Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

Blog By:
howard

Going above the status quo by delivering a "wow" experience with Dr. Anissa Holmes!

Howard: I cannot believe that today I get to interview the woman behind Delivering Wow and you are simply wow. I mean, you are so amazing. You've got 40,000 fans on Facebook. Your dentistry's biggest rock star that I know of. Maybe you and Delia Tuttle are at a tie. You guys will have to battle it out who's the most awesome, unbelievable woman in dentistry. You were born and raised in Jamaica, but you went to dental school in Alabama. Is that correct? 

Anissa: I'm actually from New Orleans. 

Howard: Really? 

Anissa: Yes. I grew up in New Orleans and I actually went to dental school at UAB.

Howard: Which is University of Alabama?

Anissa: While there, I actually met my husband ... University of Alabama. While there, I actually met my husband, who's from Jamaica, and he was training to be an oral surgeon. I actually practiced in Birmingham for awhile, while he was doing his residency and then really, he had a strong commitment to come back home to Jamaica, so ten years ago, we decided to move to Jamaica. I had a really successful practice in Birmingham, and sold the practice and for the last ten years, Jamaica's been our home.

Howard: Pardon my lack of history understanding. New Orleans was a French colony. Is there a French community in Jamaica? Do you speak French?

Anissa: No. I do have a strong Louisiana heritage and culture, but I have no connections to Jamaica other than my husband, and I'm really happy to be here. 

Howard: Did you move back just because he promised to pull your wisdom teeth for free?

Anissa: No, but he actually did this year. We've been married for quite a while, and this year I decided, you know what? It's time to do it, I'm not getting any younger and it's time to clean them but it's really good. He's one of two oral surgeons in the country, and he's able to really give back. He said there were a lot of oral surgeons doing great things in America and he wanted to move back home and help his own people, so I said, "Let's go and if it doesn't work, we can always move back." But things have been really, really amazing. One thing that I've told him is that if I decided to move Jamaica, that my practice would have to be the same or even better than it was in the states and it's really happened so I'm really excited.

Howard: Can I podcast interview him someday?

Anissa: Sure.

Howard: I would love that because getting an oral surgeon to have time to do a podcast ... I mean, they're like dental unicorns. They're just non-existent. We really have a couple, thank God for Jay Reznick on Dental Town. He single handedly answers almost all the oral surgery questions and he's just a saint at giving back and that's what he says. He feels so blessed that he wants to give back and share and answer all these oral surgeon questions on [inaudible 00:03:06].

I want to start with the million dollar question because I don't know which comes first, the chicken or the egg. Like for instance, my podcast, the reason I started doing these podcasts because at fifty three years old, I realized that all the dentists, when they got out of school, that committed to a hundred plus hours of CE every year, they just became stellar practice and I understand the dentist. She's married, she has a husband, she has kids and her local study club has one meeting a month and it's a last Thursday of the month and it's after work, she needs to do dinner, she's tired.

I thought, "You know what? I can give her an hour lecture that she can multitask while she's commuting to work." Then, I get so many complaints that I don't do enough podcasts that I started doing two a day so she has one on her hour commute home because I think deep down inside, if these people can listen to a hundred hours a year, of people like you, they'll be successful. Here's my question. When you walk into an office, every dental consultant will tell you that within one millisecond, if they smell that energy and wow, it's a million dollar practice. 

Did the Wow start with you at birth? Are you genetically hard wired to have high energy, a high intelligence, high integrity or is this something teachable? Right now, you're talking to seven thousand dentists. Most of them are mathematicians, scientists, cellular biologists and are probably right now, dreaming how many ATP come out of glucose on the crub cycle. Can you take a science-minded person like that and get them to deliver Wow?

Anissa: Absolutely.

Howard: Okay. Well, you got one hour to do it, you got one hour to do it. Tell me how you can make every dentist, one half as wow as you.

Anissa: Really, it starts with your vision and really that's where I start with all dentists or business owners that asked me how can they have this amazing culture. It starts with your vision. Really, it starts with even before that, the business cycle. The business cycle says that as the dentist, you are the owner. What is it that you want? What is it that you're trying to achieve? The business cycle says that the owner really must inspire the team. They must have a vision. They must inspire the team. The team now wows the customers. The customers grow the business and it goes back to the business owner and really, when you look at your vision, what is it that you want in life?

I know that people are really into their crowns and all of these stuff but is that really what gives you happiness? For me, what gives me happiness is spending time with my family, spending time with my friends. What I've learned is that my business is my vehicle to create an income that would allow me to achieve my personal dreams. Creating this culture in my business where we really looked at wowing our customers, making them happy, having amazing engaged team members as well. Next, really what you're working for? Yes, we deliver amazing dentistry but it's really more than that.  

Howard: Everybody knows a practice doing a million dollars a year, the dentistry is horrible. Patients don't know if the root canal is good or not. They know if they like you. They know if you listen to them. If you want to have an amazing sports team, you need amazing players. I truly believe that eighty percent of winning the game is attracting and retaining a great staff. Talk about that. How do you pick staff? Because I know how dentistry, the resume, "Oh well, she had a 4.0 in hygiene school and she won the Hugh Friedy Golden Scaler Award so I will hire her." 

Then, it's like some introvert geek afraid of its own shadow. How do you attract and retain and develop a culture of fun people who deliver wow? By the way, that's the name of your website. Your dental office is jamaicasmiles but her website is DeliveringWow.com. When I keep saying, "Delivering Wow," that's the brand I think of. When I see your picture, I always think of wow, Delivering Wow. How do you develop this team of wow?

Anissa: Again, it starts with your culture. We put some things in place. We put in our core values and our core values really are what we stand for, what our company is all about. A few of our core values are deliver a wow experience every time and that means that anybody that works for our company knows that really, that's our mission. That's what we're there to do. We're there to serve our customers. A few of our other core values are think big, really, really big and have fun and we do. We have fun at work. It's a great environment. We all love going to work. We love wowing our customers.

