then the cycle repeats itself. So it's a very ugly and dangerous flywheel, in my opinion. PPOs aren't keeping up with the cost of providing service. So waiting for insurance reform is delusional, I think. And so we have to redefine the game in our organizations, or this will keep being the default. And right now, there are many burnout triggers that are alive and well in a dental practice. The obvious one is work overload. Another one is values conflict, which means I'm doing things in a way that I wouldn't naturally do them. Inadequate reward, which means I'm not getting paid the way that I should feel like I should be paid. And so this slowly is the death by a thousand cuts that first I think impacts the practice owner, that it impacts team morale, and then it leads to the patient attrition that you were asking about.

Paul Etchison 25:47

Yeah, absolutely. What about the values conflict? Where does that show up?

Speaker 1 25:51

I think it's created by one PPOs. Like I work with a lot of people that are incredibly skilled. Like I look at their work, I look at their temporaries, and I'm like, those look like ceramic to me. But then they're working on PPO fees, right? So that's uh I developed this craft. I'm probably best in my community, but yet I have patients that are saying, does my insurance cover it? I have insurance companies that are saying it wasn't necessary. There's a dentist in a cubicle 800 miles away saying that wasn't the proper service. Being everything to everyone, not really being able to lead your team because you're afraid of attrition. So you end up being empathy means that you're feeling the pain yourself and removing the pain, which isn't great leadership. Compassionate leadership means I understand what's going on here, but it'll always guide us to the next level, which would be more of a delayed gratification thing. And then the obvious one is social media. I think people lose sight of this is who I am and this is what I want. And it ends up being this default of more is better and money equals success. And I'm not against more is better, and I'm not against money equals success. But the way human biology works, that kind of has to be tuned into a unique path for you. And if you don't, then you really start feeling like, I like what's in my bank account. I really like this trip to Maui, but for what? Like, I don't it's it's not why I went to dental school. So it's this empty feeling despite having all the extrinsic motivators available and alive and well on your Instagram feed for you. You're experiencing them, but you always have to go inside out when it comes to human performance. If you don't get the inner game right, no amount of extrinsic reward will make up for that.

Paul Etchison 27:44

I feel like this is like a really palatable thing for most owners because like as I'm listening to you, I mean, what I'm hearing is like we got to be more heartfelt. We gotta follow what's more more heartfelt for us, but we have all these forces that are telling us that's not what you should be doing. Don't do that. Don't follow your heart. You need to be doing this, this, and this. And I mean, you've been working with dentists now, and you you love what you do. You you transform dentists' lives. I just I'm curious if you would share a story of someone that you worked with and just what kind of things you did and what it changed for them, what kind of the results they got.

Speaker 1 28:18

Yeah, I'd be happy to. I am working with a client right now. I think we've been working together for two or three years.

Performance Over Production Mindset

Speaker 1 28:26

She reached out to me with a cancer diagnosis and was already overwhelmed with her practice. Classical, this happens to be a female, but I call it nice guy syndrome, trying to be everything to everyone. And so you show up as how many ever team members you have, plus how many ever patients you have. In this case, she's a pediatric dentist, so how many uh parents into the room with the child and you know, got a startling diagnosis and didn't know what to do. She was fighting things like should we show up for the huddle on time or can we start seven minutes late? Like little trivial things like that. And it's obnoxious. I've experienced the same thing in my own practice. Like, is this really a conversation? Like, yes, that's what smart businesses do, and that's what competent employees do. But in today's day and age, it's just like my way right away. And now she is healthy, admittedly numbers allergic. She sent me a text a few months ago that says, my accountant says that I'm 25% more profitable than I was last year.

Paul Etchison 29:35

All right.

