How a Non-Dentist Turned Failing Dental Practices Around | with Rebecca Ding, BOAC #74

0:00In one of our sites, every month someone was handing their notice in and that was tough because you're still trying to fulfil the NHS contract. It was never my dream to get into dentistry at all. My background is actually in literature. I thought, great, I'll step in. I can order some scrubs, I can do some rotas. But quickly realised, oh goodness, this is definitely more involved than I thought it would be. When I first started, I came on board as Charlie's wife. People obviously aren't respecting me in this because I'm not clinical in any way, shape or form. okay i don't have to have a dental background to still make this work i was meant to be stepping back and doing three days instead i've stepped up and made myself the chief operating officer we took on three practices one would have been now 2022 we took over one on the first of january one on the first of february and one on the first of march and that turned us into a group our main site we took it on as a five surgery practice and it had five team members we're now pushing on for 11 surgeries and about 38 team members.

0:57Sometimes there will be things that just slip through the net and someone will say, why did I find out about that on LinkedIn? And you think, oh, because LinkedIn was my focus last week. If I didn't tell them what my expectations were in the first place, that's on me. That's my overall responsibility because I fundamentally didn't tell you the Google reviews that were probably one to two stars quite consistently. Suddenly it's coming in four and five stars instead. You can't just blag it every single day and think that's your one and only strategy. Try it, do it, but do try and back it up with something.

1:33Welcome back, everyone. I'm Jared, one of the co-founders at Coherent Healthcare. Today, I am joined by Becky, who is a co-owner and chief operating officer at the Wooding Dental Group in Wales. Hello. Hello. We've been trying to get Becky on for a while now, and fortunately, logistics played in our favour today because I think you're in town for a conference more generally so we lined up the dots I obviously have a chance to speak with you beforehand and to look at your experience and journey but many of the folks who are joining for this episode have not had that pleasure so if you wouldn't mind giving us the two-minute version three-minute version the short version of how you got here yes and then we'll sort of go from there yeah well thank you for having me and I know that I'm not really a very well-known name within the dental sector and we are quite a new group we've only been running now for about four and a bit years and so it was never my dream to get into dentistry at all my background is actually in literature and it was however my husband's dream so he decided to buy practice with our business partner and when we first took on that site there was no practice manager so I thought great I'll step in I can order some scrubs, I can do some rotors, you know.

2:48But quickly realised, oh goodness, this is definitely more involved than I thought it would be. So I decided I either needed to step in or step out because I was definitely asking more questions than I was solving. So, yeah, I keep promoting myself every, I don't know, few years. So that's the joy of being the owner. You can do what you want. I didn't really think that I'd be sitting where we are now. so we only bought the first site thinking that would be the only one and but then a lot of practices came on the market all at the same time so we thought well this is an opportunity to grow and turn into a group and so we took on three practices uh one would have been now 2022 we took over one on the first of january one on the first of february and one on the first of march and that turned us into a group and so within about a year of running all of those i realized again a bit more than I could chew here so it's time to bring on board a regional manager I've got a clinical director now as well so that's enabled me to well I was meant to be stepping back and doing three days instead I've stepped up and made myself the chief operating officer I think it's the title that fits most what it is I actually do day to day.

3:59I have a few questions one of the questions is maybe I'll put a pin in is what is it that you do day to day so I'll just put that on a pin for a minute. The thing that we were talking about just before, like you, I came into healthcare not with a background in healthcare. And so I always think it's very interesting to understand what I describe as the aha moments. So when you're going through that journey into the sector and you're coming to terms with fighting off a little bit more than you can chew which is the thing that I'm very familiar with in that sense. What are you thinking, feeling, what were those moments where you said, ah, that's how that happens or ah, that's how that happens?

4:42Do you remember some of those sort of markers in time where suddenly you felt like you were going from outsider to insider? Yeah, I think it's that when I first started I came on board as Charlie's wife. You know, I'm coming in to do things to help him out and to get things up and run in. and then I realized okay people obviously aren't respecting me in this because I'm not clinical in any way shape or form people definitely took advantage of that at times trying to lead me to believe that things needed to be a certain way when actually they didn't there was no rhyme and reason to it so I think for me it was saying okay I'm not clinical and that's fine I can draw that line and say well I'm not going to interfere in that particular process I don't have the right to have an opinion on that but actually I am still the owner of this business So I do have the rights to put my stamp on things.

5:30And you do need to listen to what I have to say, because actually, when I tried that thing last month, that worked really well. Or when we put in this system and procedure, well, that's also approved efficiency or patient care or whatever it might be that we're aiming for. And I think over time, as they've seen, actually, these guys are quite good at what they're doing. I think it made me sit up and think, OK, I don't have to have a dental background to still make this work. It makes sense. And I think for me, the thing that I remember is, much like you're saying, this discovery that actually it's quite okay to challenge people in their backyard.