A few of our other core values are build stronger communities and we're really known in our community for giving back. Every month, we have a different charity that we donate proceeds from new patient exams to. We're known in our community as really being very charitable and giving back. A few of our other ones are pursue growth and learning. Our team members, when we recruit them, know that that's very, very important to us. We have a Lunch and Learn every Thursday where we actually close the office. I bring in lunch and we do different things. Sometimes, we're talking about dental procedures and what we're doing so the team can better understand. 

Sometimes we're doing scripting. Sometime we're looking at how can we better serve our customers and by having all of these things, these core values in place, any new team member, they know what sort of company that they're going to. Even with the growth and learning, all of my team members have Kindles and so we have a monthly book club and we're constantly just trying to get better and better. We know that we're not at where we can be. We can always stretch our arms up a little bit higher and really, that culture of the practice and also our core values. 

But in terms of asking your question of how we recruit these people, one, they know what culture that they're going to and so what's happened now is that, because we have this huge social media presence, a lot of people that are really ... Once we put it, a lot of times we're using social media to post about openings and people know the culture. People are actually coming to us now that work at other dental offices and they want to be a part of this really fun and amazing team. They know that they will be supported and it's a great community. We give back.

But one thing that's really interesting and a lot of dentists are not really aware of this sort of thing is actually personality profiling. What that means, actually is that before we create a position, we decide what sort of personality type that person must have. For example, for my front desk, I have two ladies that are up front. One is really amazing. She has a very outgoing personality so when a patients walk in, she's like, "Hi. How are you today?" She's, you know, "Can I make you some coffee or tea? Can I get you anything?" She's amazing. She's a connector. 

The other lady up front is really very detail oriented. She ensures that the ledgers are done correctly, completely. She's the one that responds to all of our patients' e-mails within the allotted time that we've actually set for her key performance [inaudible 00:10:57]. We personality profiled. Now, anytime we have somebody coming up front, we're not just going to put it out there, that we have a job. We actually put it out there, we send out a pre-interview questionnaire that ask questions about what do you know about our company; what are your goals; where do you want to be in five years? 

We ask them their fees and their desired starting salary so we can sort of see what they're thinking. Then, we give them a quick personality profile test and it really allows us to see what sort of personality. If they are shy person, they're not going to be the right person for that position so it does not make any sense to really interview them for that role. We've also looked at other things like for example, in the back, our hygienist is very outgoing. We've also put her with someone who is that sensitive, very caring, nurturing type.

That way, we have a patient have an amazing experience where she has both the hygienist who's amazing and also the assistant whose very caring and nurturing so we do that as well, but like I said, it's really the culture and having deliverables. We have systems for everything. All of our team members have manuals which we created over time. It didn't happen like that overnight. We've created manuals and so they know what they need to do daily, weekly. It's all written down. Really, the overall goal, the number one mission of our practice is to wow our customers.

Howard: My personality is perfect for dental anesthesia because if I talk to a patient, they just fall asleep. They're just so bored and they just pass out and I don't even have to numb them. I want to ask you a question. Do you think it's more important to motivate your employees daily or to, through HR hiring, find internally motivated people? Again, which comes first, the chicken or egg? Do you think you attracted an internally motivated person who adds to wow or do you think you're actually motivating them and making them wow or a combination?

Anissa: Right. I think it comes from both but really, when you're looking for a team member you want somebody whose really excited to be there, who believes in again, what you're trying to deliver. In my particular practice, our number one goal is to wow our customers, to give them an amazing experience. Some of the things that we've put in is all of our patients have complimentary arm and hand massages before their procedures. We offer iPads to take away the sound. We actually make coffee and tea and hot chocolate and we all have freshly baked plantain tarts. That's our wow. That's what we're known for. Having someone who doesn't buy into that culture, they're not going to be a right fit for my team and that's the bottom line.

Once we start to put in these systems and had our core values, there are some people that had maybe been with me for a while and they struggled because they really weren't buying into what we were trying to achieve, but I said, "Guys, this is where we're going. I have a vision for something really amazing and really big and if you're going to be part of this team, this is how it's gonna be from now on." I lost maybe one or two people that weren't really committed to the vision and that's okay. They found another practice where they're very happy at and they're okay with the status quo but for me, that's just not okay and that's not what makes us unique because being unique, of course, set you apart and that's what makes to be number one and makes your business grow.

Howard: There are some subjects a male can't talk about without being called a sexist so I want to be very delicate on how I ask this. I probably get about three hundred questions, e-mails, texts a day and so many women dentist tell me, they go, "Howard, you don't get it. When you tell a woman employee to do something, they act totally different than when a woman tells them." They tell me that when these employees were little, their daddy would be sitting in the chair and tell his wife, "Honey, go get me a beer," and she'd run and go get it. When a male dentist tells her to go get this or get me a cup of coffee or whatever, they're just doing that because that's what they grew up with. 

But when mom tells them to do something, you talk back and you argue and you say, "Why don't you get it?" Do you believe that's real or do you think that's an excuse? I am in no position to discuss, is there any different issues by being a woman owner, CEO, president of a small business dental office than a male if all of your employees are women?

Anissa: I don't think it matters. To me, it boils down to leadership. If you are a leader and you say that these are the things that I need, this is what I expect, and these are the deliverables, then they happen. If you're the leader that allows your team to do what they want to do, then you're going to get that results. That's the bottom line. Like I said, I have a culture of thinking big and having fun and my team, they are great. They do everything that needs to be done but they know what needs to be done because we've taken the time to write it down. When they come in as a new team member, they have a position contract and it states everything that they are responsible for. When I tell them, "You guys, once you do your job there's no reason for me to come back and keep telling you what to do." 

