AME: Testing and Improving Systems

[00:00:01] This is a production of The Very Dental Podcast Network. Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement.

[00:00:16] Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before. I give you the Alan Mead experience. Well, hello and welcome to another episode of the Alan Mead experience. I'm your host, Dr. Alan Mead.

[00:00:36] I'm a dentist, podcaster and a systems analyst. So I'm not really a systems analyst, but it sounds pretty cool, right? So it's kind of funny. I went to college.

[00:00:47] I went to Miami University in Ohio, and I had some friends who were in a degree program at Miami that was called Systems Analysis. Which sounds really cool. And as it turns out now, they just call that computer science.

[00:01:03] But I remember at the time it was systems analysis. So, I mean, I graduated from high school in 1989. So this was like early 90s kind of stuff. Apparently now that degree is called computer science. But in any case, systems analysis sounds kind of interesting.

[00:01:17] It was a computer degree.

[00:01:18] But what I'm going to talk a little bit about today is the concept of systems, because in dentistry you kind of can't get away from a lot of talk about systems and how systems are in systems in dentistry are wildly important and how your office can't do well without great systems and stuff like that.

[00:01:42] So something frustrating to me is that you'll hear gurus, you'll hear oftentimes business gurus, but even clinical gurus are talking about how you can't do well without having great systems.

[00:01:55] And they make it sound like they're the only person that can explain systems to you and how to add systems to your office.

[00:02:01] And what makes me laugh is that your office has systems, whether you're intentional about it or not, because I mean, all a system is, is OK, the dictionary definition of system.

[00:02:13] I got this for you. A set of principles or procedures according to which something is done, an organized framework or method. I might change that because in a lot of cases it's not necessarily organized, I think.

[00:02:23] But the reality is your office has systems, whether you were intentional about it or not. And so what they really should be talking about is, is, you know, taking a look at your systems, analyzing them, if you will, and making sure that they're serving you well.

[00:02:36] So basically a system is just the way that something is done in your office. Right. Like, you know, what's your system of impressioning your crown preparations? Well, my system happens to be a Meta I-700 and I've talked about that system.

[00:02:51] And actually, I'm going to talk about a little bit more about how that system broke down a little bit and how I had to fix it.

[00:02:58] It's kind of interesting. So in particular, it's the systems that I think about are the things that have to be done repetitively in the office. You know, whether you're talking about, you know, giving anesthesia. Do you have a system with which you give anesthesia?

[00:03:17] Of course you do. I mean, because you give anesthesia so often that there's just a way that you do it. And whether or not you've thought a lot about how you do it, there is a way that you do it.

[00:03:26] And thus you have a system prepping your crown same way. I mean, that a lot of times these systems are the ones that we look at because we can we try and shave a little time off that or whatever.

[00:03:35] But getting paid, you know, how you how you get paid, how you ask for money, how you submit insurance, all those things have a system. And whether or not you're intentional about it, you have a system.

[00:03:48] You can either think about it and optimize it, or you can just do it like we've always done it. And honestly, either way, oftentimes works. Sometimes people tell you that, you know, don't do it how just how you've always done it.

[00:04:01] I mean, unless how you've always done is working really well, then in which case go for it. Right. Systems are emergent, whether we like that or not. So, for instance.

[00:04:15] If you get a new piece of equipment, let's say let's say you get a CBCT and you don't take training and you don't you don't get a bunch of training, you just learn how to use it and you start, you know, throwing patients into it in a certain way or using it at a certain time.

[00:04:32] You're going to have a system of how you do it come about, whether you you write it down, whether you think about, you know, workflow, where you think about how and when it's going to become in the system that happened just because it happens is called emergent, an emergent system.

[00:04:50] And this is sort of it emerges from from how you work, whether you were intentional about it or not. So and a lot of times emergent systems are just fine. Just so you understand that.

[00:05:00] I think I think there's people that talk about this stuff in organizing your office and such that, you know, any emergent system has to be beaten down and shaped into a certain way. Really depends on how it's working for you.

[00:05:11] So everyone kind of gets to pick how their systems are working for them or not.

[00:05:16] So a classic example of emergent systems and just doing it the way we've always done it would be if you bought an office, an existing office, and you're the new guy coming into the existing office, everyone said, man, you shouldn't just change everything all right off the bat.

[00:05:33] And that is that's a classic example of taking a look at the systems and understanding how they have been working and then figuring out what ones you may or may not change over a period of time.

[00:05:43] I bought I bought an office in 1998 and I just basically kept doing everything the same way they were doing because I didn't know anything. There weren't podcasts. There weren't a lot of there weren't a lot of mentorship opportunities.

[00:05:56] I just kind of did what they were doing and sort of picked it up. You know, there's probably bad habits I found out about in 1998 that I'm actually still doing right now. It wouldn't surprise me if I have some of those.

