Exceptional Dental Practice Management

Well Seasoned Service

    I really want to continue to focus on service for a while.  After all, in this time of economic unhappiness, it may be the only thing that sets us apart.  Good service will surely be a bright spot in a stressful day and an often unexpected but very welcome pleasure in the midst of a growing tendency toward casual inattentiveness on the part of service providers.

    It seems that some people don't even realize they are supposed to be providing service.  Fortunately there are others out there who knock themselves out providing fabulous service.  In my enthusiasm for praising 131 Main, I almost took the excellent care I receive at Rezaz  in Asheville, for granted.  I say care because the kindness with which our last server attended to us goes beyond the duty of service.  Let me tell you why.  I had just sat down to dinner with my husband and was happy to be in one of my very favortie restaurants.  I was wearing a new necklace and caught it on the table and broke it.  Since I felt that the necklace made my outfit I was pretty unhappy.  As my sweetie-pie husband struggled to fix it with no luck, our server came to take our order.  Well, I was too wrapped up in the necklace disaster to think about the menu and he patiently waited until I was past the disaster.  Now I'm sure he wanted to move on because undoubtedly that table was booked all through the night, but he acted like he had all the time in the world.    When I finally got over my obsession with the darn necklace, which breaks every time I wear it by the way, he came back to take our drink order.  Since I'm am somewhat on a diet, I asked if the bartender could make me a Skinny Girl Margarita.  He was sure the bartender would be happy to try.  I was delighted to look up from my first sip to see the bartender watching.  He gave me a questioning look and a tentative thumbs up which I happily returned.  I've been in other places where they won't even try, but this guy not only made it, he really cared about whether I liked it.  So, they've got it all figured out.  Great food, fantastic funky atmosphere, personable, caring service, what more could I want?  Well, I could want to get in to their Argentinian Wine Tasting but we were too late, not surprisingly they are sold out already.  I'll just have to react faster next time.

    So you're probably thinking, what's this got to do with dentistry?  Nothing, it has to do with service and service is important in all areas of life.  Money doesn't have to change hands to make service important.  Think about the difference that could be made in a life when someone shows genuine human caring.  Whether it's in a soup kitchen, a homeless shelter, Buckingham Palace, the White House, or your own home, doing something with care for another makes an impact and affects how they will treat the next person.  Service is good.  Adding care to that same service in the seasoning that makes it memorable and important.  I'm going to continue talking about great and not so great service I receive around town because I'd love to see Hendersonville become known as the little town with great, caring service. 

Let's Get Engaged

    How many times have you wondered why your team or employees just don't seem as excited about work as you do?  Yeesh, even reading that sentence makes me realize I may be a bit of a dork.  I really do get excited about what I do.  Most people seem to be resigned to work as a rat race, though.  A lot of times we think that if we can just hire someone with the "right work ethic", the right character traits, or even (sure, blame it on the mother), the right upbringing, we'll have the committed, selfless, engaged star that we're looking for.  And we'll all live happily ever after. 

    So, enough fairy tales, engagement takes effort.  The effort initially must come from the leader, be it a manager, owner, or both.  We have to get people interested, excited and motivated.  We have to show them the value in the work we are asking them to do, the value in presenting themselves the way we want them to, and the value in serving our patients the way we are asking them to.   We hire people because we feel they have what we are looking for in a certain position.  Often, when we are interviewing people we notice their appearance first.  We notice that they took care in dressing for the interview, or that they appear messy or unkempt.  Realize, that in our mind we have a tally sheet with a plus column and a minus column and we've just put a check mark on one side or the other.  The next thing is the expression on their face.  Are they pleasant and approachable, or are they unfriendly looking?  Check.  As we go through the interview the check marks keep adding up and we make our decision based on that.  But, have we really been able to get to the heart of things?  Have we found out what makes them feel passionate about their work?  What engages them?  Probably not, because most people are saying what they think you want to hear so that you will hire them.  You usually don't get into the reality of how they will work until you're actually there working with them.    Ok, so I said I get excited about what I do.  That's true, but then again, not always.  I don't love everything I do, but I love a lot of it.  I hate cleaning the plaster trap, but I do it once every six months and only start remembering how much I hate it when I realize it's time to do it again.  I hate when someone forgets to put an appointment on the schedule and a patient shows up with their appointment card that says they're supposed to be there.  That's not fun at all, but it's an important time for me to be able to engage and use whatever strengths I possess to make that situation turn out positively.  Now, that's what I love.  I consider it a save.  So, I have to deal with something I hate, to do something I love. 

