Episode 120 – Cadence Above & Below the Line

“Cadence isn’t a matter of personality, it’s a matter of process.” ~Dr. Victoria Peterson

Welcome to the third part of a special four-part crossover series of Everyday Practices Dental Podcast and the Investment Grade Practices Podcast. This collaboration brings together the expertise and insights of Everyday Practices Dental Podcast co-host Regan Robertson, and Investment Grade Practices host Dr. Victoria Peterson as they marry high-level visionary planning with essential nuts-and-bolts day-to-day practice management. 

In this episode, Regan and Dr. Victoria continue their discussion about the concept of above-the-line vs. below-the-line thinking – a framework that distinguishes between strategic, aspirational planning and the practical, often challenging aspects of implementation. They explore the significance of cadence in business operations, and the importance of establishing the right rhythm for meetings and processes to ensure effectiveness without overwhelming the team. 

The conversation moves into the challenges of setting the right pace for different stages of business growth, from scrappy startups to predictable, durable practices. Leaders need to understand how to adjust cadence according to their team’s capacity for change.

As you listen to this episode, we want you to think about the following questions:

• What steps can I take to foster more “above the line” behaviors in my practice?
• As a leader, am I effectively promoting accountability and clear communication within my practice? 
• What can I do to set a better cadence for my team?
• How can business coaching for dentists help me?
• What benefits can my practice get from dental practice coaching?
• Do I view practice management support as an investment in my practice’s long-term success or merely as an additional expense?

EPISODE TRANSCRIPT

Regan Robertson: Welcome to part three of the four-part series collaboration between Everyday Practices Dental Podcast. I am your host, Regan Robertson and Investment Grade Practices Podcast with Victoria Peterson. Hello, Victoria.

Dr. Victoria Peterson: Hello, Regan.

Regan Robertson: You know, in the first two parts of the series, our theme is above and below-the-line, uh, kudos to Skip Miller who wrote selling above and below the line, uh, with our theme. The first was bridging the gap between vision and reality. Uh, and the part two was metrics above and below the line nd this week we are focusing on cadence above and below the line.

Dr. Victoria Peterson: Yes.

Regan Robertson: What are your thoughts, Victoria, around cadence? Do we do everything at once? Do we meet every single day? What do we meet about? Do we do it weekly, monthly? Who’s involved? There’s a lot of big questions around it and I don’t mean to make light or sound light of it, because if you don’t, if you don’t have certain areas, keyed in and tuned right, you can overwhelm your team. You can become ineffective. You can make yourself overly busy, uh, for very detrimental reasons and think you’re doing the right things and it’s actually pushing you backwards. So, uh, from a seasoned business professional, I would love to understand how are we defining cadence in this context?

Dr. Victoria Peterson: I’m laughing and smiling because I’m raising my hand saying, “Yes, I’ve made all of those mistakes and I still do on a daily basis.” I’m, I’m such a visionary big picture leader that I’m sure that our team is going to groan and say, “What, what is Victoria doing talking about cadence and process?” But, um, I love cadence and process. Um, I, as a visionary, it’s tough for me to stick to it cause I’m like a five year out. So my struggle as a leader is always bringing it back and you’re brilliant at this, which is why I love our two podcasts hosting together, because I’m out there and you say, okay, let’s dial that back. What has to be done in the next 12 months, six months, three months, one month, daily, weekly moving forward. So I think that’s the beauty. So the above-the-line piece is to go out far enough that you can see the whole picture, you know, sometimes as leaders, we get myopic and we’re just like, “How do I survive today?” But organically just moving from today to tomorrow, to the next day, as Stephen Covey says, first, you’ve got to make sure that your ladder is on the right wall. So the above-the-line piece is if you’re climbing the ladder, sure it’s on the right wall. So that’s the above-the-line piece and then the below-the-line piece is what, what is the rung on each step of that ladder and that’s where the cadence comes. You know, if you’ve got long legs, maybe you can take two rungs at a time, most people can’t take three. So trying to do too much too quick can overwhelm the team. You spoke to that. Um, and I think it depends on the stage of business that you’re in. You know, we talked about that last time. If I’m not, if I’m young, I’m startup, I’m scrappy, I’ve got energetic, enthusiastic people, we’re just there and we’re making bank, right? Like get them in. Let’s, let’s get the revenue going. Let’s get some systems built. They’re not perfect. We’re okay that they’re not perfect cause we’re all excited and then you break through to that next level where it’s more predictable and that’s where I think the cadence really gets honed in that predictability. Um, but you still have flexibility. You still have place for innovation and you’ve got other things that might trickle in. When you get to durable, I think that’s where it’s. It’s the cadence really gets locked and it’s more difficult to make sweeping changes in the business.

