202: Innovative Strategies for Transforming Patient Experience with Tend Dental

The average dentist NPS is 1. And this is a scale of 0 to 100. You can actually go negative. Cable television is negative. Your dentists are three points above cable. Sounds like we've got a problem here.

Hi, I'm Emmett Scott, and just like you, I've had my ups and downs in the dental industry, but times are changing. The DEO has built a map of how to succeed in one of the most challenging industries to navigate. On this show, we talk to dental industry leaders, solve problems, and get you the answers you need to these challenging times and thrive. Welcome to DEO's Growth Secrets podcast for dental organizations. Now let's get started.

All right, welcome, everyone. This is Jake Pool, the CEO of the Dentist Entrepreneur Organization. And welcome to DIO's Growth Secrets podcast. Today I have a very special guest and I'm excited to kind of bring into the limelight here in dentistry who's been working, gosh, I don't know if it's behind the scenes, but definitely inside of dentistry for a few years here and has a lot of interesting experience when it comes to patient experience and growing. One of the premier dental groups, really, in all the U.S. so, Andy Grover with 10 Dental. So, Andy, how are you doing? And maybe you can give the audience a little bit about your background.

Sure. Thanks, Jake. I'm Andy Grover. I'm one of the three co founders of Tend, a sort of urban DSO based between New York and Nashville. We started in 2018 and, well, we started sort of ideation 2017, 2018. We launched in 2019, six months before the pandemic, and then have grown from October of 2019 until now. We have 25 or six locations open across six different markets. And I think there will be up over 30, 35 by end of year early next year. So, yeah, that's. That's sort of what we're. What we're up to.

Yeah. So. So 10 is very unique. I would love to hear a little bit about. For those that don't experience 10. I think anyone in the kind of Northeast, especially New York City, knows. Knows this group very well. I think you guys are very innovative, but we'd love to hear kind of how do you. How do you think about, you know, your. Your group there?

Sure. Thanks, Jake. So when we were thinking about 10 and when we were kind of figuring out where. Where there might be a hole in the marketplace, I think it kind of came down, while it came down to really two areas. One, from a coverage standpoint, right, 40% of the, I don't know what we're at now for dental spend in America, 260, 280, I don't know where we are. Billion dollars. 40% of that happens in the top 10 MSAs. And so in the same way that probably 40% of the people live in the top 10 NSAs, like it's not a. And and MSA is metropolitan statistical area. So think kind of city geographies. Yeah, big cities. So top 10 biggest cities and most of slash all of DSOs really I won't say all, but vast, vast majority have been focused on suburban, exurban, even rural, either through roll up or some combination of roll up and de novo. So the kind of core business was, hey, what if we became the DSO that really figured out the urban business? Right? So like you staff it differently, you, you have different kinds of customers. You know, everybody needs sort of the same kind of the same kind of work done frequently. But it's a different, it's. They're less likely to have children. They are, they're less likely to have, you know, more than two, especially in New York. They tend to be wealthier, they tend to be more well educated, they tend to be more, they're familiar with kind of premium brands. And so we thought okay, well that's interesting. Just from a, like there seems to be a gap in the market here. The DSOs, I think wisely having the scars to speak to this, we're really focused on kind of greenfield development. It's much easier. You can put up a pad, throw up an office, build it as big or small as you want. You're staffing it relatively easily, especially post Covid. I think everybody is dealing with crazy staffing issues now. And so they went kind of along their merry way. And if you think about kind of growth in America over the last five decades, it's really like even take away kind of the last 20 years of the. We'll call the re urbanization of the kind of downtown cores, all the condos in, you know, downtown LA and New York and Austin, like stuff like that. But in general we've moved further and further out suburban, exurban. And so they kind of went where the people were and we're going and totally smart. But 20 years, in the last 20 years there's been a real real re urbanization. And you know, we sort of thought this was an opportunity. So that was one piece of it. And then the other piece of it was this feels like a wildly fragmented business. Even the biggest DSO still has less than 2000 locations. I actually don't know the exact number, but I think it's less than 2,000. And there were. I think there are 85,000 dental locations, something like that in America. So, like, you take the top four altogether, and they have 5% of the pie. Like, it's very much mom and pop still. Right. Even with DSOs growing and regional and. But it's still very mom pop. So we said this is a really fractured industry. That's interesting. A lot of spend. That's interesting. And to be candid, the patient experience sucks. Like we use as a euphemism, as a culture. It's like going to the dentist as something bad. Like, what was that like? Oh, God. It was like going to the dentist. We know that means bad, right? So when your bar is that low, you have nothing kind of, but upside there. And we did a ton. We did about a year and a half of research just on kind of dental. Lots of other parts of the world there, but we did a lot of research. And one of the things that sort of this comes out of the tech industry is this concept of nps, which is net promoter score. So if any of you, any of us have gone to have a service provided for us, and you get a text afterwards or an email after the word that says, tell us how we did, um, you'll notice all of the questions they have to be worded very specifically, and they kind of all are worded the same. And it's basically a bank shot at customer satisfaction, which is like, how likely are you to recommend? Right. And so this Google, Google was sort of one of the big innovators around NPS 20 years ago, 25 years ago. And this has really leaked into the Silicon Valley nomenclature. Consumer, packaged goods, consumer services. This has really become one of the big metrics that you use. So NPS, the average dentist, NPS is 1. And this is a scale of 0 to 100. You can actually go negative. Cable, cable, cable. Cable television is negative. So you're like, dentists are three points above cable. Sounds like we've got a problem here, right? And especially as you're looking at. Especially as you're looking at culture and just the way that patient demand. And I use patient and consumer pretty interchangeably because I think they are. And I come out of. We'll talk about this in a minute. But I come out of a very specific kind of world in healthcare that was really bleeding edge around the notion of, like, patients are consumers and we can let them. Can. They should be able to keep their consumer expectations in the Dental chair or in the patient chair or in whatever. And so taking a consumer lens on the dental experience, putting like I kind of, I come out of sort of two or three different areas. Retail, hospitality and then healthcare has been this weird Venn diagram of my career. And if you take that lens and you look at the kind of soup to nuts experience of going to the dentist in general, it sucks. And it, it's sort of unlike anything else you're doing as a modern urban consumer in 2020, then 20, 2018, 2019, but still 2024. So that those were kind of the dual opportunities. And we thought if we win this, like if we win the patient experience and we're kind of fishing in a very target rich environment that together I think can make a really strong, a really strong bankable business. Long winded answer?