    How about our team members?  Can we see that happening for them, too.  I'm sure our hygienist doesn't love plowing through a lot of tartar, plaque, and still identifiable food in some cases, to clean a patient's teeth.  She may feel some satisfaciton in educating the patient on oral hygiene techniques and home care (at least the first time or two), but I bet she gets her passion from seeing that patient come in six months later with a cleaner mouth.  Hearing the patient say that they took her concern to heart and are happy they did because they feel so much better would make her see the value in her effort and feel passionate about her work.  So, how do we keep that end in mind when she is feeling discouraged or unmotivated because she seems to be cleaning the same junk off everyone's teeth over and over again?  Engage her in tracking her and her patient's progress.  Set up measurable criteria for her to look for in her patient's home care progress, in what treatment she is able to educate them about and help them accept, and in the value she adds to the practice as a whole when patients are understanding how the health of their teeth affects their overall health.  Keep reminding her of the patients who have benefitted from her care.  In other words, engage her in the practice completely, not just as a part of the hygiene department.

    It's the same for other team members.  Find out what they really love about their job and help them see how the parts they don't love may be a necessary evil to deal with so that they can get to the good stuff.  In other words, engage with your team so that you know what gets them excited.  Find out what would make them feel like you do about your job.  Let them know that you are just as interested in what they don't like as in what they do like.  Make it safe to say, "I hate this part of my job."  You may find that they don't really need to be the person doing that part of the job.  Someone else may just love the challenge.  Remember how I said I like to fix the situation with the patient whose appointment was placed on the schedule?  The rest of the staff turns to me with an endearing look of hope and expectation on their faces when this happens (which, thankfully, is rarely), and I feel like a hero.  Now, come on, who wouldn't love that feeling?  What they are really feeling is trust in me, and knowing that they and my boss trust me to make things go right makes me really passionate about what I do.  For me,that trust from them and our patients is one of the things that keeps me engaged and excited about what I do. 

    Think about sitting down with one of your team members this week and finding out what she loves, what she doesn't like so much and what she thinks she can bring to the practice that she's not getting a chance to use much right now.  You might just find that you have a lot more in that employee than you realized and you will have a new level of engagement with that staff member between she and you and she and the practice. Next week do it with another staff member and keep doing it until you've talked to everyone.  Then keep doing it every now and then.  So, what are you waiting for, doesn't everyone want to get engaged?

Mastery of Office Management

    I've been lucky enough to have been asked to participate in Dr. Marc Cooper's Mastery of Office Management program.  We had our introductory call tonight and I'm excited to see that there is an energetic, interesting group of managers that seem to deal with the same issues I face.  That made me realize that many of the experiences of an office manager are universal. 

    It sounds like the program is going to help us learn how to manage up (or gain influence with the doctor), manage down (gain influence with the staff) and manage ourselves. 
    I find that often, managers tend to be very progressive, always wanting to keep moving forward.  Just as often, we can be stymied by the people around us who are probably thinking, "Can't we just take a break for a while?  Aren't we good enough already?"  I have a feeling that the answer will be forthcoming. 

    This course feels like a support system, a place to get another point of view, support and even some empathy.  I hope that's what this blog provides for all of you, too.  I know how important that can be because as I listened to the other participants talk about what they hoped to get out of the program, I found myself breathing a sigh of relief.  I'm excited about it and I'll report back here on our monthly conference calls.

I Don't Blame You

    Have you ever noticed how hard it can be to get your message across when you are trying to tell a staff member that something needs to be done better or differently?  Basically, people almost automatically assume that if something is wrong, it only stands to reason that someone is going to get blamed.  It's a knee jerk reaction that stands in the way of getting to a solution. 

