Keeping the plates spinning!

Oct. 1, 1999
This seems to be the way most of us practice - running from treatment room to treatment room, constantly respinning our plates and hoping they won`t fall!

This seems to be the way most of us practice - running from treatment room to treatment room, constantly respinning our plates and hoping they won`t fall!

Michael R. Gradeless, DDS

One perk of being middle-aged is being out of step with today`s hip-hop culture. I don`t watch much TV, so I have never seen "E.R." or "Friends." I also missed the last episode of "Seinfeld." I do remember watching "The Ed Sullivan Show" as a child. I especially remember a novelty act that I believe is a perfect metaphor for how most of us practice dentistry today. The act was very simple. It consisted of a man running around balancing many spinning plates on thin poles. If you have never seen this, it was very exciting (It didn`t take much to entertain us in the early days of television!).

The entertainer would come on stage and set up one spinning plate on top of a rod. After it was spinning nicely, he would set up more rods with plates. Whenever one plate began to wobble, he would go back and give it the attention it needed. Any time he had all the plates spinning well, he would erect more plates. Eventually, the entire stage was covered with a virtual forest of spinning plates that seemed impossible to keep going. The entertainer was running from wobbling plate to wobbling plate, giving each one a fresh spin. We knew that if one plate fell, it would knock over others that would start a chain reaction of disaster. The act ended with the entertainer slowly dismantling his creation, taking down and stacking one plate after another until all the plates were tucked safely away and he could take his final bow.

This seems to me to be the way most of us practice dentistry. We run from treatment room to treatment room, constantly respinning our plates, checking our systems of collections, personal finance, accounts payable, staff training, etc. Whenever we can, we add to the chaos and increase our staff, increase our production, or build a larger office. We eventually hope to gradually slow down and bow out of dentistry gracefully.

This is exactly the wrong way to go about it! The real goal is to set up our forest of spinning plates and develop a cadre that can keep the plates spinning, while we walk off the stage whenever we want to. This is done by building systems and training staff to operate our systems. We all are pretty good at spinning plates, but you must ask yourself these questions:

x Does your scheduling allow you enough time for each procedure?

x Are all of your patients seen on time?

x Do you meet your production goals?

x Do you break for lunch and go home on time?

x Are your accounts receivables less than one and one-half months of production?

x Are all of your accounts payable paid immediately?

x Is every position on your staff filled with a competent person performing to his or her potential?

x Are your personal finances structured to allow you to retire when you want and replace your current income for the rest of your life?

If you answered no to any of these questions, you need to build systems before adding more treatment rooms or attending another technique course.

Set your goals

The first step to building your systems is to tackle each system separately and begin at the end rather than the beginning. To do that, you must ask yourself what you want the system to accomplish. Do not worry at this time if it seems unlikely or impossible; simply come up with your ideal system.

For example, what would be your ideal system of scheduling for your practice? In your ideal system, you probably would always want to run on time, have time for lunch, have a preblocked appointment time available every day for implant procedures, and be able to produce twice as much dentistry as you do now on a daily basis. This kind of thinking may feel like daydreaming, but it isn`t. It is vitally important to the systems-building process.

You cannot build a system to accomplish your goals if you have only a vague idea of what your goals are. The difference between this and daydreaming is in the details. Do not become bogged down in how these things will happen or when these things will happen. Create a very complete vision of what you want to happen.

Examine the current reality

The second step is a little less fun and a lot more painful. The second step requires you to examine where you are now. Look at your current systems to find out exactly how it works and what the current reality is. It may be that your current system is that you have no system!

In scheduling, your appointment coordinator simply may be filling appointments wherever there is an opening and coming to you for an answer whenever things get so fouled up she doesn`t know what to do.

I am not trying to pick on appointment coordinators, but the most powerful system that affects your level of stress and your bottom line is appointment-book scheduling. This nonsystem also describes the way appointment-book control was handled in my office only a few short years ago. Whatever quality of system you currently have in place, it needs to be reviewed carefully. Most of us don`t really know how our systems have been altered by current or past employees. This is why you must review what is happening now.

To review a system, you should have a short meeting with whoever is most involved with the operation of the system in question. This is done in private, and it should not be done in a judgmental manner. Nonjudgmental means you mostly ask questions. These should be open-ended questions that start out with phrases such as:

- "Tell me about how the appointment-scheduling is going."

- "I want to know what you think about...," or

- "How do you feel about ..."

Two major pitfalls must be avoided in this process:

First, do not tell your staff what you want to hear. We often start out a meeting by saying something like: "You know, we have been having some problems with our appointment-scheduling. I thought we would work together to see if we can`t get our new patients in a little quicker."

If you indicate that you think there is room for improvement - or you put the focus on problems - you no longer will get the candid truth from your employees.

Secondly, do not become bogged down in analysis and problem-solving. This step is for gathering information, not problem-solving.

Develop a structure

The third step in system-building is creation. What you are creating is a structure that will take you from where you are now to where you want to be. The structure of your system is defined by the tools, the rules, and the verbal skills. The tools include such things as appointment-preblocking. If you wish to become an implant dentist, one of the things you must do is to reserve time in your daily schedule for implant procedures. Preblocking the schedule is an example of a tool.

