Visual Control of Your Practice Prevents Hidden Problems

By James V. Anderson, DMD

This article represents the seventh in a series of articles discussing the 14 Management Principles of The Toyota Way, a book authored by Jeffrey Liker. The principles illustrated in Toyota’s management systems can be applied to improving the efficiency in dental practice operations.

Principle #7, of the Toyota Way, focuses on the development and use of visual controls so that no problems are hidden. It is crucial to know whether the operations are working in standard mode or are deviating from the path that interrupts the flow and pull of the business.

In a dental practice, we work from a schedule that consists of patients’ names and dental procedures planned or considered and the amount of time deemed necessary to complete this work blocked out in 10-minute increments. The required time to complete a process is determined by the clinical team and includes time to prepare the patient, confirm treatment, provide any anesthesia if required, complete the procedure, dismiss the patient, re-prep the treatment room and set it up for the next patient. The dentist’s goal is to have seamless and effortless coordination of people, equipment, and supplies to achieve a great dental experience for the patient.

Though everyone on the dental team would prefer a smooth and synergistic day, many days can be chaotic and stressful, causing a less than pleasant experience for all involved. Absenteeism of critical people and lack of knowledge of how things are performed can throw a wrench in a well-planned day.

Not wanting to be found guilty, some workers create a “secret” culture of not disturbing the dentist to not get “blamed and then punished” for errors and not knowing how to do things. They create systems that are covert so that no one knows how they do things. It can get to the point when that key person is absent; the practice comes to a halt.

The Toyota Way, Principle 7, discusses the need for visual indicators so that people know when anything is varying from the acceptable standard. Creating a culture of transparency builds trust and working together as a team.

When the office is in chaos, problems arise and are pushed under until they rise as a crisis. To be in crisis continually, is not where anyone wants to be. During this state, there is a waste in the following areas:

  • supplies due to a weak inventory system which allows duplication of orders or running out of necessary inventory
  • waste of staff time trying to put out fires instead of helping the patients be comfortable and welcome
  • poor production numbers because of lack of time for treatment planning and consultations
  • low collection numbers because patients are not given financial arrangements

For organization, standardization, control, and harmony, start putting systems of transparency in the practice so that the entire team can see what to do and how to do it.

For instance, in the business area or “front office”:

  • Share management reports with the entire team, not just the office manager. Production and collection reports teach the correlation between what is produced and the actual collections. PPO write-offs and other write-offs demonstrate the need to collect before the practice can pay its expenses. The staff can learn how they play a part in creating their worth.
  • On each business machine, including the telephone, printer, credit card machine, and computer provide laminated instructions for operations attached to the device. Anyone can change the message, print a statement, or take a payment.
  • Develop a standard telephone script for anyone that answers the phone. Laminate this and put next to every phone in the practice to ensure the best information is given to and received from the caller.

In the clinical area of the practice or “back office”:

  • Use tray set-ups with a photo of the tray set-up laminated as a visual guide. In the event, the dental assistant is absent; another staff member can see how each tray is equipped. Label all supply cupboards and doors for easy access to supplies.
  • Employ universal carts in the treatment rooms, a laminated list inside with contents of each drawer
  • Instructions for operation of the intra-oral camera should be laminated and attached to the machine.
  • Have a visual tracking guide for tasks such as trap cleaning and handpiece maintenance.
  • Instructions for operation of equipment in the sterilization area and the appropriate sterilization processes should be visually available for all to see.

Every system in the practice should be able to withstand personnel changes. Share the process and goals with the staff and work to build people not replace them. When people are not performing as we think they should be, it is often not the person; it is the system that fails. Build a network of visual guides and build a better team.

Originally published in The Dentist’s Network


James Anderson, DMD was an entrepreneur before becoming a dentist. His leadership and business presentations offer dentists the essentials needed to achieve the practice and life of their dreams. His speaking programs help dentists realize their full practice potential by combining dental clinical skills with excellent business skills to create a profitable and enjoyable dental practice career.

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