Everything comes down to trust
Without trust we are all lost, but we must be worth that trust
BDS Finals were just the beginning. Like all dental graduates, I am fortunate to have experiences and acquired a few skills beyond those that were examined and judged worthy to join the GDC register. Travelling my individual road through hospital roles, associate, practice owner and, latterly, as a business coach and consultant has opened other doors. Sometimes, I get to work with professions and professionals away from dentistry, of which I do not have in-depth knowledge, except perhaps as a consumer. I like to believe that these experiences make me a broader individual.
Initially applying the seven pillars of a successful (dental) business –vision, financials, sales, marketing, people, systems and environment – helps to start the process. Of course, there are other qualities that apply to any business that can be more difficult to measure and analyse.
It wasn’t until I accepted and defined some of these that I started to feel I made real progress. One reason was that I sometimes discovered that the business or individual lacked the ethics and professionalism that would have attracted me as a consumer, a patient or a client. I wanted to improve an organisation, to help grow and develop the people and they just wanted, to steal a phrase, “to make more profit in less time”.
There are several ways that these more ambiguous qualities manifest themselves and I want to examine a couple of them. The first one is honesty with the people you serve, whether they are patients, customers or clients; but above all, with yourself and those close to you. If you are not true to yourself, how can you be truly trusted by anyone? One way this shows itself is how an individual or organisation deals with mistakes.
A recent article discussed what is described as the “cover-up”, under the headline, “Mistakes rarely end a career, but the cover-up will”1. The article does not dwell on why mistakes are made; indeed, it accepts that, as none of us are perfect, mistakes will always happen. Rather, it asks why the errors are not dealt with properly and discusses the consequences that can arise.
My experience tells me that every organisation needs to develop a – as the phrase goes – “no-blame” culture. Instead of the automatic response to a question that starts: “Who?” being the childlike: “It wasn’t me”, people – whether they be partners, managers or employees – should all be able to hold their hand up, in private if necessary, and admit responsibility. Sadly, life is not that easy. Embarrassment or even shame for making an error, fear of being “caught” or seen as not being as good as you should be, or even of disapproval can all come into play. Psychologists refer to this as “identity threat” and sometimes we deal with that by self-protection.
One point raised by the author is the effect of the “slippery slope” which, of course, never feels slippery at the top. The first lie might be small and there is a hope you can deal with it without anyone knowing you have made a mistake. Unfortunately, the problem just gets bigger; it is rarely the initial problem but the “cover-up” that brings the real problem. Those students of US history may well remember the Watergate break-in, which led to the resignation of a president.
In dentistry, it is perhaps a “minor” issue, a telephone message or an email of concern from a patient that goes unanswered for some reason. That reason could be human error, poor messaging, failure to record or pass on the message – we have all made some or all of them. No return call or other response leads to the patient’s concern growing, perhaps they feel ignored and might even raise an official complaint.
One dentist I met on a course shared their story with me. They were keeping a number of patient files and letters in their personal drawer. The patients had all had some problems either during or after treatment and the poor Associate felt out of their depth. The principal was a distant, busy individual who ran two practices and had personal challenges. They always made it clear that “in their day” they’d had to sort out their own problems and only ever commented negatively to the associate about the state of the dental world. Finally, a letter arrived from a solicitor regarding one of the Associate’s patients. The poor soul was too scared to tell the principal, or even their own defence association, so I became “father confessor”. Fortunately I was able to help initially by getting the dentist to apologise, to talk honestly to their defence union and then to find a better job where they would feel some support.
Everything comes down to trust, and I always recommend people to read Dame Onora O’Neill’s Reith Lecture, A Question of Trust2. As she said: “The aim is to have more trust. Well frankly, I think that’s a stupid aim. It’s not what I would aim at. I would aim to have more trust in the trustworthy but not in the untrustworthy.” I agree, without trust we are all lost, but we must be worth that trust.