Your Winning Practice Playbook: Part 3 – The Middle

Let’s dive straight into what I call the “Middle” of your practice.  We are going to talk about the place where the biggest leap is made from being a run of the mill, grind it out, see as many patients as you can see in a day practice – into a slow it down, truly focus on real patient relationships, and shift to a value (not volume) driven practice.

First and foremost, this is not just one person.  We are going to layout the game plan for a single ‘play maker’ (we call a Treatment Coordinator or a Patient Concierge or any number of other titles), but it’s about more than just one person.

The middle is as much a mentality as it is a system and structure.  It is both process and protocol as well as philosophy and principle.  It means that we are going to go against the grain and the industry norm of simply checking-in and checking-out patients.  

We are not going to be a transaction-based practice cashing insurance checks and taking co-pays from patients.  Instead, we are going to cultivate relationships and create an experience that sets us up for success and as a result sets up our patients for success by aligning everyone in the same direction with the same goals in mind.

If all you have is a “front and back” then you are forced into, whether you like it or not, the exact dynamic that you want to avoid.

It is important that you understand this idea of the middle doesn’t have to mean a consultation room, though it often does.  It doesn’t have to mean a dedicated third person who owns exclusively treatment presentation and case acceptance, but it can (depending on the number of rooms, doctors, clinical team members, and patients coming out at any given time).

The math is easy to understand… when you have more patients than team members at any given moment, that means someone is not being covered and more importantly not being communicated with.

I’m not here today to convince you to add players to your team; though in order to live up to your potential and be effective with the opportunity that you are creating it might be warranted especially after next week when I take you through the playbook for Offense with the Clinical Team.

Instead, what I am going to do is show you how we can take our Four Pillars of being on Offense in your practice and turn them into strategies that allow you to play the middle more effectively and to capture more treatment and therefore increase your patient value and practice profits.

Here’s the bottom line definition: the middle is what happens between the front to the back and back to front actions, tasks, responsibilities, and experience with your patients.

For most practices, it’s a handoff (at best) and often it’s a walk down a hallway to a room and back again to a checkout counter.  Essentially, the middle is nonexistent in concept and in practicality.

Here’s how the middle looks in our Championship Playbook.


The first key to playing the middle successfully is the proper preparation and vision that should be had before a day even begins.

Obviously, everyone knows what unscheduled treatment exists in the morning huddle.  But future focused for the middle of your practice goes far deeper than that.  It must incorporate the flow of the patient experience and where someone might be needed to discuss treatment with a specific patient.

Future focused also includes new patients.  Whether it is a Treatment Coordinator or not, someone must own the patients’ mindsets, the preparation for their visits before they get to the practice, and then most critically before they get to the treatment room.

This isn’t a series about new patient experiences.  You have access to plenty of resources available from me on that topic.  None the less, future focused is directly tied to the new patient interview but it can also be tied to every single patient who comes into your practice to “check-in.”

Imagine if every patient – before they go to the back – the “middle” presets their mind as to why they are here and what all will be accomplished, whether it’s a procedural visit or a hygiene visit or a follow-up appointment or anything else.

When you think about the middle, think about everything that can be prepared for in advance of next week, of tomorrow, of today in the morning huddle, and most of all of every patient visit.

We want someone who owns the middle and has foresight for the treatment opportunities in the practice before it happens by thinking about where they need to be and what patients they need to see.

If we are talking about an actual position, the Treatment Coordinator should have their own column scheduled and managed with the highest value patient opportunities throughout any given day.

And there should never be an excuse to miss a new patient or not be available for a treatment plan or a triangle of trust.


On the creation minded side, we are going to go into an entirely different direction with an advanced process next week with your Clinical Team.

For today, the middle is about seeing the field, seeing what others don’t, seeing the entire practice.  Creation minded means always thinking about ‘what can I do today to make something happen,’ whether that is helping team members or closing cases or picking up referrals.

You never want the person who owns this part of the middle to be playing defense by doing anything other than activities that leads to scoring points.

Again, this is a mentality and should be part of the entire culture of the practice.  Everyone must consider the “middle” that in between where conversations happen that run of the mill practices “don’t have time for” because they are “too busy.”

Think about this, a patient who works at an organization that could be a healthcare partnership that doesn’t get connected properly.  A patient who has a spouse that doesn’t get invited back in to become a patient also.  A patient that doesn’t get told about ‘everything’ that you do in your practice.  A patient who doesn’t get engaged with social media or referrals.

Creation minded for the middle is about finding ways to turn nothing into something or something into something more.