6:05Mm-hmm. You've done this thing for 10 years. It's worked for you, but actually, maybe we should try it this way. And the fact that I haven't done it for 10 years may actually make this more effective. Yeah. I think for our business model, they've all been fundamentally failing practices. So to be able to step in and say, well, I get that you've been doing that for the last five, 10 years. Stopping working very well. Maybe there's a rhyme and reason as to why you need to listen to what we want to try. And let's just give it a go. I've always tried to go in with the, well, yes, I do want to lean on your experience.

6:35And I'm not going to come in as a dictator and say, you're doing it my way or else. It's very, please just try it. And then we'll circle back. We can talk about it. And if you don't like it, fine, we can scrap it. Or we can compromise or whatever it might be. It sounds like a huge part of that journey with a practice with the team is change, dealing with change, confronting change. This is not a dental problem, by the way. But this idea that we are going to do things differently. We're going to try to do things differently. As a leader coming into a practice where there is an established way of doing things, and I think many of the people that we've spoken to have come in as C-level executives, direct level and they have experienced versions of this and everyone sort of has their own tips and tricks for how they go about managing that change what has been your you know what's in your in your bag of goodies that allows you to say okay we can if we spin it this way and spin it that way and do it this way do that way then we i think at this stage change is just normal for our teams they are just so used to what crazy idea of these guys got this week so make change the normal and people won't question it anymore or obviously there's certain people that don't get along with that and you realize they're not a fit for the kind of dynamics that we have to offer and communication I think is the key one isn't it just making sure that you can say to people hey guys we're doing this thing and we're doing it actually really quickly so we just kind of need you to get on board but if you do have any questions obviously come and ask us and we can talk you through it got it so so that's it feels like there's a bit of it is around like actually the who is this person even right for us can they get into this change as a norm?

8:19Yeah, so our main site, we took it on as a five surgery practice and it had five team members. We're now pushing on for 11 surgeries and about 38 team members. And across the car park, we've built a dental academy and our headquarters. So doing that within the space of four years. Sure. If that's not for you, then I think you realise it pretty quickly that we are quite a chaotic place to be just because of the scale of growth within the timescales that we've done it. Interesting. Okay, so part of that is pace people. There's a communication piece here as well. You're going to let people know what's happening and it's open door.

8:55They come back in, they agree, disagree, express themselves, but you're able to have that dialogue with the team members more generally. Yeah, at least we try to. I'm definitely not going to sit here and pretend that we've got the communication thing down to a T. We've got WhatsApp groups and we try that and we try to implement monthly practice meetings and all these other things, but sometimes there will be things that just slip through the net and someone will say, why did I find out about that on LinkedIn? And you think, oh, because LinkedIn was kind of my focus last week. I'm really sorry that I failed to pass that out to everybody.

9:25When there are so many changes, sometimes you lose track of what they are and who you're told. So it's not always smooth, but we try. Got it. So it feels like, going back to maybe the other question, what does it look like day to day? It feels like a big part of that is probably around the change management thing. what else fits into the nine to five or more likely I mean in the right here and now who knows so we've only just launched our um dental training academy so that was only a couple of weeks back so my day-to-day looked like flat pack and interior design and painting and whatever other things it was that I wanted to turn my hand to whereas now that that is launched it's I've actually got a real day job that I need to go and do I need to sit behind my desk and work out how to run a group of four practices and how to actually be really good at that having promoted myself so frequently I haven't really given myself much chance to get to grips with the job role that I had at the time before I was then springboarded into a whole different one and yeah it's just doing whatever the business needs me to do I think ultimately this was my husband's dream to set up his set of dental practices but actually once he ticked that box of saying I just wanted to know if I could do it he's more happy to step back and do the clinical side whereas we thought actually I don't have a different career path to step into and why not make the most of this.

10:41Got it. So now you're in the COO role. Which I think is interesting and I think maybe because you don't come from the sector but of all the practices and groups that we work with the COO title is not actually commonly used which I think is interesting in and to itself. Sometimes in big groups we see it, but it's not always the case. So I'm curious, in your view, and I appreciate you're sort of building the plane as it's going. What are the big areas of responsibility inside the COO remit that you sort of look after? I think it's operations as a whole. I think it's where it's not business. You know, for me, that's more of the chief executive officer, which I don't see myself as doing.

11:27I don't get involved in the finance side of things and I don't do clinical either. So it's everything that falls outside of those other more defined categories. What are our policies, processes and procedures? Final decisions on are we going to bring in this particular new software? Is that actually going to help my team to operate more efficiently? Are there different ways that we should be writing our procedures to say, actually, we did it this way in one practice, but that didn't really go very well. That doesn't fit with our ethos. They do it like this in our other practice. Let's make that more consistent.

11:57And the scale of growth has meant that there's quite a few inconsistencies. And it's that balance between maintaining the individual personality of each practice. They've got their different patient base. They've got their different managers. They've got their different geographical areas and all the challenges that come with that. So you want to maintain that individuality, but we're still a group. So it's just putting that stamp on it to say, this is my pre-approved way of doing things, because this is what fits the wooding ethos. It's interesting. I think oftentimes we'll hear, particularly from dental leaders, although I think probably true elsewhere as well, we will often hear about this, I don't know if tension is quite the right word, but this relationship between the executive and the clinic leadership, where the executive's job is to sort of shape, mold, and direct, and the clinic leadership's job is to iterate and to execute against that vision.

