John Meis (00:01.582)
Hey everybody, welcome to this episode of The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Hey Wendy, how you doing?
Wendy Briggs (00:10.509)
I'm good today, how are you, John?
John Meis (00:12.654)
I am doing awesome. So we are talking about our model and how practices come to a higher level of performance. The last one we talked about patient flow and how necessary that is and how to adjust up or down. And today is efficient delivery. So I'm excited about this topic because there is so much variation from the best to the worst when it comes to efficiency in an office. So we're going to talk a little bit about how we look at it, we're going to talk a little bit about how we measure it, and we're going to talk a little bit about how we improve it. Sound good?
Wendy Briggs (00:51.629)
Yeah, I love this topic. Absolutely. You know, we love talking about this, especially because there's so many, I guess, misconceptions out there. There's so many circumstances where we hear, you know, the opinions of the masses that can lead people completely the opposite direction of what we see can really have an impact in profitable practices and practice growth. You know, our practice growth formula, is really a roadmap for practices, if you will. If they follow these things and they focus on these vital systems, we've seen tremendous things happen. Well, the opposite is also true. If practices follow some maybe well -intentioned but poor advice, it can have a huge impact on limiting their growth and holding them back. These practices often reach out to us and say, we've hit a ceiling or we've seen that our practice was growing, but now we've started to see a slow decline. And often when we dig in, it's related to how well we're caring for patients, which we define as efficient delivery.
John Meis (01:56.686)
Yeah, it's so true. And right now with all of the pressure on dental practices with reimbursement dropping, with costs rising significantly, we're seeing practices consider things that make us cringe because we know they're simply stepping on a landmine. They're trying their best, obviously, to solve a problem. But the way they're going about it is going to be problematic and it's going to have the opposite results of what they hoped for. So let's talk a little bit about, you know, kind of the key factors of efficient delivery.
Wendy Briggs (02:31.917)
You know, we often struggle with this because we try to narrow it down to three really critical systems that can help with each one of these profitability drivers. And this one's really difficult to limit to just three. There's so many systems that can really have a powerful impact here. I think probably more than anything though, we did decide on three. Scheduling for success has a tremendous impact on efficient delivery.
We also see the hygiene explosion process, which we'll talk about in more detail, can have a tremendous impact on efficient delivery. And then the third system is same -day dentistry. All three of those, when done well, transform a practice. And all of a sudden we've got a team that understands how to work together better. And they really elevate not only the care we're providing, but the way in which we provide it. Dr. John, you know, we're a big baseball family around here. And it's, we're in the thick of baseball season. And this year has been an especially exciting year for us Dodger fans because we have some, you know, really incredible talent that have joined the team and it's just been fun to watch. Well, I've got a baseball analogy if you'll humor me on efficient delivery, and then I'll relate it to dentistry because this really does apply. Some baseball games take hours and hours and some baseball games are a lot faster.
John Meis (03:42.67)
Ha ha!
Wendy Briggs (03:53.613)
Well, that was before this year because they made a critical change to the rules and the change was there's now a pitch clock on the pitchers, right? They have only so much time to deliver their pitches. And if you look back, I think this has been a tremendous change. I know there's some baseball diehards that hate it and think there shouldn't be a clock on baseball. Like I understand that level of thinking, but this really does bring to mind, you know, what we deal with in dental practices because you can have two pitchers that are very, very talented at the top of their game, but the time in which it takes them to deliver a pitch can vary dramatically, right? So in dentistry, we see the same thing. We see some dentists, the product that they deliver is excellent. There's really not a difference in the quality, but some dentists can deliver that product much more quickly. So when we look at...
John Meis (04:31.054)
Yes.
John Meis (04:46.126)
Yeah.
Wendy Briggs (04:46.765)
you know, what are the key differences there? It's often not necessarily in what they're actually doing in the moment, but it's all the other things. It's the prep work. It's those types of things. The teammates that they're working with maybe don't know where things are. You know, there's all those other things that can really have a negative impact on how well we're delivering care, much like the pitchers, you know? So I wish it were as simple for us dentistry as to just institute a pitch clock.
