Top tips for leading a team in primary care dentistry

Introduction

The General Dental Council (GDC) in Preparing for practice¹ group the key learning outcomes into four domains. These categories fit with those that will be required by the GDC throughout registrants' practice and mastering these skills is a lifelong commitment:

• Clinical

• Communication

• Professionalism

• Management and leadership.

The GDC highlights the challenges of developing good leadership skills: ‘Good management and leadership skills are vital to effective delivery of high-quality patient care. This includes management of time, resources, and effective team working. Upon registration a professional would not be expected to be fully competent in a management and leadership role - this will take time and experience'.¹

Whilst all domains above are intrinsically linked, there are many courses and professional journals on the first three domains but less so the domain of management and leadership. However, if you look outside the immediate dental field, there is a vast quantity of academic and practical expertise that can be accessed. Indeed, it is challenging to ‘learn' leadership as much of this development depends on experiential learning, though an understanding of leadership concepts helps frame those experiences in terms of leadership development. You may be a natural leader but you can always learn to be an excellent leader. Leadership is probably one of the most complex and complicated skills a dental professional will ever master and yet it is rarely touched upon during training, with limited opportunity to develop these skills practically. Effective leadership is key to the success of any organisation, none more so than a dental practice.

Bennis² notes that ‘leadership is the most studied and least understood topic of any in the social sciences' and ‘never have so many laboured so long to say so little'.

With that in mind, in this short paper, we offer our perspective of key elements of leadership in dentistry relevant to all members of the dental team. This is borne of experience in a wide range of leadership roles spanning almost all areas of dentistry - from primary care to running large clinical teaching facilities, and specialist practice.

Whilst leadership and management are closely linked, it is worth differentiating without getting fixated with definitions. Leadership is often described as having a vision and encouraging others to share and work towards this vision; leaders see the path. Management is enabling the processes to achieve this vision; managers navigate the path. In military terms, it is often stated you can lead soldiers into battle but you cannot manage them into battle. It is interesting that the Royal Military Academy Sandhurst - the UK's officer-training academy - have as their motto ‘Serve to Lead', highlighting service to others allows us to lead. Indeed, when we think of great leaders, their leadership skills are often forged in war or conflict. Of course, there are also visionaries outside the theatre of war - think of Anita Roddick, Steve Jobs, Elon Musk, Richard Branson. Fortunately, dentistry is not war but the concepts of leadership and service to our patients have important parallels in getting the most out of any team.

Leadership is one of the 16 ‘crucial proficiencies in the twenty-first century' identified by the World Economic Forum, ten of which are non-technical.³ If you really want to be a successful dental professional, you really need to hone your leadership skills. Times have changed in the world of leadership; it's no longer about telling, it's about creating an environment where the leader gets the best out of the whole team. See Table 1.⁴

Table 1 Information sourced from M. Myatt, Hacking leadership⁴

Below we give examples of essential leadership skills in dentistry, which help ensure a more fulfilled workplace and improved outcomes for our patients who we serve.

• 1. Lead by example: that means being authentic, not do as I say but do as I do

An example from clinic may be if you are the practice principal and you are late every day, it will be challenging for you to address lateness of other staff members when this impacts on patient care. It is thus of paramount importance to reflect on your own behaviours and lived values if you are in a leadership position. How might others perceive such a leader's behaviour?

Similarly, if you as the leader of a team park in the reserved patient's parking space every day but expect others not to, how might this be perceived? What sort of example are you setting? This type of behaviour would quickly undermine the ability of an individual to lead; others would soon lose respect and begin to turn away from that person, with a breakdown in team cohesion.

• 2. Look after every member of your team; everyone is important and has a role to play

Every member of the team has different motivations for being in the work environment. Consider what their perspectives may be and discuss this with team members individually and as a group. How does this link in with the vision of the practice and how can you facilitate success for all? Don't forget the non-clinical staff: they are just as important in the smooth running of the practice. Valuing staff isn't always about how much someone is paid, often it's more about how involved they feel and the degree of control they have over what they do. It will include how much flexibility someone has and the tasks that are delegated to them. A simple thank you for a job well done can go a long way.

• 3. Act as a professional role model - walk the talk

A leader sets the vision for a group of individuals. If the practice principal shares with other staff that respect for patients is an important value for the practice and then makes jokes about patients to other staff, that shows they do not respect patients. It also encourages other staff to act in the same way. The dentist who expects their nurse to work late because they regularly run late is being disrespectful and a poor professional role model, plus demonstrating poor time management. Whilst in clinical dentistry everyone expects running over from time to time, consider other team members' circumstances, not just your own. This respect for others and consideration of their life balance beyond the workplace leads to a more motivated and committed team.

• 4. Clinical leadership - set the standards but give people the tools to achieve them

Developing your team clinically takes time and commitment, but is time very well spent in future proofing the practice, and will encourage team members to stay at the practice. For example, if you have skills as an implantologist, take time to mentor and if practical, supervise some early cases with interested colleagues. This professional fulfilment will encourage staff to remain at the practice and share the clinical load or develop resilience if you are not present in the practice for whatever reason.

A good leader is there to catch the person who stumbles and set them back on the right road.

If attending conferences, invite wider team members so that they will feel invested in and an important part of the team. Developing every member of staff increases buy in to the shared vision and will pay benefits in the long term. Equality of development opportunities is crucial, not just for clinical-facing staff.

• 5. Mentoring, coaching, developing future leaders - be the person everyone wants to follow

Practice meetings - from time to team allow team members to lead. This shows your trust in the team and your willingness to help others to learn and shine. The team will become more confident and be more willing to participate. If you do this, always be encouraging and never publicly critical: support your team and they will support you. Praise in public, constructively criticise in private. Great leaders foster a working environment that includes mentoring and coaching. They learn how to adopt a coaching leadership style that gets the best out of those they lead. Mentoring is about supporting others to grow by signposting and sharing expertise so that the person can find their own ways forward. The best leaders know when to listen and ask the right questions at the right time.

• 6. Trust your people - they usually want to be the best they can be

People rarely go to work intending to do a poor job. We can all stumble but a good leader is there to catch the person who stumbles and set them back on the right road. The more you trust, the greater the reward will be both for the leader and the people they lead. People who are trusted and who feel valued generally go the extra mile and do so willingly.

Conclusions

Being a leader needs practice and an understanding of how to do it. You may be a natural but understanding concepts and embracing lifelong learning relevant to leadership is essential as your career progresses. Look outside dentistry to get the best information about leadership; read around the topic - there are some great books that help in this journey,^5,6,7 whatever career pathway you choose to follow.

The best leaders are authentic and ethical; they share failures and successes but learn from both in equal measure. Once the leader has set the vision and inspired those around them, they give their managers the tools and the trust to get on with the job. The leader is about motivating and setting the path, supporting their team to stay on the correct path even when the going gets tough. Great leaders have great businesses, and good leadership has a huge impact on the bottom line of the practice, whilst ensuring staff remain content and motivated. Great leaders know they can't do it alone; they need others to follow and at times to lead.

Whilst a challenging area in many respects, the rewards are great across the whole dental team and encouraging all to take on leadership roles not only fosters happier staff, but optimises outcomes for patients whom we serve to lead.