But you know, they appreciate feedback. We do performance reviews as well. We actually do it every six months and that's really a feedback session. "Guys, this is great. This is what you're doing. But these things, we really need you to really improve on," and bonuses are based on performance. The team knows that once they perform, we do have a bonus system. We have that in place now and it's based on performance and also profitability of the business. We're all working as a team to grow the business and they understand that it's not me, as the big boss at the top. I know I can't achieve this. Again, it's talking about the business, the cycle before without an amazing team. They know that I need them and I support them and I support their decisions but they have to deliver. 

Howard: Talk to that twenty five year old little girl who just got out of dental school, opened her practice and you've been doing this for decades. How does she turn into a leader? Can she be made a leader? Are you born a leader or are you just born not a leader? If you can go from a non-leader to a leader, coach her. How does she go from twenty five to, what are you, twenty nine? How do you become a leader? Who taught you how to be a leader?

Anissa: Some of it is within you but some ... Leaders can be developed. For me, personal development is huge, so listening to podcasts is huge. I'm also now following lots of periscopes. I'm periscoping as well and just finding any information that you can to grow. I've turned my car into a driving university. I'm always reading a book. One great book on leadership is the Five Levels of Leadership by John Maxwell and that's a great book for someone who really wants to understand leadership going from being a leader of position and a lot of these young dentists, that's where they are now. 

They feel like, "Okay, these assistants need to follow me," especially if you're an associate. "These dentist needs to follow me because I'm the doctor. I'm the boss." Going and transforming from that level of leadership to the point of leadership where people follow you because they respect you and then, they follow you for what you've done for them and then what they've seen you do for others. Eventually, you can become and grow that leader that you train and develop other leaders. That's really the ultimate goal. Once you get there, things become very easy for you.

Howard: By the way, you said you have a monthly book club with your staff on Kindle? Last night or yesterday, my book, Uncomplicate Business, You Only Manage Three Things: People, Time, Money, made number one on Amazon under dental business so I'm proud of that. I'm gloating. 

Anissa: Congrats.

Howard: Yeah, I hope your team reads that on Kindle books. By the way, you have to make us an online CE course called Delivering Wow because we put up three hundred and fifty courses. They've been viewed over half a million times from every country on earth and I'm going to make it a personal mission of mine to get your message out because it's important for two reasons. Number one, you're the number one Delivering Wow I know. I mean, your karma jumps out of Twitter and Facebook and your website. Every post, every tweet I see is just ... You just exude energy. 

When I was in dental school, it was an all male profession and now, half the graduating class every year is women and they need women role model leaders. They don't want to listen to a bunch of old, fat, bald guys. They want to listen to rocking, amazing women like you. You said a couple of things that made all the old guys in America cringe. You called a patient a customer and you talked about a bonus system. What is this? A business? I want you to talk about specifically, how does a bonus system work? First of all, take a step back, do you think a bonus system is necessary? Do you think it works? What exactly is your bonus system?

Anissa: I don't think you have to have a bonus system and you can get results without it. I tell you, the culture of our practice, the team will perform with or without a bonus. This is something that we have just put in place, like maybe the last six months, really. It's just because I wanted to reward my team. They're actually the ones that are doing all of the work now. I sit back, it's really interesting. I sit back there now and I walk past and I see them giving the patients tours of the office. I see them offering, giving them a hand massage and I see them wowing the customers and so I want to share it with them.

It's really just my decision but it's not something that I feel that has to be done because what happens is you don't want it to be something that's expected. To me, it's also, we are running a business, we are running a business and so for me, there are certain things that we look at. For example, I have one of my ladies who's responsible for ordering dental supplies. One thing that we recently did is we really are looking at decreasing our overhead. Right now, we're at sixty percent overhead and my goal is to get that down.

I know I'm a general office and we do lots of crown and bridge but I want that down to at least fifty so we're looking at a lot of our expenses and part of her job was actually to go and look at different suppliers and really were sort of negotiating and putting them against each other and say, "Okay, this supplier's giving us this. Can you match that price?" What I told her, she has a budget. She has a budget for supplies and so it's consistent every month. By her actually doing these negotiations, we're able to lower our overhead and our margins and it really makes us more profitable. 

I said, "Listen. You know if you can go under budget, that's ideal because that goes to profit and we only give bonus based on profit." A lot of dentist talk about production and collection which is great but at the end of the day, it's really, in terms of the business, it's about what you get to keep. That's profit. If you're giving bonus, you should never be giving bonus on certain amount of revenue especially if you don't know what your expenses are. That's where the business part comes in.

Howard: What do you think supplies should be? I mean, what were your supplies as a percent of revenue and what percent do you think is achievable?

Anissa: Right. We were at about eight percent. We're really trying to get that down to five percent. A lot of it has to do with knowing your inventory as well. We have a system where we actually have minimum on reorder list as well and we do inventory every month so we know where we are and again, this is not me. This is my amazing team that's doing these things for me. Everybody is doing a task and we're really, really productive. We're getting these results so it's really quite amazing. 

Howard: Where are you buying your supplies? From a local human rep or is it more online on the internet?

Anissa: Right. We actually do a combination of both. We order some supplies here, actually in Jamaica. We order some supplies here from local suppliers and we also order from the United States, from some bigger name suppliers. We're also getting into the online space. There were some online companies that are offering significant savings. The thing is that, if you don't really look for it, you're not going to see that there are so much [crosstalk 00:24:27].

Howard: Can you name any specifics with the companies? Even the Jamaican ones because I was looking at Jamaican downloads on our podcast. It's pretty huge.

Anissa: In Jamaica, there are few. There's actually a local Ultradent rep and that company is Cornwall distributors. They're out at Montego Bay. There's Optimum Trading which is in Kingston and they work a lot with Henry Schein. But because I've been actually practicing for sixteen years, I have a long-term relationship with Henry Schein from when I have my practice in the states. I still do lots of orders them. I'm really big in to Ultradent so I order directly actually from Ultradent from Utah.

