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Wholearchy and the Bay of Pigs invasion: Encouraging a dissenting opinion in dental offices

March 14, 2017
Dorothy Garlough, RDH, explains how a dissenting or outsider opinion within dental offices should be considered among the majority's viewpoint.  

A dissenting or outsider opinion should be considered among the majority's viewpoint

By Dorothy Garlough, RDH, MPA

Strategy is defined as a method chosen to bring about a desired future;1 and it is something we all use throughout our lives. One simple example of a strategy is the process you used to obtain your dental hygiene degree. Where and when did you go to school? How did you balance the learning with life? How did you budget for it? A successful life is full of well-thought-out strategies, and so is a successful wholearchy (i.e., a person-centered team).

Strategies are meant to deal with the demands of the moment, moving us through challenges in pursuit of overall goals.2 In a wholearchy, the strategy is embodied in the constitution and offers tactics on how we achieve the vision of the team that was described in the February 2017 issue of RDH magazine. If the vision is the long-term goal, it is the strategy that helps us get there.

There are multiple statements of strategy in a wholearchy's constitution. These include statements on decision making, marketing, key performance indicators for tracking case acceptance and periodontal therapy, team training (e.g., conflict resolution, collaboration, communication, empathetic and emotional intelligence), problem solving and idea generation, leadership, intraprofessional collaboration, behavioural guidelines, salary guidelines, mentoring and accountability partnerships, compliance building, position accountability, patient relations, and complaint handling. Over the next months, I will offer models that could be adapted or modified within office constitutions. Like an orchestra, there are many notes to ensuring a successful office; each of these strategies will ensure the harmony of the person-centered team and its achievement of outstanding results.

I would like to start with the "decision-making statement" by illustrating the need for a process through a true story.

In 1959, John F. Kennedy was starting his presidency at a tenuous time. Cuban president Fidel Castro had recently forged strong economic links with the Soviet Union. Kennedy's predecessor, Dwight D. Eisenhower, had instigated a plan to overthrow Castro with the final decision to be made by the new incoming president. The final invasion plan was set for April 4, 1961.

The new president inherited the plan that was being created by the CIA and the military. Kennedy decided to advance the plan. As it turned out, there were people who had silently questioned the invasion. However, they did not voice their dissenting views and allowed the so-called "experts" to proceed. The military leaders were already invested in their plan, thereby creating bias. They did not seek diversity by looking outside their limited thinking for input and were subject to the condition of groupthink. This condition is "a psychological phenomenon that occurs within a group of people in which the desire for conformity in the group results in an irrational or dysfunctional decision-making outcome."3

The result of the initiative was disastrous. Many men lost their lives, Fidel Castro remained in power, and the United States was embarrassed. As the leader of the free world, Kennedy had failed miserably; confidence was shaken within the new administration. But this failure sparked his resolve. He would create a decision-making process that would guide him and guard against the lack of foresight that had occurred by not challenging all perspectives. No longer would he allow bias of others to cloud his judgement. No longer would he be so insular by not looking beyond "the experts."

He did a number of things that were progressive, helping to guard against outcomes that did not serve the American people or align with the values of his administration. He began to seek advice from outside sources, not just those who had a vested interest in decisions. He sought council from a wide variety of people in various professions, adding diverse thinking to his determinations. He encouraged dissenting views and vigorous debate and would often leave the room so that others could feel free to voice their objections or concerns.

Additionally, Kennedy peppered these discussions with someone who would intentionally challenge whatever was being proposed. These trusted allies (one being his brother, Robert Kennedy) would play the devil's advocate and express contentious opinions in order to provoke debate or test the strength of the opposing arguments.

It was clever of President Kennedy to encourage dissenting views. Not only were new ideas brought to light-perhaps more importantly, potential solutions to worst-case scenarios were explored. This singular action would prevent future embarrassments and failures during Kennedy's administration. The success of Kennedy's forward thinking decision-making process was exemplified in the Cuban Missile Crisis. The sound decisions made during this crisis diffused events that could have been catastrophic for the entire world.

The decision-making process in a wholearchy is inspired and modelled after Kennedy's example. Its design is informed, comprehensive, and open while also challenging the status quo. It involves intentionally looking at challenges from different perspectives and uncovering all potential outcomes from these perspectives. It invites the entire team into discussion and debate, even appointing a devil's advocate, thus helping to prevent groupthink. It does not rush into decisions and seeks data, input, and viewpoints from both experts and others, even outside the profession of dentistry. It broadly educates the team on all ramifications and guards against biases by maintaining open minds. Individual interests are not a driving force, for these interests submit to the question: Is it good for all of the team?

As a democracy, a wholearchy gives equal value and equal time to all members of the team. Decisions are based on the highest good of the office and what will elevate everyone and pursue the office's vision. All sides are weighed with the recognition that the team needs to make decisions based on the primary objectives of the office. To help reach the best decision, the following questions are asked:

  • Have you identified the root cause of the problem?
  • Have all perspectives been explored?
  • Has the status quo been challenged?
  • Have you appointed someone to act as the devil's advocate?
  • Have you explored troubleshooting solutions to possible problems?
  • Have you challenged all biases?
  • Have you sought outside expert opinions?
  • Who else could you seek viewpoints from?
  • Does your decision align with your office values?

The decision-making strategy in a wholearchial constitution is a powerful tool. It will help to navigate the "republic of team" to make decisions in effective ways. The process of making sound decisions can elevate competency to excellence and is a driving force in creating the future the team desires. Next month we will explore this important strategy in greater depth and see how a majority rule can create an atmosphere of enthusiasm and distinction, thus propelling the team to new heights in their creating tomorrow today.


  1. Corporate strategy. BusinessDictionary website. Accessed February 3, 2017.
  2. Tactics. BusinessDictionary website. Accessed February 3, 2017.
  3. Groupthink. Wikipedia. Accessed February 3, 2017.

Dorothy Garlough, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change within dentistry. As an international speaker and writer, Dorothy trains others to broaden their skill-set to include creativity, collaborative innovation, and forward thinking. She recognizes that engagement is the outcome when the mechanisms are put in place to drive new innovations. Connect with her at [email protected] or visit