Regan Robertson: Really? Tell me more about that. I’m genuinely curious at durable you think it gets a little bit tougher.

Dr. Victoria Peterson: Yeah, because it durable as an owner, I ought to be able to step away from the business and know exactly what’s going to happen day to day, week to week, month to month. Right. So that’s the hallmark of an Investment Grade Practice is the doctor can take a month off and he’s going to come back and it’s going to look like the same practice that he left. That’s the expectation. It’s durable. It’s predictable. Um, employees are treated well, you know, according to the way we set it up. Patients are being treated well, revenues are flowing consistently, profits are flowing consistently. So if you go away for a month and one of your partners or your associate buys, uh, you know, a CAD/CAM Miller or, you know, buys a 3d and you’re like, “Wait a minute. Whoops”, and, you know, so the spontaneity isn’t quite there when it’s durable, it’s more planned out.

Regan Robertson: Yeah, that makes, that makes a lot of sense to me that yes, you have to be more intentional at that point. You know, uh, I interviewed with Chad Johnson, uh, Dr. Gwen Bach, and she talked about her journey going out of network and it really highlighted something, Victoria, that you’ve talked about multiple times in scheduling to productivity. There’s that first phase, that first template that talks about getting up the 300 an hour and where you’re at as a practice, when you are making that initial climb and then the variable changes and this I think is very important when it comes to cadence also, once you hit your profitability incentive point, you’ve explained that that variable shifts to time and Dr. Gwen Buck, I’m putting a pin here, listeners go listen to her podcast because it highlighted the importance of time, very intentional and how you meet, I think does have to reflect what it is that you’re focusing on as a company and it can feel difficult. I’m, I’m sharing from personal experience within, within PDA. You know, you have to get a system in, you know, you have to set up a rhythm to, to communicate with your team on the goals and early in my leadership, I set up that cadence, really, I mean, even based on your direction, you meet once a week, or you meet once a month and so I was like, “Okay, I do this, I have to set this up,” and then I would say, “Well, what am I going to talk about?” And so, and that’s when the, the shift can go locked in and focused, or it can start to skew and you start to fill the time thinking that you just have to meet the date and you don’t necessarily have to talk about the metrics and what’s important and, and we talked about the metrics and we talked about bridging, bridging that graph. That’s why it’s important to do those things in that order and I think the third component to this before establishing that cadence you touched on briefly is how much change can your team. implement at any given time.

Dr. Victoria Peterson: Right.

Regan Robertson: So Victoria, if you think about a dental practice in varying stages of, of its evolution, we agreed vision and reality should be the big vision. That should be the starting point, getting your mission clear and your key characteristics, and then understanding your metrics are the second part team adoption. What have you seen in your years of consulting and advising about what an average team can handle in any given year?

Dr. Victoria Peterson: Um, it depends on the maturity of the team and, and the effectiveness of the systems, but I would say foundationally as a communication cadence, there are things that we talk about every day in the morning, who’s on the schedule, what opportunities are here, something as simple as “Regan is coming in today and her two children are past due and I know that they were talking about braces for Ryland, right?” So awareness of when you come in, hi, how’s Ryland? Did you follow through on that consult? It’s time for her cleaning. Let’s get her and Ben in. So the simple daily actions of, uh, as Bruce says, we got two goals on a daily basis, number one, to take incredible care of our patients. Which that’s an example of it, and number two to make our goal. So are we on or off goal for today for production and collections and have we served every patient to the highest level? That’s your daily cadence, that’s what’s top of mind every day. And then every week, you, you just extend that and test it. So every week, whoever is in charge of new patient flow would have their metric that said we saw six new patients this week, three of them reappointed, three of them didn’t. What am I going to do about those three who did it? Are they in an automatic outbound email or text campaign? When am I going to call them next? What do I have to do to clear the financial obstacles for them? There should be some activity for those three. So those kinds of things are what you look at as a weekly cadence. So my daily on or off goal weekly, you know, do I need to catch up before the week is over? Who do I need to call? Who’s in hygiene? Who can we shift over? So like making your goal on your week and then monthly might be our big picture projects. So let’s say that we are introducing Invisalign, which is kind of a big thing, but we’re introducing a new service and so we’re going to take the next 60 days to get integrated in this. And we would set up the plan on, on this day where, you know, we’ve, we’ve started marketing, we’ve got our cases coming in, we’re tracking them at the end of the month, we’re going to say, how are we doing? Who’s feeling confident? What’s happening with our training? What’s happening with our marketing? Are we integrated? So I would say the monthly is more our project management and our overall big goals of what we’re working on.

