What your dental assistant sees that you don't

Dear colleague,

Maria has been a dental assistant for fourteen years. She knows the patients by their first name, knows who needs five extra minutes, knows who runs late because of the roadworks on their route, and she can tell when someone in the waiting room is nervous before treatment and how to settle them.

The other day she had a patient on the phone who wanted to move their appointment for the third time. Maria knew in an instant what should happen. But the decision was not hers. She waited until the owner came out between two patients, caught her in the doorway, and asked permission.

The owner had a perfectly ordinary day. The booking held, the team ran, nobody complained. Maria had a different day. She had a decision she could have made in ten seconds, parked for two hours, because no one had said out loud that it was hers to make.

That is the difference I want to write about today. It is rarely dramatic. It is an invisible problem in one of the layers of leadership, seen from the owner's chair, and it sits exactly where most team problems live.

You lead your clinic from the bottom up without knowing it

You see the clinic from the treatment chair: the patient in front of you, the appointment book, today's production. It is a good view, but a narrow one.

Your team sees the clinic from another angle, and they see things you cannot see from there. They see how long a patient waits for an answer. They see which tasks pile up because they have to pass your desk first. They see when a good idea dies because there was nowhere to put it.

A dental assistant won an award last year for an article in BDJ Team about exactly that view from below. The point was simple: a rigid hierarchy does not only cost wellbeing, it costs capacity. People who could carry more are left to carry less, because no one dared to hand them the responsibility.

I recognise this from many of the clinics I visit. The dental assistant's role has grown steadily over the past ten years. She has patient contact, runs coordination, performs preventive treatments, assists the dentist, and is a large part of what decides whether the patient comes back. But the responsibility has not grown with the tasks. The tasks have multiplied, and the decisions have stayed with the owner.

The result is a clinic where the most expensive person in the building spends their time on decisions someone else could have made better and faster.

This is not a criticism of you

You have not held back on purpose. You were simply never told that it was your job to build the layer where responsibility could land. Dental school did not mention it. All your courses were about occlusion, aesthetics, oral health, new techniques and materials, not about how you give a person responsibility and let them grow into it.

So you did what most people do. You kept the decisions, because you were the one who had always made them.

The good news is that team leadership can be learned. It is a handful of concrete things, not a personality type you either have or you don't: giving feedback without waiting for the annual review, holding a meeting that actually moves something, setting the frame for what each person may decide on their own.

I have done it wrong many times myself. It took me years to learn that my most important job was not to be right, but to make others able to act without me. I have been stubborn, a know-it-all, and far too stressed to see clearly as an owner and a leader. But I changed, and it made a difference. For me, for my team, and as a result for our patients. The best part was that it did not take rocket science.

Here is my advice to clinic owners who are tired of being the bottleneck in their own clinic. Start in one place. Take one recurring decision you make yourself today, and give it away with full authority. Not "ask me if you are in doubt". All the way. Let it be something concrete, like the appointment changes Maria was holding. Agree the frame, say it out loud to the whole team, and then keep your hands off for the first three months while it settles.

It will be uneven at the start. Mistakes and misunderstandings will happen. That is part of the price, as it is with any change.

Since the day I saw my last patient, it is not the teeth I have missed. It is the team. Watching a person do something this year she could not do last year, and knowing I had a hand in it. That is the satisfaction most clinic owners deny themselves, because they hold the handbrake so tightly that no one around them learns to drive.

You know your clinic from your own chair. The question is what your most experienced assistant would put at the top of the list, if you gave her the chance to tell you what she sees and what she would change.

With collegial regards,

Jesper Hatt DDS