The Most Expensive Problems in Your Dental Practice Are the Ones No One Talks About

Why Another System Won't Fix a Conversation You're Avoiding

Every dental practice has problems that everyone knows about but nobody actually talks about. Maybe it is the assistant who is always late. Maybe it is the hygienist who never helps turn rooms. Maybe there is drama on the admin team that everyone tiptoes around. The owner knows about it. The office manager knows about it. The team definitely knows about it. Yet instead of addressing the issue directly, we often do what practice owners are really good at doing. We create another system.

We add another checklist. We change the schedule. We create a new policy. We have another team meeting. Sometimes we even address the issue indirectly by talking to the entire team about something that really only applies to one person. Then we wait and hope that somehow the problem gets better.

Usually, it doesn't. The reason is simple: sometimes the problem isn't the system. It's the conversation that never happens.

The Truth Everyone Knows but No One Talks About

There is a word I recently came across that perfectly describes this. It is "mokita," which refers to a truth everyone knows but nobody talks about. The closest expression we have in English is probably "the elephant in the room." What I love about the concept is the idea that the health of a community can be judged by the number of mokitas that exist within it. The more things people are afraid to bring into the open, the less healthy that community becomes.

Think about that in the context of your dental practice. How many mokitas do you have right now? There may be a team member with a consistently bad attitude. There may be someone who is not pulling their weight. Maybe two departments are frustrated with each other. Maybe someone has been ignoring a system for months and everyone else is annoyed that nothing is being done about it. These are usually not secrets. Everybody knows.

The problem is that unresolved truth does not disappear simply because leadership chooses not to discuss it. It leaks out in other ways. People gossip. Resentment builds. Team members complain to each other instead of talking to the person involved. Eventually, good employees begin wondering why they are putting in the effort when someone else is allowed to ignore the standards. What started as one uncomfortable issue becomes a culture problem because nobody was willing to have one uncomfortable conversation.

As leaders, we often convince ourselves that we are protecting the culture by avoiding conflict. We don't want to hurt someone's feelings. We don't know how they are going to react. Maybe we are worried they will quit. Sometimes we simply hate confrontation and would rather change the system than deal with the person. The intention may be good, but avoiding the conversation doesn't protect the culture. It allows the problem to spread through it.

Systems Can't Fix What Silence Protects

A few years ago, we had a recurring issue in my practice with a hygienist who could not stay on time. We had checklists. We had systems. We had worked on the schedule. We had tweaked things repeatedly, but no matter what we changed, this person continued running behind.

Eventually, I sat down with the hygienist and said something along the lines of, "Hey, something isn't working here and I want to talk to you about it. I don't want you to feel like I'm blaming you. I know you're working hard and I appreciate everything you do here. I'm not trying to criticize you. I'm worried about how this is affecting our patient experience." That one conversation accomplished more than all of the systems we had tried to put around the problem.

That experience reinforced something I think practice owners need to remember: systems can't fix what silence protects. We absolutely need great systems in our dental practices. Systems create consistency, reduce mistakes, clarify expectations, and allow a practice to grow without everything depending on the doctor. But a system only works when people are willing to talk about what happens when the system is not being followed.

Sometimes what appears to be a broken system is really an unspoken tension. We keep rewriting the SOP when what we actually need is an accountability conversation. We change the schedule when what we really need to understand is why someone cannot stay on time. We create another checklist when everyone already knows exactly what is supposed to happen and one person simply isn't doing it.

Before you change another system in your practice, ask yourself one question: Is this actually a process problem, or is this a conversation problem?

You may be surprised how often the answer is the conversation.

How to Have the Conversation Without Putting Someone on Defense

Knowing that a conversation needs to happen does not necessarily make it easier to have. Some people on your team can handle very direct feedback. You can sit down with them, tell them exactly what you are seeing, and immediately start working on the solution. Other people require a little more care. You know who those people are.

The goal is not to avoid being direct. The goal is to create enough safety that the person can actually hear what you are saying instead of spending the entire conversation defending themselves. I use a very simple framework for these conversations: Ask, State, Share, Seek.

First, ask permission to have the conversation. It can be as simple as, "Hey, can I talk to you about something?" You are letting the person know that you want to have a real conversation rather than throwing feedback at them in the hallway between patients.

Next, state how you feel about having the conversation. This is one of the most useful things I have learned to do because it allows you to address the reaction you are worried about before it happens. I might say, "I'm a little nervous to bring this up because I don't want you to think I'm blaming you," or, "I don't want you to hear this as me saying I don't appreciate you." I can explain what my intention is and what it is not. That immediately changes the tone because the person understands that I am not sitting there preparing to attack them.

Then, share the issue clearly. This is where we need to separate facts from assumptions. I don't want to say, "You don't care about staying on time." I don't actually know that. Instead, I can say, "I've noticed you're frequently running behind in hygiene, and when that happens it affects the assistants, the doctors, and most importantly, our patient experience." I am describing what I see and the impact it is having without making a judgment about the person's intentions.

