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Why go Paperless? What I have now works and doesn’t cost a thing.

Why go paperless?

Paper charts don’t just appear in the office for free. The paper folder and all the other papers cost about $2.50 each. If you have 2500 charts they cost you at least $6,250 to create and every time a new patient walks in it’s another two-fifty; cha-ching.

Other chart contents, like X-Rays and photographs can be even more costly. A set of bitewings with film, processing and mounts can be a dollar or two. A photo printed from the intraoral camera is $1.50 or more. It is reasonable to add at least another $2.00 to the cost of each chart for these contents adding another $5,000 to the cost.

Storing the records isn’t free either. A typical office with 2500 charts will need three or four full size lateral files to hold them all. Depending on how nice the files are they will cost about $4,000 and could be a lot more. They will take up office space costing another $550 per year. Plus all the “inactive” charts stashed away somewhere else?

So far our inexpensive paper files are costing us $15,800, but that’s not the total cost. There is the human effort to make the chart, type the label, arrange the contents, file new bits when they arrive in the mail, write the notes, pull the charts every day and then re-file them. And of course there is the daily ritual of the lost chart, which no one can find only to have it turn up days later either misfiled or hiding in a stack on the doctor’s desk. The human cost is at least $11,520 per year.

What we have is a paper chart system that is really quite expensive costing $15,800 to create and $11,520 per year to maintain for a total of $27,320.

Help with Going Paperless

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Specific vs Diffuse: Part 2


Two weeks ago David Baker, CEO of Think.Shift, wrote a provocative article challenging axioms – statements we believe to be self-evident truths. In this article I want to use him as an example of how to intentionally use both specific and diffuse forms of communication effectively.

In a previous article I noted that some people are specific in their communication with intent to bring forth clarity of thought and others are more diffuse in their communication with intent to bring forth commonality of thought.

Both styles have value, and the value is enhanced if you’re intentional about your natural style and the style appropriate for your audience. While my natural style is specific, David Baker is able to use either style based on what is appropriate for the audience. Let me provide two examples of David’s writing to illustrate this point and speak to the value of being intentional in your communication.

In the last Food for Thought article Caution: Falling Axioms, David wanted to respect the provocative nature of these articles.

To be provocative and controversial, you need to be specific in establishing your point of view and contrasting it with alternative points of view.

In analyzing the axiom, “If you are going to bring me a problem, make sure you bring with it a solution,” David points out that the traditional view contrasts an employee who is building with an employee who is throwing rocks. Having been specific in that contrast, he switches to the other side and provides concrete and convincing arguments as to why you should promote and encourage employees raising issues for which they have no solution. His style of specific communication is very effective.

A couple decades ago, I learned an interesting lesson. Trained as an engineer, with a background in math and a passion for logic, I have always been specific in my communication. But, while listening to my VP of marketing tell our sales force about a new series of products we were introducing, I learned that diffuse communication might achieve your results better than being specific. He drew an X-Y axes, labeled the horizontal axis with old products and new products, talked about how the old products had floundered, spoke about the amazing value of the new products and drew a sweeping graph that zig-zagged from the bottom left to the top right, proclaiming that our new products are going to take our business to new heights.

Questions came to my mind: What was the X-axis? Products? How were they arranged? By introduction date? What was the Y-axis? Units? Dollars? Was this a cumulative graph? If so, how did the graph go down with the current products? I was trying to figure it all out. Meanwhile, our sales force had heard the rallying cry. They were pumped. They cheered! Had my marketing VP not accomplished his goal? How does it matter if the graph didn’t make any sense? Being diffuse might have been the best way to communicate to that audience at that moment!

Let’s come back to David Baker. In his monthly blog, David wrote an interesting post titled “What is Normal?” He pointed out that, while most people try to fit in and be normal, it is the outliers that get noticed. To make his point he drew this picture.

by Think.Shift

by Think.Shift

Of course, I had a plethora of questions: What does the line mean? What is represented by a circle on the left side versus the right side? How about circles above and below? Are circles above and to the right better because that is the way we think? And what do the size of the circles mean? Are bigger circles better? Yet, in spite of all my questions, I understood what he was saying in the article. The picture communicated it. Was he being diffuse? Absolutely! Was he effective in his communication? Superbly! In a blog, where the intent typically is to connect with people rather than provoke them, diffuse communication allows for each reader to interpret as they choose and find common ground.

