Rediscovering quality in our practices

April 7, 2014
We understand that when people move, die, or change dentists, there is an erosion of patients within our dental practices. A healthy business offsets this erosion ...

By Dorothy Garlough, RDH, MPA

We understand that when people move, die, or change dentists, there is an erosion of patients within our dental practices. A healthy business offsets this erosion by attracting and maintaining new patients. Yet many offices are running on a treadmill, working harder in challenging economic times with a decreased patient base. The problem is that many offices are practicing insanity -- doing things the same way but expecting different results. These dental practices share the same mindset as the struggling newspaper industry.

Newspapers initially resisted developing new revenue streams through digital media production, which resulted in the demise of many publications. It wasn't until they asked questions about how they could innovate in the new environment that they began to make a revival. Their business leaders now recognize that in order to orchestrate a shift, they need a process with which to massage, manipulate, and mold the challenge of the new digital format into a profitable business model.1

The "discovery cycle" is such a process. This technique engages the "whole" brain, taking many discovery components into account to spark innovation.4 There are six phases to the discovery cycle (questioning, observing, networking, experimenting, incubating, and association) and although no particular order needs to be followed, it is important to think through the entire cycle to find the best solutions. It is the purpose of this article (in a series of articles) to explore the questioning aspect of the discovery cycle.


Other articles by Garlough


Questions are powerful. Asking the right questions will deliver the right answers. Einstein once said that if he had only one hour to solve a problem and his life depended on it, he'd devote the first 55 minutes to figuring out the right question to answer. Toyota, with the No. 1 selling car in the United States, the Camry,5 attributes its success to the "Toyota Way." Through the application of four gradations of questions, they are able to avoid distracting or confusing issues to get to the heart of the challenge.2 Toyota's driving philosophy finds root causes by asking the following layers of questions:

  1. What is the initial problem
  2. How can the problem be clarified
  3. What is the real problem
  4. Where is the root problem

Dental practices need to recognize that in today's lean economy, success is more about asking the right questions. For example, if there is an attrition of patients, you understand that there is a problem. Digging further, you can clarify the problem by monitoring the number of patients who fail to rebook. To find the real problem, however, we need to ask open-ended questions to patients, or provide an anonymous survey compiled of questions that uncover the real problem.

Your patients may feel they are not being listened to, or that the office décor, equipment, or policies are outdated. They may feel uncared for or may not even trust you. Perhaps they want an innovative method of payment during an economic downturn. By asking probing questions, some of which may be uncomfortable, the real issues will begin to surface. Like an onion, when we peel away distracting layers, we get to the root cause of the problem. Then and only then can change be orchestrated and solutions be applied.

An example of a powerful question for dental offices can be the simple question, "What business are you in?"2 Answer this for yourself right now, but consider that by realizing you are not just in the teeth business, you can open up new markets, develop new revenue streams, and enhance existing ones.

The right question can direct and inspire new innovations and motivate and align employees. Your answer can be a catalyst for substantial growth. Ask yourself, what are the true needs that your service is meeting for your patients, and what are the real benefits that your service is offering? Perhaps a light bulb will go on when you realize that you are in the business of helping people maintain not only their dental health, but also their overall health and their emotional health. The confidence that emanates from an attractive smile is important to people's sense of well-being. How meaningful is that to you, the team, and your patients?

If questions are so telling, why is there hesitation in using this discovery method? Although children come into this world full of questions, they have been toned down. The notorious "why" that three-year-olds ask has been almost eliminated from their vocabulary by the time they are five because parents are tired of their children's inquiries. In addition, teachers are programmed to want answers, not questions, and students are rewarded for giving correct answers, not for asking revealing questions.

By the time people enter the workforce, they fear being perceived as incompetent or uninformed if they don't have the answer. Yet, creators such as Steve Jobs were careful to maintain their curiosity and their willingness to ask questions. In fact, inquisitiveness is a characteristic of intelligence. Research says that the child whose curiosity is fanned is three times more likely to be successful in life than the child who may in fact have a higher IQ, but whose inquisitiveness has been squelched.3

Business leaders today hold questions in high regard. They know that right answers for problems or new innovations are revealed by the right questions. Dental practices need to regularly question assumptions and conventional wisdom in order to innovate in an environment where change is happening rapidly. We need to be open to discoveries. According to Hal Gregersen,4 one of the leading authorities on innovation, leaders who question must look at an existing reality from multiple vantage points, including the viewpoint of a naïve child.

When we ask our patients what it is they want and expect from our professional services, when we uncover the root cause of dissatisfaction, we not only address the issues but we create relationships. Patients will know they are listened to. Today more than ever we need to become effective innovators in our practices.

Posing powerful questions is a skill. Like the newspaper industry, when we ask bold, original, and counterintuitive questions, we cast a familiar challenge into a new light and find effective solutions.3 Insanity evaporates and engagement occurs when we practice "discover skills." Being continually fascinated gives us the ability to process information and broaden our horizons. It is true that those who explore learn. And learning to ask questions is vital to success.

Qualities of a Powerful Question

1. Simple and sophisticated – Assumptions surface and you are restricted only by your imagination and capability
2. Open-ended – Thought provoking questions that expand cognitive maps and mental horizons
3. Generate energy – Look at other possibilities through "what if" questions
4. Diverse – The status quo is questioned, opening new possibilities that often go against the flow
5. Focuses inquiry – Finding multiple answers


2. The Toyota Way - ISBN 0-07-139231-9 Jeffrey Liker, McGraw-Hill – 2004.
3. http://www.fastcodesign,com/1663429/big-innovations-question-the-status-quo-how-do-you-ask-the-right-questions.
4. The Innovator's DNA – ISBN: 978142213481, Jeff Dyer, Hal Gregersen, Clayton M. Christensen, Barnes & Nobel – 2011.
5. Under the Influence CBC Radio – the Psychology of Price, Jan. 11, 2014 .

DOROTHY GARLOUGH, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change in both the dental and corporate worlds. 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].

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