Nobody looks forward to the dentist
There is a reason they come anyway. The same reason applies to the clinic you built yourself.
A patient sat in your chair this morning and filled an hour in the appointment book. There is another one you didn't see in the appointment book, and she fills nothing at all.
She canceled on Tuesday, the second time since spring. Reception found her a new slot in November, she said thank you, and that was the end of it. There was no reason to bring it up at the morning meeting, because the appointment book was full anyway, and an hour without a patient is a bigger problem than a patient without an hour. Eighteen months from now she comes in as an emergency, with a tooth that could have been saved this year.
Nobody in the clinic noticed anything. That is the kind of loss that never shows up in a spreadsheet: the patient who didn't come, and who nobody missed, because somebody else was standing in her slot.
She has nothing against you. She just doesn't like being there, and there is a perfectly ordinary reason for that. There are sounds she associates with something unpleasant, a smell that exists nowhere else in her life, and a real risk that it is going to hurt. And the worst one is still to come, the risk that you find something she cannot see herself. A crack under a filling, a foundation that has been losing support for years, a tooth that is expensive to save now and impossible in five years.
When she does sit down in the chair one day, the reluctance hasn't gone anywhere. She just knows, somewhere inside, that what you find today costs less than what you would have found in three years. The whole foundation under our profession is that we charge people to look for something nobody wants to hear about, because the alternative is more expensive.
The three words that land with a thud
I work on three things in clinics: leadership, sales, and marketing.
There are hardly three words that land with a bigger thud in a room full of dentists.
Leadership sounds like meetings nobody has time for, and like something that steals chair hours.
Sales sounds like something we don't do, because we are health professionals and not salespeople.
Marketing sounds like money out the window, and most of us have tried it at least once without being able to see what came back.
At the same time everybody knows perfectly well that those three things decide whether the clinic is going to work, and whether anything is left for the person who owns it.
So when I come out to a clinic and make a diagnosis, exactly the same thing happens as when your patient sits down in your chair. Nobody enjoys finding out that something isn't working the way it should. You are proud of your clinic, you have spent years on it, often more than on anything else in your life. For many people it is as much family as it is business. That is exactly why you get it looked at, and also exactly why you put it off.
The man who stopped me mid-sentence
Before the first retreat we held in Italy for clinic owners, my friend Johnny Juhl, who works in leadership, asked me to describe an ordinary day in a dental clinic minute by minute, starting from when I walk in.
I started at half past seven and talked about the patient at eight, about the five minutes of delay that turn up around half past eight because something takes longer than the appointment book had planned for, about the chart notes that have to be written somewhere between two patients, about the assistant who needs an answer while my hands are in somebody's mouth, about the lunch break that is thirty minutes in the appointment book but five minutes in real life, because the rest of it goes to an insurance case and a call to a patient reception couldn't handle. I got to lunch, took a breath, and was about to carry on into the afternoon.
Then Johnny stopped me and said he didn't need to hear any more. I looked at him, surprised, and asked why, and he looked back at me and said:
You people are insane.
I didn't get it at first.
It had been my everyday life for more than twenty years, and to me that was simply what a day looks like. Then he explained it, and I haven't been able to shake it since. Two people sit closer together than most married couples do, and between them they have a patient who is frightened. They work in tenths of a millimeter, in a field that must not get wet, in a mouth, with limited room, where everything moves and everything is wet. They work under requirements that leave no room for error, and in their own self-image there isn't even room to talk about the errors that happen anyway. And they haven't had a real break since they walked in that morning.
He was right about all of it.
I had just never heard anybody describe it, and it had never occurred to me that it could be any other way.
We inherited the day
What made the biggest impression on me when I started looking at clinics from the outside instead of from the inside was how little of this anybody had actually chosen.
The day Johnny described is one most of us inherited. The appointment book is planned on a model from a time when treatments were simpler, reimbursement better, equipment cheaper and documentation easier, and when you could therefore pack the day tight without anybody getting hurt by it. Since then treatments have become more complex, fees have stayed where they were, equipment more expensive and the requirements heavier. Nobody has done the math on the model. I call it the minute clinic, because the day is planned down to the minute without a single buffer, and a delay therefore has nowhere to go. It follows you all the way to closing time.
It matters whether we call that a personal shortcoming or a structure. There is not much you can do about a personal shortcoming, beyond feeling inadequate and working harder. A structure you can rebuild, and that is what I do.
Why it takes the time it takes
You already know the order from your own work.
If there isn't enough bone, you don't place the implant. You build the bone up first, and then you wait patiently while it heals. Not because you are slow or cautious by nature, but because the foundation has to carry before it can hold anything. The patient asks every time whether it couldn't go faster or easier, and every time you give the same answer.
A clinic works the same way. There has to be room before anything new can come in. Room in the appointment book, room in the finances, and room in the head of the person who makes the decisions. If that room isn't there, that is what we build first, and it takes the time it takes. In return it is predictable, the same way placing an implant is. The clinic owners I work with typically see around 30 percent improvement in their financial results, and that number is what buys the room. But the room and the freedom it creates is what they end up being happiest about.
Prevention and treatment
You say it yourself to your own patients several times a week. It is cheaper to find the small problem now than to treat the big one later, and both can become necessary. The difference between them is usually just when somebody looked.
The same goes for the clinic you built yourself, and it has the same bad habit as the patient who canceled on Tuesday. It keeps working right up until it doesn't, and in the meantime nobody misses the hour where somebody could have taken a look.
Do you feel like having the clinic looked at?
Probably not. Neither does your patient.
Could you use this?
I write a post when I have seen something in a clinic that is worth passing on. No fixed schedule, four to seven minutes of reading, and always one place you can do something differently tomorrow.
Facebook and LinkedIn rarely show two of my posts to the same person, so the list is really the only way to get all of them.
Thanks for reading.
Kind regards
Jesper Hatt
Dentist, advisor and advocate for clinics where safety, community and balance are a natural part of everyday life.
T: +41 78 268 0078