In March, the American Dental Association (ADA) told its 163,000 members to stop all but urgent and emergency care to limit the risk of spreading COVID-19. Effectively 95 per cent of US dental practices shut down overnight. Executive Director of the ADA Dr Kathy O’Loughlin tells PA what happened next, how her organisation changed ‘on a dime’ and why new ways of working will last beyond COVID-19. Her story illustrates the importance of motivating people by focusing on purpose, working in agile ways, the power of trust and recognising we are all human.
Telling nearly 170,000 dentists to close their practices to all but urgent and emergency care was not a popular decision. People genuinely didn’t understand the depth of this pandemic or the lack of any way to mitigate the risk of transmission. But we knew it was transmitted by aerosol, and dental practices produce a lot of that. But even though we didn’t have time to explain the risks, within five days we achieved 99 per cent compliance.
Overnight we sent all our 400 people home and started agile teams to deal with every aspect of the crisis. What science information did dentists, regulators and legislators need? What advocacy did we need? With federal authorities releasing trillions of dollars, we wanted to make sure dentists, who are mostly small businesses, had access to that.
Each of our teams understood who their customer was and kept coming back to that. The COVID-19 recovery team focused on dentists. The non-dues revenue team focused on industry and advertisers. Focusing in a crisis is really important. We needed teams to do that and work collaboratively with each other.
Luckily, we’d been training people in agile methods for three years, so they were ready to do stand-up meetings and conquer problems as they arose in real time. We also communicated a lot – two virtual town halls a week and 17 board meetings in six weeks. We got people up and running on Skype and Zoom and created a system for them to pick up chairs, technology and whatever else they needed from our loading dock, without leaving their car and in nearly real time.
There were two ways to go. You crawled into a hole or ran as fast as you could. We preferred running. Working in an agile way meant not working in silos. That made us flexible, responsive and able to get products out the door within a few days. We had people working 14- to 16-hour days, but we’ve never produced better work faster. A noble purpose drives great teams to excel – helping keep dentists practicing and delivering essential health care to their communities.
Our Health Policy Research Institute and the Science and Research Institute looked at COVID-19’s impact on the economy, dental practices, patients and the public and started publishing weekly surveys, tracking the impact over time. Now we have very good estimates of what full recovery looks like and patients’ willingness to return to practices. That’s been very helpful to industry, regulators and health officials across the country.
We also published digital toolkits almost daily on how to practise safely, what procedures could be done, what environmental controls dentists needed and so on. We worked with outside experts on aerosol-borne pathogens and produced early evidence of the impact on dentistry. And the CDC (Centers for Disease Control and Prevention) often took our lead. We also had weekly educational webinars for up to 12,000 people.
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In a crisis, you can’t be a dictator with hierarchical decision-making. We believed good decisions could be made at each level. The message was ‘please make them, and if you make a mistake, we’ll fix it, but don’t worry about blame’. We were a hierarchical, process-driven organisation, but on the path to breaking through that. If we’d had leadership that wanted to hang on to the old way and wouldn’t delegate, it would have been a disaster. We “over” communicated to everyone – the Center for Disease Control, Health and Human Services, Federal Emergency Management Administration, Occupational Safety and Hazard Administration and all of the State Dental Associations.
We created an executive committee of the senior staff and I empowered them to make decisions quickly. They didn’t have to check in with me. And each good decision and each good guess gave them more confidence. Communication became critically important, so the teams operated autonomously but still felt part of a whole. My job was to give them the big picture and let them go.
The leadership philosophy I’ve tried to instil is that motivation comes from the higher purpose and letting your teams know what it is. And keeping America safe is a pretty good purpose. My role was focusing the message and delivering it consistently, over and over again. Safety first and foremost, for everyone we touch: dentists, their teams, our staff and volunteers. That really resonated with everyone, because they were scared. Some were looking after frail elderly people or children with health conditions. Others lived alone and suddenly couldn’t go out or meet friends.
The crisis has resembled the stages of the grieving process, like denial and anger. As a leader, you have to consolidate your messages to one or two to break through that. We let people feel sad and come through to accept where we are. It was important to make sure everyone understood the meaning of the work.
Our senior management team of 13 executive VPs has become agile teams of no more than five people with a scrum master to keep them on-task and accountable. They bring in expertise as they need it. It’s very different to an executive team that meets weekly and everyone round the table gets five seconds to complain. They work more collaboratively, with team members coming in and out based on what they have to offer. No one’s offended if they’re not invited. Conflict is healthy and necessary for great decisions. The teams can make decisions, and unless I see them heading for a third rail, I don’t interfere.
We can see the results already. Producing an annual budget is pretty tough in most organisations. But our team ran a process where everyone was willing to sacrifice something for the greater good. That rarely happens. It’s a cultural shift away from siloed, hierarchical divisions that I hope never shifts back.
We’re also creating agile teams around our four strategic goals. The crisis has accelerated that. Before, we were struggling with how to focus on our core goals and eliminate work that wasn’t essential. The crisis has shoved us into a shoebox, which isn’t all bad.
Another change is remote working, which we used to be prescriptive about. For instance, one of our senior managers really needed to see his people in their cubes every day. Then suddenly he couldn’t and he was worried about the quality of work, and the engagement. Now he’s absolutely convinced remote working is wonderful and he’s far more flexible with his teams. So I can see us dramatically reducing our real estate footprint and not missing a heartbeat.
I was teaching dental students the year HIV became a national epidemic with extremely high mortality rates and easy transmission though blood-borne pathogens. We had 600 dentists working in a clinic that we had to shut down immediately. So I’ve had a little history with things like this pandemic, where you don’t have time to think or feel panic or disappointment. You just have to move as quickly as you can.
If I could tell my pre-COVID-19 self anything, it would be: recognise that the grieving process applies to you too. I found myself getting angry with things people were saying or doing. In hindsight, I’d have said: ‘You’re grieving too. Don’t miss the symptoms. Pay a little more attention to what’s driving your internal feelings and understand you’re going through a process.’ Breathe deeply and often. Next time, I’ll remember that lesson.
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