The 4 pillars of consistent quality

Dental practice owners must be willing to look closely at themselves to maintain quality in their practices. Quality means they will maintain trust with their patients and teams. Dentists cannot let fear or laziness get in the way of maintaining a quality practice.

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Scott Cairns, DDS

What happens when quality is not a constant in our practices? The simple answer is a loss of trust. We lose the trust of our team members, our patients, and our communities. This distrust is significant because it will equate to a loss of business. Why, then, are quality outcomes not always top of mind in dental practices or some businesses? The main causes include fear, laziness, ignorance, ambivalence, or lack of skill.

The solution to keeping quality a constant in a dental practice rests on four pillars: (1) self-assessment, (2) commitment to improvement, (3) validation of quality through accountability, and (4) establishing time as a variable rather than a constant.


Self-assessment is the act of reflecting on your work. You can ask yourself questions such as, “What have I noticed?” “What trends do I observe?” “Where are the cracks in the foundation of my dentistry?” Self-assessment sounds easy, but it can be difficult. This is because none of us know what we don’t know. Self-assessment doesn’t mean you must have all the answers. Self-assessment means that you take it upon yourself to learn the problems. Learning often takes the form of formal and informal interviews with your three key constituencies—your team, your patients, and your community.

Holding up the mirror to your dental practice takes courage. Fear can often be the primary deterrent to quality. You must wrestle your fear to the ground and conquer it. If you’re afraid of the truth of your work and business, you will not succeed. Approach the learning process with a genuine desire to become the best version of yourself or the best version of your practice. By establishing the why, you will develop the energy needed to create and sustain a genuine commitment to improving.

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Commitment to improvement

Commitment takes effort, passion, and purpose—a combination that could be called grit. It takes grit to develop the daily discipline required to push yourself and your team to expect excellence and reject the mediocre, or worse, the insufficient. In a dental office, establishing a culture that rejects poor outcomes and celebrates excellence is essential. If you can successfully create this culture, inertia will keep the energy flowing toward quality.

When the dental assistant knows to retake an impression with a void in the vestibule, or to retake the overlapped radiograph, you’ll know you’re on the right path. When the hygienist knows to bring a patient back to finish periodontal therapy because he or she ran out of time on the last visit, you know you’ve created that culture. When you, the dentist, tell the assistant that you will be taking a new impression or new scan after you smooth out a step in the margin, you know you’ve created that culture.

Problems happen every day, which means every day you should expect to witness the grit required to make quality the constant and time the variable. Commitment and self-assessment alone are not enough. Next, you need to complete the picture with validation through independent assessment.

Validation through independent assessment

We all need accountability in life. Accountability is the fuel to follow through with what we said we would do. Accountability doesn’t come from the person holding us accountable. Accountability is a reminder of our personal pledge that we’ll do something. To do something well we must articulate to a person or group that we want to be held accountable, that we entrust them to hold us accountable, and that we grant them permission to hold us accountable.

Choose your assessment partner well. Find someone who has obtained something that you want to achieve. This person or group will look at your results with fresh eyes, and hopefully without any emotional attachment to your outcomes. You want data, not someone who will unjustly boost your self-esteem. But this doesn’t give them permission to be mean; it gives them the obligation to be honest and to care about you enough to tell you what they see without fear of retaliation or of hurting your feelings.

time is a variable

The formula for quality must idenify time as a variable as opposed to a constant. The process engineer knows exactly how long it will take to tighten a bolt, fill a mold with plastic, sinter a metal, or frost a cupcake. In dentistry, we get into trouble when we try to make time a constant. Unfortunately, our work does not lend itself to absolutes, this is true for procedures as simple as dental cleanings to those as complex as periodontal surgery.

Business professionals will often attempt to standardize procedures and the allocation of time to complete procedures. This standardization is smart and can be beneficial, but it can also be problematic and frustrating. Standardization accompanied by understanding and flexibility will help alleviate any frustrations. The smart business approach is to have standardized amounts of time to perform procedures. These “smart schedules” exist in countless variations.

The best decision is to make the quality of the outcome your unwavering commitment. To conjoin a “smart schedule” with an unwavering commitment to quality requires you to be flexible enough to bring patients back to complete procedures that deviate from typical time allotments. Stretching appointments into the time allotted for other patients will transfer the lack of commitment to quality from one patient to the next, and this does not solve the problem. The commitment to making quality the constant and time the variable can be uncomfortable for the patient, the provider, and you, the business professional. But the inconvenience and stress from maintaining the highest quality are always less than the cost of poor outcomes, and will ultimately result in greater satisfaction and respect from your team, your patients, and your community.

Focusing on the principles of these four pillars will help you achieve consistent quality in your practice. It will also serve as a solid foundation for building trusting relationships with your patients, your team, and your community. This will help you grow your practice and maximize outcomes for healthier, happier patients.

Cairns ScottScott Cairns, DDS, graduated from Creighton University School of Dentistry in 1999. He is a multiple-office owner-dentist supported by Pacific Dental Services, a faculty member of the PDS University– Institute of Dentistry, a member of the LD Pankey Alumni Association, and a former Spear Faculty Club member.

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