What dentists consider their dream practice is certainly different for each, but regardless of what that is, some basic principles apply. Effectively managing a practice is paramount and often a major problem that is often not addressed advantageously. How effective can we be juggling the duties of doing the dentistry and being what others call the Chief Operating Officer? How much of your time is taken away from doing the dentistry to trying to manage the office effectively? Why is it that some offices get so much more production than other offices while working approximately the same amount of time? This is because they are very adept at BOTH the technical and administrative responsibilities of dentistry.

Doing the dentistry and managing the office are two entirely different things. Most dentists that are really absorbed into the technical aspects of the dentistry and aspire to do great dentistry and want to do just that: be dentists. A very small percent wants only to manage a practice and have someone else do the technical part. These diametrically opposed responsibilities can lead to a big dilemma when one is trying to do a good job with both. The vast majority of us, however, are strapped with doing both, like it or not. The question is "How do we do a good job with both, at the same time?"

My goals for you in this and succeeding papers are to address that question and to help you change some self-limiting beliefs, achieve what you want to achieve and reach all of your potential so that you will become a better, more productive and more fulfilled professional. Also, I want to help you rekindle some of your dreams to have the kind of practice that you have always wanted. For you that may be in a small part time or boutique practice practicing only a few days a week, an average 8-5 practice four to five days a week or a mega practice with a large staff and big production statistics. Whichever is right for you due to your family, financial obligations and other needs is only known by you and is not for someone to advise you otherwise. So, stick to your goals and be true to yourself rather than what someone else tells you what you should do. Row your own boat the direction you want to go rather than where someone else tells you is best for you.

The typical scenario in dental practices is: the doctor gets overloaded and overburdened because his employees are not organized or trained to handle the multitude of duties and functions needed to make an office highly productive and run smoothly at the same time. This is because he or she is dealing with front office personnel (i.e. receptionists, schedulers, account personnel, insurance secretaries, file clerks, accounts payable staff and other administrative personnel) as well as back office personnel (i.e. dental assistants, hygienists and inside or outside laboratory technicians).All of these people must be dealt with, supervised and trained as well. All of the front and back office personnel are there solely to aid and expedite the efforts of the doctor(s) and the hygienist(s) to deliver higher quality dentistry without getting burnt out and actually enjoying the art and science of doing good dentistry. Being overwhelmed by the superabundance of duties and functions only adds to the problem and handcuffs one from overcoming it all.

What I am going to discuss with you is not a panacea for your life’s or practice’s problems, nor a magic bullet for instant practice success and amassing a fortune. No one can give you that. Rather, it is a prescription for eliminating blind spots, confusion and misdirection of our work and living a productive life while creating and maintaining a practice that will be a great source of pride and satisfaction.

Go for Your Dreams and Not Unusual Solutions

Certainly, you have had a dream to have a beautiful and productive practice at some point in your life. This may have been when you got out of school, started your practice, had children and needed to educate them or at some other time of your life. Some pursue this dream for the love of dentistry, some for the love of the money, but most dentists simply want to do great dentistry and be rewarded for it. I have seen so many dentists that really had a rough go trying to provide their families with the amenities that any good professional should deserve. In order to do so, many have resorted to unusual solutions to try to generate the income they felt like they needed. Many have based their practices on HMOs, PPOs and other low paying insurance plans that did the opposite of what they were trying to do. Some dentists have tried marketing plans like expensive Yellow Page ads, targeting neighborhood areas by sending out reduced fee coupons and coupons for free examinations, radiographs, and or cleanings. Where State Boards forbid offering a free service, they get around it by offering the same service for a give-away of a dollar. These unusual or poor choice solutions rarely ever pave the road for one to reach their dreams but rather increase one’s stress and apathy toward the great profession that they used to love.

Many dentists just give up too easily and therefore don’t achieve their dreams. It’s not their dreams that fail them, we all can dream, but it is the lack of follow through to gain the know-how that prevents their dreams from becoming reality. Then, your dreams can become a nightmare.

