Click here to enlarge imageIn our example, the dentist has assumed that the critical component was the staff. The results of various switches are shown in Table 2. The dentist believes that Fran and Gail are not as well-motivated or well-trained as Alice and has already taken steps to place the Friday staff members on notice and send them to continuing-education courses. (Both remedies are expensive and uncertain, considering the complete lack of evidence. This is Level 0 Learning.) Switching this component — having Alice do the Friday billings and Gail and Fran do the ones for Monday — produces a Monday score of nine errors and a Friday score of 13 in our example. This is a small improvement, but certainly not a reversal of outcomes. The dentist had better rethink the remediation strategy.
Successive components should be switched until a reversal is identified. For illustration, let's assume the dentist now believes the critical component is the nature of the work done on each day. It is a fact that crown-and-bridge insurance cases cause more problems with authorization than do other procedures. Switching crown-and-bridge billings (actual appointments do not have to be switched) from Monday to Friday produces 11 errors on Monday and nine on Friday. There is a reversal here, but a small one — a factor the dentist should consider when refining the process.
Eventually, office hours will be switched. Changing the short, crowded schedule with no lunch hour and an early closing time to Monday instead of Friday produces 16 errors on Monday and six on Friday, a complete reversal of the procedure's effectiveness. The critical component has been isolated. More importantly, applying the correction to the practice is straightforward. Perhaps the simplest solution is to have Alice do insurance billing Monday through Thursday, with no billing on Fridays — better results, no cost, and no recrimination.
After the office makes the switch identified in the component-switching process, everyone will come forward with explanations about how obvious the solution is. Don't be impressed, unless you need something to boost office morale. Successes are popular and failures are orphans. Credit and theorizing are rationalizations. What matters is that the office works more effectively when the components are properly aligned, and some switching (while watching outcomes) is a sound way to do that. Remember, though, not to stop when minor improvements are found; instead, look for switches that substantially change the order of things.
Professionals make useful and beautiful things. Component switching is not research in the usual sense; it actually makes something more useful and beautiful. It is also a healthy antidote to unconfirmed dogmatism — "Do it my way because I am smarter than you are."