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Reflection Paper:

RAT Applied to the Oral Health Care Industry: Marketing Services and Resource Advantage Theory

Odontologίa

Graduate Histology Lab Report: Identification of Unknown Tissue Samples

By Stephanie Lomeli Graduate Student in Interdisciplinary Studies

Texas Tech University Lubbock, Texas

Cell: (832) 443-3573 Email: sa.lomeli@ttu.edu

May 2012

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Acknowledgement: I would like to acknowledge Dr. Brian Reilly and Dr. Jorge Zamora who supported and inspired me over the past few years. These two professors stood by me, even during times when I was over whelmed with school and distracted with my Pre-Dental Society officer obligations, stressing about dental school or when I would come down with a severe case of Bronchitis. I would also like to thank Dr. Arnett, Dennis who took the time to step in to review my Masters Portfolio.

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Table of Contents

Title page…………………………………………………………………………………………1

Acknowledgements………………………………………………………………………….….2

Table of Contents……………………………………………………………………………….3

Reflection Paper…………………………………………………………………………………4

Odontologίa…………………………………………………………………………………….19

Resource Advantage Theory Applied to the Oral Health Care Industry: Marketing Services and RAT……………………………………………………………………………..31

Graduate Histology Lab Report: Identification of Unknown Tissue Samples…………...66

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It was a beautiful July summer day in Farmington Connecticut, but despite the

warm sun and the cool breeze outside, I found myself stressed, exhausted, and sleep

deprived inside a conference room face to face with 12 other prospective dental

students in a similar state of mind, who lined both sides of a long rectangular table. At

the head of the table sat Dr. Edward A. Thibodeau Associate Dean of Admissions for

the University of Connecticut School of Dental Medicine. As he sat there arms folded to

his chest speaking in a stern matter of fact way he proceeded to enlighten the students

of the sobering reality of our chances of getting into dental school. As he splits the table

in half, he states half of us present would gain entry to dental school, while the other

half won’t. As he said this you could see reality hit in each and every person. The fact is

that on average 11,000 students will apply to a limited number of spots with only 5,000

lucky students able to pursue their dream career in any given applications cycle. For

many students in the room they were hearing this for the first time. As the mood

changed from one of nervous excitement to fearful depression I, on the other hand, felt

a sigh of relief that I was not hearing this information for the first time. Although I felt a

rush of relief, due to the experience gained during my masters’ studies, I knew I had

come a long way. In fact, two years before this somber day I had visited Baylor College

of Dentistry where I had learned about these critically important dental application

statistics. It was at this visit that I came to the realization that I was so close but yet still

so far from accomplishing my career goals. It was this realization that inspired me to

pursue my masters.

Every year students spend hundreds to even thousands of dollars applying to

dental school only to receive disappointing news. I always knew I never wanted to be in

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that devastating predicament. When it was time to apply I wanted to be 100% ready and

confident that I would gain admission to the dental school of my choice. As I write this

reflection paper, at the end of my masters’ studies, I am proud to say that I

accomplished my goal by gaining entry into several dental schools. I am confident that

my Masters in Interdisciplinary Studies allowed me to develop into a better dental

school candidate, enabling me to score in the 97% tile on the DAT when previously I

had failed to even receive a passing score.

In 2008, I found myself studying for the DAT for the first time. At the time I was in

my third year of my biochemistry undergraduate degree where I was taking particularly

challenging classes. It was at this time that I took a moment to really analyze my long

term and short-term goals for the future. I evaluated my strengths and weaknesses, and

identified areas for development. After careful reflection, I postponed taking the DAT,

and applications for the 2008 dental school cycle. I also made the decision to return to

the Texas Tech Center located in Seville, Spain where I had spent the previous spring

semester in Seville and had fallen in love with the language and the culture. Studying

Spanish in Seville, Spain ended up being an opportunity of a lifetime that inspired me to

pursue a dual degree in Spanish.

As the academic year wound down in the spring of 2009 and graduation grew

ever nearer, I found myself exploring my options once again. I had decided that I was

still not ready to apply to dental school. I wanted to transform my weaknesses into

strengths. It was during this time that I had been invited to tour Baylor College of

Dentistry, where I was armed with the knowledge necessary to accurately evaluate my

candidacy as a dental school applicant. Upon evaluating my academic history against

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the information I obtained at the dental school tour it became clear that there were some

gaps I need to fill based on my grades, estimated practice DAT score, and classes in

order to better position myself to accomplish my career and personal life goals.

An Ideal dental school candidate will have a thorough knowledge of the biological

sciences. During my undergraduate career I found chemistry to be almost effortless,

while struggling to understand and link many of the concepts in the biological sciences. I

knew that if I wanted to be successful in dental school and have a chance at ranking in

the top 10% of dental students then I would need to drastically develop my

understanding of the biological sciences. The desire to gain a better understanding of

the biological sciences lead me to take classes such as Microbiology, Immunology,

Pathogenic Microbiology, Virology and Histology. Histology proved to be a particularly

important area of knowledge to obtain, a fact I realized during multiple meet and greets

with dental students. Through these interactions I learned that one of the most

challenging biological sciences that dental students take in their first two years is

Histology. A class that leaves many 3rd and 4th year dental students stating that they

regretted not taking this class as an undergraduate, especially due to the sheer mass of

specific information the students are exposed to in such a short duration.

After the dental school tour, I became the secretary of the Pre-Dental Society.

During my recruitment and retention efforts I meet with several dentists, and sought

their advice. After speaking with many dentists it was clear that there was a common

trend in the advice they gave finding the main take home message being that if you

want to have a successful dental practice then it is imperative that you gain a basic

understanding of business and learn Spanish. Probably one of the most common advice

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dentists would stress was the importance of taking business classes. I had heard

multiple dentists state that you can be the best dentist but your practice will fail if you

are not business smart. This because, once you complete your Doctorate of Dental

Surgery and enter the real world your focus shifts from the sciences to running a

business. These interactions lead to my decision become educated with a basic

business foundation in order to secure my future personal career goals after dental

school. It was this strong desire to have my own successful practice that inspired me to

take Marketing Tools and Concepts, an introductory Marketing class followed by

Marketing Services, as dentistry is a service based business. I choose to take Personal

Financial Planning to gain a basic understanding in finance that would assist me in

reaching my goals. The Negotiations and Conflict Management class helped develop

my interpersonal and negotiation skills. These skills will give me the competitive

advantage necessary to accomplish the superior financial performance I desire in the

future.

Any health care provider will stress the importance of being proficient in multiple

languages. For those who aspire to practice in Texas, especially the southwest, it is

highly beneficial to speak Spanish. My desire to maintain and further develop the

language That I began learning during my last two years of my undergraduate studies

inspired me to take Business Spanish, Spanish Colonial Literature, and Medical

Spanish. Throughout my maters studies I found my Spanish classes were heavily

interrelated with the other two areas of discipline I was studying.

Project Assessment

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Having heard many excellent peer reviews about Business Spanish, I was eager

to take this class. I was deeply intrigued with the class and its interactive nature. When I

sought out Dr. Zamora concerning the class, he was very enthusiastic and immediately

had an idea for a graduate project. His eagerness was contagious, and I was

immediately captivated by the class and the graduate project he assigned to me. During

our initial conversation Dr. Zamora inquired as to what my career goals were. I

explained to him my passion for dentistry, the purpose behind my masters, and what I

hoped to achieve in the future. He understood that I had a fascination with orthodontics

and most importantly that I one day aspired to have my own practice. I had explained to

him how ambitious I was and he felt strongly that in order to execute a successful

practice in the southwest that Spanish would play a key role in gaining the competitive

advantage over fellow practitioners. Because my aspirations are to be the best he also

stressed the importance of needing to understand what goes on behind the scenes, so

he encouraged me to see how a top orthodontics office runs. He recommended top

Lubbock orthodontics practice, Smile by St. Clair. Prior to this assignment I had done

extensive shadowing and volunteering at multiple dental practices with a focus on

learning about dental techniques, but I have never shadowed and orthodontics practice.

I had also never stopped to explore and analyze how a dental practice runs or how the

office is organized. During my shadowing sessions it seemed as though the dentist’s

only focus was the patient. Dr. Zamora had pointed out that if I wanted to be successful,

I would have to understand how the practice runs in the absence of the dentist’s

attention. For his project I would need to be able to translate this understanding to the

Spanish language.

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I began my project by first conducting basic research on dentistry, orthodontics,

and the Texas Dental Association. As I conducted my research, I took note of any key

vocabulary terms that were new and then translated any relevant information I found. I

then proceeded to research the orthodontics’ office in question. I began by first googling

Smile by St. Clair where I found the practice’s web page and proceeded to study every

aspect of their website in order to learn as much as I could about the practice. My next

step in the research process was to make arrangements to observe the orthodontics

office, this was a portion of the project that proved to be a more challenging. I began by

explaining the nature of my call, providing a brief description of what the project entailed

and what I would need to observe. The receptionist who took my call informed me that

she would have to speak with the orthodontist first. With his permission she would then

call me back with a time and date that I could conduct my observation. I received a call

the next day confirming the date and time of my observation, along with directions to

report to head public relations representative Lindsey Trook. I reported to the office

eager and armed with a pen and small pocket pad to take notes of any relevant

information. Upon arriving I was initially directed to Lindsey who began by introducing

me to Dr. St. Clair, along with his staff of dental assistants. I was informed that if I

wanted to I could start and end the day on the dental floor observing the orthodontist

and his assistants Smile by St. Clair’s runs very different from other offices owing to the

fact that the dental floor was organized quite differently. Rather than having individual

cubicles the floor was organized with a circular arrangement that was open and free

flowing.

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Before and after lunch they did new patient screenings which were confidential.

