For a majority of dental offices, there seems to be a trend: As the years slide by our systems and protocols seem to become more and more complex. While that may be true for a majority of dental offices, the best run, most profitable offices are bucking that myth. When we used to have doctors visit our offices, it was usually prompted by the results they saw we were getting: Unlimited numbers of new patients, consistent growth of 15%-20% a year, direct referrals in the 80% range, and hygiene recall over 90%, with consistent great reviews from everyone. We consistently drew the best staff with the best attitude who stayed for most of their career in dentistry. Certainly, this did not happen to this degree earlier in my career, but it was a steady simple climb every year with very little, if any, backsliding.
The strange thing I observed with almost every office that visited, was that they were both surprised and disappointed. These might seem to be emotions on the opposite end of the spectrum, but not really. They say that happiness occurs when reality exceeds our expectations. These visits from various offices from all over the U.S. confirmed this but also called into question what their real expectations were. I can only assume that they expected to see some never before heard of system or protocol from a litany of super amazons and supermen that they could take back to their offices and completely erase a trend of mediocrity, stress, and high staff and patient turnover to become the big fish in their pond. Result: Disappointment, because that was not the case. It was like having a magician actually show you how they had just mystified and entertained you with a routine. Once you know, you are surprised at the simplicity of it, but somewhat disappointed because once you knew the secret, even you could do it.
Most were surprised that even though we had 250-300 new patients a month with 47% being children, there was no stress, no rushing, not out of control or chaotic (and we never ran late). Just a smooth-running office with competent staff and happy patients coming and going in an efficient, well-orchestrated, systematic approach that embraced consumerism while exceeding the expectations of our clients. I think most of the staffs that visited were amazed that their counterparts in my office loved working there, respected the doctors, and were fully committed to making each year better than the last. Forget the economy, pandemics, jobless rate or any other challenge, my staff was committed to seeing us through. I overheard one visiting assistant asking her counterpart on my team about her work schedule. This particular assistant worked with our youngest doctor who was there Wednesday-Friday 8-5 and Saturdays 8-1. The assistant from the visiting office stated that she would never work Saturdays and no one else in their office would either. NOTE: I hear this from just about every doctor I know or have ever spoken with. Our assistant smiled and said that she loved it. She got a half a day Saturday off, all day Sunday, all day Monday, and all day Tuesday off. It was perfect for her. The kicker that left the visiting assistant flabbergasted was when she heard that this same assistant that was working a schedule that she would never consider was paid 30% more than she was, had medical insurance, a 401K savings plan, routinely got $2,500 to $3,200 a month in bonuses, was taken on a four-day cruise last year, and had all of her uniforms and continuing education paid for.
The doctors were much the same. While looking for that hidden gem, they observed how well we executed the basics. I remember one doctor being dumbfounded that there was nothing kept in the ops and that everything was contained in tub and tray setups. It was simple, consistent, and foolproof. I could have a 10-year old set up my room for a crown prep. Just go get the beige tray and the orange tub. If they could do that the room was ready. Every aspect of the office was created for simplicity. We never had to have the assistant leave a patient to retrieve another instrument. It was already on the setup even if I just used it once every ten times. Fundamentals done well was the mantra.
Even clinical speed comes from simplifying the basics. The right system, the best instruments, the best burs automatically decrease the amount of time it takes to perform a service. Even not having staff turnover actually sets the stage for excellence in a complex world. You are not trying to do it faster. You are moving toward excellence and simplicity of action. Let me dumb this down to five basic steps to ensure that you are staging everything you do towards the simplest and most efficient manner possible.
Teachable/trainable: These words indicate that you must be organized enough and communicate well enough to devise and demonstrate a well thought out system for your staff member to follow. Sure, it takes time, but it is time well spent. Too often, doctors complain about things that if done right the first time, would never be a challenge later. We always make time to redo the things we should have done correctly the first time. This is the sign of lack of engagement and misplaced attention. Usually this is seen when we overcomplicate the simple things.
Scalability: Well-run offices grow, things change, and life happens. Great systems and protocols are designed with the functionality to be scalable. As you grow, the systems still work. This is a sign of staging the system and the process in a well thought out way. Keep in mind that 99% of what you do is already being done perfectly. Find a mentor or coach and listen. Get the right system the first time and you won’t have to waste your energy trying to adapt it when you find that it is coming up short or the circumstances change.
Repeatability: Are your protocols and systems simple and fundamental enough that from one person to another, they are repeatable. Most great systems just make common sense. It is that moment when you realize that different people from different backgrounds always seem to “get it” or “catch on” quickly when the system is repeatable. Remember that your systems face the most stress when staff are out of their comfort zone.
Flexibility: In much the same way as repeatability involves a multitude of different staff using the system, flexibility means that the protocol is so good that it can be used in a multitude of situations. Great systems are “universal” in their application. Once again, we should move from complex to simple.
Sustainability: One of the weird things about writing down your thoughts is that 40 years later, people remind you of what you said. I am happy to report that the one or two doctors that have actually mentioned this to me always report, “you said the same thing three decades ago”. Truth never seems to change. It never goes out of style and you never have to apologize for a truth you spoke years ago. This is very much like great systems. The one great acclamation is that they stand the test of time. They are sustainable throughout your career.
The complex question of simplicity comes down to results. The simplest, teachable, scalable, flexible and sustainable route is the correct way to stage success in dentistry. Take the time to sit and ponder both what you do and why you do it. Don’t just think that some new book or guru on the speaking circuit will have the “never heard of, best of all time, new whatchamacallit”. Simple and consistent forms the path to a better future in dentistry. This is how you Summit.
Michael Abernathy, DDS
PS. Ten quotes from a few smart people on the topic of simplicity. Enjoy!
- “Life is really simple, but we insist on making it complicated.” Confucius
- “Simplicity is the ultimate sophistication.” Leonard da Vinci
- “Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.” Steve Jobs
- “There is no greatness where there is not simplicity, goodness, and truth.” Leo Tolstoy
- “Everything should be made as simple as possible, but not simpler.” Albert Einstein
- “I have just three things to teach: simplicity, patience, compassion. These three are your greatest treasures.” Lao Tzu
- “Three Rules of Work: Out of clutter find simplicity; From discord find harmony; In the middle of difficulty lies opportunity.” Albert Einstein
- “A vocabulary of truth and simplicity will be of service throughout your life.” Winston Churchill
- “Great leaders are almost always great simplifiers, who can cut through argument, debate, and doubt to offer a solution everybody can understand.” General Colin Powell
- “Don’t make the process harder than it is.” Jack Welch