This, the second in a series of three posts, is for students, residents and young dentists. Anyone, of course, can read it and I hope it is useful to all.
Oh, this post isn't going to explore everything about how patients decide which dental practice to visit for their care. I will explain one aspect of that decision process, though, and in great detail. In this post I explain why some patients choose a dental practice based on cost and why, for some patients, cost is not the only consideration.
You will learn why some patients go to corporate practices where everything and everyone is interchangeable, and why some patients seek care in private practice, from a dentist they know personally.
This post is for anyone, but I'm particularly writing for students of dentistry and young dentists. This is a follow-on to my post "A Message to Young Dentists."
http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2014/01/a-message-to-young-dentists.html
Many dentists are somewhat fearful of corporate dental practice, partly because a corporate practice can supposedly provide dental care at a lower cost than private practice can. This is not quite so threatening as it seems at first glance. As we saw in our last post, there are many human factors that surround the dentistry itself. These factors include, but are not limited to: listening to patients; educating them about prevention; solving their problems (often in terms of physical pain or esthetic pain); and generally expending emotional labor to make a real connection with the human being in the chair.
Corporate dental practice is not interested in, equipped for, nor capable of providing these "soft innovations" for patients. By definition, corporations are legal instruments which are mandated to maximize profits for their shareholders. In dentistry, corporate practices "race to the bottom" on cost, and often strive to maximize profitability by means of over-diagnosis and over-treatment. Common examples include performing root canal treatment when a tooth could remain healthy with its vital pulp, or performing periodontal therapy on all new patients--whether they need it or not.
But corporate dental practice (supposedly) costs less to the patient. (When they claim that, I suppose they are not factoring in their over-diagnosis and aggresssive over-treatment.) This assertion generates important questions for we who are in private practice or small group practice. Do patients generally seek dental care based solely on cost considerations? How are we to compete with corporate dentistry if they do?
Insights into these questions are to be found in Diffusion of Innovations theory.
Diffusion of Innovations theory seeks to explain how, over time, an idea, technology, product or behavior gains momentum and diffuses (or spreads) through a specific population, culture or social system. The definitive text is Diffusion of Innovations, Everett Rogers, 5th Edition (2003). Diffusion theory posits four main elements that influence the spread of a new idea: the innovation, communication channels, time, and a social system. There are five categories of adopters of innovations: Innovators, Early Adopters, Early Majority, Late Majority, and Laggards. Study after study of all sorts of innovations and all sizes of social systems show that categories of adopters can be recognized and defined. Further, these studies show that the successful spread of an innovation follows an S-shaped curve, with these adopter categories plotted against time. Here are the two curves combined into one graph:
Let's let Dr. Rogers himself explain a bit more about how this all works:
"The innovation-decision process is the process through which an individual (or other decision-making unit) passes from gaining initial knowledge of an innovation, to forming an attitude toward the innovation, to making a decision to adopt or reject, to implementation of the new idea, and to confirmation of this decision. This process consists of a series of choices and actions over time through which an individual or a system evaluates a new idea and decides whether or not to incorporate the innovation into ongoing practice. This behavior consists essentially of dealing with the uncertainty that is inherently involved in deciding about a new alternative to an idea previously in existence. The perceived newness of an innovation, and the uncertainty associated with this newness, is a distinctive aspect of innovation decision making (compared to other types of decision making)."
These remarkable concepts apply to every purchase you make, every project you start at work, every new technology you decide to adopt--they even apply to every person you date. For our purposes here, we can take "innovation" to mean "your dental practice," or any specific attribute within your dental practice.
Let's now present an overview of the main characteristics and values of each adopter category, which will be followed by more detailed generalizations. Here again is the Diffusion curve, followed by Dr. Roger's descriptions from his text of each adopter category.
Innovators: Venturesome
Venturesomeness is almost an obsession with innovators. Their interest in new ideas leads them out of a local circle of peer networks and into more cosmopolite social relationships. Communication patterns and friendships among a clique of innovators are common, even though these individuals may be quite geographically distanced. Being an innovator has several prerequisites. Control of substantial financial resources is helpful in absorbing the possible losses from an unprofitable innovation. The ability to understand and apply complex technical knowledge is also needed. The innovator must be able to cope with a high degree of uncertainty about an innovation at the time he or she adopts. The salient value of the innovator is venturesomeness, due to a desire for the rash, the daring, and the risky. The innovator must also be willing to accept an occasional setback when a new idea proves unsuccessful, as inevitably happens. While an innovator may not be respected by other members of a local system, the innovator plays an important role in the diffusion process: that of launching the new idea in the system by importing the innovation from outside of the system’s boundaries. Thus, the innovator plays a gatekeeping role in the flow of new ideas into a system.
