Special List #12: Why the Doctor Isn’t the Most Important Person in the Practice with Dr. Deana Cook

Dr. Souyias (00:00):
Thanks for listening to The Special Lists, presented by Referral Lab, the podcast for dentists and dental specialists. Hello and welcome to another episode of The Special Lists. Welcome. I'm your host this evening, Dr. Jason Souyias. A big shout out to my co-host, Dr. Michael Seda.

Dr. Seda (00:21):
Yes, yes, Yes.

Dr. Souyias (00:22):
And Dr. Cameron Full.

Cameron Full (00:24):
Yes, sir.

Dr. Souyias (00:26):
And we are absolutely thrilled to welcome Dr. Deana Cook to the show tonight.

Cameron Full (00:31):
Understatement.

Dr. Souyias (00:31):
Welcome.

Cameron Full (00:32):
Welcome. Understatement.

Dr. Souyias (00:34):
Understatement. We are so excited to get going into what you have to talk about. But before we get into that, I'm going to give you a little background on Dr. Cook. She attended the University of North Carolina at Chapel Hill for her undergrad education in art history. That's a long ways off to get to dentistry, isn't it? We'll talk about that a little bit. After studying abroad in Italy, which sounds amazing, she began to appreciate the wonderful mix of art and science dentistry provided and went on to graduate from UNC School of Dentistry with honors in 2009. She graduated with her master's degree in biomedical science and a certificate in periodontics from the University of Texas Health Science Center in San Antonio in 2012.

(01:18):
And additionally, she graduated with honors from the executive MBA program at UNC Keenan Flagler Business School in 2023. Dr. Cook is the owner of two periodontal practices in Southeastern North Carolina, Wilmington and Leland, and is the director of a Spear Study Club. She is also proud wife and mom to two girls, Emory and Sutton. Please welcome Dr. Deana Cook.

Dr. Cook (01:42):
Thank you for having me.

Dr. Souyias (01:43):
Awesome. We're so excited. I can tell you've put some serious work into this. This is one of the best lists we've had in a while. Prep prep work, I love prep work like this.

Dr. Seda (01:54):
I'm afraid you don't have enough qualifications, Dr. Cook.

Dr. Cook (01:59):
I need a few more degrees.

Dr. Souyias (02:01):
A few more degrees. Hey, let's spend a minute. Actually, I know we talked about that briefly. What made you decide to do that executive MBA program?

Dr. Cook (02:10):
Again, I need a psych eval for the actual explanation. No, really, I asked a mentor if they would write a recommendation and he said, "Only if you get a psych eval." But I honestly wanted, I've never worked for a big corporation and I wanted to understand the corporate world. It was a phase where in dentistry, I felt like there was a lot of talk of corporate dentistry taking over. And honestly, as a referral-based practice, I was a little scared of what that could look like. And instead of letting them take over, I wanted to see some of the things that they knew and understand a little bit more of the corporate world. But I also in that learned that small businesses still certainly run the world.

Dr. Souyias (02:56):
I love what you told me about this when we were talking offline of one of the biggest insights you took away from your cohort that you were in that program with. Would you mind sharing that?

Dr. Cook (03:08):
Yeah. So most of them, I loved all of them and they were like, "I just want to be like you. Own a business, run it how I want to do it, learn from other industries." And I was 29 when I purchased the practice, and I don't think I realized what was going to entail all of that. So I think I was eight or nine years into practice when I did my executive MBA. So that was really helpful too, because I had been in the weeds for a long time, but the people in corporate America, there's pros and cons to everything, but I knew how important my people were, but I realized how other industries don't value that as much as I would prefer.

Dr. Souyias (03:52):
Yeah. It's a pretty amazing insight to have that, that some of the people in the corporate world just want to be able to have the opportunity of being the boss, calling the shots. They don't see that very often. And we're very fortunate. Sometimes we get bogged down in the stress of that within our practices and don't forget what a gift that really is. My dad just turned 85 the other day

Cameron Full (04:17):
Shout out.

Dr. Souyias (04:17):
and one of his pieces, shout out to my dad.

Cameron Full (04:19):
You can't do that without telling everybody your dad's name.

Dr. Souyias (04:22):
Socrates. Socrates.

Cameron Full (04:23):
Socrates.

Dr. Souyias (04:23):
Socratis. Socratis. He was a big mentor of mine. I mean, and he told me from the time I was little, he's like, "Whatever you do, own your own business." And that was from frustration of the corporate world, exactly what you were just talking about. Well, shall we start diving into the list?

Cameron Full (04:49):
So before we do this-

Dr. Souyias (04:50):
Oh, you want something else first? Sorry.

Cameron Full (04:51):
Yeah. Before we do this, Deana and I've got the opportunity to spend quite a bit of time together. We're friends with our spouses. I've eaten at her home with her family. Deana runs a pretty cool practice and she does some things pretty unique. And I hope she gets into some of that appropriately as we talk. But that's one of the cool things about Referral Lab is when you've got 300 some odd practices that use this thing, there's outliers. And Deana is truly an outlier with how she manages her practice. And I think some of that's because of who she is, but some of that's also because some of the additional training that she's opened her mind up to with obviously this executive MBA. And so I just wanted to give a shout out before we get started on how I ... One of the reasons when we're looking at this massive list of people that are interested in talking with us and getting on here and sharing, I was like, "We're not going much further without getting Deana Cook on here." So to shout out to you before we get going, Deana, appropriately, you do run a pretty special practice.