John Meis (04:56.014)
Yes.
Wendy Briggs (05:13.805)
Right? Turn on a pitch clock. And this is how much time you have. And then it's like an episode of Chopped, right? When the buzzer goes off, you just step away. It doesn't work that way in dentistry. And it's not quite as easy as just instituting a pitch clock. But there are some things, some vital systems that we can do to help really deliver care. Still the same quality, you know, excellent quality care. That's really critical. We don't want to sacrifice that, but we can do it more efficiently.
John Meis (05:27.15)
Yeah.
John Meis (05:38.638)
So if we think about how we measure that, you know, it's for pitchers, it would be pitches per, you know, pitches per hour or pitches per minute or whatever. It would be a, how many did you deliver over how much time in dentistry? Because we're not doing exactly the same thing. A pitcher, it's a, it's a pitch every time it's a pitch. we're doing different things. So we look at it a little differently. We look at productivity per hour.
And the range that we see among dentists, among our clients, is some dentists producing at $300 an hour and some at $16, $17, $1800 an hour. And so when we talk about efficient delivery, that's a really good measure to use because it gives you an idea of how much throughput you're doing over a given point of time. So one of the main ways of improving that is with scheduling and scheduling properly. The trick with scheduling properly is to have your time filled, be productive the entire day, never having any point where you're running around with your hair on fire, and never having any point where you're mentally exhausted and you have to take a break. So steady throughout the day is what wins. So that requires a lot of systems, doesn't it, Wendy?
Wendy Briggs (07:02.765)
It absolutely does. And I can tell you, this is always a fine line. And I would say it's a very common point of contention in a dental practice, right? We have dentists who by nature are very particular and they turn into like an excellent schedule watcher, right? So at the very beginning of the day, they're looking at the schedule, this isn't gonna work. We need to move this patient down. We need to shift this here. We need to cancel this patient.
There's a lot of that that's happening when in reality, in the moment, it often tends to work itself out. Also, I would say, I've heard you talk about this as well, that schedule watching dentists are less productive than dentists who don't watch the schedule.
John Meis (07:44.622)
Yeah, for sure. And you schedule watchers, you know who you are. You're always looking down the schedule. You're looking later in the day and you're not looking for ways. Typically, we're not looking for ways to add more in. We're looking for ways that it's not going to work and we have to change this and adjust this and do all this. So schedule watching doesn't work, number one, because you're looking at how to do less. Number two, you are using mental energy and time to do that.
And number three, you're changing a schedule that you don't even know. You know, the schedule is our partner. Heather says the schedule is only a suggestion because nobody has the same schedule from the beginning of the day to the end of the day. So you're changing things that might have fell apart anyway. And one of the dentists that I worked with and he was a wonderful dentist and a really wonderful man too, but he was very much a schedule watcher. And I was like saying, instead of spending this time looking at that, why don't you go take care of this patient who just had a single tooth restoration diagnosed in high -teen? Why don't you just go do that? And we'll figure out what happens later in the day, later in the day. But he just, he couldn't do it. He was just so, I guess, anxious about what might happen later in the day. So giving that up.
Wendy Briggs (09:06.093)
Right.
John Meis (09:07.374)
focusing on what's here right now, doing what's right in front of you right now, it's a much better way to spend your time.
