Old Dog gives you 100 bones. Atomic Dental habits, Dental Kaizen. TIMEfactors.
"Common sense is genius dressed in it's working clothes.."
~Ralph Waldo Emerson
In the book "Atomic Habits" (James Clear) discusses the law of least effort. TIMEfactors is about the law of least effort!
The point of the law is that a cumulative affect of least effort results in more production.
Think of Japanese KAIZEN, or "good change".
Kaizen is about TEAM. Kaizen is about ORGANIZATION. Kaizen is about RESULTS. People, Process, Product.
At one point in history Americans manufactured more televisions than competitive Japan! We can BLAME cheaper labour as the death of many manufacturing industries - but I don't believe this alone is the problem. The Japanese found that by using the "KAIZEN" method of "people, process, product" they could create a television that was much more reliable (product) using a process that took less time, less tools, using more mechanized production. Assembly lines. Robots. Technology.
The product they produced had to be "TIMEfactors"
#1 - Good for the customer.
In my world - patient - means that a product has to be scientifically proven to be better. Longer lasting results. Less chair time. Less trauma. More comfortable. Less expensive. Credible and proven with independent scientific results and more important STREET credibility.
The televisions the Japanese started to produce using the "good for the customer" meant 5 times less repairs. Longer lasting. Less expensive. Easier to afford. Delivered to the home. Available in more stores.
Do you think this is what our patients want? Invisible aligners instead of wire? With payment plans they can afford, in locations that are easier to access? Can we provide that with KAIZEN? I think so....
#2 - Good for the business.
In my world - dental clinic - this means a product has to offer more efficiency. Take less labour and time to place. Provide results so patients are not coming back for retreatment. Provide techniques and services that my patient wants so I don't have to send them away. It means my team is trained to provide the service at a high level in an efficient manner. The type of patient experience that results in referral - likely where the MAJORITY of your new patients come from. And the cycle continues. The business works for YOU when structured like this!
The Japanese needed to be able to use LESS TOOLS, REDUCE LABOUR COSTS SIGNIFICANTLY and provide a HIGHER QUALITY PRODUCT in order to compete with the american televisions of the time.
My top producing clinics make very efficient use of technology and people to produce an exceptional product. Patients with longer lasting restorations, performed in less time, less visits. These clinics are profitable and engaged. They continually improve and invest. You don't sit still or you become Japan that now has to worry about the efficiencies of China....
KAIZEN or TIMEFACTORS or ATOMIC DENTAL HABITS....
No matter how good the idea is - without a base of customers efficiency and quality of product won't matter! The first steps to success involve a lot of work, patience, and perseverance.
You can FAST TRACK your success by learning from the THOUSANDS of masters and stories of other clinics. Find your mentors, imitate them. You will find they incorporate many of these successful habits...
Be ready to work. Be ready for failures. Learn from them.
Some of these ideas will be infinite and constant. Some are small and simple. None of this is about doing things you hate. Just be a little uncomfortable. If it really doesn't work for you - find another way to accomplish that goal.
Let's get to the meat of the matter. Right down to the bones....
Ideas to make your business thrive.
1 - TEAM. Up to 80% of the overhead in a dental practice is labour! In Canada we still see owners paying associates 40%. Dental team costing 30%. Profit of 10% (or the owner is the associate and takes home 50%). That is 80%! These offices rarely worry about the variable costs (relative to the volume of procedures). They are FOCUSED on PRODUCTIVITY. Meaning the TEAM is trained to PERFORM at a HIGH LEVEL. Invest in your TEAM first and the rest of these ideas will fall into place.
2 - Continual Improvement/ Continuing Education. Just because you have 3 patients tomorrow (thanks for coming mom and sis and her friend) doesn't mean you don't have to be thinking TIMEfactors! When you aren't CHAIRSIDE you can be LEARNING. Making a habit of continual improvement. If you are stuck in your office - get online and read. Learn the business. Learn your practice management. Understand KPI. Obsess over your career choice and specifically those things you wish you could do better. Learn to do them.
3 - MARKETING. You only have 3 patients tomorrow (thanks again fam). Here are the most effective ways I have watched practices build their business. First and foremost SINCERITY in your intentions!! Nobody wants that FAKE ASS Car salesman, ambulance chasing lawyer!
-Get involved with your community! Sponsor events. BE THERE! Engage with sincerity and good intentions.
-Create a social community among these same people - but also within your own interests!
-With sincerity - give your time or donate to charities you believe in
-RECALL is more than just sending a text. It's an opportunity to build your business. Recall should involve MARKETING CAMPAIGNS. don't cheap out on your recall system. Integrate recall into marketing and into practice efficiency
-Patient rewards for referrals
-Website - create a website that explains who you are. Your core values. Your mission statement. Don't let it be stale!
-Effective Marketing. BOOST your posts. Use GENUINE and SINCERE posts - not "off the shelf brush and floss daily with our attractive people and babies.