Become a Good Manager

Some of the very best technical dentists have never seen a good management model done by another dentist and therefore do not have a concept or a vision of what effective dental management is. Take a concert pianist as an example. No great concert pianist has ever achieved greatness without studying and listening to other proven piano players. No great concert pianist is self-taught but they learn, practice and invest the time to become exceptional. The literature is filled with a plethora of technical instructions on clinical dentistry, but not much on training the dentists as managers or chief executive officers. When the dentist cannot create a well-managed office or is not trained on how to step up and manage the office, the income and the profit can suffer or at best never come close to its potential. There is no question that the highest paid people in society are good administrators. This is also true for dentists who are good administrators as well. They not only have a better bottom line, they are happier and enjoy their practices because they are running it and it is not running them. Many of these concepts will be presented in this three issue series.

Time Management is Necessary and Rewarding

One of the most important things I’ve ever learned was that most people are filled with wasted time and motion. I learned that by not wasting time and investing it with the same care wealthy people exercise in investing their money, I could in effect have much more productive time in my life and in essence, lengthen my life. Time is the most important of our resources. We can’t change it, we can’t alter it and we can’t manage it. We can’t manage time. That is a misnomer. We can only manage ourselves in relation to time. We have our practices, our family and our dreams. We want to provide for our loved ones and still have a great practice. So, how do we achieve doing both and still get sleep? You do it by incorporating the principles coming up.

Setting and Reaching Your Goals

If you are going to be successful, first it is necessary to have goals. If you don’t know where you are going, any road will get you there. However, to reach your goals you may have to reengineer your whole office or you may simply just have to tune it up here and there. Only you know what you want. Is it more production, work less hours, have a better bottom line, have a more organized less stressful life, or all the above? In order to have these things mentioned, there must be a plan and know how to make it happen.

Start with a Plan of Networking and Implement it

How is it possible to reach our goals? We do it by networking and delegating.
Networking is the most powerful success tool to get you where you want to go. Networking historically is something that dentists are not good at. What do I mean by this? Networking is a system or pattern made up of interconnecting parts. Networking is one of the most valuable things I have ever done.

What do I mean by networking? It is about putting together the interconnecting parts in a chain of command with trained staff that function properly together. In other words, you set up your organization and staff so they function like the ports on your computer. All the major positions in the entire office must be listed, posted and known by the entire office staff. Like the positions on any athletic team, there are different functions that are necessary to make a complete team. No football team could ever be complete without a left tackle or someone to call the plays. Under these positions, every duty and function in the office must be accounted for and assigned to someone or they become everybody’s job which insures that they never get done. This is no quick task in itself but not difficult for those who know how, of course. I’ll talk more about this later.

There comes a time for us to demand that we get the changes implemented, get the job done, and see it through. Even though, some staff members often times will not agree with this or understand it, they will greatly benefit from it themselves. If the staff is on your team they will follow your leadership. It is also important to remember that if they are not on your team they’ll do everything they can to sabotage your efforts even if they have to do it in a hidden way. If you run into this problem you’ll have to send in another player.

Know that Money Motivation can Kill Your Practice

The George Bernard Show said, “Money is the most important thing in the world. Money represents health, strength, honor, generosity and beauty as conspicuously as the want of it represents illness, weakness, disgrace, meanness and ugliness.” To some extent we all are motivated by money for what it can buy us and what it can do for us.

However, this quest for money can get out of hand. When money becomes someone’s motivating factor and gets dollar signs in their eyes, they will be blinded by what is in the best interest of the patients. The patients will be able feel it or perceive that the motivation is for money and you’ll see the backs of a lot of people’s heads as they march out of your office and never come back.

So, it is necessary to abandon the pursuit of money and put our attention on becoming better at dentistry and managing our practice on a higher healthier and enjoyable level. Then the rewards will come.

What you are going to read about in these papers will make you more money but, it will come as a by-product of doing what is the right thing for your patients in a manner that they can perceive you really care about then and take their best interest at heart.

