The Silence That Can Cost Your Practice $480,000

Leadership Roots: Weekly Insights for Dental Practice Owners — Issue #8

As the year winds down, I’ve been reflecting on the practices I’ve worked with over the past twelve months. The ones that thrived weren’t necessarily the ones with the best systems or the most revenue. They were the ones where problems surfaced early, before they became crises. The ones where the team felt safe raising red flags, even when they didn’t have all the answers.

The practices that struggled? They had the opposite culture. Problems festered in silence until they exploded. And by the time leadership found out, the damage was done.

Let me tell you about one of those explosions.

The $480,000 Insurance AR Disaster

Last year, I got a call from a practice owner in a bind. His practice was producing nearly $2 million annually—a number most dentists would be thrilled with—but he was constantly struggling with cash flow. He was working harder than ever, the schedule was full, but the practice was floundering. He couldn’t figure out why.

He asked me to come in and diagnose the problem. I started where I always do: the data. Production was strong. Collections were a mystery. So I dug into their insurance accounts receivable.

What I found was a catastrophe years in the making. There was $480,000 in outstanding insurance claims. Some went back to 2018. The insurance team member had recently quit, leaving behind a mess that no one understood. As I started the painstaking work of researching these claims, the story got worse. After accounting for expected write-offs, the realistic payout was $253,000. But even that number was a mirage.

The dentist was shocked. But here’s the part that should scare you: he wasn’t the only one who knew there was a problem. The office manager knew the numbers felt wrong. The front desk team knew the insurance process was a mess. The insurance coordinator who quit definitely knew.

Everyone knew there was a fire, but nobody pulled the alarm until the building was halfway burned to the ground.

Here’s what makes this even more alarming: The average practice in our benchmarking data sits on about $74,000 in over-30-day insurance AR. That’s already a problem most practices aren’t addressing. This practice had $480,000—more than six times the average. And nobody said a word until it was a crisis.

The Problems You Don’t Know About

This isn’t an isolated incident. It’s a pattern I see in practice after practice. The biggest threats aren’t the problems on your radar—they’re the ones your team is too afraid to bring you. The broken processes they’ve learned to work around. The patient complaints they’re quietly managing. The inefficiencies they’ve accepted as “just how things are.”

Most practices “have a process” for insurance AR. But having a process and having a working process are two very different things. And when your team doesn’t feel safe raising red flags, you won’t know the difference until it’s too late.

And the reason they stay silent? Because in most practices, there’s an unwritten rule: Don’t bring the leader a problem unless you also have the solution.

The “Bring Me Solutions” Trap: Why Good Intentions Create Silence

Organizational psychologist Adam Grant posted a quote on LinkedIn last week that perfectly captures this dynamic:

“Hey Leaders: ‘Don’t bring me problems, bring me solutions’ doesn’t eliminate problems. It stops people from raising the hardest problems. You need to make it safe for people to tell you what’s broken even if they don’t have a fix yet.”

Understanding this leadership dynamic is essential for every practice owner dealing with team retention. This is one of the most common—and most destructive—leadership traps. We think we’re empowering our teams by asking for solutions. We think we’re training them to be independent problem-solvers. But what we’re actually doing is creating a culture of silence.

Your team members on the front lines—the ones dealing with messy handoffs, confusing processes, and frustrated patients—are the first to see the cracks in the foundation. But they don’t always have the perspective, authority, or knowledge to design the perfect solution. So if the price of admission to your office is a fully-formed answer, they’ll stay silent.

The insurance coordinator in that $253,000 disaster didn’t know how to fix a years-long systemic problem. So instead of raising a red flag, she just quit. The problems festered, the write-offs grew, and the practice nearly drowned.

Your biggest threats aren’t the problems you know about. They’re the ones your team is too afraid to bring you.

The Seven Most Expensive Words in Dentistry

This fear of raising problems is often rooted in a culture of operational complacency. It’s the seven most expensive words in business: “This is how we’ve always done it.”

In these practices, there’s a process for everything, but the processes themselves are broken. The team knows the workflow for patient check-in is clunky. They know the inventory system is inefficient. They know the insurance AR process is a black hole. But they keep doing it that way because challenging the status quo is seen as disruptive or critical.

