The business of football and TQM

3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

Whether it`s football or dentistry, today`s successful coach is more of a problem-solver than a micromanager.

Dr. Bruce Waterman

Aformer player for the Green Bay Packers was asked how he was treated by his coach, Vince Lombardi. He said, "He treated us all the same." Sounds like a very fair man... "He treated us all like dogs." Still fair, but definitely a controlling leader.

Now, contrast this type of leadership to the style we often see with many modern football coaches. Head coaches like Mike Holgrem of the Green Bay Packers, Steve Mariucci of the San Francisco 49ers, or Mike Shanahan of the Denver Broncos mirror the new methods of management also seen in the corporate world.

Instead of the intimidating, command and control, military model of the old era, modern management involves statistics, continuous improvement, and participative management. One player who played football for both styles of coaches explained the difference as evident in a typical film session. With the old-era coach, every mistake was addressed with screaming and humiliation. In contrast, while a mistake still is acknowledged in the modern coach`s film session, there is no ranting and raving. Instead, the coach typically might ask, "What did you learn from this?" A striking difference in style. Who do you think the players would rather play for? And, in general, which style has been winning Super Bowls?

From these analogies, you can see that the modern methods of management have spread beyond the corporate world into the sports world, without anyone chanting TQM (Total Quality Management). Football and other organizations look to the corporate model for methods that work. So, it is not surprising that these effective methods have been adopted and successfully applied all around us. In dentistry, we need to do more of the same.

Decision-making methodologies

Traditional Management (TM) uses a decision-making style similar to the style of the old-era football coach. The methods of modern management are exemplified by the application of TQM by many successful companies in America and around the globe. DQM (Dental Quality Management) is the specific application of TQM to dentistry. Figure 1 contrasts TM and TQM/DQM methods of decision-making. Let`s evaluate some examples of the contrasts in these two styles:

1. "In God we trust; all others use data." When a problem occurs, you often are impulsively guessing with TM, hoping somehow to divine an answer. With TQM/DQM, data is collected to determine the true diagnosis of the problem. Sound absurd? Look at all the data and statistics inherent in football compared to 30 years ago. Most coaches would not even think of making a decision without a battery of data.

Dental Example: In my office, my dental hygienist noticed that it often took too much time for me to check her patient. Utilizing TM, my impulsive guess was that I probably was involved in a procedure when the light system was activated. Our TM solution was to devise different methods to interrupt me. The result: marginal at best.

Utilizing DQM, we collected data about all the circumstances involved when this timing problem occurred. Surprisingly, we found that 80 percent of the timing problem was directly related to the hygienist`s patient arriving late. Our TM diagnosis was at least 80 percent wrong! With the proper problem diagnosis, we were able to devise more-effective solutions. We set up guidelines on when to reappoint a patient and established various methods to abbreviate the appointment. The result: Dental hygiene timing problems decreased dramatically.

Challenge: The next time you are faced with a management problem, instead of making an impulsive decision about its origin, collect as much data as possible. It will help you determine the real problem and, consequently, devise a better solution. Data collection and problem diagnosis are already part of your current clinical armamentarium. You validate its effectiveness daily. The challenge is to transfer this success to your management style.

2. "If it ain`t broke, don`t fix it" is the justification of maintaining the status quo in TM. Basically, no decision needs to be made because TM does not acknowledge that the current system is inefficient or could be improved. Denial allows a nondecision. In DQM, something does not have to be broken to warrant continuous improvement. In the football world, the whole emphasis also is toward continuous improvement. The team must aggressively innovate to stay competitive. It happens routinely and on purpose.

Dental Example: We noticed that even though we had eliminated the timing problem related to our late hygiene patients, the communication method from hygienist to doctor still could use some improvement.

TM would not perceive that such a problem exists. Instead, TM would have tended to defend the existing light-communication system and demanded better utilization. With the continuous improvement mindset of DQM, we decided we could add a new system to augment the light communicator. The hygienist would put a "Post-It" note beside the doctor in the treatment room as a reminder to check the patient. Not only did this improve this particular communication, but by utilizing additional continuous improvement, we found we could add more information on the Post-It note. Radiograph status, areas of concern, etc., were added, and now I know any new concerns before seeing the patient. In terms of efficiency, I am able to budget my time better and focus more effectively on the needs of the patient.

Challenge: Adopt a new attitude toward continuous improvement instead of defending all managerial methods that are in use now. You utilize this methodology currently in the clinical aspect of your practice. It applies in the same way to practice management.

3. "It`s hard to worry about picking out new curtains when the mansion is on fire." In a dental office, it is hard to plan ahead when urgent problems require that you constantly be putting out fires. With TM, it takes a crisis to initiate some type of action. Unfortunately, this action usually is blaming people. With DQM, preparation, organization, and contingency planning are dominant methodologies. Urgent matters still will come up, but they will be fewer and usually will be anticipated as variabilities. In football, tremendous emphasis is placed on preparation and organization. When variability occurs, there are contingency plans to adapt to the situation (i.e., calling an audible at the line of scrimmage).

Dental Example: Emergency patients are so variable in their needs that our TM response was routine crisis management, scheduling dilemmas, and disbursement of blame to staff. Once the emphasis turned toward DQM methodology, our system improved dramatically. We revised our methods of collecting and internally communicating data about emergency patients. We could, therefore, prepare and organize better when emergency-patient needs could be anticipated and effectively communicated. For emergency-patient variabilities that we could not anticipate or eliminate, we developed guidelines for contingency plans. We were able to see emergency patients efficiently without ruining our schedule.

Challenge: Instead of micromanaging emergency patients, proactively improve your system by better preparation, organization, and contingency planning for variabilities. Again, this mindset mirrors what you already do for clinical procedures. Apply it to your management methodology.

4. "Minds of Many vs. The Wisdom of One." In TM, the doctor usually is the one who makes all management decisions. The relationship to staff is: "When I want your opinion, I will give it to you." In contrast, with TQM/DQM, the staff is encouraged to be active in participative management.

If everyone is using his or her combined intellect in recognizing and solving problems, the organization functions dramatically better. In football, coaching has evolved from the head coach blaming his assistants and players for all that went wrong to a combined intellectual pursuit. There is shared responsibility, accountability, and respect.

Dental Example: See previous items 1, 2, and, 3. They were all the result of team efforts.

Challenge: Involve your staff in the mutual pursuit of problem-solving. You will be surprised not only at the depth of their ideas, but the solutions that are obvious to them and oblivious to you.

Dr. Deming, the guru of the TQM movement, emphasized the need for businesses to eliminate fear as a primary management tool. It is evident that the corporate and football worlds are evolving in this direction.

They are increasingly choosing to be democratic problem-solvers instead of autocratic micromanagers. Motivation through respect has replaced motivation by intimidation. The "my way or the highway" philosophy has given way to a new road to success. With methodical decision-making and a self-motivated team, it does not have to be a lonely journey.

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