Full Transcript for From Single Chair To Small, Strong Group

over a practice or when you're setting up a squat. 29 00:05:09.320 --> 00:05:19.200 Um, so as long as it's in a really great location, then, uh, you know, you, you can grow that, no problem. It doesn't have to be the number of clinics, it can be the number of chairs. 30 00:05:19.460 --> 00:05:31.560 But quality definitely over quantity. Okay. So on that note, if you look at the current environment today, as a, as a, as a, an individual, you go to a hospital today and you have a-- 31 00:05:32.660 --> 00:05:45.420 you go to an NHS hospital and your normal care is you're waiting for quite a while, could be a number of hours. But-- and I suppose patients are used to that kind of mindset in the NHS world. 32 00:05:45.880 --> 00:05:52.590 But now, if you were going down the route of, as you've done in pr- private, private clinics, private care, um, 33 00:05:53.720 --> 00:06:02.620 how does a new group design a patient journey that actually feels like an oasis rather than a clinical assembly line like you might feel when you go to an NHS clinic or an NHS hospital? 34 00:06:04.256 --> 00:06:15.086 Well, like, like everything, I think it's all about the quality and the small touches. It's about the front of house. Um, and the first port of call has to be, um, top-notch. 35 00:06:15.156 --> 00:06:25.376 It's g- it's, it's customer service or patient care. Um, y- you know, you've got to have a bright, smiley face at the front desk, a very cheery voice on the phone. Um, that's where it all starts. 36 00:06:25.476 --> 00:06:37.106 Their first point of contact has to be, um, uh, you know, quite, q- quite a sort of wow, uh, service. And then little touches within the, in the, the clinic or, or little touches within reception. 37 00:06:37.156 --> 00:06:54.056 A nice environment, a bright environment, fresh environment, regularly changed, redecorated, um, is what i- you know, it takes so that a patient comes in and feels like they wanna take a deep breath as opposed to hunch up their shoulders with, with worry because the phone's constantly ringing and it sounds like intensive care. 38 00:06:54.576 --> 00:07:08.536 So these sorts of things matter, but again, it depends on your, what, what sort of, um, your ethos is within the practice. Um, these little things where the patient is treated like a VVIP is, is what matters. 39 00:07:08.816 --> 00:07:13.576 Uh, and that can be in a, in a wide variety of different clinical settings and non-clinical settings. 40 00:07:14.156 --> 00:07:26.836 Uh, the bottom line is the patient has to be on top of your list and on top of your wish list of, of who to treat really, really well, and then the rest follows. Okay. All right. So you've always said 41 00:07:27.816 --> 00:07:38.696 staffing, um, not staffing, location is an important aspect in dentistry, okay? As you mentioned that earlier. Um, now we're in a world of remote work and changing city centers. 42 00:07:39.896 --> 00:07:51.056 In your mind, someone who's been doing this for so long, what does the ideal 2026 location look like for someone who wanted to build a multi-site group? Because remember, patients work from home a lot more now, okay? 43 00:07:51.496 --> 00:08:02.336 Um, you ha- you had a clinic many years ago in Canary Wharf, right in the heart of the financial district. Um, would you open up one there again? D- just, just wondering what your thoughts were. Uh, really good question. 44 00:08:02.496 --> 00:08:11.236 I think, um, my-- the, the main kind of, kind of drastic shift in my mindset with regards to thinking about this, it has to have been COVID. 45 00:08:12.116 --> 00:08:18.216 I think prior to COVID, there was the life before COVID, uh, BC, and li- life after COVID, AC. 46 00:08:18.316 --> 00:08:36.126 So I think before COVID, obviously the, the high footfall, central city, London, for example, um, locations were, were key, uh, where everybody went to work and they saw you at work and, and, and that was, you know, uh, very visible, um, centers, um, and, and high footfall. 47 00:08:36.476 --> 00:08:48.576 I think after COVID, um, the, the big change has been, for me, the answer to this question would be still a high density population, but somewhere that's got a high residential population. 48 00:08:48.676 --> 00:08:57.486 Uh, and still maybe a, a nice village street or a, or a nice town street. Um, probably not in central London or centr- center of the city, wherever you are in the country. 