Thursday, January 17, 2013

Whale in a Bathtub

Does anyone remember Helen Palmer's A Fish Out of Water, one of the classics from my childhood? The plot is simple, but compelling: A boy brings home a fish, overfeeds it, and the fish gets bigger and bigger and bigger until it is immense. I won't spoil the ending for you.

The need for growth management is one of the main points of what I've heard and read so far in the Coursera business class. Every owner of a successful business should carefully consider growth management. I'm thinking about small businesses now, like mine, but we've previously discussed problems associated with a failure to plan for and manage growth in larger companies. Quality is what seems to go out the window first when growth exceeds capacity.

This is not exclusive to educational publishing, or even publishing in general: it's a universal principle, as previously applied to dentistry.

Now I'd like to apply it to orthodontics. What up with the teeth? I have teen-agers, one of whom has recently been freed from braces, the other of whom is still wired up. They are twins, as you know, so why is one wired and the other free? The orthodontist's failure to manage the growth of his practice.

Like Dr. Bad Dentist, Dr. Too Successful Orthodontist came highly recommended. By three different people, one being my current dentist and another being an orthodontist in another state who went to school with Dr. Too Successful. During our consultation, he was friendly, explained everything clearly, answered all our questions, and seemed highly attentive.

Once we had signed on for a course of treatment for both my daughters, our experience turned southward. Dr. Too Successful's practice is booming. This means for a negative client experience, characterized by:

  • a loud, crowded waiting room
  • waits of up to and exceeding an hour for scheduled appointments
  • difficulty in making appointments that will accommodate one's own schedule
  • impossibility in rescheduling appointments
  • technicians who are hurried and under stress, which doesn't really bring out the best in anybody
  • necessity of having to see Dr. Too Successful's junior partner orthodontist
  • a breakdown in communication between the client, technician, and doctor, resulting in a six month extension of treatment
The latter being what happened with us. That is, we were concerned about how my daughter's teeth were slanting, I mentioned it to the technician, she said that the junior partner doctor was aware of it, and I assumed he knew what he was doing. Three months later, when treatment was due to conclude, the junior partner doctor said that whoops, some girls look really pretty with teeth that slant outwards, it makes their lips look full, some people really like that. . .but if we wanted, we could have 4 teeth extracted and start all over. That was six months ago, my daughter is still in braces, and poor thing, she may be wearing them until she is thirty.

Regardless, the main point is that Dr. Too Successful has completely lost control of his business. Soon after my conversation with the junior partner doctor, I called Dr. Too Successful to let him know that I'd experienced an erosion of trust. He said he appreciated my call and we talked about what happened. I explained that I didn't fault his office for making a mistake, but what bothered me was that the mistake was preventable, being as it was a direct result of either the technician not telling the junior partner doctor about my concerns, or of the junior partner doctor simply not paying attention.

The call concluded with Dr. Too Successful assuring me that he was dedicated to regaining my trust. And so he had seemed to be, for the next few appointments, but then his attention was captured by other clients and more pressing demands, and our experience as clients is once again suffering.

Would I ever recommend Dr. Too Successful to anyone? No, on the contrary, I would tell everyone to flee as fast as their feet will carry them. I don't like saying this, because Dr. Too Successful is likable and seems committed to doing good work. And yet, by neglecting to control the growth of his practice and by forgetting to consider his clients' experience, Dr. Too Successful caused my daughter unnecessary pain and me unnecessary inconvenience. And he has had a negative effect on my business, in that I've had to take additional time away from my work to keep taking my daughter to orthodontist appointments, appointments for which I always have to wait at least 20 minutes, and often have to wait an hour. 

Here are the questions I ask myself:
  • What is my typical client's experience?
  • Is there any negative aspect to my client's experience of Inkspot?
  • How can I improve my client's experience?

One of the little mottoes of the business course is that one has to love the client more than one loves the product. It's worth thinking about.

UPDATE: Lest anyone think I am casting stones from a glass house, I'd like to add this bit of irony. Last week, I had to call and reschedule an appointment at the last minute because my daughters had a school obligation arise suddenly that could not be missed. I was told the next available appointment was toward the end of February. The day and time offered conflicted with cello lessons, and I was offered an appointment in mid-March. By this time, feeling frustrated with having to find a time that fit my daughter's schedule, my schedule, and the straitjacketed schedule of the orthodontist, I said that I really needed the office to accommodate me and be more flexible, and here I mentioned that my daughter's treatment had only been extended to this point as a result of mistakes made in their office. I was given an appointment for yesterday.

We went to the office, and even though everyone was courteous, it was strained, formal courtesy. Something was amiss, something more than what had passed between the receptionist and me on the phone. When the doctor examined my daughter's teeth, he spoke exclusively to her, as if I weren't there.

At the end of the appointment, I opened my planner to make our next appointment and saw that WE HAD ARRIVED AN HOUR LATE. That's right. In my mind, our appointment was at 2:30, because that was the time of the original appointment, but we should have been there at 1:30 and NO ONE HAD SAID A WORD. Though their body language and tone said plenty.

I was so astounded that I didn't know what to do, but immediately upon arriving home, I called the office to offer abject apologies. I apologized about ten different ways, and I sure hope that my apologies made their way to the technicians and the doctor.

And yet? You understand that the doctor has never made that kind of apology to me for their mistake. I was an hour late for an appointment, but their mistake means that my daughter will remain in braces for what looks like a year after the original estimated end of treatment. But I guess some people find it much more difficult to apologize than others.


  1. Their mistake sounds like malpractice to me...

    1. It may well have been! Not for the first time, I almost regret that I lack the litigious temperament.