Episode 571: Breaking Down the Benefits of DSOs

dso Sep 01, 2022

Brit is fresh off visiting a ton of practices, many of which are part of dental support organizations (DSOs), and she’s sharing her insight. With Kiera, she talks about the foundational pieces to set up DSOs for success — everything from training the leadership team, setting up KPIs, providing profit and loss statement education, and allowing culture and patient experience to grow in each practice while keeping an overall brand.

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0:00:05.6 Kiera Dent: Hey everyone. Welcome to The Dental A Team Podcast, I'm your host, Kiera Dent, and I have this crazy idea that maybe I could combine a doctor and a team member's perspective because, let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, teller, office manager, regional manager, practice owner, and I have a team of travelling consultants, where we have travelled over 165 different offices, coaching teams. Yep, we don't just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress, and create A teams. Welcome to The Dental A Team Podcast.

0:00:51.8 KD: Hello, Dental A Team listeners. This is Kiera, and I've got the one and only Brittany Stone back on the pod. Guys, she has been a freaking road warrior, travelling to seven offices in one day. Dang, Brit, welcome back. How you doing? How you feeling? How are you today?

0:01:07.3 Brittany Stone: I'm good, You made me sound better than I was in one day, seven in a week, so long, but seven in a week.

0:01:13.7 KD: Yeah, that's exactly what I meant. We could edit that or you guys can just know. In my mind, I think it felt like you were seven in a day. You were cruising to practices. Seven in a week is so many offices, but guys don't worry, Brit wasn't leaving them high and dry, hanging out. You were seeing... Walk us through, I know you went to quite a few DSOs that had multi-practices, multi-locations. What was that like, and how does that even look when you're going to multiple practices like that?

0:01:42.1 BS: Yeah, it's fun, so that was... It was a week of my multi-practice location, so one had three offices, one had four offices, the two groups that I worked with last week, and so it's fun. It's fun to see, one, you get to know like the visionaries who started a thing, whether it's just owner or multiple partners that are involved in it, yeah, just to see their vision. And it's fun to see the different also types of practices that are underneath their umbrellas and how they run, 'cause usually we've got some different sizes, obviously different locations. So yeah, I got to go in, meet everybody, go see all the different practices, see what's going on with them, what things we can help with on an individual practice level and then also as an organisation, so it was a good time.

0:02:29.6 KD: That's a lot. And I do think it is fun when you go see multiple practices, because this whole idea of DSO is that we want all of our practices to run exactly the same, and I know when I was a regional manager of 10 practices, the bottom line is there is no such thing as running every practice the same, I think it's more like getting rid of that illusion that they're all gonna be the same, and it's more, what are the foundational pieces and the silver-lining strings that we want running amongst them all? Brit, I know you had one practice that wanted to do their own thing within a group...


0:03:03.1 KD: How do you, one, paint the vision of all the practices needing to be at least fundamentally pretty consistent and similar, and then also helping the doctors and the team members understand like, 'I get it, it might be annoying for you, but for the greater good of all the practices, it really does make everything easier when we run the same?' Because I know a lot of practices just wanna run a solo practice, but when you're in a group and multi-offices, that no longer serves the greater organisation. What was your findings with that? How are you finding to get people on board? Is that something you were running into? Just give us your thoughts around that.

0:03:38.5 BS: Yeah, I think every DSO probably struggles, or group practice struggles with, 'Alright, how much do we have the same and where can we let them be their own and shine in their own way?' And also from the business side of things, for the DSO, what things are more financially beneficial for us to be able to do them in the same and have them on the same system, so that we run it across all offices to get the true benefit of the DSO? And so that's where you start to figure out, 'Alright, there's gonna be a lot of systems that, one, yes, anything that impacts other offices or the group overall, we've gotta make the best decision for the group on how we want that to run, whether it's easy things, like payroll is a pretty common one, that's gotta be obviously the same across all offices, if we're using the same software, the way we run our schedule, who's allowed to be in our schedule. All of those things need guidelines that go across the board, so we all know a little bit of the rules of engagement on things like the schedule.'

0:04:42.2 BS: So I start to think of it as, 'Alright, what are the most important things that impact each other that we need to have the same that's also gonna allow us to be most financially beneficial for the DSO? And then what things don't necessarily impact the other offices, where those offices can start to really like, 'Alright, what are procedures you do great? Go run with it, build it up, and even if we can get some referrals from other offices for that thing, fantastic', and they do their own a little bit.