This time provided an excellent opportunity for me to meet back up with PR Rep

Lindsey for an in depth explanation on how the practice is run as well as a chance for

me to ask any question. I immediately realized that Dr. St. Clair was not exaggerating

about the different manner in which his office ran. It was amazing how efficient and

effective the floor ran. Not a moment was wasted, with every action executed with

purpose. I highly value efficiency and effectiveness and in viewing how smoothly every

aspect of the office ran, I found myself in awe, knowing that I would one day aspire to

have an office that ran in a similar manner.

When my time on the orthodontics floor ended, I met back up with Lindsey, and

she began explaining certain key background elements that facilitated in the smooth

operation of the orthodontics office. She explained Dr. St. Clair’s daily schedule, as well

as his weekly schedule, with special attention to his weekly lunch meetings with local

dentists and the bi-weekly closing of the office on Tuesday afternoons in order for a

special consultant to come in for staff development. As she spoke, I began to

understand why Dr. St. Clair was so successful, with his attention to relationships and

his drive to constantly improve. She also explained that Dr. St. Clair went out of his way

to make the patients feel that they were active participants in the service experience.

Some of the ways he executed this was by allowing patients to check themselves in via

thumb print identification, rewarding them for clean teeth and being early, as well as

describing many other forms of participation. Before leaving for the day, Lindsey

showed me around the front desk area where she explained to me what each

administrative representative’s specific job entailed. Because administrators each had a

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specific job assignment, they were experts, thus allowing the business side to run more

efficiently and effectively.

After my observation, I created a detailed outline for my paper and presentation

incorporating as much as possible of what I had seen. From here I began to focus on

translating the new terms and then creating a Spanish PPT presentation and paper to

accompany it. This part of the project proved to be the most challenging, having to go

through several drafts, which required a significant amount of editing. I personally found

the editing part to also be extremely educational since I strongly believe you learn a

great deal from your mistakes.

The last part of the project focused on the presentation. I spent a significant

amount of time focusing on how to properly pronounce the new terminology I had

learned during this project. As I reflect back on the experience I gained from this project

it is clear that this exposure gave me an excellent foundation for my Marketing class.

During the fall semester of 2010 I took Marketing Tools and Concepts, a class

that came highly recommended by many students. After missing a test in order to

present at a national science conference in Anaheim, California through the Society for

the Advancement of Chicanos and Native Americas in Science (SACNAS), I was given

the task of writing an extensive paper over the Resource Advantage Theory (RAT)

applied to any industry of my choice. Rather than viewing this paper as a chore, I saw it

as a great opportunity to gain a deeper understanding of the various business aspects

of dentistry. Although I observed how a practice ran the previous semester I knew that

certain aspects were important but didn’t understand the significance of each of the

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elements that I’d identified and how they contributed to the practice’s success until I

analyzed them in the context of the RAT. The concepts I learned in class literally gave

me the tools and knowledge to understand what needed to be done and why in order to

be a successful business, while writing this paper allowed me to link these concepts to

real world examples. The basic foundation I received in marketing and previous multiple

exposures to different dentist offices allowed me to identify how small differences in the

way a practice is run can have a major impact on the overall success of the practice.

Using Dr. St. Clair’s business as a foundation I also observed several other offices to

make a comparison against. The knowledge gained in this class combined with the

concept of the RAT, proved to be very important in understanding how specific

elements of a business can have a significant impact on the overall performance of the

office.

I had always approached the class with the intent on learning how to create a

better dental practice once I had gained the necessary experience. After I was given

this assignment I realized my outlook of the entire class changed. Because of its

significance due to its interdisciplinary nature, I knew instantly that I wanted to apply the

RAT to the oral health care industry. I received the assignment for the paper in October,

but at this point in the class I still didn’t have enough background knowledge to start

relating the RAT to dentistry. My initial research began with me going back over the

RAT content already covered in class as well as reviewing a journal article over the RAT

by Dr. Shelby Hunt. At this point I gathered a collection of notes related to the topic that

would be useful.

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Once I felt more comfortable with my understanding of the RAT, I began relating

every aspect of the knowledge gained to how it would affect a dental practice, reflecting

on my past exposure to multiple practices. I began to notice small details which before

seemed insignificant. It was these small details that determined the success of the

practice, the targeted market segment, and the market offerings presented to them.

As the semester progressed my main focus was the accumulation of information.

I kept a notebook were I would transfer any content I found either through my research,

lecture, or in the textbook. Initially the notebook started as the location of paraphrased

research and quotes that I found interesting and possibly relevant. In the beginning of

my research I choose not to limit myself by any specific topic or purpose other than the

broad ones assigned to me (the RAT and oral health care). I chose to execute my

research in this manner because it allowed me to look at the big picture of obtaining

information relevant to my future career, rather than having blinders on so to speak.

Since Professor Hunt was the initial visionary of the RAT I knew that his book, A

General Theory of Competition: Resources, Competences, Productivity, Economic

Growth, and journal articles he wrote and co-authored would be my most valuable

resources. I found his book to be a particularly critical element, as it explained the nine

premises behind the RAT in exhaustive detail. I read though the book twice, once upon

the start of my research and then again prior to beginning my first draft when I’d

completed my research. The first time I read through the book, it was with the purpose

to develop a better understanding of the RAT, giving me a foundation to build upon.

After I had a basic understanding of the RAT I was then able to cast a wider net with the

material I included in my research, finding journal articles that summed up the RAT or

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that focused on a specific concept involved in the theory. This allowed me to fill in the

gap in my understanding of the RAT and marketing in general. Having developed my

understanding I reread Hunt’s book prior to writing my paper. Rereading it helped me

notice the small details I missed the first time. Those small details ended up being

essential element that allowed me to understand Dr. Hunt’s deeper purpose.

After I had conducted a sufficient amount of research and felt more confident with

the direction I wanted to go in, I created an outline of how I wanted to write and organize

the paper. From here I was able to easily organize all the notes I had accumulated. I

also did a round of shadowing rotations to several different dentist offices in order to

obtain more examples of how the RAT applied. Now that I had a better understanding of

the theory I was able to better identify the small differences between dental offices that

set each apart from the other. From here it was simply linking ideas into a cohesive and

informative paper. The research conducted during the project took months to learn and

understand, as well as weeks to link into a cohesive manner. The knowledge I gained

here is invaluable as it was content I wouldn’t have been exposed to in such depth had I

not pursued my masters. I am confident that, armed with this knowledge I will be able to

better lay out what direction my future career will take.

My masters studies also allowed me to gain deeper knowledge of other areas of

study. One of the biological sciences that often plague dental students is histology. Over

the past few years I have visited multiple dental schools for tours as well as interviews.

At each of these tours we had the opportunity to meet with dental students and question

them during the panel discussion. One of my favorite questions to ask was a variation of

the following: “What is the hardest biological science in dental school?” or “what

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classes do you wish you would have taken that would have better prepared you for

dental school?” Without fail at every discussion with dental students, at least one

student would mention Histology. It is for this reason that I chose to take Histology. As I

write this paper reflecting back on my experience, I am so very thankful I listened to

their answers. This class ended up changing my whole perspective of the biological

science. This was definitely a class I found to be extremely rich in content. Although we

were going through subject matter I had been exposed to before, I had never seen it in

such depth and specificity. Since I would need to be able to identify the tissue samples

taken from various murine organs, based on their Histological characteristics in order to

complete my graduate histology final project I would need to develop a high

competency at preparing, mounting and staining unknown samples.

We were informed about the details of the project from the start of class, but did

not begin until late October. At the start of the project we were able to see how large

precut samples taken from various murine organs were first dehydrated and then

embedded with paraffin over the course of several hours using the fully automated

Tissue TRK II histological tissue processor. From here our lab TA stored the samples in

fabric softener and then refrigerated them. The fabric softener, I learned, was a

histology trick used to allow for better sectioning by softening up the hardened paraffin.

The sectioning and identification of the tissue samples proved to be the most

challenging. I began sectioning my tissue samples right away learning immediately that

this part of this project had its limitations. Since the paraffin would become rock hard,

we had to soak it in fabric softener, but it quickly became clear that only the portion of

the paraffin that was in direct contact would become soft. Therefore on any given day I

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was only able to a small sample from each tissue, then have to replace the sample in

fabric softener for at least a day. Another challenge I encountered in the beginning was

getting the hang of the microtome, which produces sections in the form of a ribbon, that

are then mounted on glass slides. Unfortunately the sectioning process did not run this

ideally at first, rather than nice flat ribbons, I was producing shredded crinkled strips, but

with much practice I finally got the hang of sectioning. As the class and lab progressed

throughout the semester I worked diligently to understand what each tissue presented

looked like, focusing on form meets function It was this new focus that allowed me to

understand the reason why each tissue looked the way it did and how its appearance

contributed to its specific action. In focusing on form meets function, I was able to learn

how to understand why each tissue preformed its action, and how this impacted the

organ as a whole, which then impacted the digestive system or reproductive system for

example. This approach to learning the biological sciences was different from simply

memorizing facts. When it came time to identify my samples, I had to search for several

of my best slides from each sample and then take photos using a microphotograph. I

initially examined each specimen in detail making note of any identifying characteristics

that were present. I started by making an educated guess of what I thought each

specimen was and then proceeded to confirm my suspicions using my lab manual,

textbook, and known tissue slides that were used in lab. I found that reexamining the

known tissue slides from lab proved to be the most useful source in making a

comparison against my unknown tissue samples. In order to make the proper

identification, it took a certain eye for detail an important trait for dental school. I chose

to spend a great deal of time confirming my predictions so that I was positive of the

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outcome. In most cases I ended up finding a known specimen slide that looked exactly

as the unknown I sought to identify.