Wendy Briggs (09:14.829)
Absolutely, Dr. John, you mentioned the importance of systems. I think having clearly defined systems in place when it comes to the schedule is an important element as well because it does diminish the conflict, right? But there's still always this conflict. There's gonna be doctors who come to the front desk and they're not happy with the schedule and so they're griping about this thing or this thing. And then you have people at the front desk that are like, gosh, you know what, we can't win. If the schedule's full, then we get in trouble. But if the schedule's not full, then we get in trouble. And so having those systems clearly defined so that everyone knows what our expectations are is the first thing. But also, like you mentioned, recognizing that the schedule is often a living, breathing thing and is never going to be perfect. There's a system that some software companies developed called Perfect Day Scheduling. And even just the title of it makes me laugh because there is literally no such thing as Perfect Day Scheduling. And I think, you know,
But what they're trying to say, I think they were well -intentioned, what they're trying to say is having some type of system, some type of parameters or guardrails with how you want the schedule to be is often what's missing in a practice. So we walk practices through how to look at this schedule, how to deal with this schedule, as well as how to recognize opportunities within this schedule. Because scheduling for success is one of the systems, but the next is same -day dentistry. So we often see a little bit of conflict between, wait a minute, we're supposed to have these systems for scheduling and we're supposed to have the schedule this way. But then you're telling us that we're supposed to be able to find time to do dentistry when the patient wants it, which is now. And don't those two things, you know, it's like oil and water, they don't merge together, but they actually really do. When it's done well, they actually really do work well together.
John Meis (10:56.654)
Yep, they do. So if you have your scheduled patients and everybody shows up and all the procedures take exactly the amount of time that you thought it would, no more, no less, then you may not have a room for any same day dentistry. But when we have dentists come to our high impact dentists course, one of the things that we do is we have them estimate how much time they're spending doing doctor things that only a doctor can do.
And the answer is often 40 % of their time, 60 % of their time, maybe 70 % of the time. But I don't think I've had anybody that was more than 70 % of the time, which means 30 % of your time is available for same day dentistry if you're open to it. And if you can lead your team to be open to it. And so that's an automatic 30 % increase in productivity and a much, much greater increase in profitability because your fixed overhead is already covered by the other procedures. So additional procedures are highly profitable. And that's the next dollar phenomena that I've talked about extensively.
Wendy Briggs (12:00.013)
Right, so I think that's the most exciting thing to look at is, you know, pitch count, production per visit, all those things, those are really important data points that'll tell us maybe where our biggest opportunities are for efficient delivery. And then look at the systems. What systems do you have for scheduling? Are they followed? Are they working? Do they need to be adapted and adjusted given the current stress that we're under? As you mentioned before, the costs are rising, cost of materials, cost of team reimbursements are not growing or rising to meet that. So sometimes we have to be realistic with our adjustments in how we work. We're not going to sacrifice the quality of care, but we may need to be open to doing things differently or thinking about things differently. And that's ultimately what we see. Many of our practices when they begin working with us, they often say we're too full. There's no way we have time for same day. But when they really dig in and identify the systems and look at how we can improve our efficiency when it comes to delivering care,
We're so proud to hear, even just a few months later, they're like, we've improved our same day dentistry by 25%. We've improved same day by 40%. Because they often find that when they dig in and look closely at the systems of what they're currently doing, there are opportunities for making small tweaks, just small adjustments here and there, and they can make a huge impact on the bottom line.
John Meis (13:18.19)
Absolutely. So systems that are required to do same day dentistry well, one is how do we talk to the patients about it? Number two is how do we manage financial arrangements so that we make sure that there's no financial surprises for patients or the practice? Next is how do we get the team involved? Next is how do we have rooms available? What are the ways that we don't block rooms from being usable? So there's multiple systems that are required to do it at a very, very high level, but pretty much everybody can do it to some degree. There's a chair, there's an assistant, there's a single tooth restoration, let's just do it right now. Pretty much everybody can get started there.
Wendy Briggs (14:00.941)
Right. And what I love about Same Day Dentistry, we've done courses on this, you know, for more than 10 years. We have a actually have a really in -depth training on Same Day Dentistry on our member website that's available to members. And certainly we have people that subscribe to that website because it's such a great training. If you feel like you need opportunity or you see an opportunity for improving Same Day Dentistry in your practice, there's some incredible resources for you to learn how to do that. Like Dr. John mentioned, it's not as simple as saying we're going to do this today.
In fact, we'd highly advise you against that if you want to keep your team and keep your team on board. You know, you got to really focus on those systems that can make or break the successes of this strategy in your practice.
