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Be more productive with less stress

March 1, 2008
Identify and eliminate unproductive and stressful layers of complexity in your practice.
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Identify and eliminate unproductive and stressful layers of complexity in your practice.

by Sandy Roth

To begin, we must ask a basic question: What does a low-stress practice look like? In a word, “simple.” The more simple a practice, the lower the stress; the more complex, the greater the stress. Consider this: a single patient, a single procedure, a single appointment, a single fee, a single payment, a single dentist, and a single employee adds up to little, if any, stress. Each time you add another element or layer of complexity, you increase the stress. While some stress is essential to keep people and systems on their toes, needless and debilitating stress can undermine even the best clinician and team efforts. While one would, of course, never create a single-patient, single-procedure practice, there is a lesson buried in this concept of simplicity.

Most mature practices began as simple ones. It is through time and day-to-day experiences that the organization goes down a path of increasing complexity. After a period of time, any practice can resemble a ball of yarn after a kitten has had an hour of play with it — tangled, disorganized; a mess. It is interesting to consider how this happens: You have a strategy or plan that works most of the time. An exception or two occur. The strategy or plan gets modified to account for those exceptions. Sometime later a different exception occurs and a new modification gets put into place.

Over the years, the practice begins to resemble an old shipwreck with barnacles and coral heads attached to the hull. Let’s consider how to strip away these redundancies and complexities and get back to the simple, vital elements that form the strength of the practice. Here is a checklist of areas and ideas I encourage you and your team to review.


Spend a few hours experiencing your own environment with fresh eyes and ears. Have your visual and auditory clutter created a cacophony of jarring and discordant images and sounds? Common suspects include yackity drive-time radio DJs spewing silly banter laden with sexual innuendo; hands-free broadcast phone calls and loud ring tones; fish tank motors that grind away laboriously and cancel out the soothing effect of the aquarium; annoying vibrations from the cold sterilizer and whirring from the compressor and vacuum; conversations drifting from rooms whose doors should be closed; the instructional video that goes on and on and on; or the reception room TV tuned to Maury Povich. These factors add up to an auditory barrage that cannot help increasing the stress in any practice.

Add to that any visual clutter and you have a recipe for stress squared. Every counter laden with stuff — brochures, credit card applications, and signs; charity collection receptacles and sign-up sheets; whitening advertisements, toothpaste samples and mouthwash coupons; electric and sonic toothbrush models; signs and other ineffective forms of “communication”; raggedy stacks of old magazines of every shape and size in the reception area and operatories; tissue boxes with pharmaceutical advertisements; cardboard boxes of supplies stored in every open nook and cranny, on top of every shelf and cabinet, and in the hallways; tattered and overstuffed patient charts (more about that later) jammed into filing cabinets well within patient view; yellow sticky notes surrounding the computer screen and lining the counter overhangs; personal photographs stuck up on cabinets, walls and under the reception counter; open shelves doing duty as temporary storage for all things begging for a more permanent home or a quick death in the trash bin; in-boxes crammed to overflowing with paperwork; operatory counters prestocked with bits of dental detritus, glove and mask boxes, over-copied instruction sheets, and Costco dispenser boxes of wrap and foil; and spray bottles of various shapes and sizes.

These and other examples of environmental busyness can significantly add to stress because there is simply too much for the brain to process and sort through. Like an overfilled refrigerator, there is no way to spot the mustard among the containers, jars, and bottles.

What do you do about this? De-clutter absolutely everything you can. Stage your physical plant as if you were preparing for a buyer’s inspection. Then add only those things that must be seen at all times. Because there are very few things that fit this description, you must be judicious with your choices.


It’s 2008. Are you still using paper instead of electronic data storage systems? Most dentists are quick to upgrade their clinical arena but slow to apply the same modern technology in other areas of the practice. Likely you have a computer system that has the capability of recording every bit of data digitally rather than in old-fashioned charts. There is nothing more stressful and debilitating than information that cannot easily be found. Where is the chart? Where do we write these notes? The pink sheet? The green sheet? The blue sheet? Pulling a chart — or tracking it down — often can be such a burden that many things go unrecorded (more about that later.) Digital X-rays and photographs allow you to store high-quality images that are easy to retrieve and show patients. There really is no excuse for continuing to muddle through paper charts, illegible handwriting, unclear abbreviations, and missing information.

A truly paperless practice reduces stress on many levels. Information is available to everyone on the team simultaneously; in a chart it is not. Data can be accessed from any terminal through the practice. The dentist can be entering a treatment plan and the patient coordinator can be setting up the financial arrangements. The clinical assistant can be charting and the business assistant can be compiling the insurance claim. The receptionist can be looking up the next appointment while the facilitator can be reviewing the balance on the account. Writing notes by hand takes longer than using the keyboard, and many systems have pull and drop menus and shortcuts that make everything more clear and certainly more legible. Miscellaneous documents can be scanned and stored for the rare times when they are needed. Virtually every piece of paper can be reduced to a digital record.

