Superior results, continual improvement, consistent growth

Dr. Roger P. Levin.
Dr. Roger P. Levin.

Dental practices, like other businesses or organizations, go through stages of growth and development. The ultimate success of any dental practice depends on how well it navigates each of the phases that are essential to building and maintaining an extraordinarily successful practice.

Over the last 30 years, Levin Group has studied the top 10% of performing practices. This study has identified 17 principles that these practices have in common, but more importantly, it has helped us to understand the commonalities in the processes that these practices go through to reach the top 10%.

This study of over 30,000 dental practices has allowed us to identify four key phases that every practice must go through to reach high levels of success. When each of these levels is established, implemented, measured, and maintained, practices inevitably become extraordinarily successful. We find that most practices that move through all four phases and maintain their principles are generally able to retain prominent levels of success over lengthy periods of time.

This article lays out the four phases of achieving superior results, continual improvement, and consistent growth. Moving through each phase and mastering the principles has helped top practices experience great financial success and career satisfaction.

 The four phases of practice success

For Levin Group, studying dental practices since 1985 is like having a front-row courtside seat at a basketball game. During that time, we have had the opportunity to see the inner workings of practices of all sizes, conduct a study of the top 10% of performing practices, and then create a model that contains four phases that almost any practice can use to improve performance and move to another level. 

The goal of this article is not to show every practice how to enter the top 10%. As my seminar joke goes, “Ninety percent of practices will not be in the top 10%.” 

The good news is that dentists in the top 20% or 30% can also have outstanding careers. It would certainly be our objective to encourage any practice to gradually move into the top 30%. I also believe that almost every practice can do this within three to five years if they understand the four phases and the principles of each phase that will be discussed in this article. 

The four phases are as follows: 

  • Phase one: A capable and stable staff
  • Phase two: Proven business systems
  • Phase three: Leadership
  • Phase four: A relevant strategy

Each of the four phases has a basic set of principles. It is possible to build a highly successful practice without implementing every principle. 

The challenge is trying to figure out in advance which principles can be left out without impeding success. Therefore, we encourage each practice to at least examine each principle, evaluate how well they have implemented or not implemented that principle, and decide about action steps and what can be done. It is in the best interest of most practices to implement most of the principles. 

The key will be to understand each principle, where the practice stands regarding the implementation and continuity of that principle, and how to improve certain principles and completely eliminate others. These actions will help to determine practice success more than any other single factor.

One final comment before delving into the phases: Practices did not excel due to concepts like luck, location, dental insurance, and other factors. There may have been certain slight benefits to specific decisions made along the way, but in most cases, it had far more to do with moving through the four phases and implementing the principles of each phase.

Phase one: A capable and stable staff

In the first phase, the practice is growing and staff are being hired. It becomes critical to hire staff that have capability. In the current era, it is very difficult to hire highly trained and experienced dental staff, and many new or fairly new practices can’t afford them anyway. The reality is that many practices will have to hire “attitude over skill” and then train them to develop skills.

Let’s start with attitude. The best way to hire the right people is to take the time to interview them properly. When there is a staff shortage, the fact that the person has a pulse can seem more important than their long-term capability. This is understandable in that it is difficult to manage a growing practice without enough staff. However, for the long-term benefit of the practice and the pathway to real success, it is important to hire people with the right attitude.

What is the right attitude and how do you know? After years of teaching recruiting, hiring, and interviewing skills, I boil the attitude factor down to three simple questions: 

  1. Does this person excite you?
  2. Would you like to have dinner with this person?
  3. How will this person treat our patients?

If you can answer affirmatively to all three of these questions, then you probably have the right person. If you emotionally find this person engaging, enthusiastic, pleasant and fun, then so will your patients, which is the most crucial factor. 

In most cases, people with good attitudes are willing to learn. The truth is that the complexity of dental practices is highly overrated. Yes, there are jobs and tasks to learn and master, but once they are grasped, they are fairly repetitive. The code for hygiene is still the code for hygiene. The code for a crown is still the code for a crown. The scheduling protocol and policies remain the same. Once a staff member learns the basic job, the rest is all about attitude and how they treat your patients.

