Dr. John Meis: Hey, welcome everybody to this week’s edition of The Strategic Thinker. I’m Dr. John Meis and I’m here with Melissa Thomas. Hey Melissa!

Melissa Thomas: Hello, Dr. John, how are ya?

Dr. John Meis: I’m doing good, how about you?

Melissa Thomas: I’m good.

Dr. John Meis: So, Melissa’s one of the team here at Spark and she’s going to be helping us think through some things with maybe a different lens than you’ve used before. So, we’re going to talk about the Theory of Constraints, and the seminal book on this is a book called The Goal. And in this book, it tells it in a great story. But really, anything that isn’t achieving what you want to achieve, if you’re not hitting your goals or exceeding your goals, it’s generally because of a very small number of constraints. And, those constraints can be very difficult to find, but if you don’t find the root cause of the constraint, you’re kind of stuck there. And so, Melissa, we’ve seen this happen in so many practices, they grow and grow and they seem like they’re doing great. Now we’ve got 2 locations… now we’ve got 3. Then all of a sudden, the growth just stops or plateaus. And so, whether it’s an individual office or groups of them, constraints can be elements of capacity. And so, I thought we would talk about the elements of capacity, how they can be constraints, and then how we can think about it differently. So, these are some of the elements of capacity that we talk about most frequently. These are the ones that really practices run into trouble with, isn’t it? 

Melissa Thomas: And, they almost always start with people, right? 

Dr. John Meis: Yep. People is the big one. And, we say processes, having unique systems that are proven successful. Technology, boy we could go on and on, we could spend a day talking about technology as elements of capacity. Sometimes it’s just that you don’t have enough rooms, you don’t have enough ops. Sometimes you don’t have enough locations. And, we could go on and on with the list, but the most common one, Melissa, is people, isn’t it?

Melissa Thomas: It sure is.

Dr. John Meis: So, what’s one of the situations that practices run into where they’re having a people capacity question?

Melissa Thomas: I think most often, I like to think about the front desk, right? So, if there’s not someone there to answer the phone for a patient, if there’s not someone to check out the patient. If we’re fortunate enough that the patient’s going to pay us on their way in or out the door, we want someone there to accept the payment, right? And so, I think of it through the lens of the front desk, but it’s also in the back. If we don’t have enough assistants to produce dentistry, that’s a huge capacity constraint. And so, I think most commonly I think about those layers, because I think people are more diligent about thinking through an extra provider, when it comes to an extra doctor or an extra hygienist, those seem to be more outlined. The processes for those are more common, if you will. When we think about the supporting force there, that’s when people start to think, “When do I need another one?”

Dr. John Meis: When somebody’s a producer, you know when you need another one of those, right? A hygienist, you know when you need another one of those because… well, we could argue that one too (laughs). But, the front desk is probably the biggest challenge. And so, why don’t we talk about that? So, different practices use different staffing models, and different offices have a different level of support. So for instance, in some systems, some groups, the insurance for instance is all centralized and the office doesn’t deal with insurance. Or, it may be that they have call-center support. So, technically if you have that support, you shouldn’t need as many people, right Melissa? You should need as many people at the front desk.

Melissa Thomas: You shouldn’t, because unlike providers it’s harder to equate how much return you get on each of these individual team members, right? And so, I think it’s often hard to, if you think it, just adding an expense without really thinking through all of the logistics on the things where they can have that ROI, whether it be calling on aged accounts receivable or more advanced treatment-planning presentation. Things like that they’re harder to quantify, but they can be done. And, I think that’s one of the biggest pieces, trying to outline where is your biggest need and do you have the right people to fit it? Is adding an employee even going to fix it? You know, to your point on centralizing services with groups, you may often have - insurance and call centers are probably your biggest ones - but, what we see too across maybe a larger practice or a couple of practices, is that they start to centralize within the practice. And so, maybe they have an insurance guru, right? And, they’re the only one that’s educated enough to have treatment-planning conversations. And so, we have new patients waiting to have that treatment plan. Or, heaven forbid, we have to call them back to discuss their options. And, the same goes with potentially… I’ve seen at a practice, and it was probably my biggest frustration moment, because I was observing the interactions that day and I just wanted to jump in and take over because there was only one person who checked out patients, right? And so, they had a line of patients waiting to check out with 3 other people sitting at the front desk. And I thought, “You mean nobody knows how to run a credit card? Let me do that for you.” And I thought, “Gosh…” You just see it happen, and in their minds, they’re specializing the tasks. And, I think that works to a certain extent, but not when you’re having patients wait to be checked out.

Dr. John Meis: Yeah, and that’s a great example of, “Do you need another employee or do you need to change the process?” Because the process could easily be changed, and they were rigid in, “I’m the only one who can do this.” And, if you lose that rigidity, and now you have multiple people who are already there who know how to do it, you have more flexibility in dealing with things that pop up. So, if we take an example… I think that’s an interesting example, Melissa, because it really does show you how systems and processes are so important and how they can also go awry. If people aren’t using good common sense at the office, if for instance for that office that was their process, it’s clear that it’s inefficient. So, the processes may need to be fixed as much as the people. 

Melissa Thomas: Do you have a process for assessing your process, right? (Laughs)

Dr. John Meis: Yeah, right!

Melissa Thomas: Making sure that it’s still the correct way, and really thinking you probably could minimize the people you have supporting you if you just made a couple of shifts in the process or cross-train some individuals. You can have a first-in-line for this and someone that can back up that person, right? You never want to be too dependent on the only person in the office that knows how to apply for CareCredit, right?

Dr. John Meis: One person knowing anything is a bad number, right? There’s not enough redundancy in that to be safe, by any means. So, one of the ways in front of offices that you can use to kind of see if we’re staying on top of things… so, if they’re not staying on top of things, it may be motivation, it may be the team that you have, it may be that the processes are bad, it could be all those things. It could be any one of those things as well. So, one of the things that I think is a helpful tool to use is to ask the front desk what duties they like to do least. And, those are kind of the ones to watch for, because if they start getting tight on time, they’re going to drop the ones… they’re not going to be as steady with the ones that they don’t like to do. So, just a little tip there, if you know what that is, you can check on them fairly easily by seeing if their least-favorite duty is being done. And then if it’s not, now you’ve got to figure out what it is? What are all the constraints? 

Melissa Thomas: So true. That’s a great tip there. I think that I always like to listen for the phone, right? Sometimes you can listen to how many times it rings before they answer it. And, sometimes it might be out of necessity, but then it’s really kind of thinking through, “Are they too busy to answer it? Or, is there a resistance to answer it?” 

Dr. John Meis: And, if you have a call center, do they just think, “Ah, I’m not going to mess with it, the call center can take it.” 

Melissa Thomas: Yep, “They’ll take it.”

Dr. John Meis: Yep, and all of those things are just a matter of observation. The metrics can tell you when there’s something to look for, but it doesn’t really tell you… Sometimes you just have to be there to get a sense. 

Melissa Thomas: Absolutely.

Dr. John Meis: Alright, very good. Well, I hope you can use this Theory of Constraints as you look through what challenges you have. Think about how it’s not everything that’s wrong, there’s just probably one or two things that are causing that challenge and causing us not to hit and exceed our goals. So, I hope that was helpful, and as always if you want to have a 45-minute practice scale strategy session with me, all you have to do is call 866-277-2758. Melissa Thomas, thanks for being on today and we’ll see you next time on The Strategic Thinker. Bye-bye!

Melissa Thomas: Bye!