Insist Upon High Ethical Standards

It is impossible to achieve your goals and dreams without also having high ethical standards in all operations of the office. Any staff member that exercises low ethical standards is like a team member who keeps fumbling the ball. The other team members have to fight like crazy to get it back and still lose it to the other side. These people are obvious and easy to recognize. Others with low ethical standards are not so easy to identify or in reality hidden, concealed and very difficult to uncover. They booby trap your operations and create extra work by sometimes having to frantically cover and handle things messed up or not done. These things create discord with patients and harm our practices. What kind of things am I talking about? You name it. This includes everything from incompetence, laziness and don’t care attitude to stealing prescription pads. I always thought I heard it all until someone tells me the latest story.

For brevity here, I’ll just say that if you know of someone’s behavior that you know is wrong or you have a bad feeling about, it is likely that it is creeping into the office in other areas as well. I’m not only talking about our staff members, I am talking about us as well. We also must have high ethical and moral standards as well. An example is how we speak to our patients about dentistry and other dentists. As chairman of our local peer review committee for over 25 years, I can honestly say that putting down other dentists and saying critical derogatory things caused the vast majority of complaints by patients to our dental society. Staff members do similar things to each other and this causes strife. No one can make themselves look better by putting down on somebody else, but apparently some think they can and continue to try to hold others down. It is important that we have standardized ways of dealing with ethical and other personnel matters that cause problems and interrupts the smooth flow of production in our offices.

Visualize and Write Down What You Want

Between now and next month formulate some concepts in your mind of what you want your practice to be like and write them down. What kinds of dentistry do you enjoy doing or aspire to do? How much time can you devote to your work? What are your family and financial obligations? What are you willing to do to change your conditions?

In future papers we will address some things that might have been a blind spot for you or some things you already know but needs to be addressed in your practice to get and have what you want. In the next two issues of Dentistry Today we will address how to unburden the dentist by organizing your staff to handle major organizational problems that dentists face in their practices.

 

PART II: The Next Steps

Unburden Yourself by Removing the Bottleneck Around You

DELEGATE AND TRUST YOUR STAFF.

Achieving the practice of your dreams it is incumbent upon your understanding and exercising some basic organizational applications. One of the first things to do is to remove the bottleneck around you.

Good administrative and technical help is needed to take the load off and unstop the bottleneck. Sometimes, there are those who do not recognize how much the doctor is overloaded. They think this is normal or business as usual. The staff also must be aware of the problems and know that conditions can change. Then basic systems and procedures must be adopted for everyone to follow. When they get a taste of the efficiency of how much the new organizing works they will all be more willing to continue. You will soon see how magical the results are on relieving the workload.

Have and Use a Staff Employment Policy Manual

As long as agreements exist between individuals, groups, countries, etc. there are no problems. Where there is disagreement, problems exist. This also applies to doctors and staff in dental offices. A complete and easily understood manual that spells out employment arrangements, policies and philosophy is mandatory. This manual informs an incoming new employee of what they can expect and gets their agreement prior to becoming a team member. It is also used for review from time to time for tenured employees. Employees may ask you, “Can I clean my husband’s teeth for free? Is Memorial Day a paid holiday? Do I get funeral leave for my cousin who passed away up in Canada? Can I get a loan from you for a couple of months?. Having a General Policy Manual already answers these questions for you and them and makes employment fair for everyone and greatly unburdens those in managerial positions.

Have Detailed Job Descriptions for Every Position

HAVE SPECIFIC INSTRUCTIONS READY FOR STAFF

Organize all the duties that you and your staff do. Start by listing every duty that you and each of your staff can possibly think of and get everyone a job description as a permanent record in your office. They will need help and encouragement with this, so show some leadership. Another way to do this is to acquire these from someone else who has proven that theirs work. This list is done and can easily be added to and handed down from incumbent to incumbent as your staff changes. Just beginning this process on the basic duties starts to undo the logjam on the dentist and the unburdening brings about happiness, higher morale and more production where more quality can be delivered.

