Dental News - Efficiency is the key to a prosperous and fulfilling orthodontic practice

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Efficiency is the key to a prosperous and fulfilling orthodontic practice

Robin Vaughn, USA

Robin Vaughn, USA

Fri. 20. February 2009

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While growing up, I always enjoyed brain teasers. When my career in orthodontics began, I was intrigued because everything seemed like a puzzle. While working as a clinical assistant, I was mystified by mechanics and anchorage and their bearing on clinical procedures. As a treatment coordinator, I have experienced the obstacles presented with payment plans, recall systems, follow-up with patients pending a decision to pursue treatment, facilitating and sequencing visits. During my years of training some 200 assistants, I have come to view the causes of malocclusions, facial changes, treatment types, stages and treatment timing as brainteasers or puzzles as well. For me, the entire concept of orthodontics is a puzzle. All the pieces must fit or work together well in order to render an optimal result.

As when solving a Rubik’s Cube, or the peg puzzle at Cracker Barrel, it is important to follow basic principles and a logical order. We find this to be especially true in orthodontics also. For instance, each case must be managed from the diagnosis and treatment planning to the stages of implementation of biomechanics, and finally through finishing and retention.

Not only are logical systems used in planning and mechanics of treatment, they can also be successfully utilized in almost every aspect of the entire orthodontic practice. When creating the methods by which tasks are completed, the goal should be to work more efficiently without sacrificing quality. Efficiency is the key to a prosperous and fulfilling practice, and is a result of well-designed operations. The term efficiency should not be confused with cutting corners. On the contrary, quality is the corridor to efficiency. Excellence is necessary in order to give outstanding orthodontic care to more individuals in less time.

After these efficient systems are devised, they must be implemented. Too many times I have seen good money and time wasted on the formulation of a plan, without ever seeing execution. Only when efficient strategies are developed and then implemented can there be less room for error and more profitability.

I have always had a passion for the clinical aspects of the orthodontic practice. All too often, substantial amounts of time, money and effort is spent to fabricate, maintain and tweak clerical, administrative and marketing methods, while the clinic itself is repeatedly overlooked. Often the value of the effort spent to bring in the new revenue is reduced by the inefficiency of the clinic. The following are some questions to answer in order to determine if clinical operations could use revamping.

• Is clinical staff turnover high?

• Are assistants overwhelmed during the training phase?

• Are many patients over their estimated date of completion?

• Do patients make unnecessary visits?

• Do many patients return to the office before their next scheduled visit?

• Are supplies ordered only when the stock is conspicuously low?

Inefficient practices squander money each day because of a lack of structure in the clinic. Significant, but often overlooked, is the time wasted searching for items, gathering supplies, looking for charts and performing procedures inefficiently. No one will dispute, however, the significant expense a clinic will experience while training a new assistant. Staff turnover happens many times because the employee was overwhelmed during training, or because she/he felt unappreciated, or because of miscommunication. The coaching period is vital because the quality of the clinical assistants’ technique is a huge factor in profitability.

Take bracket failure, for instance. It is amazing how quickly the expense of bracket failure can increase. If a clinic repairs a few loose brackets a day instead of a few loose brackets a month, the expense can add up to well over US$10,000 per month. Revenue per case is also greatly reduced when the clinic is clogged by patients receiving limited adjustments that are not actually advancing them further along through treatment. This is sometimes a result of supplies being out of stock, an overbooked schedule, appliances not being ready, or appointments scheduled incorrectly.

More often than not, this is because patients have loose or broken appliances. Many times these unnecessary occurrences are a result of improper assistant and/or patient education and technique. Sometimes the clinic operates inefficiently because routine maintenance schedules are not followed for the odd duties to be done during non-patient times. When odd jobs are not done routinely during non-patient times, they must be done while patients are present.

The task then takes more time to complete and is usually not done properly or thoroughly, which causes future problems. Another common way efficiency is compromised in the clinic is when there is no inventory system in place. A good deal of time and money is exhausted placing small orders during each day or each week when the stock is out, instead of having a monthly/quarterly ordering routine.

Throughout my years of working in an office, running my orthodontic assistant training school, consulting in other practices, researching and teaching for various orthodontic vendors, I have tailored an overview of what I would envision as the ideal orthodontic practice wherein every aspect is satisfied.

Patients know that when they take valuable time out of their day for a visit, significant work will be performed. Very few unnecessary appointments are made because the patients are well-educated about the importance of appliance care and because the staff has well-laid instructions for the clinical procedures. Patients make minimal visits, yet they end treatment with a gorgeous, healthy smile.

Employees are well-trained and fulfilled, and their longevity is a testimony to patients and others in the community. They function together, mimicking a well-oiled machine. They know the course to follow and the standards of quality for the work they perform. They have excellent patient communication and motivation skills.

A typical day at the office is a structured day. Routines are followed in every aspect, and if not followed, staff members are held accountable. Mistakes are avoided because staff members complete all of their duties, and the organized systems catch anything that may try to fall through the cracks. The equipment is consistently in good working order, and supplies are always in stock and purchased prudently. Patient care and customer service remains top priority. Last but not least, past-due collections are minimal.

There is no single aspect that can be developed to make the entire operation run efficiently. On the other hand, there isn’t a single aspect that can be left undeveloped. I suggest performing an 'all systems' over-view. This may be overwhelming, but will be well worth it in the end. Established procedures will be identified that seemed sensible at the time and were integrated years prior, but current technology will offer better solutions. A simple overhaul of the logical process can frequently reduce time spent performing the task.