We've been looking into the online space as well like I said. Staffco is one that we've looked at. There's some different buying groups as well. There are different options but the thing is that sometimes, it doesn't mean that you have to change. Sometimes, you can go to your original supplier and say, "Listen, can you just ... You know, I've been a long term customer," and you can negotiate and say, "Can I ... You know, I wanna stay with you but your prices are really too high." 

I've known dentists that have been able to make that call to their supplier and just like that, they drop their supply cost by twenty percent. That twenty percent savings can go into some other area of your business to help it grow like your marketing, your social media marketing budget and those sort of things or it can go to the business owner in your own pocket or it can go to support your team for their bonus. There are lots of ways that you can put that savings.

Howard: Is your name pronounced An-essa, like Vanessa with an a?

Anissa: It's like Anes-sa  kind of like Melissa. Anissa.

Howard: Melissa like Anissa. I want to ask another question to you very specifically. I get this a lot by young women who just graduated. They say, "I just walked out of school with two hundred and fifty thousand dollars in student loans. If I want to deliver wow, do I got to double down on my debt and buy a hundred and fifty thousand dollar CAD cam and a seventy five thousand dollar Biolase and a hundred thousand dollar CBCT? Do I need to drop another three hundred thousand so I can be like Anissa and be crushing it and rocketing it in Jamaica?"

Anissa: Absolutely not. That's the most interesting thing because a lot of people, even patients, a lot of them think this practice is very expensive. But the thing about it is that giving good service, it doesn't cost a thing. Having amazing systems in place, on Facebook responding immediately when somebody ask a question, that doesn't cost anything. Having somebody coming to you you, you actually make them coffee or tea, we also serve them plantain tarts. Our budget for that is like thirty dollars a month. It really doesn't cost anything. We put perfume in our bathrooms and lotions. That costs really nothing. We bought some iPads and even with that, if you don't have a lot of money, you can buy a used one on eBay. We put that in place with the biggest wow. That has made a huge difference is the complementary arm and hand massages. 

What I did was actually sent all of my dental assistants to become certified in massage therapy so I made that investment in them. Now, we offer this as a complimentary service and I'm not paying for a massage therapist. All of my dental assistants do this and basically, it was like a twenty five hour course. They did it amongst a few Friday and now we deliver this. This really doesn't cost anything. Patients don't care about what type of chair that they're sitting in, if it's name brand. They really don't even care about the quality of the hand pieces. 

They care about how you make them feel and to me, that's really the most important thing. In my practice, I don't have CAD cam. I'm in an island that costs a fair bit of money to import these things but our practice is really growing. Even on a small island, we consistently have a a hundred and fifty new patients a month which is crazy and it's really because of this wow and also the guarantee that we give our patients as well.

Howard: What is your guarantee?

Anissa: Right. This is really interesting because really and I think this really applies to all dentists. Finding out what your customers want. This is what happened in my practice and I think it really relates to other dentists. We know that our customers by asking them. What is it that's most important to you? We'd ask our Facebook community, we've sent out surveys and it's number one. They want to be seen on time. They want to be seen on time. People don't want to come and sit forever. We have lots of executives. They want to get in and out.

We actually, because we now have systems in place, we're able to offer an on-time guarantee. We have an on-time guarantee. If the patients were not seen within fifteen minutes of their appointment time, their next exam is free. Guess what? There are times that we went behind. Every dental office does, but it's respecting your customer. What that means is that, if we see that we're running behind, we call them and say, "Hey, doc is running a little bit late. Can you come at this time instead?" They really appreciate that so we have one, an on-time guarantee.

The second thing that we offer is that our patients will have quality and consistency in their dental work. Their fillings will look natural. It will be long lasting. That's really important for some people as well. Some people have a lot of time. Maybe they're retired and most important thing to them is having a denture that fits or the most important thing to them, a bride that's getting married, is having a beautiful smile. She'll wait forever to see you but the most important thing is that the quality, at the end of the day, has to be consistent and it has to be long lasting and give you peace of mind. That's the second thing, part of our guarantee.

The third is that every patient will have a wow experience every time. Those were our three-point guarantees and that wow experience really speaks to people who are very fearful. We all know many people, most people, many people are afraid to go to the dentist so if you can offer a guarantee that they will have an amazing experience, it's just going to grow your business and it will set you apart and will make you very unique.

Howard: Okay. For reading comprehension purposes, you said it's your three-part guarantee. Succinctly say them again. If we don't see you for your dental appointment within fifteen minutes, your next exam is free. Did I say that right?

Anissa: Right.

Howard: What was number two?

Anissa: Number two is that we guarantee quality and consistency of your dental work. Your fillings will be strong, they will look natural and they will be long lasting. 

Howard: Quality and what?

Anissa: Quality and consistency of your dental work. Your dental work will look natural, it will be strong and it will be long lasting. People want peace of mind. 

Howard: It will look natural, be strong ...

Anissa: ... and will be long lasting.

Howard: You're so neat. You think so much outside of the box. What was number three?

Anissa: Number three is that you'd have a wow experience every time.

Howard: I can't imagine anybody now not having a wow experience in your office. Like I said, every time I see you, you just feel it. It just jumps out of the screen. Here's another thing you do that makes the old farts cringe. You actually have a white board and you actually measure numbers and finance and you share it to your staff. Anissa, Melissa with an A, so Melissa, Anissa, Anissa, the problem that my homies have back home here is that they keep all that a secret. They'll be coughing up blood clots because their overhead is so high and then I'll go talk to their staff, "Do you think our overhead is high or medium or low?" 

"I don't know." "What do we have to do to break even?" "I don't know." Then I go back to this, I say, "Your whole team loves you. They respect you. They adore you but you don't give them any numbers. They have no idea. You're back at your coughing of blood clots and can't make payroll on Friday." They're hardwired at birth not to be transparent. Why are you and I so transparent and an open book with all your employees and share these numbers and put them on grease boards and ninety five to ninety eight percent every office I walk in, do not have one person in this staff can tell me one number. Why is that?

