Leadership skills versus managerial skills within businesses

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Introduction

As I began to think of how to write my Management Skills Report (MSR) for my Master of Business Administration program, I thought of the many "bottlenecks & systems" that I've come across in my dental practice. The MBA program has helped me to identified them, whilst applying sound business models, and seeing a gradual change in my practicing career. Examples of identified bottlenecks include treatment plans break down, with patients leaving as a direct result of inappropriate or incorrect communication given out by staff.

The question is what does a bottleneck & systems have to do with writing a MSR. This goes back to my days at the dental school, which incidentally is one of the best in the country. It rates 4 out of 5 points, from leading academic research, high success rate of dental graduates, and a world renowned avenue for attracting international students.

However, in my view, the missing component in these list of achievements, is that the dental school focuses on the traditional view that "becoming an acclaimed clinician" is more important that knowing anything about the commercial aspect of dentistry. In fact I can still hear one of my colleagues asking "so how much will this denture cost in practice?" and the reply from one of the senior clinical tutor was "Mr. XXXX, we don't talk about money at the dental school!" Yet the very first question I was asked when I got into practice was "how much will this cost me doctor?" I hesitated to answer the question partly because I did not know the answer, and because I did not have any reference point to refer to from my days at the dental school. And I did what any respectable clinician who was trying to be bold and courteous to the patient will do - I asked the patient to check with the practice receptionist or manager.

In a sense I needed not to know because I was on a fixed salary, and this salary was paid regardless of the number of patients or treatments that I complete in one day. The salary was paid on a monthly basis because I was on a one-year Vocational Training program - that was a bridge between dental school and working full-time in a dental practice. At the end of the one-year training, I had to learn how to earn a living - not only to put my 5 years of clinical dentistry into practice, but also to know how to balance clinical dentistry with repaying my student and bank loans. Quickly, I realised that I was in a scientific and humanitarian business.

The sad truth is most dental graduates have no knowledge of dental business management, and they are struggling to work in practice. Likewise, our universities are not equipped with business models and applications for operating dental practices efficiently. Yet market forces tells us that it is only the well prepared dental professional who can keep pace with such forces. The latest in the field is the mandatory registration of all dental care professional in UK with the Care Quality Commission (CQC). After April 2011, it will become illegal, punishable by law, for anyone to practice dentistry in the UK without registering with the CQC.

Having navigated my way through the dental school, and dental vocational training, I was introduced into day-to-day realities of working as a dental practitioner. My first point of protocol was to have an accountant, as I now have to declare "all my taxable income." Soon I had to be concerned about "bookkeeping" which was a major weakness for me - see later how the MBA helped to deal with this issue. Bookkeeping forced me to be concerned with, and aware of my financial performance as a dental practitioner, and later as a practice owner. This is important because practicing in the 21st century as a dentist meant that one needed business acumen and will as the clinical skills. A right mixture of the two is critical for any dental practitioner whether in the UK and anywhere in the world.

The business of dentistry in the 21st century demands radical changes. It is not enough to have excellent clinical expertise, and good financial management skills; it is absolutely essential to be able to balance this with workable practice management that encompasses all clinical, financial and non-financial aspects of dentistry.

This brings me back to my opening statement of bottlenecks and systems. For many dental graduates who are in practice, we are confronted with many systems without definite goals of how to measure whether these systems are performing to their optimum levels or not. The resulting chaos is bottlenecks. Bottlenecks slow down workflow leading to high level of stress, low practice morale, and frustration for both the dentist and dental staff.

Defining clear visions and objectives - how to implement and measure these objectives will hopefully help to clear the bottlenecks so that my work as a practice owner/manager runs more smoothly. I intend to draw on primarily on the management skills that I learnt whilst going though the MBA program. And contrast the differences between Dentistry and the MBA.

Firstly, I want to emphasis the difference between a manager and a leader. Management is primarily about order and control. On the other hand, leadership is about making changes, setting and achieving goals. The skills will be revisited later in this management and skills report.