Histology proved to be a very valuable class allowing me to gain an

understanding of the concept “where form meets function”, a statement later repeated

by Dr. Ravindra Nanda, B.D.S, M.D.S., Ph.D., Professor and Head, Department of

Craniofacial Sciences Chair, Division of Orthodontics at University of Connecticut

School of Dental Medicine, who explained to me how Fundamental this idea is in

dentistry. Dr. Nanda pointed out that dentistry is at the intersection where art meets

science, stressing the importance of not only developing an eye for detail, but knowing

what to do with these details. Histology exposed me to the specific images I would need

to recognize, as well as the understanding of why each specific characteristic

contributed to tissue function. While the class gave me the knowledge, it was my

graduate project that allowed me to gain valuable experience in tissue identification.

This experience enabled me to dominate the biological sciences section of the Dental

Admissions Test. When my fellow Kaplan Test Prep peers would ask me how I

memorized the details behind all the systems of the body so fast, I would tell them that I

didn’t need to memorize since I’d learned to understand the specifics in Histology, which

made remembering the basic biology facts easy. This experience will allow me to excel

in dental school when other students will struggle.

I started my masters in interdisciplinary studies for very specific reasons. I

studied the biological sciences with the goal of become a better dental school

candidate, as well as increasing the probability of my success in dental school. In order

to increase my chances of becoming a successful private practice owner I chose to

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study business with a focus on marketing. The ability to speak Spanish and obtain a

wider segment of the market inspired me to continue my education in Spanish. With that

said I feel very strongly that I have been able to accomplish my goals. I write this

conclusion a future dentist in dental school, who has developed her vocabulary and also

had a very detailed plan for the future. Plans that would not have been realized had I

not taken the risk of delaying applying to dental school and pursuing my masters.

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Odontologia By Stephanie Lomeli

Jorge Zamora

Advance Business Spanish

SPAN 5304

Spring 2010

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La odontología es un tipo de medicina que lidia con el estudio y práctico de

diagnósticos, prevención y tratamiento de enfermedades bucales. El cuidado dental

regular es necesario para una gozar de una salud completa. Las investigaciones

demuestran que la primera cosa que otros toman en cuenta es nuestras sonrisa sana y

hermosa. En realidad una sonrisa es un rasgo prominente que sirve de “tarjeta de

presentación”. Los dientes torcidos son el resultado de una incorrecta alineación de los

mismos, causada a menudo por presión de la lengua o la configuración muscular de la

región. Por su parte, la ortodoncia tiene como tarea la supervisión del correcto

crecimiento y desarrollo de los dientes para lograr una sonrisa sana y hermosa. Los

materiales y las técnicas que eran sólo sueños hace años. Los avances permiten una

revolución en la experiencia dental. La tecnología ha cambiado la manera en la que

llevamos los aparatos de corrección dental y la imagen que tenemos de nosotros

mismos. Los pacientes necesitan menos visitas, se ha reducido el tiempo y las

molestias. Hay muchas ventajas en la especialización en este sector gracias al

constante progreso de tecnología. El salario medio que un dentista general gana al año

es casi doscientos miles dólares con un aumento de valor significativo para un

especialista como un ortodontista que puede llegar a ganar más que trescientos miles

dólares. Hay varios factores que juegan un papel en estas cifras. Las organizaciones

dentales son muy importantes y tienen un papel significativo en el desarrollo personal y

profesional. Las sociedades de futuros dentistas son fundamentales para el éxito de un

estudiante universitario y para facilitar la transición del ámbito universitario al

profesional. La Asociación de Dentistas en Texas integra a los doctores en una

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comunidad profesional y les da recursos fundamentales para realizar trabajo con total

profesionalismo.

En Lubbock hay una clínica de odontología que demostró una ética de negocios

ejemplar, se llama “Smile by St. Clair”. Esta clínica de ortodoncia se dedica a proveer

un servicio con calidad excelente y habilidades técnicas. Algo de lo que el Dr. John St.

Clair y el Dr. James St. Clair se enorgullecen es el hecho de que tiene la tecnología

más avanzada del mercado. Los Doctores tienen dos clínicas con su oficina principal

en Lubbock. Esta clínica celebra treinta años de excelente servicio en ortodoncia.

Cuando la clínica de Lubbock empezó había sólo cuatro empleados, durante los años

esta empresa ha crecido a treinta empleados con una facturación de ciento cincuenta

pacientes al día. Tienen una capacidad tan grande gracias a que cuentan con lo último

en tecnología de radiografía, fotografía y diagnósticos. Dicha tecnología les da la

habilidad de efectuar un reconocimiento riguroso de los dientes, los relaciones de

estructura facial y las de la mandíbula. La información que ellos reciben les ayuda al

desarrollo un plan de tratamiento personal. Después la evaluación y creación del plan

de tratamiento, uno de los doctores determina qué tipo de aplicación de los aparatos es

necesario. Los aparatos usados en esta clínica se llaman “Damon System” y es el

equipo más moderno en el área. El sistema Damon mueve los dientes utilizando

presión muy suave que trabaja con la presión natural del cuerpo. Estas fuerzas se

realizan mediante por la aplicación de un alambre creado de materiales de la NASA. La

única cualidad del alambre que contribuye al función especial continuamente

trabajando a vuélvase a forma original. Después de la aplicación de los aparatos el plan

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de tratamiento sigue con chequeo de rutina y termina con la eliminación de los aparatos

y aplicación de un retenedor detrás de los dientes.

Tecnologías de punta y habilidades de negocios son factores claves que

contribuyeron a la práctica exitosa que distingue a la clínica de St. Clair de otras

empresas de ortodoncia. Además de estos factores clave, una ética superior ayuda a la

clínica de St. Clair en manteniendo sus principios básicos y relaciones estrechas y

personales con sus clientes. Dr. John St. Clair, fundador de “Smile by St. Clair”

entendió los conceptos de negocios y la importancia de enfocarse en ciertos elementos

para producir una empresa más eficiente y personal. Cada aspecto de la empresa

“Smile by St. Clair” funciona con juntos y puede describir como una “máquina bien

afinada”. La realidad de la medicina privada en el mundo de la odontología es que el

aspecto económico es una parte primordial del mundo del dentista recién graduado. Es

muy común a escucha que unos odontólogos digan, “Un doctor puede ser el mejor y

tener más éxito odontólogo, pero su práctica fracasará si él es un mal empresario malo.

Una vez que pases por las puertas de la escuela de odontología, es importante que te

conviertas en un empresario”.

Los negocios juegan un papel importante en el mundo dentista. Un aspecto

fundamental del dentista es el “networking”, ósea las conexiones y relaciones públicas

que puede realizar. Este aspecto es una idea central para los odontólogos de St. Clair y

trabajan para levantar la empresa hacia el logro de relaciones estrechas con clientes.

Trabajan en relaciones entre doctores a través la “Texas Dental Association” y

almuerzos regulares con otros odontólogo. Esto ayuda a formar relaciones personales

entre los doctores y a facilitar referencias. Tan importante como las relaciones entre

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doctores son las relaciones con los pacientes. La Clínica St. Clair hizo diferentes

actividades que captan la atención de los clientes y pacientes: fiestas de apreciación,

preminos y pequeños incentivos para cuidarse los dientes, y concursos son varias

actividades para los pacientes. En la oficina de St.Clair hay muchos trabajadores que

tienen un trabajo muy específico y cada personal ejecuta un trabajo. Algunos ejemplos

de los trabajos son Relaciones de Pacientes, Coordinador de Tratamiento, Coordinador

de Finanzas, Coordinador de Seguro, Coordinador de cita, Coordinador de

Documentos, Relaciones Públicas. Cada puesto tiene un trabajo específico y esencial

para que el siguiente puesto o trabajo funcioner. Generalmente el paciente va a

comunicarse con el coordinador de cita y pedirá hora al dentista para una evaluación

de tratamiento. El coordinador de Tratamiento acompañará al dentista en la evaluación.

Después de evaluar, los dos hablan con la paciente sobre su plan de tratamiento

personal y discuten varias opciones de pago. Este coordinador le da una llamada de

seguimiento a cada paciente, le informa sobre cambios o mejoras y le mandará una

segunda carta de seguimiento. El coordinador de finanzas establece una cuenta

automática de retiro después cada cita. En general es muy importante ser competitivo

en la industria. La tecnología de última moda lo ayuda a ser competitivo, organizado y

un innovador. La Clínica de St. Clair ha utilizado tecnología para crear una página de

Internet que da información sobre cada aspecto de su empresa. La clínica de St. Clair

usa el mencionado sistema de Damon que es más rápido, seguro y fácil de usar. Las

instalaciones de la clínica tienen equipo de tecnología avanzado y ayudan a trabajar

mejor con cosas como registro de huella digital y todos los documentos se pueden

obtener por el ordenador. Los aparatos típicamente cuestan alrededor de 5000 dólares

24    

por esta razón esta clínica tiene varias maneras para pagar sus honorarios. Se provee

con tratamiento asequible de alta calidad que te lo puede permitir.

Un odontólogo con una práctica exitosa es aquel quien entiende que cada uno

de estos aspectos es esencial para tener una clínica exitosa y lucrativa. Cada elemento

investigado es uno de los pilares de los negocios. Si se tienen buenas relaciones con

otros doctores se obtendrán referencias que son buenas para los negocios. Un equipo

administrativo ayuda a que la oficinal funcione de una manera eficaz sin supervisión del

dentista y que lo permite ver a más pacientes y pasar más tiempo con cada paciente

también. Las instalaciones con tecnología de punta producen resultados más rápidos y

más precisos en un corto tiempo que también ayuda con rotaciones de pacientes. La

Clínica de St. Clair le ofrece varias opciones a sus clientes para el pago de servicios

médicos que le da un plan personal para ajustarse a cada presupuesto. Cada punto

ayuda a hacer un negocio más fuerte y más exitoso, lo que permite obtener más

clientes y ganar más dinero

25    

Spanish Presentation Outline • ¿Que es la odontología?

o un tipo de medicina que trata con el estudio y práctico de enfermedades bucales.