No. I mean I think that was really important to hear. I think the people that are generally attracted to DEO and our kind of community are a little more ahead of the curve, which is ahead of the average on patient experience. And when they think about business, great. But that does, but that doesn't mean they're anywhere near the expectations. And I think the people that listen to us are like, they appreciate kind of the harsh reality of like this is where this industry is. For all the amazing and beautiful things that we're doing, there is a lot of room to grow especially relative to what consumers want. You know, we oftentimes call dental retail health care. It really is a retail environment. It is disposable income that, that folks are trying, that people are trying to capture and not just so what consumers are wanting. And really where the rest of businesses in industry is, there's a lot of other industries are able to satisfy customer demand here and we're just, we're just not there. So you saw that five or six years ago. And so far I would say proving to play out for the places that you guys are playing. Yeah, a lot of success with this hypothesis.

Yeah, yeah. And I, you know, we, you get a little lucky, you get a little, you're a little smart, you get a little lucky, like I'm sure parts of that and then you get Covid which is very unplug in general. I think it really, really resonated with our audience. And if you think about York and specific very specifically it's a little bit. And these, these big cities are also more transient. Right. So you have on sort of undental potential patients out there and you move all around New York City. And one of the things if You've lived here or, you know, Chicago or other big cities, you know, you move. It's a joke where like you move eight blocks and your whole world change. You have a different dry cleaner, you have a different barber, you have a different groceries. Like your whole world changes. So if you're moving around the city, you're going to want a different dentist. And we thought, well, but if we're everywhere, you get to capture them, right? So they can move from Williamsburg and then they're going to have kids and then they're going to be in the Upper west side. Great. We got you in both places. You work down on Wall street. We got you. So that was part of the thought process as well. But yeah, it's really resonated, I think that we, we're certainly not the first obviously dental company, but particularly DSO to think about, call it brand writ large. The idea of brand. Yeah, but we really, I think, blew past what other people were doing and we really thought about it in terms of not just like brand for brand sake, but driving, driving, performance, marketing. Right. So if you are having a social, if you have a social strategy and you have an influencer strategy and you have a TikTok strategy. Nnnn. Now I, I completely understand that like, you know, mom and pop dentists are not going to have a social team, but I do think that there are things that you can do much, much lighter weight. You know, we designed the offices, we get a lot of kudos. And this is my, my world, so my baby. And I'm obviously proud of it. But it's a. We really thought of the whole experience as an ecosystem and a big part of that ecosystem that both enables and reinforces the brand is the office. We call them studios. We call them studios very specifically because it takes some of the medical out of it. And we designed it to be like, to be like put on Facebook like we wanted you to our Instagram. We were sort of post Instagram and TikTok.

I love that. And before we get to. I want to go through the exact patient experience and how you're thinking because this, this is where it gets to mad scientist level. And you're one of the, you know, most qualified and probably put the most thought towards this of anyone in the world. Truly, I really mean that. So in order for people to understand that, I would love to hear a little bit about what got here, your background before you decided to tackle mental.