Leadership skills versus Managerial skills

Leadership skills

Managerial skills

Native talent

Developed abilities

Vision and Risk takers

Innovative thinkers

Passionate, Excitement

Inspirational

Planning

Organising

Direction

Controlling

Resourcing

Outsourcing

The Business of Dentistry

According to the business of dentistry is summarized as, receiving payment for dental services rendered in the course of the practice of dentistry. This statement implies that there is an environment - dental environment - where the business of dentistry takes place between the patient (the consumer) and the clinician (the producer). And one of the means of exchange is money i.e. the dentist gets paid for the services rendered to the patient. For this environment to exist certain structures must be put in place.

The Concept of Balance Scorecard

According to of Bain & Company one of the top 10 Management Tools and Trends observed in 2009 was Balance Scorecard. Balance scorecard was developed by . Prior to 1992, most businesses including dental surgeries were focused on measuring the success of a business based on financial performance. The ability for a small to medium size dental practice to have a good "cash flow" was considered good return on investing in the practice.

However, when R. Kaplan introduced "Balanced Scorecard," businesses began to incorporate key non-financial measures in their business. These non-financial measure provided answers to four basic questions.

How do customers (patients) see us - Patient Perspective

What must we excel at? - Internal Perspective

Can we continue to improve and create value? - Innovation and Learning Perspective

How do we look to Shareholders? - Financial Perspective. Though this question is not very relevant to a dental practice.

Today, the concept of balance scorecard is evident in dental literatures, where emphasis is not only given to the financial aspect but to non-financial matters. For example, attracting new patients whilst retaining existing ones, is critical to the success of any dental practice - Patient Perspective. Given that patient list size is one of the critical success factors, then identifying the key indicator for measuring new registrants whilst retaining existing one is termed as Key Performance Indicators. (KPIs). Although, Balance scorecard has its limitations, it is generally accepted that good dental practice management revolves around identifying one's critical success factor in the light of the balance scorecard.

The 21st Dental Practice

The balance scorecard allowed me to look at my dental practice anew. For example, we recently conducted a randomized patient satisfaction survey, in order to gain their perspective about the services we provide. As a new dental practice, our mission is "to care for peoples mouth by word of mouth." The vision was to provide quality dental service worth recommending by word-of-mouth. Our goal was to grow the practice to a patient list size of 10,000 by year 5. To date we have over 5000 patients.

Based on the survey, we were able to deduce the following: firstly, we needed to look at our marketing strategy, which up till the end of 2008, was based on the traditional approach - adverts in news and print media. However, the survey showed us that "word-of-mouth" was more important than any other form of marketing. We asked the question: how did you get to know about the surgery?

Some of the replies we are tabulated below

How I got to know about the surgery

% Rating

Recommended - (word-of-mouth)

39

Family dentist

18

Nearest

19

By chance

5

Surgery use to be my GP surgery

6

News & Print Media

13

Further analysis of the survey age demographics revealed that 30% of patients aged ≥55 a greater influence on their children and grand-children when it comes to attending a dental surgery on a regular basis, compared to 13% of patients aged 18-25. One reason might be that most of the ≥55s' have many decayed, missed or filled tooth, and they do not want their children (and grand-children) to experience the same trauma to losing. Also the ≥55s' have good value judgment to be able to access whether a dentist/dental practice is worth recommending or not - service level encounter.

In addition, the survey allowed us to get to know our patients better. We identified that by focusing on the ≥55s' we were able to identify those who are in early retirement with maturing investments, and those that have been separated from their spouse and in need of a new look.

Next we looked at how to attract future patients in order to achieve our goal. These led to the following questions:

What are the current market headings in UK dentistry

What new trends are emerging?

How can we make better use of available dental technology to attract new patients - for example "tooth coloured crown preparation while you wait"

At this point, we looked at our internal human resources structure, and saw that we needed to train and re-train our staff. To date everyone is on a continuing professional development that are documented and used as part of his or her staff appraisal. This has proved very useful as the feedbacks from the staff suggest staff role enrichment with good morale and a stress free environment.