§ necesario para una gozar de una salud completa o la primera cosa que otros hacen caso es nuestros sonrisa sana y hermosa

• ¿Ortodoncia? o Los dientes torcidos son el resultado de una incorrecta alineación de los

mismos, causada a menudo por la presión de la lengua o la configuración muscular de la región. La ortodoncia tiene como tarea la supervisión del correcto crecimiento y desarrollo de los dientes para potenciar una sonrisa sana y hermosa

§ Los materiales y las técnicas que eran sólo sueños hace años § Los progresos permiten una revolución en la experiencia dental

• Necesitan menos visitas, se ha reducido el tiempo uso diario y las molestias

• Ventajas en la Especialización o El salario medio que un dentista general gana

§ Al año 198,354 dólares o Un aumento de valor significativo para un especialista como un ortodoncista

§ Puede llegar a ganar 304,024 dólares • Organizaciones Dentales

o Muy importantes y tienen un papel significativo en el desarrollo personal y profesional

§ Las sociedades de futuros dentistas • Facilitar la transición del ámbito universitario al profesional

§ La Asociación de Dentistas en Texas • Una comunidad profesional y les da recursos fundamentales

• Smile by St. Clair o Demostró una ética de negocios ejemplar o Se dedica a proveer un servicio con calidad excelente y habilidades técnicas o Tienen la más nueva tecnología disponible

§ Dr. John St. Clair § Dr. James St. Clair

• La Clínica de St. Clair de Lubbock o Celebra 30 años de excelente servicio en ortodoncia o Cuando empezó había sólo 4 empleados

§ ha crecido a 30 empleados con una facturación de 150 pacientes a día.

o Las rotaciones de pacientes § Evaluación de los nuevos pacientes

• Instalaciones son los últimos modelos para radiografía, fotografía y diagnósticos

26    

• La habilidad de desempeñar un reconocimiento riguroso de sus dientes, relaciones de estructura facial y de la mandíbula

• Desarrollo un plan de tratamiento personal § La aplicación de los aparatos

• El sistema Damon o El equipo disponible más moderno o Mueve los dientes utilizando presión muy suave que

trabaja con la presión natural del cuerpo o Presión a través de la aplicación de un alambre creado

de materiales de NASA § Sigue con chequeo de rutina § Eliminación de los aparatos § Aplicación de un retenedor

• ¿ Qué contribuye a la práctica de éxito que distingue a la clínica de St. Clair? o Tecnologías de punta y habilidades de negocios con éticas superiores

§ “máquina bien afinada” o “Un doctor puede ser el mejor y tener más éxito odontólogo, pero su práctica

fracasará si es un mal empresario”. • Los negocios en el mundo dental

o “Networking” y Relaciones § Relaciones entre doctores

• La Asociación de Dentistas en Texas • Almuerzos regulares con un odontólogo

o Formar relaciones personales entre los doctores o Facilitan referencias

§ Relaciones con los pacientes • Fiestas de apreciación • Carrera de relevo para cepillar los dientes • Concursos que captan la atención de los clientes y pacientes

o Equipo Administrativo § Relaciones de Pacientes § Coordinador de Tratamiento § Coordinador de Finanzas § Coordinador de Seguro § Coordinador de cita § Coordinador de Documentos § Relaciones Públicas

o El último modelo de las instalaciones y las tecnologías § ser competitivo, organizado y un innovador

• una página de Internet que da información • registro de huella digital • los documentos pueden obtener se por el ordenador • una cuenta automática de retiro

§ El sistema de Damon • Más rápido, seguro y menos fuerzas

o Aparatos cuestan alrededor de 5000 dólares

27    

§ Se provee con tratamiento asequible del alta calidad que te lo puede permitir.

§ Varias maneras para pagar sus honorarios • Opciones para pago • Tarjetas de Créditos aceptadas

o Depósito directo § Póliza de seguros incluido beneficios de ortodoncia

o Educación Dental § Edad de 7 años es el momento crítico para prevenir daños § Escuela primaria pública

• febrero – el mes de salud dental • octubre – el mes de ortodoncia

• ¿Qué significa todo esto? o $$$$$

§ tener una clínica con éxito que sea lucrativa o Recapitula de negocio en el mundo dental

§ Conexiones de Redes y Relaciones • Obtener referencias de otros dentistas/pacientes

o Equipo de Administrativo § La oficina funciona en una manera eficaz sin supervisión de dentista

• permite ver más pacientes • tiene más tiempo con cada paciente

o Instalaciones con tecnologías de punta § producen resultados más rápidos § más precisos en un corto tiempo § ayudan con rotaciones de pacientes

o Opciones para paga § Crea un plan personal para ajustarse a cada presupuesto § Ganar clientes si no puede hacerlo

28    

English Presentation Outline

• What is Dentistry? o Beautiful healthy smile is the first thing others notice about us

• Orthodontics? o Crooked teeth are cause by the tong and muscles in the face that are out

of balance § Technology has provided us with materials and techniques that

were only dreams a few short years ago. § Shorter time with less discomfort and fewer visits

• Benefits of Specialization o $198,354 general o $304,024 for a specialist

• Dental Organizations o Pre-Dental Society o Texas Dental Association

• Smiles by St. Clair o Dedicated to providing excellence in the field of orthodontics through

quality service and technical expertise o Always on the cutting edge of new technology

§ Dr. John St. Clair § Dr. James St. Clair

• Lubbock Location o Celebrating over 30 years of orthodontic excellence o Pictures o History

§ Progress (4 employees – 30) o Turn over rate 150 patients a day

§ New patient screening • State of the art facilities to X-ray, photograph and diagnose • Thorough examination of your teeth, facial structure and jaw

relations • Series of radiographs, models of your teeth and photographs

to assist the doctors in diagnosing and developing a personalized treatment plan

§ Application of Braces • Damon system

o most modern equipment available o vary gentle pressure working with the natural

pressures of the body o Space aged wires are unique in that they continually

work to return to their original form. § Check ups § Removal of Braces § Retention check-ups

29    

• What makes St. Clair’s office such a successful practice? o State of the art Technology and business skills

§ Well oiled machine o A doctor can be the best most successful Dentist, but his practice will fail

because he is a poor business man • Business in the Dental World

o Networking/Relationships § Doctor/Doctor Relationships

• Texas Dental Association • Doctor lunches

o Work on Doctor person relations ship • Facilitation of Referral

§ Doctor/Patient Relationships • Patient appreciation parties • Bush your teeth relay • Contest to keep patients engaged

o Administrative Team § Patient Relations § Treatment Coordinator § Financial Coordinator § Insurance Coordinator § Scheduling Coordinator § Records Coordinator § Public Relations

• Marketing • Facilitator

o State of the Art Technology/Facilities § Accessible information

• Internet Web Page § Damen3 Braces system

• Faster, safer, less force o Orthodontics cost ($5000)

§ Provide you with affordable, high quality treatment that fits your budget

§ Variety of payment options to meet your needs • Financing options

§ Many insurance policies have a lifetime orthodontic benefit § Credit Cards Accepted

• Direct Deposit o Dental Education

§ Age 7 is critical time to prevent damages § Public Elementary Schools

• February – Dental Health Month • October – orthodontist month

• What does this all mean?

30    

o $$$$$ • Business in the Dental World Recapped

o Networking/Relationships § Obtain referrals from other dentists/patients

o Administrative Team § Office runs smoothly without Dentist supervision § Enables Dr. to see more patients and have more face time.

o State of the Art Technology/Facilities § Faster more accurate results in a shorter about of time § High turnover rate

o Financing options § Creates a plan to fit every budget, gain clientele

31    

Resource Advantage Theory Applied to the Oral health care Industry: Marketing Services and Resource Advantage Theory

By Stephanie Lomeli

Graduate Student in Interdisciplinary Studies Texas Tech University

Department of Marketing Lubbock, Texas 79409-2101

Cell: (832) 443-3573 E-mail: sa.lomeli@ttu.edu

December 2010

32    

Resource Advantage Theory Applied to the Oral health care Industry: Marketing Services and Resource Advantage Theory

ABSTRACT

Resource Advantage Theory takes into consideration all of the “tangible and

intangible entities” utilized by an oral health care provider viewing them as resources when

they enable an organization to produce efficiently and/or effectively a market offering that

has value for its customers. Knowing what resources are available and understanding how

an oral health care provider can utilize them is instrumental in creating an efficient and

effective market offering that exhibits the most value.

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1. Introduction

When all of the available resources are taken into consideration and analyzed properly according

to the Resource Advantage Theory (R-A theory) oral health care providers have the

understanding to take into consideration all resources involved in creating a specific market offer

that is valuable for a market segment.

In a business service industry there are a variety of factors, consisting of both internal and

external to the organization, which come together to create a business strategy. Understanding

industry-based, resources-based, competence-based, and knowledge-based strategies enable an

oral health care practice to maintain a position of sustained superior financial performance in a

dynamic business industry. The theories behind market-orientated, market segmentation,

relationship marketing and brand equity strategies are important marketing strategies, which in

many ways heavily over-lap business strategies. There are nine premises that underline the R-A

theory (Hunt and Morgan, 1997). Each premise will be supported by an explanation in further

detail.

2. An Overview of R-A Theory

The R-A theory fills in the gaps that other theories left out defining resources’ heterogeneous

nature, and explains how firms can apply this general theory of competition to any industrial

aspect of business, including marketing relationships (Hunt 1997), ethics (Hunt and Sparks 1998,

Hunt and Hanse 2007) and management (Hunt and Lambe 2000), to create an effective and

efficient competitive market offering that particular market segment(s) perceive as valuable. The

incorporation of a variety of disciplines enables R-A theory to explain the evolutionary dynamic

34    

nature of competition, there-by, providing a better understanding of how to gain a competitive

advantage needed for superior financial performance. Figure 1, A Schematic of the Resource-

Advantage Theory of Competition and Figure 2, Competitive Position Matrix, provide key

constructs of R-A theory in an easy to follow schematic depiction.