(05:55):
On your consult days, everybody's dressed more casually, interesting things that make you and your practice hum, which is a great curtail straight into our first topics. Go ahead.

Dr. Souyias (06:07):
Awesome. So the first thing on your list is the doctor isn't the most important person in the practice.

Cameron Full (06:13):
Bingo.

Dr. Souyias (06:14):
So let's get into that. Tell me about that.

Dr. Cook (06:17):
Yeah. So if you think of, especially throughout our career, starting out in dental school, you had to do a lot of work individually to get there, get good grades, study, do all the things. We're often told we're the best and the brightest and all the things. I do a lot of leadership work with the dental students to try to show the minute you graduate, it's not just up to you. And now you're a leader in the community and you have to set a good example for that. So instead of it being related to you as an individual, it's like you have to really focus on the team. So Cam, thank you so much for the kind words. Also, it takes an actual village. My team is humongously important to me. It's very special, very bright humans that help me do a lot. So I certainly couldn't do it without them.

Dr. Souyias (07:06):
Well, what are some of the tips and tricks you've used over the years to build? You obviously aren't given a team that starts that way in most instances. So you've had to build that, you've had to craft that over time. What's done that for you? What have you done to make that happen?

Dr. Cook (07:21):
Well, one of the things that I do is I really help the team do the hiring. So I flippantly say that I don't actually do the hiring. That's the team's decision because I've had colleagues and friends who've asked the same question of like, how did you get your team to be the way that it is? And honestly, I haven't done it perfectly every time, but utilizing the team's feedback and seeing how they can best work together is so helpful. Because most of them, think of it on the admin side, they're not going to work every minute of every day with me, so they have to work better together. And again, if I put team number one, they're going to then take great care. If I take great care of them, then they'll take great care of my patients.

Dr. Souyias (08:09):
Yeah. This is not an Austin Powers joke. You've probably read the same book I've read, Patients Come Second. Have you read that book?

Dr. Cook (08:16):
I think a long time ago.

Dr. Souyias (08:17):
Long time ago. It's actually a great book written by a hospital administrator who realized when he really wanted to take great care of patients, for him as the administrator, the patients have to come second. He had to put the team first. And it's a wonderful, wonderful read and it's covering exactly this topic. And I love, how did you get to realize that? I mean, that's a really foreign concept to most dentists. Is there an event that happened in your life? Is there something that happened that got you to this realization?

Dr. Cook (08:50):
Yeah. So I was at a lecture a long time ago and they ranked the order of importance in a patient's mind, the order of importance in seeking care. And so it was like the cleanliness of the facility, how kindly they were greeted, how ... The dentist was pretty low, number 10. And so I was like, that's mind-blowing. And it is important that you are high quality in what you actually do perform surgically, but that was eye-opening for me. And then I've also seen throughout the years, either before I came into practice, but it's really hard to work day in and day out with people who really aren't enjoying what they're doing. So I was like, I'm going to be spending more time with these wonderful humans than I do my kids and my husband most weeks. And so I really wanted to make sure that I was surrounding myself with people who kind of cared as much as I did.

Dr. Souyias (09:49):
That's fantastic. It's a little ego blowing, I think, to a lot of dentists that-

Cameron Full (09:57):
A little bit.

Dr. Souyias (09:59):
We're not that important, right?

Cameron Full (10:00):
A little bit.

Dr. Cook (10:01):
I don't want to be that important.

Dr. Souyias (10:03):
Oh, I totally agree with you. I don't want to be that important

Cameron Full (10:06):
Seda?

Dr. Souyias (10:06):
anymore once you've learned that. You agree too? He's quiet. He's really quiet.

Dr. Seda (10:12):
As you're talking, I'm just kind of ... A couple things strike me. The first is Dr. Cook's humility, right? For sure. I think it goes back to as you're in dental school and in college, you're kind of working your way through the ranks. There's some level of abuse we all take. And I think a lot of people come out of school with this kind of grudge like, "I am now, I've arrived." And there's this ego that can kind of take over if we're not aware. And I probably was one of the worst offenders of feeling that, well, I have the white coat now and the world is my ... But really the reality is that's where the learning just begins and having humility around so many things like knowing how to run a business or the lack thereof, how to lead a team.

(11:09):
And as I matured, and I'm still obviously as my friends will attest, still in the maturation process, it's remarkable how much I still have to learn and allowing my team to kind of set the course for where that learning happens.

(11:28):
Deana, you were referring to letting them do the hiring. I've evolved to the same exact system with the hiring. And I look back and I struggled for years to have a team that worked with heart and joy and was cohesive. And it was only when I removed myself from the equation that it actually came together to exist in the form that it does today, something I'm very proud of, but really it's pride in the team that's assembled this team, not myself. So I think if there's one message that comes from this, it's really from early on as a doctor to be as humble as you can and recognize that there's a lot of people that can do a lot of things much better than we can and to try to identify where those things are and let people flourish.