For a team member to be willing to say, “Hey, this process is broken,” two things need to be true:

1. They have to respect you enough to believe you genuinely want to improve.
2. You have to have the capability to handle the criticism without getting defensive.

If your first reaction to someone pointing out a flaw is to defend the existing process or blame the person raising the issue, you’ve just taught your entire team to keep their mouths shut. You’ve prioritized your ego over the health of the practice.

This is where I admire the principle of Radical Transparency, a concept championed by investor Ray Dalio. You don’t have to agree with all his methods to appreciate the core idea: great leaders have the courage to seek out issues and take them on, even when it’s uncomfortable. They create a culture where problems are gifts, because each one is an opportunity to get better.

From Dictator to Coach: The Power of the Right Question

So what’s the alternative? Adam Grant offers a simple but powerful reframe:

“Bring me problems, as long as you’re willing to be part of the solution.”

This small shift in language changes everything. It removes the pressure of needing a perfect answer and replaces it with an invitation to collaborate. It says, “I don’t expect you to have it all figured out, but I do expect you to engage your brain and help me fix it.”

This turns the relationship from a dictatorship into a partnership. It leverages the unique knowledge of your team—the “boots on the ground” who almost always know the root cause of the problem—and combines it with your leadership perspective and authority.

This is the essence of what Michael Bungay Stanier calls The Coaching Habit in his book of the same name. When a team member comes to you with an issue, your job isn’t to provide the answer. It’s to ask the right questions.

Team Member: “The new patient check-in process is a mess!”

The Old Way (Shuts down conversation): “What do you mean? Just follow the checklist. If you have a better idea, let me know.”

The New Way (Opens the door): “Thanks for bringing that to me. What are your thoughts on what’s making it messy? Are we overbooking? Do we need more training? Is the process itself the problem?”

By responding with questions, you empower your team member to think critically, you gain valuable insight from their on-the-ground perspective, and you make them a partner in building the solution. You’re not just fixing a process; you’re developing a leader.

Your Challenge Before the New Year

This is the last issue of Leadership Roots for 2025. We’ll pick back up in early January 2026.

A few weeks ago, I wrote about the importance of sharpening the saw—taking time to rest and renew so you can lead at your best. I’m taking my own advice and stepping away for the holidays. I encourage you to do the same.

But before you fully unplug, use the next two weeks to start building a culture where problems surface before they become crises. The holidays are a natural time for reflection, and many practices are slower between Christmas and New Year. It’s the perfect opportunity to have these conversations without the daily chaos.

Here’s how you can start:

1. Set the Stage

At your next team huddle before the break, share the Adam Grant quote and set a clear expectation. Say something like, “I want to be clear about something as we head into 2026: I want to know what’s broken, even if you don’t have the fix yet. If you see a problem, bring it to me. We’ll figure out the solution together.”

2. Ask the Question

Before the year ends, go to each department or team member and ask one simple question: “What’s one thing we do that doesn’t make sense anymore?” or “What’s the most frustrating part of your day?“

3. Just Listen and Ask Questions

When they answer, your only job is to listen and respond with coaching questions. Do not defend, do not justify, and do not immediately offer a solution. Try these:

• “Tell me more about that.”
• “What’s the real challenge here for you?”
• “What are your thoughts on what might be causing that?”
• “If you were in my shoes, what’s the first thing you’d look at?”

A word of caution: This isn’t an invitation for a complaint session or a chance to air grievances about coworkers. We’re not looking for “Jane is frustrating to work with” or “Suzie never does her job.” We’re looking for “The handoff between front desk and hygiene is unclear” or “Our inventory system creates bottlenecks.”

The key is in the second half of Adam Grant’s principle: “as long as you’re willing to be part of the solution.” Keep the conversation focused on systems and processes, not personalities. If someone starts venting about a person, redirect them: “I hear you. Let’s focus on the process that’s breaking down. What’s one thing we could change about how we work together?”

The goal isn’t to solve every problem before January. It’s to prove to your team—and to yourself—that it’s safe to talk about what’s broken. Start 2026 with a culture where your team brings you problems early, before they become the next $253,000 disaster.

Enjoy the holidays. Rest well. And I’ll see you in the new year.

Leading with you,

Joe DeLuca