Speaker 1 29:36

And his average client is seven. And we don't really talk numbers, we talk culture and all the things that we just talked about. I'm happy to talk numbers, but it's just a testament to the numbers take care of themselves when you're in a human performance mindset. Can't keep up with the demand, cutting back days, has a unique service that is in a category all of its own, something that other dental practices do, but we've defined the patient journey so that it's unlike anything else in the world. And now she has a waiting list for that, a high value service. So her outlook on life between two, three years ago and now is completely different. And I think the most important thing, and if I'm being honest, it's the thing that always gets me. I know these people go home and are better parents. And the reason that is always my motivator is because I know in 2013, 2014, 2015, when I literally didn't know how I was gonna make it work, I would go home and look at Bennett and say, I don't know how I'm gonna make this happen, but I'm gonna find a way. And also so that are my team members. They go home and are much better parents because work isn't this soul-sucking thing anymore. And so I say all that because I believe it is possible to have your dream practice. And I don't like either or, I think both and like, how do we check all the boxes? How do we make sure that first we're playing to your strengths at work as the practice owner? Second of all, we're unifying or aligning strengths of the team members. How do we create a referral-centric practice where the purpose of an appointment isn't just to get the job done, it's to generate a referral. And when we check those few boxes, the rewards are really abundant. And that's just following very founded coaching principles where we start with the owner, then we go to the team, then we go to the practice. And the business, you're just kind of doing some movement and making some decisions based on the numbers, as opposed to being fixated on why is case acceptance this and not that? Why do we only have uh this many new patients and this many reviews? It's just a very natural way to run a company.

Paul Etchison 31:54

You know, it's amazing, is the scoreboard takes care of itself. You mentioned the Bill Walsh thing. Yeah. I have been very I feel like coaching clients reaching out to me often they they almost want that number. They do. They want to go deep into it. And I I share the same kind of outlook as you feel like they're important, they're there, but I don't want to be so focused on them. Like, you know, it's like because it's more about the heart and it's more about managing and leading your team by feel. And there's a lot of things you're saying that I think you're putting, you're articulating very well, like things that I've already believed. I wonder if you touch on when you take somebody through this transformation, naturally there's going to be some turnover. And I think that's always going to make a client or a dentist question what they're doing. We've got these two opposing forces, one of which is like, you know what? I had a little turnover before, but I was kind of managing it. It was okay. Now I'm really, you know, I'm shaking the boat and people are just falling off left and right. How do you get somebody through that with confidence that there is an other side that they're going to come out on and it's going to be worth that transition and that consistency?

Speaker 1 32:59

I think the thing that we have to appreciate is that people respect authority. And authority comes from certainty. And certainty comes from clarity. And when you're vague on the outcome, you're going to have that attrition anyway. Or worse, you're going to have those people like the what's the term I use before, the actively disengaged that are cashing your checks, but going in the break room and stirring up the pot about doctor is evil. He's just in it for the money. He just treatment planned this thing. I'm not sure that patient needed it. So I think the risks are high either way. I think they're higher if you're not determined to plant your flag and say, this is who we are, this is what we stand for, these are our core values. This is the mission. And it's good for you too. So I think if we look at the dopamine circuits and the norepinephrine circuits, your body really needs that. So let's just call this burnout proofing yourself, first and foremost, because now you're aligning with your core values. But the next step, and I don't think we're very good at this, is you need some form of unity counsel. And I learned this um working in high-level athletics and undergrad. I worked for a national championship football team. And they had a unity council, which was a the player-led uh leadership aspect of the team.

Meaning Mastery Autonomy And Purpose

Speaker 1 34:16

So in my practice, I liked one person from each department. It wasn't always that way. It has to be organic. I wasn't going to force anybody into that, but I needed people to be my eyes and ears. And if there was a threat to the zero gossip policy, I needed to know it because I needed to address it. If there was conflict with the core values, I needed to know it so I could address it. And the way organizational behavior works typically is a third are on board, a third or not are on board, and a third could go either way. So you just need that critical mass to switch to your favor. And then it makes it a lot easier because now the environment says that's not how we do things around here. And that you don't have to be the sheriff of everything. The mission is the boss. And those three or four people are saying we're here to define the mission and defend the mission today. As I tell my clients, human behavior works like this. If you can't trigger the heart, you won't trigger the head, you won't get the intellect. And if you don't get the head, you won't get the hands, you won't get the action. So that's forgotten in a lot of dental discussions that, but human behavior, if we don't get the buy-in here, they'll do it. But it's kind of like the half-ass go through the motions version and not the fully invested uh version. So we have to tip that scale in our favor and say, are you with me or are you against me and make it very binary? But environment is very potent. So the whole key is creating engineering an environment where that is the default and not the exception. And mechanically, I think I explained it in pretty simple terms where I see it go wrong in a lot of ways. Because if you just walk into your end of the room and stomp your foot and say, We're better than this, this is where we're headed. That's that's when you trigger your own mutiny. It's more of a consistent, ongoing enrollment conversation when done and done well.

