Dental Systems Unlocked: The Key to Efficiency and Growth

https://Drmoorhead.com

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William J. Moorhead DMD has developed and teaches systems and strategies for overcoming the challenging issues most practices face with absenteeism, turnover, lack of quick and adequate training, and high overhead.  

Sometimes affectionately referred to as “Dr. Checklist,” Dr. Moorhead speaks across the United States on topics related to systems management, clinical efficiency, dental technology, medical emergencies, treating anxious patients and leadership. Dr. Moorhead practices full time in Flemingsburg, Kentucky,  is co-founder of IV Sedation Training for Dentists LLC, and is also the founder and owner of StreamDent® software.

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Transcript

  I had like to welcome Dr. Moorhead to the show. Welcome. 

Christine, thank you for having me. It's a delight. 

I am so glad you're on the program today, and usually we just get started right with the questions. So let's go.  You're an expert in systems managements for dental offices, so how do you define the term systems  and how does it apply in dentistry? 

Systems is an organized way of  making your workflow to where you have  way to hold yourself. And  others that are using the system accountable.  Uh, so for instance, uh, you're going about a set of tasks and the usual way without systems is we depend on our memory and experience to remember to do everything the right way each time.  But the trouble is we're human. We're fallible, we get interrupted, we get busy, we get too much going on. We try to multitask  and ultimately we wind up dropping the same balls over and over again. 

Yeah, definitely that happened. So how did you get started doing this? 

It's an interesting story and a kind of a scary story. It was back in 2009. Uh, I, I, I do IV sedation in my office, moderate IV sedation, and I trained other dentists to do IV sedation now, but back in oh nine, I was new to it. I had done oral sedation for  nine years, pretty much knew my way around. But, uh, long story short, I had a patient in.  Uh, 70 years old, I gave him a tiny dose of a sedative as we're taught with older patients because they're more susceptible to those sedatives, and his breathing slowed down. But I'd seen that plenty of times before. So, uh, like you're taught in basic life support, I tipped his head back,  and I reached for the oxygen,  and I turned on the oxygen  and nothing happened. 

Wow.

We wear radios in the office. I rather angrily radioed somebody didn't turn on the oxygen, get it on now,  and it what seemed like an eternity later is probably  30, 45 seconds. They come back on the radio and say, doctor,  all of the oxygen tanks are empty  now. It worked out. I was able to give the patient a reversal agent. I was even able to keep the appointment.  But that was a wake up call. It, it, it caused me to panic. I, I was rattled and didn't have any checklists on what to do. I knew what to do, but I got too rattled to react promptly.  And like I said, it could have been a very life altering situation for both the patient and me.  thankful it wasn't, but that was the wake up call that got me interested in doing things differently. 

Yeah, I can only imagine. That is just so scary. So, um, by doing these systems,  what are some of the advantages  to using that kind of approach? I. 

The system has your back instead of a team member or even a doctor, hygienist, whoever, getting blamed for something.  As long as everyone's using the system. When there's a system failure, you look at the system and solve the problem.  instead of pointing fingers,  you work through it and use it as a learning opportunity.  And  the system's build on themselves and you continue error proofing them and finding different ways to tweak them, they're never static. You, they, they've constantly gotta be revisited. But when a problem happens. You fix the system? 

Yeah, and, and, and this is just not just for the business side or the business office.

As a matter of fact, I see a lot of DSOs, uh, that feel like they have their system strong, but they haven't tackled the clinical side where all the production happens, where the, the, the good stuff, in my opinion happens. Um, and, and that's, and I'm not just talking about.  life-threatening, like IV sedation, we wind up, uh, having to do things over, remake whatever, whatever.

Because we didn't follow a system, we followed our memory and we're fallible. 

So what are some examples of how you would apply systems in the clinical setting? 

Um,  first of all, direct me, what direction do you wanna go? Do you wanna go hygiene? You wanna go exam, you wanna go  a doctor procedure? 

Um, why don't you do hygiene? That would be great.

Okay. Um,  say for example, that a hygienist is using a hygienist assistant.  and there are some offices that can make that work well, especially if there's multiple operatories. There's some that are not, I'm not advocating for that, but I'm gonna use that as an example. So you have a hy assistant that is, does not have a degree like a hygienist or a dentist.  Uh, many of them will have a high school degree. Same thing for the dental assistants on the, the doctor side.  Um, yet we as dentist and hygienists expect them to be able to perform at our level, and that's not fair.  we give them the tools.  So if the hygiene assistant, let's say you've got a patient scheduled on hygiene for a new patient, prophy,

Mm-hmm.

