Change: How to Make it Stick

By Dana C. Ackley, Ph.D. Originally published by ACT Dental.

Has this happened in your practice? A consultant gives you a great idea or you go to a program at a place like the Pankey Institute and discover an exciting but different approach to practice. You become enthused and bring the idea or program to your staff. They agree that it's great and you and your staff begin to implement the change. A month later, everything is back to the way it was. Why does this happen?

You may blame low motivation or passive-aggressive behavior. While these factors do sabotage change sometimes, it's much less frequent than people think. You probably were pretty motivated. Most staff members mean well and want to support their leader.

Implementing organizational change is harder than it looks. If changes in your office have not gone the way that you want, you have a lot of company. Most attempts at organizational change fail, whether we are talking about large Fortune 500 companies or small organizations like a dental office. I know. I've seen it at all levels.

While organizational change is complicated, a simple model can guide your efforts to successful change. It succeeds where others fail because it accounts for human psychology, basic to changes in behavior.

A simple model for complex change

Suppose that you want to have a less hectic schedule, or have more harmony among staff members, or you want to free your practice from the burdens of dental insurance. It would seem natural to simply schedule fewer hours, or encourage staff to treat each other more kindly, or stop signing up with insurance plans. Why don't such steps work? They don't work, paradoxically, because they are only focused on changing behavior.

As long as you only focus on changing behavior, your efforts are doomed. Successful change requires that you also attend to the building blocks of behavior, the factors that determine how we all behave.

Where does behavior come from? Behavior germinates from our thoughts and feelings. How we think and feel about a situation controls how we respond to it.

For example, suppose that you want that less hectic schedule. You work too many hours, get too tired, and your take-home profits don't reflect your efforts anyway. So you instruct your office staff to schedule fewer hours. The office staff agrees, and in fact, are a bit relieved because they have been worried about you.

But they are not clear how to implement the change. To implement the change to meet your desires, they consult with you about whether you want to accept various requests for treatment. They find that you never say no. Not only that, but when an hour goes unfilled, you get upset. Your answers to their questions and your emotional response to lulls lead them to resume overbooking your schedule. You are right back to where you started, except perhaps feeling even more helpless.

What went wrong? You only focused on changing behavior. If we could hear what was going on in your head, we would discover thoughts and feelings that led you away from your goal.

 Thoughts: Your basic thought about how you should build your practice might be "If it has a mouth, I'll treat it." Many dentists early in their practice think this way. They reasonably prefer to have some business over no business, i.e., some income rather than no income.

However, once their practice gets busy, many dentists forget to notice that they are still thinking in the same way, even though it no longer fits their circumstances. They now need to change their thoughts to something like: "I am now well enough established that I can be selective about the kind of work that I do, whom I accept referrals from, and the extent to which I have to work inconvenient hours." Notice how this thought is aligned with the goal of a manageable schedule.

Feelings: Many dentists get nervous saying no to any request for dental services. If this is true of you, then it is easy to reduce your anxiety in the moment by simply saying "Yes." Of course, doing so runs counter to your goal of a less hectic schedule. You will be as busy as ever.

To reduce your hectic schedule successfully, in addition to changing your thinking, you must change your feeling of anxiety when saying "no thank you" to an undesired request for service. The feeling must change from anxiety to one of calm. Initially, this will probably take focused effort. You may find that it helps to take a deep breath or two while relaxing your muscles. When you have a hole in your schedule, you will need to calm the initial anxiety you may feel rather than getting nervous (and then berating your office staff for the hole).

Much anxiety is based in irrational thinking. (All of us engage in irrational thinking from time to time.) Anxiety is designed to alert us to danger in our environment, just as physical pain is designed to alert us to something wrong with our body. However, irrational thinking leads us to identify events as threats that are not threats at all.

If you listen to yourself closely, you may find yourself thinking that the hole in your schedule means that your practice is teetering on a cliff of disaster. I don't know about you, but when I feel on the cliff of disaster, I get scared. Usually, though, I'm not on such a cliff, and, probably, you aren't either. More rational thought will remind you that even highly successful practices have holes in their schedules and that such holes are great times to catch up on treatment planning and office paper work.

Implementation: Not always so easy

The model is simple - to change behavior, change the thoughts and feelings that drive that behavior.

For some changes in our office, you and your staff can probably figure out what the thoughts and feelings are that drive the behavior you want to change. Sometimes, however, it's not so easy to discover the key thoughts and feelings. For a variety of reasons, they may be hidden. Some thoughts are so habitual that they become assumptions, which are notoriously hard to bring into awareness. Some feelings are hard to identify.

To really have a less hectic schedule, you will have to change the way that you think and feel about building your practice. Only then will you be able to sustain the behavioral change of saying "no thank you" to certain requests for service.

I am a specialist in helping dentists and staff uncover hidden thoughts and feelings that are driving behavior in undesired directions. Once uncovered, they are available to change. Feel free to call me if you have been struggling unsuccessfully with a change that you want to make in your office. When dentists and staff discover what is really driving behavior, they can quit blaming each other and get on with the business of success.

Dana C. Ackley, Ph.D. is a psychologist who provides coaching and consultation to dentists and their staffs. He has been a guest lecturer at the Pankey Institute for Advanced Dental Education and writes frequently for Dentistry Today. He can be reached at , or 540-774-1927, or EQ Leader, Inc., 2840 Electric Rd, Suite 208, Roanoke, Virginia 24018.

The comprehensive science based EQ Leader Program builds lasting change in EQ skills that make a dramatic difference in performance.

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