Weathering the storms of leadership

Editor’s intro: Drs. Joel C. Small and Edwin McDonald share their leadership essentials to bringing clarity, values, and vision to a practice. 

Drs. Joel C. Small and Edwin McDonald discuss how a seasoned leader can create a balance

A leader brings the “weather” to the organization that he/she leads, be it large or small. The weather can range from stormy and turbulent to sunny and full of the sun’s energy. A weather that supports healthy, growing lives requires a balance of rain, sun, and the seasonal variations that allow for a complete cycle of life. What kind of weather do we find when the leader is not leading?

A practice in survival mode

For all forms of life to be healthy, including human beings, they need the right mix of elements to breathe life into them. Effective, purpose-driven leadership cannot exist without these essential ingredients that create a healthy environment. The first sign that a leader is not leading is that the individuals under their leadership are not thriving; in fact, they are struggling to survive. The most significant leadership competency that correlates with high levels of organizational performance is strong people skills. Those skills pertain more to the leader being personable, approachable, and a good listener rather than possessing a dynamic personality. All people need to be heard and understood and, equally important, need a positive and safe environment that encourages open and direct dialogue. When leadership is deficient, the people’s need to be heard and to have a voice is absent. Their relationship with the leader is superficial and lacks the depth that people need to commit to the organization’s purpose. Their low-level motivation and commitment reflect an organizational culture that is transactional rather than transformational in nature.

Symptoms: high staff turnover, internal conflict, low productivity

Lack of clarity, purpose, and vision

Great leaders bring clarity, establish values, and articulate vision. There exists a commonly shared belief and understanding about where the leader is taking the organization. The team understands the organizational values, and therefore, they know how to make decisions in alignment with the shared purpose. This creates an entire team of decision-makers and energy producers that are working toward the same goal. In this ideal scenario, the doctor is no longer the “bottleneck” through which all decisions emanate. This allows the overall team to develop their capabilities and capacity to be more productive.

When clarity, values, and vision are missing, there is greater confusion, more hesitation to act, and more internal conflict. This inevitably results in organizational stagnation. Stagnant teams find themselves spending excessive energy maintaining the status quo, rather than taking necessary measures and calculated risks designed to promote practice growth. This description defines an enterprise that is stuck and performing below its capability.

Symptoms: low productivity, wasted energy, confusion, conflict


By definition, a team comes together to accomplish something as a group that they could not do by themselves. Each team member has a specific role and responsibility. An effective leader orchestrates the function of the overall team as well as each individual. These leaders communicate the importance of each position and what success looks like. In short, they are great people developers and intentionally empower those that they lead.

It is not uncommon, as coaches, to encounter doctors who are seeking a better work/life balance. They are exhausted by the persistent conflict between family and practice — feeling caught between the constant pull of the practice on their purse strings and the opposing pull of their family on their heartstrings. Invariably, these doctors have failed to develop their teams’ capacity to lessen the doctors’ load. These doctors have not provided their staff with the training, resources, and authority to manage and oversee practice systems. Sadly, these doctors have done a great disservice to themselves and their staff. The doctors are exhausted, and their staff has lost an opportunity to experience growth. Even worse, these doctors find that they are spending an inordinate amount of time and energy on low-level tasks rather than value-producing tasks that greatly benefit the practice — tasks that only they can accomplish.

Symptoms: lack of energy, failure to achieve high-priority goals, undeveloped staff, strained interpersonal relationships, reduced production

Lack of trust

The “currency” of relationships is trust. Trusting relationships are the building blocks of a successful contemporary practice. Highly effective leaders understand this and have spent a great deal of time and effort on the inner game of personal development to become more trusting and trustworthy leaders. Most successful practices have leaders and teams that trust one another. They trust in one another’s integrity and capability.

Exceptional leaders understand that trust is established through both words and actions. They not only believe in their people, but also speak and act in a manner consistent with this belief. In contrast, underdeveloped leaders cancel out their personal strengths and erode trust with words and behaviors that are grounded in distorted beliefs and assumptions.

Let’s use exhausted doctors mentioned earlier as an example. These doctors may be high achievers, but when we look at their team dynamics, it is obvious that they are not utilizing the staff’s capabilities to achieve their goals. These doctors may be harboring the false assumption that they do not need the team’s input or skill to accomplish their goals. The doctors may even believe that their team is incapable of carrying out the more intricate tasks necessary to achieve high-priority goals. Given this false assumption, the doctors may then adopt a self-limiting belief that only they can do the work necessary to accomplish these goals. Thus, these doctors see no value in developing the team — choosing to “go it alone” and isolating themselves — forgoing valuable collaboration and assistance that would lighten the load, allowing for a better work/life balance, and resolving their state of exhaustion. Through the doctor’s words and actions, the team members sense that the doctor lacks confidence in their abilities. They see that the doctor does not value their thoughts or efforts. They feel the obvious lack of trust, and from that point on, dialogue breaks down, creativity and collaboration cease to exist, and stagnation arises. In the absence of trust, team members will fail to make the commitments that will unlock their potential.