Current Market Place - Opportunities and Threats

A quick SWOT analysis of the dental market showed that in spite of the many opportunities (NHS Dental commissioning with good base contract, many retiring dentist looking for quick sale of their dental practices & goodwill, and the growth of Sports dentistry in view of the coming London 2012 Olympics), there are many threats from other "players" in the dental market. These include retailers such as the Virgin group, Tesco, Sainsbury and Smilepods offering tooth whitening that have been springing up at shopping centers all over the UK.

Other threats include Centers of Excellence such as the Eastman Dental Institute that offer referral services as a means of reducing the burden of waiting time for an NHS dental appointment. Recently, there has been a quite but growing wave of companies that started in the USA offering dental franchises - the big attractions are:

Standard practice system - "dentistry in a box"

National branding and marketing

The Importance of Branding

According to Kotler & Keller, the role of a marketing professional includes creating, maintaining, enhancing and protecting brand(s). They defined brand as "a name, term, sign, symbol, or design or a combination of them, intended to identify the goods and services of one seller or groups of sellers and to differentiate them from those of competitors," Thus the role of a brand is to "identify the source or maker of a product and allow consumers i.e. patients … to assign responsibility for its performance to a particular manufacturer."

Branding was first introduced in dental practice in 1992 when practices started using brass plates with the name of the practitioner inscribed whilst a concurrent advert was placed in yellow pages. This evolved in 1997 to logos and celebrity endorsements. In 2001 we saw the advent of the internet changed the way dental brands were portrayed, and by 2008, a brand culture developed with dental marketing companies such as Dental Focus offering a bespoke dental logo, website and marketing services.

Today, dental branding helps to educate patients; through past dental service experiences, in ascertaining which brand service satisfy their needs and which do not. For example most elderly patients would prefer to retain their back tooth than to have it extracted. And in order to diversity our brand service we put together an opportunity matrix - see figure 1

Our practice Opportunity Matrix painted the following picture

18-25

26-40

41-55

Over 55

Tooth Whitening

√

√

√

Facial Aesthetic

√

√

√

√

Tooth straightening with orthodontic appliances

√

Tooth colored crown in "one hour"

√

√

√

The Smile Makeover

√

√

Dental implants

√

√

√

Stable denture with implants

√

√

This opportunity matrix is helping to drive the vision, mission statement and goal of the practice in breaking new grounds. For example, in order to provide the tooth coloured crown in one hour, we budgeted some funds to buy a Cerac machine which can cast a crown I under one hour from a mould of a prepared tooth, whilst the patient has enough time to go shopping in readiness for the crown to be fitted on return. This reduces waiting time, whilst cutting out the need for work to be sent to a dental laboratory with a turn around time o 7 - 10 working days.

In addition, the patients do not have a return on another visit for local anaesthetic to administer. Patients like these benefits and the potential return on invest are vital to the continuing success of the practice.

Managing a brand - influence of the brand culture

My dental practice relies on quality service from my staff. We demand a good relationship amongst staff members and an excellent rapport between patients and staff for successful delivery of services. Thus one has to constantly updating oneself and using the knowledge and experienced gained to develop our staff, both in their clinical skills as well as the softer people skills, so they are able to handle patients effectively. Our staff understands that they are the human face of the practice - similar to billboards ads for the practice. Efficient, polite service will have a positive impact on how patients perceive the practice. Thus it is vital not only to attract and retain quality individuals to the practice, but also to develop them and ensure that they are valued and content within their jobs.

Managing a dental practice

Though there is not clear definition in the literature of how to manage a dental practice. There are several characteristics that have been cited. The common tread in all citations is that managing a dental practice depends

Organizational context

Level of the dentist within the profession

Type of applied management application style for example dental processes

Dental processes looks at the way in which services are delivered to patients - right from the time they first have contact with the practice until the time they step out the door at the end of their treatment - the patient's journey within the practice and how efficiently it is managed. The smoother the journey is, the better the impression for the patient and the happier the patient. A happy patient can become a repeat patient; an unhappy patient means not only a patient who may not return, but also adverse publicity for the practice through negative word of mouth. One well-known marketing statistic is that consumers who have a bad experience tell on average 9 people, whilst one study has shown that 13% of people will tell 20 or more friends and colleagues. It is therefore imperative to manage patients' expectations and to ensure that they are happy with the service they are receiving - that they have been placed at the centre of the practice. We look at the practice from the patient's point of view.

