Running a successful dental practice in today's challenging environment requires more than clinical excellence. With rising costs, stagnant insurance reimbursements, and ongoing staffing shortages, practice owners must master three fundamental areas to thrive: people, process, and production.

Dr. David Rice, founder of IgniteDDS and a popular speaker in the dental industry, has helped countless practices achieve dramatic growth by focusing on these core pillars. His approach emphasizes that success comes from having financial control, systems control, and clinical control—but achieving these requires strategic thinking about how people, processes, and production work together.

Why People Come First: Building Character-Based Culture

"People who don't have character, they're going to break process every single time," Dr. Rice emphasizes. While many practices focus on creating systems and protocols, Rice argues that without the right people implementing them, even the best processes will fail.

The foundation of any successful practice culture goes beyond basic teamwork. It requires what Rice calls "leveling people up to character"—building a team where every member demonstrates trustworthiness, honesty, passion, and genuine commitment to practice success rather than just collecting a paycheck.

Creating a Team-Centered Environment

A character-based culture creates a ripple effect throughout the practice. When patients walk through the door, they immediately sense whether the team is genuinely happy and eager to help. "When somebody walks in the door and everything is firing on all cylinders and people are happy and happy to help, people say yes more," Rice notes. "When they walk in and the culture's off, they're tuned out right away."

This cultural foundation becomes especially critical for:

• Employee retention — Good team members stay when they work alongside other committed professionals
• Case acceptance — Patients respond positively to genuine enthusiasm and care
• Practice reputation — Word-of-mouth referrals increase when patients experience exceptional service

Handling the Difficult Employee

Even with careful hiring, practices occasionally face the challenge of a team member who doesn't fit the established culture. Given today's staffing shortages—where only 25% of hygiene students who start their programs actually finish—many practice owners hesitate to address problem employees.

Rice recommends a structured approach to these situations:

First, have the crucial conversation. Recognize when you're entering emotionally charged territory—feeling fear or anger signals it's time to step back and approach the situation logically. "Pull them back to that original vision, pull them back to who they promised to be," Rice advises.

Set clear expectations. If the employee is willing to meet expectations, continue developing them. If they're unwilling to change, it's time for them to leave. "I'd rather a practice runs short than have that proverbial bad apple in there because all the people who are doing it right are watching."

Remember who created the conflict. Many practice owners feel guilty about disciplinary conversations, but Rice reminds them: "It's not you who brought this conflict to the table. This is the team member who brought the conflict to the table."

For practice owners who struggle with difficult conversations, Rice recommends that often the simplest approach works best: ask the employee directly if they're living up to who they promised to be, then stop talking and listen to their response.

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Process: Finding and Eliminating the Hidden 90 Minutes

Most dental practices operate with significant inefficiencies that drain productivity and create stress. Rice's team consistently finds approximately 90 minutes of waste in the average practice day—time that could be redirected toward patient care or additional production.

The Two Types of Operating Procedures

Rice categorizes practice procedures into two essential types:

Standard Operating Procedures (SOPs) handle the business functions that keep the practice running: phone protocols, scheduling systems, billing processes, collections, and HR functions.

Clinical Operating Procedures (COPs) focus on patient care efficiencies and clinical workflow optimization.

Both types require measurement and optimization. "What we actually schedule happens, what we randomly think is going to happen becomes really difficult to execute," Rice explains.

Common Process Inefficiencies

The Hygiene Check Problem: One of the most frequent workflow issues involves the timing of doctor hygiene checks. Hygienists wait for doctors who are busy with other patients, while doctors feel frustrated being interrupted at inopportune moments. The solution involves scheduling specific time ranges for checks, allowing flexibility while maintaining workflow.

Accounts Receivable: Rice reports finding a minimum of $80,000 in outstanding receivables within the first 45 days of coaching most practices. These problems stem from inefficient patient collection processes and poor insurance follow-up procedures.

New Patient Scheduling: Data shows that if a new patient calls and cannot be scheduled within two weeks, over 85% will not keep their appointment. This makes rapid response and efficient scheduling systems critical for practice growth.