12:52is that the right balance in your group is does it where do those lines sort of fall i think it changes because the two co-owners that i've got are both dentists so we can very much take their vision as to what they want things to look like because they are dentists and one who does more private kind of implants and that side of things whereas the other does the more nhs and lots of exempt patients the more challenging kind of side of things not the private isn't challenging don't mistake me there but the NHS does throw a whole different kind of thing around it and then you've got me who's not from dentistry at all so between the three of us we've got quite a balanced view of what our patients need because some will understand a lot about dentistry and a lot about their options some will understand nothing same within your practice teams you'll have some who have been in it for years and some who it's their first job because they've just come out of school age 16 you know don't know what they're looking at and everything in between so just having a balanced view as to what everybody wants.

13:51But still very dental led, I think is important, dentist led. Without good clinicians, the whole thing's going to crumble. There's no point in having great dentists though, if you haven't got the great reception teams and the great nurses, and then the support staff with your managers. I just want everyone to just do the best and we want to try and get the best out of them that we can. So you sort of broke down that team structure quite clearly you have dental stroke clinical there's a whole world there which obviously you interact a lot with yeah in and i guess out of clinic as well given the nature of the co-ownership yeah and then you have the you used words reception practice manager so on and so forth these are all your teams effectively they roll up into you into the center function and i tend not to speak to the dentist much myself I have been in the past when we were smaller but fundamentally I think there was a bit of a disjointed relationship of them very much thinking well who are you to question what I'm doing and they have been to university for a very long time it's a very specialized skill and so anything that I was questioning which would never be from a clinical perspective because I've always been aware that I can't do that but there was still a bit of a brick wall to think who do you think you are telling me this so we did bring on board a co-practice manager within the first I don't know nine months of opening probably and it's just something that I recognized I can't continue to have these conversations with people because it's causing more aggro than it's actually fixing problems and so yeah don't know if that answered your question I think it does and I guess it's interesting to even be able to recognize that hey there's this tension inside the organization because I don't know if its expertise is being challenged or whatever those dynamics were a change in to be made and it sounds like that's now happened and now you have from what I remember the four practice managers so site level practice management regional management on top of those plus yourself and then obviously the frontline team yes one of the exercises that I remember running when I was running clinic and multi-site is can you can then you sort of trace like how do issues get handled?

16:06And so if there's a problem with a patient in practice one, what happened? Where does it go? How does it sort of make its way up to you? What happened before that happened? I mean this is what I'm going to be spending the next however many months doing is looking at all of these different processes but actually writing it down because I do find that a lot of our expectations are a bit muddied. Sometimes people don't necessarily know who's supposed to deal with these issues and they might try and handle it themselves and you think, oh, that is not the response we would have used, but A for effort.

16:38And sometimes it's more that it's the regional manager that steps in to help do things and you think actually you should have guided rather than stepping in. But when people don't have those firm expectations laid by myself, then how are they going to do what I want them to do? It's funny you say that. When we start working with practices in our work, we always say that the lion's share of the work is in onboarding and it's around SOPs. So show me the SOPs and we'll show you the problems. Yeah, 100 % that. There are very many times where you think, oh, I really want to tell that person that they did a terrible job.

17:15But do you know what? If I didn't tell them what my expectations were in the first place, got to fall on my sword now and go, right, this didn't quite go to plan. But hey, that's on me. that's my overall responsibility because I fundamentally didn't tell you so what part of it do you think went really well and obviously they'll tell me okay well what part didn't you think went well hopefully they'll say what's in my head because if we don't that's when we've got slight issues but generally speaking it's yeah we all agree what should have happened let's just make sure that it does in future and I'll make sure I write that up so that everyone's made clear on that there's a source of truth yeah in the operating layer and it's interesting because I so often, particularly from a compliance perspective, regulatory perspective, I remember dealing with CQC, we were saying earlier, it's different in Wales, but same thing, but different.

18:00So much of the regulatory oversight is specific to the clinical journey. Have you washed your hands this way? Does your floor bend up in the corner? The clinical side is really black and white. There's no room for judgment in this. You're either doing it right or you're doing it wrong. And if you're doing it wrong, we've got a real problem here because this is about patient safety now this isn't about preferences everything outside of the surgery total gray zone opinions you know but it's trying to make sure that you're not making things so rigid that it has to be you know with your dental software you must do a certain process by clicking these exact buttons and following that exact way it could be five different ways of doing it but then there are certain things where you think no that one's not actually up to preference this is company ethos and this is yeah this is our business line this is our reputation this is how we do things You use the word a few times now.