[00:06:08] Now, on the other hand, we've changed some things obviously since 1998. I haven't placed amalgam in a while, for instance. And so I had to come up with and have really tweaked my system of, let's say, posterior composites. So I do it a very certain way now.

[00:06:26] And I'm going to tell you that that way is not necessarily written down. I don't have it is the offices that are really good at plugging people in to like plugging new people into the systems are the ones that have a really well documented.

[00:06:39] Some of the stuff we have is really well documented. Somebody really isn't. A lot of my clinical systems probably are not very well documented. And so anyone coming into them new is probably going to think, oh, they just do it the way that they've always done it.

[00:06:50] And it kind of is. But the system has sort of refined itself over time. So it and I mean, the system also has to be adaptable to situations. It's you can't necessarily fit every situation into the exact same way doing things over and over again.

[00:07:03] As much as you'd like to, you'd like it to just be McDonald's and they have a, you know, a system from beginning to end of your order or beginning to end to how they make a cheeseburger or whatever. It's in a dental office.

[00:07:15] The systems have to be very well documented. But flexible, in my opinion, just so you know, too. I am no expert at this. I've just thought about it a lot lately. I thought about it. I'm going to tell you why.

[00:07:26] Because I had a couple of things come up that just made me think, man, you got to you got to have a system, but you got to be able to change the system to you have to you have to be able to think about your system and decide if something isn't serving you.

[00:07:45] So the other thing is, if you're adding something new, let's say you're building a new office. That's probably the time you don't have to invent your own system. You know what I'm saying? Like classic example of this is is the company Zerk. I've worked with Zerk for years.

[00:08:02] They've been on and off sponsors and stuff. But one of the things that Zerk has done, they have really good products. They make, you know, they make trays and tubs and organizational equipment and sterilization equipment and all that stuff. And in and of itself, it's good equipment.

[00:08:16] But what Zerk's real value add is that they've done a lot of thought about the systems of getting your instruments deployed, you know, to the operatory efficient instruments and materials deployed, you know, really organized way and then how to sterilize them, how to put them away.

[00:08:32] So you'll know, you know, to save time and make things more efficient. That's what Zerk is. The value add is how they make things in efficient. You know, yes, they have products that they want to sell you the, you know, sterilization cassettes and tubs and all.

[00:08:44] But but also they've got experts in how to make this really efficient. So if you're in a position to to basically redo your systems, that's that's the kind of person you want to ask if you're not sure. Some people really get into inventing new systems.

[00:08:59] OK, so I just said the word system about a thousand times. And I've just been thinking about it a lot. So the first thing I had something happen last week to me and and it was I was several weeks ago on an Alameda Experience podcast.

[00:09:14] And I was talking to a guy named Alan. And he was like, you know, I'm not sure if you're going to be able to do this. I'm not sure if you're going to be able to do this. And he said, well, I'm not sure.

[00:09:21] I'm not sure if you're going to be able to do this. And and it was I was several weeks ago on an Alameda Experience podcast. I was bragging about how awesome my my Crown and Bridge system is set up because I really I really like the MetaDyze 700.

[00:09:37] I like how quickly we can do a single or double unit, you know, just even a quadrant of Crown and Bridge quickly and efficiently. It's probably the quickest and efficient. You know, it's probably the most efficient process we have in my office. And and I love it.

[00:09:51] So and I've talked about it, and I think I've I can even put in the show notes that episode if you're interested. But something happened. OK, so typically I am doing I get my preparation done.

[00:10:03] I will I will either pack cord or place place retraction paste or whatever. And I have to let that sit for a couple. It's got to do its thing for a couple minutes before we impression.

[00:10:13] But I'll come in, take the scan, and then I sneak into my private office while the assistant is fabricating the temporary. And I will mark the margins.

[00:10:23] I like to mark margins before I say I feel like I owe my lab the margins because I can see them when I can see them most effectively and efficiently right after I've prepared because I'm like, yeah, I've just been looking at this tooth for 10 minutes.

[00:10:35] And I know where I put these margins. So I mark them for the lab. So I'm in the in my office on my great big screen with my favorite mouse and all that system remoted into the laptop and marking the margins on this bridge.

[00:10:48] And I and they turned out really good. I was really happy with him, so I was ready to kind of press go. And all of a sudden I look up in in the laptop had restarted itself. Okay.

[00:11:01] And Medit does the thing where once it's processed, it will upload your data to their their cloud system so you can access it on any computer. But also, you know, you haven't lost the data will shoot this just by chance. My windows did a restart.

[00:11:18] I don't know why they would do it in the middle of the day, but it did. It did a restart on its own. I didn't do anything to it. It just all of a sudden, boom, it was gone and restarted. I don't think it was a problem.