    I recently decided to talk about blame at a staff meeting.  As I was saying that just because I may need to tell someone that there is a problem with something, it doesn't mean that I am placing blame on them, so they don't need to feel defensive, one person started defending herself for being defensive earlier that day.  When I told her that she was proving my point, she defended herself about that.  No matter what I responded, she defended.  After about 10 minutes of that, with the staff quietly observing, I asked her what solution she felt we had reached.  She thought for a moment and then began defending herself for not getting to a solution.  I stopped her and asked her if she could even identify the problem at that point.  You got it, she couldn't. 
    I reminded everyone that the original issue was about the futility of blame.  The staff member said, "Well, I guess I proved your point, didn't I?"  I couldn't have paid her to have proved it more thoroughly.  Blame is useless.  When a problem arises, I immediately want to find a solution, especially if it involves a patient.  That doesn't mean I don't want to understand why the problem occured, of course I do.  Understanding is not blaming.  If people know they are not going to be blamed, they will be much more likely to admit to mistakes so that you can help find a solution or teach them how to do the thing right. 

    Blame misplaces focus.  The focus should be on solutions when problems arise.  As managers, we have to be careful not to automatically fall into blame mode when something goes wrong.  Examine your feelings the next time a problem arises at work.  Do you feel like you need to find someone to blame so that no one thinks you messed up?  Are you reacting in anger and placing the blame on someone in an effort to get the spotlight off of you?  Blaming and shaming have long-lasting effects.  So do supporting and teaching.  Which makes more sense to you?

What Makes You Unique?

    I was walking my dog Lucy and an airplane flew overhead.  Whenever that happens Lucy stops, looks up and watches until the plane is out of sight.  I think that makes her unique.  I've never seen a dog do that before.  She has a lot of things that make her unique.   She is the shyest dog I've ever owned, she's the only dog I've had that must bury her bones, every one of them.  She is also the sweetest, most gentle dog I've ever had.  She also passes the most wicked gas of any dog I've ever known.  That is something that sets her apart in a way I don't admire very much.  But, all of her good unique qualities make putting up with the gas, worth it.

    That got me thinking about what makes employees unique.  I decided to start with myself and I realized that some of the things that I think make me unique have been admired by some employers and co-workers and disliked by others.  For instance, I really have a need to understand why things happen and why people do what they do and feel how they feel.  That used to drive a former boss up the wall.   He hated it so much that it often made for some tense and hurtful conversations.  My present boss thinks it's an asset.  I tend to be a very hard worker who rarely misses work.  Former co-workers didn't love that about me, but my present co-workers count on it.  I talk a lot and have a wide-ranging sense of humor which causes my boss and I to really have a lot of fun most days.  Other bosses thought I was too much some days.  Frankly, I know I am, but sometimes it seems to just burst forth.  Hopefully, like Lucy's gas, my good assets make that worth putting up with.
    When I look at my co-workers I see the same thing.  They all have a lot of positive unique characteristics and a few that are not so enjoyable.  I also notice that some of the things that irk me, don't bother anyone else and vice versa.  What this tells me is that we have to make our uniqueness work for all concerned.  We have to find the place that our good unique qualities override our "gas." 
    A hygienist sent me an email today about some things she is struggling with in her job.  To be honest, her workplace is dysfunctional for her because her uniquely good qualities aren't appreciated and the uniquely dysfunctional qualities of the office she's in are making her miserable.  She needs to find an office in which her unique goodness works.  Days and weeks turn into years quicker than we realize.  Staying in a situation that never changes for the better will never be good for anyone.  Once those years pass, it is painful to realize that you could have found your uniquely good fit. 

    I feel fortunate to be in a uniquely perfect work position.  It really couldn't be better.  I work with a happy boss, nice co-workers, and for the most part, take care of wonderful patients.  I then go home to a uniquely great family life.  Yes, my kids are grown, but they're wonderful and I know how lucky we are.  Take a look at yourself and your life.  What makes you and your life uniquely wonderful?  Can you improve it?  What would it take?  What would you gain by doing that?  What would you lose by not trying?  Does the good make up for the gas?

Oh, Trust Me

Really listening and suspending one's own judgment is necessary in order to understand other people on their own terms... This is a process that requires trust and builds trust.                    ~Mary Field Belenky~

    How many times have you been in a relationship in which you felt like you'd developed a firm feeling of trust in the other person, only to find yourself feeling betrayed by them?  So many relationships in life seem to be based on a high degree of trust.  Your relationship with your spouse, your parents, your children, your friends, your co-workers, your boss...the list goes on and on.  You feel so sure you know the other person and that they understand what's important to you. 

