Clearing the right jungle

April 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.

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

Deming`s concept of leadership encourages delegation of managerial responsibilities

Dr. Bruce Waterman

Dr. W. Edwards Deming, the guru of the economic revolution of Japan and the quality transformation of American business, once said: "Export anything to a friendly country except American management."

His obvious condemnation of American management was based on his profound and personal knowledge of Japan`s successes and the stark contrast of American failures. In 1986, he published Out of Crisis, a guide to the "transformation of the style of American Management." This became the bible for Deming disciples and the success model for major American businesses.

The question for America was and is: Can we modernize our style of management to reflect this successful model? The answer has been a resounding and successful "yes" for many companies all over America. The Deming model seems to have been implemented everywhere but in dentistry. The successful applications all around us should serve as an impetus for dentistry to move into quality management. My term for this application is: dental quality management (DQM).

The core of the Deming Philosophy is the 14 Points (if you still have your March 1998 Dental Economics, the 14 Points appeared on Page 32). In our continuing series, we will explore practical applications of these points to dentistry.

We begin with Point 7, which reads: "Institute leadership. The job of a supervisor is not to tell people what to do or to punish them, but to lead. Leading consists of helping people do a better job and of learning by objective methods who is in need of individual help."

Stephen Covey, author of The 7 Habits of Highly Effective People, differentiates leadership from management functions. Leadership involves defining and implementing your practice vision and values - what Covey calls "doing the right things." In contrast, management deals with directing the day-to-day functional operations of dentistry, what Covey calls "doing things right."

To illustrate this concept, he describes the task of clearing a jungle. Good management is making sure the machetes are sharp and the workers are working hard. Good leadership is making sure you are in the right jungle. Good management without good leadership is akin to straightening the chairs on the deck of the Titanic.

One CEO of a major corporation reported that once he realized leadership was different from management, his vision of his job became more clear. He delegated most of the day-to-day management activities and concentrated on providing leadership. He could see the forest, the trees and the right jungle - consequently, his company improved miraculously.

Dentistry provides a unique challenge because the dentist has to be involved in leadership and management. He also, though, has the added challenge of being the primary producer.

Being the primary producer and manager takes up all the time, leaving little or no time for thoughtful leadership. The DQM philosophy provides solutions for developing the needed leadership in your practice.

* Teamwork - This term sounds like a clichè, but real teamwork can lighten the management load on the dentist.

At a recent staff meeting, I listed over 200 management duties I was doing (not including clinical functions). By identifying these duties, it became apparent that many of them could be accomplished or shared by staff. Staff must be empowered and trained before they can adequately take on these management tasks.

Sharing appropriate management functions, or "participative management," frees up time for the dentist to be a leader and producer. An added plus is that your new "managers" often perform the functions better than you did. Dr. Deming taught us that the people closest to the job know it the best.

For example, giving your receptionist the broad authority to make financial-adjustment decisions up to a specified dollar amount frees up the dentist from this management decision. In fact, the receptionist likely will have a better handle on when and where this is most appropriate. The Ritz-Carlton does this for all their desk hosts.

* DQM vs. traditional management - Traditional management is the typical command-and-control style of management based on the military model of governance. It is a macho image of management. As a dentist, the command-and-control method of management spreads you too thin.

With DQM, you are able to release many management functions to staff. The doctor`s role can now be compared to a maestro - orchestrating the talents of the team rather than having an iron-fisted control over everything. DQM vs. traditional management is akin to "maestro vs. macho."

Additionally, with participative management, the combined brainpower of the group, including the dentist, is more effective than that of the dentist alone. I call this "the minds of many vs. the wisdom of one." The net effect of the maestro method is more effective, shared and enlightened management.

* The wheel of fortune - Traditional-management structure is a vertical pyramid. This served as the American corporate model until the 1980s. The doctor is at the top, and the patient is at the foundation. In between are the layers for suppliers, administrative and clinical functions and communication. These layers in the pyramid separate the doctor from the patients.

The quality-management structure is more horizontal or what I call the "wheel of fortune" (see chart). Notice in the wheel of fortune that the two-way arrows provide for interaction within the office and externally with suppliers. Communication flows easily in the wheel of fortune, but it is very difficult for communication to flow uphill in a pyramid structure. In the wheel of fortune, communication flows laterally within the central hub of dentist and staff, and peripherally to suppliers.

Enhanced communications makes your organization more effective as all members of the extended team engage in participative management.

The net result is more managing by others and more time for the dentist to execute leadership for continuous improvement (which is Deming`s Point 5). Notice that at the center of the wheel of fortune is the organization`s ultimate customer and focus - the patient.

To create a vision for this new leadership, dentists must look in the mirror and honestly assess their practice and effectiveness as leaders. By accepting accountability to reconcile the good, the bad and the ugly of the practice, a true constancy of purpose is created (which is Deming`s Point 1). To succeed as a leader, this constancy must be the driving force for the practice to improve continuously (again, Deming`s Point 5).

The true leader keeps the quality quest going, as this style of leadership is a journey that takes time. We must avoid the typical American mentality of the quick fix that Dr. Deming called "instant pudding." The new leader knows with certainty that the best way to predict the future is to create it.

Next month, I will explore how to apply quality management when enhancing relationships with suppliers.

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