High Capacity (Quality) Dentistry P4


So, doing an endo hand off, if you have loops on like most of us wear for endo, is it beneficial for you to be putting the endo piece down changing your field of vision, or would it be better to lock those loops in around where they need to be on the mouth mirror and you just trying to put the wireless piece in your hand exactly at the right position each time and all you have to do is she hands it to you, you put it on the tooth. She hands you another one, put it in the tooth, another one.  We have two cordless handpieces when we do endo.  That’s just the way we do that.

So, wasted motion is a big deal when you’re talking about chair side time. Doctors think they’re slow. It’s not slowness. You can look at it two ways: It could be a lack of confidence on their stroke, maybe, with the bur, or they’re just very conscientious and they don’t want to mess up.  Whatever it is, if you’ve been in the industry any length of time, chances are you’re very good.  You’re a very good clinician.  Just learn to be good with your dentistry and don’t spend a bunch of time checking, checking, re-checking.

The number three deadly sin of wasted time is waiting time.  Now, there are four ways you can have waiting time in the practice.  You can have patients waiting.  That’s bad when the patients are just in the waiting room and they’re staring at the receptionist or whoever’s at the front window and they’re just all upset.  That’s a combat position in the practice.  When you’re running behind in the back, those people are catching the glares and the angry stares and everything else.

There’s staff waiting.   Sometimes, the staff have to wait on the doctor, believe it or not. Hopefully it doesn’t happen much in my practice, but how many people know about the hygienist that waits at the door waiting on a hygiene chair?  That’s staff waiting.  That’s not good.  By the way, if we have a chance, we’ll talk about the route board.  It is my opinion and my belief that the route board, when properly done, eliminates completely on the hygienists waiting on the doctor to see their patient 100% of the time.  It works in my practice.  I guarantee it will do in your practice if you implement a system something like that, and I’ll tell you the trick to it as we get a little closer.  There’s a trick to it, and for some reason it’s hard to grasp.  Once it’s grasped, it solves the problems.

Doctor waiting.  That’s what we talked about with the templates.  The doctor doesn’t need to be waiting.  If the room is set up completely, the doctor doesn’t have to wait.  The doctor shouldn’t have to wait. If you’re in a culture in your practice where you’re constantly waiting on someone to go get something once or twice a procedure, that’s ridiculous.  You don’t need to be doing that.  The staff shouldn’t be waiting on you.  You shouldn’t be waiting on them. Everyone should do their job in a proper flowing system.

Of course, the old room waiting like we talked about in the perishable inventory.  It’s what we absolutely try to avoid.  Obviously, if you’ve got six or seven chairs, unless there’s the doctor plus all the hygienists plus all the assistants they could do something legal, there’s going to be occasionally a chair waiting with nothing to do, but you need to minimize it as much as possible.

Number four, the waste of procedure processing time.  Now, we talked earlier about giving your scheduler the correct tools to be able to schedule properly.  One of the first steps to doing that, by the way, is learning how long it takes you to do something.  So, here’s one of the forms that we use, on the side, in one of my coaching programs.  We try to get people when they’re in our programs to just spend a couple of weeks to get to know how long it takes them to do something.  Some people are gung ho about finding this out.  Some people are not that interested.

The truth is this is what we did, and I didn’t invent this.  I got this from Scott Perkins 12 years ago or whatever it was.  This is an idea that he had.  This is my form, but his idea was the timed procedures.  I just took it to the next level.  If you look at a procedure, I think there are really about five components of time that need to be measure.  So, one of them is what we call reset time.  That’s how long it takes you to take a completely dirty room and get the room back to completely pristine, clean condition ready to be sitting in a new patient.

Then, there are other times.  Anesthesia time is important.  We find that doctors take different amounts of time numbing folks up.  Some people take 30 seconds to give the same number of injections that take me 3 minutes.  Thinking about that, it doesn’t hurt the patient as much.  However, in my experience, I’ve seen those patients that get the 30 second injections wince a lot more than the ones that are given the 3 minute injections.  If you give them 5 to 10 minutes that’s too long right?

Doctor procedure time.  We need to know how long it takes that doctor to do stuff.  The doctor may not believe it.  They may think the team are the ones that are slow.  It’s really the doctor a lot of time.  The doctor procedure time.  That’s how long it takes them to do their time, and, of course, total time.

If you want to use a tool, if you have Windows, you can go to a thing called online-watch.com, and you can pick the jumbo stopwatch in five different windows, minimize it to where they all fit on your screen at once, and then, go through and start them at those different times for five times.  Do that for each procedure two or three times, and you will have a good idea of how long it takes you to do something.  It’s going to help every single part of your practice, and guess what?  Just measuring it is going to make things move a lot faster, and that’s just the way it is.

