Dentistry has a measurement problem. Today I'm doing something about it.

By Andy Sloan

2 August 2026 · 5 min read

Ask a lender what a dental practice is worth and you'll get a number.

Ask them how well it's run, and you'll get a feeling.

That gap is the most expensive blind spot in UK dentistry. After fifteen years and more than 120 acquisitions, I've watched it cost owners millions. Not through fraud. Not through bad dentistry. Through the absence of a shared language for operational quality.

Let me show you what I mean.

Two practices, same profit, different fates

Picture two practices with identical earnings. Same turnover, same margin, same postcode profile.

The first runs on the heroics of its principal. The systems live in people's heads. The compliance file gets assembled the week before an inspection. The accounts arrive once a year, and the practice's real performance is something the owner senses rather than measures.

The second runs on evidence. Monthly management accounts. Documented processes a new team member can actually follow. A leadership rhythm that doesn't route every decision through one person. A compliance file that is maintained, not manufactured.

On paper, the paper most of the sector uses, these practices look the same. In a transaction, they are not remotely the same. One attracts a clean structure and a confident buyer. The other attracts an earn-out, a longer tie-in, and a diligence process that feels like an interrogation.

I've sat in the room while more than half of a seller's headline EBITDA evaporated in due diligence. He wasn't dishonest. Nobody had ever shown him what a buyer would strip out: the adjustments, the one-offs that weren't, his own chairside hours priced at nothing. He'd anchored on a number that was never real, and the deal died of disappointment. The scale of that one was unusual. The pattern behind it wasn't: most owners meet the buyer's version of their practice for the first time mid-deal, under exclusivity, with the clock running. In this sector, that's the default.

Here's the part that should bother you

Almost every serious industry has a maturity framework. Manufacturing has had capability models for decades. Software has them. Healthcare systems internationally have them. They give operators a ladder: here's where you are, here's what the next level looks like, here's the gap.

Dentistry has consolidated at extraordinary pace, absorbed billions in institutional capital, and professionalised almost everything else. And yet the only people running maturity assessments on your practice today are the people buying it, lending to it, or investing in it. They do it informally, inconsistently, and behind closed doors. You are the subject of the assessment and the last to see the result.

I've spent my career on the other side of that table. I know exactly what the informal scorecard looks like, because I've applied it.

So I've published it.

DOMI is live today

The Dental Operational Maturity Index is a structured framework for measuring how well a dental business is actually run. Not how good the dentistry is. How good the business is.

It assesses an organisation across six domains: clinical governance, leadership and culture, operational systems, financial maturity, workforce and talent, and patient experience. It places the organisation on a five-level scale, from Foundation to Exemplar. The full framework is live now at sloanstrategic.com/framework.

The levels are deliberately honest. Foundation isn't an insult. It describes a practice that delivers care but runs on individual effort rather than systems, which is where most owner-led businesses genuinely sit, and where every business starts. Exemplar isn't a fantasy. It describes the operational standard the best-run groups in this sector already demonstrate. The ladder between them is the point. Each level describes something recognisable, achievable, and worth reaching. On my own instrument, honestly scored, my ventures haven't always flattered me either. That's rather the point of a mirror.

Three things DOMI deliberately is not.

It is not regulation. CQC asks whether care is safe and compliant. DOMI asks the question nobody formally asks: is this business mature? The framework is voluntary, and it will stay that way.

It is not a league table. The purpose isn't to rank practices against each other. It's to give every operator, from a single-chair squat to a hundred-site group, the same honest mirror and the same map forward.

It is not owned by one firm. A framework like this only works if the whole sector can trust it, which is why it's being developed openly and why conversations about its stewardship involve the organisations this sector already trusts.

Why this matters beyond the deal table

If DOMI were only a transaction tool, it wouldn't deserve the sector's attention. The case is bigger.

Mature practices are better places to work. In a profession losing clinicians to burnout and frustration, the difference between a systemised practice and a chaotic one is the difference between a career and an exit plan.

Mature practices are safer for patients, because governance that lives in a system survives the departure of the person who built it.

And mature practices keep the sector's power balance honest. Capital flows to what it can measure. A sector that can evidence its own quality negotiates with investors, lenders and policymakers from strength. A sector that can't gets measured by other people's yardsticks, priced on other people's assumptions, and told the result at the worst possible moment.

This is where you come in

DOMI is not finished. Deliberately.

A maturity framework built in a back room by one adviser would deserve exactly the scepticism it would get. The frameworks that endure were shaped by the people they measure. So there is no launch date on this. Version one publishes when the formation phase has done its work, not when a conference diary says so.

That formation phase opens today, and two things are live right now.

The framework itself is at sloanstrategic.com/framework. Read it. Challenge it. If you run a practice or a group, tell me whether the six domains match the business you actually operate. If you're a clinician, tell me where governance frameworks have helped and where they've been a box-ticking burden, because DOMI must never become the latter. If you're an investor or a lender, tell me what evidence of maturity would genuinely change your view of a business. And if you think the whole idea is wrong, I especially want to hear from you. Frameworks improve through friction, not applause.

The self-assessment is at sloanstrategic.com/assessment. Eighteen questions, five minutes, and you'll see your practice the way a buyer, lender or partner already sees it: your level, your profile across all six domains, and the two gaps a due diligence team would find first. It's free, it's confidential, and it only works if you answer honestly.

The people who take part now will be credited as exactly what they are: the people who helped write it. Email me at andy@sloanstrategic.com if you want to be one of them.

Because here's the thing about maturity frameworks. The incumbents in every other industry resisted them, right up until they realised the assessment was happening anyway: informally, inconsistently, and without them in the room.

Your practice is already being scored. As of today, so is the scorecard.

Next read: The three prices of a dental business →