Sabka Dentist: Taking Accessible Dental Care to Scale

Introduction

Sabka Dentist (SD) is the largest chain of dental clinics in India, with an emphasis on affordable care. Currently SD owns and runs 112 dental clinics in India, with 250 dental chairs, more than five hundred dentists, and one thousand five hundred people. The company is active in Mumbai, Pune, Ahmedabad, Surat, and Bangalore, and it serves approximately three hundred thousand patients every year. The company reports strong revenue growth, increasing from $187 thousand in 2012 to $8.1 million in 2016.1

The company’s mission is to provide affordable dental care to all people in India, with a special focus on the poorest members of the urban population. This goal was the main driver for creating SD’s innovative business model, which uses a low capital expenditure model, exemplified by the small clinic size and focused menu of procedures, to make dental care accessible to everyone.

Pain Points in the Ecosystem

Dental care is important for everyone, yet it tends to be overlooked as a component of overall health and well-being, and it is often expensive and in short supply. With a dentist-to-population ratio of 1:10,000 in urban areas and 1:150,000 in rural areas, most Indians have no access at all to basic oral health services.2 As a result dental diseases are a significant public health menace across the country, where they have a substantial impact on the quality of life, daily performance, and general life satisfaction A 2016 study on oral health in the country found 50 per cent of school children are suffering from cavities and tooth decay and more than 90 per cent of the adult population is affected by periodontal disease.3

Traditionally in India there was little provision between high-priced private treatment or the primitive street-corner tooth-puller. Anyone who could not afford the top-of-the-range treatment had little incentive to visit the dentist and no knowledge of what they could do in the way of preventative care.

To tackle this problem, SD first developed an efficient model that enables dental clinics to offer affordable access to dental services. The company estimates that it has reduced the cost of treatment by 40 per cent compared to competitors, enabling it to lower the price to patients. SD has since made the details of their model publicly available, in order to help other businesses also treat as many people as possible.

Business Strategy

At the heart of SD’s approach is creating a high degree of standardization, which enables it to scale operations easily and offer a high-quality service.

The majority of the clinics operate for 12 hours from 9am to 9pm and each clinic is fitted out according to a standard unit model which comprises two chairs in a small clinical area of around 400 sq ft. This means that a new clinic can be fitted out and launched within three weeks. SD also offers free check-ups in clinics and through the use of mobile van units to create a better preventive environment, which enables patients to know about dental problems earlier, making treatment easier and cheaper.

The company provides massive training programmes that cover all dental procedures in detail, enabling consistent care. SD organizes continuous education programmes for their dentists. This also includes a plus-one invitation for each dentist to offer free training to an external colleague. This means that training to improve the quality of dental care is provided to the whole industry and not just the company itself. By offering training not only in-house, but also to dentists outside the clinic, SD tackles low-quality dental care and human capital creation at the same time.

SD has worked to recruit and retain female employees; 95 per cent of employees are now women. In India a high proportion of graduating dentists are female, but they often do not practice. To address this and make the workspace more attractive to women, the company has been built around their preferences for flexibility.

In addition, to making dental care more accessible, the company enables its patients to make payments in twelve interest-free instalments. In these credit arrangements, either SD will pay the interest itself or it will seek partnerships with financial institutions.

The high standards and quality of care in SD clinics have started to attract affluent patients, making it possible to cross-subsidize care for the poorest. SD has added a premium, higher-margin offering (for example, a ceramic crown instead of metal or resin) which is attractive to wealthier patients; the higher margin is used to subsidize lower-margin treatments for the poorer patients. The prices charged to the poorest patients can then be reduced by up to 50 per cent.

When a similar company was started in the North of India, Sabka Dentist’s CEO decided to share his entire strategy with them, including procedures, prices, and technology, so that they could benefit from SD’s experience and provide affordable dental care better and faster. When asked why he helped a potential competitor, the CEO answered: ‘I want all Indians to have access to affordable dental care. What you call competition, I call people working towards my purpose for free so I help them if I can.’ He has since created an online platform where all these resources are freely available to the public.