49 00:08:58.096 --> 00:09:07.856 But, uh, somewhere suburban, where, as I say, there's a high density, but more residential and definitely somewhere close to a supermarket. We all know the power of the supermarket back in COVID. 50 00:09:08.276 --> 00:09:21.016 That never stopped, uh, even for a single day. So, um, yeah, that has changed. In other words, high density, but residential, but still a kind of affluent population, but that's just my business model. 51 00:09:21.476 --> 00:09:28.266 So people have to eat at the end of the day, as you said. They need to go to the supermarket. Correct. Correct. And that will never stop. So- Sure... yes. Okay. 52 00:09:28.556 --> 00:09:34.236 So now as, as you mentioned earlier, staffing clinics is a massive hurdle still in this industry. 53 00:09:34.696 --> 00:09:42.876 So if you were building a team from scratch today, how would you structure the practice culture to ensure that you're the employer of choice, so people would choose you? 54 00:09:44.336 --> 00:09:55.436 Well, I guess, again, since COVID, things have changed a lot, and Brexit, because, um, there's been so much movement of labor, uh, you know, uh, well, to, to, to Europe and beyond. 55 00:09:55.536 --> 00:10:08.886 Um, and so I think the, the sort of, uh, people that are, are now looking for jobs and certainly auxiliary, uh, team members, um, they have got used to this kind of hybrid working pattern. 56 00:10:08.956 --> 00:10:18.006 And even though within the dental industry, i- that's not really been

a possibility, far less than other industries anyway. Uh, people sort of have that expectation. 57 00:10:18.096 --> 00:10:28.296 So if you can, if you want to be an ideal employer, if you can, either instead of, let's say, having two or three or four full-time members of staff, what you might do is do split shifts. 58 00:10:28.356 --> 00:10:36.856 So you might have some people who want to work mornings, and they want to get home for their children, et cetera. And that's fine. If your business can allow that, then why not? 59 00:10:37.116 --> 00:10:41.975 Why not listen to, to the, the sort of l- uh, labor demands, I suppose, that are, that are out there right now. 60 00:10:42.496 --> 00:10:47.656 Uh, and others, uh, for example, they might have other issues going on in the morning and they-- but they can do the afternoon, evening. 61 00:10:47.696 --> 00:10:56.476 They can't get to you in, in rush hour, so they can-- you can then offer them a split shift, and they can do afternoon, evenings, or they can do-- or you get separate peop- members of staff at the weekend. 62 00:10:56.816 --> 00:11:09.536 It's a little bit more of a hassle, but it certainly can be done where you're listening to the demands and needs of your team members, but still running, uh, a viable business whereby, um, everyone's a winner, I guess. 63 00:11:10.036 --> 00:11:17.586 Sure. Okay. Thank you. I suppose now let's move on to something more kind of financially orientated, I suppose, with my he- hat on. 64 00:11:18.176 --> 00:11:29.296 Um, now, in, uh, in the DSO playbook, we talk about EBITDA and the predictability of EBITDA above all else, okay, for folk-- for groups to focus on in terms of profitability for, for valuation purposes. 65 00:11:29.316 --> 00:11:41.256 But from your perspective as a clinician, okay, and this is sometimes where it gets lost in the translation by many investors, is that ultimately EBITDA is important, but what do you measure instead? 66 00:11:41.536 --> 00:11:49.616 Okay, what are the metrics that makes you know or makes you happy that, okay, my clinic, so if we get that right, the EBITDA will follow anyway. 67 00:11:49.696 --> 00:11:53.076 Okay, so from a clinic-- I suppose from a clinician's point of view, what's the most important metric? 68 00:11:53.136 --> 00:12:01.876 Yeah, I, I get the question, and I think it's, uh, obviously EBITDA is very, very valuable, certainly when you're looking at your business as an asset, and certainly when you're looking to buy and sell. 69 00:12:01.896 --> 00:12:26.748 But from a pure clinical point of view, I suppose, you know, now when I look at the, uh, at the practice, I suppose my measure of success are full books because, um, the practices are mature enough To be, uh, looking at, um, recall appointments, i.e., you know, the, the quality of your dentists that you have, in my case, associate dentists, are measured at the six-month stage or the three-month stage or whenever they recall their patients. 