The productivity paradox

By Dr Mark Hassed

During the past several years I've been extremely fortunate to work as a locum dentist in more than 20 practices all over Australia. As I travelled around, I couldn't help but contrast my experiences in the various practices.

Over time I noticed a very interesting phenomenon that I call “the productivity paradox”. It's the exact opposite of what I'd expected and it greatly surprised me, yet it's been consistently validated in all the practices that I've visited.

When I first started, I'd expected that working in high grossing, highly productive practices would be more tiring and more stressful than working in low grossing practices. What I actually found was the exact opposite.

I discovered that it's less tiring and stressful producing $7,500 of dentistry per day than producing $2,500 of dentistry.

Now, I bet that you're saying: “That's impossible. How could it be easier to do three times as much work?”

Therein lies the paradox.

The answer to this paradox is in the way the practice is set up and the way the practice runs.

Superbly run practices have systems that make the the entire team's life, particularly the dentist's, easy and productive. In high grossing practices all the road blocks have been removed.

 

How long does it take to set up?

While working in a practice some time ago a patient came in with a toothache and decided to save the tooth with a root filling.

I said to the nurse: “Let's go!” Immediately she vanished out of the room and headed for steri.

10 minutes later I wondered what had happened and set off to find her. She was still getting things ready — opening and closing drawers and fetching individual items with tweezers. Finally, after 16 minutes we were good to go.

By then we were hopelessly late for the next patient.

Have you got your material and equipment set up in kits and modules so everything can be ready in a moment? To completely set up for endodontics should take less time than you take to give the local anaesthetic, if you're doing it right.

In low grossing practices it feels like you're trying to ride a push bike with flat tires up a steep, corrugated dirt road. Everything is so very hard.

I'm not for one moment saying that dentists and team in lower producing practices are not good at what they do, but maybe they just haven't been exposed to all the subtleties of time and motion and setting up for efficiency that can make their lives incredibly easier.

To give you an idea what I'm talking about let's look at just a few very simple examples from a practice where the dentist produces $2,500 per day.

…the treatment rooms often have instruments and materials laid out in pretty much random fashion.

In such a practice, the treatment rooms often have instruments and materials laid out in pretty much random fashion. To set up for a procedure you might need to open 4 or 5 different drawers, or, even worse, the nurse might need to take a trip to the steri room. Because of this, setting up for procedures takes ages. For example, it took 16 minutes to set up for a root filling in the slowest practice I've been in. In another practice it took 7 minutes just to get rubber dam ready.

The teams in such practices have not been trained to be pro-active and they mostly just sit and wait for instructions. In many cases they neither listen to what I'm saying nor anticipate what I need next. This slows everything down as well as tiring me out.

In low productivity practices, I have to carry out many tasks that the team can do. This is bad from two points of view. Firstly, it prevents me from treating more patients and secondly it deprives the nurses of tasks that can add variety and interest to their jobs.

In addition, because there are often no checklists in place, I must constantly watch the team and correct mistakes.
Such practices are exhausting. By 5.00pm I feel like a rung out dish mop.

Checking a patient out

In the least dentist-friendly practice I've worked in the checkout procedure was a nightmare for the dentist. It ran like this:

  1. Enter the item numbers
  2. Enter the clinical notes
  3. Debrief the patient on what had happened today
  4. Enter the treatment plan on the computer
  5. Write out the treatment plan on a sheet of paper
  6. Walk the patient to the front desk
  7. Hand over the sheet of paper and explain it to the front desk person
  8. Say “goodbye” to the patient.

No matter how hard I tried I could never get that all done in less than 12 minutes. Sometimes it took longer. If I saw 12 patients a day it means I spent over 2 hours checking patients out.

Now, let's contrast that with a $7,500 per day practice.

At this level of productivity the practice systems are streamlined. Setting up for any procedure takes just moments. I often find that the teams in productive practices are so smart and well trained that they have the instruments ready before I even know I need them.

I only have to treat patients — everything else is taken care of by the team.
Instead of me watching the team, the team watches me. If I forget something they gently remind me. They virtually never need to ask me questions.

The systems in a practice like this have been perfected — nothing is random. There's neither wasted time nor wasted movement. The instruments and materials are the fewest and fastest that are required to achieve each procedure.

While working on a patient I never break my concentration. I never have to look up or ask or wait. Working in this environment is total relaxation and focus. Everything just happens magically around me. I'm almost like a spectator.

At this level I just go with the flow. I find myself standing in the hallway and a team member says to me: “Surgery 2, Mrs Mary Jones, ceramic crowns 14, 15.” I salute and off I go. When I enter the room everything is ready and the team is waiting. I just sit down and start.

If you'd like to have a super star practice then you have two options. Firstly, you can try to reinvent the wheel which is a process that may take years. Or, secondly, you could find a high producing dentist to mentor and guide you.

They’ll be able to show you the dozens of tips, tricks and techniques that you never learnt in dental school — the myriad big and little things that will make your working life dramatically more productive and less stressful.

Things like how to get case acceptance on a crown in less than 2 minutes. Or, how to cut treatment times by 30-40% even if you are already fast. Or, the best burs and hand-piece for productive practice.

As dentists we are often isolated in our own practices and this really is a case of you don't know what you don't know. If you would like to take the next step toward lower stress and higher productivity I encourage you to get started and find someone to guide you today.

Perth 2 December

The art of case acceptance returns to Perth. Don't miss it.

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