Can you imagine how great this becomes when your staff is trained to handle all the administrative tasks that you as the dentist prefer not to do? The staff is usually very willing to do this because they would like to have more order and less stress in their jobs as well. Everyone wants a better job, and when they realize how much it will help them and their job they will nearly always back you up on organizing your office. However, if they are objecting, however, quietly or loudly, then you need to find someone else who really wants cooperate on your team. No matter how important you think a particular staff member is, the whole organization is more important than any one staff member. You need staff that will be with you and back you up on this.

When you have all the duties assigned to staff and everyone doing their jobs as they should, it takes the stress off and confidence is built on the entire team.

Don't Mistakenly Solve the Wrong Problem

I have had hundreds of participants in my office for training and workshops for office administration, scheduling, accounts receivable and office manager training. When we ask these dentists and their staff members what they think their number one problem is they nearly always say it is getting good staff. This is a vast misconception. I have been teaching this in my training manuals, workshops and seminars for over twenty years. After “preaching” this for over 20 years it is finally being proposed by many others. This misconception can be deadly and often is. The problem is threefold but the number one problem is the lack of training of staff members. Another major problem is a lack of systems that are staff and patient user friendly. We must have and implement systems that mechanize practically everything in the office and adopt these systems as standard operating procedures and expect everyone to follow them. Then thirdly comes finding the right staff members. We often get these three major problems mixed up and fail to see where our problems really lie. We need the correct number of staff, workable systems and the training of those staff on the systems. If we think of these three things in terms circles, we also need to be aware that all the circles need to be in focus. If any one circle is out of focus with another we will never be in control enough to accomplish any goal. Knowing this one principle greatly simplifies how we manage a practice.

Imagine the lost work, research, and money we caused in the past by “solving the wrong problem.” Example: you hire an employee to work in the front office area in reception, scheduling, finance, or management area. If there is no exact workable system of scheduling and appointment book control or recall and reactivation that employee will fail at doing the vital functions of the post. This employee had no chance of succeeding from the beginning and this type of situation sets up everyone involved for a loss including our patients. On the other hand, assume we have an appointment book control system in place. It may not be the best system but it works to some degree. What will happen if we take that new employee and put her to work without first training her completely on the existing system? Basically she would not know what to do. There would be many things done incorrectly and many left undone and therefore would not be successful. This opens the door for many other problems to ensue. Likewise, if we only partially trained the new employee on the existing system, it would hurt production, ruin our bottom line and be disastrous. This is the scenario that we usually see happen in many dental offices.

How many basically good employees have left our employment through quitting or dismissal due to a misunderstanding that was actually an organizational problem? On the other hand, how many times have we spent time and money to train an employee and they just couldn’t cut the mustard?

Let’s look at what would happen if we implemented a proven system of scheduling in our office and spent the time and money to train an employee on that system. And in spite of all the training, we could not achieve the desired results, then should we replace that employee because she for any one or more of a number of reasons will not accomplish what needs to be done with our scheduling? It would be unfair to the operation of the office, other staff members and our patients to not correct the problem by taking whatever action is necessary regardless of how bitter the pill is.

You Lose!

So to summarize this point: when a problem shows up it can be tricky trying to determine which of the three the main problem is. It’s like the street magician with the pea and the shell game. Unless you have a mighty keen eye, it is almost impossible to tell which of the three shells the pea is under. This is because the hand is quicker than the eye. This same maxim holds true in management as well. But like the magician, if you know the systems and have them in place you’ll be able to tell where the problem is every time.

You Win!

Know the Ingredients for a Successful Practice

Dentists often ask me what all it takes to make a successful practice. They also ask what is the quick fix or bag of tricks. There are none. So, to amuse myself one day I sat down to address this question and make a list of some of the ingredients it takes. The practice of dentistry is an interesting profession from the standpoint of everything it takes to create the practice of your dreams. As a general dentist, you have to have knowledge of anesthesia, operative dentistry, endodontics, oral surgery, pharmacology, periodontics, pedodontics, crown and bridge, removable prosthodontics, implants and have some knowledge as an engineer, business manager, financial expert, personnel and hiring manager, ethics officer, counselor, public relations person, customer service expert, an organizational genius, administrator, management expert, loan officer, personnel trainer, marketing expert and so on. Also, under the topics above they each have many subtitles. This is why dentistry can be an extremely difficult profession. Dr. Ingle has described the practice of dentistry as trying to run a four-minute mile and trying to keep up the pace all the way from Chicago to Denver. This is especially true if you have blind spots that prevent you from fully addressing all the responsibilities listed above.