John Meis (14:40.878)
Do it poorly and it creates chaos and stress. Do it well. The doctor doesn't even know what he's doing. He doesn't know whether it's the same day or not. He's just doing what's next on his horizontal schedule and he's just taking care of, he's moving from one thing to the other steadily. He or she can become much more productive by doing this, by taking the doctor out of the equation on deciding what's done and what's not done and just making sure that the team understands where there is time, where there isn't time. And that's how we keep that schedule where we're just running just really smoothly right through the day, never our hair on fire and never with nothing to do. Now that's the ideal, of course, this is the real world and every day isn't like that. And most days maybe even aren't like that, but you can work towards it and you can get close.
Wendy Briggs (15:31.405)
Yeah, I love that. Interestingly enough, Dr. John, the third system that we focus on with efficient delivery is our hygiene explosion process, which when you think about it is a combination of both scheduling for success and same day dentistry. It really is an important component. So when we have practices that come to us, we often hear things. I heard this just this morning. A practice said, we followed this advice from a former consulting group.
John Meis (15:43.998)
Yes. Yep. Yep.
Wendy Briggs (15:59.565)
our hygiene adult recall appointments are only scheduled for 30 minutes. We know that our hygiene wages have gone up, we are PPO practice. So the only way we can actually be profitable is if we cram two patients, adult patients into an hour. And it's actually mind blowing how many people follow this terrible advice and that this is a trend that in 2024 is actually happening in dentistry. Our approach is radically different than that.
You know, for us, it's not about cramming more people in. It's long -term goals and long -term strategies. And what we know about that is when you reduce the standard of care to improve your profitability, nobody feels good about that. Patients don't feel good about that. Hygienists don't feel good about that. Doctors often don't feel good about that, but they may feel like they're between a rock and a hard place and they're following this horrible advice.
John Meis (16:54.094)
Right.
Wendy Briggs (16:57.581)
And in reality, we have found there's so many better ways to accomplish the same end goal. When we see practices shorten those appointments down, usually it's very difficult to retain hygiene providers. And we know if you don't retain hygiene providers, you don't retain your patients at the same level. And so we know over time, the practice ends up working harder for the same result. And certainly some practices never completely recover from making a shift like that. So danger, danger, go carefully here. This is something that you've got to be very, very mindful of.
John Meis (17:32.526)
And I think people think that switching to a 30 minute appointment is going to make them, because they're seeing two patients an hour, they're going to be more productive and more profitable than if they're only seeing one. And the answer to that is that's not true. We have shown it over and over again. We've looked at people's numbers who've made the switch from one direction, had them make the switch back. We know that an hour of...
An hour -long hygiene visit allows time for same -day hygiene procedures. And when we have same -day hygiene procedures, we're improving productivity. More importantly is we're improving the dental health of our patients. So if we're trying to scramble through a prophy in 30 minutes, there are probably hygienists who can do a fantastic job in 30 minutes, but there probably aren't many. That might be some superstars or maybe some very easy patients. But otherwise, cutting down the time that much is going to have a bite in the quality of care. So we don't want to do that. We want to improve the quality of care. We want to improve the dental health of our patient pool. And so having the systems in place to be able to do same day procedures, perio procedures, preventive procedures, being able to do those right now, right here today, is really the secret to having maximal productivity and maximal quality of care.
Wendy Briggs (19:02.637)
Absolutely. So one of the things that we see, you know, when we really dig into that hygiene exclusion, we talk a lot about the anatomy of a hygiene appointment and we break it down into segments, right? What do we need to be doing in the diagnostic phase? What do we need to be doing in the hygiene phase? What do we need to be doing in the examination phase and the same day dentistry options? And I can tell you, if you have a practice, it's a pro female that's doing an exam, pro -fee, biot wings on everybody, and that's all they're doing. They may be able to subsist or survive on that 30 minute appointment time. I highly doubt it though, right?