In order to manage my dental practice, whilst improving quality of care, I had to adopt a performance management style on a multilevel approach. Performance management is a set of activities within a system through a business operates. It comprises of goal setting, dealing with changes within the business, coaching, motivating staff appraisal and team development. The activities are categorized under the following subheadings:

At the core of this multilevel approach are

Leadership at all levels - ownership of key tasks within the practice

An encompassing culture that support further learning and training throughout the practice

Priority to the development of effective teamwork

Greater use of information technology in order to continue to improve in the delivering of healthcare services.

Though some have argued that efforts to improve and managed a business can be ritualistic in an attempt to meet external bodies accreditation in spite of this I believe that the persistence of quality improvement initiatives is the bedrock for which the practice will grow. And the leverage for change lies in my ability to be able to motivate and inspire others.

The onset of managing a dental practice mapping out the vision of the practice a on canvas for everyone to read, understand, and work towards achieving the visions. Within the vision are goals and objectives. Without these, the foundational believes system of the practice will be unstable, and not matter the efforts to sustain it will ultimately fall apart.

Staff performances help to measure goals and objectives. These are appraised at intervals (e.g. mid-year or year end). The outcome of such appraisal can then be rewarded whilst feeding it into the business structure for use during decision making be it for promotion and/or staff retention. Each member of staff has different goals based on their primary role. Thus the goal for my nurse is different from that of the practice manager. However, these goals are designed to fit into the overall goal of the practice - quality in dental care. In past years, we have used staff appraisal, in consent with the staff member; remedy areas of deficiencies in the staff ability to performed their duty. This has proved positive as it encourages skill and career development whilst expanding the individual capabilities' and contributions to the practice.

The implications of the above statement are: the foundation of understanding the natures of an effective dentist as a business manager are based on business principle such as organisational theory & forms, multilevel management approach

Management and Organisational Theories

There are 4 evolutionary time periods of managements according to theories that were put forward by See fig. 1.

It shows a timeline of how management and organisational theories have evolved over the decade. The emphasis is on the different characteristics that are necessary for different managerial context. Managerial context refers to the type of society, nature of work etc, human nature assumptions, managerial control and key resources.

It is worth noting that managerial duties, which included reward and punishment to control employee behaviours, have shifted over the past decade has people no longer entertain the "job for life" ideology. By the turn of the century, following much criticism of the "mechanistic nature of workers," neoclassical management theories were embarked upon to look at the human aspect of a workforce.

Career developments for employees were seriously considered in the late 1960s. The rational behind this concept is that a business organisation comprises of "mutually interrelated and independent variable." This meant that if one part of an organisation were changed, it would effect changes in other parts of the organisation. The key point is that those effecting the changes must be recognized.

In addition, a dental practice is susceptible to market forces such as the rate of change in technological advancement, global market and competition, and an increasing wave of a lean but agile business. And together with quality assurances and management of workplace discontent, the roles of a manager are constantly evolving. For example, managers are required to ensure that their employees are able to work with other team members in a joint effort in other to achieve a common goal. This is based on the assumption that depending on the employee stage in life; his/her needs can be met, whilst the employee learns new skills.

Modern management theory proposes 3 key initiatives: "system theory management science and contingency theory"

"Systems theory" looks closely at the organisation from a multilevel perspective though they can be mutually dependent on one another. The theory simplifies organisational tasks into four basic components: task level (where performance is measured), strategic level (for decision making), people management level (which deals with organizational culture), and evolving subsystem to allow for contingencies.

"Management science" deals with quantitative techniques to solving management and organizational problems. It combines strategic planning with scientific forecasting in order to offer solutions for administrative concern over organizational objectives and goal accomplishment. For example, the applications of Microsoft excel to solving operational problems, just-in-time production, and total quality management.

"Contingency theory" describes the notion that there are no common models of management that can be applied to all situations, without looking first at the unique environmental factors of the business and its internal structures.

It can be deduced easily from the above theory, that managers are meant to be exceptional in all aspects of multitask if the business is to grow. They are able to assess a situation and apply the appropriate management skill.