Early Adopters: Respect
Early adopters are a more integrated part of the local social system than are innovators. Whereas innovators are cosmopolites, early adopters are localites. This adopter category, more than any other, has the highest degree of opinion leadership in most systems. Potential adopters look to early adopters for advice and information about an innovation. The early adopter is considered by many to be “the individual to check with” before adopting a new idea. This adopter category is generally sought by change agents as a local missionary for speeding the diffusion process. Because early adopters are not too far ahead of the average individual in innovativeness, they serve as a role model for many other members of a social system. Early adopters help trigger the critical mass when they adopt an innovation. The early adopter is respected by his or her peers, and is the embodiment of successful, discrete use of new ideas. The early adopter knows that to continue to earn this esteem of colleagues and to maintain a central position in the communication networks of the system, he or she must make judicious innovation-decisions. The early adopter decreases uncertainty about a new idea by adopting it, and then conveying a subjective evaluation of the innovation to near peers through interpersonal networks. In one sense, early adopters put their stamp of approval on a new idea by adopting it.
Early Majority: Deliberate
The early majority adopt new ideas just before the average member of a system. The early majority interact frequently with their peers but seldom hold positions of opinion leadership in a system. The early majority’s unique location between the very early and the relatively late to adopt makes them an important link in the diffusion process. They provide interconnectedness in the system’s interpersonal networks. The early majority are one of the most numerous adopter categories, making up one third of all members of a system. The early majority may deliberate for some time before completely adopting a new idea. Their innovation-decision period is relatively longer than that of the innovators and the early adopters (see Chapter5). “Be not the first by which the new is tried, nor the last to lay the old aside,” quoted at the beginning of this chapter, particularly fits the thinking of the early majority. They follow with deliberate willingness in adopting innovations but seldom lead.
Late Majority: Skeptical
The late majority adopt new ideas just after the average member of a system. Like the early majority, the late majority make up one third of the members of a system. Adoption may be both an economic necessity for the late majority and the result of increasing peer pressures. Innovations are approached with a skeptical and cautious air, and the late majority do not adopt until most others in their system have already done so. The weight of system norms must definitely favor an innovation before the late majority are convinced to adopt. The pressure of peers is necessary to motivate adoption. Their relatively scarce resources mean that most of the uncertainty about a new idea must be removed before the late majority feel that it is safe to adopt.
Laggards: Traditional
Laggards are the last in a social system to adopt an innovation. They possess almost no opinion leadership. Laggards are the most localite of all adopter categories in their outlook. Many are near isolates in the social networks of their system. The point of reference for the laggard is the past. Decisions are often made in terms of what has been done previously, and these individuals interact primarily with others who also have relatively traditional values. Laggards tend to be suspicious of innovations and of change agents. Their innovation-decision process is relatively lengthy, with adoption and use lagging far behind awareness-knowledge of a new idea. Resistance to innovations on the part of laggards may be entirely rational from the laggards’ viewpoint, as their resources are limited and they must be certain that a new idea will not fail before they can adopt. The laggard’s precarious economic position forces the individual to be extremely cautious in adopting innovations. “Laggard” might sound like a bad name. This title of the adopter category carries an invidious distinction (in much the same way that “lower class” is a negative nomenclature). Laggard is a bad name because most nonlaggards have a strong pro-innovation bias. Diffusion scholars who use adopter categories in their research do not mean any particular disrespect by the term “laggard.” Indeed, if they used any other term instead of laggards, such as “late adopters,” it would soon have a similar negative connotation. But it is a mistake to imply that laggards are somehow at fault for being relatively late to adopt. System-blame may more accurately describe the reality of the laggards’ situation.
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Me again. Please understand that we all have moments and phases in our lives where we act in each adopter category. For instance, back in the day I resisted buying a CD player for as long as possible. Then, I still bought CDs for a bit when online streaming of music became the delivery method of choice. Yet I practice dentistry with a surgical operating Microscope, and have an incredible array of high-tech equipment in the office. I drive a hybrid car and have two electric lawn mowers--one of which is a robot.
The point is, even though we all have Laggard as well as Early Adopter moments in our lives, each of us has a primary tendency which correlates to our risk tolerance and the size and heterogeneity of our social systems. We thus can simplify and use the above definitions of adopter categories for the purposes of this discussion.
The reason I wanted to introduce these Diffusion concepts to you is so that you can understand my assertions:
Laggards, Late Majority and some of the Early Majority tend to be highly sensitive to pricing, and tend to choose corporate dental practices. They tend to rank cost factors higher than interpersonal factors. These "soft" or interpersonal factors include personal connection to the doctor and staff, as well as other factors like thorough diagnosis, detailed explanations of treatment, practicing conservative treatment, and being listened to.
