Recently, over lunch with an old friend of mine, we were talking about his challenges in presenting workshops in health centers that were designed to provide assistance in how to follow guidelines that were clearly laid out by the Health Resources Service Administration, an agency of the US Department of Health and Human Services. After some conversation that left us in the weeds of abstraction, we both realized that the problem with connecting to folks in a deep way was not a technical issue. The subject matter was clear, the guidelines were clear, but something was getting in the way. The culture within these health centers was not open to new learning, and it was that sclerotic culture—self-protective and rigid—that presented roadblocks. Yes, I agreed that learning new stuff is risky, as one has to start from a place of not knowing and acknowledge ignorance as a starting point.
I hope this is ringing a bell for the reader, but I fear that I may seem to be entering the weeds here, so let’s back up a bit to clarify where this Viewpoint is headed.
Work Culture
The word “culture,” and the work-related concept it encompasses, is referred to a lot these days, easily articulated but not fully understood and even less appreciated. My goal in this short article is to both clearly articulate what I mean by “culture” and, perhaps more importantly, provide some guidelines on how to create a culture that every team member recognizes and owns. A note here is warranted: One owns the culture. One doesn’t simply buy in or automatically accept what the boss is promoting, for that idea often reflects a certain level of coercion. I don’t want to coerce my team. Culture is homegrown, it is organic, it is joyous, and all the team members are proud of their ownership. I refer to this as the Culture of Thank You. This is a culture that openly and graciously says “thank you” to patients and co-workers and, yes, to teachers as well. It is a culture of appreciation and gratitude.
Okay, that sounds nice, but how do we get there?
Praxis
There is a Greek word that I find helpful when I can’t figure out what is theory and what is practice: praxis. It is the word that melds the 2, when we are trying to marry the theory of building a culture and the practice of doing. Behavior that rests on a sound pedagogical footing is one way of thinking about building culture. Praxis has deep philosophical roots that I invite the reader to explore.
The Leader
Let me start with the role of the practice leader. This person has to truly believe that the day of “command and control” leadership (you know, the kind that screams “I’m up here and you are down there!”) is dead. This old concept of leadership is certainly near the final curtain, but its replacement is still trying to figure out how to do this leadership thing. Let me offer some suggestions:
• Read the work of Robert Greenleaf on Servant Leadership (greenleaf.org). He posits that to be a good leader, one first has to be a good follower. I agree, but agreeing is the easy part. To be strong, smart, and humble is a challenge. Being humble in the face of conflicting information and opinions is not an easy task.
• Create an environment that is transparent as you strive to create a safe and supportive context. Embrace your own imperfections in this spirit.
• Be persistent. The culture you are designing welcomes errors and then corrections. You have to be that person!
• Model Aristotle’s notion that courage is the first virtue, and without it nothing else is possible. In modern parlance: nothing ventured, nothing gained. Of course, be prudent and thoughtful as you embrace new technology and techniques, but be open to it all.
• Model, demand, and expect respect. The simplest way to do that is by being fanatically punctual. Start and end staff meetings on time and respect your appointment times. Imagine that your patients and staff have signed a contract and honor it. I’m not kidding! Nothing promotes your values and the values of your practice more than the meticulous attention to the clock.”
Importance of Staff Meetings
Having regular staff meetings1 is the main tool that we use to create and reinforce our culture. There are many lessons that we learn from our staff meetings; some come naturally and others not so much. The Issues and Good Stuff part of our staff meeting (the essence of these meetings) is run by a rotating facilitator in a pretty disciplined manner and is an accurate measure of the morale of the office. One of the rules, learned over a long period of time, is “No defensiveness permitted!” This means that you are required to listen to the observations made by a staff member, even if, and especially if, you think that they may have gotten it wrong.
A couple of things about this rule are worth noting. We listen differently when we are not formulating a response, answering, or being defensive. It is called active, empathic, or generative listening, and it is enormously valuable. It is the art of developing silences within and beneath the words to their true meaning. It is the basis of all true learning, according to William Isaacs, author of Dialogue and The Art of Thinking Together (Crown Business; 1999), a book I highly recommend.
The seemingly easy side of this coin—the Good Stuff—includes the praise side of the equation, and it is actually the more difficult one. Finding the reason to appreciate and praise authentically is not an easy thing to do in a society that is corrosively competitive. This requires that we be open and giving for generalities for impersonal and non-specific praise.
What About the Business Side?
The most storied and respected business schools have examined the relationship between the so-called soft stuff (see above) and the hard stuff (the numbers) and refuted the claim that they are mutually exclusive. I know that from my practice, but I am not Harvard Business School. However, James Heskitt and his colleagues are Harvard faculty, and they have discovered something they called the Service Profit Chain.2 In service businesses like ours, patients experience highly satisfied staff as a crucial quality indicator, which, in turn, leads to highly satisfied patients. We all know that it is highly satisfied patients who make the quality referrals (the kind we crave) that are vital to the growth of our practices.
Another expert on this topic is Nathanial Brandon, whose groundbreaking work on self-esteem is certainly worth a read. He says, “The policies that support self-esteem are also the policies that make money.”3 And, we can always go back to Harvard, where James Heskitt and his colleagues wrote about the patient satisfaction mirror, which he used to prove that a satisfied staff is the clearest and most effective means of creating customer satisfaction and, of course, profit for the business.
Appreciation Cocktail Party
How could we actually live in this Culture of Thank You and show our deep appreciation to our loyal and dedicated patients? Who was the appropriate cohort of people that we wanted to honor in this way? We decided to invite all of our patients who had been with us for at least 20 years to a special event. So, an invitation went out to 100 patients, and 80 showed up for cocktails, hors d’oeuvres, and lots of love. What an amazing evening, and what a wonderful living expression of the culture that everyone in the room had created.
Lots of Ways to Love and Smile
In closing, I want to share how a dear friend and an esteemed teacher found another way to create a loving culture in his classroom. He told his students, quite unashamedly, that he had great affection for them and wanted to thank them for being there. He wanted them to know that their presence, attention, and commitment to personal and professional growth were all a source of great joy to him. One can surely realize that everyone in that room was likely deeply and positively moved by his warm and sincere statement of appreciation!
References
1. Goldstein AJ. The eleven essentials of effective staff meetings, part 2: Getting it together in the name of customer service. Dent Today. 2004;23:146-149.
2. Heskett JL, Jones TO, Loveman GW, et al. Putting the Service-Profit Chain to Work. July-August 2008. https://hbr.org/2008/07/putting-the-service-profit-chain-to-work. Accessed December 18, 2018.
3. Branden N. The Six Pillars of Self-Esteem. New York, NY. Bantam Books; 1995.
Dr. Goldstein graduated from the City College of New York before receiving his dental degree from the University of Pennsylvania School of Dental Medicine in 1968. He holds leadership positions in and a Mastership with the Academy of Laser Dentistry. Dr. Goldstein is a founding member of the newly formed Dental Coaches Association, a uniquely qualified group of certified dental coaches. He maintains a general dental practice, as well as a coaching practice, in New York City. He can be reached via email at alan@coachingpractice.com or via the website coachingpractice.com.
Disclosure: Dr. Goldstein reports no disclosures.
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