Find the Missing Ingredients

To get the practice under better control, all we have to do is look and see what is missing and put it in or recognize what is weak and bolster it up. And we are continually trying to improve each facet of the office. Example: 1) Our recall system exists but it is not getting the job done. There is a lot of unfilled production time on the appointment book and there are too many broken appointments. (The first thing to remember is that almost any system is better than no system.)

Regardless the size of the practice, large or small, it is easy to lose managerial control.
As dentist’s offices grow the management problem is either not addressed or adequately planned. Then there is confusion of duties, functions and authorities. Consequently, chaos ensues. When this chaos gets too unpleasant the typical response is to try to reorganize by tweaking a few things here and there. This nearly always proved to be inadequate.

It’s a piece of cake to manage two or three staff. Four or five is somewhat tougher, but where there are six or seven employees in a dental practice it’s too much for the dentist to manage. At this point the dentist usually appoints an office manager but does not supply any plan, training, written job description or internship to see the office staff is operating at the efficiency level expected by other industry standards.

Simplify for Success by Putting Order into Staff Duties

Consider a list of every duty we perform. All the decisions that have to be made and all the armamentarium necessary to perform every dental procedure we do, all the supplies used for our dental and office procedures, and ordering, stocking and distributing them, handling all the business forms, paying the bills and taxes, doing all the scheduling and recalls, working with patients on their accounts, finances, and insurance. Then there is administering payroll, benefits handling and coordinating all the laboratory crown and bridge and removable prosthodontic cases as well as other intra-oral appliances. Then we have to do staff enhancement and training, taking care of the building maintenance, evaluating new products and procedures and on and on. You will see that so very many of these things get dropped out and never done. This is because of the great magnitude and complexity of doing all of these things and not having them simplified would drive a conscientious person crazy. Therefore, it is paramount that all the complexities and confusions be simplified whether you do it personally or hire it out to someone or some group that has experience in doing this or purchase a system that already has it done and more importantly proven that they can do it.

Duties that are not recognized and assigned never get done until a flap or a problem arises, which is too late. Handling the flap or problem then requires considerably more of your and other staff’s time to straighten it out. So, assigning these hidden or dropped out duties in the beginning saves a great deal of time in the long run and you have orderly activity.

Make Decision Making Easy with Standard Operating Procedures

One of the things many staff members don’t want to do is make decisions. The demand for us to make so many decisions so often is where a great deal of our stress comes from. This is especially true in dental offices where there are so many things to be addressed. Establishing office policy on how things are to be done in most instances, in effect makes their decisions automatic so that staff members do not have to decide on administrative actions in the office. Staff members love having the decisions already made for them. It makes their life so much easier regardless of how much you have heard to the contrary. Don’t worry, if they like making decisions there will be plenty that come up from time to time. When the various positions in the office have complete up-to-date job descriptions, the vast majority of decisions are already made.

This enormously simplifies things because the duties are divided up among staff allowing each person on the team to take care of their area, know it well, and complete every task with minimal supervision. Furthermore, this unjams the doctor’s activities and those in supervisory positions and grossly reduces stress. This is because each staff member is not responsible for making decisions about everything in the office. An example would be if a patient asked a dental assistant or hygienist if they could make a payment plan to pay for needed treatment over a period of time. They are simply told who the Accounts Receivable Secretary is and that she will work with you on your financial arrangements.

Standardize Your Scheduling and Appointment Book Control

In general, is your production lower than you would like it to be? Would you like to be producing in a higher range and realize the rewards of working smarter and not harder? Are broken appointments costing you production? Is your staff scheduling patients who may not pay you? Would you like to get your staff really trained so that they are effective and feeling better and more confident in their ability to create an ideal schedule every day? Do your staff members know the right scripts for getting patients to schedule their need treatments? Do they know the seven objections to scheduling? Do they know how to salvage broken appointments and no shows? If a staff member is not good at calling recalls and is not successful, is she going to be happy at trying to do so? Of course not! People don’t like to do things they are not good at. So, when there is poor scheduling no one is having any fun or making enough profit.

