Dental A Team Podcast
#1,191: Breaking Down the Benefits of DSOs
Re-releasing a Dental A-Team podcast fan favorite! Britt 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. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: Kiera Dent (00:00) Hello, Dental A Team listeners. This is Kiera. And today we are bringing you something so special. I am so excited because this is one of our most popular episodes from the archives. Whether you're hearing this for the first time or catching it again, I am so excited because it's jam packed with a ton of takeaways that you can start using right now in your practice. We have released thousands, literally thousands of episodes. And I wanted to start bringing a few of these amazing episodes back for you. So I hope you enjoy. And as always, thanks for listening and I'll catch you next time. on the Dental A Team podcast. speaker-0 (00:31) and I've got the one and only Brittany Stone back on the pod. Guys, she has been a freaking road warrior, traveling to seven offices in one day. Dang, Britt. Welcome back. How you doing? How you feeling? How are you today? speaker-1 (00:45) I'm good. You made me sound better than I was in one day. Seven in a week. Still a lot, but seven in a week. speaker-0 (00:51) 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. Like you were cruising speaker-1 (00:58) Yeah. speaker-0 (01:00) to practices. Seven in a week is so many offices. But guys, don't worry, Britt wasn't like leaving them high and dry hanging out. You were seeing it kind of walk us through. I know you went to quite a few DSOs that had multi practices, multi locations. Kind of what was that like and and how does that even look when you're going to multiple practices like that? speaker-1 (01:19) Yeah, it's fun. So that was it was a week of my like multi practice location. So one had three offices, one had four offices, the two groups that I work with last week. And so it's fun. It's fun to see one you get to know kind of like the visionaries who who started a thing, whether it's just an owner or multiple partners that are involved in it, get to see kind of their vision and it's 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 so yeah, I got to go in, meet everybody, go see all the different practices, kind of see what's going on with them, what things we could help with on an individual practice level and then also as an organization. So it was a good time. speaker-0 (02:07) That's a lot. And I 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 ten 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 going to be the same. And it's more what are the foundational pieces and the the silver lining strings that we want running amongst them all. Britt, I know you had one practice, that kind of wanted to do their own thing within a group. Like, how do you how do you get like 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 want to run as solo practices, but when you're in a group and multi-offices that no longer serves the greater organization. Like what was kind of your findings with that? How do you how are you finding to get people on board? Is that something you were running into? Just kinda give us your thoughts around that. speaker-1 (03:16) Yeah, I think every DSO probably struggles or like group practice struggles with all right, how much do we have the same and like where can we kind of let them be their own and shine in their own way? And also from the business side of things for the DSO, right? What things are more financially beneficial for us to be able to do them the same and have on the same system? so that we run it across all offices and get the true benefit of the DSO. And so that's where you s kind of start to to figure out, all right, 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 but easy things like payroll is a pretty pretty common one that's gotta be obviously the same across all over offices. If we're using the same software, right, the way we run our schedule, who's allowed to be on our schedule. All of those things kinda need guidelines that go across the board. So we all know a little bit of the rules of engagement on things like the schedule. So that's kinda I start to think of it as all right, 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, all right, 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 kinda kinda do their own a little bit. speaker-0 (04:48) For sure. And but I was thinking like it actually might be fun on this podcast for us to dive into when you're in a DSO, because Br 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. of kind of what are some of those things that you should have standardized. I love that you brought up the payroll for sure. for me, some of the things I know I'm looking at is I really am just looking at Key metrics amongst all practices. And I know, Britt, 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 want to do outside of those metrics, it's pretty much free reign from there. So, like 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 kind of the main things. 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 I 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 like 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 they're labeling each office based on the city. 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 probos and healthy smiles of orum. It is Healthy smiles, and then we have our Aurum location and our provo location. 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 realize 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 one, the key indicators I like to look at. And then secondly, making sure that people realize like the culture and the patient experience. really need to be dialed in in my opinion, to really help these DSOs grow and flourish. speaker-1 (07:09) Mm-hmm. I'm with you on KPIs, right? Teaching office managers how to be able to kind of 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 capitalize 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 capitalize off of that brand for all practices to where there might be a patient who's looking to go to the office, but maybe it's a little bit farther. great, they've got a location that's closer than to me. Awesome. Let me just go ahead and go to that closer location. And agreed. You've got to keep then the culture and the patient experience up to be number one. And what does that look like? What does it stand for? 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 like you start to build in if it's we're on time, right, 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. speaker-0 (08:41) Yeah. And I think like 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 that see all the practices as one company and then the the different locations are just extensions of that company are the ones that really flourish. In that same thing, I feel like Britt, 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 that are really in sync to make decisions. and that's for your operations, for your labs, for your supplies, and 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 the the forward progress And I think they 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 neighborhood and you need an HOA, like somebody who can actually just make the decisions and execute in the best interest. 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. 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 like 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 that we don't need an extra person there, maybe not. But I think if you can really get that dialed in, you're going to be able to make a lot stronger decisions and be able to move things forward more. Britt, what are you seeing? Like 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? Wha what's kind of your take on how to make sure decisions can be made? Because I truly feel like once you get the the KPIs dialed 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 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. speaker-1 (11:20) Mm-hmm. And I am big on agreed. You've got to 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 kind of smaller decisions for offices, the offices need support on and empowering office managers to make decision 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 kind of higher level, a bigger picture. but when they can have that information, know how to see it from a little bit higher level, start giving them the the opportunity to make decisions within their practice. So one, they can kind of 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 kind of 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 it's 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 o 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. speaker-0 (12:47) 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. Britt, 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 I think 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 DSL? speaker-1 (13:28) Sure. I think one of the first things is helping the office managers and regional managers understand what a PL is. Like, and it doesn't even have to be like the terms of this is a PL, 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, you know, what do we have left over? Just helping them understand not overall. kind of equation of how the business runs and what are the different pieces within that that they can impact, which is ultimately how many patients we have, how much we 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 kind of profit left over at the end. 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 realize how much we've learned along the way or people have taught us along the way, even myself kind of 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 gotta actually take the time to invest in teaching you. speaker-0 (14:59) Which I I don't think people realize that PNL. When I first looked at a PL, I'm like, this looks like a straight up foreign language. Like I don't even know what ninety percent of this means. And so just imagine, if you will, if you've been running a business, you've been looking at PNLs, pretend you were just plunked into like for me, I do not speak Chinese. So being stuck in a class speaking Chinese and them 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 want to cry. And then I'd probably take a picture with my phone and I'd start Googling and I'd hope and pray I could find some type of Google Translate to figure it out. That like I feel is a good way for you to really understand like what it feels like to be those team members when they first start looking at PL. So I think one of the best ways is just practice. and what I've done is like Britt 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 PL 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? I love HDA accounting. I think they do a great job. Profy is another one. I'd Bailey is another one. those are just some some accounting companies. I like when they send the P and L because 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 N L, what do you see that's 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 Britt said, you've got to take the time and invest with them. That way they can look at a PNL. I know Shelbi's been doing RPLs. 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'd really looked at it. Sha 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 littl