Regan Robertson: This makes all the sense to me in the world because you get what you focus on and I’ve been dinged multiple times for looking. I look to referrals and reviews first and I, we focus on the internal, it’s the lowest cost of acquisition. I will never stop talking about it. It’s also a great indicator of how your team is following a cadence or that have they adopted this as a new habit and it’s so easy. I think, especially for entrepreneurial business owners, dentists, your, and you Victoria five years out visionary, that is your highest and best and so it’s so easy to, um, assume that though that cadence is in place. And go about your way when we, when we make that intentional look though, to not just report on the data, but ask ourselves, is it to our benchmark standards?Is it where we want it to be? Do we see a change in it? That is the importance of the daily, weekly, monthly, quarterly touches. It is so critically important to look at those and I think assign people within the practice to their areas of responsibility, people want to contribute to the success of the dental practice and so in marketing, for example, if you have support, CMO, an external agency working with you, phenomenal. Doctor, who is the person that you are designating in that practice that can help take shared ownership and responsibility? Here’s the kicker. I think with cadence, once that’s assigned, how do you make sure that you are following up in relationship and know that it’s working for you? Those are, that to me is one of those little things that can get missed for weeks, then months, and then years and it really can damage the success of an organization if you’re not thinking from that. So an administrative

Dr. Victoria Peterson: Go ahead. Administrative?

Regan Robertson: I was just going to say, if you, if you find an administrative team member and they are passionate around marketing or around a specific initiative, you talked about Invisalign, giving them that responsibility and then creating that metrics and asking them about their cadence, how they’re going to be reporting that together, brings them into the conversation and I think it’s extremely powerful and it helps delegate. The trick is don’t just delegate and walk away. Okay.

Dr. Victoria Peterson: Yeah, understand those numbers. So many, so many business cliches are coming into my head, like inspect what you expect. So the cadence is set by the leader. This is what I’m committed to. I think there’s a cadence for education as well. There’s a lot of virtual training in the marketplace now for office managers, for team leads, things like that but even within our own organization, Uh, you know, we’ve got hundreds of coaching clients and we’ll have the same six or eight office managers on our monthly empowered leadership forum and the reason is always I’m too busy, I can’t, my doctor won’t support me on this call. So you have to ask yourself if you’re moving towards durability, if you’re building an Investment Grade Practice that can run without you, when do you expect your team to gain the experience and the knowledge that they lead, knowledge like conflict resolution, employee life cycle management, recruiting, onboarding, offboarding, uh, benefit investigation, like all of that can be delegated, but you don’t delegate it to a second-grade school teacher that you just hired because she didn’t want to be in the school system anymore and you made her a receptionist and everybody quit and you elevated her to office manager. So if you’ve got that educational gap, there has to be a cadence in education. Uh, and so I think that’s probably one of the most overlooked things for dentists and it goes to another cliche. You can delegate everything but leadership. You have to, you’re the leader, you have to make the decisions and one of those decisions is how much time will I carve out for my team to learn and grow and what resources will I give them to learn and grow because I can step back as a manager and that’s where doctors hate managing. I hate managing. It’s exhausting because, you know, there’s a lot of people with a lot of questions and it takes a lot of time. If you want to be in the mouth with patients, you have to train the management within the team and, you can only do that when you know the person taking over can do it as well or better than you. That’s when you have the confidence to let go of those reins a little bit. So in terms of cadence, um, it all goes out the window if you’re advocating like, “Hey, I hired these people, they should do it,” or you’re delegating without resources. It’s hard to keep up the cadence of competency and move the business forward. If you’re not surrounded by people who really understand their jobs and are growing.