The fifth deadly dental waste sin, defects.  Defects.  I got a cheerleader saying, “First and 10, do it again,” but you can’t afford to do something fast and do it crappy.  If you’re going to do it fast, it needs to be quality, or you need to go slow enough that you can do quality where you don’t have defects.  We don’t have a lot of defects.  We don’t have a lot of redos in the practice.  Some people do redos and charge for them.  I don’t do that.

If I have a redo for a reasonable amount of time, I’m just going to do it for free, but I don’t like doing that.  So, the way I get around it is I just try not to have defects. If you have a bunch of defects, there’s an issue somewhere.  It may be your problem.  Maybe someone on your team’s doing something wrong.  Maybe the lab’s the problem.  Whatever it is, you need to cut down on defects, and that’s just like any manufacturing place in the world.  They have the same issue.  They’ve got to cut down on some defects.

Here’s a good one.  Number six, opportunity cost.  Opportunity cost.  How many missed new patients are there in the practice?  So, let’s think about the time.  You got a person up there.  They’re answering the phone. If you think about a factory, a factory is made up of people that work on the floor that put the cars together, there’s a management team, and then, there’s a sales team.

Now, the people in the front, they’re answering the phone.  What are they, really, in that?  Are they the ones making the cars?  No, that’s the assistants.  That’s the hygienists, the assistants, not the doctor.  They are the ones making the cars.  The people selling the cars up front, that’s your front people. They’re the ones answering the phone, and what are they selling?  They’re selling chair time.  They’re selling time.  That’s why it’s so tough for a good chair assistant to make that transition to the front desk and vice-versa.  That’s why we learn.

I used to believe in cross-training, and I do. To a certain degree, I want to cross-train a little bit, but the truth is different personalities are for different positions in the office.  There’s no reason why you should have somebody up front that cannot answer the phone well enough to get somebody in the office. You’re missing opportunity.  You’re missing those new patients.  You’re missing those emergencies.  That’s where you get all your work.  Don’t do it. Get the right people there.  Unaccepted treatment plans.  We’ve talked about diagnosis being important.  That’s also opportunity cost if you don’t get those in.  That’s a big waste.

Number seven.  This is my wheel house.  Inefficient systems.  Inefficient systems are here’s an example.  We used to have 13 different checklists in my practice.  Is that very efficient? These are things that can’t fit on a template, right?  They’re like lock the chairs, fix the glove, mass stocked.  So, what I did was I sat down one day, and I took all 13 checklists.  I squeezed them on one sheet of paper using the same concepts as you have an algorithm in ACLS.

See I got IV certification a few years ago, and we’re learning IV and all the algorithms that go with ACLS.  I’m like, I can make all my checklists into that. I sat down and did this at night in Birmingham, Alabama, learning IV.  That’s what we did to make our systems more relevant in that regard.

So, this brings us to seven ways that I think you can make sure your practice is still relevant three years from now.  I’m not saying everyone’s practice is going to go away in three years, but it’s just that most of the ADA research is showing a slow decline. I do believe in our practice it’s harder to produce the same amount of money just because we’re having to see more patients.  Fewer people are accepting crowns.  More people want extractions.  That’s just the way it is here and all around America, North America.  I’m hearing the same type of things.  So, here’s what I think are seven things that you can absolutely do to make sure your practice is still around and thriving in three years.

Number one, you need staff excellence.  Now, it’s easy to say that, but the truth of the matter is some people get lip service of this.  Other people really take it to heart.  They try to give people that are talented, more qualified.  They pay more if they need to keep happy, and then, they do a lot of the heavy lifting for them.  Guess what?  If you have a good staff and you have targets and they hit them, do stuff for them.  We do cruises for our staff every now and then, send them to New York once.  Try to do fun things periodically, but if you don’t have a good superstar staff, then, it’s hard to do that because you’re not going to be hitting those targets like you’d like to be.

Accept human nature.  Now, this is going to be a tricky one for a lot of you.  A lot of you are not going to like this so let me just go ahead and throw this one at you.  I got this idea from the airlines.  Now, why do I hate the airlines?  By the way, I hate the airlines.  Why do I hate the airlines?  I think it is so unjust that you could have a ticket to go a certain place on a certain airline flight and get bumped or get your seat taken away from you, have them to put pressure on you to take a later flight.  I mean, it’s awful, but in our practice, our biggest problem, I’ll be honest with you, is not cancellation.  It’s no shows on the hygiene side.

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