In part one we discovered that fear, laziness, ignorance, ambivalence and lack of skill are the main root causes of a lack of quality in a dental office. In part two we will discuss the four pillars needed to keep quality outcomes a consistent event within the dental office.
The solution to keeping the quality the constant in any iteration of dental practice rests on four pillars. The pillars are self-assessment, commitment to improvement, validation of quality through independent assessment and establishing time as a variable rather than a constant.
Self-assessment doesn’t mean you have to have all the answers. Self-assessment means that you take it upon yourself to discover the problems.
Self-assessment is simply the act of reflection on your work. Ask yourself questions. What have I noticed? What trends do I observe? Where are the cracks in the foundation of my dentistry? Self-assessment sounds easy, but it is hard. The reason it is hard is that none of us know what we don’t know. Self-assessment doesn’t mean you have to have all the answers. Self-assessment means that you take it upon yourself to discover the problems. Discovery often will take the form of formal and informal interviews of your three key constituencies, your team, your patients and your community. Holding up the mirror to your dental practice or your dental business takes courage. Remember fear is the primary deterrent to quality. Here you must wrestle your fear to the ground and conquered it. If you are fearful of the truth of your work and the work of the organization you will not succeed. Approach the discovery process with a genuine desire to become the best version of yourself or the best version of your practice. Establishing the why behind the will assist you in drawing the energy to create and sustain a genuine commitment to improving.
Commitment to Improvement
A Commitment to improvement is bigger than you as a dentist or you as the principle of your organization. Commitment takes effort, passion, and purpose–a combination that could also be called “grit.” It takes grit to develop the daily discipline required to push yourself and your team to expect excellence and reject the mediocre or worse the insufficient. In a dental office, the establishment of a culture that rejects poor outcomes and celebrates the excellent is essential. If you can successfully create this culture inertia will keep the energy flowing toward quality. When the dental assistant knows to retake the impression with a void in the vestibule or to retake the overlapped x-ray, you know you have created that culture. When the hygienist knows to bring the patient back to finish a scale because she ran out of time on the last time you know you have created that culture. When the dentist tells the assistant that we will be taking a new impression or new scan after she smooths out a step in her margin you know you have created that culture. Problems will happen every day, which means every day you should expect to witness the grit required to make quality the constant and time the variable. Commitment and Self-assessment alone are not enough. We need two more elements. Next, we need to complete the picture with validation through independent assessment.
It takes grit to develop the daily discipline required to push yourself and your team to expect excellence and reject the mediocre or worse the insufficient.
Validation of Quality
Validation through independent evaluation serves two purposes. First it is accountability to our commitment, and second, it counteracts our imperfect knowledge and skill. We all need accountability in life. Accountability is the fuel to follow through with what we have said we will do. Accountability doesn’t come from the person holding us accountable. Accountability is a reminder to ourselves of our personal pledge to do something. To be done well we must articulate to the person or group that we have entrusted to validate our work the reason we want to be held accountable and grant them permission to hold us accountable. Choose the independent assessment partner well, someone who has obtained something that you want to achieve. This person or group will be looking at your results with fresh eyes and hopefully without any emotional attachment to your outcomes. You want data not someone to unjustly boost your self-esteem. That doesn’t give them permission to be mean; it gives them the obligation, to be honest, and to care about you enough to tell you what they see without fear of retaliation or of hurting your feelings.
“inconvenience and stress that is introduced by maintaining the highest quality are always less than the cost of poor outcomes”
Time is a Variable
The formula for quality must identify time as a variable as opposed to a constant. In manufacturing, time is a constant. The process engineer knows exactly how long it will take to tighten a bolt, fill a mold with plastic, sinter a metal, or frost a cupcake. In medicine and dentistry, we get in trouble when we try to make time a constant. Unfortunately, our work does not lend itself to absolutes; this is true for procedures as simple as a dental cleaning to procedures as complex as periodontal surgery. Business professionals will often attempt to standardize procedures and the allocation of time to complete procedures. This standardization is smart and can be beneficial, and it also can be problematic and frustrating. Standardization accompanied by understanding and flexibility will help to alleviate frustrations. The smart business approach is to have standardized amounts of time to work on procedures–these “smart schedules” exist in countless variations. The best decision is to make the quality of the outcome an unwavering commitment. To conjoin a “smart schedule” with an unwavering commitment to quality will require flexibility on the part of the provider to bring patients back at a later appointment to complete or replace procedures that deviate from typical time allotments. Stretching appointments into the time allotted to other patients will transfer the lack of commitment to quality from one patient to the next–this does not solve the problem. This commitment to making quality the constant and time the variable can be uncomfortable for all parties; the patient, the provider, and the business professional. The inconvenience and stress that is introduced by maintaining the highest quality are always less than the cost of poor outcomes and ultimately will result in greater satisfaction and respect among your team, your patients, and your community.