[00:11:27] I think it was just like, hey, we're going to restart for whatever reason. Okay, so I the patient had, but we put the temporary in and in. I thought that the margins were marked and it was processing, so I never looked at anything, looked at it.

[00:11:42] We cemented temporary patient was gone. I look up and see, oh, my God, they they've lost our data. It's not there. Like this did a restart and it was gone because you want it has to in Medit.

[00:11:55] It has to process your file before you can do the final order. And I hadn't pressed I hadn't sent the final order. And so we lost it. We lost the scan. The scan was gone.

[00:12:07] It does not this is not something that happens often at all, like basically almost never.

[00:12:12] And it happened in such a way that it was just the worst possible way it it rescued a little bit of data, but it wasn't enough that we could make the save at all. Like it didn't have the byte registration. Didn't have the opposing model.

[00:12:24] It had like a it was really weird. It was a it was a fluke. It was a one in a million thing. It was not like this happens all the time. Literally, this was a fluke.

[00:12:35] And we had to call the patient back, we had to get the patient back so I could rescan and I just put it to I to take the temporary off. So the guy was able to come right back. It was probably 20 minutes after we realized.

[00:12:46] So he was still numb. The temporary came off quite easily and the tissue was still in good shape. So the scan wasn't that big of a deal. We saved it, but it wouldn't always be that way. Right?

[00:12:57] Like like God, if I hadn't looked up and seen that it hadn't processed correctly, we we would not have known. So in a lot of cases, yes, I've marked the margins. Yes, I've said go to process. But a lot of times we might not necessarily order the case.

[00:13:10] So we we think it's processing and the patient leaves and it's fine. But so how and it is a fluke is one in a million. It's not like this happens all the time, but like and it ended up being OK. But it could have been tragic.

[00:13:24] It could have been, oh, my God, we got to get the patient back. We got to numb them up. We got to take that. We got to do everything over again. We've lost that time.

[00:13:30] And and is there a way to evaluate the way that my system works and change it so that that can't happen again? And there is a way I mean, the obvious way is don't.

[00:13:47] I can hardly believe I'm saying this, but don't let the patient leave and maybe even don't even put the temporary on. Until you've ordered the case, until the case is literally ordered. You know that all the data is there and it's off to the timing wise.

[00:14:00] Probably we might not wait till it's ordered, but at least or we might put the temporary on before it's ordered. But probably we should not dismiss the patient until the until the case is ordered, because then we know that they will not have to come back.

[00:14:16] It's going to get to the lab and it's going to not be messed up again. One in a million thing. Maybe it's not that big of a deal.

[00:14:21] Maybe we don't have to make that change, except the feeling in my stomach where I'm like, oh, my God, I'm going to have to get him back and numb him up and basically do this all over. What a pain for him and what a pain for us.

[00:14:32] I didn't like that feeling in my stomach at all. And knowing that there's something I could do so that it wouldn't happen again was a big deal. It was a really big deal to me.

[00:14:41] So that is an example of a system that I thought was working really well. But then having a weird fluke point out a little bit of a weakness in it, like, well, it's not not going to happen often, but it can happen.

[00:14:54] There's a hole that you can you can fill here. You can you can make this work. So the new system is we don't let the patient go until we have seen that on the computer it's ordered and it's off to the lab.

[00:15:06] We always used to brag about that to the patient. Oh, yeah. Your your case will be in the lab before you're out the door. Except we didn't always do that. Sometimes I would mark the margins later or whatever.

[00:15:14] But now this workflow leans to a position where we can really make this work. But sometimes it takes the near tragedy or something dumb happening to point out the weakness of your system, because, you know, a system that works perfectly 95 percent of the time is probably OK, actually.

[00:15:33] It's probably, you know, like that wouldn't be the worst thing ever happened. But if it was if it happened once, it could probably happen again. And so you're sort of like, yeah, this is this is a sign we need to take a look at the system.

[00:15:42] I got another one. This is doesn't have anything to do with dentistry. This has to do with with my happiness as a as a mountain biker, because. I incessantly record my calorie burn and my miles ridden when I'm cycling, and I can do that on my watch.

[00:16:00] I have I have a Garmin watch. It's nothing fancy, but I can do that on my watch. But the reality is I have a really cool cycling computer that records a lot more information than my my watch does.

[00:16:10] I've got I've got speed sensors on the front wheel of my bikes. I've got I've got, you know, a chest heart rate monitor. It just gathers better information than my than my watch does.

[00:16:22] And so I for whatever reason, I don't even know that I use that information that much. But in my mind, it makes me happy to know that I'm recording this information sort of stupid. But there it is.

[00:16:31] And I'm really good about making sure I've got my my bike computer, even if I'm I've got multiple bikes that I might be riding and it works on multiple bikes. It's pretty great. So I went to a place that I had never been to for mountain biking yesterday.