Cameron Full (12:25):
Deana has got an interesting, in her prep notes here, she's got an interesting comment in this first bullet. And I want to talk specifically on this because I can't imagine how she does this. Backing up team members in challenging situations. I love leaders that courageously defend their team. So Deana, talk about that because there's a reason you put that in there.

Dr. Cook (12:48):
Yeah. So I've been known, thankfully, not often, but to need to fire a patient and whenever kind of blanketly, like Pam said, if they come to me with that lead that this isn't the right home for this patient, I don't even ask any questions because if they're that adamant about it already, I know that that patient isn't fit for our practice, but there's been times where patients have been out of line and I've just had to step in and say, "I really need you to apologize in order to be a patient in our practice." And some are like, "Oh my gosh, I'm so sorry. I totally..." And some are like, "Well, who's going to apologize to me? " And I'm like, again, just might not be fit for our practice. But I think if I were in their shoes and I knew that my boss was willing to back me up, then I'd be much more willing to go the extra mile because again, they know that I'm going to back them up.

(13:45):
And I always tell them, "As long as you don't kill someone, we could fix everything else."

Dr. Souyias (13:48):
That's a really good point. I mean, it's not often, thankfully, but sometimes a patient can come in and be disrespectful or just you get those people that are always grumpy. I mean, you're not going to dismiss a patient over always being grumpy, but when they cross that line and start to be disrespectful for our team, one of the things I've told, we've actually been talking about this recently was that I expect my team to say to that patient, "Listen, we will never treat you with disrespect in this practice. Please don't treat us disrespectfully in return." And if that patient can't have a good response to that, they're out and I've got their back. I want my team because the problem I've run into is the behavior doesn't exist when the doctor comes in the room, right?

Dr. Cook (14:42):
That aggravates me.

Dr. Souyias (14:43):
And that's frustrating. I agree, but for some reason we don't have that same behavior. So I've asked my team to let me know when those happen and it's really important. Again, just that feeling of, man, they do have our back goes a long way with your team.

Dr. Cook (15:01):
I also like to tell everyone gets one bad day, so you don't know what happened right before what their circumstances are, but I always tell them, "Okay, that's their one bad day. Let's make sure it's not a pattern." And then that's when I tend to have a conversation or another employee might have to have the conversation with the patient.

Dr. Souyias (15:19):
That's a wonderful point, giving people some grace. Love that. Absolutely love that. All right, I love this one too, is I'm such a believer in what you're talking about here is number two on our list is you can't do two things at one time. So there's an inability to multitask and work-life balance is a misnomer. Tell me all about that.

Dr. Cook (15:43):
Well, I don't like the phrase work-life balance because I feel like if you're attempting to balance, then you're fifty fifty, and that means you're failing at both things. So it's like you kind of need to decide in that moment if you're willing what you're focusing on to give it as much as you can. It might not be 100% that day, but again, splitting yourself in half, which my daughters have actually said. One said that she'll get the top half. And I was like, so you've thought this through that you're willing to split me in half. I haven't figured out how to actually do that yet, but I think our world is built in trying to do multiple things at one time. I struggle with connecting with patients and also the 4,000 other things. So I really try to focus on my actual attention in the one time I'm doing something, understanding that life does happen and get in the way, and there's lives attached to patients, there's lives attached to the team.

(16:41):
And so it's not just like when you're here, you're here, nothing else matters, but I do think it's important that we can't try to do two things at one time.

Dr. Souyias (16:49):
Okay. So living in the moment is what I hear in there and-

Dr. Cook (16:52):
Try to.

Dr. Souyias (16:53):
Try to. Okay. I was at a ... I can't remember. I think it was a Seattle Study Club Symposium and Michael Cohen had asked all the presenters the last lecture kind of thing. If this was your last lecture, what would you tell everybody? And the presenter was like, "There is no such thing as work-life balance. It's a pendulum and sometimes your work needs more attention and sometimes your life needs more attention, but just make sure that you never swing so far in one direction that you can't get back in the other direction." And it was one of the most eloquent arguments I'd ever heard, the metaphor of how I've heard that. And I really love that. It's so true. So what are some of the things that interrupt you? We try to not have an argument with your spouse and you come into work ground, but what are some of the things that you find interrupt your focus more often than not?

Dr. Cook (17:51):
So one of the things we did a long time ago was that when I'm in with a new patient is that unless someone's bleeding, I really can't be interrupted because imagine you have maybe 15, 20 minutes directly with the patient in the new patient exam. Imagine someone walks in to get something out of the room, they walk in, oh, it's just one quick thing. It's like, well, if you were the patient in that situation, you would be like, "Well, I guess my focus isn't that important. There's something more important than me. " Absolutely. And I think it just breaks your concentration enough. Then you're like, wait, what was I talking about? You just met someone, it's still, again, that first impression. So we really focus on in that first interaction that there really shouldn't be any interruptions unless there's a true emergency.

Dr. Souyias (18:39):
Do you guys have a code word to let you know it's a true emergency?

Dr. Cook (18:42):
Yes. Yep.

