Why Your Systems Aren’t Making You Money (And the Fix That Will)

Most practices don’t fail for lack of systems—they fail because accountability shows up late, tense, and inconsistent. We unpack a practical way to fix that with the CVI method—curiosity, validation, and invitation—so your team follows through without fear, defensiveness, or drama. You’ll hear why “laminated” SOPs stall, how delayed feedback normalizes noncompliance, and how reframing protocols around patient outcomes and team fairness wins real buy-in.

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Transcript

The Silent Quitter Analogy

Paul Etchison 1:22

One day I was talking to my personal trainer and he was telling me about the gyms, what he called the silent quitters. Now, these are the type of people that hire the trainer, they get the meal plan, they get all the supplements, and they tell everybody, hey, I'm all in, I'm going after it this year, I'm gonna lose all this weight. And then they do none of the work and they start getting frustrated because they're not getting results, even though they signed up for everything, but they didn't do any of the work. Meanwhile, you've got another group where it's the people who show up every day. They sweat, they try hard, but they don't watch their diet. And they're frustrated too because they're not getting any results either. Same gym, different habits, same outcomes. Okay. No progress. Now I see the same thing happening with dental practice owners. Some have zero systems, they've got zero structure, they got zero accountability in their office, and others have really good systems. They've got the SOPs, they got the meetings, they got the checklist. They even bought a laminator off of Amazon and they laminated everything, but they still can't get their teams to follow any of it. And both of those groups end up in the same place, practice chaos. So today we're gonna talk about why accountability fails, even with great systems, and how to fix it with my CVI method curiosity, validation, and invitation, accountability without anxiety, calm confidence, and the follow-through that actually sticks. Now you are listening to the Dental Practice Heroes podcast. I am your host, Dr. Paul Etchison. I'm the author of two books on dental practice management, a dental coach, and the owner of a nearly$6 million practice in the south suburbs of Chicago. If you want a team-driven practice that runs without you, that allows you to take an insane amount of time off and still be highly profitable, all while taking great care of your team and your patients. Well, you've come to the right place. All right, let's dive into our topic. Now I want to talk a little bit more about these two different types of owners. I worked with one doctor, Dr. Scott. He was over on the West Coast. When we started working together, he had no systems. Everything was like verbal instructions, nothing was clear, everything was driven by memory. There was nothing written down, there's no clarity, there was very little consistency. And the result, well, it was a lot of the times it was chaos. There was very little consistency there. And why? Because there were no systems. I mean, you can't have consistency without systems. I want to talk to you about a client that I just started working with, and she's telling me about how she's a bad leader. She doesn't believe in our leadership skills. She's telling me how I have these meetings, I do it with my team, I create what I want, I spend a lot of time, like almost like developing lesson plans for the meetings. So she's being very intentional about what she wants to communicate to her team and the systems that she wants to create. So she has the systems, but the thing is, is that the team doesn't follow them. They got the binder, they got the SOPs, they got the meeting agendas, they hold the morning huddles, but nothing sticks. So this person who's putting all this energy into their practice is getting the same results as the first person who is kind of putting in not a lot. So the key principle here is that systems create a way of doing things in your practice, but they don't create accountability. Conversations do. So why does accountability fail in so many practices? The fact of the matter is, is because when accountability happens, it often happens way too late. Delayed accountability will always kill your system. And this happens so often. You tell your team what you want them to do. And then one day, when you have a few cancellations, you start picking apart everything happening at the practice because you're kind of mad that you had some cancellations and you're sitting on your butt in your office, and you notice a problem. You decide that it bothers you today, even though it didn't bother you the past three weeks that it was happening, and then you bring it up, and the team feels blindsided by you because why is this something so important to you today? Oh, Doc's having a bad day. And then you, as the owner, you feel resentful to your team because you're looking at these things that you told them you wanted to get done and they're not doing it. Everybody feels defeated, nobody wins. And this happens in so many practices. They have a monthly meeting, they talk about what they're going to do, and then they come back the next month and they talk about it again. And there's no follow-through in between, there's no checking in, there's no accountability. Because when you, as the owner, delay accountability, you normalize the behavior. You make it okay for your team to not follow the system. Now let's talk about the accountability that a lot of practice owners use. I call this accountability with anxiety. This doesn't work either. This is when you're leading from a title. This is when you're trying to get your team to do things because you think that they don't want to be criticized by you, that they don't want to get in trouble. Owners like this are often operating from tension, uh, leading with frustration. We talked about this before. What the heck? You know better, things like that. And that type of leadership is gonna trigger shame in your team. It's gonna trigger avoidance, defensiveness. They're