The myth of cross-training

In a small business, where does the hygienist fit in? As a hygienist, of course.

by Shirley Gutkowski, RDH, BSDH

Somehow the idea of cross-training in dentistry has been gaining traction. The idea that a dental hygienist should know how to make an appointment if the front office is backed up or turn the doctor's room over when they have a spare second is common, but is it beneficial? The team (there's no I in there) should be able to do one another's work, they say, or at least support one another in a way that makes the office more efficient. The first part is wrong, but the second part is so right!

People have strengths and weaknesses. People must play to their strengths, and not be distracted by their weaknesses to be valuable employees. You do not want me serving you dinner in a white tablecloth restaurant. One doesn't need to know the ins and outs of a server's job while eating, which is not to say that someone doesn't appreciate or know a good server when he or she sees one.

Serving and being served are two different sets of skills, by far. Could a bricklayer serve lunch as well as a server could brick in a basement? In the same vein, the receptionist shouldn't be cleaning teeth, and a hygienist shouldn't make an appointment. Who's devalued in these scenarios? Everyone. These examples assume that everyone's job is easy and can be done with minimal training. Einstein pointed this out years ago by saying "Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid."

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Cross-training works in repetitive jobs such as assembly line work, where cross-training was invented. If someone is in charge of turning screw No. 389 and giving a tap to widget number No. 320, cross-training adds to the effectiveness of the line when a worker is cross-trained with someone who turns screw No. 397 and slides widget No. 320. No one went into a screw-turning specialty; these jobs are truly interchangeable. To put another aspect of the practice of cross-training into sharp focus, cross-training is intended to take the stress off of the workers to make the job less tedious and decrease errors, not keep people busy. Cross-training does not mean to take over if someone calls in sick. There are no interchangeable jobs in medicine -- ask anyone who has taken their baby to an appointment on their primary doctor's day off.

Here's a dental example: Turning a room around after the treatment is completed. Who's best to work on a hygienist's room? The hygienist. Who's best at turning the doctor's room around? The dental assistant. If the dental assistant was working as a dental hygiene assistant, that's the right person to do the job of turning the hygiene room over. Can a dental hygienist turn around the doctor's treatment room? Sure. Will it be super clean? Sure. Will it be done in a way that is efficient and with few movements? Ummm, no. If the hygienist has enough time to learn to do that, what's not getting done?

Readers may be thinking this is a description of a person who's not a team player. Think again. Does an airline pilot serve the drinks? Do the baggage handlers swap with the mechanics? Does Donald Trump expect his accountants to dump their own garbage? Does he expect the tile setter to enter his own financial data into a Trump spreadsheet? Does that mean if the person in charge of emptying the garbage is sick or behind schedule, The Donald can't just dump his garbage one time? No again. He may. He may also draw a wall or cross off a bathroom on a blueprint. Donald Trump is not going to learn how to be an architect.

In a small business, things get a little trickier. The business owner cannot be responsible for producing every single dollar -- if he or she did, what's the point of employees? That's why this team concept for a dental office doesn't work. The dental office as a team is not an accurate metaphor. Usually the owner of a dental practice is a dentist. In the team metaphor, usually the dentist wears the coach hat. Anyone want a coach to pitch, to dribble, to shoot, to gallop, to hit, to run, to score? No. Anyone want the pitcher to coach? Probably not.

In an office team, what part does the dental hygienist play? You could say that the dental hygienist plays the role of dental hygienist in the dental office. What does that mean? She should jump in and extract a tooth if the dentist is busy filling in for the receptionist who called in sick? That's absurd. The whole concept is absurd.

What if the practice owner is a dental hygienist who hires a dentist? Now what? The team-swapping job model doesn't work, again.

The metaphor of the body works much better. Can the brain work without the skin? Can the heart pump if the lungs are removed? Who's the brain of this operation? If the rest of the body isn't there, no one part can function on its own. Learn your job, and learn it well. Until the heart can take up the slack when the liver calls in sick, we have to use a better way of streamlining a dental practice.

If the members of the body don't live up to expectations, they should be replaced with someone who will. For some readers, the burning question is: How does a hygienist avoid the label "prima donna" in this metaphor? The answer is to use downtime efficiently.

During downtime, what's a better way for an oral health-care provider to support the dental office: file paper charts, turn a room over, empty the garbage, or catch up on the new science of vitamin D and periodontal disease? Make confirmation calls, vacuum out the drawers in the treatment room, or develop a protocol for assessing patients for sleep apnea? Sharpen instruments or figure out which remineralization product will work for each case presentation?

Business owners need to focus on building their business. The employees of the airline, Trump Empire, or dental office need to fill in where the owner needs support. For the dental hygienists, it's the practice of dental hygiene -- not how to answer the phone better or do another process at which a good employee may be really good and extra clever and loves doing it. Having the right people at the right job is the only way to have a productive dental practice. Everyone has to love what they're doing and know that without them the practice wouldn't function well. Like the body with an ailing body part, the part that doesn't work is educated and given medicine in the shape of training, or is removed and replaced with a new part.

The cross-training model works only if the practice is very large. The front office group can learn to cross-train within their department. The dental assistants can cross-train within their department, and so can the dental hygienists and the dentists. Until the dentist of a small, traditional dental practice answers the office phone and knows how to schedule an appointment, or the receptionist can do periodontal therapy or prepare a tooth for a crown, the cross-training model will never work -- even worse, it will build resentment. The dental hygienist is too often the only one cross-trained to a high extent. The dental hygienist can be/should be extremely busy even if there is no patient. They should be busy on their own practice.

So, if you're a hygienist and you're required to be cross-trained, what should you do? Dive into dental hygiene. Know in your heart that scientific research on dental hygiene topics supports the practice more than chipping in to sterilize instruments. Know too that if the office is in turmoil due to one of a thousand reasons, you should chip in. If everything is running smoothly, and you find yourself with a missed appointment or a change in the schedule, use the time to really support the practice by building a new protocol or investigating a new procedure or product. Uncover legacy procedures that need to be retired. Become the dental hygienist you thought you'd be when you graduated -- play to your strengths. February is notorious for downtime. Plan ahead, build the part of the body you're responsible for, and every other part will be thankful.

Shirley Gutkowski, RDH, BSDH, is the author and publisher of The Purple Guide series of books for dental hygienists. She is also the host of the popular daily radio podcast on Blog Talk Radio and Stitcher: Cross Link Radio. Gutkowski is a faculty coach at CAREERfusion. She can be reached for speaking or consulting at crosslinkpresent@aol.com.

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