Dr. Souyias (18:43):
Awesome.

Dr. Cook (18:43):
It's Deana. If they yell at the first name.

Dr. Souyias (18:48):
Not Dr.Cook.

Dr. Seda (18:48):
Hurry.

Dr. Souyias (18:49):
We'll catch your attention.

Cameron Full (18:50):
Deana hurry.

Dr. Seda (18:50):
Deana, hurry.

Dr. Cook (18:52):
How many times do you hear Dr. Cook or Dr. Souyias all day long? It doesn't phase me, but if someone very vehemently yells, Deana, I know it's an emergency.

Dr. Souyias (19:03):
Oh, that's a great one. That's a really good tip.

Cameron Full (19:06):
It's like, dad. Mom.

Dr. Cook (19:12):
Well, newer employees are like, "Oh, Deana." And it's like, "Oh no, you really need to yell at." Yeah.

Dr. Seda (19:21):
This touches on something that I think is important to hit on and that is as dentists, people probably just think about us with our heads down in someone's mouth doing a procedure. And I think we can all agree a lot of times, if not most of the time, if not managed properly, it's like I've got 15 team members at any given time. Dr. Cook, how many team members do you have?

Dr. Cook (19:48):
We have 12.

Dr. Seda (19:49):
Yeah, 12. And I know Dr. Souyias has a big team as well. And if you just imagine that each person needs something twice a day from the doctor, right? That's 30 times in the course of eight hours that someone's going to come up and at some point it feels like people are just pulling on each arm and your legs and trying to get a piece of you. And if it's not managed maturely, it can be a huge challenge. Can you talk a little bit about how you structure that in your office so that people have awareness and kind of know what's appropriate and what's not?

Dr. Cook (20:27):
Yeah. So one of the things we do too, because my door in my office is always open, and so a lot of times they'll come in and I'll be in the middle of emailing a doctor or finishing a chart note or reviewing something. And so it's like until I make eye contact, it's like, let's not go. Because sometimes I'm on the phone and they don't even know. And then they'll come in telling about blah, blah, blah, and then I'm like, "Oh, hold on. I'm on the phone." Yes.

Dr. Seda (20:56):
Or I need to finish this chart note, get my thoughts out before we start doing something else.

Dr. Cook (21:01):
Yes.

Dr. Seda (21:01):
Exactly what I'm referring to.

Dr. Cook (21:03):
Yes.

Dr. Seda (21:04):
Yeah. So I think actually having that conversation is something that's important. I'm jumping in. For years. No, please.

Cameron Full (21:13):
I'm jumping in here. No, no, no. Deana is a remarkable ... She's an empowering person. And so some of the things that she does in her practice is empowers people to do things without her. So she's got ... For example, Michelle does a lot in her practice that she trusts. Michelle has somebody that she trusts that supports her. And so say to when you empower people underneath you or next to you, whatever way you want to put it on the org chart, when you empower those individuals, that's 30 less things that you might not have to deal with and it makes the one or two things that you do have to deal with, then you can get a Deana.

Dr. Cook (21:54):
Well, I wish I could say that I have perfected it, but we do have a true leadership team. So it's an admin leader that Michelle, surgical coordinator as well. We have an assistant leader, Carissa, and then we have a hygiene leader, Stevie. So it's a way to ... I rejected an org chart for a really long time because I wanted it to be a very linear organization. We're not humongous, but with the help of my colleagues in business school, they were like, "You need an org chart like stat." And so it helps-

Cameron Full (22:27):
Structure. Yes.

Dr. Cook (22:27):
Because me as one person to 11 people is like I'm spread too thin. I just realized I wasn't doing a very good job when we are knee deep in surgery for them to genuinely need something or I'm not the best person to answer the question. I don't know everything about every little detail and I don't want to. So by having a leader in each category, that's really helped because then it's a leader of three or four people and it's really manageable at that point.

Dr. Souyias (22:58):
What made you not want to have that organization for so long?

Dr. Cook (23:02):
Yeah, I didn't want there to be a distance between myself and the team. I didn't want there to be ... I really genuinely wanted to engage with all of them, but then I also realized I can still engage with all of them, but not directly be their leader in order to empower, like Cam said, of like, I think it's awesome in our smaller practices, there's no ladder. It's not like you go from an assistant to a hygienist unless you go back to school, go to a dentist. So I was trying to think of ways that would excite them about what's something I could then move to with not changing my job title, not changing all the curriculum that they would need to, but that would get them excited about developing new systems or training new people. But yeah, I just wanted to make sure it didn't create that distance where there's some practitioners that prefer their door is closed and they're not going to engage and they just go in and do the work, but that's not how I wanted to do it.

Dr. Souyias (24:11):
Yeah, I think that's a really important concept because I do feel in my talks with dentists and periodontists, I feel a lot of them don't want to have, for lack of a management structure or organizational structure to their practice. But I love how you put that of I can still interact and be present and know what's going on in my team's lives without having to be their direct supervisor for everybody.