    The problem is, a lot of what builds trust for you may seem perfectly reasonable and obvious, but the other person may not have a clue of how strongly you feel about it.  A lot of times when we are doing something, we just aren't clearly thinking about how someone else may be affected by it or feel about it.  We are full of expectations and beliefs that are as different from person to person as one snowflake from another.  What seems crucial to you, might seem inconsequential to the next person.  Can we really say which person is more right or rational?

    Trouble begins when we react immediately to what we perceive to be a callous disregard of our feelings, when it may really truly be a lack of awareness of the magnitude of importance a matter has for you.  More time is wasted, and problems instigated, by a rush to judgment, rather than a desire to understand.  When we immediately react with anger or hurt feelings we wipe out an opportunity to gain greater understanding, or to resolve a difference of style.  Rather we can rapidly escalate what may be a poor decision into an evil act of betrayal or careless inconsideration.

    What's the solution?  Wait a minute.  Really, 60 seconds can give you the chance to slow your heart rate and allow a few generous thoughts to germinate.  Wait 60 seconds more and those thoughts may take root and allow you to approach the situation from a more positive place.  You usually get what you're looking for in a conflict.  If you want to have a fight, you'll probably find one.  If you want peace, you will approach the other person amiably and usually find a peaceful solution.  You can let someone know where you're coming from, allow them to understand why would have liked to see a situation handled differently, without making them wrong or bad.  When you do that, it's likely that when that situation arises again, the other person will go out of their way to make it turn out right. 

    When you listen, rather than accuse you also save yourself from making yourself look silly.  How many times have you been absolutely certain someone deliberately disregarded your feelings, only to find out they really meant no harm at all.  If you had just asked, really wanting to hear what they were thinking, you could have saved both of you so much stress and hurt feelings.  Someone has to trust first, and by trusting, they increase trust for everyone involved.  When trust is consistently developed in a dental team, the culture of the practice becomes peaceful, supportive and caring.  Each aspect grows from the initial trust and the benefit is felt by the team and the patients.  How much trust do you have in your practice?  Can you begin to increase the level of trust between the members of your team?  What would you do to make that happen?

                                   

The Gratitude Campaign

I was talking to my friend Diane the other evening and my heart hurts for her. Her 20 year old son, Gavin, has just been deployed. She's not sure if he'll end up in Iraq or Afghanistan. She's holding it together like she always does, and she's had plenty of practice. She's had many challenges in her life, but in the last few years she's really had to be strong. When I think of the many times I see a military person in the airport or anywhere and I've wanted to say, "Thank you for sacrificing your time and your safety to help keep the rest of us safe." and I didn't, I wonder why. It's awkward, I guess. You don't know how they'll react, maybe. Well, after watching the following video from YouTube, I think I'll be doing something. I may not use the gesture they are showing, but I will find the nerve to speak up. In the meantime, thank you Gavin for risking it all, and thank you Don and Diane for raising that brave young man.

You Don't Say

    Ok, so I'm over the weird episode with the specialist's office last week, sort of.  No really, it'll be a gnat at the back of my brain whenever I deal with them, but hey, that's life.  What have I learned from that episode?  Good communication is the responsibility of the participant who most wants to go forth productively.  In other words, if you want to break free of the trap of immaturity, insidious nastiness, and useless blaming and defaming, if you want to move forward positively, you must make the decision to cut the crap and say, "Enough."

    There are many ways to verbally express yourself and just as many reasons.  Some folks just love the sound of their own voice.  They love to sing their own praises, or pontificate on some subject on which they feel they have some unique and amazing viewpoints.  (I know I've been guilty of pontificating.  I know it for sure because the truth is, you can hear yourself when you're doing it, you know you can, and honestly, you think you sound amazing at the time.)  Ok, enough of my confessions.  Some people love banter, my boss and I are full of banter, hopefully our patients enjoy it as much as we do.  Some people just love the give and take.  But, for some, putting someone else down, makes them feel better about themself. 

    Knowing this, there are choices to make.  Sometimes there is strength in the spoken word.  Sometimes, the ability to remain quiet is where real strength of character can be found.  And sometimes, the only way to end an out of control, spinning in circles argument is to simply and gracefully, step away.  It's so effective, because once you stop participating, there's no where left to go with it.  Now, if you can find it in yourself to agree to just move on in cooperation, you'll have the satisfaction of having done the right thing.  Even though it may seem like there would be a lot of satisfaction in shooting off the perfect come-back or having the last word, sometimes what you don't say is infinitely more powerful than a stunning rebuttal.