18:50You use the word ethos. Say more. Say more about ethos. I think it's just about making sure our group still has our personality to it. We are a family led business. And while we are a mini corporate, a lot of people still don't like the word corporate. I mean, wrongly, you know, we're part of the Association of Dental Groups. I'm with the corporate owners and decision makers all the time. And there are a great bunch of people doing a great set of things for all of dentistry throughout the UK but there is still a slight stigma around it and we have to be quite careful when we're setting in our processes because our staff once they realised that we were a group as soon as we're starting to put in the structures in terms of a regional manager are we turning into a corporate now well no we're still a group of four practices we were last month it's not just because we brought her on board this month that that turns us into a corporate it's just about maintaining that this is who we are and this is what we stand for and we're going to make sure that the managers are still very much aware of that and that that bleeds through into the whole patient journey.

19:58So I find myself agreeing and disagreeing. I'll tell you where I came about that. So I think what feels very familiar to me and where I agree is the idea that being multi-site does not necessarily equal being a corporate. Behaving like a corporate equals behaving like a corporate and so on and so forth. So I think it makes sense. What you're saying is we have a certain way of doing things. That way is non-corporate just because we have some role titles and a headquarters over there and the building with that. Fundamentally, there's that great thing from whatever it is, Jeff Bezos, who says at Amazon, it's still day one, right?

20:38It's still the beginning of the journey, even though for Amazon, it's not the beginning of the journey. So I can appreciate why the DNA, the ethos of regardless of what you can see on LinkedIn or whatever, we are actually still this family-led business. And that is very much the care and the posture that we take with respect to what we're doing. So in that sense, I agree with you. I think what I find myself less sure of or less familiar to me is the idea that, and it was at the end of what you're saying, the patient journey.

21:08I am of the belief that there are many different versions of a patient journey depending on the patient, but there is a journey that is good and then there is everything else. And that journey might be a loop, it might be a straight line, it might be a squiggle, patient-specific, but there's excellence and then there's everything else. And so I guess the thing I'm in tension with is, or maybe you've sort of found your own way of doing it, how do you operationally from almost customer rather than patient, if that makes sense, because patient is the clinical component, customer is more of the service-based component, how do you hold that line on excellence without having a sort of top-down more corporate-y this is what?

22:04I think it's just giving people more autonomy just a lot more kind of trust if you want to do a certain treatment a certain way with a certain material you know we're not going to put you through this entire kind of authorization process as to the hows and the eyes and same with the reception team it's very well it's your patient base so I can give you a script but if actually you don't think it's going to work with some of the patients because you you know them more intimately because you've worked with them alongside them they're your neighbors you see them down the supermarket you do you you know we're kind of more willing to be flexible in that sense and I think that does get noticed by patients in a way that if we were to say look this is the wooding way and this is how it's getting done my way or the highway follow it the letter or you know you're going to have a meeting with me to say spot check your phone calls and you're not following the script and I think that's that may be what I was driving at.

22:57Do you find that for the right people the kind of people that you want in the organization that that is a point of attraction for them that they can actually go further because of that flexibility? Yeah I think so, I think so. I think you know corporate is a big word for us because we took on failed sites previously and our more kind of historic staff all very feel a certain way about the bad experiences that they had so now that they're kind of getting an inkling that we're going to corporatise ourselves it's kind of taking them back to that bad space of oh gosh what is this going to look like well hopefully what it's going to look like is just more efficiency we can't run a group of four practices without setting in place specific structures and a bigger a better team around us.

23:46So I think they're coming around to the idea. Where do you go first to build that efficiency? So you've got a transformation roadmap of whatever kind, and you've got a pipeline of activities and initiatives. What's number one? I think it's just looking at what's going wrong. So it could be something that wasn't handled particularly well, and then getting right to the nubbins of why, what went wrong with that? How can we trace this back to say, okay, that bit of information wasn't sent to that person, let's make sure we create a specific tip list for this process once you've done that I can then hand that over to somebody to distribute to the teams and then say great what's the next thing that went wrong let's make sure that we're putting things in place so people know how to fix that in future and stop making the same mistakes and do that for a bit and see what happens that's that's as far as my plan has gone so halfway down the list and then feel like actually these things are not so important let's go yeah I mean I am aware that we we definitely want to grow so a lot of my job role has been jumping into exactly what the business needs me to do in that moment.

24:44So there may come a stage where I think, oh gosh, this whole COO title that I've given myself, it is no longer appropriate for whatever role I move into. Because if I'm not doing that job, I either need to find somebody that is going to do that job, or I need to stop doing the stuff that's distracted me to really focus on that instead. Makes sense. Not easy when I can kind of do and choose what jobs I please um sounds ideal and surely that's why you set up your own business right because you can pick and choose but I think the pressure of that is always that if I am going to turn around and say I don't want to do that job anymore it could just be a minor thing but I think there's something within me that thinks well they're all going to think that I'm just privileged now or that I'm lazy or um yeah it can be quite a lot of pressure to have to turn around and say no I'm going to sit at home today and read a book for the whole day and stay in my pajamas because I can.