Organisational Forms and Managerial Characteristics

The approach in which an organisation seeks to govern itself is fundamental to understanding the role of the manager. For example in order for the manager to fully take on board in the vision of the organisation, he/she must have the necessary core skill, be able to manage a mixture of organisational structures. In turn, these help to shape his/her career management.

There are five traditional forms of organisational structures that are frequently cited in the literature. These include: Functional, Divisional, Matrix, Network and Cellular. The cellular structure can be applied to managing a dental practice. See Table 1

Organisation structure

Career Path

Key Competencies

Responsibility for Career Planning

Cellular

Independent professional

Technical, Commercial, Collaborative, and Self-governance

Individual

Divisional

Single form, across divisions

Technical, Commercial

Divisional, firm

Functional

Single firm, within function

Technical

Functional development

Matrix

Single firm, across divisions

Technical, commercial

Dept., project, firm

Network

Within and across firms

Technical, commercial and collaborative

Firm and individual

Divisional.

Divisional form breaks down a company into independent centers, each with the ability to function within its resources. Within this structure, managers have more opportunities to develop and share experiences, which helps to develop their managerial skills.

Functional.

This is one of the earliest forms of an organisational structure. Individuals within the organisation trained to become specialists in specific discipline, with little or no knowledge on how to run other disciplines. Managers cater for the needs and wants of the specialists, secondary to the major task. The only prospect for an individual within this group is the hope of getting into the levels of senior management. And this can stay for many years.

Matrix.

The matrix organization borrows from both the functional and divisional structures. For example, individuals develop technical proficiencies within a functional structure, and perfect their skills in commercial matters when assigned to other cross-departmental project or program.

Network organisation.

The network organization started in the 1970, in reply to the need for increased flexibility and agility. While conventional structures enabled growth of organizations, they were slow, protracted and ineffective to meet the fast pace world of the 70s' and 80s'

Network organisations are similar to a computer network in that it connects "independent firms to provide the critical expertise needed for specific projects or products" In addition, the skills set requirement for this level of operation are (i) the ability to work in collaboration with others, (ii) technical know-how and commercial skills.

Collaboration skills include: referral, partnering, and relationship management.

Referral skills include the ability to evaluate a problem, prescribe a solution, for others within the network or across other network platforms, to act upon. In this form of organisational structure, managers work within their capabilities (core competence), whilst passing the rest on to someone else.

Partnering skills include the ability to conceptualize, consult, and execute mutually beneficial outcomes.

Relationship management deals with the expectations and perceptions of consumers and other partners.

Network organisation can be expanded to teams and team-base establishments. Within this environment, a collection of individuals are group into teams with an assigned task be it short or long term, with the flexibility of functional or cross-functional skills. The main benefit is that these teams can go on to become more specialized, self-managed, responsible for planning, scheduling, setting work goals, agenda and the type of reward system the choose to adopt. Efficient teams can sometimes replace the need for a manager.

In spite of this, managers are still crucial to the running of team and team-base establishments. Their purpose in such teams is to serve as a visionary, educator, coach and/or internal consultant. Each of these attributes helps to make fine adjustments to the smooth running of the team. This creates a support system for meeting team objectives; for example providing the day-to-day material resources that the team or work requires.

The issues of coaching individual team member to harness their team skills have gained a wide spread acceptance amongst practitioners. It is believed that by honing individual skills, the team can develop into unit. However, a review article by suggested that team planning is more critical to team effectiveness than coaching. The article stressed that poor quality team planning or design is cannot be changed by coaching. emphasized the need for manager to first learn "how to design teams effectively, then focus on coaching aspects." For example, a team can be designed around task interdependence. This interdependence comes with a cautionary note that manager might find it difficult to let go of their authority to make decision on behalf of the team, thus there is need for balance.

It is clear from the above that effective managerial characteristics within a team are crucial for both the manager and the team that is been managed. designed what they called "Teamwork Wheel" which comprises of eight key activities for creating synergy between managers and their teams. These are:

Advising - to gather information and produce a report;

Innovating - to create and experiment new ideas

Promoting - to explore and present opportunities;

Developing - to assess and plan applications.