Dr. Cook (24:37):
Right. It was an interesting transition that I will admit, I don't think I did as well as I could have. I was like, "Let's see how this goes." And in hindsight, I wish I had been very committed to the change. I think it would've supported the leaders better because that is a tricky transition to go from linear. For sure. So all of a sudden, my peer is now my leader. I just, again, I don't get it perfect, but I owned it that I didn't do it as well as I could have. But I think we're two or three years in to the official structure of it and continuing to evolve also the leadership roles, ensuring that they get more education on how to be a good leader because maybe they don't have that appropriate training.

Dr. Souyias (25:21):
That's awesome. Yeah. I mean, we see that a lot where a high performer's promoted to management and they got promoted because they were really good at their job, but they have no leadership or training or management skills. And now what do they do? Well, the answer to that question is kind of your topic three. I love this one as well, inquisitive mindset. Tell me more.

Dr. Cook (25:44):
So in business school, I was the only dentist. There was a handful of physicians, a veterinarian, lots of engineers, lots of really, really smart people, but I started to realize they have very similar challenges that we do. So we're in the service industry and just stealing other things from other service industries. And then you think of how operations works in manufacturing. It's like, I mean, we're not physically manufacturing something, but we need to understand all the steps involved in the referral process and what goes into that and how we can better improve it. I just really feel like I'm a total nerd, obviously. I'm not planning any more degrees, even though that's a family joke. I have two attorney brothers, so I could go to law school at some point, but I just think-

Cameron Full (26:30):
You want to go to law school, Deana? I was planning on it at some point.

Dr. Cook (26:33):
Are you? Good luck.

Cameron Full (26:34):
Absolutely.

Dr. Cook (26:35):
Good luck. I'm good. But just really understanding that we don't need to reinvent the wheel. There are so many other smarter people who've done it a different way. And I think of how we were trained in residency is you learn the classic literature, you learn how we thought you could have done it and how it worked or it didn't. And it's like, well, why don't we steal that from medicine or not? I don't want dentistry to go the way medicine went, and learning what not to do sometimes is helpful too.

Dr. Souyias (27:06):
I think in dentistry though too, we often are like, "Oh, well, that won't work. That practice is so different than ours." Well, now imagine when we start looking at cross industries, like you said, manufacturing. Well, we're not making a product. How does that apply to us? It takes a creative mindset to be able to understand a process and then be able to realize and say, "Okay, well, what can I learn from that that applies to what we do on a daily basis in our practice?" Have you had any examples of that in your career where you've taken some of the good things you've learned from other industries?

Cameron Full (27:43):
Talk about your huddle.

Dr. Cook (27:45):
Which part of our huddle?

Cameron Full (27:46):
It's different. Go ahead.

Dr. Cook (27:49):
Oh, about how someone else runs it?

Cameron Full (27:51):
The format of your huddle. Yeah. That is unique to your practice for sure. I don't know if you realize

Dr. Cook (27:55):
Is it? I don't know if I realize that. And what element? I mean, the team runs it. They have their prep in advance. It's pretty short. What element are you speaking of?

Cameron Full (28:13):
You talk about some daily KPIs in the huddle?

Dr. Cook (28:16):
Yes. So we talk about the referrals, we talk about where we are in terms of percentage to goal. We talk about the openings in the future so that if the whole team is aware of it, we talk about who needs help. If there's a schedule challenge, we can anticipate it, hopefully. I guess I didn't realize our huddle was different than other people's huddles.

Dr. Souyias (28:44):
It's a struggle to get some people to even have a huddle. There's a lot of time doctors or a team too don't see the value in organization for the day. So

Cameron Full (28:54):
Souyias doesn't talk about production. Seda doesn't talk about production in his huddle.

Dr. Souyias (28:58):
No. Right. Yeah, we don't.

Dr. Cook (29:03):
Is there a reason?

Dr. Souyias (29:07):
My whole team is and isn't responsible for production. A lot of that falls on the scheduling coordinator.

Dr. Cook (29:14):
Got it.

Dr. Souyias (29:15):
I love it. It was a transition in our practice.

Cameron Full (29:17):
See, told you.

Dr. Souyias (29:21):
My partner-

Cameron Full (29:21):
I like Deana's version better, Souyias.

Dr. Souyias (29:24):
I don't disagree. There's nothing wrong with that. It's a more modern approach. My business partner that I took over the practice from never had production goals or talked about money in front of the team, tried to hide how much money the practice made on any given basis. And so it's been a long transition to get us to the point that we're at to even have some numbers and have some goals. It's a more modern approach that this is the way businesses run.

Cameron Full (29:55):
It's cross industry is what it is.

Dr. Souyias (29:55):
Correct. Yeah.

Cameron Full (29:57):
If you go to a high-end restaurant, And they're doing their pre-meal huddle before they go into their main seating for the night. They talk about the tables, they do a lot of the same function. They talk about average table values, what they need to upsell on for the night. And so you can see where Deana takes some of that business function because of her experience and brings that in to keep everybody involved because I disagree with you as production is a effect of the entire team's engagement practices. Yeah.