25:36Because if my team can't do that, if my staff can't do that, what gives me the right to do that? Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic. Coherent helps fast-growing healthcare providers engage, support, retain, and nurture their patients from intake to discharge. As you get bigger, your patient body grows enormously and it becomes much more than just another hire, just another front office team member. It's no longer a people problem. You need technology that can scale with you. Coherent helps you do that by keeping every patient on track.

26:09In short, we're the agentic CRM and patient support platform for outpatient hands-on healthcare. To learn more, visit us at coherenthq.com. Now back to the episode. I think a lot of clinic leaders, whether they say that out loud or they don't say that out loud, I think everybody sort of experiences that tension. And ultimately, healthcare is a service-based business. And so unlike many other businesses, there is a reality of opening the doors every day at X o 'clock and closing the doors every day at Y. Well, yeah, we open at quarter past eight in some sites because that's just historically what we took over the practice when it was.

26:42And, you know, that's what patients are used to and staff don't leave until quarter past five. So if I swan in at nine o 'clock or half past nine because I've done the school run, if I need to leave at 10 to three because I'm likewise on the school run, it's OK for me to do that. But yeah, it can be quite a difficult role as a leader to say, well, actually, I've kind of earned this and there's the extra level of responsibility that's on my shoulders. So just because I'm going home doesn't mean that I'm stopping. But yeah, that can be tough when you can see that certain team members don't see that.

27:11And it's a bit of, oh, you're off already. Well, yeah, yeah, I've still got two children. So how do you manage that tension? What does that show? Like, how do you sort of confront that in the day to day? I think growing a thicker skin has been, I definitely used to care a lot more. I mean, that's tough in and of itself because I've definitely become a lot more kind of callous and cold hearted over the years. And that's sad. That's not really who I am. I'm normally a lot more of benefit of the doubt. And if something's gone wrong, you know, try and have that conversation. Whereas when you give opportunity after opportunity, there comes a stage where you think, oh, who's responsible for this?

27:49like oh it's me right down there I need to step in and say actually this behavior is not appropriate anymore and so yeah there's a definite tough side to leadership but people will either respect you for it or they won't that doesn't change what I am doing and the group is successful so so maybe let's talk about the group so you're foresight's now you've grown quickly you have non-dental provision activities now happening around the outside dental training academy you've got stuff going on because the foresights weren't enough so now we need you more so focusing on the foresights how many patients are you seeing per week per month per year however you define it i mean that's probably one of the good things about my job is i can decide not great with numbers so i'll make that someone else's job and i know that we're doing well that's good do you have a do you have a sense of so well where is well coming like what's your litmus for what i mean maybe quite a low bar in the sense that the doors are still open.

28:47So, you know, when you've taken on failed practices, there is that risk that if we don't turn things around, you're going to have to say, well, we tried here, but fundamentally the NHS contract hasn't worked and we've faced X amount of clawback, which means that we can't afford to pay wages or whatever it might be. So to have turned it around in the first place is the success. We have got planned, you know, memberships for our patients. So for those to be successful is a good thing when they were not in place previously. We've grown the teams from being a lot smaller to suddenly double or triple their size.

29:17So yeah, to have done that within four years, we're in a much different place than when we took the practices on. Now is the stage where we start looking at those figures. We have been very kind of boots on the ground. We need to just do the thing to just keep those doors open. But now it is getting hold of that data to say, well, great, if that was what we managed to achieve in private revenue from this month to this month, what did that look like 12 months later? Did it dip? Did it grow? What's the contributing factor to that? So yeah, it does feel good to finally reach a stage where we can get that kind of data.

29:51And start looking forward. Yeah, looking forward, putting in more plans, more efficiency and saying, oh, if there's one site that's done something particularly well, let's put that in place in another one. Yeah, see where it takes us. What has been some of that, essentially, the idea of coming to a failing practice? I think there are many ways to look at failure. Presumably one of them is financial failure in so much as it is struggling or on the way out. So that's the easiest way to define failure. What does that turnaround story look like? So if I'm a fail-in practice and you come and you acquire me, what are the knobs that you turn?

30:26I think there's two different ways that we've experienced it. So the first one is that you come in and you make some really small tweaks. It could just be that you need to support that manager to do a better job than they were doing previously because going back to what we were saying about expectations, if they didn't realise that they could and should be responsible for certain processes, it's going to fall apart. So making sure that they're well supported, it could just be that they've been asking for a new nurse for years and they just haven't been authorised to take one on board to say, well, OK, why do you need an extra nurse?

