Measuring success

Dr. Roger Levin explains how to audit your management systems

Your endodontic practice already has systems — how you schedule patients, procedures for collecting overdue accounts, the way you present cases, techniques for generating referrals, and so on. But are your existing systems serving you well or actually working against you? If you and your staff have not performed a thorough systems audit within the last 3 years, you could probably be bringing in the same revenues — or even more — with less effort and stress.

Tweaks and bottlenecks
The problem with most practice systems is that, no matter how effective they may have been when first implemented, they become obsolete over time. Conditions change, and systems that don’t change with them gradually lose both effectiveness and efficiency. When procedural stumbling blocks begin to show up, staff members try to compensate. Improvising stopgap solutions, the team adds new steps, allocates more time, tries taking shortcuts, and settles for less than ideal results.

Whatever you call these measures — patches, workarounds, tweaks — they don’t fix systems that are breaking down. If anything, they obscure the problems that need attention and allow bottlenecks to accumulate. Better by far to acknowledge that every system will someday need to be replaced — not tolerated or updated, but redesigned from the ground up.

Start with performance targets
To create a new system, define what you want it to accomplish, specifically. For example, think of a scheduling system not merely as placing patients in openings in your schedule but as how your front desk coordinator balances the workload every day. The objectives are to avoid peaks and valleys, schedule all consults and treatment within 7 days, use scripting and confirmations to keep no-shows and cancellations to less than 1%, etc.

Setting targets will not only guide system design but also enable you to gauge the effectiveness of the resulting systems, evaluate the performance of staff, and monitor your progress toward practice goals.

Create each new system step-by-step
To design a system, assemble a small team consisting of you and/or your office manager, the staff member(s) who will use the system regularly, and perhaps others who are directly affected by what the system accomplishes. Ignoring the existing protocols as best you can, go through the entire process the system will control, carefully designing each step and allowing for different paths based on various patient responses and other specifics that will be encountered.

As you near completion of a prototype, define every step specifically in writing. At this stage, you may want to test the prospective new system in real situations to see if there are any unanticipated “bugs” to be eliminated.

Prepare detailed system documentation
Once you’ve finalized a new system, write a detailed description of how to use it, including every step involved. This documentation is very important. It means that if the only team member who knows a system leaves the practice, you won’t be forced to reinvent the step-by-step process. Also, the written description will serve as the basis for thorough staff training —without which even the best system will fail to achieve the desired results.

Using the main system documentation as a resource, you should generate two types of additional documents:

1. Training scripts
Most of the systems an endo practice relies on involve interactions with patients. Scripting makes it relatively easy for staff members to say the right things in order to get the right results. Scripts are not meant to be memorized and followed verbatim. They provide conversational guidelines and key message points for team members who should be encouraged to “translate” scripts into their own words. One of the greatest advantages of using scripting is that it lends itself extremely well to training. Role-playing among staff members enables them to master the systems while they learn their scripts. Their competence and confidence increase quickly with script-based training. This approach also has great value in staff cross-training and, of course, in training new employees.

2. System quick guide
This is a simplified checklist of how a system should work. Regular users should refer to this document frequently to ensure that they will not begin drifting back to old habits or leave out any steps. The guide is especially important when introducing a new system or when a new or infrequent user is about to work with the system.

Train team members to excel
As discussed previously, team members need to learn exactly what they are expected to do with their assigned systems. Their training should include not only the “how-to’s” but also the “whys.” Acquaint staff members with the practice vision and goals — how the performance targets they are responsible for will serve as steppingstones for reaching those goals, and how the systems they use will help them achieve the desired results. Keeping team members in the loop will empower them, increasing the level of both their performance and their job satisfaction.

Be prepared to repeat the whole process
Go through the process described, and you will create new systems that are far more effective and efficient than your old systems. But conditions will continue to change, and your new systems, excellent as they are, will also need to be replaced eventually. Having the best systems is not a goal; it’s a process. Master it, and your endo practice will thrive, whatever changes the future may bring.