The Economics of Efficiency

Part 4 - The eight keys to high production continued

Instructors:

Dr. Chris Griffin, DDS

Dr. Chris Griffin, DDS

Dr. Chris Griffin founded The Capacity Academy in 2008, which focuses on helping dentists increase production and efficiency.  He has published several books and publishes an online magazine called, The Winning Dentist.

Dr. Griffin continues the eight keys to high production in a stress free environment.

Another thing about the staff. Now this is a point I would like to make. And it shocks dentist sometimes when I say it. But this is true. I had a staff in my practice for an in office day a couple of weeks ago. It was really interesting. I go back there and I’ve been talking to one doctor. And I go in and I’m talking to this other, I’m about to talk to this other doctor. And I go in and this doctor is basically getting shouted at by his staff. I’ve never seen this before and I’m like wow. I don’t know what to say. And so I’m trying to ease out the door that I came in cause I don’t want to get in the middle of this. And he’s like hey, hey, hey, Chris please come here. Come here. Help us. We got to have help. And so I stood there and I listened to his staff basically yelled at him and tell him that he expected them to do all these great things and never gave them good guidance and all these stuff. And so I started asking questions. I tried to stop the bleeding as quickly as possible. I tried to say hold up. Let’s just sit down and talk about it. And so as we got down to the basics of this, it turned out that in his practice he might give a directive but he didn’t really give it to any one person. But he would just sort of generally say it. Usually what would happen is that the staff members would sort of all look at each other and no one would really want to do it. No one would really do it. They kind of hope he forgot about it. It wouldn’t get done. It wouldn’t get done. He wouldn’t think about it for a couple of weeks. A couple of weeks later he gets mad. He starts fussing then everybody get their feelings hurt and they start fussing back at him and a couple of times several people had quit over stuff like this. And so what we established for his office and it turned out to be the only thing he really needed to be a superstar producer his need of chain of command. So I would encourage every single practice out there to have a clear chain of command, a clear chain of command. So in my practice, people are just not allowed to come up and talk to me during the day. I know it sounds terrible. My staff cannot, of course, they can chitchat. We talk about their kids. We talk about their nephews. We talk about what they like to talk about, you know, TV shows. But that’s just chitchat. If it something to do with business, if it’s a can I get off tomorrow or next week or anything to do with business or human relations, they’re not allowed to talk to me during the day. There are only two people that are allowed to talk to me during the day in my practice. Those are my two team leaders. Now I do this for a very strategic reason. If all those people are bombarding me all day long with all those questions I couldn’t focus on my patients and I got to be able to focus on those patients. So the team leaders take all that heat off me. They make decisions for me. If they have a question, they’re allowed to talk to me. But quite honestly part of their job description is being so good in handling stuff like that that they don’t come to me very much. And they handle it themselves. And then every month or every quarter we have meetings where we go through stuff. And that’s a very clear change of command. If I want something, you know, we’re training a new assistant if she misses up I don’t fuss at her. I go and I say to the clinical team leader and she trickles down until that new assistant gets that okay that’s what we need to do. So I’m not involved in directly instructing the new hires. And of course, the staff they’re not allowed to talk to them ad that’s the way I like it and that’s a really good way running your business if you can train team leaders to take the heat off you. Clinical excellence. We’re not going to talk a lot about this. I went to all those institutes and I love clinical excellence. I think it is very important. One thing I think is really important to build that base, that general base, I mean if you talk about something that’s overlooked I think. How about giving a shot. How many people give a shot that’s kind of painful and then patients really don’t want to come back. I think you spend a lot of time getting good at that. Get certified as much as you can because even though you’re building that general base you also want to have sort of like ace up your sleeve to be able to do an implant occasionally, to be able to do sedation if you need to, to be able to do braces if you need to. Hey a lot patient need braces. If you put up with aggravation it’s a great income source. So I think clinical excellence is you got to have it. But hey that’s not hard for us. We’re dentist. That’s one thing that we’re actually good at. Now the systems. Systems we