0:05:10.3 KD: For sure, but I was just thinking like it actually might be fun on this podcast for us to dive into, when you're in a DSO, 'cause Brit I know your private practice sold to a DSO, I work with lots of DSOs, you work with lots of DSOs, and I think DSOs are a pretty hot buzzword right now in dentistry. What are some of those things that you should have standardised? I love that you brought up the payroll, for sure. For me, some of the things that I know I'm looking at is... I really am just looking at key metrics amongst all practices, and I know, Brit, with a lot of the DSOs that you and I are consulting together, that is one of the biggest things, of making sure all of them are hitting the metrics, and then whatever they wanna do outside of those metrics, it's pretty much free rein from there. So we're talking labs, supplies, overhead, production per hour per provider, hygiene production. Those are like my main things. Case acceptance is another one I really like to watch. Number of new patients per practice is another key indicator that I really love watching. But those are the main things.

0:06:13.6 KD: And then I really feel like in DSOs and multi-practices, some of the biggest things that get lost are culture and patient experience, and those are to be different shades for every practice. And I really like practices to think in like, 'No, you want the patient to feel the exact same way whether they come to this location or whether they're going to another location.' It is that way. And having practices and offices think... I've got one right now, and they just acquired another practice and they're really doing a divide between the offices and they're labelling each office based on the city, and I was like, 'Whoa, whoa, whoa, let's call them all the practice name, so we are all... Let's just say Healthy Smiles. It's not Healthy Smiles of Provo and Healthy Smiles of Orem. It is Healthy Smiles, and then we have our Orem location and our Provo location.'

0:07:01.4 KD: Those are just a quick way because I think when you can have it as an umbrella of, 'All the practices operate as this way, and then here's these different locations', but helping everyone realise, 'There is the Healthy Smiles way and we operate on healthy smiles first, secondary is going to be our location.' Are those some of the things you've seen? Like those are the key indicators that I like to look at. And then secondly, making sure that people realize like the culture and the patient experience really need to be dialled in, in my opinion, to really help these DSOs grow and flourish.

0:07:32.5 BS: I'm with you on KPIs, teaching office managers how to be able to take charge of those, know what's going on in their practice, and that we're all watching those important numbers to be healthy. For sure, that's an across-the-board thing. And then I'm with you on 'capitalise off the brand.' From a lot of the DSOs we work with, where it's a few different locations, usually I feel like a lot of them are gonna be like five or less, where you can truly make sure that we are maintaining our standard, maintaining our brand, and then capitalise off of that brand for all practices to where there might be a patient who's looking to go to that office that maybe it's a little bit farther, 'Oh, great, they've got a location that's closer to me. Awesome, let me just go ahead and go to that closer location.' And I agree, you gotta keep then the culture and the patient experience up to be number one. And what does that look like? What does it stand for?

0:08:29.9 BS: And there are, I will say, different pieces that go into that when it comes to maintaining that culture in our practices and that experience, and I think those would be some non-negotiables you start to build in. If it's, we're on time with our appointments as much as possible, so that's something we really drive with our teams. We're always friendly with our patients, we're always welcoming. How do we present on the phone? You can start to dig into some of those things that you really want to represent as a practice and make sure it's ingrained in our team members and how we present.

0:09:03.3 KD: Yeah, and I think that you said it's that culture in that brand, and honestly, I think people forget that that's actually why you became successful. Like that culture, that brand you started developing, that's how you're able to multiple-scale across other practices. And I feel like offices that see all the practices as one company, and then the different locations are just extensions of that company, are the ones that really flourish. In that same thing, I feel like, Brit, something you and I have really been trying to hone in on with offices is to make sure that they have a key leadership team so people are really in sync to make decisions, and that's for your operations, for your labs, for your supplies, and then making sure that things can actually execute forward, because I feel like when we get a lot of partners involved, what happens is everybody has a strong opinion, but those opinions actually are great unless they stop all of the forward progress. And I think there really just have to be key decision players that everybody elects. It's almost like a board, I feel like all the practices are almost like a neighbourhood, and you need an HOA, somebody who can actually just make the decisions and execute in the best interest.

0:10:15.6 KD: And maybe you've got a few of them, so you've got, say, your regional manager who's overseeing all of the practices, the overhead, the operations, really. You've possibly got a clinical manager on there who's really looking at the hygiene, the dental assistants, then you've got probably a dentist on the board who's making decisions as far as, 'What are the clinical diagnoses, what are the supplies that all dentists need across the board?' And then you're probably gonna have somebody who's your finance person, so someone really looking at the financials of the practice.

0:10:43.5 KD: And if you can have one of those key players, I feel like just get that honed in, then you can have all the practices have their own little leadership teams and whatnot, but really you've got those four players who can make very strong decisions, and maybe the dentist is the same person as the clinical lead. Maybe we don't need an extra person there, maybe not, but I think if you can really get that dialled in, you're gonna be able to make a lot stronger decisions and be able to move things forward more. Brit, what are you seeing? You were literally just in DSOs. Are you finding that that type of structure helps move things along or are you finding like, 'No, we need to have key leaders in other areas?' What's your take on how to make sure decisions can be made? 'Cause I truly feel like once you get the KPIs dialled in and everyone's reporting in, once you get your office managers looking at their practices, making sure they're profitable and reporting in, then you've got your culture and your brand, it's really about getting decisions made quickly and moving things along rather than getting stagnated with so many opinions.

0:11:43.7 BS: And I am big on... Agreed. You've gotta figure out, who are your key players? What leadership team do you need in place? I am in big support of having someone who's a strong regional manager in place to help make a lot of those smaller decisions for offices the offices need support on and empowering office managers to make decisions within the balance that you give them, I think the more you expose your office managers and teach them some of the business side to where they really know what those KPIs are, they really know what they're watching, they know how to influence it, you'll become more confident in their decision-making as they see things at a higher level, a bigger picture.

0:12:21.8 BS: But when they can have that information, know how to see it from a little bit higher level, start giving them the opportunity to make decisions within their practice, so, one, they can see the fun and feel empowered to where they really can run that team and own that office, and they don't feel like they're just sitting, waiting for people to tell them what to do, and then that they've got a really strong regional behind them who also has the ability to make decisions within the parameters that if its partners or owner gives them, to keep moving things forward. And same thing, it's a super empowering thing to where they can get more creative and think of opportunities for the practices than just feeling like they need to wait because they can't make a decision or do anything because someone's not gonna approve of it.

0:13:11.1 KD: How many of you would just love to DIY and get the secrets of people who have been there, done that on your own time? Because I know for me, I love to learn from the best of the best, the people who have been there, done that and can give me the shortcuts. That's why we have created our Dental A Team Virtual Academy, where it's on-demand courses for you at your fingertips, where you literally can learn the secrets from all of my experience, all of Tiffany's experience, Brittany, Dana, our entire team's experience at your fingertips, so stop taking the hard route, guys. There's a shortcut sitting there waiting for you, and it's also CE. Head on over to thedentalateam.com and click on our virtual academy. Be sure to use coupon code 'podcast', and get started on that DIY and become the practice of your dreams.

0:14:00.1 KD: And I really love that you talked about having that regional manager understand the business, I feel like in DSOs, you have to have somebody who understands the business and can think like a business owner, that way they can make decisions, but what were some of the things that... As you were basically their regional manager, you were in that DSO role, what were some of the things you felt helped? Because I think sometimes business owners forget everything they've learned, so having somebody come through, it's almost like we've forgotten what Business 101 is, of what things we really need to teach them. What have you found that was maybe helpful for you for your owners to teach you so you could be more successful in your role within that DSO?

0:14:39.9 BS: Sure, I think one of the first things is helping the office managers and regional managers understand what a P&L is, and it doesn't even have to be like the terms of, 'This is a P&L', but understanding, I like to relate it to it's just like at home, if we have a budget. Right? And what money do we have coming in? What things are we spending money in? And at the end, what do we have left over? Just helping them understand, not overall equation of how the business runs and, what are the different pieces within that? That they could impact, which is ultimately how many patients we have, how much the treatment plan is truly our ultimate potential as an office. And then what we close, what we schedule, what we collect on, and then controlling our expenses. So then we can have a greater profit leftover at the end.

0:15:29.5 BS: So helping them understand that big picture and then helping them to understand within each of those little sections, which are then KPIs, what are the more like tangible things that we can track that impact, that bigger equation to the business? And agreed, I think we don't realise how much we've learned along the way, or people have taught us along the way, even myself, running through sometimes these KPIs when you haven't seen them before, and you don't understand, one, maybe where they come from or, two, why would we even track it? And three, what could I even do to change that number? Like those are things you have to learn over time, and someone's gotta actually take the time to invest in teaching you.

0:16:11.7 KD: Which I don't think people realise that P&L... When I first looked at a P&L, I'm like, 'This looks like a straight up foreign language, I don't even know what 90% of this means.' And so just imagine, if you will... If you've been running a business, you've been looking at P&Ls, pretend you were just plunked into... For me, I do not speak Chinese, so being stuck in a class, speaking Chinese, and then handing me a report and saying, 'Kiera, you need to be able to read this and figure it out and tell me what I should do with my business.' I would literally look at that and wanna cry and then I'd probably take a picture with my phone and I start Googling and I'd hope and pray I could find some type of Google Translate to figure it out. That I feel is a good way for you to really understand what it feels like to be those team members when they first start looking at P&Ls.

0:17:00.4 KD: So I think one of the best ways is to just practice, and what I've done is like Brit said, is really just sit with your regional, also you can do this with your office managers, especially in DSOs, because the more your office managers understand the P&L and what it should look like, that can help, so it's really, just dial into that, tell them what a healthy payroll... Like payroll should be sitting at less than 30% of our total collections every month, our lab should be at less than 9% of our total collections every month, supplies 5%, and just go down the list with them so they can see, 'Is this good or is this bad?'

0:17:33.4 KD: I love HDA accounting, I think they do a great job. Profy is another one. Eide Bailly is another one. Those are just some accounting companies, I like when they send the P&L 'cause it's red and green, like HDA is like you get a thumbs up or you get a thumbs down, makes it a little bit easier. But then asking your regional or your managers to say, 'Hey, when you look at this P&L, what do see this going? Really, really well? And what do you see are some of the areas that might be trouble areas, and why?' Because I feel like when you can start to almost quiz them and role play with them and have more of a collaboration with them, they start reading that P&L and figuring it out rather than you always telling them, but like Brit said, you've got to take the time and invest with them, that way they can look at a P&L.

0:18:15.8 KD: I know Shelby has been doing our P&Ls, she sends it to me every week. And finally I said, 'Shelbs, what do you see on this?' And that was the first time she had really looked at it, I just had an assignment for her, to send them to me every week, which she does great, but then I started asking her to look at them and then we start diving into it and looking at different numbers. And it's crazy how when you just spend a little bit of time, people can really start to find things that you as the owner might even be missing, and then they can take the accountability and the ownership of it, but just realise like it is a completely foreign language for these poor people, let's not forget to train them and educate them so they can be set up for success.

0:18:50.7 BS: For sure. And I think also when it comes down to it, when you start looking at some of these numbers and you haven't looked at it before, so even office managers, when they look at it and they haven't seen it, or regionals, they're gonna start to understand, and it's fun in a way to see their eyes open to like, 'Oh, I understand why, I really want to be able to hire an additional team member but here's where we are, so it makes sense now, why now is the time to hire and we need to work on some other things so we can afford to hire another team member.'

0:19:23.3 KD: Exactly. And then you're no longer, as the business owner, the bad guy or the good guy when your regional says, 'Hey, I wanna hire.' You say, 'Prime, can we afford this? What does the P&L say?' And they then are the ones who are answering the question rather than you giving the green light or giving the thumbs down, and then they are more again a partner with you. Brit, as a regional, and I'll give my insights of how it felt for me, how does that make you feel when you can, as a regional, start making those business decisions and truly be a trusted side partner, where you're really, really informed in the business? How does that make you as the regional manager, you as the manager of the practice? What do you feel like when you feel that competent reading P&Ls and understanding the business?

0:20:05.9 BS: I loved it, I loved it. One of the biggest reasons is because I'm in a practice... Especially as OM, I'm in a practice every day and can see what I have and what I need and what's actually going on as close to the ground as possible, so when it's something like this, we're driving numbers in a certain direction, I'm like, 'Alright, I can see multiple things in the puzzle that I can start to manipulate or impact to be able to drive those numbers, drive the results.' Or if it's like, 'Hey, we wanna get new technology, what do we need to do to get there? Great, we want another iTero, here's a plan of how we can afford to get that new piece of equipment.'