It’s important to understand both specific and diffuse communication.

Each has its value. Each is more effective in different circumstances. Each of us has a preference in our own individual style. Yet, it behooves us to be intentional about using the right style for the right situation.

On this topic, my good friend and colleague, Glenn Mangurian, pointed out that the appropriate style not only depends on the circumstance, but the speaker-listener chemistry. Glenn and I developed the following model for what might happen based on whether the speaker and the listener are specific or diffuse:

  • When the speaker and listener are both specific, they are likely to assert and evaluate. On the positive side, they might find clear agreement or find disagreement and extend their thought process. But the same conversation could turn into a debate, with each of them arguing and trying to prove that he or she is right.
  • When the speaker is specific and the listener is diffuse, they are likely to assert and consider. The listener respects the speaker’s point of view and learns. But the speaker could also be viewed as being arrogant and opinionated, with the listener agreeing in pretense.
  • When the speaker is diffuse and the listener is specific, they are likely to explore but evaluate. The listener is likely to ask for clarification and agree or offer a different point of view. Alternatively, the conversation could turn into an argument where the listener browbeats the speaker for specificity that the speaker either does not have or is not willing to offer.
  • When the speaker and the listener are both diffuse, the conversation is likely to explore and agree. Both the speaker and listener could become innovative and the conversation could become generative. Or the conversation could meander without reaching conclusion, with both the speaker and the listener agreeing without understanding.
by Think.Shift

by Think.Shift

In each case, conversation can take on a positive tone and create value or a negative tone and destroy value.

It is useful to acknowledge the natural tendency the speaker and listener and intentionally drive the conversation toward the positive, value-creating outcomes.

I want to end this article by recognizing David’s ability to switch modes when appropriate and thank him for letting me use his example to illustrate the value of being intentionally specific or diffuse. I encourage my readers to read David’s monthly blog.

We will be elaborating on these concepts in a webinar on
Wednesday, May 27th from 10:30 am – 11:30 am (PDT).

Two special guests will be at the webinar, David Baker and Glenn Mangurian, who will chime in with their thoughts on specific versus diffuse. We encourage you to sign up and attend; please visit the event registration page here for more details.

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How Little Do Users Read? 20% – Tips for an effective dental homepage



Summary: On the average Web page, users have time to read at most 28% of the words during an average visit; 20% is more likely.We’ve known since our first studies of how users read on the Web that they typically don’t read very much. Scanning text is an extremely common behavior for higher-literacy users…

I often see dental web pages that are loaded with text. Home pages will have four or five paragraphs extolling the philosophy of the office, endless treatment options and the educational accomplishments of the dentist and staff. I know that when I am faced with a sea of text I rarely read much. It seems I am not alone most people only read about 20% of the text on a web page.

The most important element a web page needs is to answer the question. Every user has landed on the page for a reason; they have a question that needs answering. The primary question is; where is the office and what is the phone number? This needs to be big, easy to see and above the fold on the home page.

Next avoid text and use images and graphics to tell the story and direct the user’s attention to items you want them to see. Do not write a sentence about treating children show an image of a happy child with nice teeth. Do not tell people you do cosmetics with a paragraph of text but show the photo of a happy patient with a gorgeous smile and a short testimonial beneath.

Make the next step easy and obvious.

New Patients Here

Pay Your Bill Here

About the Dentist

Your home page real estate is valuable use it well.

Some potential new patients will actually want to read all about the office treatment philosophy, the details of implant placement or the numerous post doc coursed the dentist has taken. Not many but some. For those people direct them to these pages but do not fill the home page with text.

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Caution: Falling Axioms

axiomWith a background in advertising, I am keenly aware of the influence that engaging and colorful words can have on the acceptance of an idea. However, I had not connected this with the business axioms that are so often embraced without challenge.

Axioms are “statements or propositions regarded as being established, accepted or self-evidently true.”

I wondered about the cultural consequences of not challenging these underlying beliefs when I read an example in “The Hard Thing About Hard Things” by Ben Horowitz. It caught my attention, perhaps because I have often shared the adage:

“If you are going to bring me a problem, make sure you bring with it a solution.”

