Market the Service and Manage the Process
There is a distinction between the results of the orthodontic service and the process by which they are achieved; orthodontists' training is strong on product and weak on process. That is why there is potential for a trained orthodontist in the process of management and marketing, and why it is helpful to listen to the best of the management professionals when they talk about the latest and best in their field.
In a recent article in the Harvard Business Review, Peter Drucker wrote about four innovative management principles and practices. The essence of the first of these is giving the frontline troops--the workers dealing with production--the responsibility for keeping production at a high level. They have more authority than traditionally has been assigned to them and the encouragement to be involved in constant improvement in the processes of production.
Orthodontists have traditionally delegated at a low level, letting staff people know what to do and how to do it, but not informing them about why they are doing it. Depending on how much information an orthodontist is willing to impart and on how much authority an orthodontist is willing to surrender (or is permitted to surrender by state statute), delegation can occur at four levels:
1. I tell you what to do. You do it. I check it.
2. You do it. I check it.
3. You do it. Let me know what you did.
4. You do it.
Information precedes delegation of authority, or chaos could follow; and while there may be some tasks in orthodontics that cannot or should not be delegated at Level 4, the amount of information will generally dictate the level of delegation of authority. Every practice could use a delegation review and a determination of how much information should be imparted and how much authority could be surrendered to good effect.
The second of the four concepts is a changed view of accounting. Cost accounting has been popular in the United States--it has even seemed attractive to some orthodontists--but its weakness has been in the emphasis on the cost side to the neglect of the benefit side. The old system looked exclusively at costs of producing, and not at the costs of non-producing. Non-producing is a significant issue in orthodontics.
Broken and canceled appointments together amount to around 14 percent of the day in the average orthodontic practice. This is non-productive time. Some of it is taken up with emergency appointments, but they are also nonproductive. In the average practice as much as 12½ percent of non-productive time, may be added by cases beyond their treatment time estimate. Time is lost in adverse tooth movements that are unintentional, as may be seen with distorted archwires and lost retainers, and time is lost with intentional adverse tooth movements such as the round trip. To these can be added poor scheduling, understaffing, and a number of outside interferences. Also, any time the orthodontist or a staff member performs a task that can be done or should be done by someone lower on the organizational ladder, productivity suffers. In all, orthodontists should account for both production and non-production.
The third concept is team effort. Until now it has been hard to have both standardization as a cost-control mechanism and flexibility as a competitive tool. In a factory, it means a reorganization into modules with their own balance of standardization and flexibility. In orthodontics, this might be expressed in the computerization of the practice, in which each aspect has individual needs that must be coordinated with the whole. All employees will have to know the whole practice plan. They will have to operate as a team, but each one understanding his and her place in the big picture of practice success.
The fourth concept is systems design. In orthodontics, it involves quality control of the processes that are involved in the service and in the delivery of the service. Drucker would view the orthodontic office as just a wide place in the road that stretches from figuring out how to attract referrals to successful completion of treatment. The whole process must be viewed as a problem of integrated flow control. Few companies have enough information about their plants to run them as systems, and few orthodontists have enough information about their practices to run them as systems.
As Drucker says: "In the systems concept, the factory is not a place at all; it is a stage in a process that adds value to materials. This is all about performance, technical analysis, organization design, work flow, planning. It is a view that the manufacturing process is a whole that is greater than the sum of its parts. In the new manufacturing concepts, the process produces results and the emphasis is on the process."
Adoption of these concepts should change orthodontic management. Orthodontists will clearly need to know more of the details of management throughout the practice. They must go from functional managers to business managers, as Drucker says, with emphasis on the process; and the practice will have to be a team effort. Some orthodontists have recognized this without Dr. Drucker's help and have moved in that direction. The rest must follow.