110% of goal in month one, and the foundation is just getting started.

One month into a CascadEffects engagement, an established orthodontic practice hit 110% of its starts goal and 101% of its production target, while the operating system underneath was still being built.

In April 2026, an established orthodontic practice engaged CascadEffects for a Six Months of Deep Work engagement. Thirty days later, the practice had hit 34 starts against a 31 goal (110% of goal) and $189,929 in production against a $188,000 target (101% of target), while simultaneously installing an entirely new operating cadence: weekly meetings, OKRs, a TC tracker, a cleaned-up patient management system, and a one-appointment new patient experience with same-day-start.

This case study covers what happened in those first 30 days, why the foundation work and the performance work were running in parallel from day one, and what May is set up to deliver.

Month One: Foundation Set

May target: 34 starts, $218K production (a 15% lift on April actual).

This Isn't a Turnaround Story, It's a Foundation Story

The practice was already a respected, well-led operation with a strong clinical reputation, a tenured team, and a doctor-owner committed to a family-first culture. The question wasn't whether the practice could perform. It was whether the operating model underneath could support the next stage of growth without the doctor carrying every decision personally.

That's a familiar pattern for established practices. The clinical work is dialed in. The patient base is loyal. But the systems have grown ad hoc, the team is working hard without a shared definition of "good," and there's no reporting layer in front of the decisions that matter. Growth, when it comes, depends on heroics rather than infrastructure.

The goal of month one wasn't to turn anything around. It was to put a foundation in place that could carry the practice through a breakout year.

The Challenge: Aligning the Team Around What Comes Next

When CascadEffects came in, the practice was performing, but the operating model had a few familiar gaps:

1. No standardized weekly meeting cadence. Leadership conversations happened reactively, not on a rhythm that drove decisions forward.
   

2. No documented core values. The culture was strong but lived in the doctor's head and the team's instincts, not in a shared language the team could anchor to.
   

3. No OKR or performance framework. The team was working hard without a structured way to measure individual or practice-level performance.
   

4. No TC tracker or conversion reporting. Case acceptance was happening, but without visibility into close rates, lost-opportunity reasons, or pending patient follow-up.
   

5. A patient management system in need of cleanup. Statuses were inconsistent, which meant every report built on top of the data was working with a noisy baseline.
   

6. No structured new patient experience. The path from first call through start was inconsistent across team members, creating friction in case acceptance and same-day-start conversion.
   

7. No active marketing motion. The referral relationships existed but weren't being actively nurtured, and there was no review program, no community presence strategy, and no clear referral marketing plan.

Importantly, none of these were crises. They were the quiet operational gaps that limit what a strong practice can become.

The Solution: Build the Foundation and Drive Performance, Simultaneously

CascadEffects designed a Six Months of Deep Work engagement structured to deliver visible performance in month one while the deeper system build ran underneath it. The first 30 days prioritized leadership cadence, reporting infrastructure, the new patient experience, and a marketing foundation, all sequenced to compound through May and beyond. April Initiatives Implemented

Leadership and Structure

• Weekly meeting cadence locked in with a consistent agenda and ownership model

• Core values defined and rolled out with a daily bucket-filler rhythm to make them operational, not theoretical

• Team member expectations aligned around accountability and professionalism, with a shared standard everyone could be measured against

New Patient Experience

• One-appointment new patient model with same-day-start built into the workflow

• Welcome call program launched to reduce no-shows and increase pre-arrival commitment

Marketing Foundation

• ABCD referral list built and segmented to set up the May activation phase

• Referral sourcing infrastructure prepared inside the practice management system

Systems and Reporting

• OKRs implemented across roles

• TC Tracker built and put in front of the leadership conversation each week

• Patient management system statuses cleaned up so every downstream report could be trusted

• Phase 1 website updates rolled out with the practice's digital partner

• Autopay system implemented to stabilize cash flow and reduce manual collections work

The point of this sequencing was simple. Foundation work that takes 90 days to show up in the numbers is foundation work the team will lose patience with. By choosing initiatives that built the system AND moved the metrics in parallel, the engagement created its own momentum.

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The Result: The Numbers Already Moved

April produced two outcomes that, on paper, look modest. In context, they're the opposite of modest.

34 starts against a 31 goal, 110% of goal. This was achieved in the same month the team adopted a new meeting cadence, a new OKR framework, a new TC tracker, a new patient management workflow, and a new same-day-start protocol. Most engagements would have flagged month one as a transition month and protected the team from goal pressure. This one didn't need to.

$189,929 in production against a $188,000 target, 101% of target. Production held while the entire operating model underneath was being rebuilt. That's not a coincidence. It's what happens when the foundation work is sequenced to support performance instead of competing with it.