Disabuse Yourself of Treating Everyone's Account the Same

Which Ones Would You not Give Credit to?

All patients are not the same, and should not be treated the same, especially when it comes to how they pay for their services.

I have talked to thousands of dentists and dental office personnel, and I can tell you that the decision to go into a cash practice is based on several things. They, like you and me, have been victims of patients that were deceiving and dishonest or actually a credit criminal that we were not aware and trusted they would pay their accounts. We have given deadbeat and untruthful patients appointments on our schedules and have the appointment times wasted by them not showing up, or if they did, never pay us. Others, however, are totally honest, sincere and trustworthy and should be treated as such.

By establishing accounts for our patients we can stimulate production by increased acceptance of our treatment plans. Establishing credit by businesses has been a way of life for selling goods and services in America. There are over 27 million credit applications made every day in the United States. Prudent businesses know to do this. Without credit our economy would never have made it to the best in the world as it is. This idea of credit is so valuable that it remains the only way anyone can discriminate against anyone else in this country.

Dental offices in general have turned their heads on this and have not dealt with credit well. This is why we get such things as “I forgot my checkbook” and other ploys more often than other businesses.

In the year 2000 there were 1,253,444 bankruptcies filed and over 1.2 million bounced checks in the U.S. for non sufficient funds, closed accounts and stop payment request. And unfortunately you can not look into a patient’s face and tell if they have a past history of stiffing people when taking their products or services. We must be like other prudent businesses and have other ways to do that. The problem again is that accounts receivables are really staff responsibilities and we have not been able to completely train our staff to handle accounts or we have never given them a system or tried to delegate these responsibilities to them. A knowledgeable well trained staff member knows the difference between patients we can trust, which ones will pay and which ones will not. They can quickly learn which ones need financing, which ones are worthy of the convenience of establishing an account and how setting them up an account is a great way to sell more extensive dentistry including cosmetic and restorative dentistry. This helps, consequently, to do more and better dentistry of the quality and amount that we would like to do. Also, if they can’t afford the cost of their scheduled appointment, you can bet they won’t show up.

 

PART III: Some Remaining Steps

Have a System for Staff Procurement and Job Orientation

ORIENT THE NEW EMPLOYEE TO START PRODUCING

As a position in the office opens up, we not only need to hire and properly orient the new employee, but it is of the utmost importance that we have a functional system to introduce them to. They need to be oriented to the entire office and their job and have an organized learning transition to get them fully productive on that job in the shortest amount of time. Someone needs be on the job and be assigned to be responsible for helping that person learn the systems. Not many dentists have this or have anyone trained to do this. I can not understate the importance of establishing this system, if for no other reason but to take away the stress of dealing with the change and to gain confidence and control. Therefore, we must have a system of staff procurement and job orientation.

Put in an Effective Training System

Mark Twain said, “Inherently, each one of us has the substance within to achieve whatever our goals and dreams define. What is missing from each of us the training, education, knowledge and insight to utilize what we already have?”

Without training and having the proper ingredients in place, production will be stymied. For instance, you have a new scheduler on the job and the phone rings. She answers and the patient says, “I hate to call you and tell you this but I can’t come in for my long two-hour bridge prep appointment this afternoon. I’ll have to call you back and reschedule.” The untrained scheduler says “O.K., when should I call you back?” or some other inappropriate response and the production is shot for the day. So, how do you feel on days like this when your production is low and your spouse needs new furniture, a car, or money to pay those big college tuition costs? I suspect your morale would be low and if this low production is chronic it can get pretty depressing.

Without the training and/or internship there is no control or inadequate control of our systems causing certain failure. Along with this, expenses go up and a lot of attention goes on to being able to pay the bills and financially delinquent. The next step then is to try to stop the spending which often includes downsizing. I’ve seen this happen often, where the doctor will lay off or fire the extra part time hygienist or some other staff member, go to a cash only practice to cut down on the number of staff members needed, find a cheaper laboratory, etc.