On the surface, this phrase makes good sense because behind the expression are two juxtaposed attitudes: one of a “passenger” type employee who has nonchalantly identified a problem but is not adequately engaged enough to offer a solution, and one who also perceived the challenge but is committed enough to wrestle with the issue until a solution is found for it. One is building and the other is throwing rocks. Which person would you rather work with?

With the above judgment in mind, step back and examine the axiom and the issues that might arise from with this thinking. The first is based on a belief that lives in many organizations: “If you point out a problem, you have a moral obligation to fix it.” If this holds true in your organization, then speaking up when you see a problem can be a great way to ensure yourself of getting more work! (And remember that your best people are probably your busiest.) Second, today’s business landscape is changing so rapidly that there are many new and undefined challenges out there. If the above obligation exists, pointing out a problem without a solution is tantamount to admitting, “I don’t know how to keep up with the changes, perhaps I am obsolete.” And third, what if I see a problem that has absolutely nothing to do with my department? If I say something, might I be creating adversaries with people I might need help from later?

In all three scenarios, the people closest to the work and, perhaps more importantly, those who see the problems best are incented to stay quiet. Then, of course, the problems go unchecked and are repeated.

In all organizations, there are beliefs and mandates that everybody knows but are not actually written.

While the notion of “bring a solution with every problem” may still be the right approach, we should explore the potential consequences of holding that belief. In this case, a danger of people thinking, “it’s better to stay quiet.” And, left unchecked, these beliefs can grow into signposts for all to see and follow.

For example, one organization we work with had an unwritten protocol that all staff knew about, accepted as valid and even promoted. It even had a name and an action to go along with it, which was meant to signify the sentiment “cover your butt” – it was like a fraternity. Quite without intention, a cultural signpost had been created, suggesting the narrative that any type of mistake will be met with fear and retribution. It was nursed over time and made easy to pass from one employee to another. And even though it was not true, new employees were quickly indoctrinated to the understanding and carried on the tradition. And so it is with culture – if we do not define it, others will. Leadership has an obligation to be “wary of what we believe and intentional of what we promote.” (Unless, of course, that’s just an axiom.)

In an attempt to define cultural “signposts,” Dan Gilbert of Quicken Loans has developed what he calls Quicken Loan ISM’s. It is a trait that can be attributed to a person or organization as reflective of personality – such as kids calling Dad’s bad jokes a “DADism.” He does this to be clear about what is required to join and stay at Quicken Loans and he is dramatic in its elevation.

Another commonly shared saying is “Culture Eats Strategy for Breakfast.”

Is this true? Are culture and strategy even separate? Perhaps. However, I would posit that the issue is not “culture eating strategy;” rather, it is the absence of the integration of the two. Many organizations have not been intentional in identifying the underlying causes, good or bad, of their culture. And whether you use ISM’s, share axioms or put up posters with motivating core values, stories will develop in the minds of your staff. Those stories will develop not based on the axiom or the poster, but on the sustained actions of the leadership. The opportunity is to ensure culture is not separate but rather PART of your strategy, and that leadership believe in and curate the culture so much so that the posters, axioms and ISM’s demonstrate the organizational narrative as authentic. When that happens, culture doesn’t eat strategy for breakfast, it sets the table for it!


Food for Thought is our way of sharing interesting concepts on corporate leadership and management with others who might find it useful. The thoughts offered are intended to be controversial and thought-provoking. They are intended to help our readers intentionally realize their potential, what we call Potentionality.

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How to kick start a new system at your office


Only One is Good

There are three possible outcomes when adding technology to the office only one of which is good.

One: The office buys a new high tech system then throws team members at it with little or no training and no plan for implementation. This all too common approach almost always results in frustrated staff and wasted money.

Two: The dental office spends the money to buy a technology system then spends additional time and money training a staff person to use it. The staff person clings to the old way of doing things, fails to implement the system and blames the technology for the failure. She is the wrong person for the job and either quits or even worse stays in place like a roadblock preventing things from progressing. The result again is frustrated staff and wasted money.

Three: The dental office buys the system, sets up multiple training sessions, develops protocols to use it effectively and engages team members to use the system, learn and get better. The result is faster better service, decreased costs and happy staff.

The determining factor in our three outcomes is not the technology – the stuff. It is the people using it – the staff. How they are trained, how the office explains the benefits of the technology and helps the team learn makes the difference.

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