The rules come into play when there still is a difference in where you are vs. where you want to be. When you decide to reserve an hour a day for implant procedures, your appointment coordinator needs a rule for when she may appoint an alternate procedure into that time slot. You may want your appointment coordinator to fill your implant time slot with any alternate procedure if there are two openings in the next two days. You may empower your appointment coordinator to offer the implant time slot for any restorative treatment with a greater value than $1,000.

Making the rules means you also understand the situations when the rules should be relaxed. Spend some time developing rules for what you and your staff will do in just about every imaginable situation.

Once you have the tools and the rules, now you develop the verbal skills. The verbal skills are necessary to influence your patients to accept the rules without ever using terms such as "office policy." Your patients don`t care that it is your office policy to not schedule crown preparations at 4 p.m. If you tell them your policy, they probably will feel a little disgruntled. But, couch this message in different terms and you have a different result - i.e., "John, your crown will fit better if the laboratory receives the impression on the same day that it is taken. That`s why I like to try to schedule all crown preparations before noon."

Phrased this way, the patient will be much more likely to accept a 10 a.m. appointment. Just because you use good verbal skills doesn`t mean a patient will automatically accept your program. But, if your staff members also use appropriate verbal skills, you should have a much higher batting average.

Write it down

Once you know where you want to go and where you are now - and you have developed the tools, rules, and verbal skills - you are ready for the next step. Write it down! If your system is not written down, it is only an idle daydream. If you have expended all the energy involved in following the previous steps, you don`t want to lose the results. If there is nothing written down, as soon as you get busy on another project, your work on the previous system will be gradually forgotten.

Once your system is written down, the documentation can be used for staff training. Your systems will remain in place even when you have staff turnover. More importantly, having written systems is what can free you from having to constantly run around and spin every plate by yourself. With written systems, your staff can know what you want done, when you want it done, and how you want things done.

Train your staff

Staff training is the next step. Handing staff members a new system and expecting them to immediately implement it is simply throwing them to the wolves. Your patients will eat them for lunch. You must take some time to train your staff, and, if you do, you will immediately move your practice ahead of most other practices. The majority of dental practices have no formalized training procedures. Schedule staff meetings to implement your new systems.

As the leader of the practice, your first step is to convince your staff that they want to do the things you want them to do. You must be prepared to explain your system in a way that will make your staff want to implement it.

They don`t care about reducing your stress or increasing your income. They do care about what`s in it for them and how your patients will benefit. Presenting the new system to your staff by describing the benefits before you describe the procedure will make your staff want to do what you want them to do.

Your second step is to practice the verbal skills by role-playing. Many staff members will initially object to adhering to a specific verbal skill on the grounds that it "sounds fake." They are right; it probably does sound fake. The problem is not with the verbal skill, but with the amount of practice the staff has had saying it. Once any verbal skill is repeated often enough, it will not only sound good, it also will be automatic.

Celebrate your results

The last step is to implement the system, inspect the results, and celebrate success. You have developed the ideal system, examined it from all directions, written it down, and trained the staff to implement it. Pick a date and go live with the new system. It is now time to inspect what you expect. As there will undoubtedly be problems, expect to re-examine the system. Any major problems must be addressed immediately.

Additionally, you should expect to review minor problems and fine-tune your system at your next staff meeting. Even when we follow this process, we can`t expect our systems to be perfect right out of the box. Schedule staff meeting time at two-three weeks out and one-two months out to improve your new system.

The last and most important step is to celebrate your results. If you have gone through this process, you all have done a great deal of work. Do something to recognize the effort. This can be as simple as giving out high fives or as exotic as taking everyone for a weekend at the beach. Any celebration must be tied directly to results, not simply to effort. Celebrations based on results will energize your staff members to repeat their success.

Celebration also involves recognition. One of the most powerful things you can do to energize your staff is to recognize their efforts. Recognition is most effective when you publicly acknowledge an individual`s specific contribution to your collective success. When you say, "I really appreciate the way you ...," you ensure that behavior will be repeated.

The lack of well-developed and poorly implemented systems is the fundamental source of stress in dental practice today. Most of us shoulder the entire burden of the operation of our practice. We are like the entertainer discussed at the beginning of this article, constantly running to spin another plate. No one else seems to want to spin the plates and they obviously don`t do it as well as we do. So, of course, we step up and do it. Only by taking on the added burden of developing and implementing systems can we ever hope to have others spin the plates for us ... and, ultimately, remove some of the responsibility that weighs so heavily on our shoulders. Only by developing systems today will our practices run smoother tomorrow.

Putting first things first

You can build your dental-office systems in three ways:

1) You can buy your systems. This is essentially what management consultants sell. The top management consultants all have excellent systems that you can plug into your practice. We developed our systems with the Pride Institute. Because this worked so well for us, I believe that utilizing a management consultant is the fastest way to build your systems.

2) You can operate under someone else`s systems. This is essentially what Dental Management Service Organizations (DMSOs) offer in return for taking your practice. If their systems are good enough, the stock they give you may also be worth some money.

3) The third and least expensive way to develop systems is to do it yourself. I call this the "CASE" method for "Copy And Steal Everything." You`ll find many great ideas that are free for you to use in journals like this.

All of your dentist friends will be happy to tell you how they do things, and they probably will be happy to give you copies of the forms they use and/or tell you where to buy them. Many of your dentist friends also will share their outside sources of advice with you.

Other resources are available through your dental society or study clubs. You don`t need to reinvent the wheel, but the effort you put into developing your own systems will pay huge dividends.

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