Time and Motion DOES Equal Money … More or Less by Sally McKenzie, CMC

Don’t get sensitive on me now, Doctor, but I’m going to cut right to the chase … and that may cause you a bit of a pang here or a cramp there. The dental practitioner often takes the prize for being the most time and motion inefficient member of the dental team. And as a result, they’re so caught up in redundant or unnecessary steps that they fail to recognize their own inefficiencies.

How many times, for example, do you change burs in a crown preparation? Every change represents time and money not earned. How often do you have to retake impressions? How many times do you have to adjust a crown? How many times do you have to take your own x-rays? How many times do you reach for the air and water syringe? How many appointments does it take you to do a root canal? And so on, ad infinitum.

According to Phil Devore, DDS, Clinical Director for McKenzie Management, one of the most common inefficiencies is not doing all the work in a quadrant at the same time. “Look at all the efficiency that would come with seating the patient only once; using one bib; numbing only one time; and only one treatment room clean-up to boot!” Dr. Devore points out that even when doctors do complete all the work in a quadrant in one sitting, they are often inefficient within that quadrant. Say, for example, that there are three fillings to be done in a quadrant. Many doctors will start and finish each one in turn, despite the fact that it is far more time and motion efficient to complete each step on all three teeth before going on to the next step and new instruments.

Our time and motion squad is really good at exposing everything from the absurd to the ridiculous. Here are a couple of examples: A clinical assistant is standing over the sink, tenaciously handscrubbing instruments while the doctor is in the treatment room with the next patient, not willing to begin the preparation because HE CAN’T FIND HIS ASSISTANT!

Despite the fact that there’s a 3pm opening in the doctor’s schedule, the business coordinator is busy filing estimate-of-benefits stubs from insurance companies into patient charts.

What’s wrong with these pictures? Time and motion inefficiency. In an effort to help make your staff more time and motion efficient, let’s scan several job descriptions and see if we can improve things. Each job description can and should be responsible for some portion of the overall financial success of the practice.

Business Coordinator – This is the same gal that was filing EOB’s into patient charts when she should have been making calls, trying to fill a hole in the doctor’s schedule. What’s more important to the practice … filling the schedule to achieve daily production objectives or filing EOB’s? Obviously, tasks that are a priority to the financial success of the practice are getting left behind. Perhaps making those calls is not in her comfort zone because she’s introverted or has trouble handling rejection. She may simply be the wrong person for the job or simply has never been asked to prioritize her tasks with regard to what’s most important to the practice.

Dental Assistant – Although she might be commended for her perseverance in handscrubbing those instruments so meticulously, it will be better for all concerned if instruments are placed by set-up (wrapped with a pipe cleaner, for example) in the ultrasonic cleaner. That action would be 16 times more effective than handscrubbing and free her to assist the doctor. while we’re on the subject of time/motion efficiency, here are some other considerations. Placing plastic in operatories as a barrier takes less time than spraying, wiping, and spraying some more. Wiping spatulas or instruments before materials harden takes less time than having to use a jackhammer later. Having materials contained by procedure takes less time to retrieve than materials stored in five different places. Completing a laboratory prescription chairside while waiting for the impression to set up makes efficient use of time versus writing it up after the patient has left.

Hygienist – The greatest efficiency here is to customize the procedure to the patient, rather than trying to fit the patient to the standard treatment. Patients have different mouths; with more or less calculus; probing tongues; gag reflexes; and of course, those patients who like to talk too much. Delivering hygiene treatment in less time while maintaining the same quality represents an important challenge that should be addressed. Instrument preparation and treatment room turnaround are identical to that performed by the dental assistant. The concept of providing an assistant to the hygienist is actually no different from the doctor having hygiene salaries when calculating department profitability.

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Sally Says: The essence of time and motion efficiency is to understand where you’re going and the most direct route to getting there.

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Sally McKenzie, Certified Management Consultant, is a nationally-known lecturer, author, and consultant to the Council on Dental Practice of the ADA. She is President of McKenzie Management and Associates, which provides in-office analysis of the business, clinical, and hygiene department; conducts on-site staff training; and offers a full line of educational management books, audio tapes, and videos. For more information call Sally toll-free at 877-777-6151. Visit her web sites at: www.mckenziemgmt.com   www.practicemanagement-online.com   www.dentalcareerdevelop.com