Trust will also erode when default leadership results in ill-defined practice values and purpose. Because there is no clarity, there is also no shared understanding of the direction of the practice. Team members, lacking this sense of common values and purpose, are left to define their own values and create their own interpretation of the organization’s purpose. In effect, each team member begins to act out of his/her own self-defined operating system. There is no common driving force within the organization, and dysfunction ensues. Dysfunction is accompanied by distrust as each team member views the other team members’ actions in conflict with his/her own self-defined organizational values and purpose.

Symptoms: conflict, disillusionment, high turnover, lack of team coordination, low production and organizational capacity


Burnout is different from exhaustion. Exhaustion is the loss of physical stamina due to an excessive workload. Burnout is the loss of passion as well as physical and emotional stamina created by a heavy workload without the benefit of personal development. Recent workforce research has shown personal development to be the secret potion that can prevent burnout. This applies to both the doctor and staff. Along with personal growth come energy, passion, and an interest to continue growing and succeeding. We have found that the most successful healthcare practices expend significant resources in the development of their people. These are the same practices that serve as icons in our industry.

With ineffective leadership and an underdeveloped staff, the practice must work harder to compensate for these deficiencies. Often the best people burn out and will eventually leave the practice in search of something more enjoyable and rewarding — a practice that is willing to invest in their personal development. Unfortunately, this leaves the less qualified team members to carry the load, which soon becomes very heavy and unsustainable. When it becomes obvious that the problems are not solvable through more work, exhaustion, burnout, and poor work/life balance become the unavoidable consequences. If these conditions persist long enough, then disillusionment, anxiety, and depression are the unfortunate outcomes.

Symptoms: exhaustion, loss of passion, widespread practice decline, turnover, dis-illusionment, anxiety, depression


In summary, all the major stress producers that dentists report — managing their team, inadequate income, lack of meaningful work, navigating a complex marketplace — have their basis and their solution around the leader’s competencies. Most dental practice owners are looking for solutions in the latest technology, business management systems, clinical training, and marketing. Without a doubt, these assets are important parts of a comprehensive strategy for success. However, their impact on the practice will have a ceiling that is determined by the level of leadership provided by the doctor. Business performance is directly correlated with the level of leadership operating within the organization. The research and case studies completed over the past 30 years consistently reveal this.

There is hope, however. Extensive research into leadership development has resulted in new tools and highly reliable assessments that pinpoint a potential leader’s generative/creative competencies that enhance leadership effectiveness as well as those reactive tendencies that inhibit his/her leadership capabilities. Armed with this vital information, individualized leadership development programs are now designed for doctors by trained professional coaches. Furthermore, new and creative ways of assessing the efficacy of these individualized leadership development programs are now available and are widely employed in the development process.

We now know that great leaders are not born; they are made. Sometimes they are made out of a crisis or adversity. Sometimes leaders are made intentionally by someone who wants to experience a better life. That someone could be you. That journey could begin today. All it takes is an awareness of the importance of leadership and the commitment to develop those skills. There are more resources to guide you now than ever before. It is up to you.

Dr. Joel Small also addressed leadership essentials in his article, “Leading through change.” Check out his method for peaceful and orderly change here.

Drs. Joel Small and Edwin (Mac) McDonald have a total of over 75 years of dental practice experience. Both doctors are trained and certified Executive Leadership Coaches. They have joined forces to create Line of Sight Coaching, a business dedicated to helping their fellow dentists discover a better and more enjoyable way to create and lead a highly productive clinical dental practice. Through their work, clients experience a better work/life balance, find more joy in their work, and develop a strong practice culture and brand that positively impact their bottom line. To receive their free ebook, 7 Surprising Steps to Grow Your Practice Through Leadership, go to

Stay Relevant With Orthodontic Practice US

Join our email list for CE courses and webinars, articles and mores

Subscribe Today

Orthodontic Practice US is a leading dental journal and your publication for Orthodontic continuing education, Orthodontic case studies, and more. Subscribe to Orthodontic Practice US today!

Online Dental CE

Earn 16 dental continuing education credits as an Orthodontic Practice US subscriber per year.

Other Dental Publications
Dental Sleep Practice
Endodontic Practice
Implant Practice
Orthodontic Practice

MedMark Media is the leading interactive marketing and advertising company specializing in marketing and advertising, custom media, and public relations for the U.S. dental industry.

AGD PACE MedMark White

Copyright © 2024 Orthodontic Practice US - Dental Journal and Online Dental CE | MedMark LLC
15720 North Greenway Hayden Loop, Suite #9 Scottsdale, AZ 85260 | All rights Reserved | Privacy Policy | Terms & Conditions

Scroll to Top