-Families picking dental clinics are 80% decided by the woman. Make sure your posts are FAMILY FRIENDLY which means they likley don't want to see a bloody picture of a surgery and probably could care less about that close up of an implant you just placed.
-Blog. Video. Create content for your Patients, what they would like. Not what you or your colleagues would like.
4- SKILL! No matter what you do, do it well. TIMEfactors is about excellence. There is no point in doing something too fast only to have to do it over again. Do not compromise on the quality of product simply for the price - you get what you pay for. Master your SKILLS. Pay to help your TEAM Master their skills, as a business owner you get the benefits!! If you have an associate that wants to continually learn - pay for it. Even better if you go with them to learn too! Receptionists should master their skills if you want your chair time to improve - but when is the last time you offered to get them training? Your auxilliary team members are the 30% of overhead that could be 15% if you teach them to be REALLY GOOD and give them the TOOLS and SKILLS they need to perform at a higher level.
Or you could just try to find the cheapest, least skilled labour possible and have the opposite effect.
5- Materials. Here is a LONG LIST of products - many you already use, and you know how well they work! Some of these will take SKILL, some are not made for you - they belong with the guy across the street. However, this old dog has watched as my friends have mastered TIMEfactors and these are among the materials they choose to work with....
-Bulk fill Restorative materials (Kerr Sonic fil, 3M Filtek One, Dentsply Surefil SDR)
-Self Etch/One step bonding (Voco FuturaBond, 3M Scotchbond Universal)
-SE one step cement (3M RelyX Unicem)
-Rotary Files (Edge endo Fire, X3, Kerr TF Adaptive)
-Bulk Obturations Systems (Kerr Elements Free)
-Fast Cure Restoratives (Ivoclar Power Cure 3S System)
-Omni-Chromatic materials (Tokuyama Omnichroma)
-Composite Matrix Systems (Palodent, Garrison)
-Non Stick instruments for restorative (HuFriedy TN Series)
-QUALITY surgical instruments (scissors that stay sharp, forceps that grip! Hufreidy)
-Wedges that stay in place (Garrison, Palodent)
-Varnishes (3M Vanish, Dentsply nupro, Voco Profluorid)
-QUALITY presterilized burs (NeoBur, Sterix)
-Fast cutting diamonds (Two Striper)
-FAST cutting burs (SS White Great white)
-Zirconia specific burs (Kerr Zircut)
Make sure to pick materials not only on QUALITY (longer lasting) but SPEED. Evaluate your chair time and savings. Look for materials that deliver higher production (labour savings).
The proper material selections can add not only efficiency in chair time - but less recall. Loger lasting results. More predictable outcomes. It's not just the 10 seconds you save now - it can be the hour of chairtime you save later. The loyal patient who appreciates less chair time and now brings their family and friends to see you.
6 - TECHNIQUES - Constant improvement of skills is somewhat inevitable. You need to be engaged and care though! Even those little tasks matter. Here are ideas to improve your skill and speed.
-Cad Cam - if you really want to learn to get your ego in check, try blowing up your crown prep 100 fold on a gigantic screen. You will soon find out why those crowns really didn't fit! If you master this skill,this is one of the highest impact products I see in a dental practice.
-Invisible aligner systems. Not just "Align Technologies" - there are a MYRIAD of great options. Don't limit yourself
-Advanced Surgical courses
-KOIS, DAWSON, SPEAR, LVI - The MAJORITY of the high performing/producing clinics I work with have doctors that attend and invest in advanced dental techniques
-Continued Education. Don't pick the fluffy CE, pick the REAL and HANDS ON CE!
-PERIODONTAL probing. Make sure to include your hygiene department - listen to them and educate them
-Advanced Practice management - educate your front team on efficient scheduling.
7 - Organization You will never be efficient among clutter. ORGANIZATION in a clinic is one matter that can have HUGE returns. As a matter of fact I am making this in ALL In BOLD large print!
-Hufreidy Instrument Management system/Cassette system
-Zirc Color Coding systems for procedures and product
-Inventory ordering systems
-Budgets for materials
-Efficient Scheduling using blocks of time
-Effective recall systems
8 - Periodontal Charting. So many of my offices have a 6 month "standard of care" for their patients. Yet, about 1/2 of these patients still have periodontal disease! They need more aggressive care. A "standard of care" that includes PERIO CHARTING and then EDUCATION. MORE VISITS. Different and more aggressive treatment.
9 - Dental Supply Audit. Some of my most profitable offices would have higher supply costs than some of my least profitable offices. Supplies are a VARIABLE expense - and often CHEAP products mean CHEAP results. More fails. If you are lucky you get to do the procedure again - but often these patients simply don't come back. Less Referrals.
This is my expertise. 36 years of product recommendations based on SUCCESSFUL products - the BEST products are not always the most expensive...but they may initially "cost more".
If your goal is to reduce your 8% supply cost to 5% - I would want to know EXACTLY what your fee guide is first. What procedures you are performing and what your productivity is first. I would like to TEACH you how to find EFFICIENT and QUALITY products first and foremost....then we can attack the supply costs.