gonna start hiding mistakes, they're gonna become disengaged. When you correct people in this way, essentially what you're doing is you're just guaranteeing that they're not gonna tell you the truth. They're gonna hide their mistakes. We do not want our teams to do things because they're scared of getting in trouble. Sure, we want them to be held accountable, but we do not want to lead on the basis of fear. We want to lead on the basis of why we do the right things for the patient, why we're doing the right things for the team. We want to lead on the basis of why what we do, it's the right thing for the patient and it's the right thing for the team. And let me give you an example. Just simple one, closing checklists. Okay, closing checklists. Why do we have a closing checklist? Well, because these are things that need to happen at night so that we can take awesome care of our patients. Now, also, I said it's got to be good for the team. Why do we have closing checklists? So that everybody knows what the responsibilities are and so that it's equitable. So everybody is responsible for the closing task. It's not one person putting in more work than the others. Everybody is accountable for that checklist. So that's why we have that system. That's what we're focusing on. That is the kind of stuff we want our team to follow that protocol because it's the right thing for the team and it's the right thing for the patients, not because if they don't, they're gonna get in trouble. So, how do we create accountability in our practice? Well, first of all, we've got to be timely with it. We've got to be on top of our team. If we're gonna tell them to do something, we have to check on it and make sure it's getting done. And we've got to point it out as soon as it doesn't get done, and we've got to get curious. So, this is what we're gonna do. This is what I call my CVI method of accountability. C stands for curiosity, V stands for validation, and I stands for invite. Okay, here we go. Curiosity. You are going to get curious with your team when they don't do something. You're gonna start asking questions because you need to understand why that didn't happen. So you might say something like this, you know, hey, I noticed that this didn't happen. Help me to understand why it, why do you think that didn't get done? Like, you know, we talked about this before. I really want to understand like why it's not getting done. Help me understand that. So it's a very neutral way of approaching it, it's very non-threatening, and it opens up for the real conversation that you're about to have with your team member. Now, they're gonna tell you their version of why it's not happening. And that might be like, I didn't have time. It might be that I forgot about it. It might be that I don't see why we're doing it that way, or I think it could be done a different way. Whatever it is, and whatever they tell you, you have to validate their experience. So this is the V and C VI. It's the second step. Validate their experience. And that means you're you're showing empathy, you're showing that their perspective, that you respect it. Okay. It doesn't mean that you're agreeing with them. It just means that you're expressing understanding of where they're coming from. So, oh, that makes sense. Or like, I could totally see why it's so overwhelming. You got so much to do and you didn't get to it, or I can see why you forgot about it. There's so many other things going on. I don't know. Just you want to validate their experience because this creates safety. I mean, you think about like marriage consulting, you know, I read a lot of books about a lot of different things, one of which is I read about how to have a better marriage. And it's all about communication. And the communication is all about the relationship. I want you to think about, say, like you go home from work, you start complaining to your wife about something, something that happened at the practice, and she immediately tells you, you know, I think you overreacted, or maybe you should try to be more forgiving with your team. Or maybe, like, maybe what you thought it wasn't really what happened, and she starts siding with the other party. How open are you to listen to anything else that she says? You're not. You shut down, you get defensive, you start defending your position, you defend your experience because someone is telling you that the way that you acted wasn't reasonable. So you immediately go on the defense. And that doesn't lead to anything constructive. It's the same with your team. If they tell you something or they give you a reason why something didn't happen, and you start telling them that their experience was wrong, they weren't too busy, they knew the system, they understood it. I don't know. If you don't validate their experience, you're dead in the water. Now let's let's go back to this example. How about if my wife, who I just explained to, I was complaining to, she said something like, Oh, I totally see your point. That really sucks. That must be really frustrating for you. I totally see where you're coming from, something like that. Now your guard is down. Okay. You're ready to move forward. You're ready to come up with solutions or next steps if you're with depending on what you're talking about. See, the thing is that validation allows the conversation to continue. It lets people's guard down. And it is such a killer of culture and dental practices when we don't validate the experience of our team and we tell them that they're wrong. Okay. So curiosity, C, we're getting curious. V, we're validating their experience. And then the I, the invitation. We are inviting participation. Okay, we're inviting them to give a solution to help us come up with a solution so that we can meet our goal. So I noticed this didn't happen, and they tell you why, you validate their experience. And then you're saying, Well, what do you think we should do? Give me some input. You're inviting them to give some solutions here to help you with fixing the problem. Because if you don't invite them, you know, you've had these systems happen at your practice where you just show up, you tell people that we're doing