Before I help initiate the 'all systems' overview, allow me to recreate a vision that I have developed throughout my years of working in an office, running my orthodontic assistant training school, consulting in other practices, researching and teaching for various orthodontic vendors. The following is a brief description of an orthodontic practice wherein every aspect is satisfied:

Patients know that when they take valuable time out of their day for a visit, significant work will be performed. Very few unnecessary appointments are made because the patients are well-educated on the importance of appliance care and because the staff has well-laid instructions for the clinical procedures. Patients make minimal visits, yet they end treatment with a gorgeous, healthy smile.

Employees are well-trained and fulfilled, and their longevity is a testament to patients and others in the community. They function together, mimicking a well-oiled machine. They know the course to follow and the standards of quality for the work they perform. They have excellent patient communication and motivation.

A typical day at the office is structured. Routines are followed in every aspect, and if not followed, staff members are held accountable. Mistakes are avoided because staff members complete all of their duties, and the organized systems catch anything that may try to fall through the cracks. The equipment is consistently in good working order, and supplies are always in stock and purchased prudently. Patient care and customer service remains top priority. Last, but not least, past-due collections are minimal.
Keep in mind that when creating the methods by which tasks are completed, the goal should be to work more efficiently without sacrificing quality.

To begin the 'all systems' over-view, simply start a list of all operations and/or issues. This may be hard at first, but before long, the list will be extensive in the ways the performance could improve. Delegate a staff member to oversee each single system review. Because the pulse of the practice is generated by the employees, this could be a good place to start. Look at the tactics used when adding a new staff member.

Many have used the following method and have experienced this scenario:

When an assistant decides to quit, and if the stars line up correctly, she will give two week’s notice. Because the schedule is filled for as many as 10 weeks after the assistant leaves, an ad is hastily placed, or whatever means is used to just get a warm body in the office. The new, untrained, inexperienced 'assistant' is swiftly (often inadequately) shown around, and given the basics on everything that comes to mind (when time permits). Before long, she is expected to be treating patients with an understanding of what she is doing. Often, because the training is haphazard at best and expectations are too high, the newly hired assistant feels frustrated and ends up leaving. This starts the revolution over again. When this happens, countless hours (not to mention dollars) are spent interviewing, hiring, explaining policies and training.

Instead of continuing this vicious cycle, a method can be established to identify and hire the ideal, competent individual for the job and team. Usually when an office is frantically looking for a new clinical assistant, the potential employee is selected from the stacks of résumés based on the amount of dental experience. Often, a well-qualified, dependable, talented individual is overlooked, which denies the practice a quality employee. If each individual is hired because of great recommendations, long work history and dexterity, instead of the amount of dental experience, the clinic will eventually be filled with dedicated employees and low staff turnover.

After a structured manner is implemented to hire the ideal individuals for the job, it is important to prepare a plan to train them properly. Many employees are lost because of unorganized training programs. If quality, inexperienced individuals are em-ployed, a program must be in place so that they can learn the concepts of orthodontics and the techniques. If a training platform is not in place, either new employees will get frustrated and leave, or new assistants learn only how to perform the procedure instead of why it is being performed. When this happens, the most important aspect of the education is omitted, resulting in assistants that simply act as robots, performing the tasks they have been told to do instead of being integral team members using their abilities to discern appropriate procedure progression. If concepts are taught, new assistants will quickly become valuable clinical assets. Although there are many training programs out there, none compares to the customized training provided in the office. The task may seem daunting, but with a little help, it can be done.

Having clearly defined procedures is a valuable tool when training newly hired assistants. Commonly, a clinic will have assistants performing the same procedure in differing amounts of time. This often happens not because one assistant is quicker than another, but because the faster assistant performs the procedure more efficiently. It could, however, be a result of the one that finishes first forgetting to perform a few steps during the procedure, or differing instructions being given to the patient. Routinely, there is one best way to perform and instruct. If procedure progression and instructions are well-outlined, all assistants should be able to regularly perform at approximately the same speed while providing the same quality.

Once a training strategy is implemented, a guideline should be created to identify and then retain the good employees. This requires a standard be set for the improvement they must show and a formula to determine the compensation. If new employees know the expectations and understand that compensation depends on performance, they will strive to meet those expectations. The orthodontist will quickly know if they have a capable employee.

To start creating a truly efficient clinic, first hire only quality individuals, then educate and train them. Give them a good basis by which they may further advance. Once they become qualified, and are able to begin making decisions and evaluations, they will feel needed. Good employees should have clearly defined job descriptions and should feel appreciated and well-compensated in order to see low turnover.

Create systems for all aspects of the practice keeping efficiency as the focus. Once the system is designed, it must be followed, and staff members not adhering should be held accountable. Establish a clinical flow and template focusing on the most efficient way to physically see the patients. Make each patient visit count by progressing treatment each visit, and by using quality products that will decrease the quantity while increasing the quality of patient visits. Reduce the number of unnecessary emergency visits by first perfecting technique, then by implementing the proper policies, instructions and motivation techniques. Create a plan for ordering supplies that will reduce expenses.

I could continue on about the ways the clinic could enhance its performance, and of course, the clinic is only a portion of the entire orthodontic puzzle. For instance, enhancing the clinical technique is only necessary provided there are patients starting treatment.

In closing, when I describe this orthodontic practice paradise, some may think it is unattainable, but I see it as an enigma, puzzle or brain teaser that can be solved using basic principles. Following standard operating procedures, providing great patient service and quality orthodontic care without being frivolous will result in satisfied patients and employees. This is the pinnacle wherein the practice will experience unparalleled profitability.

Contact info

Robin Vaughn can be reached at rhves@aol.com.

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