in that new patient prophy, uh, there's going to be a medical history workup. There's gonna be radiographs, uh, hopefully photographs or scans. Uh, there's going to be  probing. There's going to be, uh, a, a prophy or some sort of. Periotherapy as time permits and there's going to be a doctor exam.  That's a lot of little pieces of the puzzle that have to come through to be able to go, well, if the hygiene assistant, for instance, is trained to be able to  use handoffs and I, we can come back to that if, if you're not familiar with the concept or if you want me to talk about it with the, with the audience. But if the dental assistant is properly trained with those handoffs.  he or she can be able to make the process smooth so that uh, he or she can go over the medical history and remind me to come back and talk to you about some really cool tools for, for medical history updates and just a little bit. Uh, but they can go through the medical history because they've got it on their checklist. They know exactly what photographs that they're supposed to take. They can know in the medical history what. Follow up questions to ask, even though they don't have a degree. If you give them the information with the system,  uh, they can then call in the hygienist, give them a handoff on what's been learned.

Referral source, what's important to the patient, the chief complaint, their, their, uh, motivating factors, obstacles that are in the way.  Hygienists can perio probe with the assistance help.  Uh, then, uh, hygienists can talk about needed periotherapy, have the doctor in one of the other, the hygienist, or the, the dental assistant is giving a handoff to the doctor.  of those little things can be very smooth by using a training checklist. 

Yeah, I like that. I really like that a lot.

then,

what a, oh, go ahead.

let me mention, for someone that's experienced. You don't want to slow them down with a lengthy checklist. So checklists are by design, supposed to ca capture the key parts.  if it's repeat, repeat, repeat, repeat,  common knowledge, you don't put on the checklist. For instance, how to set up the room  except for someone that's new. 

Right.

I use double checklist, so we have things that will pop open for the newbies to learn on how to clean up the room, how to turn around the room afterward, those kind of things.  I'm sorry for interrupting. Go ahead, Christine.

Okay. No, that's okay. I was just wondering. So, all right, so we got the clinical team, the hygienist in the back. What about the business office? So I'm sure there's systems in place that are good for that as well. 

Uh, from the first phone call, um, when the phone call comes in, the business assistant might not have been in that office for two weeks,  what if they had systems so they knew exactly what you wanted them to say? I. And whether no matter whether the patient called for a  a new appointment, whether it's for a prophy or exam, whether it's for an emergency,  if they're scheduling to  calling to schedule their next appointment, their recare, uh, any of those scenarios, uh, if the  business assistant has at their fingertips  checklist to be able to go through what needs to be said.  In the fewest words possible.  And again, we don't want, I, I, I, I like the concept of scripts, but I don't like the concept of scripts. I like to have some words  the page or the digital page to be able to teach someone what needs to be said.  But I don't want,  I, I don't want anyone that trains under me to sound like, do you want fries with that?

Right.

Points to, to help teach them and then let them run with, with, with what they know. Uh, I have, I keep separate checklists for experienced people and admin checklists. The minimum number of things that someone that's experienced needs to know to handle each of those phone call types. 

Yeah, and I'm sure that's appreciated. 'cause I know as a, you know, a seasoned hygienist, you know, having like  a checklist that's for a new grad would be a little frustrating for somebody like me.  So have you found ways to apply other business models,  um,  to dentistry? 

That's a good question, Christine.  there are concepts like, uh, Sigma six, lean manufacturing  have been made popular by, for instance, Toyota and Japan,  to look at every step of their, for instance, with Toyota, their assembly line,  and figure out where the bottlenecks are, where the capacity issues were, and be able to solve those.

Yeah, we can apply those same concepts to dentistry. And let me give you an example.  Many offices still  get their instruments out,  arrange them on a tray  out of a bag,  and the process, they wind up taking very little time at the end of the procedure to get 'em all up. They dump 'em in the ultrasonic, then the time investment comes up, sorting the instruments out if there's two or three trays in there. And the mistakes that happen with those.  Uh, then into the autoclave  then  ba uh, and then bagged and, and waiting again.  You can, the, the rate limiting step. We're talking now industry concepts. The rate limiting step in our sterilization and instrument turnaround process is the autoclave.  It takes about 75 minutes to run  a cycle of bagged instruments, whether they're in a bag, a cassette, whatever.  If they're cassettes, it might take a larger autoclave, but the rate limiting set is about 75 minutes.  If you use  cassettes to where,  it leaves the operatory, before it leaves the operatory, the rule is  make sure that all the instruments in there, in the cassette and the cassette of the number of, uh, instruments that ca the cassette will hold  Hole in the cassette has an instrument, even if you don't need it. So put an extra mirror or two in there  so that the hygienist, the assistant can see,  okay, everything's in there. I can close it up. Once it's closed up and it goes out of the room, then there's no mixing up, uh, instruments. Between cassettes, everything's going to be there. You can use an instrument washer instead of an ultrasonic.  That will take more time than an ultrasonic, but it's less time than the autoclave, so it doesn't matter  in the process. The number of minutes that the instruments take to go through the cycle  are identical,  but the amount of time  labor for a sterilization technician to spend and for the dental assistant or hygienist to turn around their room with the instruments is markedly less.