Dr. Cook (30:33):
That's what I was going to say, that even though Michelle, our surgical coordinator, physically schedules, I think when I actually did the full operations of the touchpoints from the minute a patient is referred to their postoperative visit is 16 different interactions, and it literally involved every member of the team. So the goals that we set and then the bonus structure that we'll do is that one is level because every single person at some point we even had a sterilization technician was part of the bonus because she helps us run as efficiently as we can because that was really important to me. And one of the things that when I did buy the practice, the goals weren't being achieved. And so I broke it instead of a monthly goal into a daily goal because I found, and I probably stole it from somebody else, that that's a really big number to digest.

(31:33):
Could be 16 working days. Well, how do we know if we're not close enough? But when we're really close, my team will make sure they're going to get to their goal. And so that's actually fun. The gamification of it is really fun too of like, man, we can do this. And it's not that we're recommending anything someone doesn't need, but it's really just I enjoy watching them come together to really try to achieve it as well.

Cameron Full (32:01):
Yeah. In our practice, I'm not sure if you guys do this, but there's a meeting that happens kind of early to midweek where they'll look into the schedule to see if there are any openings, slots where patients can be scheduled. And then I'll see everyone kind of working together, huddling and banding together to see how they can kind of ... It's like fitting that Rubik's cube together. And it's amazing. There's a sense of accomplishment that comes when that schedule does come together and the schedule's this big living, breathing entity.

Dr. Cook (32:39):
Yes. Well, we also do two new patient days and two surgery days. So when we implemented the bonus structure, which was based on collections per day, one of the things of feedback the team gave was, well, what about those new patient days? We don't produce as much as we do on the surgery days. And I was like, but there's a constant where we're ... We also, Cam knows that we're kind of crazy about ensuring that everything is collected in advance. And so it's this revolving ... We can collect a lot more on days that we're not actually producing it. And again, I try to utilize my team to understand and not have all of it weigh on me that there's bills to be paid. It's not just pure profit, we're just rolling in excess. So it's important to pay attention to it because it's how the business needs to stay profitable.

Cameron Full (33:33):
Elaborate a little bit more on how you break down the bonus.

Dr. Cook (33:37):
Yeah. So we look at the number of working days in that month and then divide it based on that. Over the years, the actual number has ebbed and flowed based on number of doctors, number of hygienists.

(33:52):
So then I look at historical trends to see where we tend to be from a production standpoint. And again, it changes, so it's not always the same, but an example is in December, we take two weeks off to be with our family. So the daily goal is significantly higher than it is when sometimes July has five weeks. So it's just a little bit different. But I want the team to also share in the profits of the practice as well. So we have some physical structured things through retirement, profit sharing and whatnot, but also these smaller ones that it's not an all or nothing because I also don't think that it's like if you get close, you don't get anything. So by doing it as a daily thing, there's ways to get tiers so that you still get something.

Cameron Full (34:44):
Sure. And so you break that down per team member at the practice. Do they all get the same or is it based on hours worked or what's it based on?

Dr. Cook (34:52):
They're all full-time. So when someone was part-time, that was a little bit different, but it is all the same because again, it's not like one person's role is different. It is different, but it's just as important. And the same with hygienists, they don't produce as much as doctors, but their role in identifying and helping to diagnose things that are ... One of our best referral sources is our hygienist because they're identifying things. So it's helping them to understand that they play a huge role in that.

Cameron Full (35:27):
Oh, I got the hard question. Now you're ready for it?

Dr. Cook (35:29):
Oh, no.

Cameron Full (35:31):
What in the heck do you do because you've got a pooled bonus structure, which is awesome. Do you find that your team is less likely to let you hire someone new?

Dr. Cook (35:42):
Oh, great question. Oh, okay. So they don't divide it amongst, it's not like, here's the amount. They get a fixed amount per person.

Cameron Full (35:51):
Oh, that's clever.

Dr. Cook (35:54):
Yes.

Cameron Full (35:55):
You beat it. You beat it. Okay.

Dr. Cook (35:58):
And it sounds silly based on the number, it's $25 per person per day, but in one week you can get $100 and one month you can get $400. And then if we hit the overall, you get an extra hundred. So it's $500 a month is the possible thing. Now some months, I know Jason's like, wow, that's a lot. But when I see the amount that they actually will exceed the goal, and that's an investment in them. I want them to share. And if we're doing really well, I want it not to just go into the business bank account, I want them to get it as well. And it's just hard because when it's like this past year, I took a lot more time off than I have before, and so our numbers were a little bit lower. So we have less excess to go around.

(36:47):
And it's like that's a later topic, but there's times where there won't be as much excess, but when there is, I definitely want to share it with them.

Dr. Souyias (36:56):
Nice. I love that. I think that's important. I think it helps build what we talk about here in step four on your list, which is ownership mentality for the team.

Cameron Full (37:06):
Beautiful pivot there, beautiful.

Dr. Souyias (37:09):
Beautiful pivot. Thank you. Yes.

Dr. Seda (37:11):
So smooth, Dr. Souyias.

Dr. Souyias (37:12):
So smooth. But it does. It gives that ownership mentality. Tell me what you mean by ownership mentality with your team.

Dr. Cook (37:19):
Well, one of the things that I started, and I wish I could know when I did it, but I used the phrase your patient, because it is their patient. It's not my patient. It's like when the assistant is helping them, it's their patient. So really it came as a structure for the schedule because when I first joined the practice, I said, "Well, who's going to be seeing that patient? Which assistant?" "Oh, we just figure it out. "And I was like, " I don't get that.