And once again you can easily tie together the creation mindset with the awareness of opportunity both require initiative, one is being resourceful to bring something to life and the other is always paying attention and thinking about opportunity so you know it when you see it.

This one is the one that plagues all practices because they, and yes even you, get caught up in just getting through the day whether it’s chaotic or it’s about staying on time or whatever.  It makes no difference, it’s still one in the same, missed opportunity.

Championship Teams who play the middle effectively believe in never missing an opportunity to help a patient and to score points.  They don’t take for granted the idea that maybe the patient will never be back, maybe this is it, maybe this visit is the only chance I have to seize the opportunity that exists right now.

Even when a practice has a great treatment coordinator or they are reasonably good at playing the middle, it does still get cluttered up.  The person gets bogged down, the practice becomes hectic, communication becomes incomplete, and execution becomes inconsistent.

Don’t let this happen.  If someone is properly playing the middle then they will be ready to capture and capitalize on every opportunity.  Sometimes that simply means delegating or calling other people’s attention to things.

Everyone else is head down focused on patient in front of them (whether phone call or clinical visit or check-in or check-out), the middle is the missing piece staying aware of opportunity and move on it in real time.

We’ll use this to transition to our proactive action because this is where the points go from opportunity on the field to on the scoreboard in reality.


Proactive is the opposite of procrastinate.  The middle, when properly in place, is dialed in at making sure no patients are left behind, no opportunities are missed, and no one is unaccounted for.

This must become a habitual discipline and determination that exemplifies your culture and practice expectations in every way.  

Now, this is a very interesting approach because the first thing you want to do is ensure that everyone is on the same page with everything I have outlined elsewhere in the Playbook; that these items are expected to be proactively acted upon and they take precedence.

Therefore, future focused in the huddle, creation minded with patients, aware of opportunity are all the things that get done no matter what else is on the list or in your way or occupying any minute.  That’s first.

Second is understanding the fact that the magic in the middle is getting the patient out of the operatory and into the hands of someone who can talk with them until the deal is done, the case is closed, the money is collected, and the treatment is scheduled.

Way too much and too many get stuck in that in-between limbo of discussion on the back and generic meaningless inconclusive handoffs where nothing is solidified.  It is all…

Reactive follow-up.

Reactive treatment planning.

Reactive next steps.

So, we change that dynamic by ensuring that every treatment discussion from the back gets placed into the middle before it goes to the front and out the door.

Don’t get hung up on the physical space or the logistics, while they matter and have some implication, the point is that the real offensive point scoring is achieved and done in the middle – between the treatment room and clinical team member and then the check-out counter and the exit door.

Retention on a basic level and a run of the mill practice model is handled by “re-appointing” patients without much concern or consideration let alone concentration on “what” they are being reappointed for compared to what the potential and possibility of the comprehensive opportunity, the complete creation, the complete future being taken into perspective.  

That is why you want to have consultative and conclusive closing conversations in the middle before the patient exits no matter if that means a second visit, a come-back treatment decision visit (conference or consultation), or some staged out phases of next appointments being solidified.

When you refuse to accept patients leaving without the job being done and with loose ends being left, then you end up with closing a lot more treatment, capturing a lot more dentistry, making a lot more money, and above all else you helping a lot more patients get healthy faster.

The middle is all about providing a guide on the patients’ pathway to health.  So, without a specific person and time allocated for the real relationship building and this type of communication to happen, you will experience missed treatment opportunities and less engaged patients on a consistent basis.  

Have you ever wondered why you are performing far below the potential of your practice?  Why you are always having to grind it out every single month?  Why you are very busy but rarely achieve the results you expect?

The answer is right here… in the middle of the practice.

Don’t settle for being mediocre on your offense or playing only one side of the ball at a time.  Instead, commit to formalizing the systems and strategies that ensure you win at the highest level where real dentistry is developed, real relationships are forms, real patient retention is crated, and real profits are made.

Know this, these concepts can be applied to any team member with any position.  However, if you have enough opportunity, you need a dedicated person to do this justice and if you have enough patients flowing in and out then you might need more than one.

It’s very simple, when you outline the key creation priorities and add those on top of the actual tasks that have to get done with every patient every visit every day, then you will quickly see that the highest value and most important offense activities are at least delayed and more often than not left out entirely.

When you fix this, you will be amazed how much dentistry you capture on a daily basis.

Next up, we’ll go to the most powerful force in creation and where offense comes to life with the Clinical Team.  I’ll show you the plays that will take you to a Championship Level and allow you to score more points on offense that you can even imagine!

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