Paul Etchison 36:11

So all that, like it really reminds me of something. I mean, I've had a small practice I've had where I was the solo doc. I would say, did things run the best when I was the solo doc and had the smallest team? Absolutely. All had this social contract together that we are going to do amazing things for the people. And I think that's changed to some extent. And I'm not saying there's a bad culture in my practice by any means. It's very great. And I'm very thankful for the people I have on my team. But I will say that there is a department on my team where it's very normal to show up late and it's very normal to call in. And we have attacked it over the past few years with like, hey, like, okay, you broke the rules. You broke the rules, right job. Okay, now we're gonna let you go over it. And what's interesting to me is that I remember talking to one of my leads about this and saying, I get that we're trying to write people up for not showing up on time and calling in often. But where is the social contract between these team members where they just don't want to call in because they don't want that other people, their their friends, their coworkers, to have a more difficult day because they're not there. That is completely missing in a department. And it's interesting because I hear you say that, and I say that is what it is. We had that culture there that was, you know, this is how we do things. And we don't need write-ups. We don't need a police officer to go walk around. The team will do that and the culture will do that for us. And for some reason, that might be missing. I think it's it's making me realize hearing you say that.

Speaker 1 37:37

It's easy to drift. I mean, we're I think society is pulling us in a direction that we have to create our own society, our own norms in the practice because the selfishness and uh going back to like nervous system, in a scared society, it is natural to become more selfish. So uh the division and you can call it race, you can call politics, you can call it socioeconomic. Like there's a thousand divisions, and that every one of those divisions means me against you.

Paul Etchison 38:07

Yeah.

Speaker 1 38:08

In the group flow science, there's a principle called blending egos, where more we language is used to your point. And it's very difficult if you have to go into law enforcement and your dental practice, because then I think the rift and the divide almost intensifies. You almost have to let the, I think of culture as the immune system, the immune system absorb or reject the behavior. Um, but you need people, and our conversation would be the unity council to say, like, hey, you're letting people down. I created a very simple framework when I moved from four days to three days in my practice because I knew that I had to create uh simple methodologies or algorithms to allow my team members to think like I thought, because I wasn't gonna be there and I wasn't gonna let them bother me when I wasn't there. And one of the things that we created was called the trust triangle. And it's a simple decision framework. And the three questions are: is it good for the team? Is it good for the practice? And is it good for the patient? If it fits in that triangle, I want them to make the decision, full knowing that it may not be the same decision that I would make. But if I check them and say, was it good for the practice, is it good for the team, and good for the patients, and they made the decision, I don't really care what the outcome is because their intentions were pure. In this case, there's a question whether they're considering, is it good for the practice and is it good for the patients and is it good for the team? Because in all cases, if you're calling out, the answer would be a hard no. And one of the most important things that I learned in leadership, and I'm sure you ran across this too, Paul, is that we get angry or pissed because we keep having to say the same things over and over. And one of my mentors said, No, it's your job to connect the dots. They can't see that. And so great leaders repeat themselves, great leaders repeat themselves, great leaders repeat themselves to the point where it's annoying to us. But that's part of our job and our internal leadership teams to say, remember, this is what we're about. Remember the trust triangle. And I think that gets more important because their brain loves novelty. So we go on to the next thing, the more sophisticated thing. But all great businesses come down to the simple fundamentals that we've been talking about.

Paul Etchison 40:23

Yeah, it's so true. Well, you know, if listeners are checking and they're listening to you and they want to learn more about what you offer, the podcast, Irreplaceable Practice, they can subscribe to that wherever they listen. What about if they want to just hear more about what you offer

Handling Turnover With Clarity

Paul Etchison 40:36

as far as your services?