(37:46):
"So each assistant has their own column just like each hygienist has their own column. So then if I had a question or we do a lot of preparation for surgery and new patients, was like, " Well, which assistant do I need to relay this information to? "And so again, I don't know when I develop that language difference, but it just helps them to really understand how valuable their relationship is with them. And I'm not going to lie, I'm just kind of the cog in the wheel that the relationships that the patients have with my team is mind blowing. They get presence. I don't get presence. The team does. And I'm like, "That's okay. I'm okay with it. "But I'll have surgical assistants that'll pop into surgery when they're not sitting chairside just to say hi, or the hygienist will do the same thing. And so the number of compliments I get on my team, I mean, that's my happiest thing because watching them be so successful is awesome and it's like they just need me to be bop in between all the things.

(38:50):
And again, I want them to stick around. I want them to enjoy it. And by being part of the team, I think that's really helpful to really empower them to feel like they're genuinely part of the ownership of the practice.

Dr. Souyias (39:05):
What behaviors do you see that differentiate a team member that's buying into this and taking ownership versus one that isn't?

Dr. Cook (39:14):
That'd be a great question. I think more than anything, maybe the initiative to help develop and improve systems instead of just like, okay, we do this because that's what we've always done is like, well, this isn't working as well. What could we do differently? Or again, just that personal engagement that they have of like, hey, and my team, they help each other out so much of like, "Hey, can I clean your room or see this patient or whatever it is. " But that initiative I think helps me to understand that they're really kind of part of it.

Dr. Seda (39:50):
Dr. Deana, do you have a formal structure how you guys will allow team members to bring things to the table or for you guys to discuss what's not just working, but also what's not working and suggestions on system implementation, et cetera. Can you touch a little bit about how you guys approach that in your practice?

Dr. Cook (40:11):
Yeah, so we have that leadership team. They are the SET team. So the acronym is Service Excellence Team, and they can certainly bring anything to them. They have a Monday board that kind of goes through the things that they've tackled, the things that they want to continue to improve upon. We're working way more on getting everything written down much more officially, but at any time, everybody knows that I'm willing to see if it'll work, and if it doesn't, we can change it again. That's the beauty of a small business too. It's not like you have to have 75 layers to make a change.

Dr. Seda (40:48):
Do you guys have weekly team meetings or monthly team meetings?

Dr. Cook (40:52):
Yeah, so we have monthly team meetings, and then with the SET team, every two weeks they meet. Actually without me on purpose, I get myself out of the way because I'd probably muddy the waters. And then really working on consistent one-on-ones, we find it's more feasible with the administrative team, but the providers, it's really tough to really carve out that time. But I've said once we put it on the schedule, it actually happens, but being intentional about that time.

Dr. Souyias (41:23):
That's awesome. Yeah. I think a practice that can really focus and even potentially take away a little bit of time from production to focus on development reaps the rewards manyfold. So has that been your experience as well?

Dr. Cook (41:41):
Yeah. One of the things we do too, and this is Michelle helps feed us, keeps us going.

Cameron Full (41:46):
Shout out, Michelle.

Dr. Cook (41:48):
And we do a monthly team lunch. So we don't take a full hour lunch normally, but once a month we'll block off a full hour because everyone has staggered lunches other times, but that way everybody has lunch. At the same time, it's either catered or Michelle fixes something delicious and we just get to sit and chat. And that I've really enjoyed where it's just talk and hang and catch up. And that I like, it's not like a actual meeting, it's where we just get to enjoy each other's company.

Dr. Souyias (42:24):
That's wonderful. That's a wonderful thing. Well, it's awesome when things are going well, but fifth on your list is what happens when not every day is sunshine and roses.

Dr. Cook (42:35):
Yes.

Dr. Souyias (42:36):
This is a tricky thing for a lot of people to deal with.

Dr. Cook (42:38):
Yes. And I mean, I've only been in practice 13, almost 14 years, but there's times where crazy recessions, there's times where people are doom and gloom about dentistry. And so I just wanted to, in my business-minded world, it's like, oh, we've got continued growth, more growth. How do we continue to grow? It's like sometimes there's times where you don't have to continue to grow and that you can focus on your systems and time is our most valuable asset. So if you don't have as much time, maybe there's more life things that are ... I was in business school, I had less physical time in the office. It's like there's going to be times where it's not as productive and just understanding and/or planning for that because I think again, the way that a lot of people love to think of the top number, the revenue of how much and is that getting bigger and bigger.

(43:39):
And it's like, well, sometimes it's actually you can be more profitable with less revenue if you are intentional about certain things. And not that profit is the only thing, but it is a business and we want to keep it healthy so that we can continue to grow and/or make decisions as we want.

Dr. Souyias (43:57):
Cam, I love your ... You want to talk about your trampoline analogy here?

Cameron Full (44:01):
I think, we talk about plateaus, but what I don't like about the plateau concept is it doesn't acknowledge the amount of work it takes to stay at the level that you're at. And so instead of thought about, it's more like trampolines because you've got to jump on these trampolines and then you got to exhibit, if they're at different levels like a step, you got to exhibit a lot more energy to then get to the next step of trampolines. And so that's, Souyias is that what you were talking about?