Regan Robertson: You know, you bring up a really exceptional point and that is the profitability per employee and what that employee is worth to the practice itself and then, and then aligning that with activities and educational opportunities that best serve themselves and the practice. That is a wonderful and powerful formula you and, and PDA does walk that talk. So PDA is, is I think exceptional at aligning educational opportunities that allow our employees to grow in their controlling idea, if we say it to quote Donald Miller, but, uh, controlling ideas so that we can lift up the organization together. I was on a client call. I love that you brought this up. I was on a client call recently and this uh, particular office manager was engaging, uh, in, uh, I would say a series of initiatives. We’ll just say a series of initiatives and, um, and the business advisor on the call asked the doctor, “How much does this office manager make again?” And they responded and, and, uh, the business advisor replied back, “What type of value would it be if we had your office manager had the time free for them to focus on this instead?” And the value difference in the tasks, the daily tasks and the cadence that this office manager would engage in was pretty stark, it was a nice sizable gap that would be felt positively as far as revenue goes for the practice and you could see the light bulb turn on in the doctor’s head and so you have to, I think, like you said, you can’t delegate leadership, you do have to be open and curious and willing to shift your mindset and that can be frustrating for any leader. We get stuck in our ruts. Especially if we are somewhat successful, you know, most of the practices that come to us, they are not desperate. They’re doing good. They’re often doing solid and they’re comfortable, uh, in order to get to that next level. Uh, it can be tricky to get your wagon wheels out of that rut and looking in a new direction and I think aligning, like you said, the education with that and, and to quote Adrienne Reynolds, our Chief Human Resources Officer. You know, she certainly blew my mind with aligning our job descriptions and core competencies together and, and, and putting, you know, all the pay bands and where, where our industry’s at and looking at things competitively. That got me thinking about our business in a different light as well and everything flowed from that. The clarity is incredible.

Dr. Victoria Peterson: I love it. I, I think we’re just flowing right into our fourth topic, which is going to be support, cadence and support. How fast can I do something? How quickly can I, Implement initiatives or, you know, get to that place of predictability. It really does depend on the support that you surround yourself with.

Regan Robertson: Yes, agreed. So to summarize in this, your cadence, your cadence might be different for your practice. It does determine, uh, is determined by a few factors, uh, your team’s willingness to change, uh, your clarity, where your goals are at, how crystal clear you are on those and your milestones. So your own Gantt chart for your economic objectives. So once you have those, those first two pieces in place, you can start to think about the cadence and how much your team is willing to commit to the daily, the morning huddle, PDA always recommends the morning huddle. I don’t believe I’ll ever hear us say differently and the, the weekly and the monthly sessions and I have seen varying results. You know, to, to dentists that come into us that hold those or don’t hold those. Some dentists use traction, uh, by Gina Wickman. Some use the, uh, Business Made Simple model. Some have made up their own it’s, it’s kind of all over the board. So I feel like once we get past that morning huddle, it can get a little bit fuzzy. So my recommendation is if you are clear and you understand everyone’s role in the practice, they are clear on their responsibilities, most importantly, when you decide the weekly, the monthly, and the quarterly, who is going to own each of those metrics in there, and do they understand what it means? Do they understand why it matters to the practice and do they understand how they can influence the results themselves? That was the other thing. Can you influence the results? It’s kind of like bonus plans that say, we’ll bonus you on the performance of the practice. That’s fantastic. Okay, wonderful. How can I personally contribute to that? That is my own personal cadence and I want to be responsible for that.

Dr. Victoria Peterson: I love it.

Regan Robertson: Final thoughts, Victoria.

Dr. Victoria Peterson: Um, it isn’t a matter of personality, it’s a matter of process. So even if someone can’t be a part of a meeting, the meetings go on, right? Make sure that you have a proxy and that you’re well-informed. Make sure that you have your fingers on the pulse as a leader and you’ve got, um, you’ve got those lines of communication going up above and below the line. You know, and, uh, I’m really envious of brick-and-mortar doctors who have all their employees in one building easier than being a virtual company with three different divisions spread across 17 states. So we, we oftentimes have, uh, we, we do a great, great job, but there are times due to time zone, this or that, where some know some don’t, and we’re like catching up in this virtual world. So. I think, uh, that plays a role in cadence as well.

Regan Robertson: Well, thank you, Victoria. I look forward to the fourth and final part of our series, which is support and as I often say on Everyday Practices, success requires support. So I will see you soon.

Narrator: Thank you for tuning in to this episode of Investment Grade Practices Podcast. If you find value in this episode, help us spread the word by passing it along to a dental friend. Subscribe and give us a like on iTunes or Spotify. Learn more about building your Investment Grade Practice at productivedentist.com today.