In this workshop‑style discussion, DEO faculty member Emmet Scott explains why misalignment is the primary reason most practice projects fail and outlines how to secure genuine buy‑in from both owners and non‑owners. He emphasizes that alignment must be assessed by observing actions, priorities, and the incentives that drive clinicians, rather than relying on surface agreement. Scott describes a "pressure‑test" approach—asking concrete questions about time commitment, obstacles, and true priorities—to surface hidden misalignments. He highlights the tension between a clinician’s dual role as employee and owner, noting that many prioritize wage over practice net income, leading to resistance when asked to allocate time to hygiene training. The conversation also covers how to reframe presentations to align short‑term financial incentives (e.g., increased daily earnings from hygiene work) with long‑term practice goals, and the importance of transparent, data‑driven communication to overcome naysayers and achieve collective execution.
Chapters
Use internally. And it's almost like you discover things as a business person in this space. And then you're like, you keep coming back to it. You realize, holy crap, this, like, solves all my life problems. This has been one of those. Okay, so this helps me assess every project and issue. That we've had as an organization and the whole executive team and then regional managers. We've started to adopt this jargon over the last couple years. And every time I can find the problem right here. First one is alignment, man. Almost like 90% of projects we're not executing on is because there's misalignment. And all of us want to be like, this is a brilliant idea. Huh? And everyone's like, yeah, it's a brilliant idea. It's going to make everybody a lot of money. Yeah, I think so, too. Great, let's do it. All right. That is not alignment. Right. Half the people are thinking, but it's not a good idea for me. But I don't want to, like, put any effort into that. So especially when you have partners figuring out, like, alignment and taking the time to ensure alignment. So that that ops person, they might have other issues, but I'm just going to kind of. They're set to fail in that situation because you've got a clinician who their alignment is around their personal income. And you're like, yeah, but they should, because they own it, have a bigger mindset. They don't. And until you have alignment there, there is no ops person that can overcome that issue. Right. No one's going to be, like, brilliant enough unless that ops person comes back to you and says, so what would be the right technique that you use to get alignment with your owners so they actually care about the net income of the practice and not just their personal income. And unless you can say, oh, sorry, I didn't realize that. Let me get that straightened up for you, or they magically have the capability to create an owner to have a bigger mindset. But we're asking an ops person to, like, come up with that. That's pretty tough, you know? Is it here? It's here. Okay, we're going to go through this really fast and we're going to. Yes. 15 minutes.
Real quick. How do you know if they're in alignment? How do you measure that?
Oh, that's a really good question. Well, I definitely look at actions and priorities, so, I mean, I don't think we have to be rocket scientists to say this doctor is not in alignment. I think you just ask.
You have to Know what they value, to figure out where their incentives are because they're going to be incentivized to go toward what they value. Right. And if you're aligning your incentives with theirs, but you think that they care more about this than that, then you're going to go astray.
I am going to pressure test it. Like, I won't take on their surface answer that they're aligned. I'd want to pressure test like, so from a time commitment perspective, are you going to have time to focus on this? I think that's a big one, you know, hey, as you look at your other priorities, do you feel like this is a priority for you? Do you see any obstacles coming up that would keep you from being able to help and execute on this? I'm almost like hunting. Whereas I think sometimes as entrepreneurs we get sold in the business books. Create the vision. Create the vision. Create the vision. Ignore the naysayers. Ignore the naysayers. Right. We actually need the naysayers to tell us what all the obstacles are because otherwise I can't get alignment with everybody. So I'm probably hunting for it. Which comes down to my transparency piece. Like, I need you to be transparent, Doc. Like, clearly you're not looking at our ownership as being as important as your wage piece of this because he's playing two roles, right? He is. He's an employee of the organization and he's an owner of the organization. And at least from what you've gotten from the OPS person, he values the wage more than the ownership. However this has happened, when I go and talk to the clinician and say, here's what I'm seeing, they're like, well, it was never presented to me that way. All she was saying was blah, blah, blah. And I'm like, okay, well, that's not the best presentation. You know, like, hey, doctor, we want you to spend 50% of your time training hygienists. You know, that wouldn't be as good a presentation on we want to improve our hygiene.
His future wages go up because he does the hygiene diagnosis, the treatment and earns it later. So it sounds like he has a very high time preference.
Well, that and he doesn't have a long term thinking.
Or again, it could be presented poorly. So like, I've had this happen. OPS goes out and says, listen, we really need to improve the hygiene piece and I need your help. I need you to be doing this. And then the doctor hears like, I'm going to be spending all my time training these hygienists so all that comes out of his mouth is, listen, I can't do that. I've got to focus on what I'm doing OPS wise. And then the OPS person says he's totally resistant, he doesn't want to help.
Yeah, but maybe another approach, meaning focus right in on what his desires are, you know, to make that immediate income rather than long term thinking. And just focus to the point that by doing more hygiene, you're going to make more money per day, you know, to hit it that way, you know, so that it's the.
But again, we're making a big assumption, which is that we believe this OPS person communicated well and presented it in such a way that made it for the clinician to fully understand the vision of what we're doing.