Dr. Souyias (44:36):
Yep, that's the one.

Cameron Full (44:37):
And so you look about these systems and the same systems that you have today are not the same systems that will work for you when you get 20 team members or a third location or X amount of dollars or another doctor. That's something that ... Actually, Deana, that's something that you were talking about when you were here last is like, "Hey, your systems are perfect for you. What about when you got doctor two or three?" Those same systems don't necessarily work. And now we have to exhibit more energy to get to the next trampoline to then exhibit the same amount of energy to stay on that trampoline.

Dr. Souyias (45:06):
Yeah. Well, I think sometimes too with these growth things, in my own practice, what's happened is sometimes I'll be flat for a year because we're spending time working and refining systems and doing stuff. And then I think that idea- You have to create that.

Cameron Full (45:24):
You got to create that slack.

Dr. Souyias (45:27):
Right. You've got to make the room to grow, that continuous five to 7% growth year after year. I think that's a fallacy, at least it has been in my career. I'll be flat two years in a row, and then boom, I'll have a 20% jump. And so it's like because we've been focused and working on things, I think what you put out there is really insightful. A lot of times, I think we have this idea in our mind that it has to be just 5% year over year every year and well, that's not really how it works. Some years are better, some years are worse. We had the post COVID glow, we took the dentist away for people for a couple months and we had years of booming dentistry. And so it's interesting how

Cameron Full (46:14):
Seda's glowing.

Dr. Souyias (46:14):
that slows down. Seda is always glowing. It's that beautiful Persian skin. Persian skin.

Cameron Full (46:22):
Sorry, Souyias.

Dr. Seda (46:24):
I moisturize.

Dr. Souyias (46:25):
You moisturize. Good tip. What products do you ... No, it's not the subject of this podcast. What are some of the things that have helped you really getting through those periods that aren't wonderful?

Dr. Cook (46:40):
Well, I'll never forget right before I had, I think it was my first daughter, referrals were very low and I was like, "I'm real scared now. I'm about to have a baby and be gone for a little bit." I was really worried. And so what I always try to do is when things aren't as busy is like you said, focus on some of the systems that we can improve. Instead of beating ourself up about like, "Oh my gosh, we're not as busy." It's like, well, let's figure out what we can do to improve in order to then things will be more efficient when and if we are busier. So to go to the root cause of it instead of just like, "Oh my gosh, we're just going to panic and really focus on how we can improve during those times."

Dr. Souyias (47:26):
That's wonderful. Learn everything you can about how to read people and patients and referring doctors. Tell me more about that part of it.

Dr. Cook (47:33):
Yeah, the people part, I mean, no one else's brain works like mine and trying to understand what motivates team members, what motivates the patients, what motivates referring doctors because they're all very different as they should be. And so that's what I focused on when I first finished residency was like, man, how can I understand what it's like to be a dental assistant? I mean, I'm a terrible dental assistant, but what can I do to really get their point of view in order to help, I think, be a better leader? And again, referral patterns will change over time. Team members will change over time, but really understanding, again, it's like going back to that very first point of it was all up to us at the very beginning, and now we're so intentionally reliant on other people that I want to understand more about them in order to, I think, be more successful.

Dr. Souyias (48:31):
All right, so we've got to start wrapping it up here. Tell me what you think your biggest tip is for a doctor who's trying to make these changes in their practice.

Dr. Cook (48:41):
One bite of the elephant at a time.

Dr. Souyias (48:44):
Love that analogy.

Dr. Cook (48:46):
Don't do it all at once. You'll make mistakes and ask really smart people, pick their brains because there's a lot of ... I think I didn't want to reinvent the wheel with all the other people who've preceded me on the podcast, but I mean, I reach out to mentors all the time. I was texting with a referral lab podcast, Dr. Stoner today. So it's like just reaching out to people, asking what you may think is a dumb question certainly isn't. And just being humble of, yes, it was up to us at the very beginning, but the people that you surround yourself with will genuinely make you so successful. So if you take good care of them, they're really awesome. So I just take care of the good people that you surround yourself with.

Cameron Full (49:37):
We are the average of our five.

Dr. Cook (49:39):
Yep.

Dr. Souyias (49:41):
Deana, thank you. That was an incredible episode. Thank you for joining us again on The Special Lists. And Cameron and Seda, thank you guys. This was a great episode.

Dr. Seda (50:10):
Dr. Cook, thank you for your contribution really. You've got a lot to.

Dr. Souyias (50:13):
Amazing.

Dr. Seda (50:14):
A lot of positive messages out there.

Dr. Cook (50:16):
Thank you so much. Thanks y'all.

Dr. Souyias (50:20):
Thanks for listening to The Special Lists. Presented by Referral Lab, the podcast for dentists and dental specialists. Featuring a special list from a specialist. Got a question for us? Send us a message at speciallists.com with two Ls. Transform your referral workflow with Referral Lab, the purpose-built platform for dental specialists to track, manage, and convert every referral. Request a demo at referrallab.io.