Organizing - to acquire staff and manage resources

Producing - to deliver goods and services as promised;

Inspecting - to monitor and audit work systems

Maintaining - to ensure that the standard and values of the organisation are upheld and safeguarded

The above forms of organisational structure are the foundations on which most businesses were traditionally built upon. However, in today's' 21st century society a new kind of organisational structure is needed. There is a gradual shift towards the need for all employees to have managerial skills and characteristics. In my dental practice, every staff member is given a job description that includes managerial roles. This creates a sense of ownership and commitment towards the goal of the business.

This form of organisational structure is referred to as cellular. The term cellular suggests "a living, adaptive organisation" In this organisational system, the each cellular unit reports to the organisation, and in return the organisation is adaptive to the needs of the unit. They key to working in this environment is the ability to be skilled in the use of computers whilst managing a project. In addition, knowing ones position within the unit either as a leader or members is critical to the success of the unit. Constant learning is critical in order to keep pace with the global market that is constantly changing.

In Nov 2010, I conducted an audit of all the systems at my dental practice. The rest of the report is based on the skills and experiences I acquired whilst at the business school.

Skills Needed to Manage the 21st Century Dental Practice.

Firstly, it is clear that if my dental practice is to continue into the future, it must change. At the core of this change are our (i) Mission statement: To care for people's mouth by word of mouth, (ii) Vision: To provide quality dental service worth recommending by word-of-mouth. (iii) Goal: To grow the practice to a patient list size of 10,000 by year 5. When communicated and implemented effectively, the three pillars of the practice will help create excitement and enthusiasm amongst the staff. This is important because my staff spend more time with the patients; thus, representing the practice. Without proper management skills, it will be difficult to build and motivate them, given that they are responsible for a good portion of the practice's productivity.

Communication versus Implementation

Communication can be defined, as a process whereby information is encapsulated in a package and is channeled and imparted by a sender to a receiver via a medium. In response, the receiver then decodes the packaged information and gives the sender a feedback. The receiver needs not to be present when the information is sent, so long as there is an area of communicative commonality. Communication can be verbal or non-verbal.

Communication modeling

Traditionally, were the first to propose a model for communication. They demonstrated how information is transmitted via radio or telephone. Some of the many questions of this model were: (i) the accuracy of the transmitted message, (ii) what was the precise massage that was transmitted, and (iii) what is the impact of the message of the recipient. Though communication seemed straightforward, it is fraught with dangers, for example only a small percentage of what we speak is considered as communication, the rest comes from visual imagery, the sound of one's voice and the facial or body expressions. Secondly, the recipient of the information needs to acknowledge the information in the form of a feedback if the communication cycle is to be completed. Where this is not the case, it leaves the sender in a limbo.

Implementation

Generally, it is widely accepted that it is not just enough to communication the core values of a business, these core values must be acted upon or implemented. Implementation connotes an action plan for fulfilling the business core values. The combination of communication and implementation makes a business core value to become reality. Implementation central theme is that it needs to be dynamic, and continuous - that is a process that regulates to internal or external pressures.

Managing Dentistry of the Future - Creating Strategy

The first thing I considered was how to get every member of my team will commit to, take ownership of and implement the core values of the business. I looked into their unique values and preferences; for example, my dental nurse is meticulous about keeping the surgery neat and tidy, most materials and tools correctly labeled for easy identification during an operative procedure. This unique attribute was used in as goal setting in order to train other trainee nurses. Boyatzis in found that "goal-setting and personal change" show that adults are more likely to change and improve their working style when working towards a personal goal.

Collectively, our practice meetings are a source of brainstorming in order to think about new ways to do the things we do. No idea is ignore as it encourages members of the team to voice their opinions. At the end one of such meetings, we introduced a Smile Day in the month of June, every year, when we invite school children to attend the practice for Oral Health education. The program is widely accepted amongst the local schools surrounding the, and the practice staff alike. With the Smile Day, I was able to capitalize on the strengths of every team member. And we celebrated this team effort.