Phase two: Proven business systems

In the second phase, you have to train the team. If you hire people based more on attitude, then you have to train for that. Training should not be nagging or annoying. In fact, it is best accomplished by implementing excellent step-by-step comprehensive business systems.

After 39 years of watching practices increase production and profit and lower stress, we know at Levin Group that the absolute key factor of training is implementing the right systems. Systems such as scheduling, collections, hygiene production, managing no-shows and late patients, and insurance management all contribute to the training of the team. 

Consider how easy this really is. All you must do is get your systems implemented and then the team follows the systems. You are giving them an exact playbook of what to do and how to handle their jobs and perform at superior levels. The performance is built into the systems and not by daily micromanagement. This is a phenomenal way to train people with great attitudes and allow them to reach their highest levels.

When you have documented systems, training gets even easier. All the team member has to do is follow the systems, add the appropriate scripting, and within months they can be firing on all cylinders. We have seen practices that have hired and trained one train team member after another with immense success by following this methodology.

Phase three: Leadership

One of the most important key factors in developing your practice, increasing production and profit, and keeping stress low will be leadership. The first step in being a great leader is to simply act the way you want your team to act. 

Talk positively about your patients, emphasize customer service, celebrate small wins, and keep the team motivated and excited about treating patients really well. Remember, patients judge your clinical dentistry more by how you treat them from a customer service perspective than by how you treat them clinically.

The second step to ensuring great leadership is to delegate everything possible to the team, and I do mean everything possible. I call it extreme delegation. If a dentist only performs the tasks that only they should do and leave the rest of the duties for their team, they will develop the most productive team and highest production business.

And guess what? Team members really like it. People like to know that you trust them, and they enjoy the challenge of increased responsibility if they have great attitudes (see the first phase). 

If a person resists any type of delegation, it is usually for one of two reasons. Either their attitude is not as good as you thought, or they are simply overwhelmed and can’t fit everything on their plate. 

It is the leader’s job to know how much a team member can handle, move tasks around for better efficiency, and make sure team members can get it done. Just because they do not know how to do a specific task does not mean you don’t delegate it. Just like when you first hired them, you had to train them on all the basics, and now you have to train them on the rest.

Don’t overcomplicate leadership. Great leaders are compassionate, they care about their teams, and they behave accordingly. You can go deeper and establish your core values, mission, and vision, but start by acting the way you want the team to act and talk about it. One of my foremost beliefs is that if you want someone to know something, you have to tell them.

Phase four: A relevant strategy

By reaching this phase, you should already be producing in the top 20% of all practices. This happens automatically if you have a desire to grow by following the first three phases. The fourth phase is about strategy. It is about the future (your five-year plan), which should outline what will be accomplished by what deadline and by what responsible party over the next five years.

We have had the privilege of being involved in hundreds of strategic five-year planning meetings. We start all of them with a simple question: “Where do you want your practice to be in five years?” 

The answer takes about a day. You answer this by working through the core values and mission of the practice. You may think you have these, but so often they are merely words that no one remembers. 

You look at your goals over five years and then you do a SWOT analysis, which stands for strengths, weaknesses, opportunities, and threats. Armed with this information, you can then fill out the five-year timeline. This is one of the greatest exercises that a practice can do annually.

Strategy is the backbone of almost any company and one of the singular most crucial factors in success. When we meet practices that have performed well in the past but are now in decline, they rarely have a strategic plan. They did a lot of things right, got to a plateau, and as the world changed, they did not change with it. When a good strategic plan is developed, the practice usually gets back on track.


Dental practices like biological organisms. They are always developing and changing. Understanding the four phases laid out in this article will help any practice improve their performance, continue to increase production and profit, and lower stress. This creates an enjoyable, motivating, and exciting practice atmosphere. As one practice leader said to us, “We spend a lot of time here. We may as well make it a wonderful place to be.” 

Dr. Roger P. Levin is CEO of Levin Group, a leading practice management and marketing consulting firm. To contact him or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit or email [email protected].

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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