The story of month one isn't the percentage over goal. It's that the practice now has the reporting layer, the team alignment, and the new patient infrastructure to make those numbers compound.

Where It's Going: The May Activation

May is when the foundation gets converted into momentum.

Marketing Activation

• A community sports raffle launching mid-May, running for 60 days as a community awareness and lead generation campaign

• Referral partner appreciation drops to A-list dental referrers

• A Mother's Day gift drop to deepen patient and team connection

• Referral source data going live inside the practice management system, so for the first time the practice will have closed-loop visibility into where new patients actually come from

• A formal referral marketing strategy stood up

• A Google review program launched to convert the existing patient base into the practice's most powerful marketing channel

• Phase 2 website updates rolled out
  

Same-Day Start Alignment

A morning huddle reset designed to align the clinical and TC teams behind the same-day-start workflow that surfaced friction in April

Core values anchored as the framing for the conversation: families serving families

Nurture

• A pending patient follow-up protocol launched to recover the patients who've already said yes to a consult but haven't yet committed to a start
  

The May target is 34 starts and $218K in production, a 15% lift on April actual. The systems to support that lift are already in place.

Why This Engagement Worked

The foundation work was sequenced to support performance, not compete with it. Every system installed in April was chosen because it would either show up in the numbers immediately or unlock the next layer of work that would.

Reporting went in front of every decision. OKRs, the TC tracker, and the cleaned-up patient management data meant that within 30 days, leadership conversations were grounded in evidence instead of intuition.

The new patient experience was rebuilt from first call through start. One appointment, same-day-start, welcome calls, all aligned to a single workflow the whole team could execute consistently.

The team got alignment, not pressure. Core values, weekly cadence, and accountability standards gave the team a shared definition of good. Performance followed.

The marketing foundation was built before the activation. April was about getting the referral list, the system fields, and the review infrastructure ready. May is about turning that foundation into pipeline.

Case Study Details & Performance Breakdown

This orthodontic case study highlights the first 30 days of a Six Months of Deep Work engagement between an established orthodontic practice and CascadEffects, a fractional COO and orthodontic consulting firm specializing in operational systems, leadership development, and practice growth.

The practice entered the engagement as a respected, profitable operation with a strong clinical reputation and a loyal patient base. Like many established orthodontic practices preparing for the next stage of growth, the operating model underneath the clinical performance had developed organically rather than by design. Key gaps included the absence of a structured weekly meeting cadence, undocumented core values, no formal OKR or performance framework, no treatment coordinator tracking system, inconsistent patient management data, an unstructured new patient experience, and no active marketing or reviews program.

CascadEffects partnered with the practice to implement a structured operational framework across leadership, new patient experience, marketing foundation, and systems and reporting. This included weekly meeting cadence implementation, core values rollout, OKR design across roles, TC tracker implementation, patient management system cleanup, a one-appointment new patient experience with same-day-start, welcome call program launch, ABCD referral list build, autopay system implementation, and Phase 1 website updates.

Within the first 30 days of the engagement, the practice achieved 110% of its new patient starts goal (34 starts against a 31 target) and 101% of its production target ($189,929 against a $188,000 target), while simultaneously absorbing a complete operational rebuild. The May focus extends the engagement into marketing activation, same-day-start alignment, and pending patient nurture, with a target of 34 starts and $218,000 in production representing a 15% lift on April actual.

This case study demonstrates how foundational orthodontic consulting work, when sequenced correctly, can deliver immediate performance gains while building the operational infrastructure for long-term, compounding growth. For orthodontists and dental practice owners considering operational consulting, fractional COO services, or a structured engagement to scale a high-performing practice, this case reflects the impact of installing the right reporting, the right cadence, and the right team alignment in the first month of work.

CASCADEFFECTS

The People Behind the Results

CascadEffects doesn't advise from the sideline,

we embed with your team and build alongside you.

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CascadEffects partners with orthodontic practices to build lasting operational excellence. Let's talk about what's possible for yours.

www.cascadeffects.com

About CascadEffects

CascadEffects is an orthodontic consulting firm that partners with growth-minded practices through a six-month embedded engagement model. Founded by Casey Bull, a former COO and Global Director with over a decade of orthodontic leadership experience and an MBA from Pepperdine University, CascadEffects is powered by a leadership team that has operated at every level of practice management.

Director of Operations Heather Broughton brings years of hands-on orthodontic operations experience, having managed multi-location practices from the inside, overseeing teams, systems, and day-to-day execution before stepping into a consulting role.

Together, Casey and Heather work shoulder to shoulder with practice teams to install leadership infrastructure, accountability systems, and team culture frameworks that drive measurable production growth, with clients achieving 20–150% growth.

CascadEffects also publishes The Cascade Report, an industry publication for orthodontic professionals.

Learn more at cascadeffects.com