Yeah, I will caveat the first part of that as I am part of a team and it was Absolutely a team effort. And so I, I brought a lot to the table. But there is in no stretch of the imagination there were a lot of other really talented people at the table. But my, my kind of path specifically, I really grew up in it, in real estate. Like it's real estate has always been. You know, my parents tell stories about me being 8 and 9 and going through like the open house ads and circ and dragging my poor parents, who have moved three times in 50 years of marriage to open houses and having opinions on value of real estate at 9. So like very early on, real estate was a thing that I liked. Also all of my jobs in high school are retail. And so I sort of have this natural retail brain. You know, you do your 20s, blah, blah, blah. Basically my entire career has been in retail or excuse me, and in real estate. I went to grad school at nyu. Did they have a. Basically an MBA in real estate. You just get to nerd out about real estate for two years. It was dream come true. And after that kind of launched me on this commercial slash retail path that really was not healthcare. My first gig was Chevron, which sounds really lame. And it, it was kind of very highly corporate. But man, are they good at the retail game. They know retail. It was like PhD and in retail and site selection. And so it was a great couple of years. I found my way to a company called One Medical, which is based in Seattle, or, excuse me, based. They were bought by Amazon. So now it's based in Seattle, but was originally based in San Francisco, founded by a guy named Dr. Tom Lee, who is sort of in the mad scientist way, this wild combination of md, MBA burner, like goes to Burning man and so has this very like great brain, like really fun, amazing brain. And I started at One, at One Medical. I was their first like, call it traditional real estate hire. Other people were. There was a very, very small team, There's a construction guy and the woman who hired me had some real estate experience, but I was like kind of hardcore leasing real estate and I hit there. They had about 25 locations across maybe four or five. Basically the size 10 is now. I started there. They had just pulled in some funding round and they wanted to grow and so I was going to do their real estate and it was like, okay, well this weird thing, healthcare. There was a part of my path that I was going to be a doctor. So this also made a lot of sense where like I wanted to be a doctor at one point. And it's still great. And the real is I got to sort of sit at the knee, so to speak, of Tom Lee, who was a real innovator in patient experience and consumer experience starting in about 2007, 2008. So he was like, way ahead of the curve. So now it's not that weird that you get to email your doctor in 2007 and eight when he was asking the question, why the heck can't we email our doctors? And like, that was like blue sky thinking. By the time I got there in 2012, 2013, 14, something like that, he. So he had a few years, it was still totally novel. I would explain this to landlords and they would just be like, wow, that's really cool. Now 12 years later, it's sort of table stakes. But I also then got to really learn about patient experience and to really learn about the ways in which space design can help and influence a patient experience. And dental's different and we'll get back to that. But if you think about primary care, primary care at its boiled down core is two people having a conversation, one of whom knows a lot about bodies and one of whom have a body, and you're going to talk about it. That is like, right, you. Other types of healthcare, like, are much more invasive and oncology is a different thing. And, but, but primary care, you are having a conversation about your body and we have, you know, at that time, think of like kind of probably the primary care experience, maybe you still have, but definitely like when you were kids and a medical assistant would come out and weigh you and then, you know, you tell your story three times, you're with the doctor for five minutes, they slap your knee, they move on to the next thing. And Tom really was like, this sucks. Like this. We can do better than this. Let's, let's think about this from a consumer lens. And so that influenced the entire company. And so he basically rewrote and picked apart what the primary care experience got rid of. Medical assistance. So at one medical, the doctor comes and gets you and takes you back. And that might, you might think, oh, isn't that nice? Like, that's nice. The doctor comes and gets me. What it really means is your appointment starts right away and so you can sort of get the Wiggles out. I call them, like the silly small talk we all do with the doctor that's like, oh, yeah, what were you doing last week? Hey, how about the game? How are the kids? Like, whatever it is you're doing to get the Wiggles out, then when you get into the room, you can start to have a more thoughtful, rich, efficacious conversation faster. And so this 20 minute appointment, and they also do 20 and 40 minute appointments, which was a really big innovation, essentially you can provide better care. And so your doctors are happy because they get to practice medicine like they thought they were going to in medical school. And your patients are happy because they're getting to talk to sort of talk and tell about their story. Right. And so how do we in primary care create an environment and you can go as big as you want on that word environment to booking, to payment, to app, to website. How do we create this environment, this ecosystem that this patient is going to live in that boils itself down to a really good conversation with somebody who has a body and somebody who knows a bunch about bodies. And so when you start to pick that all apart in every single place, and we did, what are the emotions that the patients are feeling right there? What are the operational needs of the office? Like, how do we turn these rooms? Okay. Like there's, it's really, it gets complicated really fast and it's really fun. Like to me it's like nine to five dimensional chess. And hotels have been doing this for years, right? Like we've all gone to a great, hopefully we've all been able to go to like a great hotel where they are anticipating needs and you feel cared for and yeah, it's expensive, but you feel like it's worth every single penny and wow, right like that that's why can healthcare that be the North Star in healthcare instead of. And Motel 6 has a place in the world. But like if that's your bar, the pretty low bar. So long story long, I got to learn all of that with this real estate background, eventually sort of took over design and construction and real estate into this thing called development. And that really was a big step function change in my career. So if grad school was grad school, that was my Ph.D. and I was, you know, kind of after four or five years at one medical in a like not, you know, braggadocious way. My mom's word, she loves the word braggadocious. Braggadocious way. There just weren't that many people that had done what I had done and scaled. And so I had taken one medical at that point from 25 to about a hundred, both de novo and corporate on sites and so had truly scaled. I knew they were going to IPO in a year and so which they ended up doing successfully. They ultimately were acquired by Amazon. So sort of two successful exits for them. And I really Think a lot of the reason One Medical has been able to do what One Medical does is this patient experience that is still very sacrosanct at the company. Now I think they have two or three hundred locations. But I got to hit it like this very sweet spot, Tom's last couple of years. And then I also got to learn from this guy Amir, who had a much more traditional healthcare background running bigger companies, which was another great learning experience. So that all was what came. I came to 10 with yeah, it's

this, it's this intersection of, of health care, retail sales really and hospitality all kind of intersecting into one.

Yeah.

And so you know, One Medical is kind of now Amazon's Whole Foods. Right. It's like their medical Whole Foods and that many people even know that. So Andy, what's kind of a just rapid fire. What are just some other innovations that One Medical didn't. Patient experience that some of them might be. I mean they probably led the way and they're. You can see that everywhere now. Although a lot of those things still don't, still don't happen in a lot of places. Kind of like bullet or some bullets on some other end of it.

Yeah. So like they're, you know, back end. They had their own emr, right. So they had developed their own emr, proprietary emr. I think that was money well spent. But like they spent a lot of money and a lot of time on it. But back then they had that. They really thought about their clinical experience. Right. So they knew exactly what their sort of pitch to clinicians would be. Right. And you have these clinicians who are coming from offices where they're seeing 29 or 30. 30 patients a day. And when Medical's promise was we won't make you see more than we. You don't. You 16 will cap you at 16 patients a day, 16 yourself.

How do they, how do they make that the economics work there?