go to have good systems. In my practice we have a system for just about everything. This is a picture of actually the system of me not having to stop a procedure if I have to physical sign a prescription in my practice. So what will happen is Lupita or whoever the assistant is they’ll come into the laboratory. Telling me they need me to sign something. I’ll stop working. Keep my glove on. And my glove may have spit and blood all over it, right. But they have this sort of big lunch lady gloves. They held it up. I slide my hand into it. Take a pen. Of course, the lunch lady glove is touching the pen, sign a prescription, then they grab it, drop it into the waste area of the laboratory and my hand goes back to work. All it touched was the inside of the lunch lady glove which was sterile. And now I don’t have to stop and change glove, wash my hands. They don’t have to do a lot of trickery to get the things sign. That’s just an example of one system we have. We have a whole book called the standard operating procedure book where we put all of our systems. And I think that that book, you know, if my house caught on fire, I’d get my kids out. I’d get my dogs out and my wife of course and the next thing I’d go is I’d go into my safe and I grab my backup copy and my standard operating procedure manual cause that thing is worth its weight in gold. Just think if you’ve already figured out a system why would you not record it. So you can go by to it in the future and you can train your staff again. Of course you would want to do that, right. A lot of people work hard to figure something out. Once they figured it out, they never document it. Now that’s no better than the ancient Mayans, right. They didn’t write a lot of stuff down and see what happened to them. But in your practice if you write staff down then when things, they’re going to mess up, right. They’re going to mess up so you can go back to your manual that has all your system in it and you can be like oh this is what we’re supposed to be doing. This is what we’re meant to do. Let’s get back on track. Now of course with any new systems in the practice, you’re going to always have staff push back. And it’s usually going to get looks like the one we’re going to show here. And your staff members were going to say new system, come on, are you kidding me. Cause they don’t want to change even if it’s for their better month. They don’t want to change cause they don’t like change. No humans like change, okay, especially not staff and even not doctors. Even when we know it would be so much better for us to change a lot of times we’re not going to but you do it. You got to get this system down to run the practice for you. You see what I’m trying to do is I’m trying to teach you how to get the load off your back and put the load on the system back. Let the system carried the load guys so you can be the dentist. There’s all kind of system you’re going to have to develop or you can develop front office systems, clinical systems, systems that link the front and the back together. We got a great one, what I’m going to talk about in a minute that sort of link the front and the back during a new patient exam. Then you’re going to want to do training. You’re going to want to do some ongoing training for staff. We no longer work on Thursday. So Thursdays are a great day for us. It may not be for you but for us we take two hours out of each Thursdays for trainings and meetings for each department. And that’s just something that’s exploded our clinical efficiency and of course our management also in the practice being able to do it. And the way we drew up a lot of these systems, it wasn’t like we sat down and we just had a meeting where we had a book to go by. We sat down actually after visiting one of the doctors we visit in North Carolina. We stop at Outback Steakhouse. We’re having dinner as a team. I actually took a napkin and borrowed a pen from one of the girls out of her purse and we just started jotting down a system for flow of hygiene patient checking out. Cause at that time that was one of the big problems we have was a lot of hygiene patients were having trouble getting out and the front desk were backing up and it was making the staff upset and the patients were upset. So we map out that system on the back of a napkin. Brought it home, developed it, recorded it, wrote it down, trained on it, and you know what that was six-seven years ago. We haven’t even thought about it again. It’s been done for that long and if it ever gets off track all I have to say is well let’s go back to the standard operating procedure manual and see what the system says. And sure enough we get if fixed. Doctor efficiency. Now everybody probably knows Dr. Howard Farran. I’ve known him for a long time. He’s been a big influence on me, a big friend to me. One quote of his I love is he said in 2009 he said, “I’ve said this before and I’ll say this again to the day I die. Faster is directly related to higher quality.” Now get that through your head. Now Howard Farran said it not me. I believe it too. But a lot of dentist out there think if you go fast, your quality is not good. But