Time waits for no one

14 October, 2019 / management

Working smarter not harder takes effort, willingness to let go of old ideas and desire to embrace change

[ words: Alun K Rees ]

Confucius said: “We have two lives; the second begins when we realise, we only have one.” This article is about time, how we use it and how we waste it. Successful people use time well. They have the same amount – there are no more minutes, hours or days available – and yet they accomplish more in their allotted span.

Time is the greatest stressor in most dental businesses, yet it should not be. Time requires thought, measurement and planning. Dentistry has ‘3Es’. It must be ethical, doing the right thing for the right reason; effective, it must work; and economic, it must give value for the patient and provide a profit. I would add to those my ‘2Es’, efficient and ergonomic.

My first job in general practice was in an NHS ‘amalgam factory’ treating patients with relatively high needs; prevention hadn’t been adopted. Quadrants of teeth were filled at a sitting, patient after patient. We worked ‘six-handed’ with one close support nurse and one ‘floater’. I learned a lot, earned a reasonable amount and hated it. Treadmill doesn’t do justice. Instead of a professional relationship with patients, I was working on a production line of mouths.

Two things happened. I read Harold Kilpatrick’s book Work Simplification in Dental Practice, and I started my own practice – so was free to experiment. Kilpatrick’s book was published in 1964 but the lessons remain. I took on board the lessons of Ellis Paul and Martin Amsel about posture and respecting your body. 

One change was to say to my nurse when she asked me how long I wanted for a procedure: “Book as long as you know I will take.” 

That one, offhand, comment freed me from the huge pressure of my associate years. The dental mantra, ‘fill the book’, was left behind and I focussed on my ‘2Es’.

An efficient system is ‘maximum productivity with minimum wasted effort or expense’. An efficient person, ‘working in a well-organised and competent way’. 

We looked at how I spent my time both in a macro and micro manner. There were large chunks of my days when I was not doing what only I could do, times when I could have been usefully employed not ‘waiting’ and the times when I was working could have been shortened.

Every stage of every procedure was broken down into its constituent steps and examined. Adopting ‘hygiene-led recall’ meant that I was free to effectively use two rooms (three when seeing children during their sessions). Having something else to do meant that ‘local waiting’ time was utilised.

Working with a close support nurse meant that I never looked away when doing restorative dentistry. Using good light and magnification makes working better but moving your eyes hard work. 

Great surgeons are fascinating to watch because, like musicians, their hands hardly move. I was not instinctively a great operator and knew I never would be, but I watched and learned.

Our set process for every procedure meant that my nurse always knew what to expect next. Which instrument, bur, material, and procedure. Their life was easier with no surprises. This did not happen as if by magic, it took practice, practice and more practice until my team and I were like dance partners.

I took inspiration from the chefs whose policy is mise en place and prepare dishes and ingredients before the beginning of service. 

In the same way that a good chef will know that their knives are sharpened, their surfaces cleared and ingredients ready before the start of a session, my team knew a day ahead what equipment would be needed for each and every procedure and it would be ready when we started. No wandering around searching for instruments, lab work or materials when the patient was ready.

One important tool was a timer; we knew how long materials took to set and how long each stage should take. Everything from the time for topical anaesthetic to the length of time to give a painless local was known and measured. 

Did it suit everyone? No, a couple of nurses during maternity breaks could not cope and would not adapt because they were ‘already competent’. There was always another cab on the rank.

The result made my life easier, the procedures optimal for all concerned and stress levels lower. Was everything perfect every day? Of course not; life is never that easy. Did we keep learning and improving? Definitely. Was the system adaptable for emergencies? Certainly. 

I went from a five-day to a four-day clinical week. I was less tired at the end of the day. Operative work was more satisfactory and easier. Appointment lengths worked and we rarely overran. The flexibility in the appointment book worked for us.

The cliché is work smarter not harder. It can happen but it takes effort, willingness to let go of old ideas and desire to embrace change.

About the author

Alun K Rees BDS is The Dental Business Coach. An experienced dental practice owner who changed career, he now works as a coach, consultant, trouble-shooter, analyst, speaker, writer and broadcaster. He brings the wisdom gained from his and others’ successes to help his clients achieve the rewards their work and dedication deserve. 

Find out more, visit: www.thedentalbusinesscoach.com

Categories: Magazine / Management

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