When I perform a typical audit, I can find opportunity to reduce and replace inefficient and expensive products resulting in 10 - 20% savings. That gets you from 8% to 6.4%.
Once you learn how and when to order - set it and forget it.
10. WASTE Productive and PROFITABLE offices think about TIME as MONEY. If you have too much time between patients you need to train the front end how to book more efficiently. If you are waiting for your assistant because she is still cleaning up the last room or processing instruments - consider investing in more efficient systems to help them be more productive. If your hygiene team isn't producing 2.5 - 3 TIMES SALARY then consider how you can help produce more. It isn't by cutting the amount of time to chart either....it's MORE time educating with an intraoral camera, periodontal charting.....
Understanding that not all the time you use is BILLING TIME - its INVESTMENT time! INVESTING in education results in patients that will end up spending MORE TIME in your chair getting treatment. You will be needing to ADD more team members and you will get results.
WASTE is also about supplies. Have a team meeting where everyone plays "the price is right" about supply costs. This strategy alone will help reduce waste and cost. Most offices with HIGH SUPPLY COSTS have POOR INVENTORY management! They buy at the wrong times,change products mid stream, don't rotate inventory...
Usually it's a reflection of management. Is your own desk clean?
11. PRODUCTIVITY I have watched experienced dentists perform at high levels with minimal instruments and product. This goes back to KAIZEN! ALWAYS LOOKING for ways to improve while reducing waste and saving time. All the time you spend changing files for that endo...isn't there a 1 or two file system? Can't you just grab a bulk fill restorative and "fill it up" instead of bond, sandwich, cure, cure again, and cure again and then repeat for the next 10 minutes? Yes you can.
And you CAN stop worrying about whether it's good or not - just read a little. go to a course about it. It's good. Proven. Works.
How about shade matching? Quit worrying and pick an omnichromatic material perhaps?
Once you start to identify opportunity - you will get results. The rewards will be more time to perform more procedures...or maybe to take a break from the busy day.
You aren't ALONE in this! Make sure to INVEST in your team. Every minute they save makes you more profit as well.
12 Equipment I HATE salesmen who make it sound so easy. Just get this crown making machine...or should I call it a money making machine? Ya right!! I have seen so many of these gather dust after the doctor realizes the poor results....and yet I have seen the same machines produce INCREDIBLE results!
Why the discrepancy?
TIMEfactors. The people who realized that when they bought the equipment that there was still work to do in order to perfect the new machine. Education and constant improvement. Don't trust a salesman that tells you the ROI without adding in the time you need to invest to LEARN to use the machine and the cost of the FAILURES and REDO that you will have.
You SHOULD consider this equipment:
-HIGH QUALITY digital pan (not crappy image intro level)
-Rotary Endo System
13 BUSINESS OF DENTISTRY Understand that every dollar of PROFIT is worth up to 7X BUSINESS VALUE. If you can make an investment into Cad Cam and generate gross income PLUS profit of just $1000 a month, $12,000 a year - this is investable profit. You can use that profit to GROW your business further...you will also increase your BUSINESS VALUE up to $84,000 (based on 2019 EBITDA/Corporate offers for profit and cash flow).
14 FOCUS I have watched clinics go on "crash diets" or try to perform aerobics during in a rain storm. Keep your menu light. Make sure that the systems you implement can be maintained. They can't be complicated...or if they are make sure to take even MORE TIME to get good before adding another.
When you hear about people who lose a lot of weight only to gain it back - it's because they didn't try to change the lifestyle. The diet was punishing, difficult. The exercises made them sore. They hated it.
If you FOCUS on your practice. Be uncomfortable only because you keep taking it up another level - and eventually you will simply be healthy and happy.
I have been involved in a BILLION DOLLARS of Dentistry through hundreds of clinics. Worked through countless practice appraisals. Evaluated and consulted. There are still hundreds of other "bones" I have buried...all containing that juicy bone marrow that can nourish the wolf pack.
Here is a summary of the blog - if you are like me you probably skipped to the bottom and just want me to shut up and get to the point.
Focus on this list.
-Team members educate and invest
-Continual Improvement of skill level, speed, quality
-Market with impact
-Support community organizations and charities with sincerity
-Implement Perio Charting
-Use intraoral cameras on all patients
-Use the 3D scanner on all patients
-Use efficient materials like Bulk fill, SE Bond
-Invest in operatory turnover
-Invest in Practice management systems
-Recall systems are marketing tools
-Learn the business of dentistry
-Digital Xray invest in HIGH QUALITY IMAGES! Direct Sensor, Higher resolution Panoramic
-CBCT as well as the skills to perform procedures associated with the extra treatment
-Cad Cam - same day crowns
-3D printing applicances same day delivery
-Invisible aligner orthodontics
-Advanced education like KOIS, LVI, DAWSON, SPEARS ALWAYS pay off!
-Make your website great
-Be real on your social media
-Understand the ROI of materials compared to labour
-Audit your materials useage
-Get rid of WASTE - mostly TIME waste, but product waste as well