70 00:12:26.808 --> 00:12:45.098 If the patients want to come back and see them and agree to booking that at the time that they treatment complete or, or they finish their last course of treatment, then that to me is a real measure of success in that I've got my, my team right and, um, and the customer service is right and, uh, you know, everything we're doing is aligning. 71 00:12:45.708 --> 00:12:59.168 Um, if however, they see these dentists or clinicians or hygienists, um, and, and they sort of don't book back and you've got empty books in three months or in six months or whenever or even next week, um, and, you know, everything else is equal. 72 00:12:59.228 --> 00:13:06.608 In other words, the financial s- situation of the country is okay and, um, there are no tsunamis or there's no COVID or there's no- nothing else. 73 00:13:06.688 --> 00:13:16.668 If everything else is equal, then to me, full books and, and good comments and good reviews, um, are a real measure of success. Okay. 74 00:13:16.828 --> 00:13:28.148 No, it's very, very interesting because, uh, me from an accountant's perspective is valuation and EBITA, you from a clinical perspective is the chair occupancy ultimately and, and positive comments. Correct. Yeah. Yeah. 75 00:13:28.208 --> 00:13:38.708 Okay. Very- Happy patients at the end of the day. If you've got happy customers, happy patients, um, you've got a really good, viable, and successful business. Correct. And that translates ultimately into- Correct. 76 00:13:38.738 --> 00:13:48.488 -profitability. EBITDA. Yeah. EBITDA. Okay. All right. So you've over the years set up multiple practices, um, i- in, across the kind of Southeast and London area. 77 00:13:49.808 --> 00:13:57.468 What is the one mistake you made early in, in the early days that you would be most, would be m- be most careful to avoid if you started another practice tomorrow? 78 00:13:59.728 --> 00:14:06.468 If I were to open up a squat, um, again tomorrow, I think that the biggest mistake I made right at the beginning was just going with one provider for everything. 79 00:14:06.928 --> 00:14:18.208 Not having the knowledge, being very green, uh, not, not sort of getting the best of three quotes in, in anything really. Um, and as a, as a result, like many others, you know, you tend to get ripped off. 80 00:14:18.328 --> 00:14:29.728 Um, I don't think I'd make that mistake again now because I've got my little black book of, of everything from, uh, electricians to chair providers to, uh, sundries, um, and also specialists. 81 00:14:29.808 --> 00:14:36.768 So, uh, I'd like to think I wouldn't be making that mistake again, but made plenty of mistakes across the years. Sure. 82 00:14:37.168 --> 00:14:49.448 I suppose, okay, I suppose a closing question here on this short podcast today is, um, we have lots of listeners who are young dental associates, not just here in the UK, but all over the world, male, female. 83 00:14:49.528 --> 00:15:02.548 Um, if you had to

give a 60-second elevator pitch, who wants to start their own practice or even their own group today, what would your golden rule be? Um, [chuckles] great. That's being put on the spot. 84 00:15:02.908 --> 00:15:13.948 I think, um, my elevator speech today would be, let's say, I mean, I, you know, I wouldn't say I was a specialist, but I, my, my sort of pet passion is, um, squat practices. 85 00:15:14.408 --> 00:15:22.308 So I, I suppose my pitch would be more related to the squat practices. Um, and things have changed so dramatically over the last 22 years. 86 00:15:22.328 --> 00:15:28.238 For example, the whole E-class planning permission has changed the whole landscape of opening up squats. 87 00:15:28.568 --> 00:15:44.808 Back in the day, it was D- D1 planning and, you know, we fought long and hard to get D1 planning status for the, certainly the five clinics that we looked to open, um, which were anything from, uh, architectural offices to laundrettes, to basement car parks and, and so on and so forth. 88 00:15:45.138 --> 00:15:50.268 And there was such a joy in actually converting them, but it was a bit of a battle to try and get that planning permission. 89 00:15:50.638 --> 00:16:02.428 Nowadays, you don't have to worry about any of that, as a result of which, many, many more, uh, young, uh, dentists ha- have sort of joined the force, as it were, to open up squat practices on, on busy high streets. 