it this way. And sometimes your team will try everything they can to poke holes in your system to show how it doesn't work, how you're wrong, and how this is unreasonable. But if you involve them, you invite their participation, you involve them in the creation of the solutions, creation of the systems. Now they have something, they've got something invested in the game and they want to figure out a way to make it work. So we're inviting participation. So we're showing up, we're using this CVI technique, and we're being consistent with it. And what I mean by being consistent is every single day we're checking on these things to make sure that they're getting done. Now, when you build a larger practice, you're leading your leaders, your leaders are holding people accountable in this way. Obviously, you can't check on every single thing, but you can build a practice that's systematic, that has accountability built into it. So we want to give same-day feedback. It has to be timely. These little 30-second conversations, they're not confrontational, they're really quick. We're just making sure our team knows that it's important to us and that we're watching. We're being very calm, we're being direct, we're not getting emotional. And every time we have these conversations, we're using that CVI technique. And no one should get upset because accountability, it's not a confrontation. It's just a checking that we're aligned still. We're checking for alignment. We're not confronting anybody. And this is what my coaching client was doing, the one that had all the systems, but nobody was following through with it, is she was setting up the systems. And when I asked her, I said, why do you think that system's not being followed? And she said, I don't really know. And I said, Have you ever asked your team? She goes, No. So she never got curious. And the thing is, is if you bring something up at a meeting, you bring up a system and it doesn't get followed for the next month, and you bring it up at the next meeting, that's still too long of time. That's still 30 days that went by. You need to be timely. It needs to be, we're going to decide as a team what we're doing with the system. We're going to hold everybody accountable to it every single day. So whether your practice has no systems like the first example, or those beautiful systems that nobody follows, accountability is the glue. And the way that you deliver that accountability determines whether your systems live or die, CVI, curiosity, validation, invitation. It is the difference between chaos and clarity. And these are the sort of things that we teach our coaching clients that work with us one-on-one. This is why I think DPH is super special compared to other coaching programs, because we, myself and Dr. Henry and Dr. Steve, we have large teams. We have seen it all. We have the experience and the wisdom to get the results versus maybe like a consultant that's not a dentist. I mean, they might have the systems, but they've never personally gotten a team to do these things. And that's the challenge. The systems, I mean, we could talk about best practices all day, but whether or not you can get your team to do these things, that's what's going to make the big difference. So here are your tactical takeaways for this episode. Address the issues the same day, not someday. Don't save accountability for that weekly meeting or the monthly meeting. Don't wait until you have time. Don't let it slide and hope it fixes itself. Tackle it today. If you see it, say it. 30 seconds of curiosity beats three months of resentment. Trust me. Takeaway number two, use that CVI script. Curiosity. Hey, I noticed what got in the way. Validation. Yeah, I get it. It makes sense. Invitation. So what can we adjust? What do you think we can do to make this easier or more consistent? This removes the conflict. It adds the clarity. And takeaway number three, I want you to separate the person from the pattern. If you get frustrated, it is so easy to attack the individual. But the real win is in attacking the pattern. I want you to say this isn't about you, it's about the process. Let's fix the system. Grace over guilt. You get to keep the dignity and you get to get the results. And the more you have these calm, little accountability conversations every day, the less dramatic they're gonna feel. You need to normalize this type of culture, normalize checking in, normalize asking how's it going, normalize clarifying expectations, things like that. It's a steady drip. You don't want to bring the fire hose like so many of us doctors do. We have one day where we get a lot of cancellations and we have a bunch of time to go poke holes and find out what our team's not doing just to get us even more pissed off because we're really just pissed off about the schedule. And as the leader, it's so easy to notice when things aren't happening. Let's try to notice when things are happening. When you see something good, call it out, celebrate it, reinforce it, celebrate the wins. We don't do it enough. People repeat what gets recognized. So this week, I want you to try to have one of those CVI conversations with your week and really pay attention to the energy of the person you're talking to as soon as you validate their experience. I promise you, it's one of the strongest communication tactics I have. Validate their experience. Doesn't mean you're agreeing with them, you're just validating their experience. So have one of those conversations this week around something that's not happening in your practice. Try it out, see how it works. And if you want a practice where things run smoothly and a team that actually follows through with everything, go check out our coaching options at dentalpracticeheroes.com or set up a free strategy call with me at dentalpracticeheroes.com slash strategy because a smooth running practice is exactly what we help you build. Thank you so much for listening. I really appreciate it. If you've got a second, please leave us a five-star review on Apple Podcasts. It means a lot to me and I could really use some new reviews. It's been a bit. Thank you so much for listening. Take care. We'll talk to you next time.