2.1. An Interdisciplinary Research Program

The integrated business and marketing strategy of the R-A theory of competition is a truly

interdisciplinary theory that merges Evolutionary economics, Austrian economics, Institutional

economics, Socio-economics, Economic Sociology, Strategic Management, and Marketing to

create a revolutionary theory1. When all of the available resources are taken into consideration

and analyzed in accordance with the tenants of R-A theory, it is easy to see that other theories

either did not apply or did not fully take into consideration all aspects of a specific market offer.

The R-A theory fills in the gaps that other theories neglect while specifically defining resources,

along with their heterogeneous nature. This explains how firms can apply this Theory to any

business to create an effective and efficient competitive market offering that particular market

segment(s) perceive as valuable. The key to the R-A theories’ success is that it provides and

accurate description of competition due to its interdisciplinary nature, and provides a foundation

for other less broad theories in business including the Heterogeneous Demand Theory, Resource

Based Theory of Firm, and Alderson’s Differential Advantage Theory. R-A theory is a genuinely

modern one that transfers ideas and concepts from other disciplines horizontally, creating a

Horizontal Layers Model where information can easily go across specific disciplines as opposed

to the Silo Model where information goes vertically rather freely but does not go across easily.

35    

2.2. Contributions of R-A Theory

R-A theory can contribute to the understanding behind many important business aspects. R-A

theory can explain the diversity of firms ranging large corporations to small entrepreneur firms

that may make large profits to those that bring in smaller profits. R-A theory explains how

variables between market-based and command economies can result in differences in quality,

productivity, and innovation when cooperation due to government influence is removed and

competitive marketing can flourish into a better market due to better products and market

offering. Perfect competition is viewed and incorporated into the R-A theory, which consist of

general theory of competition requisites as a limiting, special case. The Neoclassical theory’s

predictive successes are incorporated into the R-A theory, along with preserving economic

science’s cumulativeness.

3. Business/Marketing Strategy

3.1. Business Strategy

Andrews, along with his colleagues at Harvard, produced works on Administrative policy that

heavily influences the modern business strategy. In a business there are a variety of factors,

consisting of both internal and external factors, which come together to create a business

strategy. In today’s growing and diversifying world, there are a number of resources and skills

that form combinations of internal factors as well as influence the external environment to

present opportunities and risks. Together these external and internal factors create the framework

for (SWOT) strengths, weaknesses, opportunities, and threats.

3.1.1. Industry-Based Strategy

36    

Porter addresses an “external factors” approach, Industry-based strategy that focuses on entering

an industry of choice and/or manipulating the industries structure. Making small adjustments

upon entering an industry can result in improvement by elevating the entrance bar and bargaining

power. A recent example in the dental industry would be the introduction of a revolutionary line

of orthodontic products, by ClassOne Orthodontics, which are coated with unique selenium

based chemical compound that has proven to present antimicrobial qualities. Through Selenium

Ltd., creator Julian Spallholz, Ph.D., professor of nutrition and biochemistry, along with Ted

Reid, Ph.D., TTUHSC professor of ophthalmology, collaborated with Kenny Gallagher,

President and CEO of the Lubbock-based company ClassOne Orthodontics, to modify the way

the oral health care industry viewed traditional braces. Upon entering an industry, it is important

to choose a generic strategy of either cost leadership, marketing a lower cost position;

differentiation, with a unique market offering; or focus, on a specific market segment for which a

tailored market offering is created. Once fixated on a generic strategy the attention focuses on the

internal factors.

3.1.2 Resource-Based Strategy

Resource-based strategy is an “internal factors” approach which considers how all resources are

heterogeneous and imperfectly mobile leading firms to acquire valuable, unique, and rare

resources that are inimitable and nonsubstitutable. Penrose’s states a firm is a “ collection of

productive resources” elaborating that, it is never the resources themselves that act as the

production ‘inputs’ process, but on the services that the resources can render (Penrose, 1959, p

24-5; italics in original) Penrose relays the idea that when resources are brought together the

unique combination forms possible services bundles.

37    

3.1.3 Competence-Based Strategy

A second theory of “internal factors” is the competence-based strategy that states that in order

for a firm to achieve competitive advantage, and thus achieve a superior financial performance

firms should identify, seek, develop, reinforce, maintain, and leverage distinctive competences.

Resource leveraging leads to competitive advantage and productivity gains due to:

“… more effectively concentrating resources on key strategic goals… more efficiently accumulating resources… complementing resources of one type with those of another to create high-order value rapidly recovering resources by minimizing the time between expenditure and payback (Hamel and Prahalad, 1994, p.160).”

3.1.4 Knowledge-Based Strategy

If a firm wishes to achieve superior financial performance through competitive advantage it is

imperative that the firm realizes that the process of competition is knowledge-discovery.

Therefore firms should methodically gather a knowledge stockpile, which can be then utilized to

fuel innovation for Knowledge-based strategy.

3.2. Marketing Strategy

The theories of marketing strategy heavily overlap business strategy in terms of product,

promotion, distribution, pricing, and sales force.

3.2.1 Market Orientation Strategy- Systematically

Market orientation strategy systematically accumulates information to be utilized in an

integrated manner that leads to the development of strategy recognition, understanding, creation,

selection, implementation, and modification. According to Capon, “ The marketer must decide

the nature of the total “offer” – that constellation of attributes embracing the product or service,

38    

its distribution, promotion, and price which is presented to potential consumers.” Capon goes on

to state “Independent private dentist and sellers of the more recently introduced dental delivery

systems make offers to consumers in the market just as do such corporations as Proctor and

Gamble, Lever Brothers, or General Motors.”(p.679) Attributes that prove to be significant when

considering a dental offering consist of the likelihood of successfully treating the presently faced

dental problem, a proactive approach to preventing complications and disease, competency of

controlling and alleviating pain, and most important the personable nature and chair side manner

of the dentist (Lipscomb and Douglass, 1980)

3.2.2. Market Segmentation Strategy

Market segmentation strategy should be used by firms to acquire superior financial performance

by gaining a competitive advantage based on the identification of target demand. Upon

identification of demand, firms can further determine which populations are attractive target

markets that allows the firm to obtain a superior financial performance due to the firms belief

that they can provide this specific market segment more value to than competitors. According to

McGuigan and Eisner, the main reasons for which a patient will visit the dentist falls into four

categories: hygiene, pain-relief, esthetics, or replacement/maintained (p.1429). A specific

segment of patients may put a significant weight of concern about pain and will seek out the best

dentist who full fills this dimension of oral health care (Capon, 680). Therefore in order to create

a market offer for a particular market segment that is perceived as valuable, then it is imperative

that firms understand how patients perceive value and recognize which attributes can be used to

create the desired value (McGuigan and Eisner, 1429).

39    

3.2.3 Relationship Marketing Strategy

Relationship marketing strategy, initially defined as “attracting, maintaining, and in multi-

service organizations-enhancing customer relationships” by Berry (1983, p. 25), and as since

evolved into a number of definitions. According to Morgan and Hunt (1994) “RM refers to all

marketing activities directed towards establishing, developing, and maintaining successful

relational exchanges.” Amongst the differing RM perspective a commonality found is that the

development of long-term relationships attributes to the competitive advantage by achieving

efficiency and effectiveness through production’s enhancement. As not all relationships will

prove beneficial to the firm’s productivity enhancement Gummesson, suggests the skillful

handling of a relationship portfolio identified as essential for your specific business (1994, p.

17). For an oral health care provider to achieve a competitive advantage that results in superior

financial performance, then a firm should identify a relationship portfolio that will prove most

beneficial by developing a long-term relationship that when nurtured contributes to efficiency

and effectiveness enhancement. According to McGuigan and Eisner a doctors list of patients is

one of the most value resources which they posses that if developed and nurtured properly will

only increase in value, offering increasing returns on investment. The manner in which a dentist

handles its patient list determines the dental practice’s value. Previously it was viewed that a

major success prerequisite was a dentist’s reputation. In a market where competition is

disequilibrating and dynamic, it is critical that the practitioner view “their practice as a business”

and understands how valuable of an asset a relationship can be (McGuigan and Eisner, p.1427).

Dentists, along with their dental team, can create a welcoming atmosphere for patients that can

relay appreciation for the patients business. Patients acknowledge the welcoming atmosphere and

appreciation through referrals to the practice (McGuigan and Eisner, p.1429). When services are

40    

concerned service and the people delivering them are inseparable it is essential that dentist have

interpersonal skills, because it is impossible to separate the person from the services they are

rendering. Dentists need to be aware that not only are their clinical skills being judged by

patients but also interpersonal skills. When dentists are skilled at combining professional clinical

skills with interpersonal skills they are able to build not only confidence in the dentist’s skills but

also build a valuable relationship at the same time. The loyalty base that you build will work in

your favor to refer friends, family, and other relations to your practice (McGuigan and Eisner,

p.1430). When the primary asset involved is a valuable commodity such as a dentist’s list of

patients, a practitioner cannot afford to “leave relationships to chance” (McGuigan and Eisner,

p.1431). When “left to chance”, relationships between the practitioner and the patient become a

“transaction-based practice”, rather than a “relationship-base practice” which could lead to

comparative disadvantages of the firm, causing an inferior financial performance. If a dentist

wants to achieve a competitive advantage, then the dentist needs to create a meaningful and

satisfying relationship between a practice and patient through personalization (McGuigan and

Eisner, p.1432).

3.2.4. Brand Equity Strategy

Firms can add significant value to a market offering by utilizing brand equity strategy. When a

brand adds customer perceived value to a market offering it is considered a resource. Some

brands are considered high-equity due to the great value they add. When targeted patients see

that the brand is a part of the market offering, highly favorable association are triggered for the

targeted patient. The triggering of these “highly favorable associations” in targeted consumers

increases firms effectiveness, thus the market offering moves its competitive matrix position to

41    

the right. The law protects a brand by preventing competitors from using its name; the protection

the law creates a valuable legal resource. The brands image is a strong motivator for patients.