In the last 3 years of the program, we've had no fewer that 3 main local schools wanting to attend the program each year. This has energized the staff, to the extent that they are capturing their owning individual stories of their contribution towards the program. The generate energy meant that we are able to continue with the program on a yearly bases.

One business model that seeks to explain how a business strategy becomes reality is the Appreciative Inquiry (AI). David Cooperrider at Case Western University pioneered AI, in the 80's. Today, it is recognized as a key innovation in management and organizational development. AI, focuses on positive reinforcement rather negativity that is central to most problem centered approach.

Appreciative Inquiry (AI)

AI is the act of recognizing the best in people; affirming past and present successes, strengths and potentials; and to identify those factors or conditions that encourages an individual to excel. AI promotes dental team interaction, and between the dental team and other stakeholders.

AI is a four stage process:

Discovery stage - this stage looks at what works best in a dental practice. It highlights the practice strengths, times of excellence and what is considered to be of vlaue. In ther words, it is a process that focuses the practice acommplishments.

Dream stage - this is the brainstoming phase, when team members come up with ideads of the practice potentials. This stage encourages innovation, whilst trying to leaverage itself above other compettition.

Design stage - as the name suggests, this is the stage when all ideas are put together by every member of the dental team. The goal at this stage is to gather together a set of propositions of what an ideal dental practice and team is, and to work towards creating a framework by which both internal and external change can be understood and managed effectivly.

Destiny stage - This is the strategic creative stage in which the dental team develops an action plan to make the practice core values the new reality, and implemented as their personal goal.

have recommeded that, depending on the practice needs, the stages can be put into practice over a period of 3 days for the first 2 stages, and the 3 stage review after 6 months when when the dental team would have had time to formulate an initial draft of the practice vision and design the initail action steps such as would will champion the different aspects of the draft document.

Susbquent sessions might be necessary to help refine the refocus the vision and encourage continual developenmemnt of the strategic action plan. It is important to have a key person - a project manager - monitor the progress of the actions, whilst helping the inidual team members to work within the framework of the project.

Limitations of AI

Studies conducted by of team effectioveness in several small groups suggested that a group composition or identity determine the outcome of AI. Bushe coined the terms: pre-indentiy and post-indetity social systems. . He defined a pre-indenity system as "one in which the majority of members do not identify with the system and a post‐identity system as one in which a majority of members do identify with the system." Bushe argued that in pre‐identity systems, "members don't really care that much about the system's needs and instead, see the group or organization as one more thing in their environment that must be dealt with in the pursuit of personal interests." In contrast, a post‐identity systems, sees its "members take the needs and interests of the system into account and in some cases, might even be willing to sacrifice personal interests for the betterment of the group."

Another criticism of AI is that focusing on only positive stories and experiences during the discovery phase can invalidate the negative organizational experiences of participants thereby repressing important and meaningful conversations that need to take place.

Obviously, it is clear that AI has limitations, and might not work for every dental practice team, however, there is a need to further explore these limitations and how they can be improved upon.

Next challenge

The BDA dental article on "Dentistry Future - Forward to Twenty Twenty" summarizes my next challenge as a business owner and dentist. In the article, oral health was defined as "a state, which should enable the individual to eat, speak and socialise without discomfort or embarrassment, and contribute to general well-being"

The nuance of this definition is a basic marketing principle - to have a thorough knowledge of the people one wants to serve. The UK dental population can be divided into three broad categories - (i) those patients who were brought before the 1930s,' (ii) those brought up in the 30s' to 60's, (ii) those brought up since the 60s'.

The first groups of people, most of which are edentulous, are vulnerable to the medical conditions such as strokes or dementia, making denture wearing problematic.

Those brought up in the 30s' to 60s' are know to retain their teeth far greater that the first groups of people, albeit these are heavily restored dentition. These groups have high expectation to maintain a natural dentition. And it has been suggested that they will play a significant role in predicting oral health needs for the next 30 years, more so when the generation is nearing old age.

The population group that were brought up in the 60s', 70s' and 80's are known to have benefited from the advent of fluoridate toothpaste and preventative measures such as a decrease in the consumption of cariogenic food, have help to managed their dentition. As a result most of the people in this population group have not had any restorative dental treatment. In spite of this, their expectation lies in the ability to maintain their natural dentition. And with healthcare consumerism, the might enter a cosmetic rather than a restorative cycle of their dentition.