Anissa: What's really interesting is that most times, the team actually thinks you're making more money than you actually are which is quite interesting. One thing that I did with my team, when I started this whole journey of transforming my practice is that I actually told them my story. I told them my story and my dream of why I became a dentist and what it took for me to get there. The many hours that I spent when friends were out partying, I was studying. The amounts of money that I had to sacrifice and save for and I worked three jobs in college to put myself through college and I told them my story. 

Howard: Tell us your story. Tell us your story.

Anissa: Right. The thing about it is that, what I share with them is that, and everybody has a story. I came from a family of very humble beginnings. My parents, my father was his first generation, college graduate. He said, "I don't have a lot of money but if you work really hard, you can achieve all of your goals." That's basically what I did. Lots of encouragement. Like I said, in college, I worked three jobs to put myself through school and I came out with no debt. I also had some scholarships for the dental school but I had a big vision and a big dream to give back and I really had a passion for dentistry. I have grown this successful practice and my vision is to continue to give back and to make a difference. 

For me, having a business that is a profitable business, that is a successful business, that's what allows me to give back even more. If I didn't have a successful business, I couldn't help other people. I have no problem sharing things with my team. They have really stood behind me and supported me and they want to see me become successful. Again, this comes back to your vision and their vision and their vision is also to support their families. The business is really how they achieve their personal dreams as well and so us all working together, we all can achieve our goals that we want to achieve. 

We do have some numbers and percentages but one thing for people, if they're not comfortable sharing numbers, you don't have to share numbers but you have to know your numbers. You have to know your margins. You have to look at things every month because that allows you to plan. You have to know what your expenses are. You have to know if you're profitable. It's more than just, you know, I have cash in a bank so I'm okay. It's not about that because perhaps the supplier didn't send you a bill for two months and all of a sudden, you can get hit with this big bill and you don't realize it's coming because you're not really looking at your cash flow. You can't plan to buy more equipment.

One tool that we use to talk about white boards and how we use white boards is really interesting and I'll just share a little story. What we did was I actually have a budget and in my budget, my budget not only list my expenses but my budget list how I'm going to achieve my goals. Every year, I set a revenue goal. I set that goal of what I want to achieve from my business. It is a business and I want it to be profitable, again, so we can continue to grow and touch many more lives.

What we did was, I created a list of services. This was based on the last three months in the last year. I said, "Okay. The last three months, this was our revenue for cleanings. This was our revenue for sealants. This was our revenue for crown and bridge." Then I said, "Okay. How much do we charge for that?" On average, we did twenty five crowns a months or we did a hundred cleanings or whatever the number was. Based on that, what I said was, "Okay, for me to reach my revenue goal, how many of these would we have to do?" That's what we track on our white board.

We're not tracking like, "We have to do ten thousand dollars today or a thousand dollars today or three thousand dollars today." We're tracking by procedures and it becomes fun. It's like a game with my team. What happens is that I actually say to them, "Okay, we need to do two hundred cleanings. We need to do however many sealants." Everyday, we actually track. We have in our practice management software we prepare a report and my office manager actually updates the list. We have all of our targets and everyday she updates so we see where we are. 

Maybe at the middle of month, we realize, "Okay, we are kind of falling short on crowns this month." What will happen is that, perhaps, we'll do a newsletter to our patients, an educational piece on crowns or maybe we'll offer a promotion on Facebook, "For this month, if you schedule before the end of the month, you'll get a certain amount off your crowns." By doing this, we actually achieve our goals. What we realized is we are not diagnosing anything new. We're not saying, "Well, we have a goal to do thirty crowns. Every patient that comes in, I need to tell them they need a crown." 

It's definitely not about that. What it is about is just having systems. Perhaps, that day that you're tired and you're not feeling doing that extra crown and you have time. You say, "You know what? We have a goal this month so I'm going to do the crown." Maybe you're team is now committed to that goal so they're going to work through lunch, they're going to stay late. They're going to do what it takes. Perhaps, a new patient calling on a phone and wants to know about a crown. The person on the phone is going to make sure they take time to educate the new potential patient about the amazing crowns that you do in your office and maybe why your office is different and why they should come to you. 

It's these systems of how you get to that number. It's interesting. The first month we did this, we actually met all of our goals except for one and it was sealants. My hygienist is like, "Dr. Holmes, you know it's way too high. There's no way." I was like, "There's no way. I'm actually going to double it. We're going to meet it." We did. It was really cool and it has become like a little game. Every month, now the team is saying, "No. We can't do this amount. We can do this amount." They're actually setting the goals for me so that's really cool.

Howard: Describe your team. Do you have an associate? How many hygienist do you have? What is an ideal team? You're seeing a hundred to a hundred and fifty to three hundred patients in your month. How big of a facility ... Describe your logistics.

Anissa: Right. Originally my first office that I opened in Jamaica was very tiny. We only had eight hundred square feet and I started it with three team members. That was just a few years ago, really, starting my new office again. I was an independent contractor for five years with another well established dentist and then I said, "You know, we're not leaving Jamaica," so I started my practice again." We started with three team members and then I said, "Guys, I have a vision for something really amazing and huge." We actually outgrew that space. 

Right now, we're on a twenty five hundred square foot facility. I have an associate. The plan is actually to have her to buy in as a partner with fractional ownership which is something we can talk about on a whole different day in terms of how dentists transition out now or how they can better transition out. But I have an associate now. I'm looking at bringing in another dentist just to handle the volume that's coming out in January. I have one full time hygienist and two other hygienists as well and all of us have assistants. We have a fair bit of assistants and that's why we're able to deliver on the wows. That's why every patient can get a hand and arm massage. Our hygienist, our assistant as well with dental assistants.