30:56Because of this. Well, great, let's hire one then. It could just be from quite small tweaks and then suddenly it just succeeds. In one of our sites, it was the opposite in the sense that when we came on board, they for whatever reason just did not gel with us they didn't gel with who we were as out as as people even um didn't like our ethos so every month someone was handing their notice in um and that that was tough because you're still trying to fulfill the nhs contract because that was again a huge portion of why they were failing so being able to step in and think what what does that need then that just needed a lot of time and effort it was more my husband who stepped in in that particular site he was working clinical five days a week which when you're also trying to own and run a business had its own challenges but then it was just building that team up with it with a different culture I won't say better culture it's just what was working for us and if that culture didn't fit what you want then that's why the notices kept coming in so over time patient reviews started to go up as well so you know the google reviews that were probably one to two stars quite consistently suddenly it's coming in the four and five stars instead lots of patients that are saying been to this practice for years and it's always been horrendous now under the new ownership i'm so pleased that i'm still registered here on the nhs i'll never go anywhere else so soft signals are coming you can sort of see maybe it's not in the in the number yeah as so much as you're seeing the anecdotal yeah signal that hey something's happening here it's positive We don't know exactly what it is, but it's going in that direction and we're happy with that.

32:34I think for me, what I pick up on of success is it's an atmosphere. When you step into that practice, you can tell if people are stressed, if they're unhappy, if they don't know what they're doing, if patients don't feel content, if they don't feel like they know what's going on, if their expectations are really low, you can feel it in the air. Whereas if you step into a successful practice, suddenly everybody's smiling and everybody's happy and the patients are sat and they're calm. And even if things are running over, they don't care, they're happy. Yeah, the atmosphere makes a big, big difference.

33:05It's interesting. When we get involved with a clinic group, single site, whatever it might be, I haven't thought of the word. Atmosphere is an interesting word. One of the things that happens in our engagement with clinics is that we, as and when issues surface, someone has to opine on it, a clinical issue or whatever it is. one of the things I always look for is how quickly does the clinic team respond to that issue and even though it's a silly little thing that is almost one of the biggest indicators of the overall health and success of the practice is do you respond to a patient issue even if it's a small issue do you respond in a minute in some cases we actually have someone who will respond in a minute and so it's effectively real time or do we have to chase five times yeah and the practices where we see that immediacy and that urgency in the customer focus, almost the obsession over no patient should be waiting for a response to something for a thing.

34:04I think that that posture, that ethos, that atmosphere, that DNA seems to permeate every corner of the business. And consequently, you see it in the revenue, in the profitability, in the reviews, all sort of works together. I think patients can feel if the intentions are correct. So if you've not got back to them, but genuinely you've tried and you can say to them, I'm so sorry it's taken us a week to get in contact, but we tried to call you on this date, we emailed on this date, and you can list all the things that you've tried. They'll know if that's truthful versus just a script that they're told to say, right?

34:40Patients can feel what's authentic and they can feel that good intention. I'm curious when you intersect that statement with a lot of the things that are happening right now in the AI-ification of patient relationship stuff, be it receptioning or how does that gel? How does the authenticity and the empathy and the intention of the team, where do you fall on the line? on. I'm all for it. I think that you can't take the human element away. You know, if you've got an AI receptionist who is answering those initial queries, well, actually, what that's going to do is give my reception team and my TCOs more information.

35:20So when they do pick up the phone to say, hi, just picking up your inquiry, they've already got all the stuff that they need as to, you were calling us about this issue and you want to see a dentist within this timescale. They'll know already if they've been on our website and they've looked at a specific clinician's web page or whatever it might be so information is key to help the humans help patients fine so this is a uh this is an end story it's a let's use tech to make team better more productive more patient-centric not let's use tech to rip out i don't think you can remove it entirely i mean some places have probably tried and that's it's working for them and that's great but it's not something that we're looking to do um you know we're not going to have robot dentists so they're going to have to see a human eventually so surely that dentist still needs humans around them to help as well so yeah interesting when when you think about the uh the future of the group uh i guess maybe focusing slightly more broadly you've got the four sites you've got the training academy there's nothing else just not right now not right now that's it got me again in a couple of months right quite quickly but right you'll have a physio so you've got the four the four sites, the training academy.

36:34Let's look forward. I appreciate that. You were saying earlier, the vision is, there's a long-term vision, but the journey to getting there is very much driven by opportunity. What do we see as the next thing? And sometimes that next thing is not known per se until it shows up and then suddenly it's the obvious thing. What does the next 12 months look like? If you can look out that far, where are we going? Stability, I think is needed. As much as I joke about how we are a chaotic group. I don't think that's ever going to stop, but at least being able to provide that stability for staff to say, okay, at least in this particular building, we're not going to do any more building work.

37:11We're not going to push upstairs. We're not going to move your staff room again. We're not going to do all these different things. Making sure all those processes are in place so that people can genuinely come into work thinking, I do know what the expectations are. I know what to do. I know what my journey within this organization looks like hopefully that's alongside our training academy and that should be all up and running um yeah a few things in the pipeline there to make sure we can start running a lot more courses but it's just a matter of time until they're up and running we've got three training spaces at the minute but i think the longer term vision is that they're going to be full constantly so we're going to have to put across the car park into a different unit and start building in there um growth definitely um we're just not quite sure what that's going to look like my ideal is to stay within Wales.