A paperless practice increases productivity as well by helping to eliminate errors that can easily occur when paperflow is interrupted. Lab communication is more accurate and timely. Insurance claims are transferred electronically — speeding up payments or reimbursements. Staff time is freed so attention can be paid to patients and their issues. Treatment plans are complete and easily referenced so that options can be discussed and reviewed regularly. Information is productive power. When more information is collected, recorded, retrieved, and reviewed, the practice will always run more smoothly, relationships with patients will be stronger, confusion will be minimized, and misunderstandings will be avoided.

Eliminate every piece of paper you can. It will lower stress and increase productivity.


It takes discipline to document every single event and discussion, but you can “take it to the bank” that doing so will significantly reduce stress and increase productivity. Let’s assume you have the proper tools — a fully operational computer with enough workstations for every member of the team. Given this advantage, each team member must hold himself or herself accountable to this level of documentation — a telephone call, a financial arrangements discussion, a change in clinical plans, a delay in case return from the lab. It is almost impossible to document too much.

How many times have you spoken with a patient on the phone or in the operatory and realized that you don’t remember anything about your last conversation? He or she was on one wavelength while you were on another. This is not only embarrassing but costly and stressful. When you lack basic information, you appear incompetent and it affects the patient’s opinion of the entire practice.

What must be documented? Everything: What you told the patient, how the patient responded, the options you offered, the patient’s choice, what the patient rejected and why, and what limitations and implications were discussed.

Of course, all treatment notes must be documented and all agreements recorded, but discussions and conversations must also be recorded. Think how impressive it is for the patient to hear each team member enter the next phase fully briefed on all of the issues that had been discussed previously.

Internal e-mail

Internal e-mail is the new bulletin board or inbox of the practice. Most computers allow information to be conveyed quickly and accurately to every member of the team simultaneously, thus eliminating confusion and gaps. The economic advantages of this type of communication are significant.

Because many staff meetings are spent in prolonged discussion of basic housekeeping agendas — many of which could be easily handled by internal e-mail — the savings are obvious. This time might be readily turned to more productive discussions and planning or, at least, patient care.


I didn’t think I’d be a fan of this technology, but I am. Headsets cut stress by getting simple questions answered without running all over the office. Staff members can alert one another to changes and events and ask for help quickly and conveniently. And I’ve observed an unintended advantage in several practices — humor and congeniality shared among staff. Laughter definitely reduces stress. There should be more of it in every practice.


Nothing will reduce stress and increase productivity more than being properly prepared for each day. Whether you meet first thing in the morning (which may be too late to avert some looming problems) or the day before, a full staff meeting to plan for the day is a low-cost way to put everyone on the best footing. While reviewing the schedule is an important part of this meeting, it is not enough. Who will greet whom? What things should be discussed before the patient is taken to the operatory? What portions of the treatment plan or clinical recommendations need to be reviewed or introduced? What have we missed learning in previous interactions? Where will we have a bit of extra time and where will we be crunching the schedule?

There is a wide variety of potentially stressful situations that can be avoided with better preparation and more productive discussion about the plan for each patient interaction.


While you would certainly want every member of the team to keep the big picture in mind, a person must be designated as the one where “the buck stops” on each important variable and element in the practice. The least stressful practices use their internal experts extensively. Too many generalists depress productivity and reduce performance to the range of mediocrity.

People should be hired for their strengths and allowed to excel in those areas while resisting the pressure to shift to sameness among the staff. Each member of the team must know who the “go to” expert is and how to access that person’s expertise.


There is nothing that increases stress and decreases productivity more than infighting, internal discord, or festering interpersonal distress. Every ounce of energy that goes to giving each other the cold shoulder, sharp language, hurt feelings, or working at cross-purposes is energy that cannot be given to the patients. When there are issues to be cleared, the dentist and team must commit to learning the skills to keep working relationships mature and healthy.

While this is not easy, it is not really optional, either. Sometimes the group needs help, and bringing in an outside expert to perform a team exorcism may be what is needed. (For help with this challenging problem, call me at 800-848-8326.)

I’m certain that there is nothing new in this article. I am equally certain that very few teams have fully addressed each of these issues. Sometimes that is because they have morphed or drifted into their complexity and don’t even realize how many layers of extraneous effort have been incorporated into their daily operations. Simple is better.

And simple can be accomplished without sacrificing quality. By eliminating clutter, reducing paper, documenting fully, using internal e-mail and headsets, preparing fully and designating an internal expert for key issues, and clearing the junk, you, too, can reduce stress and increase productivity. It is only a matter of what you are willing to do.

For more than 20 years, Sandy Roth has been helping dentists and team members learn effective communication skills and develop healthy, functional relationships in their practices. In addition to her company, ProSynergy Dental Communications, she serves on the faculty of The Dawson Center in St. Petersburg, Fla., and is an editor for numerous professional journals. To learn more, call MaryBeth Head at (800) 848-8326 or Roth at (206) 953-7717. You may also e-mail [email protected] or visit

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