A Commitment to Change

Change is inevitable. Examples of this surround us on a daily basis. Recently, as we moved from the 20th to the 21st century, it was observed here and elsewhere that there are countless examples of significant change or progress that could be cited in society over the previous 100 years.

In dentistry, there were many changes in materials and techniques that resulted in improved care to the patient. There were improvements in access to dental care and progress in preventive dentistry through fluoridation and sealants. There were efforts and discoveries by individuals both inside and outside of the profession that resulted in an improvement in the public’s oral health.

Perhaps the area of dentistry and society that tends to show the least amount of change over time is organizational. In most business, including the most isolated dental office, there is a level of change from time to time. Personnel may change, some procedures undertaken will be modified, outside regulations may force change, but the philosophy, the business plan, or the mission of those who own or operate the business seldom undergoes revision unless the business is failing to show the necessary financial return.

Organizations and individuals operating them find it difficult to change processes that have worked well over the years unless analysis shows that a given procedures is directly responsible for deficiencies in organizational operation. The often-repeated phrase, "but we have always done it that way," has often described the method of choice when individuals evaluate what they have been doing and the results of these efforts. The results of such an analysis is usually to fine-tune the effort through increased staffing or financial expenditure.

This brings us to the focus of this column and this issue of the Journal of the California Dental Association -- the mission and management of both our membership organization and our dental businesses. The two are very much related because members expect CDA to support their needs and concerns in the conduct of their business through the services the association provides. Our observation over the years has been that neither entity is able to easily make changes in how it conducts its business.

There is one ingredient to the process of change that is essential if the large or the small organization is to contemplate change and successfully embrace it. We shall call that characteristic "a commitment to change." However, that is where the similarity ends. A large membership organization with many employees and a multitude of programs and departments providing a large variety of services to thousands of members has a far different challenge and set of problems than does a dental does a dental business owner with just a few employees.

Many leaders, staff, and grassroots members of CDA and its component societies have believed for some time that the efforts expended on behalf of the membership should be yielding stronger results. Despite some obvious strengths, many rank-and-file members have been critical of the membership benefits as they perceive them to be, believing that they should receive something that is either more than or different from what they are currently receiving. In other cases, there has been apathy, with very little participation or concern coming from a large segment of the membership.

Over the years, we have observed or listened to leaders express concern about perceived deficiencies in existing programs or organizational operations. There has always been appropriate effort expended to modify the programs or operations that have been questioned. Whether it has been a directive from the House of Delegates, the Board of Trustees, or an administrative decision, we have always seen an effort to make needed changes. Whether it is a response to a crisis facing the profession or development of new policies and operating procedures, business has always been conducted in the best interests of the membership.

However, particularly in the past decade, everything affecting the profession of dentistry has been changing. The demographics of the profession have been changing rapidly, including ethnicity and gender. The regulatory environment has brought new challenges every year. Dentists starting out in practice face significant debt and hardship in starting their careers and require assistance that was never before an issue. Communication from the top down and from the bottom up has not been effective enough for a vital organization representing more than 15,000 members. These are just a few of the issues that staff and leadership have recognized as part of the rationale for leading CDA into a multifaceted process that appears to have a real commitment to change written all over it.

The overriding activity is an applied strategic planning process involving a dedicated group of staff and leadership from all levels of CDA (including component societies), as well as some everyday members without leadership experience. Within a 12-month period, this group will be taking an exhaustive look at everything about CDA, including the purpose and mission of the organization and its future operation.

At the same time, staff is in the process of implementing a new statewide management system that will improve the effectiveness of business transactions by CDA and the component dental societies. Not to be overlooked is the current effort by leadership to improve the internal communication among the various participants in the process, including staff, leadership, and the component societies. Communication has become rapid with e-mail capabilities enhancing the speed and quality of the decision-making process. There is a tremendous commitment to change, unlike any we have witnessed in our many years of observing the process at work. It is clear that meaningful change will be the result.

Change in the individual dental practice is a more-difficult process. Providing a quality service to patients is the overriding purpose and focus of most practices, often leaving the owner/manager little time to contemplate some of the changes that might better position the practice for a more successful future in a marketplace that is becoming increasingly complex. Effective management of a dental practice is not an exact science. There is no one authority who has all of the right answers, either about the most effective current techniques or what might work best for the dental businessperson of the future.

What contributing Editor Steve Gold has done this month is to assemble a group of experienced consultants who share either their vision of the future or their advice about personnel or office systems that they have seen successfully employed in a multitude of private practice environs.

We believe it is useful from time to time to review what others are saying about successful strategies in the business of dentistry. It is our hope that some of these ideas might stimulate or motivate those looking at the need for change in their practices to develop the necessary commitment to successfully pursue it.