0:20:44.9 KD: Exactly. And it feels so good. For me, it just felt like the... I like to win, and I felt like it was finally my roadmap to being able to be successful and hit the goals that my doctor had, but literally have the optics, if you will, for success. And so I think it's super paramount of teaching your team members and empowering them. Like even as team members, I know Tiff, Brit, Shelby, our whole team, they'll look at me like, 'Kiera, can we actually afford that?' That is one of the happiest days of all of my business time because I'm like, 'They're actually looking to see, "Can we afford that? Can we do this? Does this make sense for the business?"' And it's not me just carrying the weight anymore. So I feel like it's really important for offices, especially DSOs, I would say if we were to recap this...

0:21:32.6 KD: And Brit, it's fun that you just came in off of DSO, so I thought like, 'Hey, let's dive into DSO success of, one, like set up your KPIs, make sure you've got all practices reporting in and they understand and truly spend the time to teach your office managers at each practice what those KPIs need to look like, how to get the information and then have a set cadence where they're really reporting in with you. The next thing is, build up that leadership team within the DSO of the strong people that can actually make the decisions, and they have the autonomy and the authority to execute, and then third, train the team members to really look at these P&Ls so they understand.'

0:22:08.5 KD: Before all that, we did talk about like having the standardisation of culture, the name, making sure those things run the same, and I feel like within DSOs, you are way, way, way more needed to be structured and to overcommunicate than you are in solo or even secondary practices, like the type of communication, the amount of communication, the amount of, I would say 'rules' with massive air quotes. People just need to know the guidelines of what we can or can't do, and they've gotta be black and white, that's like my recap of everything we talked about Brit, of DSO success, but is there anything I may have missed or things you wanna just highlight on your own that you feel really makes or breaks a DSO from your perspective?

0:22:47.2 BS: I think those are all key pieces that ultimately build to... There's no one or three people at the top, depending on how big you get, that can be responsible for making all decisions, so a lot of it is making sure you've got that fly wall of culture gonna where you don't have to put so much effort into controlling it, and then you've got key people in support, so that the people at the top or the OGs, the originals who started it, that you build in support for yourself and you're not having to make all of those decisions for everybody.

0:23:22.1 KD: I think that that's actually one of the key pieces that I hadn't even realised, is this allows more freedom of those visionaries to go and make decisions, but have a team that can also make decisions and think like that visionary more so. And to be honest, a lot of people get excited about going and buying the practices that they forget, you need to have that foundation, those guidelines, those ways for people to make decisions without the OGs being there to answer everything, and if you don't have that in play, get that in play, hire a coach. That's what we do, we literary help offices get these things set up, things they might not have thought about, be that mediator who can really remind, show, guide people to get things done but make sure you have that in play as you're building or I would truly suggest, before you do it, however, I know all visionaries just go and they buy the practice and then figure it out. So it's cool, we know you, we see you, but really getting that ability for people to have autonomy and so that way the owners don't have to always be making every decision I think, one, just empowers our own, and two, it's an easier-flowing process for sure.

0:24:27.7 BS: Absolutely.

0:24:29.8 KD: So guys, there you go, there's a road warrior break coming back in off of the DSO week, and we love our DSO practices, but really, it just had to be fun for us to highlight today of what are some of the key success for DSOs. And Brit, I know you came from a very successful DSO before joining the Dental A Team, and so I feel like you just have such a knack for it, and officers who work with you, shoot, you got some of the most raving reviews from the offices you were with... I got personal text messages from those doctors thanking you for being there and how much you're able to clarify, so Brit kudos to you, it's fun to have you share on DSO secrets and success.

0:25:05.4 BS: Thanks, I do love my DSOs.


0:25:08.5 KD: They're just fun. Brit and I get going like, we love our new practices, but man, those DSOs, they're like puzzles for us to have to try and figure out put together, Brit and I will collaborate on these all the time, and it's so fun for those DSOs.


0:25:24.1 KD: So guys, if you, if you're a DSO needing help, be sure to reach out [email protected] And as always, thank you for listening and we'll catch you next time on The Dental A Team Podcast.

0:25:36.9 KD: And that wraps it up for another episode of The Dental A Team Podcast. Thank you so much for listening, and we'll talk to you next time.



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