By Shirley Gutkowski
A variety of ways describe organizational groups. In dentistry, the word "team" usually is adopted to illustrate the organization. It brings to mind a game of some kind. To me the game is baseball. Everyone on the team has a job. Certain people on the team are talented in one single thing, such as the pitcher. There are a number of players, and the thought is that no one member of the team is more or less important than another. Without all the players doing their job the team won't win. If I understand this game of baseball, the catcher is just as important as the pitcher.
The problems or difficulties with this metaphor are the reality that some team members are paid more than others, some are more famous than others, and the inherent rivalry within the ranks exists. The team is viable and functions regardless of celebrity. Only some team members attract fame; base coaches are seldom famous. The big but is that, unlike dental offices, teams function in an environment of competition. The reason teams exist is to clash with other teams, and the competitive spirit extends between players.
A metaphor that fits the dental office much better than a baseball team is the human body. The body is a closed system, and no one part is more important than another. No body part brings in more money than another. One part isn't more famous than another. The body can't function without blood, a heart, a pancreas, lungs, a liver, or a nervous system. The body is holistic, not manufactured; the body is not a game. It is life. That's how I look at dental office employees and owners.
By way of example, let's use the lungs as the body part for each department of the office. Lungs are useful pieces of anatomy. They provide oxygen to the blood for transport to the tiniest cells. Without lungs, the body would become blue and assume room temperature. Bodies at room temperature begin to smell bad.
If we call the hygiene department of the dental office the lungs, we find that the department is the center of the office. Hygienists spend a great deal of time with patients. They have an instrument on each surface of each tooth and are valuable co-diagnosticians.
Without the hygiene department, doctors are on their own. Trying to find decay in one of more than 20 teeth with 120 surfaces, discern tissue abnormalities, build rapport, review a health history, ask probing questions, and comply with OSHA and Health Insurance Portability And Accountability Act Of 1996 (HIPAA) requirements in under five minutes is a big job. The hygiene department does all that and assures the dentist that a real exam was performed. The hygienist sets up the treatment plan and provides billable services and treatments. When the hygienist's hands are in the mouth of the patient, it is profitable; the practice is vertical.
Lowered frustration level
If the assisting or support staff of the office is considered to be the lungs, patients are cared for in the most efficient manner possible. Instruments are on the tray and the dentist's hands never leave the patient's mouth. The frustration level in the provider's/production department is kept low, patients move in and out of treatment rooms without incident, and the provider's time is spent delivering quality care, which in turn delivers paychecks to the support department. Without them, the body becomes oxygen-deprived and inefficient. With them, the body thrives.
If the hygiene department is not working effectively then the system breaks down. The practice turns blue and assumes room temperature. If the hygienist is doing dishes while his patient is out in the reception room, he's not thinking about providing optimal care for that patient. He's wondering how the heck he's going to get everything done.
Much like the lungs trying to apply enough force during respiration to pump blood through the body, this isn't going to work. If the first base coach on the baseball team tries to pitch, they'll lose the game. But it's a game; they're called players. If the lungs are asked to do something they're not educated to do, death will occur.
Asking hygienists or dentists to do dishes assumes also that the job of instrument sterilization is unimportant and easy; anyone can do it. A central person in charge of sterilization can prove that assumption wrong, wrong, wrong. Sterilization is a complex procedure that takes forethought and education. Understanding the autoclave and its functions, as well as instrument and packaging materials, protecting mirrors, sharp instruments, chemicals, and safety is not something anyone can do with a few minutes of training. If the sterilization technician was asked to polish or floss teeth, his talents would be misappropriated the same way the hygienist's, receptionist's, or dentist's talents would be by packaging instruments.
If the sterilization technician was the lungs of the office, and expected to do something out of the domain of respiration, the body would encounter some serious problems. This also is true if the doctor was asked to provide supportive tasks for the rest of the system. What happens if the dentist answers the phone? Should her hands be slapped? What if the doctor tries to offer payment plans in the operatory? System failure, the body shuts down. The patient with dental requirements no longer will be able to have those needs met at this office.
Human bodies, like a dental practice, contain parts that work in concert, each part carrying a load that complements and supports other parts. When one system breaks down, other parts cannot take over. Try this metaphor with any department, as any body system. What if the dentist was the blood and the reception department was the heart? What if the hygiene department was the skin, and the dental assistant department was the brain? Those systems are not interchangeable. The brain cannot take over the part of the blood, the skin and lungs are not interchangeable. No one system can take credit for keeping the body above ground.
The coach is often considered the most important or most responsible. During a game, there is a need for multiple decisions. Changes are required minute by minute. If the opposing team's pitcher becomes injured, a new strategy must be developed on the spot and put into action.
No coach for the body
In a team metaphor, the dentist is usually associated with the coaching. The dentist is the one to motivate, and tell people where to go and what to do. Much like the dental office staff, all the systems in a body already know what to do. Changes in philosophy don't change moment by moment. If one patient shows up in place of another, the doctor doesn't have to restructure a philosophical plan to address the situation. The staff can handle it without input from the doctor. If the body is confronted with a shot of whiskey, all the systems react and take care of it. There's no need for coaching.
Every system within the body is specialized to a point where it's impossible for that system to cross over and take up the slack of a system that's going poorly. Hearts are interchangeable, lungs are interchangeable, dentists are interchangeable, assistants are interchangeable and hygienists are interchangeable; yet they are not able to cross over to do each other's job without the practice suffering.
Doctors assume the most risk and have the most education of all the departments. However, they cannot work entirely alone and still maintain a viable practice.
If more offices/practices use the body metaphor to describe themselves, there would be fewer turf wars in the office. Hygienists and dentists could provide billable services; assistants could be supportive in managing patient flow without jealousy of the hygienist's wage and freedoms.
Hygienists who strut like a big shot would have empathy for support staff, a dentist's need to micromanage would disappear, and receptionists would know that they are vital parts of the practice. Dentists, often the owners of the practice, can rest assured that when the parts are working at peak efficiency the practice will remain vivacious.
Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected].