Upstream thinking, Problems Solved In your dental practice


Creating an efficient dental practice with an excellent team all rowing in the same direction, takes more than bootstrapping and working harder. It takes big-picture thinking and an honest appraisal of what is getting in the way. 


In my years of working with dentists and teams, I have noticed that leaders tend to address what is directly in front of them. They are simply too busy to notice that the issues of today will likely be back tomorrow, and the next day and so on if they don’t find the root cause and build systems from there. My favorite book on this subject ‘Upstream’ by Dan Heath is a fantastic read when it comes to shifting from reactive to proactive decision making. His goal with this book is to help us stop reacting to problems and instead look for ways to prevent them in the first place.  


If you feel like you have become more of a firefighter than a clinician it may be time to shift your thinking and go Upstream. 


In the book, Dan recalls a quote from Paul Batalden “Every system is perfectly designed to get the results it gets.” I love this quote; it is as exact as it is simple and begs the follow up question… are your systems working to get you the results you actually want?


Think of a few frustrations you have experienced in your practice lately and look at the related systems – real or intended.  If the systems are not getting you the results you intend, meet with your team to locate where the weaknesses are showing up. As you start to pull back the layers on your processes, begin to draw attention to the barriers that can get in the way of going upstream.


These barriers include:


Problem Blindness: (I don’t see the problem)

This is the belief that negative outcomes are natural and inevitable. We treat these problems like we treat the weather, – it is something out of our control.  We normalized problems and even quit seeing them at all.  I see this in practices all the time, teams will tell me, “that’s just the way it is here” when I ask about a specific issue I’ve noticed. They have become accustomed to the problem entirely and have either given up or see no way to fix it. This finite thinking is one of the first challenges I usually uncover when going upstream with teams.


Lack of Ownership: (The problem is not mine to fix)

If an issue arises and no one claims ownership of fixing it, the problem will persist. In order to really develop upstream thinking you need someone who will say, “even if I wasn’t the one to create this problem, I will lead us to finding a solution.”  It is necessary for you and your team to be open to trying a new approach to solving problems that you see. To create a culture where teams have ownership over decisions, leaders have to trust the team to make decisions on behalf of the group. On the flip-side, the team must choose to take charge of issues as they see them.  Upstream work is optional work; if someone does not choose the option to tackle an underlying problem, you will keep getting the same results. This layers on top of problem blindness and is generally the second competent I address with teams in coaching. 


Tunneling: (I can’t deal with that right now)

Tunneling is exactly like it sounds. You focus on short-sighted problems and have reactive thinking. You get stuck in a routine of short-term decision making and are unable to move forward. The more problems you are juggling at once, the harder it is to solve them all.  If you can’t solve problems systematically you will stay in an endless cycle of reaction, because tunneling begets more tunneling.  Compound tunneling with stress and scarcity, and you get stuck.


These barriers to solving problems get in the way often, some even at the same time. Being aware of them is step one.  Even if you think your systems are working, I challenge you to take time at your next team meeting to sit down as a group and evaluate them. Ask yourself the question; Are you getting the results you want? You may find there are simple ways to make them even more successful. Add a target or metric to your systems and see if you can improve your outcomes as a team. If you want support in this journey, know I am just a phone call or email away. 

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