University of Manchester
Conventional wisdom suggests that every business has to renew itself to become and remain competitive. An example from a Dental Surgery shows how management of technology, knowledge and people all have their parts to play
When I arrived at his surgery to interview him, Ian Smith was on a mobile, discussing a technical problem. His space-age dental chair had produced some space-age symptoms. A dental version of Hal from Space Odyssey seemed to be misbehaving. In another part of the practice, a more recent piece of new technology looking not unlike a mini-lathe was creating a replacement tooth, working to data and dimensions specified by a more compliant computer.
Dentistry is not the most obvious profession in which to search for examples of innovative leadership. Ian Smith took me back through changes which had taken place in his business which had transformed practice over the years.
“In the 1970s” he recalled “we were mostly drillers and fixers”. As a young graduate he had continued his professional development, setting up a study group to explore the possibilities of transferring skills from best international practice. Arguably, he was among the pioneering dentists in the UK to see the benefits of preventative dentistry. Still within the NHS he began to assemble teams including a dental hygienist. The National Heath Service system in the UK was (and still is) the dominant provider of dental services, augmented by a smaller private sector.
In the 1980s, his interest in dental innovations drew his attention to advances in dental implants. “It was Brånemark’s work in the 1950s [Professor of Anatomy at Gothenburg University] which led to the technical breakthrough” he explained. The research had discovered by accident that titanium probes inserted into a rabbit within an experimental programme could not be removed afterwards because bone grows around the surface of the titanium [“osseointegration”].
The implications for human applications and particularly dentistry became recognised. They were to change practices had been around for thousands of years. Smith was introduced to the implant approach because the commercializing company, Nobel Biocare, had already known of his interests in dental innovation.
This was to be one example of a sequence of innovations. Ian Smith had set in action a continuous learning process which helps understand how this business has been able to renew itself over time. He later took an opportunity to acquire a private practice, while still working where he had built up his patient base. “I had to hope my patients would come with me.” he recalled “They mostly did. Since then, I’ve given talks to other dentists who say, ah yes that might work in Didsbury [a prosperous South Manchester location] but not for most places. That’s nonsense of course. You just have to explain what’s going to happen, face to face. Some patients I’d given a lot of time to just walked away. But it wasn’t a case of only keeping the better-off patients.”
He shows deft people skills. The author of this post had become one of his new patients around that time. It had been a decision based on word-of-mouth recommendation (No pun intended). It is clear he has a calming impact on people. There is something of the horse-whisperer about him.
The digital revolution
By the 1990s, information technology was becoming available throughout the professions. “Digitalization which was another big change” he recalled. “I could see that the costs were going to pay for themselves.” He is a bit of a technology enthusiast. He has the researcher’s interest in trying out new ideas, getting immersed in the application process, whether it is a new system for digitalising records, or fixing the bells and whistles of his dental chair.
Restless for Innovation
His story reveals a pattern of dissatisfaction with the status quo, and decisiveness in investing in introducing changes. In is said that entrepreneurs are not risk junkies, but are more prepared to assess risks and act accordingly. They are calculative risk-takers
The premises were acquired at a time when little attention was being paid to the psychological climate for patients. Ian Smith talks fondly of ‘the refurb’, the major redesign which he commissioned, and in which he appears to have been involved with considerable attention to detail. Rooms are now decorated in rather subtle shades of creams and yellows. Colours were important,” he recalls “I spent a lot of time getting the right colours for relaxed psychological conditions.”
And now its CEREC
He took me to part of the refurbished practice which housed his latest innovation. We passed a patient doing what patients do, (waiting, patiently). Something looking like a mini-lathe had been installed in a small location which reminded be of a mini-laboratory you find in a high-technology engineering department of a University.
“Cerec” he explained. “It’s revolutionising dental treatment. We’ve been using the same sorts of methods as the ancient Egyptians”. I suppose he meant archaeological evidence of ancestral scrapers and spatulas. Millennia later, you still needed close encounters with your dentist involving albeit with modern anaesthetics, and heavy duty drilling. Now a computer scan (“much lower radiation levels”) permits design and installations of “metal free dental restorations”. The mini-lathe I had seen in action, complete with cooling sprays, was carving out a precision tooth from a little block of ceramic. The patient waiting-time would be twenty minutes, followed by an immediate fitting which itself would be of a high-precision and less-invasive kind.
The Human Side of Business
Parkfield Dental practice is a business that has been engaged in a process of regular innovative change. It is easy to develop a story line based around its entrepreneurial leader, and the transforming power of new technology. You have to look more carefully to tease out aspects which might be called the human side of the process. However, the outward signs are that the practice has established a good staff climate.
Parkfield has renewed its working practices in a way which seems unlikely to have happened without the influence of Ian Smith’s leadership style and strategic decision-making. I left the premises musing on the nature of entrepreneurial leadership, technology, and the people skills needed in successful business renewal.
Acknowledgements and Disclaimers
This post was prepared as a business case suitable for study on leadership and related business courses. The image of Professor Brånemark is from Nobel BioCare’s web site. My interest in medical innovation in Sweden was deepened during a visit to the University of Upsalla’s junior faculty workshop on creativity in 2009. The author acknowledges the generous time given in preparing this post by Ian Smith and staff at Parkfield Dental Surgery. However, no financial sponsorship was provided, or promised for the future by Parkfield or any other person or Corporation in the preparing the materials contained in this post. Permission to use the post for teaching purposes will be freely granted with appropriate acknowledgement.