90 00:16:03.008 --> 00:16:15.648 What that has done though is it, it has flooded the market, um, with providers, and that has its own problems with competition and so on and so forth, which, you know, is not-- competition's never a bad thing, but, um, 91 00:16:16.588 --> 00:16:26.668 you know, a, a little bit of experience with sort of handling practices and business does go a long way. So, uh, good and bad has happened over the last, you know, 22 years. 92 00:16:26.708 --> 00:16:40.588 But, uh, like I suppose my advice was, uh, then, is exactly the same now. It's all about location, location, location. Okay. And then one, one final question to kinda just get your thoughts on is 93 00:16:42.168 --> 00:16:54.168 when we, when you started, when we started these group many, many years ago, back in 2002, 2003, okay, we were fresh-faced, kinda naive, not really sure, thinking, "Oh, okay, we can start a group up." And 94 00:16:55.368 --> 00:17:02.768 you, you saw the groups of other industries like coffee shops like Starbucks or Costa and, and we thought, "Oh, well, maybe we could mirror that." 95 00:17:03.288 --> 00:17:13.368 But the reality is that running dental clinics is very, very different to running a, a franchise coffee chain or whatever it like, as, as, as, as I just mentioned. Okay? 96 00:17:13.908 --> 00:17:24.868 So, and we've seen many, many groups emerge over the years, but struggle really with keeping the soul of the practices alive whilst they try to scale. 97 00:17:24.928 --> 00:17:34.328 So from your perspective, how do you, how, how, how do you, or how do you suggest people keep the soul of the practices alive whilst they try to scale? 98 00:17:34.428 --> 00:17:45.108 Um, I don't think I've seen many people do that particularly well, but I've seen that worked well in the Neen Tree when you got to a size of about five clinics. Um, but going beyond that, it gets even harder. 99 00:17:45.748 --> 00:17:49.728 What would your advice and thoughts be on this point? I think you're absolutely right. 100 00:17:49.928 --> 00:18:01.028 Um, the difference between a coffee shop and a dental practice is, is very, very difficult because, uh, I suppose a coffee shop or a chain of shops like, I don't know, H&M or Marks & Spencer, et cetera, they all are product-based. 101 00:18:01.118 --> 00:18:11.128 And I suppose if you've got the general culture, uh, or staff, um, ethos or customer service, then you're kind of onto a bit of a winner because what you're trying to sell is the same product. 102 00:18:11.208 --> 00:18:22.858 You've just gotta look after your customers and how you sell it to them or how you market it or how you label it. But in a dental practice, it's all about the service, and it's a need and want-based industry. 103 00:18:23.368 --> 00:18:30.048 But patients really, really rank their dentists based on the, the, the care levels and their personalities. 104 00:18:30.128 --> 00:18:36.068 In other words, the, the dentist's personality or the clinician's personalities, as well as front of house and nurses, of course. 105 00:18:36.848 --> 00:18:47.008 So, um, I think, yes, g- getting to, let's say, five clinics is, is doable, I suppose, because you can try and translate that culture across the board. 106 00:18:47.028 --> 00:19:05.068 But getting beyond that is very, very hard unless you've got a sort of owner-operated person within each clinic or a heavily incentivized, let's say, clinician or somebody who's got shares or some other financial, uh, incentive to, for the clinic to do really, really well. 107 00:19:05.468 --> 00:19:11.468 If that's the case, then the clinic has a chance of translating that vision across the board. 108 00:19:12.088 --> 00:19:24.308 Um, but if not, then it becomes very, very difficult as you scale and grow because then it, then it starts to become about the numbers, uh, and less about the ethos. Very interesting, Smita. 109 00:19:24.388 --> 00:19:34.828 Well, thank you very much today for sharing your insights, uh, of, and your experiences. Um, um, so this is Arun Mehra, and we've had Dr. Smita Mehra talking about- Thank you very much. Yeah, no problem at all. 110 00:19:34.908 --> 00:19:52.368 On, on topics ar- sur- surrounding DSOs. Uh, and, uh, watch out for our next, uh, podcast soon. Thank you. [outro jingle] Thanks for listening in to the Dental Business Guide podcast. 111 00:19:53.008 --> 00:19:59.768 We welcome your feedback, and if you're enjoying it, please let your friends know too. Until the next time on the Dental Business Guide podcast.