Confidence Lost And Found

"Life is not easy for any of us. But what of that? We must have perseverance and above all confidence in ourselves. We must believe that we are gifted for something, and that this thing, at whatever cost, must be attained."
Marie Curie

Well, if you read my post yesterday you might understand the title of this post.  I don't know about you, but conflict that is left unresolved tends to torment me.  I keep re-winding the situation in my mind to see if additional viewings might lead me to understand what went wrong.  My boss calls it ruminating and even accuses me of extrapolating now and then.  He's right, I guess.  I seem to have an overactive "what if" mechanism in my brain.  I have a hard time letting things play themselves out without trying to massage them into the outcome that I think would work best for everyone.  I was searching for inspiration on my friend Tom Morris' Institute For Human Values Website when I read the above quote.  I find so many answers on Tom's site, they just seem to jump off the screen for me.
So, to the quote:  Life is not easy for any of us.  So maybe we need to give each other a break, now and then.  Ok, so maybe it's not my turn to get a break in the scenario with the staff member who was offended by me.  Maybe it's my turn to give her one.  Which brings us to perseverance and confidence.  I prefer to see my  habit of ruminating as a way of persevering to solution.  That's how I figure out solutions, by running the issue around in my mind and looking at it from different angles.  So, maybe ruminating is the weakness characteristic that has it's strength in perseverance.  I think I make it work in the end if I come up with a solution and that restores my confidence. 
I didn't feel very confident about the way this situation was going because I can usually fix these things quickly.  I believe that's a gift I've been lucky enough to have been given.  It cost me some peace this weekend but I think I've finally realized that by allowing my confidence to falter, I've been able to look at someone else's view of my words and actions.  Letting go of confidence allowed me to see that to someone else, who doesn't really know me, I might have come off as critical or undermining.  I could have never seen that if I didn't give up some surety about myself.  Knowing I can look at myself critically and see that I may have been perceived differently that I intended, has given me the ability to come to the solution that I've been searching for.  I can apologize and not feel that it is an empty apology.  If I'd apologized immediately, I would have offered words with no meaning behind them.  We might have moved on, but it would have been unresolved for me.  Now I can truly offer an apology, with dignity and feel ok about how it all went.  I can feel confident in my behavior and truly move forward.  Sometimes you have to lose your confidence for a while if you want to develop more confidence.

Critical Feedback

    There is no harder conversation to have than one in which you will be passing on critical comments.  Let's face it criticism is hard to hear.  It's also hard to give, especially if you feel that the person or people you're giving it to won't take it as you intend it. 
    I had to pass on some information to a staff member at a practice that we refer to the other day.  I asked for the staff member who was concerned in the issue, told her what the problem was and felt we'd had an amicable talk.  I wasn't annoyed with her, I didn't even know for sure if she was at fault.  I just wanted to give her the information that I'd been given about a situation and let her take it from there.  I went on and felt we were done with it.  Well, hold on a minute.  Her office manager called me back and asked me if I was having a bad day.  I was mystified at why she'd ask that and she told me she felt it might explain why I'd attacked their staff member.  Since attacking is not my style, and I'd felt we'd had a good conversation I was shocked.  I told her that I hadn't attacked anyone, but that was not to be the end of it.  She insisted that I had and what should have been an acknowledgment of a misunderstanding became a mess. 
    Now, I'm incredibly stressed because I don't understand why it would benefit either practice to continue this.  I suggested agreeing to disagree and move on, but that's not going to happen, it seems.  So, how to fix it?  I was thinking about it and I've decided that I can do one more thing.  I can take my own interest out of the situation and look at it from the other staff member's view of what happened.  Obviously, she felt criticized, whether that was my intent or not.  The other om felt she needed to defend her staff member.  Maybe she feels that will build loyalty, maybe she truly feels I offended her.          There's one thing I can do if I really want to move forward.  I can acknowledge her view of the situation and tell her that although it was not my intent to hurt her, I obviously did and I'm sorry she experienced that.  Then I'm done with it.  Now, they have to deal with the fact that I'll never be able to give them critical feedback.  It may mean that eventually we won't be able to continue a professional relationship, because if our patients won't be served well because of it, we'll have to make a change.  I for one, welcome critical feedback as much as I welcome praise.  I like praise better, who doesn't?  But, I know that giving critical feedback means that the other person cares enough to risk doing it.  Most people will just walk away when they don't like something and find something else.  I'd rather be given the opportunity to rectify a problem. 
    We have to have the ability to hear criticism without letting it crush us, or taking it personally.  If we feel it is given unfairly, then just acknowledge it and move on.  It's a sign of maturity to be able to hear that we need to make changes or corrections and accept it in a spirit of goodwill.  It's a sign of humanity to be able to give another person the benefit of the doubt if they say no harm was intended and accept that. 
    For myself, I look at this unpleasant situation as a learning experience.  I will never casually pass on a critical comment again.  I will think through my words and look for any way in which I might make anyone feel defensive.  If nothing else it will be worth it to save myself days of stress and replaying the conversation. I also value my relationship with staff in other practices.  We all work better when we work together.  In the end, stress is felt by the patients and the rest of the staff and that's not what we're about.