The reason most dental offices try to control costs first is that they cannot predict income and expenses week-by-week, month-by-month or year-to-year what their income will be. If the income is on a roller coaster ride it makes it almost impossible to have any prediction of a profit margin on a regular or routine basis.

So, each time a manager tries to solve a problem by methods that are by a shotgun approach or by some other unpredictable method, it usually just causes more problems, which further causes more chaos and contributes more to the downward spiral. Then the dentist gets apathetic about his or her practice, and doubts his or her ability as a dentist and or as a manager. Some people call this burnout.

The solution is not to live a life of guilt, desperation, or apathy or reduce the practice down to a practicette especially if you have kids to send to college or live in an expensive area.
I’m talking about just making things go right in the direction we want them to go. Example: we decide to do something about the backlog of recalls for all those patients we promised to call. This is assigned to a staff member to get this started. Weeks later, nothing is done or only a few or small number of patients are called. The problem was that the staff member did not start the project because of some confusion, fixed attitude, no directions, no training or lack of supervision.

At this point most people get apathetic about even trying and say “That didn’t work” and give up on trying to get the staff member to do the project and the result is costly and disastrous.

The point here is that if you don’t know what to do and how to do it you can’t control it. This goes for any function in the office such as controlling the appointment book, accounts receivable, accounts payable, ordering supplies or whatever.

Set Up Systems and Checklists for Moving Things Through the Office

Monitor Duties & Responsibilities

Physically routing things through the office is a constant necessity. So many things are going in and out of the office that it really eases the work load and decision making when systems are set up to make this routing automatic. As an example, take the case of a new patient. It is very important that they be taken care of by everyone in the office that deals with them and all aspects of their treatment and business. There are certain steps the Receptionist does when this patient walks into the office. Where do they go from there? What forms do they fill out? What office policies are they given? Who sees them next? How and where are finances addressed with them” How is the treatment plan presented to them” What do we do with them when the treatment is finished for that day? By having a checklist all of these things, the decision is already made in advance so everyone inherently knows and does not have to decide what to do next. This makes everything flow smoothly and completely. This principal holds true for patients, payments, dental supplies, administrative supplies, mail, laboratory cases, etc.
Other good businesses do this and we should as well.

DON’T TURN YOUR EAR FAR FROM INTEROFFICE QUARRELING

Discord among staff members is a major distraction when we are trying to keep our attention on doing dentistry. Oddly enough, these problems all can be enumerated as “C” words such as conflict, contention, clashing, combat, controversy, competiveness, corivalry and cut-throating. We are not our staff member’s religious leader, psychologist, judge or jury. We are not trying to change people’s inherent beliefs or psyche. We only want to get back to the work of doing good dentistry; without the distractions and interoffice fighting. Championship teams work together, not by fighting with each other, criticizing others behind their backs, or trying to sweep the strife under the carpet. When staff members team up in groups of two or more to speak badly of another or whisper secrets, you have trouble in the camp. In successful practices the staff members have an admiration for each other because they get to the bottom of quarreling so that we all understand each other and work in a hand to hand effort. To get all the staff members working together and not in conflict requires only a small amount of basic knowledge and skills. It’s not as complicated as it usually seems to be but there are simple ways to bring about harmony.

Take Advantage of the Effectiveness of Forms

Do not underestimate the value of using forms and checklists. Their value in office use is evidenced by the great number of request for them when we have had visitors and workshops in our office. They make life easier and safer. You would never see an airplane pilot skip his checklist before taking off. That’s because his life depends on it. A checklist is the same thing and has been used by good businesses since the 1800’s. If you want things done right in you office you’ll use them too. The problem I see in most offices is that they have too few because it takes some creativity to make good ones. Any form or checklist is better that none at all. They do not have to be perfect and rarely are at the start. Some examples of checksheets are: daily, weekly and monthly duties, routing forms, time off requests, operative set ups, etc. They can be added to and fine tuned as you use them. Just start writing them or acquire them.