Yeah, they, well the do. I mean frankly the doctors are paid less. So it's a, it's a quality of life like and one medical. I shouldn't say that One Medical is going to, I'm going to get a call from their chief people officer. But they, they don't overcome. Right. They, they know they're providing a better lifestyle for a lot of these providers that want to practice medicine this way. They want to, they want a more humane way to practice medicine and so they're able to, they're able to do that.

Non, non monetary compensation.

Right.

I mean like lifestyle is really becoming a highly sought after type of compensation.

Compensation, yeah. Correct. So. So that was one of the things. I mean, the app, they are. They were the first, if not the first, then very near to it. The first company, first health care provider, primary care doctor that, like, the whole thing lived in your phone. It wasn't like kind of this nothing burger app that you, like, weren't able to do. It was your. Your charts are in there. You can do your. You can email, text, your. Your provider or your provider's team. It all lived in the app. And that was like, nobody had done that before. Like, nobody had done that. And guess what, you're real sticky. You become very, very, very, very sticky. Like, they did all of these little touch points to keep their patients sticky and. Or to be sticky to their patients, and it really worked. Like, I know very, very few people. 100% biased, and they know that I work there, but I have met very few people who have joined One Medical and then have decided, like, it wasn't worth. And that was the other thing. Pricing was also really innovative. The One Medical membership is 100, 200 bucks a year. And if you are having Starbucks twice a week, like, it's. It's like right at that sweet spot of pricing where you're like, oh, that's 200 bucks to, like, get into the doctor when I want to get into the doctor, and to be able, like to get in next day and to be able to do all this stuff, that's totally worth it. And so that's another party economics, right? They had this revenue stream from the membership.

Yeah, yeah. Even though it's, like I said, it seems like it's table stakes, I. What percentage of people are actually using an app in any kind of primary care? Still not happening a lot. Right. It just shows the kind of blue ocean that's still out there. And then. So let's take this to Dentistry now, because I think it's super interesting. You took all of this and, you know, you helped. Helped one medical exit onto Amazon. They're still going to continue to thrive there. And you took all this to dental. So when it came to 10, you and the team.

Yep.

Was a team effort. You guys analyzed the patient experience. You literally took it from every single step. You know, from like, pulling into the parking lot, from the walk to the parking lot to the door. How they open the door, they open up. How bright is it? I mean, I'm imagining every single. Over a year and a half. You analyze this, right? And you probably asked yourself a whole bunch of why in the world. Is it like this? Questions. Right?

Yeah.

So what did that lead to? Like maybe give us a. What does a 10 patient experience look like?

Sure. As far as, you know. Yeah, sure. So I think a couple of the things to caveat this with is, you know, in the. The way that like blessed naivete. None of us really came from dental. So I came from one medical. One of my co founders came from the digital product world in mental health and the other one of my co founders came from the aligner world. And so kind of if one medical had a baby dental products, like kind of there, right? But then we other. We had other brilliant people that were coming from places like Blue Apron and hellofresh. Right. So they really got brand and they really got like, you wouldn't think these things together would make greater than the whole, but it really ended up being that way. And so we thought about everything. So I always really design from like the five senses, right. And I try and because I wasn't a dentist, we obviously had dentists around the table as well. But I have been a patient for 40 years and that I know very well and can tell you what it's like to be a patient. But I had a particular patient experience. I got super lucky and had good teeth. My parents did. We had fluoride in the water. My parents made me brush my teeth. And so going to the dentist until I was about 35 years old when I got my first cavity was literally just gold star, like, good job, keep it up. So I loved going to the dentist. My teeth felt clean. It was great. I know a lot of people don't have that experience and some people have a much worse experience. So I try and get into the emotional space of what is the sort of range of possibilities for emotions in going to the dentist. And this is directly from primary care. And in primary care it really is. We thought about this a lot. You have no idea who's coming through the door and you don't know what they're thinking. And it could be she could be coming in for some travel shots because she has just gotten her first sort of overseas assignment for work and it's kind of cool and she feels kind of like badass about it and she's got to go overseas and like it's. She's doing it on her lunch hour and da, da, da, da. And she's working the whole time and it's not a big deal. Or he's coming through the door and he found a lump and he hasn't been to the Doctor in three years. And he's losing his mind inside. Both of these people are coming through the door. They look the same. They both have Starbucks or whatever coffee they're drinking. They're right. They're both the same. How do you create an environment to hold him and, like, meet her expectations? Right? So how do you do that? And you are kind of left with the five senses, Right? How do you design around those people? Now, gratefully, I found quickly in dental, that sort of range is a little bit smaller, Right. And maybe not quite so dire on the. On the bad side, right. You either go from like, I love going to the dentist. A small minority. I don't mind going to the dentist. Going to the dentist. Something I have to do twice a year. It's not a big deal. And then there's people that are really afraid, and we really thought a lot about them, and we thought a lot about shame, because I think shame comes into why people aren't going to the dentist, Right? So we really thought about the emotional experience here. So not that we didn't care about, like, the people that liked going to the dentist, but we knew we could meet their expectations, like, make a cool experience. They're going to, like, love going to the dentist even more. These people. How do we think about these people and how do we get them through the door and how do we get them calm and comfortable? Right? Because in the same way you want to have this experience, somebody that knows a lot about mouths and somebody that has a mouth. Now, granted, you can't talk quite so much, but sort of same dynamic except some really interesting changes here. But so how do you think about this person over here on the scared section and, like, what is making up that fear? Right? And we ended up realizing that it was a lot of. A lot of shame, a lot of judgment, right? And a lot of times, like, you can get kind of emotional. Like, a lot of times people have shame and judgment around their. Their oral health care for things they had nothing to do with it, right. How much money their parents had growing up, where they grew up. Right. Like a lot of things that they have. No. That they have nothing around. Like, they can affect effect, but it's causing them shame as an older person,

bone structure, just how they're.