Finally, seek to understand. Ask, "What's your perspective on this?" or, "What do you think is going on?" Then actually listen. We talk a lot at DPH about getting curious, and this is where curiosity becomes incredibly powerful. The goal isn't to walk into the conversation with a verdict. The goal is to get clarity so you can solve the problem together.

You Can Validate Someone Without Lowering the Standard

Once you ask someone what is going on, you may hear something you did not expect. Maybe the hygienist feels overwhelmed by everything they are expected to accomplish during the appointment. Maybe they believe they have been given too many responsibilities. Maybe they do not have the skills or training they need to stay on time. Maybe there is something about the system that really does need to change.

Whatever they tell you, start by validating what you can. "I understand." "I can see why you feel that way." "That makes sense." Validation does not mean agreement, and it definitely does not mean eliminating accountability. It simply means letting someone know you heard them.

You can understand why someone is struggling and still expect them to improve. You can acknowledge that the schedule is difficult and still say that patients need to be seated on time. You can understand someone's frustration and still hold them accountable for how they communicate with coworkers. Those ideas are not opposites.

In fact, people are often more willing to accept accountability when they feel understood. When every difficult conversation feels like an attack, people hide problems and defend themselves. When they know leadership will listen and be reasonable, they become much more willing to tell the truth, admit mistakes, and participate in solving the problem.

That is the type of safety we should be trying to create in our dental practices. Not a culture where nobody is ever uncomfortable, but a culture where people know they can talk about uncomfortable things.

The Cost of Avoiding the Conversation

When people do not feel safe bringing problems into the open, those problems become what I call energy leaks. Instead of talking directly to the person involved, employees talk to each other. They gossip. They complain. They replay the same frustration over and over. People begin working around each other instead of with each other.

You can feel these energy leaks when you walk into a practice. There is tension in the air, but nobody will say what it is. Leadership starts spending time managing personalities instead of improving the business. The office manager becomes exhausted trying to keep everyone happy. Strong employees get frustrated because they see problems that never get addressed. Eventually, the issue affects patient experience, team retention, productivity, and the overall performance of the practice.

This is why difficult conversations are not just a "culture" topic. They are a dental practice management issue and, ultimately, a profitability issue. Dysfunction is expensive. Turnover is expensive. Poor execution is expensive. Having a team distracted by resentment and gossip is expensive. A problem that could have been addressed in a 15-minute conversation can create months of unnecessary stress when leadership allows it to sit.

There is also another cost that owners sometimes miss. Every time the team sees leadership tolerate something that clearly violates the standards of the practice, the standards become a little less meaningful. If one employee is consistently late and nothing happens, everyone who arrives on time notices. If one person refuses to help the team and nobody addresses it, everyone who does help notices. If someone has a terrible attitude and leadership keeps looking the other way because that person is a high performer, everybody notices.

Your team is always watching what you tolerate.

Healthy Cultures Are Not Conflict-Free

I think many practice owners imagine that a great culture is one where everyone gets along and there is very little conflict. I don't think that's realistic. Put 20 or 30 people together in a stressful environment where they are working with patients, managing schedules, dealing with insurance, performing clinical procedures, and trying to keep everything moving on time, and there are going to be disagreements.

The goal is not to eliminate conflict. The goal is to build a culture capable of handling it.

When your team sees you consistently approach difficult conversations with curiosity instead of blame, something begins to change. People start bringing problems to you before they explode. They become more comfortable taking accountability because they know a mistake will lead to a conversation rather than an attack. Eventually, team members begin having healthier conversations with each other instead of always needing leadership to mediate them.

That is when the culture gets stronger. Problems still happen, but they do not sit underneath the surface collecting resentment.

These conversations may always feel a little uncomfortable, especially in the beginning. That discomfort is part of leadership. The good news is that the more often you have them successfully, the easier they become. You develop confidence that you can say something difficult without destroying the relationship. Your team develops confidence that feedback does not automatically mean punishment.

You are going to pay for these issues one way or another. You can pay with the short-term discomfort of having the conversation, or you can pay with long-term team dysfunction. The second option costs a lot more.

The Bottom Line

There is probably a mokita in your practice right now. You probably don't need to think very hard to identify it. It is that thing everyone knows about but nobody wants to bring up.

Maybe you have been trying to fix it with systems. Maybe you have been hoping it resolves itself. Maybe you have been waiting for your office manager to address it. Maybe you know it is your conversation to have and you simply haven't wanted to have it.

Pick one.

Ask permission to have the conversation. State how you feel and make your intentions clear. Share the issue without assigning motives or attacking the person. Then seek to understand their perspective. Listen, validate what you can, and work together on the solution.

You may be surprised by how much lighter the practice feels afterward.

Building a team-driven dental practice absolutely requires great systems. But systems only take you so far. At some point, leadership requires us to say the things that need to be said, hear the things we may not want to hear, and bring the problems everyone already knows about into the open.

Sometimes it's not the system. It's the conversation.