Dentists need to display in a visible place within the practice their credentials and explain the

significances of these credentials. It is important that doctors inform patients of the details about

the products used in the market offering and fully explain the reasoning why they have chosen

the particular items that create the bundle that makes up the market offering (p.1430). The

Internet is a valuable technological resource that dentist should utilize to create a website for the

oral health care provider that would aid the firm as an informational resource that can aid the

patient in making an educated choice. Dentists can help provide information to influence the

product choices of a patient by developing an advantage proposition, which is a written

statement that should be posted on the firms web page stating the practice and dentist

professional stance (p.1431).

4. Foundational Premises of R-A Theory

There are nine premises that underline the R-A theory (Hunt and Morgan, 1997). Each premise

will be supported by an explanation in further detail.

4.1. Premises 1 :: Demand is Heterogeneous Across Industries, Heterogeneous Within Industries and Dynamic. Heterogeneous demand theory of marketing influences the demand view of the R-A theory,

acknowledging the predominating heterogeneity of intra-industry demand, contributing to the

necessity by different market segments of product differentiation in a market offerings within the

same industry (Hunt book, 2000, p. 10). Differentiations of commodities occur partly in response

to buyers variation in desired taste, preferences, location, etc. (Hunt book, 2000, p. 45). The

42    

heterogeneous nature of demand across and within industries is the result of differences in the

perceived value of importance’s of various attributions which when combined or bundled create

a market offer. The demand for oral health care can be broadly broken down into four categories

hygiene, pain relief, esthetics, and/or replacement. R-A theory helps explains that within those

categories the demand becomes more specific and tailored to meet the individuals preferences.

Using the demand for esthetics as an example, there are some patients that have the desire of

wearing braces for a shorter length of time with less Doctor visit and minimal discomfort;

Patients who fall into this demand segment would view the Damon System’s passive self-

ligating braces, which utilizes state of the art memory wires to move teeth with less pressure and

force faster than traditional braces and with fewer adjustments, as highly valuable. Some may

require a demand for braces containing an antibiotic coating, SELect Defense, on the

orthodontics to prevent deterioration of the teeth, which results from the buildup of bacteria due

to very poor bushing and/ or poor hygiene. Still there are others who demand quick/instant

cosmetic dentistry preformed as oppose to braces where dentist would utilize venires or demand

a discrete correctional device such as Invisialine. In order for a firm to fulfill a targeted demand,

the buyer may have a preference for one product variety over another. Therefore, different firms

or oral health care providers within the same industry will solve this problem differently due to

their preferences for braces being substantially heterogeneous resulting in differentiate demand

for resources.

4.2. Premises 2 :: Consumer Information is Imperfect and Costly

Patients have imperfect information concerning dental products that might suit their tastes and

preferences, but obtaining such information is often costly in terms of both time and money. For

43    

this reason, it would be wise for oral health care providers to utilize social institutions, such as

trademarks, licenses, and patents, to reduce patient search cost by signaling a market offers’

attributes (Hunt 2000, book, p.110). A dentist can better assist a patient in making an educated

decision through development of a written advantage proposition that explicitly states the stances

of the practice and dentist. To achieve maximum exposure of the advantage proposition

utilization of the practice’s Web site and other available communication vehicles must occur

(McGuigan and Eisner, p.1431). In an ever modernizing world, it is becoming an oral health care

norm for a practice to have a fully functional website which allows patients to get a look into the

business and inform themselves about the available options, thus enabling patients to make an

educated choice.

4.3. Premises 3 :: Human Motivation Constrained Self-Interest Seeking

R-A Theory explains the best way to view human motivation is “as constrained, self-interest

seeking” (Hunt 2000, book, 118). Human motivation is constrained by personal moral codes,

which influence societal, professional, industry, and organizational moral codes shape.

Deontologists believe that it is the actions people take that should be examined when

determining whether something is ethical or not. To better understand the factors that contribute

to moral views and the choices those views lead to can be obtained from Hunt Vitell Theory of

Ethics (Hunt 2000, book, 120).

Concern over investment return is a strong motivating factor for patients, especially when

a considerable amount of money is in question. When the returns on investment are highly

valued by the patient then the decision to purchase can be justified in terms of logical

cost/benefit analysis. It is important for the patient to know up front what the benefit, such as

44    

esthetics and/or improved function will be for a specified procedure. When a patient chooses to

invest a significant amount of money in oral health care such as braces, it is important that the

patient feel a justification on spending the money and going through the painful and

uncomfortable experience, such as an opportunity to get a better job or become more attractive.

In the work place it is very important to create an emotionally welcoming environment and

companies stress the idea of service with a smile. According to a study conducted by Krumhuber

and associates, the effects of the dynamic attributes that contribute to characteristic qualities

significantly shaped the judgment of those who perceived the smile in an interviewing

atmosphere. This shift in judgment effected the interviewer employment decisions (p.2). Social

Intelligences’ Theory gives the reasoning behind this shift in perception due to mirror neurons,

which are responsible for making emotion contagious in turn effecting mood and passing the

smile on due to our natural response to reflect emotion (Stanley).

Time is another strong motivation factor for patients when considering an oral health care

provider. Due to increasing time constraints on patients, more weight is being added to the value

of dentists offices that are efficient at saving time. Clinicians that respect the appointment

schedule or justify rare deviations from specified time gain a comparative advantage with

treating this type of patient (McGuigan and Eisner, p.1426). An example of how Smile by St.

Clair’s resources such as, a fully automated system which begins with a quick finger print scan

that instantly checks the patient in with a time stamp, pulls the patients digital charts utilizing the

Dolphin Management 4.5 software, along with their digital x-rays and photos of the patients

treatment plan progress through the software Dolphin Image. This fully automated system tracks

the patient’s location and duration of wait time, also referred to as “Patient GPS”. These

informational technology resources facilitate in Smile by St. Clair’s competence at achieving

45    

their goal of avoiding wait times that exceed 15min between each transition from check-

in/waiting area; assistant preparation/Dentist work; end of procedure/check-out. Smile by St.

Clair also reduces check-out time by utilizing automatic billing withdraws. The patients have the

option of having their checking or credit information on file, allowing the financial coordinator

to send the patient a bill for services rendered, while simultaneously withdrawing the agreed

upon payment. These competences assist the dentist in nurturing the patient’s time motivations,

which in turn results in a higher level of satisfaction with the perceived value of the service thus

resulting in more referrals.

As there is an ethical diversity which exist between people, in this case between the

patient and dentist and in most cases between the dentist and his own dental staff, it is important

to understand the nature behind this diversity (Hunt and Hasen)

4.4. Premises 4 :: The Firm’s Objective is Superior Financial Performance

Superior financial performance is pursued by firms as the primary objective. When a firm has the

security of finances then it can pursue other interest, such as maintaining a substantial

competitive advantage and has the resources to take action towards utilizing these advantages to

create a more efficient operation and the most effective service. . The flow of the resulting

positive superior rewards accumulated through superior financial performance is to the firm’s

owners, managers, and employees (Hunt 2000, book, p.123). By improving patient relationships

doctors can improve the experience patients receive, which cause marketing cost to reduce for

doctors resulting from an increase in patient retention. A reduction in marketing cost results in

the firm achieving a competitive advantage leading to superior financial performance.

(McGuigan and Eisner, p.1426).

46    

4.5. Premises 5 :: The Firm’s Information is Imperfect and Costly

Marketing cost begin to rapidly incur when creating a “focused word of mouth campaign” due to

the investment of time, money, and effort required to build as well as sustain (McGuigan and

Eisner, p.1426). R-A theory explains that a competitive advantage is key to achieving superior

financial performance but due to the disequilibrating dynamic nature of competition a firm

should seek a “sustainable competitive advantage in the marketplace”(Hunt, 1999).

Programs implemented towards understanding a practice’s strengths and weaknesses can

be a great benefit by assessing how the patients experience is affected. If a Dental practice

launches a marketing campaign to gain a comparative advantage it must be fact based,

dismissing assumptions (McGuigan and Eisner, p.1426). When dentist understand their “Value

Creation Circle” it allows the firm to better target a segments desired service, thereby enabling

them to create value, but they must also be able to communicate this created value to their

patients in a language they can easily understand (McGuigan and Eisner, p.1429). Consultants

can help firms accomplish their goal of achieving superior financial performance by analyzing

the company for areas of weakness or inefficiencies where changes can be made. Consultants

can perform practice management audits to obtain the information needed to identify the areas of

operation that are hindered by inefficiencies previously overlooked. Valuable information can

also be obtained when the firm’s business practices are compared against a standard. When

measuring a firm against a standard, it allows practices to not only identify inefficiencies but also

deficiencies, or gaps in services, and communication failures. (McGuigan and Eisner, p.1428). If

a company performs regular audits by consultants, then it is given the resources to identify

changes that can be made, enabling it to achieve a sustainable competitive advantage through

47    

innovation and change. Utilizing consultants monthly as resources for information allows smile

by St. Clair to be dynamic, staying ahead of the competition.

4.6. Premises 6 :: The Firm’s Resources are Financial, Physical, Legal, Human, Organizational, Informational and Relational

R-A theory defines resources as the tangible and intangible entities available tot the firm that enable it to produce efficiently and/or effectively a market offering that has value for some market segment(s). Resources can be categorized as financial; physical (plant, raw materials, and equipment); legal (e.g. trademarks and licenses); human (the skills and knowledge of individual employees, including, importantly, their entrepreneurial skills) organizational (e.g. controls, routines, cultures and competences); informational (e.g. knowledge about market segments, competitors, and technology); and relational (e.g. relationships with competitors, suppliers, and customers)(p.34, Hunt 2000).