I’m here to tell you, the best surgeons go fast. Really the best dentist go fast even if they’ve done a complex procedure, a lot of dentist are not going slow, right. They’re going pretty fast. And I’ve witnessed some of the business in America. Nobody really go that slow. When I get dentist down to Mississippi for some training days, we got a mannequin in there. We’ll sit down and we’ll go through how to do a crown prep. And some dentist they catch on quick. Other dentist have bad habits like drilling for two seconds, stopping, checking, picking up the hand piece, drilling. These are things that you just may not realize you’re doing but you have to work on getting faster. Howard also said it’s a known fact that dentist who go faster do so because they know exactly what they’re doing. And not that the other guy don’t know what they’re doing but a lot of times you have bad habits you just don’t realize. You got to find ways to get faster. Then once you get faster, another trouble that we as doctor have in the practice is focus. Because if everybody is bombarding you with stuff and you don’t know which room to go to if you have more than one room going at the time, you’re going to lose focus. Focus is one of those things that a doctor needs because the patient really deserves your full focus. They deserve for you to be as focus on them as you possibly can be. And so this is something that we had created a system for. So here’s how we solve the problem of doctor chaos in our practice. We’ve got what we called the [RALT] board. This is kind of our eagle eye. In our practice, we have a board that’s located centrally. And it’s evolved over time. And trust me we tried it all. We tried software system, tried [live] system. None of that was as effective or as faster as efficient as this board. And so with this board, we record exactly where I need to be at all times. So if I’m working on a crown prepping here, then I don’t have to think about anything else that’s going on the practice. But as soon as I’m through with the crown prep, I step back into the hallway. I look at priority no. 1 on this board and I just go straight to that room. It tells me what’s going on. In this case maybe a hygiene exam. I go straight to room 3 or whatever and I think about that. When I step back into the hall I found priority 1. I go there. I don’t even look at the other stuff. The other stuff is for the staff and all the clinical staff update it. We do a closed-circuit TV feed on this that goes through five areas throughout the practice in our MI practice. One goes up front to the scheduler. They used to see exactly where I’m at at all times. So this is just something that my practice couldn’t run without. And the practices that I’ve coached and installed in their practices after just a couple of weeks and you get through that initial staff push back of saying we don’t need something like this. The doctor might even say I don’t need it. We’re not that busy. After you get it in your practice, you realize oh gosh I was thinking about, I was working on somebody and I was thinking well I need to be down on room 3 quickly or whatever. Now this is not something that you just throw up on the wall. You got to have some rules, some ground rules you have to learn. It’s not a big deal. The offices that we worked with, they seemed to get it in a couple of weeks like I said. Or you can even develop something for yourself that’s just really personal that helps you with this. But you have to find the way for the doctor to be focused on what they’re doing and not worry about what else is going on in the practice. You have to have a consistent reliable new patient acquisition system. Now you know we’re not marketers like I said. But you can certainly get some systems going to make sure that you have some marketing. You can start programs and let staff members take care of them. Let me share with you guys, this is actually one of the programs that we started that I’ll just share. This has been a huge boost to our practice, patient of the day. So we actually have one day each day the staff, they select the patient. They get the patient in and after their procedure they give them a little gift card like usually it’s Subway for $5 or a couple of movie ticket. They take their picture with them. We put it in our Facebook fan page. Now you talk about exploding your Facebook fans. The picture goes up and all of the sudden all their friends get push to this page. They like it or whatever. And so we’ve actually ended up with over a thousand Facebook fans and is primarily due to this program, patient of the day. I would encourage everybody to do something like that. But you need to have a steady stream of patients coming in and you have to work on referrals. Referrals always need to be the best part of your marketing. After a while, you can market it first to get patients in. But at some point there needs to be a deal where you’re actually getting more referrals throwing off those people that you get in from external marketing than what you’re having to pay for. Cause that’s really important cause those referral patients are worth so much more.