Right. Yeah. What's your DNA? Right. Like, I got lucky, somebody else doesn't. Right. So there's a. A million things that affect kind of your mouth and then how you feel about your mouth and how you feel about yourself. And God forbid, though, happens more frequently Than, than I'm sure any of us would admit. There's some really not great dentists out there that have scarred people in a really bad way. And you know, so how do we think about that? How do we create a calming, soothing environment for those people? How do we hold their hand? So we kind of came up with different archetypes and how to address them. Right. And so there's a ton of scripting around how to deal with somebody who's really, really scared. And we were never going to be the people who didn't give if nitrous was the thing that was really going to do it. Okay, I'm probably last ditch effort there. But like if we need to get to that and we get there, that's okay. And we ended up, that ended up being really powerful. And so, so there's part of this like patient experience for patient experience's sake. But the thing that was really interesting to my business mind in dental versus primary care, primary care is this weird triangulated and real weird triangulated relationship. I think I just did a square of patient provider insurance which you technically have in dentist dental, but not in the same way. So in primary care that the patient's going to say yes to most anything because they're not paying for it or they're not paying for the full freight of it. We're paying for more of it than we used to, but you're still not paying the full freight. So testing. A test, sure. You want to send me for any, you want to send me to the X ray. Okay. Like you, you say yes. Right. In dental we have this. I, I very quickly starting kind of digging into dental. Dental. I was like, oh, there's a buy moment. There's a buy moment. And you can call it whatever you want to call it, but there's a buy moment. They have to agree to spend their money on the thing that you are offering. Right. It's no different than Apple. It's no different than anything else. And the way dental insurance works, it's basically prepaid care. We all have 90, whatever, we all have the same dental plan, right? You get two, you get two cleanings a year and then you get 300. If you're, if you're a teacher or you work at Goldman Sachs, you get 300 or 3,000 or $10,000 a year towards anything above that. And so for the vast majority of the population, maybe you're going to get that first filling free, quote unquote free, but probably not anything beyond that. You're Paying for. So this is a buy moment. And how do you not only address this patient experience, patient experience sake, but how do you get them to trust what you're saying in this what will be transaction, which kind of muddies the water, but if you're not gross about it, it doesn't, right? Because if you're providing, if you're, if you're providing care at the top of your licensure, if you're doing the right thing, if you're not overselling, if you're kind of hitting them where they need to be to take care of their teeth, there's plenty of money in dentistry, doing it just straight, right? Like there's plenty of money in dentistry. But how do you get them to believe you? Because everybody on that spectrum, many people have had the experience of going to a new dentist. Nothing's changed with your oral healthcare routine. But now you have six new cavities. We've all had this experience. And you go, what? The last guy, I was going to him for 10 years and barely never any, right? And now you think we've all had that experience. So dentistry writ large, unfortunately has to deal with that. So now you have people who naturally don't trust you, right? So how do you build trust? Not only how do you take down shame, how do you take down fear, how do you build trust so that when they do have a cavity, when they do need, when you do want to have a conversation about, about smile improvement, when you do whatever it is, they trust you. And so we built the experience around the case acceptance, right? Is the, is the real. And we thought about it, obviously, from a business standpoint. But taking your business hat off, if these people have to say yes and pay for the thing and they need it, you want them to say yes because they need it, not because you're going to, you know, pay off your student loans faster. You want them to say they need it because they need it. And so how do we get them there? And so then we started thinking about all these other kinds of emotions that are happening. So you're starting from a place of maybe not total trust. Okay, well, in the dental experience, then you ask these people to come sit in these weird reclining chairs in there. That is your, literally, as a human, your most vulnerable stance. You are soft. Tummies up, tummy up, you can't really move like you are wildly. It is like vulnerable. And we are so used to it, we sort of don't feel that way. But, like, that's not true. If you really Sort of dig in. You're like, oh, this is okay. So I'm just gonna trust. Okay, great. So how do you talk them through it? How during a case acceptance or case presentation conversation do you have them sit up and basically get their feet underneath them so that you can have, they can feel secure in that conversation? We thought about all this stuff. We thought about the scent. We have a custom scent attend. Like we went, worked with the perfumier that created a scent that is calming. We did new uniforms. We created new, different uniforms. Right. We wanted it to feel branded. We wanted it to feel cool and fresh. We thought about lighting. We had a lighting consultant. So very early on we had like wild ambitions where we had this idea of through your, through your appointment, it would sort of mimic like a sunrise and sunset, like with the lighting, because lighting can really affect your, your feeling. That turned out to be like a little more complicated operation than ultimately we thought it was going to be. But, you know, you sit in dental office and you hear like, you hear not nice sounds. Dennis are used to it. Hygienists are used to it. Most people aren't. So we gave them Beats headphones so they can't hear anything. And you know, it's not, I wouldn't say, like wildly innovative to put a TV on the, on the ceiling. But like, we're like, yeah, let them watch. Love it or list it. Great. People love HGTV or, or Blue Planet or whatever they want to watch, right? They let them do that. And so we have, we have a lot of tech in the rooms, but we also, visually, when you came in, we didn't want you to see anything medical. We didn't want you to see anything dental. Dentists have a really hard time with this because you've spent a lot of time and a lot of money on a thing that you think everybody else cares about as much as you do and they don't. And so what they care about is a great experience. And seeing dental crap, that is not a nice experience. So we actually worked with a really great, really great design team up in Massachusetts that helped us think about this. But essentially like you walk in and your eye basically does like a up, down, over, like everybody's eye does the same thing. And if they're scanning the room and you can't see X ray machines and you can't see drills, all you're seeing is a big, beautiful 55 inch television. Great. So what do people like more than anything? Their names. They like to be told their names. So that big, beautiful 55 inch television says, hello, Jake, this suite has been prepped just for you. Great start. That's a great start. Right? Like all of that kind of stuff. Like, okay, great. Now there's obviously technology that's backing some of this up and some of this is easier to do than others. But like, those are like a handful of examples.