R-A theory takes into consideration all of the resources utilized by a firm, or in this case an oral

health care provider or practice, defining them as the “tangible and intangible entities” accessible

to individual firms, or Practice, that permit the firm to create a market offering, such as a dental

care package, which is efficient and/or effective, for a particular market segment(s) that perceive

the said offer as valuable. When taking a dental practice into consideration it is important to

understand that the main service, which the Dentist is officering, is their dental services, whether

it is for the purpose of hygiene, pain relief, esthetics, and/or replacement. These services that the

Dentist provides are an example of an intangible good or resource, with the instruments and tools

used to perform the job are tangible resources that enable the practitioner to perform their duty.

When analyzing and breaking down available resources there are a number of categories

which tangible and intangible resources can fall under, many of which are often over looked or

taken for granted. Knowing what resources are available is instrumental in creating an efficient

and effective market offering which exhibits the most value.

4.6.1. Physical Resources

48    

Physical resources consist of the plant, or in this case the oral health care practice, that when

positioned in a strategic location and/or additional convenient locations are built can lead to

increased efficiencies by allowing the practice to target market segments locally as well satisfy

the needs of a larger market segment; equipment such as the Damon System of self-ligating

brackets used by Smile by St. Clair, along with all of the instruments the practitioners use to

apply the Damon System; and raw materials such as the unique chemical compound of

Selenium, that attributes to SELect Defenses antibacterial characteristic. Abbeville dentistry

utilizes its physical resources through its two convenient Lubbock locations differently than

Smile by St. Clair’s uses of a local Lubbock office, along with a Clovis, NM location to gain

access to a larger segment of the market.

4.6.2. Human Resources

The human element plays a key role when services are involved; in terms of the unique skills and

professional knowledge each individual employee contributes. According to McGuigan, in order

to be a successful dentist in today’s professional health career it not just enough to be a skilled

clinician one must also exhibit strong entrepreneurial talent in order to run a profitable practice

(p.1426). When a service is provided such as with oral health care a key element of the practice’s

success is the dentist’s reputation (p.1427).

4.6.3. Legal Resources

Legal resources for dentist would not include other company's patents. It could include a contract

to be the only dentist in an area to be able to offer a service (e.g., if a company had a new

technique for removing plaque and gave an exclusive contract for using it to a particular dentist).

49    

The incorporation of the Damon System name when marketing the Smile by St. Clair business as

seen in the internet banner of there website. Utilizing licensed tools such as the Dolphin

Management 4.5 operating system registered to St. Clair Orthodontics to create a fully integrated

software to track and chart patients progress, as oppose to using inefficient paper charts.

Dolphin Management works in conjunction with Dolphin Imagine, a software for

accessing/viewing patient X-rays, initial patient photos pre-braces, as well as photos tracking the

orthodontic progress of the patient by date. Grimes Dentistry, a family cosmetics dental practice,

utilizes a similar Software Dentrix Patient Chart, which also works in conjunction with an X-ray

software, Dex-ray which captures and view images. Other legal forms of licensing consist of

dental licenses, and certification showing that you are legally and professionally qualified to

perform the offered task. Grimes Dentist office has several of the founding dentist certificate of

completion and acknowledgements on the clinic walls including the International Congress of

Oral Implantologist certificate. These forms of licenses are essential to have visible because it is

not only the law but it also turns an intangible item (education/skill) into a tangible items

(license/credentials) that can be utilized to display the doctor’s significance and credentials.

4.6.4. Organizational Resources

Organizational resources are things like work culture, processes, and procedures that allow the

dentist to provide more value for his/her patients. In dentistry when patients are key it is critical

to keep meticulous records in order to better understand your patient bases. By enhancing

operating strategy a dental clinic can gain a significant competitive advantage (Lee and Shih,

200). Control and specific delegation of duties within a practice will attribute significantly to the

efficiency and effectiveness of each administrator. There are specific competences which some

50    

patients’ value more in a dentist office such as duration of waiting time. Smile by St. Clair is

highly competent is this area by making it a point that patients wait no longer than 15min

between each transition (check-in/waiting area; Assistant prep/Dentist work; End of

procedure/check-out). St. Clair orthodontic’s competence is due to the utilization of organization

technological, administrative and informational resources

4.6.5. Informational Resources

Informational resources would be things like knowing more about what patients want then other

dentists by doing marketing research and knowing a lot about your competitors by conducting

competitive intelligence. The ability to access knowledge at the click of a button can save ample

amounts of time, in an industry where time is money and predominating factor, fully automated

computerized charts can be highly valuable to doctors; similarly a well organized informational

website can be a major selling feature for a dentist office when the patient would otherwise be

forced to make a treatment decision in the face of an inadequate understanding of the various

alternative due to limited information provided (McGuigan and Eisner, p.1431).

4.6.6. Relational Resources

In the oral health care field relational resources are perhaps one of the most valuable assets that a

dentist has available. Patient relationships are key business resources with services, such as

dentistry, and cannot afford to be left to chance by practitioners. It is important that dentist

realized that their patient list acts as a primary asset, which retains its value through the strength

of its relationship between the patient and practitioner. Relationships are nonperishable resources

in a perishable service industry that present themselves as rare assets that do not depreciate with

51    

use. According to McGuigan and Eisner, “dentist needs to personalize the relationship between

the patient and the practice for it to be meaningful and satisfying” (p.1432). Smile by St. Clair

Orthodontist recognize this essential element as a valuable resource and works diligently to

nurture this resource. Dr. James St. Clair has weekly lunches with local oral health professionals

in the area, which enables him to not only build and nurture relationships with fellow colleges

but also allows him to have a network of available doctors if a referral is needed. As the private

practice oral health industry is largely based off of referrals, it in crucial to maintain a nurturing

relationship with patient.

4.7. Premises 7 :: Resource Characteristics are Heterogeneous And Imperfectly Mobile The characteristics of resources are heterogeneous and imperfectly mobile due to the

heterogeneous nature of demand. When a firm’s market offering is enhanced by available

entities, tangible and/or intangible, that provide firms the means to produce a valuable offer

efficiently and/or effectively for (a) particular market segment(s), then that entity becomes a

resource to the firm.

R-A theory defines resources as the tangible and intangible entities available to the firm that enable it to produce efficiently and/or effectively a market offering that has value for some market segment(s). Resources can be categorized as financial; physical (plant, raw materials, and equipment); legal (e.g. trademarks and licenses); human (the skills and knowledge of individual employees, including, importantly, their entrepreneurial skills) organizational (e.g. controls, routines, cultures and competences); informational (e.g. knowledge about market segments, competitors, and technology); and relational (e.g. relationships with competitors, suppliers, and customers)(p.34, Hunt 2000).

When firms are enabled to utilize available entities that contribute to an increase in perceived

value of a market offering made available to a market segment that is produced both efficiently

and/or effectively, allowing the firm to gain a comparable competitive advantage, thereby,

superior financial performance, then each is considered a resource. Each market offering consists

52    

of a market mix of attributes that are tangible (eg. Damon System, Ortho Essentials, Mr. Fresh

disposable toothbrushes) and intangible (eg. clinical skills, credentials, relationship) entities that

when combined in a unique mixture to fill a significantly heterogeneous intra-industry demand.

Within a service industry such as dentistry, different practices will have access to different

products, as well as choose products targeted to answer patients particular taste and preferences

for braces which differ greatly, and are not easily obtained by a competitor. Despite firms

attempts to acquire competitors resources, heterogeneity can persist because of “ those resources

built into the organization such as systems, procedures, contracts, and brands which are not

dependent on single individuals” according to Gummesson (1995, p.17). Gummesson goes on to

point out that firms are beginning to recognize “ the fact that the customer base and customer

relationships are… assets, even the most important assets” (p.18). Therefore, in order to achieve

superior financial performance it is essential to view “Firm’s relational resources… as the

principal determinant of its wealth-creating capacity. Furthermore, it strongly supports R-A

theory’s contention that important firm resources are intangible, significantly heterogeneous, and

immobile” According to hunt (2000, p.129)

4.8. Premises 8 :: The role of management is to recognize, understand, create, select, implement, and modify strategies. The view of management’s role in R-A theory is a business strategy manager. “Specifically, the

role of management (both owner and nonowner managers) is to recognize and understand current

strategies, create new strategies, select preferred strategies, implement the strategies selected,

and modify strategies through time” (Hunt 2000, p. 131). Performance is influenced by the

manager’s strategic choices. “All strategies (at the business-unit level) involve, at the minimum,

the identification of (1) market segments, (2) appropriate market offerings, and (3) the resources

53    

required to produce the offerings” (Hunt 2000, p. 131). The continued competitive advantage

resulting from a comparative advantage is due to firm’s strategic dynamic contributions to the

“sustained superior financial performance” (Hunt 2000, p. 131) despite the competitor’s actions.

4.9. Premises 9 :: Competitive dynamics are disequilibrium-provoking, with innovation endogenous. The evolutionary process of competition is explained in the R-A theory as the result of the

disequilibrium provoking actions of firms. Some firms will have more competences in specific

areas that are perceived to be of high value to some markets segment(s), thus influencing the

firm’s performance due to the heterogeneity and immobility of the relative resources that are

strategically chosen. The allocation of resources contributes to R-A theory’s process of

competition, when it enables a firm to produce a more efficient more effective market offering

(Hunt 2000, p. 132).