Speaker 1 40:37

Well, I would say the great, the best starting point would be this new assessment that I created. I'm sincerely worried about a certain body of dental practice owners that's not ready to play this elevated game and fight these compressive forces and think that 2019 tactics and ideas will be sufficient in 2028 and 2029. So I created a commodity threat assessment. It's 10 questions. It gives them a real look at where they are in the intergame, like themselves and the practice, and then their relationship with the marketplace, the financial side, their positioning side. It's just 10 questions. It's at assessment.irreplaceable.com. That's the best starting point. And I think it's a it's what I would do in an initial session anyway, is just what we do in a dental practice, sit them down, get a very clear diagnosis. Sometimes it's uncomfortable, but all progress begins with telling the truth. Until we know what our starting point is, I don't think we have any shot at preparing ourselves for the future. So that commoditization threat assessment is exactly where I would start.

Paul Etchison 41:53

Awesome. That will be in the show notes. Dr. David Maloli, thanks so much for coming on, man. I love your ideas. I love the way you articulate things and always somebody I always look up to. And man, just so thankful, appreciative to have you in my life. I really do appreciate you, Dave.

Speaker 1 42:06

Paul, you've been a great friend. I appreciate the opportunity to connect. And I want to honor you. I think when I look back at the journey of where dental podcasting started and where it's headed, you've been a real pillar in this industry of dental thought leadership. And you probably can't estimate how many practices that you've touched. I know it's a bit of an echo chamber where dialogue goes out and not much comes back, but I know from conversations that I have I have had that you're you've made a big impact on the lives and the abundance and other practices. And I think the reason I respect that that I know that comes from experience. So you're not somebody theorizing, you've done it. And two, it comes back to the principles of, hey, let's just take great care of people. So the admiration is mutual and our friendship means a lot to me. Thanks, too.

Paul Etchison 43:02

All right. What a great interview. One of the biggest takeaways from this conversation is that production can't be the only measure of a healthy practice. A practice can be busy, but still be extremely fragile. You know, I mean, it's it can be profitable and can still really just be burning everybody out that's working there. It can look successful on the outside while the people inside are exhausted, disconnected, and just trying to get through the day. And I can tell you from experience, I have been there. So, environment, it matters. Culture matters, employee experience. We need to take it seriously. It needs to matter to us because the way that the people feel that are doing the work, that is going to show up in the work itself. So here's a few tactical takeaways from this episode. I want you to start with the human side of performance. Your team can't create a great experience if they're disengaged, if they're just run around overwhelmed, or you've never made things clear, or they're unclear about what matters at the practice. So try to create more meaning in the work. We do something very special, and people need to know that they're not just completing tasks, they're helping patients, they're helping other humans, they're supporting each other, they're contributing to something that matters and protect the culture. The strongest practices don't depend on the doctor and other leaders policing everything and writing people up. They build an environment where the team understands the missions and they help defend it against anyone who might come into the practice and not work towards that mission. And pay attention to your own burnout as the dental practice owner. If the practice is draining the life out of you, that's not just a personal issue. It is a business issue as well, but it's fixable. So if this episode made you realize that your practice may need a stronger culture, maybe some better leadership or a healthier way to grow without burning everyone out, including you as the owner, that is something we can help you with at Dental Practice Heroes. Head to dentalpracticeherous.com/slash strategy and schedule a strategy call with me. We have created the seven-phase omnipractice system, and we think we have never made it easier to implement this in your practice. We show you how to lead, we show you how to inspire, we show you how to hold people accountable, and then we train your team how to do everything as well as we roll out and implement systems in your practice so that things start becoming predictable. So reach out to us, dentalpracticaros.com/slash strategy. And if you loved this conversation with Dr. David Maloli, please leave me a five-star review. I would really appreciate it. We try to bring on the best guests. I really try hard to curate who I bring on this podcast. So if you love it, leave a five-star review. I would mean the world to me. Thanks for listening. Go out there at the office and kill it this week, and we'll talk to you next time.