No, I'd love to, I'd love to go even into a few more because, I mean, so you actually thought about the eye movement as somebody walks in. First of all, it's called studio. Sure. You're not calling it an operatory or something. Like all of these things are just like, just scream white coat. You know, doctor who's going to poke instruments into my body. All that stuff does. Right. And so, so you're kind of making it more of a, like a hotel experience. But truly, I mean, I think some, some dentists and some of us out there or some of those folks out there kind of thinking about this, kind of get into this, but you're taking it to a whole other level. So you thought about the, I like, you know, path as somebody walks into a room and you made sure that that ipath was exactly what you wanted. What else? I mean, so you have the studios and then how about how the doctors are talking to the patient?

Yeah, yeah. So we had a lot of scripting around, around how we talk, how we talk to patients. One of the things, one of the things we found as we moved through our life cycle was we sort of over indexed actually on some of the stuff, on some of the hospitality where our NPS going back to net promoter short score was showing that people weren't believing, weren't trusting us clinically the way we wanted them to. Right. Because they were like, oh, this is all real nice, but are these real dentists? So, okay, great feedback. Number one, we have great dentists, so we're not worried about the care we're providing. How do we show them? How do we. Right. So initially, like, we didn't want Dennis wearing white coats. Now they wear white coats. We only wear white coats because it shows that we're experts.

Like, I love how, I love how you use the data on us. I take back the white coat thing because there's some element that people.

Yeah, we're like, great, but you know what? We're not going to do hideous white, white coats. We're going to get the chicest white coats.

Right.

That we can find and then we're going to have them tailored so that our dentists look great.

The other thing that's kind of coming up here is you are constantly tweaking and you're measuring the NPS score.

So, yeah, it's kind of constant patient feedback.

Yeah. And so you're just going through the process of iteration, you know, hypothesis. Go and try something, see what the data shows us. So, yeah. Cool. I think. I think a lot of us will be happy to hear that the white coat is what people want.

Dennis. Hate to give up those white coats. I'll tell you what.

Well, it's a great point. I mean, your balance saying, you know, you don't want, like, a major D. Right. It's like, you know, you don't want to feel like you're. And also, you don't want to feel like this person is going to poke and prod and, you know, you want to feel like kind of bedside person, understands everything.

A great. A guy that does this really well in New York is this guy named Dr. Apa, which I'm sure some of

you out of Oklahoma.

Yeah. He's, you know, very famous and our world sort of mixed in New York. He does the white coat thing brilliantly. He wears a white bomber jacket. Right. So, like, it's still a white coat, but it's a cool white coat. Right. Like, that's the way you need to think about some of that stuff. So, yeah, white coats. White coat's an example. Another thing is sort of this hits both efficacy and reinforcement of clinical prowess, which is we take everybody's blood pressure when you come in, and it's weird the first time, but then they explain to you why they're doing that. And then they were able to talk a little bit about, like, a mouth, gut, like the body. The mouth, the mouth, body relationship. Right. We're at. It's a learning moment. And so people are also then end up being like, oh, okay, great. Yeah, check my blood pressure. And surprise. We have found high blood pressure for some people who didn't know they had. Like you. You. You take yourself from health care kind of in quotes, not medical. Right. But you get to go into sort of. Yeah. This is part of your healthcare. This is just as much a part of your health care as your primary care routine. And we are. We are all concerned about your health, not just your mouth.

So that's. That's a whole. That's a whole frontier. The. The integration of medical and dental. And the fact, you know, we've talked a lot about it inside the deo, which. The fact that, you know, somebody's dentists and dental industry is better positioned because of that hygiene check every once a year to. To keep up on people than. Than even primary care is sometimes for sure. So okay, so the scripting, any. Anything else that comes in mind? There's probably just so many.

Yeah, you know, it's like. So we, we took a. This is, this is a page right out of one medical. But we did an app and I fought for it early on and was like guys, I'm telling you, I know you think it's a waste of time right now. I'm telling you, this is a great tool, right? So now you get to schedule, you get to track your smile progress you can. And what this really means is you force people to put in their insurance verification information before they get to the office. So one of the innovations we thought about at tend did this one medical also attend is small waiting rooms, right? Large waiting rooms with magazines connote that people will be there a while and music and fish tanks. And they know you're giving them something to look at because they're going to be sitting there a while. We were like, we don't want to give ourselves the opportunity of creating a schedule that's going to back people up to the point where people are going to be sitting here for 20 or 30 or 40 minutes. Right. So how do we use the app? How do we use scheduling? How do we do this? So that, that seemingly kind of small thing, a small waiting area actually means the whole thing is running in a way that you aren't. So when Covid happened, this was actually like, this was a like good job team. When Covid happened, we didn't really change anything. Jake. Like, I'll be real honest, like, we certainly put people in more ppp, right? Our dentists went from dentists to looking like they were in surgery and everything was covered in plastic. And you know, we did the same, some of a lot of the same stuff other people did with air filtration. And we certainly ramped the dial up there. And people, we haven't even talked about the brushery, but we closed down this thing that we do called the brushery because spit Covid. But that was kind of it. We didn't have to think that it really scrambled the eggs of some of our colleagues across dental of like and healthcare sort of writ large. Oh my God, people, what are we gonna do? How is the child's check in gonna work? Well, check in already worked. Check in was done before they got there. They Covid or no Covid, they come in and Give you their name and you say, okay, we'll be with you in about two minutes. And then about two minutes later, you're back in your chair.