Because there's still conversations that should be happening with patients. If we're worried about retaining patients, and we all should be, we should be focusing on providing a world -class patient experience. And so in our mind, you know, there's true value that comes by elevating the care we provide rather than diminishing it. So that's what we teach in our whole hygiene and collision process. When we dig into the anatomy of an appointment, and how to maximize our time. We help hygiene providers maximize three really important roles, preventive therapy, periodontal therapy, and that of a patient treatment advocate. And as you mentioned, if we're shortening that appointment time down, one of the first things to go is that important conversation about restorative needs. And we love the approach where the doctor and the hygienist have a team approach.
They really are a true partnership in regards to case acceptance and restorative procedures and helping patients understand why they need the services that they need, that's gonna go. And if 75 % of our restorative dentistry comes out of that hygiene appointment, and we're not taking the time that we need to have those important conversations, the practice is gonna take a hit more than we probably even realize is possible on the restorative side as well. So these things are all really very important elements. I would also say, I think we've spoken about this briefly on another podcast, there's another alarming trend in that dentists are saying, we can't find a hygienist, we don't even need a hygienist, we're just gonna use our assistants to do the polishing and we're gonna do a couple minutes of scaling.
And there was one dentist that was posting about the fact that he sees four patients in an hour himself with no hygienist. Now granted, I'm not gonna make any judgments about the level of care that's happening there. I don't know. I don't know anything about the level of care that's happening there. But I also would argue that every time a doctor's hand is on a scaler, we're losing out on productive capacity, right? We know that when the doctor's hand's on a hand piece,
the end result can be significantly higher, even if you're trying to cram four hygiene patients in an hour and having your assistants doing the polishing and some of those things. So yeah, you know, there's so many different ways to run a dental practice.
There's not a right way and a wrong way, but there are certain things that we have learned that we help our clients embrace and utilize to the fullest. And I can tell you in our experience, having well -trained world -class hygienists will drive your practice of success and growth far beyond anything that you can do by yourselves, right? So that's the whole key with the Team Training Institute. Of course, we believe in a team driven approach. But I would say, you know, the hygiene explosion and those critical systems that we teach in part of that really has become what we're known for. It's not the only thing we do well, but it's something we really do very, very well within our industry. And those vital systems are such a key part of efficient delivery that it's just stunning how quickly when practices step in and embrace those systems, it's stunning how quickly things change.
John Meis (22:30.094)
No, it sure is. So if we want to have efficient delivery, we have to have really good scheduling. Part of having really good scheduling and having that flow throughout the day where we're always being providing value as dentists, never having time to sit down, but never never being stressed and never being rushed, never feeling like our hair is on fire. And then the hygiene explosion principles, which are same day, doing same day preventive and periodontal procedures and having enough time to do that and enough time to talk about restorative needs that the patient might have. You put those all together and it has a powerful power.
So, anything else, Wendy?
Wendy Briggs (23:08.653)
It really does. Yeah, one more thing. It is so powerful that we've actually chosen this as our topic for an upcoming practice growth retreat. We have practice growth retreats every quarter all around the country and usually we pick one key topic for the entire meeting. And the entire meeting is based on systems required to really drive this key topic. And this upcoming retreat, for those of you that are listening to this in 2024, in July,
In Miami, Florida, we are having our quarterly practice growth retreat and everything about that retreat is all about efficient delivery and the systems that drive practice profitability. So if you are not currently working with us and one of our amazing members, we do have a few tickets available for guests at this retreat. And if you realize by listening to this podcast today that you need to focus on efficient delivery and you may be missing a few of these vital systems in your practice, we'd love to have you join us as a guest. So on the show notes, we're going to have a link for you to to click maybe even a QR code to make it easy for you, where you can get information about what it looks like to attend our retreat as a guest and schedule a call to see if you're a good candidate for that.
John Meis (24:17.518)
Yep, that'd be awesome. We'd love to see you there. So thanks for everybody for joining us. We'll see you next time on the W Production Podcast.
Wendy Briggs (24:26.285)
Thanks everyone.