Howard: Explain the details of the arm and hand massage? Is this something that every patient gets the first couple of minutes of every appointment? How does that work?

Anissa: Right. What happens with the hand and arm massage is that for cleaning patients, this is how it works. A new patient for example, they come in, we offer to make them coffee or tea. When we are ready for them which is basically right away because we don't really make people wait, we give them an office tour. They see the office tour. In office tour, we actually points out our core values to them and we let them know what our practice is about.

We also show them sterilization because for some patients, that's their hot button, making sure that everything is clean. We point out our technology. We do have the internal cameras in all of the rooms and the nomad x-ray and all of that stuff so we point that out as well. Then, we have them come in. Then, we actually take before pictures of all our patients before their cleaning, their teeth, so that they can see where they're starting out and we do our X-rays. Then, after we do that, then we actually offer every patient, "Would you like to have a complimentary arm and hand massage to relax you before your appointment?"

It's just a five-minute thing but what happens is we set up the head phones and we do that service for them. Then, they have their procedure done. It's really, really amazing. Like I said, we have assistant hygienists. My hygienist is super productive. She actually has blocks of thirty minute slots, now the patient is not there for thirty minutes. While all of this is going on, she's actually in the other room with another assistant actually doing her work. Once she finished, she comes in and she just slots right in and she does her hygiene. The patient may be there for an hour including the check that I do but the patient has an amazing experience and we really just work it in. 

In terms of the dental procedures, how we work it in is once the patient comes in and we numb them, there's normally a five-minute waiting period before you can actually start your procedure. It's during that process that we actually set up the music for the patients to relax them, get them ready for their appointment. We use tune in radios so it's a free internet streaming site and they choose our music and we offer their massage. It allows them to really relax and we have found people who are super, super petrified that at the end of their appointment, they're hugging us because they're so relaxed and they can't believe how amazing their dental appointment was.

Howard: Whenever I hug a patient they always ask me when was the last time I showered and I tried using the perfume cologne like you recommended but hey- I want to give you a secret about speaking because I really think dentistry, everyone needs to hear you. There's two hundred and fifty societies in America that pick speakers and it's all volunteers so they'll be saying, "Okay. We need three volunteers to pick the speakers for next years quarterly and annual meeting," and then three geeks raise their hands and they say, "Okay, you find one on endo, you find one on product management." 

They don't know who to get because they're always told, "Don't get this one we had any of the last couple years, get someone new and fresh." So they go to Dental Town where every one of those courses is only an hour and they'll say, "Okay. I'm supposed to pick someone in endo," and they'll watch  six different guys for an hour. I know a guy who put up a one hour endo course and got booked seventy six invitationals and everyone said, "Oh yeah, I watched your [inaudible 00:44:45]." You put up your Delivering Wow and you're going to be turning down speaking gigs because you are truly amazing.

They say, "I believe that success comes to those who are able to ask uncomfortable questions," and I don't mean to insult you at all but most dentists tell me that Facebook is a waste of time and that if you want to build your dental practice, delete your Facebook account and go back in the opportunity and start drilling and filling in teeth and I'm just told all the time, "We put up a Facebook page and I can't name any single person that came in from Facebook and it's just basically a waste of time," but you claim it's not a waste of time. Why do all my fifty year old, half dead, dinosaur friends believe it's a waste of time and why is it working for you? What makes it work and not work? I see you not just on Facebook, I see you on Twitter too. What social medias are you on and can you really honestly say that you can track this new patient actually came from my efforts on Facebook?

Anissa: Absolutely. In my dental practice, we have a huge following on Facebook. We have actually now it's over forty four thousand people that are following the Facebook page and it's huge. It's huge. Forty percent and we track, we know where all of our leads are coming from or all of our new customers are.

Howard: But is that just because you're gorgeous? I mean, my mother told me I had a face for radio. If they saw my face, they might be blocking me. Do you think a short, fat, bald dentist would have the same success as a movie star face like yours?

Anissa: Absolutely and it really comes from through the content that you're sharing. Howard, you know this. Once you can provide value, you're going to have followers and so, we provide a lot of value, we speak a lot also. That's dental value, what services that we're offering, before and after pictures, so that speaks to the quality and consistency but a lot of what we really share is really our culture. They see us giving back to the community, they see us having fun. I mean, we recently had a thirty day flossing challenge and my team actually did a silly video to some Soka song, you know, "Floss like a boss," and they're dancing and they're having fun.

Howard: Email that video and I'll post it on Dental Town, then I'll push it on my social media. Have you ever posted on Dental Town? I know you're a member since 2007 but have you ever posted yet?

Anissa: Right. I'm blogging on Dental Town now and I'm actually on some of the threads, some social media and practice management threads and really looking forward to doing a lot more. 

Howard: Post that video because if it's on YouTube, you can share a link but you can click share and then embed and if you drop that, and go to Dental Town, you drop that embed, t here's a YouTube logo above the post.

Anissa: Okay, cool.

Howard: You click that and you drop the embed and then the videos posted on Dental Town and that will hit two hundred thousand dentists and I'll put it on my Facebook, Twitter and all that stuff. What is your Facebook page? How would a listener find your Facebook page?

Anissa: Right. I do have two different areas. My dental practice is Jamaica Cosmetic Dental Services, so my dental practice's Facebook page is Facebook/jamaicasmiles with an s. Jamaicasmiles. 

Howard: S-M-I-L-E. Jamaica, and Jamaica is J-A-M-A-I-C-A?

Anissa: Right.

Howard: Jamaica Smiles ...

Anissa: .com and the thing about it [crosstalk 00:48:37].

Howard: That's your dental office?

Anissa: Right.

Howard: Is there a different Facebook page for dentist? 