If, if I, if I'm in the, if I'm listening right now and I'm like, ah, I want to make an app. What's just roughly, maybe I don't know when 10 went through. Just in roughly, you know, how much does it cost to make.

Oh, God. This is where I will say somebody else at the table was in charge of. I, I'm sure that there's an off the shelf answer at this point.

I don't know. I don't know if they're.

I don't know. Yeah. If not somebody out there listening. That's a great business. Go for it. Yeah. We, that is 1000s, millions.

I mean.

Oh God. I wouldn't say you, you would need millions of dollars for hundreds of thousands. Yeah, yeah.

I, I think, I mean, just. Yeah.

Is that not the chief technology officer? Very clearly. Yeah, But I know that. Yeah. And I think, you know, if there was an off the shelf answer to that. I bet there is. I'd have to look. Yeah, that was a, that was an innovation because of the funding that we received because of the sort of who we were differently from a mom and pop we were able to do. And that was really successful.

Yeah. Yeah. And so I would love to actually touch on as well. How did you implement this across many locations?

Right.

Because it's one thing to do it in one, but with your experience at one medical scaling, anything, any process across multiple four walls is difficult. How did you all think about this?

Yeah, man, that's. It's not very early on and I. Very, very early on this quickly changed where we had actual operators. But early early days, I was sort of the only person had done like true 4 wall multi unit operating like this. Other people had run really other complex businesses, but like this. And I was like, so at scale, we basically become a training organization. Like that's what we are. We're an ops. We're always an ops first organization, operations first organization. And we're a training organization that just happens to do dentistry. Right? We are. And I think that's still true. Right. You. It's training, it's constant training. It's retraining, it's having a great, having great operators. Right. Like there's, it's. I wish that there was some like secret. But it's hiring great people who are passionate about what you're doing, who want to make the changes. You know, we had, we had great operators, we had great training. We hired really good providers, we really good clinicians. We treated them well. Like we, it was, it was kind of. It's like grinding multi units. Yeah yeah, it's multi unit, multi, multi unit. Multi state is just, it's a grind.

Yeah, it's a grind. And any, anything that you all did that seemed to work well for you as far as the training goes. I mean just really, you know, this high touch pacing experience, obviously using a lot of technology is helping out with that. But yeah, to duplicate that and create consistency that all quickly becomes your next challenge.

Yeah. So you know I, we, I launched six different markets with them when I while I was there. And yeah, you have this big training like before the long market launches and you have regional, you have regional directors who are running the office managers and finding the right office manager. And it is, the answer is it is never done. Every office has its own little culture and then you hire somebody new and then the culture changes sometimes for good. Sometimes we're not so good like it is, it is constant. So what ended up happening was you end up having to you know, bring in a lot of, of rigor and a lot of kind of metrics and we, we got there pretty quickly because we had to, we had, we had had and have pretty big ambitions and so we wanted to get a kind of professionalized kind of training regimen as, as quickly as we could. And our ops teams are heroic and they are the ones that you know, they are the business. So. Yeah.

Nice. Well, I want to just touch on one last thing and I want to hear what you're up to these days. Last thing is, I think it's interesting as far as like venture capital, you talked a little bit about 10 is VC backed which as far as we know there's private equity which a lot of our listeners are learning a lot about how this works. Right?

Yep.

Private equity is different than venture. Venture is a lot of your, you know, Palo Alto kind of San Francisco money that's wanting to bet on a make a lot of bets and hoping one of them skyrockets. Right. And I'm curious how you look at the difference and tend was was it was venture backed as far as we know. As far as you were saying, the only venture backed dental group that we know of.

Maybe there's other ones very small hand. I've heard of maybe one or two more but very. And certainly not to the you know we've raised $200 million certainly not to the level that that tend has. Yeah, for sure.

And so. So yeah. In your difference between venture and pe, and then what was your experience having venture in dental, which seemed like a whole new thing.

Yeah, you know, it's interesting. Venture is. My world has been. Has been venture for 12 years. And so it's kind of, you know, the devil you know. And there's good and bad about. About everything. I would say early, especially like 12, 15 years ago. Venture PE knows how to do bricks and mortar. Not all PE does, but there are PE groups that like, know bricks and mortar and have a playbook, and they apply that playbook to. They apply that playbook to these businesses, and that's how you run the businesses. Venture for good and bad is a lot less structured around that. They've gotten much more structured in the last decade because they've been pouring money to bricks and mortar and realizing that they don't always know what those businesses are. And so they need to learn and then they have to have opinions on how they're run. So there's more freedom to play. Like you said, venture capital really is about innovation. If we want to get into the finance piece of this, their hold times are often shorter than pe. Right. So they're looking to flip their investment often faster than a private equity firm. And so that drives different. Like you need to. That drives different parts of the business. I think it was. It's interesting. Venture is very scared right now about. A lot of venture capitalists are very scared of bricks and mortar. It is. There have been through these last decade and a half, there now have become VCs that know bricks and mortar, and that's kind of the thing. And they continue to remain excited about it, but a lot of them got burned. And so they're scared of it. And everybody's obsessed with AI and super excited and that's where all that money is going. But yeah, there's big differences. I think that you get more freedom initially in venture capital and there's more freedom to play. Ten wouldn't be what tend is. I can tell you if we were PE backed from the jump, we wouldn't have been able to innovate like that because that's not. That isn't the chassis that they build.