In addition to the above classification, other groups of people at risk of poor oral health include

People with learning disabilities or mental health. Present trends suggest that this will continue to increase into the foreseeable future.

The homeless, asylum seekers and refugees are all known to have compromised dentition are in need of oral health attention

Attitudes towards dentistry

Within the above group classifications are potential patients for the dental practice. My role is to be able to identify their dental problems, and together with my team, plan how they will be managed.

Patients & Attitudes

Potential Marketing Solution

Patients with negative attitude towards restorative treatment

To do an audit of all patients attending for dental emergency treatment, and seek to change their negative attitudes towards dentistry.

Patients who can't be bothered to see a dentist. They generally complain that the practice opening times are inconvenient and they are too busy. In addition, the following have been highlighted in the past: belief that dental fees are unreasonable, dentistry is always painful, it will involve the loss of working hours for those in employment.

To aggressively challenge the misconception that dentistry is only for the rich.

To communicate the benefits of good oral health as everyone is prone to dental disease.

To stress that prevention of dental disease reduces the need for corrective treatment, which invariably reduces the cost of dental treatment.

Patient who are fully engaged in seeing a dentist regularly

This is one of the many areas that create industry rivalry according to Porters 5 forces of competition. The UK population trend of those attending the dentistry regularly is generally low, however, they are sensitive price sensitive, and must be handle with care.

Patients who constitute an unrealized market. These include teenage children in competitive sports, or those in need of braces.

The coming London 2012 Olympic is a good leverage to plan a marketing program to reach is groups of potential patients.

Patient categorised as declining market are the heart beat of a dental practice, has they have stopped attending the practice

As a manager, one needs to identify the reason for the decline, and put measure in place to correct the situation. The formulated measures must be communicated and implemented by all staff.

The undesired patient comprises of patients that no one wants for they are never satisfied with the dental service, they threaten the practice with litigations, and refuse to pay for their dental treatment or follow instructions.

Simply, these are to be eliminated from the practice.

Final Thoughts… Intentional Living (Foundations of Success)

Having spotted these opportunities, my role as a leader is to take the risk of envisioning the positives, and put together a plan in order to achieve the vision (see above under AI), These opportunities require had work and a wind of sound prayer to see me through. Hard work can lead to celebrations of success, however, adversity in risk taking acts as a life lesson. Hence the hallmark of a great leader is strong result over a sustained period.

has put together a leadership pyramid that is to help one identify strengths and weaknesses, whilst providing a guide into leadership excellence.

Great Leaders

Reptilian requirements

Mammalian requirements

Foundational requirements

Foundational requirement

To be a great leader, I must continue to show that I have a great desire for change. These changes relates back to the above examples. At this level, success will be based on ability, strength and character achievement to sustain change.

Reptilian requirement

This is considered to be the "hard side" of leadership according to . It serves as a foundation for economic thinking combined with financial management skills. It is described as an intuition to verify event audits, a drive for a strong sense of control, follow-up and great attention to detail. The bedrock of this stage is a rational analytical mind, strong sense of discipline and toughness in the face of adversity.

Mammalian requirement

This is the converse of the "hard side" of leadership. For example a good people sense is dependent on great intuition and the ability to empathize. At the core of this stage are communication skills (both listening and speaking). This provides a warm sense of engaging members of the team whilst nurturing them to learn, develop, grow and succeed.

Leadership requirement

This is the peak of leadership as any decision I make on behalf of the practice, whether good or bad, is my sole responsibility. At this stage, one's hard and soft skills are crucial, as one's instincts and experience will be tested to the limit. Changes always bring about innovation and risk. Thus a hunger to hire and work with talented people creates a drive. When coupled with a birds' eye view of the business, one creates an aura of charisma and a presence.

Finally…

To develop myself in a journey that I can never finish

To strive for a good ending by leaving on good terms and manage succession responsibly

To be resilient - to learn from doubts, discouragement, disappointment and setbacks.

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