Performance

SD’s model contributes to a better distribution of human resources and treatment of patients. Regular check-ups not only decrease the severity of interventions, they also enable SD dentists and employees to save time and treat more patients in shorter appointments, thereby making dental care more available. This is an important factor because of the disproportionate ratio between the number of patients in need of dental care and the number of dentists.

Sabka Dentist has invested in establishing a set of performance indicators that go beyond a focus on financial performance. These are listed below in order of importance:

1. Purpose: Number of patients treated

2. Quality (inside-out): In-house surprise audit score (out of 200)

3. Quality (outside-in): Patient satisfaction score (likelihood that patient will recommend clinic to family and friends)

4. Sustainability: Average revenue per patient.

These metrics are used to guide management decisions. Both the CEO and the managers’ performance and variable pay are indexed on these four measures, with the highest weight on the first (purpose metric).

These indicators inform every management decision at every level: Who to promote? Which clinic to close? Where to allocate resources? When a clinic fails on the first measure, it triggers an immediate audit and intervention. If issues are not sufficiently addressed within nine months, the clinic enters the ‘red alert zone’ (receiving more marketing and more senior dentists) for three months. If it still does not achieve the target number of patients, it will be closed. The purpose metric (the number of patients treated) is thus used to ensure a responsible allocation of the firm’s resources.

As a further example, the third measure reflects a fundamental focus on patient experience and feedback. There is a feedback link on the website which directly emails the CEO. In addition, a random sample of patients get called back by phone, and specially trained personnel tease out negative feedback. This is a challenge in a society where people are culturally reluctant to say bad things about their doctors.

Each strategy deployed by SD essentially addresses these performance metrics. Quality is thus addressed through high levels of standardization, which guarantees high quality and fast scalability of operations. Quality audits are thorough and led by an internal team with specialist training to get patient satisfaction feedback through phone surveys. Transparency is another important factor, which SD addresses by making all prices publicly available on its website.

On the financial side, SD’s business model and strategy can be called a success. Firstly, the company witnesses steady growth: in the early stages the company saw an expansion of two clinics per month; now SD has a steady increase of seven additional clinics per month. Secondly, operations are not only a social impact success, but also both profitable and sustainable. Today SD is a lucrative dental care chain with 100 clinics.

Prognosis

There are several explanations for this overall success. SD has sought a high degree of standardization, low capital expenditure and standardized quality in order to make operations scalable. By scaling and increasing affordability, the company hopes to increase the use of regular check-ups across India and decrease the need for complicated surgeries, which are more expensive. In other words, enabling people to have regular access to dental care decreases their need for more complicated interventions and this is financially beneficial for both clients and the company. Thirdly, SD have found a way to further subsidize the dental care for the poorest patients (having dropped prices by 50 per cent), while increasing the offer for their more affluent patients.

SD expects to continue its performance and make dental healthcare affordable to all classes of people. Considering the social scale of the business, governments could also become interested and make a contribution by supporting their model in the future. A major challenge is the access to more people willing to pursue dental studies in order to increase the number of dentists. Despite this challenge, considering the existing evidence, Sabka Dentist expects more growth in the future. Building on the lessons learned throughout careful observations and the patient services at Sabka Dentist clinics, the business is likely to adapt quickly to potential challenges.

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Notes

1. https://www.healthcarebusinessinternational.com/awards/samsung-innovative-low-cost-business-%20model-finalist-2017/.

2. Tandon (2004).

3. Gambhir and Gupta (2016).

Case Study Contributors

• Yassine El Ouarzazi, Mars Catalyst

• Lionel Khalil, Mars Catalyst

• Aida Hadzic, (formerly) University of Oxford

• Kate Roll, University of Oxford

• Judith C. Stroehle, University of Oxford

• Vikram Vora, Sabka Dentist

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