[00:16:46] It's called DTE Energy Foundation Trails or Park or whatever. It's in it's down. It's it's in a town called Chelsea, Michigan. It's near Ann Arbor. It was a two hour drive just to get to the trails. And I'd never been there before.

[00:17:01] They there's talk that they're the best trails in Michigan. They were pretty great. I had a pretty good time. But I got there and I was convinced that like I had charged my bike computer, I don't know, last week.

[00:17:12] And usually a charge will last for for a couple of weeks at least. So I went to put my bike computer on. I was about ready to go. And the battery was flat. It was dead. There was no, and I didn't know at all. I had no idea.

[00:17:26] I apparently I must have left it on the last time I was riding or something like that. Cause it, you know, it doesn't use that much battery and it was just dead. It had the little, little blinking battery light, like nothing.

[00:17:37] And of course I didn't have a charger that would fit that one in my car. I, and of course I didn't know it was dead until I was ready to start riding. So I was frustrated. I got all the way there.

[00:17:46] I'd done anything and I'm like, man, I don't get to record all the data in this new place, which was a bummer. I ended up using my watch. It was fine. But I thought to myself, I need a system for this.

[00:17:56] I need, I need to improve my system. So now I need to check the battery on that thing before I get in the car.

[00:18:05] If I'm going somewhere where I have to, to, to haul my bike somewhere, cause, cause even if the battery's dead, I can get a charger and charge it in the car while I'm getting there. Okay.

[00:18:16] So it wouldn't have been, if I had figured this out before I left, it wouldn't have been the tragedy that it was. I didn't get to use my bike computer and it wasn't that big of a tragedy, but still.

[00:18:25] And honestly, even the, the, the impression for this bridge wasn't that big of a tragedy. Like the guy was reasonable, but in a dental office where you'd like to remain profitable, you don't want that happening.

[00:18:35] You don't want to lose those appointments or have to add extra appointments, stuff like that. So, so it comes back to how the system, yes, you have systems in your office already.

[00:18:45] Some of them may just be emergent that have come up because this is how you do things and you weren't necessarily creating them out, you know, creating them on a piece of paper with

[00:18:54] a check bar, maybe they have, maybe they haven't, but you need to be able to evaluate how that system is working.

[00:19:01] And a lot of times the way that you can have it pointed out that the system isn't working as well as you'd like is when something dumb happens, when, when something near tragic happens.

[00:19:11] And then you have to be able to figure out the way to make that system a little better. You need to improve the system, figure a way to make, make sure that, that, you know, the, the problem.

[00:19:21] So what it really is saying is your system is being tested all the time. How are you paying attention to the tests that your systems are being thrown at? Cause that's, and if you are, then you can make better choices about how the system works.

[00:19:35] I just, I had been thinking about this a lot the last week and I thought, man, this would be a really good thing to talk about because so many, you know, gurus and in, in.

[00:19:45] Practice management consultants will talk about systems and how the only, you know, they will help you invent systems. And I'm like, yeah, I get it. But also probably what they're doing is helping you improve your systems, if anything, because the systems are there.

[00:19:58] And the question is, how much are you paying attention to those systems? Uh, I just, I think it's an interesting concept. I hope you guys have thoughts about this. We should totally talk about this in the Facebook group.

[00:20:09] If you're not in the Facebook group, you need to join, you go to Facebook search for very dental. And it's going to ask you for a password. It's all I do. I asked for a password, one of five passwords, McQuaffie, Lipscomb, Papa Randy, Timmerman or Hornbrook.

[00:20:22] Any of those five passwords will get you in. Um, and we can have a conversation. It's good. We've had several people join. We had probably, I don't know, five or 10 people in the last week or two join the very dental Facebook group. And it's all from podcast listening.

[00:20:35] Uh, cause I only let people in who I only talk about the Facebook group on the podcast. So you already know that it's not as much of a shit show as a lot of Facebook groups because it's people who are already going to listen to this podcast.

[00:20:48] And so that generally speaking, there's not a lot of, there's not a lot of fighting. There's not a lot of, there's no nastiness. I I'm the only administrator and I kick people out if they're nasty. And I, I think I've only kicked like two people out ever.

[00:21:00] And it's cause they were, they were putting up ads that they didn't ask me about. So that's bottom line. It's like the safest of, of safe dental Facebook groups. And we have good conversations there.

[00:21:11] It's not as busy as some of them, but the conversations are always really good. So I hope you would join there and we'll talk about systems a little bit.

[00:21:17] I feel like it's an important concept that people can complicate and make scarier than it really is because it's not, it's, it's everyone's got systems in their office. It's just a matter of how are you evaluating them and how easily can they be changed for the better?

[00:21:32] I like it. Thank you guys for listening. I really appreciate it. Uh, drop me a line in the Facebook group or on Facebook, uh, and I'll catch you next episode.