5. R-A Theory and Marketing Services 5.1. Oral health care services According to Kotler and Keller, “A service is any act or performance one party can offer to

another that is essentially intangible and does not result in the ownership of anything. Its

production may or may not be tied to a physical product” (2010). The oral health care industry

provides a major service, an example of this is the Orthodontic treatment provided by Smile by

St.Clair’s Orthodontist Dr. John St. Claire, D.D.S. and Dr. James St. Clair, D.D.S., M.S. along

with the newest member of their dental team Dr. C.C. Masey, as the skilled service providers, to

improve the smile of patients. The ability of the Orthodontist to provide this service is dependent

54    

on minor goods, such as the Damon System’s braces applied by the Orthodontist and then

maintained by the Patient daily with the help of the Ortho :) Essentials a Proctor and Gamble

Crest/OralB dental care package; as well as minor services such as the prompt and friendly

service provided by the dental team. In services such as dentistry, patients do not only purchase

the orthodontics services, which includes the braces, but are responsible in the Coproduction of

results, superior results occur from “high-performance customers” (Kotler and Keller) who play

a very active role in the daily maintenance of their oral health by brushing properly with the

provided “Ortho :) Essentials” dental care package. It is important for Business Services like

Smile by St. Clair’s office to understand how R-A Theory explains how each element in this

marketing mix forms a service bundle which if provided highly efficiently and effectively can

enable the practice to create a marketing offer highly valuable to a market segment.

5.2. Inseparability of services

There is an inseparability of services in dentistry between the clinical skills and functional skills

during the simultaneous production and consumption of a service, therefore in a services market

the interaction between the provider and client is a special feature. The orthodontist at Smile by

St. Clair understand how valuable of an asset the patient is to the firm and manages the

relationship of each patient by adding a personal and friendly touch to make the patient feel

welcomed and valued by the practice. Everyone on the dental team realizes that each person has

a very limited amount of time to make a big impression. To assist the doctors be as efficient as

possibly during the short time together during an appointment they will prep the patient,

including making notes of any significant information in the patients digital charts that may help

the orthodontist make an effective connection with the patient For example, an orthodontic

55    

assistant learns from the patient that he is very excite that his cousin went to nationals in golf, the

assistant then makes a note in the patient’s charts. Before the Orthodontist begins to work on the

patient they read the patients charts to see what work has been done and what they discussed

they would be doing, during this time they can also read the personal notes the assistant wrote

and then engage the patient in a conversation tailored to the patients interest. The patient is not

only judging the clinical skills of the doctors, but also the doctors interpersonal skills in making

the customer feel important and of value. By showing interest in the things that stimulate a

patient, St. Clair’s orthodontists form a deeper connection with the patient.

5.3.Variablility of Quality Dependent On Variability of Resources

Services vary greatly among oral health care practices depending on the provider, receiver,

location and circumstances, leading to variability of service quality delivered. When patients

view the services provided to them the quality of service depends on what the patient values and

what they are willing to pay for that value. Many intangible resources contribute to the quality of

service delivered, one element that is a major effector of quality is the firm’s employees and the

training procedures that prepare them for their job. The more skilled and knowledgeable those

providing service are they can be more competent at their job. The service provider, whether it’s

the Orthodontist or an assistant, their professional licenses act as credentials vouching for

credibility of their knowledge and skills. Smile by St. Clair uses their credentials to make their

intangible knowledge and skill resources into tangible resources by publicly displaying them in

the office and posting all resources that contribute to credibility on their website. St. Clair’s

Orthodontist not only gains the patient’s trust by proving their credibility through their

credentials but also by providing consistent and accurate service. Consistent delivery of quick

56    

responsive service is possible due to the available resources such as the Dolphin Management

4.5 software and Patient GPS, in conjunction with a highly proficient team. When the highly

proficient team is given not only the proper resources to conduct the job, but is also trained

properly, then they are a valuable source of information and communicate this knowledge to the

patient. When information in communicated properly to patients in a manner that increases their

understanding the firm can gain a comparative competitive advantage.

5.4. Tangibilizing intangible service resources.

Customers judge the “perceived services” based on the experience received against the

“expected services” (Kotler and Keller). According to R-A theory intangible resources are a

major contributor to the heterogeneous nature of a market offering, therefore, to maximize a

patients perception of services their receive it is imperative for firms to tangibilize these

intangible resources that differentiate the quality of one practice from another. When quality of

service is based on patient perception, there are certain determinates of quality that can impact

the patients perception greatly. It is important that patients feel they are receiving the promised

service.

5.4.1. Reliability

St. Clair’s orthodontists are able to demonstrate the reliability of their discussed treatment plan

with regularly take photos that track the patient’s progress. Damon System’s revolutionary

technology allows for fewer adjustments and fewer patient visits needed, while still making

drastic changes in a shorter amount of time. Dolphin Image allows the patients to visually see the

progression of treatment.

57    

5.4.2. Responsiveness

Innovativeness can assist firms in maintaining a sustainable comparative advantage according to

R-A theory. Innovative suppliers of information systems can create a sustainable comparative

advantage for firms, such as the fully digital interfaces systems Dolphin Management that is

licensed to St. Clair orthodontics, allowing doctors to access charts, treatment plan, and photos

showing X-Ray and progression. Smile by St.Clair’s patient GPS system is an element of the

information system that allows the team to provide prompt service. Smile by St. Clair’s

utilization of Self-Service Technologies (SSTs) allow the patient to become an interactive part of

this prompt service by scanning their fingerprint to check-in for their appointment. Automatic

thumbprint identification check-in is considered a technological resource by R-A theory. At

check-in a timestamp tells the staff the exact time the patient checked in. Patients are rewarded

by the Orthodontist for early check in and can receive wooden nickels that they can exchange for

prizes.

5.4.3 Assurance

Part of a St. Clair’s orthodontic assistants’ responsiveness is to assure patients they are getting

the expected service by explaining the procedure that will be done by the orthodontist, then the

orthodontist will tell the patient what procedure he is about to perform, followed by the

orthodontic assistance’s explanation of what was done by the Orthodontist. This repetitive

communication of the procedure performed is an Information resource for the firm and attributes

to the firm’s competence in achieving a comparative competitive advantage in obtaining superior

financial performance.

58    

5.4.4 Relational Empathy

In a service business, such as the orthodontic treatment provided by St. Clair orthodontists,

relationships are an extremely valuable asset to the firm. R-A theory views relationships as

valuable resources when development of long-term relationships occur, which attributes to the

competitive advantage. For doctors to develop this relationship they must give the patient

personal attention. Each administrator has a competence for a specific job focus (insurance,

charts, schedule) to perform in the office that will increase the practice’s performance efficiency,

thereby, allowing the orthodontist to concentrate specifically on performing their professional

skills enabling them to not only see more patients but spend more time with patients giving them

individual attention. The ability to spend more time giving individual attention to patients can

improve their relationship.

5.4.5. Tangibles

It is the tangible resources that create and reinforce the perception of quality to a patient and the

inability of competitor to easily obtain or duplicate these services attributes to the firm’s

differentiation. The fully digital interfaces systems Dolphin Management 4.5 is licensed to St.

Clair orthodontics allowing them to access patient information at the click of a mouse. Another

major differentiator in the service delivered by Smile by St. Clair is the stylish, uniformed

appearance of the entire orthodontic staff. St. Clair orthodontics gives their staff an allowance

each quarter to help offset the cost of regular changes in the staff’s attire. One member of the

staff is in charge of choosing outfits to create the staff’s neat, uniformed appearance. Damon

System’s revolutionary technology allows for fewer adjustments and fewer patient visits needed,

59    

while still making drastic changes is a shorter amount of time. One aspect that differentiates this

resource from others firms that may offer the Damon System is that not only dose the St. Clair

practice use this system of orthodontic, but Dr. James St. Clair teaches this revolutionary way of

performing orthodontic at the University of Texas Houston branch dental School. These are

examples of tangible resources that allow Smile by St. Clair to sustain a comparative competitive

advantage that allows them to achieve superior financial performance.

6. Conclusion

The Resource Advantage theory can explain to an oral health care provider how to better merge

business and marketing strategies to better utilized available heterogeneous, immobile resources

allowing the firm to create a market offering with the appropriate quality and value for a target

market to achieve superior financial performance that can be sustained through innovation and

adoption to competitive dynamics.

60    

FIGURE  1  

 

A  Schematic  of  the  Resource-­‐Advantage  Theory  of  Competition  

Read:  Competition  is  the  disequilibrating,  ongoing  process  that  consists  of  the  constant  struggle  among  firms  for  a  comparative  advantage  in  resources  that  will  yield  a  marketplace  position  of  competitive  advantage  and,  thereby,  superior  financial  performance.  Firms  learn  through  competition  as  a  result  of  feedback  from  relative  financial  performance  “signaling”  relative  market  position,  which,  in  turn  signals  relative  resources.  

 

Source:  Hunt  and  Morgan  (1997)  

Societal  Resources   Societal  Institutions  

Competitors-­‐Suppliers   Consumers   Public  Policy  

 Resources   Market  Position   Financial  Performance  

     •  Comparative  Advantage  

   •  Parity  

 •  Comparative  Disadvantage  

   •  Competitive  Advantage  

 •  Parity  

•  Competitive  Disadvantage  

   •  Superior  

 •  Parity  

•  Inferior  

61    

Figure 2 Competitive Position Matrixa

Relative Resource-Produced Value

Lower

Parity

Superior

Relative

Resource

Costs

Lower

1 Community Health

Center Indeterminate

Position

2

Competitive Advantage

3

Competitive Advantage

Relative Resource Costs

Parity

4

Competitive Disadvantage

5 Abbevill Dentistry

Parity Position

6

Grimes Dentistry Competitive Advantage

Higher

7

Competitive Disadvantage

8

Wentz Orthodontics

Competitive Disadvantage

9

Smile by St. Clair Indeterminate

Position

----------------------------------------------------------------------------------------------------

aRead: The marketplace position of competitive advantage identified as Cell 3 results from the firm, relative to its competitors, having a resource assortment that enables it to produce an offering for some market segment(s) that (a) is perceived to be of superior value and (b) is produced at lower costs. Source: Hunt and Morgan (1997).

62    

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