There Must be a System for Measuring Everyone's Performance

KNOW WHAT YOUR STAFF IS DOING; KNOW WHO’S CARRYING THE LOAD

Most dental offices keep track or their collections and productions as a way of knowing if all the bills can be paid at the end of the month and how much they have left over to spend. These are important statistics but it is the work not usually measured that makes production happen and the dollars collected. Patients have to be scheduled and without someone making the calls to patients and skillfully scheduling their recalls and needed treatments, they wouldn’t be in the dental chair to get the dentistry delivered and paid for. This is why measuring the behind the scenes activities such as outgoing calls is so important. Keeping statistics is nothing new, only to dentists. Measuring performances has been used throughout industry and businesses worldwide for decades.

The dentist working at the chair cannot supervise employees, see what they are doing, monitor their progress or coach and teach them. This is why we need a system to measure their progress and effectiveness for the things they do that eventually ends in the patient scheduled and getting their needed treatment and paid for. The same is true for all the other staff members in other positions.

Keeping statistics is nothing more than keeping score and is looked upon as a game. This actually keeps things interesting and fun. Like any other game of monopoly, checkers or athletic activity, it would not be interesting or fun if no one kept score. When you get your head out of a patient’s mouth, and review the posted statistics, you or your office manager can monitor progress of each staff member and function very quickly and make management decisions based on what you see, and avoid the rollercoaster ride of production and collections.

Put Emphasis on the People Part of Your Practice

Knowing how to deal with the teeth and surrounding structures is challenging but usually not as much as the people they are attached to. Recently I asked a pretty new veterinarian how she was enjoying her practice. She said “Not too well. The animals are fine. The problem is they are brought in by people.” We, like anybody else in the people business had better get a grip on dealing with all kinds of people effectively because a large degree our success or failure depends on it. I have read that Ann Landers said that patients change dentists every 5 years due to poor communication with the doctor and or his staff. I do not know if that is true or not, but I do know that patients leave us because we fail to handle or adequately address their concerns, disappointments and upsets. Furthermore their concerns etc. are very often not communicated to us, which presents a greater challenge since we would like to retain them as a long term patient. This is a huge area to address and I could not begin to cover the subject here. Suffice it to say that nothing is more valuable than good interpersonal relations and dealing with a huge variety of personality types and emotions. Establishing a habit of reading good materials on this subject for only 10 minutes a day can greatly increase you ability to deal with a variety of patients and staff effectively and bring more enjoyment to your practice. Your success depends on it.

Don't Let Your Building Limit Your Practice

Gain the Space You Needed

Whether we purchase, build, rent or lease an office space, do not let that building limit your practice. If you are in a practice and still would like to grow, but are worried about the time, trouble and exposure of moving or knocking out the walls, don’t give it a second thought. Just do it. I can tell you that bricks, pipe, and dry wall should never limit what your heart desires. Initiate plans for office space to create your future practice the way you want it to be. If you have physical plant needs, don’t be afraid to address them.

Be Devoted to the Art and Science of Dentistry

There is no substitute for technical competence. If there are things in dentistry that you are not interested in doing that is OK. There are others out there that do like those things. For those things that you most enjoy or are interested in doing, pursue excellence in those areas and do them to our hearts desire. No one can be happy doing things they don’t want to do but on the contrary it can be exhilarating when we are challenged and pushed to our limits even on difficult things that we enjoy doing. And the better or more technically competent we become the better it is.

Make an Assessment of Your Practice

Take a look at your practice and be honest with yourself based on what I recommend here. You don’t have to share or discuss this with anybody. Just be honest with yourself. And if you have these things covered, then that is great. If it seems like an elephant you’re trying to eat, and then start with one bite at a time.

If I helped you spot or identify something or some area of your practice that may be holding your practice back, I will have accomplished what I have set out to do here. After all, it may not be some earth shattering data. Confucius said, “Man does not stumble over mountains, but over molehills.” So, step a little higher.

Wishing you the best,
Robert D. Westerman, D.D.S., F.I.C.D.