Join The Tribe

  I love it when someone gives me a new way to think about how to make our dental practices better.  I've been reading Seth Godin's Blog lately and I like his idea of Tribes.  Tribes are groups of people working together to affect change.  They work to make things better.  Think about how that can apply to dental practices and dentistry as a profession.

    I get frustrated.  I get frustrated when I hear a dentist complain that he can't find a good staff, can't ge t them to do what he wants them to do, that they basically show up, stay for 8 hours and go home.  I hate to hear about staff that take up so much time worrying about petty gossip, in-fighting, jealousy, hierarchy and other nonsense, that there is really little time for practice building, working on building patient service or actually giving care to patients.  In the end, everyone whines and no one wins, including the patient.  Whining begets more whining until something explodes, implodes or wastes away.  Been there, done that, I know the subject, tense and verb.

    I get frustrated.  I get frustrated when I hear employees gripe behind the dentist's back, behind the dentist's wife's back, behind the assistant's back, behind the hygienist's back, you get it.  I hate it when employees tear down rather than work toward a solution.  Useless griping solves absolutely nothing.  Telling Mary that you hate it when Dr. Jones stays in the operatory talking to Mr. Wright about his golf game after the appointment is over doesn't change anything.  Letting Dr. Jones know that you could stay on schedule better if he walked into the hall with Mr. Wright so you could clean the room will have a better outcome.  Shooting him dirty looks will only confuse him and make him defensive so don't bother trying that either.   

    I really get frustrated.  I really get frustrated when I hear dental assistants complain about their salary, their respect, their responsibilities, when they won't do anything to help themselves.  Guess what?  No one should expect a raise just because they've logged another year.  No one should expect to make as much as Sally, RDH, just because they think they are just as important or work just as hard.  Things like this don't change just because you don't think it's fair. By the way, I'm not saying it is fair, I'm asking, "Whatcha gonna do about it?"

 I get inspired.  I get inspired when I see someone clearly state what they will expect from the people who work for and with them, and then follow-up and along and make sure it happens that way.  I love it when they don't overlook poor performance, apathy, pot-stirring and laziness.  I love it when they not only lead, but encourage others to lead, as well.  Call them emissaries, apostles, evangilizers, marketers, do-gooders, whatever, if they are leading change for good, it's a tribe that is well worth joining.   

    I urge dental assistants to stand up and work toward mandatory certification.  It's the only way to end the "I can just hire someone from McDonald's for a lot less..."  comments and create a more professional, better trained tribe.  I urge dentists to hire certified assistants or at least insist that they work toward and attain certification.Lot's of people who want a fast job that looks interesting might think they can just walk into a dental office and learn how to suction.  Career assistants know it's much more than that. Dentists who employ career assistants know it, too.   So why don't more of us care about building and growing respect for our profession?  Don't whine, work toward that goal.  We can make it happen, we just have to want it bad enough. 

    We waste so much.  We waste time, energy and talent when we complain endlessly, wait for someday and keep putting up with just enough to get through another day.  We let fear of change, fear of loss and fear of the unknown trap us into just good enough, or less. 
    We don't have to.  We can say, "Enough!  This is a new day, a new way, a new tribe.  We can make our dental practices places of inspiration and dedication that will leave employer, employee and patient with a feeling of well-being and pride.  So, what are you waiting for, lead or follow, but let's get this tribe growing.