What the dental chains understood first

Jesper Hatt DDS
Jul 17
4 min read

Dear colleague,

The last time I sat across from a clinic owner in Bergen, three A4 sheets lay on the table between us. She had printed them from Dental24 Norge. The numbers were not new, but it was the first time she had seen them pulled out in plain text in front of her. Colosseum, 75 clinics in Norway. Oris, more than 80. Odontia, 35. She had one.

She sat looking at the numbers, and it was not envy I saw in her face. It was closer to grief.

"I didn't know it was that many," she said. "How did they do it?"

That is the right question. It is rarely the first one anyone asks. The first question is usually: what do I do so I don't get overtaken? That is understandable, and it is wrong. The moment a private owner starts measuring herself against a chain, she has already lost half the conversation, because she is measuring on the numbers the chain is best at.

What they actually built

When I talk to the owners of the chains that have grown large, one thing is clear. They are not better dentists than the rest of the profession. They hold no patent on a good patient experience. They built one layer, and that layer is the one we usually miss when we look at their numbers.

The system layer.

It is the protocol that makes a treatment plan in Bergen look like a treatment plan in Oslo. It is the onboarding that gets a new employee ready in fourteen days instead of three months. It is the KPI board on the wall that the team can talk from, even on the days the owner is in Trondheim.

It is not technically hard. It is just built, and it took them years.

That is exactly the layer most private owners have not built, because nothing ever forced them to. When you are in the clinic every day and take the decisions by the coffee machine, it works. You are the bottleneck, and standing in the neck of the bottle has one advantage: you can see everything that runs through. Until you can't any more.

What the chains gave away

I want to challenge you on something. The chain built the system layer, and it paid a price for it. It moved decisions away from the individual clinic. It has possibly made it harder for the dentist on the floor to say no to a patient she knows she should not treat. It swapped the personal patient relationship for a standardised process.

That process is often better. But not always.

When I visit private clinics, the employed dentists talk about the same things. They value being able to take a decision without consulting an accountant in another city. They value that the boss knows their patient. They value picking up the phone to a colleague about a case without going through five layers first.

That is real clinical value, not nostalgia. It does not show up on a KPI board. The patients feel it anyway. Every time.

What private owners should copy, and what they should leave

I am not taking sides for the chains. I am not taking sides for private clinics either. I am taking sides for the owner who wants the best of both, and who now has to choose which parts of the chain structure she wants to build into her own clinic.

What I would start with is the lowest hanging: a written protocol for how a new employee is introduced during the first week. Not a policy. A set of guidelines with times, conversations and names. If you have replaced an employee more than once in the past year, this is where you are losing money you cannot see. The chains have this worked out because they have to. You can steal the system without stealing the rest.

What I would be more careful with is standardising clinical judgement. Where the chains have turned the screw too hard on case acceptance scripts, the patients have noticed. It has happened a number of times in the US and Spain, and the after-effects damaged the reputation of the whole profession. I have not seen it play out in Scandinavia yet. Patients come back to private clinics because they meet a dentist who listens, rather than one who follows a pitch template. Hold on to that.

The one exercise I would do tomorrow

What is the first step?

If I sat in your chair, I would write a list on paper tomorrow morning. Three columns. In the first: what the chains do better than me. In the second: what I do better than the chains. In the third: what from column one I will actually build.

Do not move everything from column one into column three. That is a trap. You are not building a small chain. You are building the clinic that took the best systems and kept the best relationships. That is a different clinic from the one a chain builds.

The clinic that wins the next ten years is not the biggest one. It is the one that built the system layer early enough for it to carry, and held on to what made her the one who got chosen in the first place.

One last tip

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