Smooth running

SUCCESSFUL individuals and great teams have two things in common: the ability to do the simple things correctly time after time, and the facility to build on the simple so that the complex also works well.

Without doubt, the practice of dentistry has become more complex with associated pressures on professionals. One reason is the increasing sophistication of available patient treatments and another is the rise in technology required in practice. Other elements include the rise in patient demand/expectations plus the growth in the compliance “industry”.

We are where we are, the genie has well and truly escaped and no amount of complaining or reminiscing about a return to the “good old days” will get it back into the bottle.

I often ask new clients: “How does your business run?” and I try to provoke them to look at what happens at every stage of the patient’s progress through their practice. The phrase “patient journey” trips easily off the tongue yet is rarely looked at in any detail.

My interest in systems was sparked by my Uncle Dave who owned a manufacturing engineering business which produced the “widgets” beloved of MBA case studies. In Dave’s case these were steel clips, made by the thousand and sold to large, multinational firms who demanded consistently high quality. All suppliers had to be BS/ISO compliant, which was summed up for me as: “Everything must be of a consistent, repeatable high standard, that standard to be agreed upon by all parties, and documentable”.

The consequence in my practice was to encourage every team member to ask the simple question: “Why?” about everything that we did and then: “Could it be done better?”

The next stage was to break down every task into its constituent parts. From answering the telephone through the administration of a patient visit and of course our clinical procedures, we examined, dissected, discussed and rebuilt our processes.

We found large gaps and anomalies as we progressed and the number of presumptions proved revealing. We had always taken pride in being a small team that communicated well with each other and our patients but came to realise that we weren’t as good as we thought. As we proceeded with what was an invaluable team building exercise we documented everything to produce our practice manual, the “Practice Red Book”, or “How we do things here”.

When the practice was sold several years later the new owner showed little interest in the manual, however he later told me how they had used the “red folder in reception” as the basis for passing their CQC inspection.

In many practices that I visit I am told how the practice manager, the head nurse or the senior receptionist “takes care” of everything. The owner is neither sure how things work nor how the systems have evolved over time. They secretly admit that they would be lost without X or Y. They cross their fingers that their key team members are faithful, that they will never get or take a better offer or get bored and want to do something totally different.

If I were starting a practice again, I would also incorporate the work of Atul Gawande from his book, The Checklist Manifesto, into practice systems. Gawande explains how to avoid errors without becoming hidebound by bureaucracy.

In these days of routine inspections, most practices have a practice manual of sorts as a file full of the “necessary” forms. Many choose to pay one of the compliance “off the shelf providers” to be kept up-to-date with the legal changes without ever taking full ownership. So what should a practice systems manual be and why bother writing one?

• It must be a living document, the basis of the administration of the practice and therefore has to be constantly updated.
• Everyone in the business must contribute and their contributions valued. This will help gain their commitment to implementing policies.
• The writing and reviewing make a great basis for staff meetings.
• The role of all team members is clearly and unambiguously defined.
• By writing a statement of philosophy and mission statement everybody understands what the practice is trying to achieve.
• The induction of new team members is simplified and they can see and understand their role and those of fellow team members.
• It produces improvements in morale and stability.
• All systems are put in place and documented.
• You have clearly documented guidelines and defined standards.
• The improvement in customer service helps to serve your patients better.
• By working smarter, the practice becomes more efficient and is able to work closer to its maximum potential. It saves time, energy, and money.
• Clearly defined systems are essential to avoid conflicts and protect against litigation.
• It marks out your practice as unique.

Further reading:

• Start with Why - Simon Sinek
• The Checklist Manifesto – Atul Gawande

Alun K Rees BDS is The Dental Business Coach. An experienced dental practice owner who now works as a coach, consultant, troubleshooter, analyst, speaker, writer and broadcaster. www.dentalbusinesscoach.co.uk