Sheri Kay is a published author and voted as one of the Top 25 Women in Dentistry by DPR magazine in 2011. As owner of Sky Dental Practice Coaching, Sheri has impacted hundreds of practices and takes pride in helping team members maximize their contributions. Starting in dentistry in 1980, Sheri has gained experience in every aspect of the dental practice as hygienist, assistant, and administrator. With a passion for service, Sheri enjoys volunteer work in her local community, mentoring women across the country, and is always looking for ways to make a positive difference in the world. She has been a spokesperson for the American Cancer Society, has been rescued by a pit bull named Lego, and when not working can most likely be found either teaching or taking a yoga class.

Building Your Practice From the Bottom Up


Nothing makes me smile bigger than walking into a practice that clearly differentiates themselves from every other practice. Yet, there are fundamentals consistently found in high performing teams that minimize the need to “re-invent the wheel” when in search of organization and predictability. So yep, there is a way to follow the yellow brick road AND create your very own individual Oz at the same time.

Having worked with over 300 practices across North America, I have learned there are integral steps that can lead you to a practice that is rewarding, individualized, structured, effective and profitable. Oftentimes, what I find is that dentists want to move through these steps quickly, or in an order that may not be the best in the longterm interest of the practice. Let’s take a look together at this purple pyramid model to explore the layers and the rationale behind them.

In our current culture, there is a high awareness around the idea of work/life balance. That being said, I like to start with the notion that it really is possible to find. Because I look at balance as something that I’m always moving toward rather than maintaining, I have found that starting with a clear vision of what you want for your life as the base of this pyramid makes the most sense. It’s tempting to simply jump into a practice with both feet for the purposes of having a place to practice, earning a living or repaying any debt. Other details to consider include actually enjoying your work, having specific times for interests outside of the office and being able to spend time with family, friends, vacation, mission work, etc. One of the first things I do when I meet a new dentist is ask what they enjoy outside of their practice. All too often, what I hear is that there are not enough waking hours to fit everything in. Just imagine how your life could be enhanced if you DID plan and carve out time from work to enjoy other aspects of your life from the very beginning?

The second base layer is about your actual practice. Being clear and articulating specifically what the three aspects of your practice could be like: Business, Team and Patients. This part of the exercise is where you literally put to paper your desires and expectations of how you want your practice to look, feel, function and perform. Consider what is ideal for you in terms of demographics and the types of people you want to surround yourself with both in and out of your chairs. Think about your physical space, relationships, specialties, quality of clinical care and level of hospitality. These things can be planned for rather than figured out along the way. Cool concept, right? I love the notion that your vision actually becomes the guidepost for all behaviors and decisions made in your practice by you AND by your team. Your vision presents as a common theme, a clear direction to lead from.

Level 3 supports the idea that you and your team share common values for personal and professional learning and growth. It’s this growth mindset that supports a model of continuous improvement, engagement and commitment to the vision that called you all together. When a group of individuals are working, learning and growing together toward a coming vision … that’s when magic happens.

All three of these lower levels represent mindset, values, belief and purpose. Although you may not be able to touch or see these things, they are always foundational in what drives us, what inspires us, what connects us to something greater than ourselves. These lower levels are what separate the high performers from the folks who wake up just to go get a paycheck.

It’s the middle piece of this model that holds the key to consistency, follow through, clear expectations, accountability and innovation. Literally creating a manual of written standard operating systems is no easy task, and yet it is always worth the time and energy involved. The most important part of this is to have the team co-create the development and initiation of the systems that get written. When systems emerge rather than being imposed, the level of ownership and responsibility to them can be extraordinary and sustainable. This is the piece of the puzzle that helps to improve communication and ensure that the day to day activities align with the vision. Although not an easy process, it truly is priceless.

One of the goals of any successful practice is to create a consistent positive patient experience. At this level you have an opportunity to pay attention to all the details that can contribute to that actually occurring. This level is about asking for feedback and gaining confidence that your patients will become missionaries for you, dragging their friends and families because you’ve met and exceeded their expectations of what a dental practice can be. You’ve gained trust and built solid relationships.

Now is the time to market! For fear of sounding like the flight attendant on American Airlines, patients have many choices about what dental practice they will visit. Help them find YOU. Help them choose YOU. Whether it be optimizing your website or creating a video to play at your local move theater, patients need to be able to find you. Make yourself visible and be sure that all marketing is aligned to very directly reflect the vision and values that you created a few steps ago. One of the worst things that can happen is attracting patients that are different from those you want.

Many people ask me why the marketing doesn’t happen sooner. To be honest, sometimes it can. Especially if you have a brand new quickly building practice. In my perfect world, all of the previous steps will be in place. Marketing prior to having your self together organizationally can lead to confusion, failed expectations, stress and frustration on everyone’s part. Tried and true, this model works well in the designed format and order.

The cherry on top is where your success lives and breathes, and the best part is that you’ve defined what that means to you. I always encourage my clients to define personal success first, and it’s amazing how this entire model can just about build itself to support you getting there.

The last piece of this pyramid that I appreciate so much is how it can be used as both a planning and a diagnostic tool. If/ when you recognize that something is not working, all you have to do is look down the rows. For example, if patients are not having a consistent positive experience, I’d look first to see if our systems are in order. If systems are effective, time to look at the team and doctor’s commitment, and down she goes. Isn’t it beautiful? Build from the bottom up, assess from the top down. I call this: Everything you ever needed to know about practice management in one purple pyramid. Keep in mind that it can take years to master this pyramid. It takes a huge commitment to go up and down over and over again … because you will change, and your practice will change. For me the most important part of having a practice is remembering that it is your practice, beginning with your vision. Who knows, maybe the purple pyramid will take you to someplace even more magical than Oz.