37:55It is a system that is different to England. But I know that my business partners don't necessarily agree with that. They would like to have aid practice in England. Opportunities driven, let's see. What is the, I'm sort of curious about, you've mentioned a few times, Wales, non-Wales, elements of it carry across, some don't, language we were talking about earlier. One of those examples, appreciating, of course, that the NHS components are probably where the bulk of that difference lives. Yeah, a huge difference. Yeah, private is private, right? We can all do private to whatever standard we think is necessary for whatever prices we think is necessary.

38:35Yeah, the NHS is worlds apart. So as of the 1st of April this year, a completely new contract came in. No more UDAs. So no more, you know, those units of dental activity, that's not a thing. We instead have got different care packages. I think there's 13. There was a time where I was well-versed in it, but I lost the will to live about four months ago. It's just exceedingly complicated, and I think the problem with it is that it was implemented really quickly. So everybody's been scrabbling to try and get this system running and safe for patients and a lot of ambiguities and uncertainties and just lack of clarity with it.

39:16What is the impact of that? I mean, I think you're seeing this in, I'm pretty sure I was in medical aesthetics, dermatology space, and there was a huge set of changes both on the CTC components and also actually from a VAT perspective, both of which sort of hit the sector in rapid succession. And the people who felt it the most, I think, were probably patients. The practices tried to juggle the plates and try not to stop anything if you think it's but ultimately the patient experienced that discontinuity much more than anyone else. It is confusing. I think when as a practice, we don't necessarily know all of the answers because we're not being given the answers, trying to explain that to a patient, it's really hard.

40:03And, you know, throw this into a sector that's not straightforward anyway. A patient will come to the desk with a complicated treatment plan that at the time they thought they understood. But, you know, it's common, isn't it? they'll go to the desk and think oh actually I'm not too sure if I have taken all of that in and now what's this bill that's attached to it I don't understand I just don't understand what's going on so it does cause a bit of a headache for our reception teams because not being clinical either and there might be some nurses on the reception team you know previous nurses and that's fine but still when it becomes their job to explain the fees and everything else that's associated the hows and whys of well what do you mean I can't have it on that care package and why am I adding four different care packages one on top of the other?

40:47Sorry, that's what the dentist has said is necessary. That's what the system is telling us we need to do. And I'm very sorry if you don't understand that. Yeah, patients have to pay their own lab bills as well, and I said, for example, so that's been a big change. Interesting. So it feels like that perhaps grey area, you know, clear as mud, that you were trying to navigate at a leadership level in some ways shows up in that patient experience. Yeah, and it's hard because as a leader, you want to be able to go to your team of clarity and say, this is what we're doing. This is how we do it. So it's difficult when you have to go to your teams and say, I don't really know.

41:21We've asked, but we've not really been given a very clear answer. And I'm really sorry about that. But yeah, this is what we've got for now. So, you know, we've reached the mid-year point of it now. And last I was understanding of it, that basically every practice across Wales is underperforming to our current targets. Well, that's not sustainable moving forward. So, yeah, it'd be an interesting thing to watch over the next month. I mean, interesting for outsiders. Quite scary for us on the inside. What is going to happen? Is it going to be preemptive clawback? Well, that's not fair when we don't know what we're doing.

41:52You know, to my mind, well, the targets must be wrong if everybody's underperforming. But, you know, who am I to say what needs to happen next? No, no, it's interesting. And I guess, you know, on our side, we don't hear a lot about the NHS contract. It's not something that we spend a long time thinking about. And we also do work outside of dentistry. And I think what you're describing in its own way might be very specific to Wales and dentistry and NHS. But equally, I think there is a lot of change in and around. I describe it as sort of the consumerization of health care services, retail health care services, either NHS or private.

42:31I think a lot of things are changing. You can tell by my accent, I grew up west of here in the U.S. And I've been here for about 10 years, which is over 10 years. That's been a long time. And every year I can see more and more issues around value-based care that look very similar to what I grew up with, I was familiar with. And that's how I said the UK model is starting to look like the US model. But I think as you start to see this sort of sector maturing, it brings these problems. It brings tension with central bodies. It brings tension with technology providers who are now trying to tweak and change and figure out how to do associate pay and figure out all this sort of mess.

43:21And now we've got a whole new issue with patient demographics. People don't answer the phone anymore. How do you get in touch? The problems just sort of cascade. I'm curious in your seat from all the things that you're seeing, the convergence of these changes, what is the one thing that you're trying to address, resolve right now? Like if we followed you home or to work or wherever it is that we follow you when you try to solve that problem, of all the things you could be focused on solving? What is the one thing that you're really trying to move the needle on? Right now, it is the NHS contract.

44:00It's not fit for purpose. So while we are only our small little group of four practices, being part of wider groups such as the ADG, they are very much in conversation with Welsh government. We were really lucky, actually, when we did our academy launch. We invited the chief dental officer, Andrew Dickinson, to come and join us, and he accepted. So it was great to be able to show him around and make a point of, look at these extra surgeries we're putting in because we can't service our NHS contract without bringing in more clinicians. So look at the money we have to spend in doing this, you know.

