-Ideas to Improve the Dental Practice-

The Tale of Two Coronavirus Vaccinations

(with apologies to Charles Dickens)

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness.   So starts Charles Dicken’s novel but this also seemed to characterize the differences between my two vaccination experiences.

Although we are in the middle of a world-wide pandemic, the worst of times.   I was about to finally get my vaccination, the best of times.  It was the age of wisdom; the vaccines had been developed with unprecedented speed and the entire world was in anticipation of the relief it would bring. It was the age of foolishness; despite knowing that we needed to vaccinate somewhere in the neighborhood of 70% of the population, the vaccination roll out was not well planned nor was it going smoothly.

Similarly, my two experiences for my vaccinations were the best of times (my first vaccination) and the worst of times (my second vaccination; well not all that bad but, far worse that the first vaccination).

I had been waiting a while for my opportunity to receive the corona virus vaccination.  So, I was psyched about going to the Rec center to receive my vaccination that day.  As with all things provided to a large public audience (think going to the Dept. of Motor Vehicles) I wanted to see how long this would take.  So, as I stepped out of my car, I started the timer on my phone. I did NOT have high hopes.

Approaching the building a volunteer asked if I had an appointment today and did I bring my government ID and an employee ID (to identify me as a healthcare worker) or a letter from my employer. I answered yes and they pointed me to the front door. There I was ushered to a registration table to check my registration and then pointed to a line (one person).  Entering the gym there were 10 tables each with two volunteers.  Only about half seemed to have someone waiting for a vaccination. I was taken almost immediately, sat at one of the tables and was handed a vaccination card to fill out.  While I was doing this, the EMT asked me about allergies etc. as he was opening, assembling the syringe and drawing up the medication.    A second person was entering information into the database.

Once I was finished, the EMT was ready with an alcohol swab. He swabbed my shoulder as he asked me if I had any questions.  After my “no” answer he stuck me with the needle, and I looked at my phone.

Six minutes! It had been six minutes from exiting the car to having a needle in my arm.  

They were SO efficient! So fast!

Optimizing Patient Flow in the Dental Office

Well, you know where I’m going with this.   Let’s see how this might apply to our dental offices.

First, they were ready for me.  Someone was out front confirming that I had an appointment and that I was in the right place.  Once inside there were numerous “receptionists” to check me in and point me in the right direction.  They knew why I was there.  

Dental Office Scheduling – Templates and Systemization

 There was plenty of “capacity”.  No waiting

In our offices, we offer more services than this clinic did.  However, knowing who’s coming in and for what procedures makes things run smoother.  And is everything ready to receive our patient?  Has the lab case been returned from the lab?  Is it ready to go?  Do we need the patient to fill out new paperwork because it’s the new year?  Do we want to contact the patient to do it online or have them come a bit early to accomplish this? By looking ahead a bit, many issues can be anticipated ahead of time and solutions instituted so that we are not running around trying to make “game time” decisions to make the day work. 

All of this needs to be systematized to assure that all of these items are accomplished each day so that we are always ready for “game day”.  A front office daily checklist is a good place to start.

Maybe a beginning and end of day checklist for the front office or maybe even for each position.

Increasing Production in the Dental Office

Once, in the gym, there were numerous stations all waiting for folks who needed vaccinations. Again, plenty of capacity.  Many times, if all our chairs aren’t filled all the time, we see this as a waste.  Instead, we should realize it for what it is, sufficient capacity to deal with the unexpected and to add production to our day.   If every chair is full all the time, we are being inefficient.   We are probably pushing work that could have been accomplished this month (if we had the capacity) into next month.  It would be like trying to pour water into an already full glass.  It has to spill over somewhere.  It won’t all fit into the glass.  Similarly, it will “spill’ over into the next month.   And that month to the following month.  And so, on and so on.  Using this method, it is possible to turn a one million dollar a year practice into a $850K or $900K a year practice.   And really, who wants that?

Four Handed Dentistry and Treatment Flow

Next, they were ready and performed as many of their duties as possible at the same time. So, there was no wasted time.

I was filling out my card, the assistant was entering information, the EMT was assembling the syringe, drawing up vaccine and asking me about allergies etc. all at the same time. It was super-efficient. No one was watching while others were working.  It was a well-orchestrated operation.  No one was just sitting around waiting for something to happen.

This is akin to four-handed dentistry in our offices 

Sure, we know about this principle but how do we get it implemented?
First, we need to know how we want to do the procedure. What parts can be given to a trained assistant? The more we can lean on our assistants to perform “their” part while we are performing “ours”, the less time is wasted in the process.

Dental Team Training

When training docs about clinical efficiency, I always tell them that the first place to look is to notice where you are watching your assistant do something.  Or vice versa. Whether its opening instruments and bottles or digging for an instrument or an anesthetic carpule, all of that can be avoided.  Most of these items can be prepped before the patient ever arrives in the operatory.  That way when it is “game time” there is no wasted time! 

A procedure checklist with pictures or a delivery template can assure us that no needed item for the procedure is forgotten or not in its proper place on the delivery.

How Does an Assistant Learn to Anticipate the Doctor?

On the assistant’s side of things, if the doctor does the procedure generally the same way every time (same materials/instruments in the same order) it is much easier for them to anticipate what they will need next.  That way, the assistant will be prepping the next item rather than watching the doctor work and waiting for the next command.

Speed Dentistry

Typically, when we talk about “efficiency” people think “faster”.  This is almost never the way to go.  The speed comes as a byproduct of using a well thought out plan that anticipates bottlenecks and handles them before they can occur.  Think “smooth”.  

The Navy seals have a saying “slow is smooth and smooth is fast”.  In other words, if you prepare and then move slower so that problems can be anticipated and dealt with as you go along, in the end you will finish faster.
In my office, whenever we are working on a mandibular molar, the PDL syringe is always laid out in anticipation of not achieving adequate anesthesia with the IAN block. I’d say that this happens less than 10% of the time that I give that block.  But, by having the syringe in the room, it will easily save 5-10 minutes that it would have taken to call an assistant, get them to run to the lab, retrieve the syringe and return it to the operatory.  And let’s face it, it’s always a little jarring when the patient isn’t numb on the first try.  Already having the syringe in the room and ready to go helps both the progress of the procedure and the nerves of all involved.

OK, so how about my “worst of times” experience... stay tuned next week.