Yeah. And I think the cool, fun takeaway is that, you know, your experience was maybe with multiple venture companies and just the people, you know, when it comes to bricks and brick and mortar, four walls and even in dentistry, you know, a lot of the venture folks are used to softwares that can scale Just like exponentially without any additional labor. And what I think what you learned was that when you have humans and you have four walls, you have real estate, that it's much harder than softwares. And I think kind of.

Yeah, yeah. And granted, like we have great investors and great partners and like a great board, but there's a learning experience there. If you're used to scaling your busy or SaaS business software as a service. So like your, your SaaS, your SaaS, your SaaS business, you put VC money into it. You hire a sales team, a bunch of devs, maybe they live in somewhere other part of the world. You create this thing and then you sell it and then you scale it not at the touch of a button, but kind of at the touch of a button. And in bricks and mortar, you've got all sorts of people that you have no control over who are. Do not care what you want to do with your business. And city, municipalities and contractors, like all over the place. Like it just it. And it's expensive, right? Bricks and mortar is expensive. You try to get it as cheap as you can, but it is more like they're. You're sinking a lot of money into bricks and mortar. Like it's, it's, it's a different game.

It's a different.

You have to have, you have to have like a strong stomach for it.

That's right.

Very strong stomach.

I think for anyone listening, you know, it's like you turn on the news and CNBC and all this stuff, and all these businesses are growing and they're skyrocketing. Even, even some of our DSOs, right. Probably have the same experience. You're growing.

You have 10 for sure.

Billion. But it feels, what we're doing feels so hard, right? Like this feels harder yet, you know, the software just like triple the revenue in like three months. Well, it's. Because it is, it is harder. And the smartest, you know, kind of financial minds out there in the world and Wall street, whatever, they, you know, either do or are starting to realize that they kind of know, like, yeah, this is a different game. So it's not as fast. It's highly impactful. Right. You're in health care as you're impacting your lives. But it's a difficult game. It's very difficult.

It's a difficult game. And it's one of the reasons, right. Pe, I think, has gotten this for a long time, especially when all of the money was pouring into dentistry. What was that five, ten years ago, right. When there were some really Big, really big, really big purchases. You know, it's a, it's a great business if you're, if you're planning to have it for a long time. Right. There's a moat. All that difficulty creates a moat that people don't want to, don't want to learn how to do all this, fine, you can like you get your own kingdom. So it creates a moat and it creates a kind of an annuity like return structure where it's like you get these steady eddy returns that are going right and you're, you're never going to increase 600% in a year, like, but unless something really crazy is happening, but you're going to do a great business. Right. And most successful businesses are small and medium sized businesses.

Yeah. And so what are you up to these days, Andy? So you kind of helped launch Tend and then now you've moved into some other things.

Yeah, so I've got this sort of really fun, pretty robust advising company which is great and having a blast doing that. I rolled off of tendencies full time toward the end of last year. Still an advisor there, still involved, love everybody there. But advising people across the spectrum, they. With one medical intent kind of in my, in my, on my resume, right, It's, I'm working with a really fun veterinary concept out of Boston that's launching in Cambridge. Working with a tattoo company that wants to sort of make the tattoo process much more, much more customer friendly. Working with a fitness company out of Toronto, kind of all over the place. I've really broadened beyond healthcare. Healthcare is definitely my first love. But yeah, I'm having fun advising people, talking to PE firms and VC firms and yeah, it's, it's, it's really, it's a good time.

It's been really, it seems to me any, any kind of experience, healthcare or retail, where there's a human going into a place and you're asking yourself why is it done this way? Like is it always the best way to do it? That seems to be where you live

is that's where I live. That's exactly where I live. That's exactly where I live. Yeah.

And so for anyone, one of the reasons I, I just think what you're doing is amazing. I think it makes the world a better place. Right. If we can create better consumer experiences, no matter what the industry is, I think that's always a positive. How can people reach out to you if they happen to have a question?

Sure, yeah. Hop on LinkedIn. Like that's, that's a great spot, Andy. Grover there. Andyndygrover.com I'm still working on sort of the corporate piece of the advising business. So we'll have a website. Sterling Advisory is what it's called. We'll have a website and email there soon. But Andy and Andy Grover, it's easier to remember. So hit me up on LinkedIn. Find me there. Email me.

Yeah, awesome.

I'm not on Twitter.

Yes.

I don't do Twitter.

I don't like.

We'll see.

Well, on behalf of all the other patients and you know, even, even if you're a dentist, you're a patient somewhere.

Yeah.

You know, thanks for pushing the envelope on all of this. If we keep doing this, it's just going to lead to better and better. Talking about like shame and feelings and how people feel. That's like big time stuff. And it, you know, it just, it's, it really does make everything around us better. So thank you for your work. Thanks for coming on and sharing your wisdom with everyone.

Thank you for listening to deo's Growth Secrets podcast for dental organizations. Continue the conversation on our Facebook group and meet other dental leaders. Get questions answered and the strategies you need to succeed. Plus, we have some free resources for you right there on the Facebook page. Remember, you're not alone. Let's do this together. Join DEO's Growth Secrets Group on Facebook. And until next time, keep smiling.