The Role of Technology in Process Improvement

Modern technology offers powerful solutions for streamlining operations:

• Online scheduling allows patients to book appointments at their convenience, reducing phone volume and improving efficiency
• AI phone systems can handle routine inquiries and guide patients through processes with natural-sounding interactions
• Insurance processing AI streamlines claim submission and follow-up procedures
• Diagnostic AI provides consistent radiographic interpretation and helps calibrate team responses

"Regarding online scheduling, I highly recommend that if you do nothing else, get with your IT team and create the ability on your website for patients to schedule there," Rice emphasizes.

Production: Diagnosis, Treatment, and Technology Integration

Rice approaches production differently than many practice management systems. Rather than focusing solely on revenue generation, he emphasizes that "the money's going to come if our diagnostic process is on point, if our treatment's on point, if we have core pieces of technology."

The Master Diagnostician Advantage

"The greatest dentist I know clinically, as well as the most successful dentist I know, I think they're master diagnosticians," Rice observes. These practitioners can predict future problems and intervene early, saving patients significant expense and discomfort while building practice revenue through comprehensive care.

Current case acceptance rates for complete care in North America range from just 22% to 34%—a concerning statistic that indicates significant undertreatment. Improving diagnostic capabilities and patient communication can dramatically increase acceptance rates while delivering better patient outcomes.

Technology as a Competitive Advantage

Certain technologies have become essential rather than optional:

CBCT imaging serves as a powerful diagnostic and case presentation tool. Rice notes that adjusted for inflation, today's CBCT investment is similar to purchasing a panoramic X-ray machine decades ago, but with dramatically superior diagnostic capabilities.

Intraoral scanners represent a must-have technology with only 40% market penetration, meaning 60% of practices can immediately differentiate themselves with this investment. Modern scanners are available for around $20,000, making them accessible for most practices.

For practices planning succession, staying current with technology becomes critical. "If you want a young dentist to buy your practice, yes, you need current technology," Rice states. "They want it to walk and talk the way they like it."

Developing a Subspecialty Focus

Many general practitioners find success by developing expertise in specific areas such as:

• Airway and sleep medicine
• TMJ treatment
• Implant dentistry
• Anterior aesthetics

Rice recommends choosing subspecialties based on genuine interest rather than trends. "Find something that you really love, don't be concerned about the shiny penny because that shiny penny is going to change in six months and a year."

Success in subspecialty development requires deep, focused education rather than sampling multiple programs. "My greatest mistake was thinking I needed to go to Panky and Dawson and Spear and Kois and I didn't. I needed to focus on one and take a deep dive."

Implementation Strategy: Measuring What Matters

Successful practice transformation begins with measuring key performance indicators (KPIs). While different consultants may emphasize different metrics, Rice focuses on approximately 10 critical measurements that provide insight into practice health and growth potential.

The implementation process involves:

Assessment: Understanding current performance levels and identifying specific improvement opportunities

Targeted intervention: Focusing on one area at a time rather than attempting wholesale changes

Measurement and adjustment: Tracking progress and refining approaches based on results

Sustained growth: Building systems that maintain improvements over time

Rice's IgniteDDS program works with practices through either intensive year-long engagements that typically produce 5-8x returns on investment, or focused 90-day programs targeting specific areas like case acceptance, accounts receivable, or phone protocols.

Conclusion

The three pillars of practice success—people, process, and production—work synergistically to create thriving dental practices. Character-based culture provides the foundation for everything else, efficient processes eliminate waste and stress, and strategic production focus ensures sustainable growth.

As Dr. Rice demonstrates, practices that master these three areas can navigate today's challenging environment while building long-term success. The key lies in understanding that all three pillars must be developed together, with people always serving as the foundation upon which everything else is built.

"Because most of the time what happens is one of two things. We either have one bad experience so we add 10 minutes to everything that we don't need, or we have one home run and we shave 10 minutes and then we're stressed the rest of the day. So we want to find what's predictable, what's repeatable and schedule our lives to that."

This systematic approach to practice management transforms not just financial performance, but also the daily experience of providing dental care—creating practices where both team members and patients thrive.

Image sourced from Freepik.