DSO perspectives: Part 1―maintaining clinical autonomy and culture in a group practice setting

Pursue alignment from the top down and bottom up

Once the vision is clear, the next step is making sure that the entire team—front desk staff, assistants, hygienists and laboratory technicians—understands and embodies it. Clinical autonomy can only extend as far as the team is willing and able to support.

Autonomy does not mean going it alone. It means leading by example, practising what you preach and building a practice culture where everyone understands the why behind decisions and believes in it enough to support it.

Protect the culture you build: The laboratory technician lesson

Creating the right culture by hiring the right people is only half the battle. Protecting that culture is where real leadership lies. It is easy to live by your values when everything is going well. The challenge is staying the course when tough decisions test patience, business models and boundaries. Let me give an example of leadership in action.

A few months ago, I made the decision to bring on a second laboratory technician. It was a stretch for the business financially, but I have always believed that, if you lead with integrity, treat people fairly and work hard, the money will follow. I paid both technicians above the market average—not only because I value their skills and experience, but because I respect the cost of raising a family in today’s economy.

The financials, however, did not add up the way I had hoped. After several months, I had to have some difficult conversations with leadership. A clear, data-driven plan was needed—or the possibility of letting someone go would become real, an outcome I was trying to avoid.

I sat both technicians down. I was transparent: for this to work, we needed to be aligned on day-to-day deliverables, goals and new processes. Not only did I need productivity, but I also needed them both to be fully committed. After this conversation, it became clear that one technician understood the assignment and was willing to rise to the challenge, while the other did not and was not.

There was a shift in the office that no leader ever wants to feel—friction, disengagement and resentment. The final straw came on a day when we saw 12 patients. That meant:

• preparing and cleaning the treatment room 12 times;
• reviewing 12 health histories;
• taking 12 sets of radiographs;
• holding 12 consultations;
• verifying 12 insurance plans;
• processing 12 financial applications; and
• providing 12 patients with time, attention and care.

Despite this, I could tell that there was still tension building and one of the technicians was not onboard regarding the practice vision and purpose. As a leader, I had to make a decision that was in the best interest of the business and other members of my team, who were consistently showing up, completing the work and prioritising quality patient care.

I approached the conversation with empathy and conviction. My office manager and I sat down with the dental technician and had an honest, direct conversation. We did not soften the message or avoid the uncomfortable parts. We talked openly about the numbers, workflow issues and impact on the rest of the team. It became clear that something had to change. Together, expectations, gaps and necessary support were identified. It was not easy, but it was necessary.

Structure sets you free: Plan for profit, patients and parenthood

To have autonomy, infrastructure must exist to support it. For me, that means honouring what matters most:

• delivering the best possible care to my patients;
• keeping the practice profitable and productive; and
• being present for my family.

I am a room mom. I am at class parties. I volunteer for field day, and I make it home in time to cook dinner. That is not accidental. It is the result of structure, mutual respect and proactive scheduling.

Each year, my associate and I sit down to pre-plan time off. We alternate holidays like Christmas and Thanksgiving, and we coordinate our schedules to avoid disruption. Yes, I own the practice, but I deeply respect that he has a family too. This mutual respect makes our collaboration work. Also, by staying ahead of the calendar, we reduce the need to reschedule patients, a key factor in maintaining patient trust and operational flow.

Autonomy does not mean doing whatever, whenever. It means taking ownership of outcomes. The way I do this is by channelling energy into production by:

• prioritising high-impact procedures;
• planning more new patient days before time out of the office;
• coordinating with specialists to keep production on track during absences; and
• scheduling to serve the practice goals, not just to fill time slots.

I find this to be the perfect balance of working harder and smarter. I plan for success that allows everyone—my team, patients and business—to benefit.

Embrace a clear vision, consistency and courage

Clinical autonomy within a DSO is not only possible; it is powerful. Growth requires clarity. Culture requires consistency. Leadership requires courage. The business side of the dental office does not thrive by chance but by design. That design starts with a clear vision, a strong team and consistent support from the leadership that stands behind it.