44:33Look at our large reception team that we need to service this contract because the amount of admin is wild. So, yeah, he's been a good contact to have. He wants us to host the GDC in our practice soon. So I'm mildly terrified by that proposition. I mean I'm not GDC registered of course but it's still very like do I have everything I need I don't need anything but do I just in case yeah we are only a small group but if we can have any influence in how things are being run with this NHS contract I would hate to see the whole system collapse overnight but try and call back from every practice in Wales and see what happens they can't but they can't not because they said they wouldn't be lenient so we'll see what influence we can have and go from there You mentioned being a parent as well and the experience you just described of you can't or you can claw back, but also you can't because then you'll be crippling.

45:30And so now you've made this promise and I have kids of my own. And so now you've made this promise and now you have to you have to exert the consequence. Why did I say I do that? That was the wrong thing to say, but now someone's going to die on this hill. It will be me. It will be me. Interesting. Okay. So NHS contracts. Okay, got it. I'm conscious of time. I want to respect the time you've given us. Thank you very much. I always try to think for those who are listening who are running either groups or other practices or who are confronting central body tension or any of the challenges you just described.

46:06what are what do we leave them with what we leave others with in terms of you've come into the sector four and a half ish years ago if my math is right so ballpark four and a half years you came in with a different background you've trialed by fire all the way through this thing yeah you've come away with some things that keep you sane that really work for you that But when someone reaches out to you and says, hey, I'm thinking of opening a dental practice, you say to them over coffee, do this and don't do this. What are your sort of linchpin? I'd say that expectations is key. So, you know, try and keep on top of your paperwork.

46:48Make sure you've written those SOPs because without them, you're going to find yourself in a bit of a mess that no one really knows who's responsible for what. Well, that's not my job role. Well, it is because it's in your job description and you signed to say that you understood that. So just trying to make sure that those kind of baseline bits of how you want your business to be run, just get it written down. Get it written down and no one can question it. But also just do it. Do the thing. What's the worst that could happen? Just try it. And if it doesn't go, then? Try something else. Right.

47:20We're back on that. Okay. Right. The cycle of iteration. And what about your no-fly zones? if you're thinking about, I'm thinking particularly for people who are coming into the sector, much like yourself and myself, when I came into the sector, who don't have 10 years of this. Yeah, I think it's just recognizing your own limitations. It doesn't mean that you're weak or that you're not a good leader if you can just put your hands up and say, I know nothing about this. Make sure you're asking the right people that do though, because you can't just blag it. Yes, there's a certain fake it till you make it, but you do need to back that up with something.

47:56You need to be able to show that you're putting the correct processes in place because you've thought about it or you've gone away and you've researched it. You can't just blag it every single day and think that that's your one and only strategy. Try it, do it, but do try and back it up with something. Right, so sort of one out of five are sort of throw away, let's wing this, but actually the rest needs some substance. Yeah, and I think if you're aware that you are winging it, it's just making sure that you do go back to revisit that process though. You can't wing every process and then wing all the processes after that.

48:24You need to be able to say, you know, that thing that we said we try, we've tried it. How's it going? Because the answer is, well, great. Well, let's write it up and make that formally how we're going to do things moving forward. But if it hasn't worked, well, OK, come on, then. Everyone that's been doing this process, what's your opinion on why this didn't work then? And what do you suggest we do to improve it moving forward? Constant revisiting, but. I don't think that the constant revisiting is something that as an industry, we are particularly good at. I don't know that that's sort of learn and improve.

48:54Yeah, I mean, maybe that's from not being within dentistry. I think once you've learned to do dentistry, you don't need to revisit a certain process. You're constantly improving upon it, improving on your skills and such, but you're not going back to the beginning and scrapping it because that's not how that skill set works. But all the other processes and procedures, nothing's set in stone. Right, it's almost exactly how that other stuff works is the process of creative destruction, which is interesting. And it's interesting also, I mean, if I think about the practice leadership that we speak to and that we work with, there is definitely a difference between the mindset of clinical and business.

49:31There's tension there. And I haven't thought about it the way you just described it, which is in the clinical journey, your skill set and know-how, your knowledge base compounds and becomes sharper in theory over time. You want to revisit and sort of freshen your, you know refresh your your tools but i mean there might be a new technique that comes out a new material but that is still adding to what you already know and improving upon it whereas all of the rest of it you could scrap the whole thing overnight and say we're not going to do it that way anymore this way now yeah that's a very different posture becky thank you so much um for those joining this is becky the chief operating officer of wooding dental group in wales four sites dental training academy next time we sit down with becky it will be 12 sites dental training the Academy and four other kinds of practices and a vet surgery.

50:16Or even more. It's Wednesday. Or even more. Thank you so much for joining. Thank you everyone else for joining as well. Really appreciate it. Thank you. Thanks for having me. Pleasure. Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way. We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time. Thanks so much.