ar-long "Quality Management" series.

June 1, 1998
3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

A team`s pride is sparked by `input`

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

Quality workmanship is based on the belief that all employees can generate good ideas.

Dr. Bruce Waterman

Harley Davidson was losing money and market share to the superior quality and better priced Japanese motorcycle industry. There was no real secret about the cause: New Harleys had cardboard underneath them on the showroom floor to catch the leaking oil. Harley Davidson was living on its reputation and not even past glamour could sustain it. The company had tried robotics and other fancy modernization techniques to no avail. Then, within two years, Harley Davidson re-emerged as the dominant motorcycle manufacturer in the world. Harley now was making a high quality product at a substantial profit; it was teaching other major manufacturers how to achieve the same. The secret, in the words of its leader: "We finally listened to our people."

This and other compelling success stories of teamwork reinforce Dr. W. Edwards Deming`s quality-management teachings. Dr. Deming was largely responsible for the quality revolution of Japanese manufacturing companies and many American companies. His 14 Points are integral to his quality-management philosophy. In particular, Point 12, is exactly what Harley Davidson did. All 14 points were published in the March 1998 issue of Dental Economics. To refresh the reader`s memory, Point 12 states: "Remove barriers to pride of workmanship. People are eager to do a good job and distressed when they can`t. Too often, misguided supervisors, faulty equipment, and defective materials stand in the way. These barriers must be removed."

One major barrier was the misconception that only management knew how to build Harley motorcycles. In reality, it was the workers who had the profound knowledge of the problems and the necessary solutions. It was true teamwork that resulted in renewed success.

In dentistry, how do we listen to our people better to create this new type of teamwork? We do not need to reinvent the wheel. The best way is to copy the Deming-inspired success models that have created teamwork by removing barriers to quality performance and enhancing communication. To achieve this, we must transform our organizations relative to structure, style and process management.

Structure of management

In the April 1998 issue of Dental Economics, the Deming series discussed the traditional vertical-management structure, which is called the Pyramid of Power. In this structure, it is difficult to have good communication. Feedback and information have trouble flowing uphill to the decision-makers in management. Successful corporations, such as Harley Davidson, are restructuring to a more horizontal model: one that I call the Wheel of Fortune. By design, communication flows easily from the customer (patient), to staff, to the doctor, and even to suppliers (referral offices, labs, dental suppliers, and support services).

I am aware of one global corporate example in which an idea from an engineer in a European division was e-mailed to the CEO in the United States. This is a routine part of communication within the company`s horizontal structure. The result was a major innovation in product design that meant millions in income. This type of teamwork through structure easily can be applied to the dental office. After all, there are no geographical barriers to overcome.

The enhanced communication in the horizontal model more effectively uses the brainpower within your organization. Harley Davidson certainly found this to be successful. I call this phenomenon the "minds of many" (doctor, staff, patient feedback, suppliers) vs. "the wisdom of one" (doctor only). Dr. Deming taught that those closest to the job know it the best. Harley Davidson found this to be true when management started asking employees to identify problems and develop solutions. The same is true when dentists truly embrace participative management within their practices.

Style of participative management

Within the horizontal structure of the Wheel of Fortune, empowering employees with authority and responsibility allows them to assume some of your management duties. This frees up the dentist, allowing more time for production and leadership activities.

In traditional management, employees only have about 5 percent of the decision-making and problem-solving input. In contrast, participative management encourages 50 percent input and active involvement in management activities. Management is defined as directing the day-to-day functional operations of dentistry. Since staff is intricately involved in these daily activities, they are more than capable of helping in the management of your practice.

A barrier to pride of workmanship (Point 12) is the American belief that it is top management`s exclusive responsibility to generate ideas. In Japan, where a participative management style is the norm, one study showed that its leading companies solicit ideas from their employees 100 to 200 times more that the average American business. There certainly is room for improvement relative to input from employees in American management. You must have free-flowing communication of employee ideas to have participative management.

Just as Harley Davidson successfully implemented these concepts, dentistry can capitalize on the employee ideas and management abilities within their organizations. It`s very simple; just ask!

The 85/15 rule

Dr. Deming found that, when problems occurred in an operating system (your dental office operations), 85 percent of the time the problems were caused by faulty processes and 15 percent of the time they were caused by people. Unfortunately, in most companies - and dental practices - people are blamed for problems most of the time. How frustrating it is to be blamed for something that you have no control over! If you operate within an inefficient and faulty system, your best efforts will never be enough to overcome the system.

To improve our systems and create teamwork, we must remove the barrier of blame. The organizational emphasis must be on process improvement instead of blame. When Harley Davidson began to listen to its people instead of blaming them, true teamwork flourished. Everyone`s best efforts were now directed toward system improvement. Contrast this to the company`s previous futile and discredited attempts to overcome a faulty system. As Harley Davidson found out, teamwork is your vehicle for improvement; it will take you where you want to go.

In a future article, we will explore methods of process analysis that will help you solve these process problems within your operating system.

Teamwork is a very broad subject that cannot be totally covered in one article. If we can gain insight and inspiration from the successful teamwork implementation at Harley Davidson, it should be self-evident that the potential is tremendous for application to our dental practices. We do not always have to seek an outside source of wisdom or some mystical higher authority. Instead, our teamwork tune-up can evolve from within by listening to our people.

Next month, we will further explore teamwork through an interview with Joan Forrest Eleazer. Joan is executive director of Dr. Peter Dawson`s Center for Advanced Dental Study in St. Petersburg, Fla. She has expertise in team-building and teaches the subject at the Center and around the country.

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