Anissa: Right. My dental office page and so we have that Facebook and we also are really big on Instagram which is jcdssmiles for Jamaica Cosmetic Dental Services, so it's J-C-D-S-S-M-I-L,-E-S and that's my Instagram and it's really interesting because Instagram and Twitter have a really different target. Facebook, if you're trying to target the thirty five to fifty year old patients, a lot of them, they're hanging out on Facebook. People check their Facebook accounts most times, many people are checking it four times a day and I mean the great thing about Facebook is that it's really targeted.

Why it's made a difference for us is that we have an amazing ROI, an amazing return on investment. Because we're sharing all of this stuff and we're targeting posts. I'll give you an example. We wanted to share a post and a promotion about teeth whitening and so what we did was we created a post and we targeted it to women between the ages of eighteen and thirty five years old who were engaged. We allowed that post to be seen in the feeds of those people that met those criteria on Facebook and we offered a teeth whitening promotion, you know, fifty percent off teeth whitening.

Teeth whitening is something that has high margins, it really doesn't cost a whole lot to do and it's really a great introduction to the office. We offered that and we typically see two or three whitenings a day and that's an ongoing promotion that we have going on and you can be very targeted. I don't mean to really go against Yellow Pages but I mean, you really need to test and measure. When was the last time you actually read or picked up a physical book of the Yellow Pages? I mean, people are just not doing that anymore so to spend seven hundred dollars or a thousand dollars on a Yellow Pages ad and hope somebody flips through or spending a lot of money on- for me, I'll just say. 

I tested and measured and that's why I'm able to speak to this. Spending a lot of money on a newspaper ad that people may look at when there's so many things that are looking to attract their eye, maybe you won't have the same return. What we have done by testing and measuring is that every time we have a new patient, we ask them, "How did you hear about us?" Like I said, we have forty percent now coming from Facebook. I mean, that's basically, at least based on our new patient numbers, forty or fifty people that are coming and when they come they know about us. 

They know our culture, they've been to my website. My website for my office is Jamaicasmiles.com. They've been to our website, they know all about us. They know about our team, they know that we will be wow. They've seen our before and after pictures and they're ready to actually come in and start their work. They're very connected so it's like word of mouth. A lot of dentists talk about, "Word of mouth is the best," but it's so amazing because what happens is that, I get tagged in posts all the time in people's social media. Somebody's saying, "Where can I find a good dentist," and they're tagging my practice's page and we're finding people or people are finding us by word of mouth that way.

Social media is like word of mouth on steroids and what happens is that as a dentist, again, we spoke about this. As a dentist, you don't have to do everything. As a business owner, you get to decide what you want to do and what you don't want to do and social media doesn't have to be your thing. Your thing can be cutting crown preps all day or doing extractions but it's really important that you have somebody on your team whose amazing that can get these things done because these are strategies that you don't have to pay a lot of money for. I have, like I said, over a hundred and fifty new patients a month and my marketing budget is five hundred dollars a month and that's just going to my Facebook. That's really quite amazing. 

Howard: The only thing I've really mastered is snacking in between meals, that's my only accomplishment so far. What is the culture of Facebook? If one of my listeners went to Facebook.com/jamaicasmiles and they like what you were doing, is it rude and evil to steal that idea from you and then post it on their Facebook page?

Anissa: No. The thing about it is that we do have a lot of people that are following us now and to me it's just really a compliment. It means that we're doing something right. I encourage dentists to follow us. One thing that you'll notice is that we have a lot of interaction with our Facebook fans and again, this is not me. This is my team. I have somebody and her job is every hour to log into Facebook. At any time we'll have five or six questions coming in about, "How much does a crown cost," or "Can you tell me more about an implant?"

Now, what's really cool about Facebook is you can actually go ahead and customize these things and you can save the customized responses which can have a YouTube video in it about the procedure so you can do two clicks and you can respond really quickly. But we're very responsive and people see that and they know that if we can be responsive to them on social media, just imagine what happens when they're in our practice so that's really cool. 

Howard: You said forty percent from Facebook. Go through the next social medias on most importance to least importance. I mean, you can only manage people, time and money. Go through other ones that are worth your time and effort and why?

Anissa: Right. It really depends on your goals. For my dental practice, Facebook is huge because really my goals are to share our culture. Our goals are to share pictures of before and after work that we've done. We also do a lot of promotions. This is really interesting too. There have been times when say a patient calls you at eight o'clock in the morning and they're like, "Okay. I'm cancelling two appointments, one for me and my child for a cleaning."

We'll put a Facebook promotion up that says, and we'll boost it so it gets into a lot of feeds, "The first three people to call get a fifty percent off cleaning." In like ten minutes, they're filled. We use social media [inaudible 00:55:08] to really bring in new patients when those sort of things happen and it happens to all of us. Facebook is huge. I think Instagram is another really huge one and Instagram tends to have a little bit different target. 

What I have seen and what I've read also is that it tends to be more fluent people actually. If we're promoting teeth whitening or cosmetic dentistry, we're more on Instagram whereas if we're promoting more general services then promotions for cleanings, we're on Facebook. Instagram tends to have a younger target audience. We're also on Twitter and there is a fair bit of interaction that goes on Twitter but if you're going to choose two, I think that Instagram and Facebook are big. We're also on Google Plus. We have Pinterest. 

We're on all of the social media channels but we are a very social practice and so, to us, that's really important but if you're just starting out, those are the two. But I am doing a fair bit on Twitter. I actually am in the process of writing my book which will be out by the middle of 2016 which is on Delivering Wow which is speaking to developing an amazing culture, on developing your systems and also your brand. So for that part of my business, I've been practicing for sixteen years and I am evolving and I have a lot of value to share.

Lots of that value now is on my Delivering Wow Twitter page and to me, that's a different target and a different objective. I'm doing a lot of stuff on Twitter and I'm also really big in LinkedIn as well but again, that's with my Delivering Wow because that's a different audience. That's people who are looking for articles to help grow their businesses so if you're that business owner that wants to really get to know more about how to take your practice to the next level, follow me on LinkedIn. I know Howard's on LinkedIn. There's so many people that are on LinkedIn that can help you achieve your goals. But I'm not sure if LinkedIn is the right strategy for your dental practice to put it out to patients, I'm not really sure. I haven't really seen a great result with that sort of thing. 

