The maestro

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.

In pursuing quality, the dentist blends together the various talents of staff, guiding the team in a well-orchestrated effort.

Joan Forrest Eleazer

Robert Reich, U.S. secretary of labor and former professor at the John F. Kennedy School of Government at Harvard University wrote: "W. Edwards Deming is to management what Benjamin Franklin was to the Republican conscience - a guide, a prophet, an instigator."

There is no doubt that Dr. Deming has had a lasting and profound impact on worldwide management philosophy. The principles he taught have been applied across industry lines from automobile manufacturing to hospitals. The successful application of his principles was responsible for Japan`s domination of the world economy and now a similar transformation is occurring in many American businesses (i.e., Saturn).

The heart of Dr. Deming`s philosophy is embodied in his Fourteen Points. Together, they form a comprehensive philosophy of management, and understanding them is the foundation to this revolutionary and effective managerial approach.

In a conversation with the author, Dr. Bruce Waterman discusses the impact these principles have had on his dental practice.

Dr. Waterman is a general dentist in Brandon, Fla. In 1993, he attended a lecture titled, "Deming in Dentistry." Intrigued by Dr. Deming`s principles of management, Dr. Waterman became a student of the quality management movement, studying the concepts of Deming, Juran and Conway. He also became a member of the American Society of Quality.

Dr. Waterman has actively implemented these quality concepts in his practice for four years. He now conducts seminars on quality management in dentistry titled, "DQM - Dental Quality Management."

Why did the Deming philosophy appeal to you?

Dr. Waterman: Traditional practice management programs seemed to focus solely on increasing production and new patients. I liked Deming`s emphasis in point 1 on the need to attend to today and tomorrow. He said that traditional American management is too focused on today and short-term profits to the exclusion of tomorrow.

I was always uncomfortable focusing on production. The emphasis on quality and continuous improvement seemed like the right thing to do. My staff and I now measure our effectiveness based on the number of improvements we make. Increases in production and profitability have been a byproduct.

Which of the 14 points has had the greatest impact on your approach to management?

Dr. Waterman: It`s very difficult to isolate one point because they all work together to form a total philosophy of management. It`s important to adopt the whole philosophy and not try to pick and choose. All the points must be embraced because they are interrelated. For instance, trying to get your team committed to point 5 - Continuous Improvement - without being true to point 8 - Drive out Fear - won`t work. Each staff member has to be comfortable and secure enough to voice any conditions that interfere with quality. This includes telling me when my behavior is ineffective. We are now at the point where we all give and receive feedback about specific ways we can improve our quality to our patients without fear of hurting feelings or retribution.

How does point 7 - "Institute Leadership" - fit in a dental practice? After all, the dentist is the leader.

Dr. Waterman: Yes, the dentist is the leader. However, very few dentists have had any training or experience in leadership. I believe that the type of leadership Dr. Deming advocated can be represented by a maestro.

The symphony orchestra makes beautiful music when each member plays his instrument well. The maestro brings out the best in each musician and blends the individual talents together. Each musician follows the maestro`s direction and tempo to create the final product. In effect, the maestro blends the talents of his orchestra.

This is how I now understand leadership. I no longer try to control staff members. Rather, I expect each player to do her specific job with excellence and in concert with her teammates. I provide the direction to blend everyone`s efforts for the achievement of our results. Just as the maestro isn`t expected to master each instrument, I do not get involved in the day-to-day execution of tasks.

My leadership role is to provide direction and remove any barriers to performance.

In point 9, Dr. Deming instructs management to break down barriers between staff areas. Is this relevant to a dental practice with just five or six staff members?

Dr. Waterman: The number of employees really doesn`t matter with regard to this principle. Even in a small dental practice, there are inevitable issues between the "back" and the "front" office. These issues form barriers to effectively serving our patients. As a team, we had to learn to focus on meeting the needs of our patients rather than meeting the needs of our segment of the practice.

Accomplishing this requires open feedback among all team members. When we work together to continuously improve our service to our patients, the barriers seem to automatically fail. However, maintaining this barrier-free atmosphere is a daily and dynamic proces.

What steps would you recommend for anyone interested in furthering this interest in Dr. Deming`s management methods?

Dr. Waterman: I would recommend anyone interested start by reading The Deming Management Method by Mary Walton. This is the first book I read about quality management. I was struck by the relevancy of the concepts. Of course, there is no mention of dentistry, and most of the examples deal with large corporations, but the extrapolation is evident.

This has been an overview of Dr. Deming`s Fourteen Points. In the coming months, we will continue the Deming In Dentistry series by taking an in depth look at each of the 14 points and how to use them to manage a dental practice. Make no mistake, this is not just a philosophical exercise - the Fourteen Points are very practical and very applicable to dentistry.

Deming`s Fourteen Points

1) Create constancy of purpose for improvement of product and service. Dr. Deming suggests a radical new definition of a company`s role. Rather than making money, it is to stay in business and provide jobs through innovation, research, constant improvement and maintenance.

2) Adopt the new philosophy. Americans are too tolerant of poor workmanship and sullen service. We need a new religion in which mistakes and negativism are unacceptable.

3) Cease dependence on mass inspection. American firms typically inspect a product as it comes off the line or at major stages. Defective products are either thrown out or reworked; both are unnecessarily expensive. In effect, a company is paying workers to make defects and then to correct them. Quality comes not from inspection but from improvement of the process. With instruction, workers can be enlisted in this improvement.

4) End the practice of awarding business on price tag alone. Purchasing departments customarily operate on orders to seek the lowest-priced vendor. Frequently, this leads to supplies of low quality. Instead, they should seek the best quality and work to achieve it with a single supplier for any one item in a long-term relationship.

5) Improve constantly and forever the system of production and service. Improvement is not a one-time effort. Management is obligated to continually look for ways to reduce waste and improve quality.

6) Institute training. Too often, workers have learned their job from another worker who was never trained properly. They are forced to follow unintelligible instructions. They can`t do their jobs because no one tells them how.

7) 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.

8) Drive out fear. Many employees are afraid to ask questions or to take a position, even when they do not understand what the job is or what is right or wrong. People will continue to do things the wrong way, or to not do them at all. The economic loss from fear is appalling. It is necessary for better quality and productivity that people feel secure.

9) Break down barriers between staff areas. Often staff areas - departments, units, whatever - are competing with each other or have goals that conflict. They do not work as a team so they can solve or foresee problems. Worse, one department`s goals may cause trouble for another.

10) Eliminate slogans, exhortations, and targets for the workforce. These never helped anybody do a good job. Let people put up their own slogans.

11) Eliminate numerical quotas. Quotas take account only of numbers, not quality or methods. They are usually a guarantee of inefficiency and high cost. A person, to hold a job, meets a quota at any cost, without regard to damage to the company.

12) 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.

13) Institute a vigorous program of education and retraining. Both management and the workforce will have to be educated in the new methods, including teamwork and statistical techniques.

14) Take action to accomplish the transformation. It will take a special top management team with a plan of action to carry out the quality mission. Workers can`t do it on their own, nor can managers. A critical mass of people in the company must understand the Fourteen Points, the Seven Deadly Diseases and the Obstacles.

- From the Deming Management Method by Mary Walton

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