Innovators, Early Adopters and some of the Early Majority tend to be highly sensitive to interpersonal factors, and tend to choose private or small group dental practices. They tend to rank interpersonal factors higher than cost factors.
There are always exceptions. As I look back through practice, I can recall Innovators and Early Adopters who left our practice when some lower-cost alterative became available. I can also recall Laggards who have happily visited us for years and years, and would never turn to an anonymous corporate dental experience. By and large, however, the above tendencies appear to me to hold true. Always one to turn to hard science for answers to tough quesitons, I would like to see this question studied by qualified Diffusion scholars.
We now have an important part of the answer to the question, "Why do some patients choose a dentist purely based on cost considerations?" We also can answer the question, "Is corporate dentistry going to put me out of business?"
The answer is no.
Again, as I asserted in my previous post, many modern consumers are looking for Certainty, and also for simple, basic human Connection. They want to be delighted, and they want their problems solved. Consumers are highly connected, informed and they know how to cut through the clutter to find what they want. Lastly, consumers are sick and tired of being interrupted. As the marketers in the world respond to being ignored by yelling ever louder at us, we turn away with ears that become ever less attuned to the cacaphony going on around us.
Thus, many Innovators, Early Adopters and Early Majority are seeking out business experiences where they find Connection, Certainty, sustained trust, respect and good listening. These are things that corporate dental practice is neither inclined to, nor capable of, providing.
After all this detail, you deserve some brevity. I can sum the whole thing up in eight words: "Listen to your patients, and you shall prosper."
We have one more issue to deal with: Interruption Advertising versus Permission Marketing.
Interruption Advertising means, ah, let me just say it simply: interrupting us with ads. The thing is, nowadays we are interrupted by advertising messages in all media and in every place and time marketers, in their near-infinite deviousness, can place them in. We're watching the game and--!bam!--interrupted by an ad. Reading a dental journal? !Bam! Interrupted by an ad, and we have to pause and turn the page and re-start our reading. (In a more genteel age they put them all at the back!) Need to gas up our car? !Bam! Interrupted by an ad, right there on the pump. Often these days, gas pumps have more than pictures. They have video and blaring sound. Buses, billboards, online banners...now they're even talking about ads on the grounds of public schools.
Permission Marketing, on the other hand, as defined by Seth Godin is: "The privilege (not the right) of delivering anticipated, personal and relevant messages to people who actually want to get them."
http://sethgodin.typepad.com/seths_blog/2008/01/permission-mark.html
I have two more assertions for you, and they are summed up in this image:
My assertions are:
Innovators, Early Adopters and some of the Early Majority tend to be influenced by messages delivered by Permission Marketing.
Laggards, Late Majority and some of the Early Majority tend to be influenced by messages delivered by Interruption Advertising.
I'll leave you with a final thought. When we market our dental practice, we don't need to try to reach Everyone. That's too expensive, and to reach Everyone we would need to water down our message too much. Weaken what we stand for. Average ourselves out. Sand off all our edges--all our edges that are interesting.
We need to reach Opinion Leaders. These are folks with the ability to influence, informally, other's attitudes or behavior. Opinion Leadership is earned and maintained. It's not a sure thing. And Opinion Leaders tend to reside in the Early Adopter and Early Majority categories. Not so much the Innovator category--often, Innovators lie outside the norms of their social system, and they're too quirky in their venturesomeness to have direct influence over the majority. Rather, Innovators exert their profound influence on their social system through the Early Adopters who try their ideas and talk about them to all who will listen.
If we use Permission Marketing to spread awareness of our dental practice and what we do for our patients, we can be efficient with our efforts. We don't have to spread out a vast marketing funnel in hopes that some tiny fraction of the people who see the message will actually appoint in our office. We need only reach Opinion Leaders--and knock their socks off with delight and problem-solving, and they will become megaphones for us.
http://sethgodin.typepad.com/seths_blog/files/flippingfunnelPRO.pdf
I would also like to see these two assertions given proper scientific study by a Diffusion scholar. Meantime, I am utterly convinced that they are true.
As you grow your practice, consider employing Permission Marketing and minimizing your expensive Interruption Advertising efforts. (It's still a good idea to have a little bit of it in your marketing mix.) One other advantage of Permission Marketing: it's more congruent with who you really are.
Now why would I say that?
Most advertisements present an idealized version of the product or service that they’re attempting to make us aware of. They promise glitz and glamour where the product is only dross. Romance when the customer is only going to be let down by the banal. Powerful experiences where there is really no experience at all, only a commodity. The truth is, the best marketing is not an advertisement at all, but rather a remarkable product or service.
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Next post we will discuss specific Permission Marketing steps you can take in your dental practice that lead to success.
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