I. 

Wow, that's really interesting.  So how do you get started creating systems for your office? I. 

I teach my clients and, and I own them. I won't make this thing commercial, but I own a company  online checklists for running a dental office.  Whether they're using my concept or they're making their own, I teach, I.  that when they're starting out  to look at your pain points, look at where the biggest problems are and start there.  And I, I, I was embarrassed back in 2021, I was lecturing at my state dental association  and on one of the evaluations, the doctor put,  is all well and good, but you could never have time to do all this.  And I, I had made it an non-commercial presentation. I didn't show anything about. Digital checklists,  but it smacked me in the face.

I had never stopped to realize,  I've gotta teach doctors,  for instance, on the doctor clinical side.  In a GP office, there's maybe 10 or 12 procedures that we do  that are 90 to 95% of what we do every day.  You don't have to to make this work, you don't have to have checklists. For everything we do. I've got that eventually I've gotten that done.

Eventually. I've been working on checklists for my office and for, uh, for what I provide commercially for now, uh, 15, 16 years.  look at the pain points. Start there,  whether clinical, whether business office, whether hygiene, whatever. 

So how does anybody ever find time to do all this, though? Really? I mean, you're setting up the systems, it sounds like it's a massive undertaking. I. 

It, it, it can be a messy undertaking if you look at the entire elephant.  I think you might have ordered the expression, uh, one bite at a time.  little pieces, uh, I started on this during the great recession and when I didn't have a patient, when I had a cancellation or an open hole, I started working on them.  Um, but, uh, there's a concept that the, uh, Stephen Covey people teach on, uh, being able to look at time management and  what we spend in time reacting to emergencies and urgencies. We wind up wasting a lot of time where if we spend things, if we, if we plan time for things that are  but not urgent.

Uh,  wind up getting ahead a lot.  a book by a, uh,  an author, uh, the, the book is Take the Stairs. I'm, uh, blanking at right now on the, author. Um,  but he teaches in one of his concepts, uh, long-term  difficult leads to, or, I'm sorry, short-term difficult leads to long-term easy  side.  If you flip it around and, and if you're doing it  term, difficult, you're going to have, or if, if, if you're going upfront easy, you're going always going to have the long term difficult. So it's about planning and making your life easier. 

Yeah, I love that concept. So a lot of the listeners out there are established practitioners and they've been running their offices for years without systems. So why would they want to change what they're doing when things seem to be fine? 

Well, if they're fine,  do they wind up, uh, during a procedure, having to stop a couple of times during every procedure and have someone run and get. Something that's not in the room  and add up how many times a day that happens and  it might wind up that you could see an extra patient in all the wasted time. 

Sure.

And then in training new people, we have had since the pandemic and so many people leaving dentistry, we have had to train so many people. DSOs understand this way better than anyone in dentistry.  And with all of the training that we have to do,  systems can make it very practical to bring someone new that is, has no experience in dentistry, and get them up to speed quickly and to give you a, a, a, a really good carrot to dangle out in front of you.  I can routinely take someone that has no prior experience in dentistry,  it's in the business office or in the clinical side.  Now, I'm not talking about hygiene that requires a license. I'm not talking about a dentist that requires a license. I'm talking about the auxiliaries, the assistance, the hygiene assistance, the business assistance. I can routinely take some with no experience in dentistry  and have them at the competent stage where they can do it on their own or look it up on their own with the systems  in six weeks instead of six months, 

Wow, that's invaluable. 

and I've done it over and over. 

Well, this has been such a great talk today, Dr. Moorhead. So, um, if people would like to get in touch with you because you've got these great systems that they can use, how do they get in touch with you?

Um,  they want to look at digital ways to do checklists, uh, they can look@www.stream dent that's like streamlined dentistry, S-T-R-E-A-M-D-E-N t.com.  Uh, my speaker website, my last name Morehead, is spelled a little differently. Uh, it's www.drmoorhead.com. I'm sure Christine will have that in some notes that you can get at.  Um, and my  email address is dr  dot m as in Dr. morehead@streamdent.com, phone number, Google voice that rings my office and my cell.  5 0 2 5 0 9 1 5 7 0. 

Well, thanks so much for coming on the DSO Hygienist podcast today. I really appreciate it.

Thank you so much for having me, Christine. It has been a pleasure.