Howard: You know, I was the first social media in dentistry with Dental Town in 1998. You probably weren't even born yet and we had a thousand dentists sign up the first month so I really hope you do all the social medias except the original one with me on Dental Town. I hope you put up that Delivering Wow. I think that message will be huge. I want to ask you two specifics. The reason Facebook is the largest of all the social medias is because Mark Beiderbecke was born from a dad who was a dentist, Ed Beiderbecke and he was on this podcast and he said that he thought the most overlooked, missed opportunity on Facebook was having your patients check in when they come to your office because when they check in, all their friends see it. Do you do that or do you believe that? What are your thoughts on using Facebook and have them check in?

Anissa: You know, I think it's really great. We actually don't do check in. I'm outside of the United States but there are some different guidelines of what you can actually do in terms of these things internationally so I have not been able to, at this point, or maybe things have changed and now I can do it. 

Howard: All you got to do is send me an email and I'll reply to Ed Beiderbecke and Mark will see the email within three minutes and if it's a rational ... If Ed Beiderbecke thought, "Oh wow, that shouldn't be that way," it would be changed in two minutes. You might be the founding father of that. I want you to end on- I only got you for two more minutes and you just said something that's so profound and so went over everyone's head and that is giving a new patient an office tour. I can't tell you how only the cream of the crop does that and how it's so associated with all the mega successful practices. Close with why do you do a new office tour and specifically, who does it? How long does it last? Why do you do this? How do you do that?

Anissa: Right. You know Howard, it's always about making yourself unique and if you do something different, people are going to take notice. In terms of who does it, it's actually my dental assistants. When they're going to walk the patient to the back to have their cleaning done or their procedure. Well, it would be a new patient, so it's actually my dental assistants that do it but again, it's always about being unique. That's unique. Offering the hand massages, unique. What we're doing on Facebook is unique. 

You always want to be different. One mistake that dentists make when they're doing advertising is they actually say, "I do cleanings, I do fillings, I do root canals," and they talk about that. I mean, you're a dentist. You're supposed to be doing those things, right? What we talk about in our marketing is what makes us unique, your experience and you'll have peace of mind with your dental work. We talk about those things and that's what really draws people to us and allows you to have amazing, raving fans that will help to grow your business for you. 

Howard: Did you know in the state of California, in the economic book, Freakonomics, in the state of California, the name unique is registered over two hundred and seventy six different ways and what does a dentist come back with? We do cleanings, x-rays and exams. Come on, come on. Mothers can spell unique two hundred and seventy six different ways, you gotta be unique. You are the most unique, the most special and I can't remember when I lectured in Jamaica but it was at a ... I think it was the AACD meeting and I was at a resort there.

Oh my God, that is the most beautiful island. Can we go to overtime just for a minute because a lot of our viewers in the United States, how many people live in Jamaica? How many dentists are there? You've practiced in the United States and Jamaica. Do they use water fluoridation? Tell us what it's like being a dentist in Jamaica?

Anissa: Right. There are actually three million people that live in the country.

Howard: Three million?

Anissa: Three million and there are three hundred dentists.

Howard: Oh my.

Anissa: You know, it's really interesting. Yes, it's really interesting because what I love about it, which you know, honestly is that patients here really own their dental work and so, it's not about what is my insurance going to pay. It's about what do I need and how is it going to benefit me and how will it help me? I'm so happy and fortunate to be in a country that has that sort of culture about doing things like [crosstalk 01:02:03].

Howard: The United States has a dentist for every eighteen hundred and fifty people. Let's round that off to one in two thousand. You just said for three million, so that's one dentist for every ten thousand. Did I do my math right?

Anissa: Right.

Howard: Is it a lot more demand for a dentist in a country with one dentist for every ten thousand versus in a country of one dentist for every two thousand?

Anissa: You know, it's very interesting. It is a third world country and so what you find is that you have a lot of people who are really aware of the benefits of dentistry and you have a lot of people that really take emergency treatment only or only go when things are really hurting. But I mean there is definitely enough demand that I've been able to really create something really unique and even with that, we have a lot of new patients. Our practice is growing so it's really cool. 

Howard: Okay. You go home tonight and you tell your husband no more hand and arm massages until he does a podcast. 

Anissa: Right.

Howard: I would love to have you. I mean, you know how rare an oral surgeon online CE course is? I mean, you ask him to do that and they say, "Dude, I'm booked three months in advance. I don't even have time to breathe." Hey, it was an amazing hour. Thank you for all your amazing energy, your amazing karma. I really think if you did an online deal. By the way, when you come out with your book, next month Dental Town is launching it's audio book so you could do the audio book and put it on the audio book for free just so everybody who listens to Build Your Brand or you could, just like Kendall, you could sell it on Dental Town. Thank you so much for all that you do for dentistry. Thank you so much for all that you do for dentistry in general. I just think you're an amazing person. It was an honor to interview you.

Anissa: Thanks so much Howard and I just want to share one more thing. If any dentists want to continue to follow me to learn more, they can go to my speaking and consulting website which is deliveringwow.com. I do lots of blogs on there and share lots of useful tips to really help dentists take their practices to the next level. 

Howard: I've been on your website and spent a lot of time. I think the only problem is everybody's going to go to your website and say, "Hell yeah, if I looked that hot, I'd be successful too. I'm a short, fat, bald guy. Does it really work for ugly people?"

Anissa: It's about value Howard, you know that. 

Howard: It's about your karma, isn't it? It's about your energy and you are Wow. Thank you for Delivering Wow with me today for an hour.

Anissa: Thanks so much for having me, Howard. Take care.

Howard: All right, bye bye.

Anissa: All right