The Big Dig

What Boston’s Complicated Roadways Teach Us About Business Simplicity

I recently took my team on a client project to Boston for a few days. Even though we were working in a suburban neighborhood, we decided to stay downtown and enjoy the city. Boston, as charming as it is, has to be one of the most complicated cities I’ve ever navigated.

It ends up I’m not the only one that thinks this way. Boston has actually been voted “Most complicated city to get around in.” To understand why, we have to go all the way back to the 17th century when many of the roadways began as cow paths, weaving around water ways, bogs and difficult terrain. Very rarely did they take the most direct route and nobody was thinking about long-term future development.

Boston’s roads were designed by cows, not for cars.

The result is a complex road system without an organized structure. There is no north/south, east/west grid that most of us intuitively follow. Instead, Boston is known for its rotaries — roundabout type intersections that put you off in any number of directions onto crooked and winding streets.

To help solve the traffic complexity problem, Boston built its central artery, Interstate 93 in the 1950s in an effort to move traffic through the heart of the city. Although it initially allviated the problem, the solution was short lived. Within a few decades traffic peaked at 190,000 cars a day creating constant gridlock for six to eight hours per day and accidents four times the national average.

City engineers proposed a solution: The Big Dig. The most expensive highway project in the history of the United States rerouting the central artery underground. The project started in 1991 and was projected to finish in 1998 at a cost of $2.8 billion. Almost a decade behind schedule it was finally finished in 2007 at a cost of $14.6 billion. Sounds about right.

Here’s the before:

Here’s the after:

Today, traffic is… better. Instead of 190,000 vehicles a day, the central artery now handles 536,000 vehicles. While congestion through the city might be better, navigating the streets still remains a challenge. Once underground, GPS signals no longer work creating chaos and stress among the multitude of exits, interchanges and quick turns. Many locals still use a dashboard GPS system that is updated regularly because of the frequency of road closings and detours.

Business Is Complicated

Boston’s complicated roadways are a great metaphor for building a business. What starts out as us finding our way ends up with years of adding “solutions” to it. Most of our businesses tend to look more like Boston and less like our modern day master planned communities with perfect grid structures.

One of the most important keys to owning a business is realizing that its natural state creeps towards complexity. We solve short-term problems without calculating long-term effects. We don’t stop to think through scalability. The issues you faced and solutions you created as a $500K business are not the same at $1M or $10M. Yet most of those systems are still around. Nobody stopped to ask if they were still relevant and more importantly, “removing outdated systems” is a job we seldom think about.

Steve Jobs commonly talked about simplicity as one of his most difficult jobs as the CEO of Apple,

“Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.”

If you feel like your business isn’t moving mountains, perhaps it’s because the thinking isn’t clean. Maybe you need a Big Dig style project to clear out the old and build the new.

Here are some questions I use to help myself to THINK CLEAN:

  • Multiply the solution by ten. Does it still work?
  • If you take me out of the equation, does it still work?
  • What are we manufacturing energy for?
  • What do my employees procrastinate because it’s a headache? (e.g. expense reports, vacation requests)
  • What old systems do we need to eliminate?
  • If I had to start this from scratch, how would it be different?

I know my team thinks I’m crazy sometimes. They joke about how everything has to fit into nice, neat boxes, but one of my main roles is to create simplicity. It has to be simple and clean in my head if I expect my team to move forward clearly without friction.

Keep It Simple For Patients

As practices grow I routinely witness complexity becoming the single largest source of frustration and stress in the life of the owner: “This used to be fun. Now I’m just overwhelmed.” Left unchecked it will begin to erode your practice, your team and your patients’ experience.

We need to follow the advise of Amelia Bar, the great British novelist,

“It is always the simple that produces marvelous.”

If we want a marvelous patient experience, we must make it simple.

Is your check in process quick and easy? Did you get all the paperwork out of the way before the patient arrived? The way new patients begin their experience with you sets the tone for the relationship. We can’t complain that they don’t accept treatment at the end of the appointment if they weren’t treated professionally at the start.

Is insurance clearly explained ahead of time and easily understood? While dental benefit plans are the opposite of simple, we must work hard to minimize surprises. “Well, you know… Insurance is so complicated. We never really know,” doesn’t work anymore. We must invest in a team member who understands the system and communicates simply to patients.

Are treatment plans visually presented? In my experience, assuming a patient can process a treatment plan audibly leads to nothing but confusion. There’s too much technology now not to simplify your case presentation. You know the old adage, a picture is worth a million words? So give them a picture and simplify what needs to be said.

Do you hire principle based team members or do you create rules to manage behavior? Nothing causes complexity like people. Hiring principle based people simplifies everything down to a set of core principles. Hiring rule responsive employees ends up in large policy manuals and “unwritten” rules floating around the practice.

Growth Requires Simplicity

The natural state of any business will always tend towards complexity. Atlanta-based mega-church leader, Andy Stanley said it best,

“Growth creates complexity, which requires simplicity.”

As a business owner or leader, we can’t be afraid to dig up old solutions and rebuild, replace or reroute our systems. Create clear thinking that allows your team to move without friction and your patients to experience marvelous.


Joshua Scott is a marketing speaker and consultant. He has been speaking to crowds for over 20 years and has spent the last 14 years in the dental industry. He works with practices around the country to create clear and confident marketing strategies.

He co-leads Studio 8E8 (pronounced “88”), a creative marketing firm specializing in brand creation and digital marketing solutions. He is also the host of The 8E8 Dental Marketing Show — a regular YouTube show answering dentistry’s most important marketing questions.

Discover more about Josh’s approach to marketing at joshuascott.com.