Stop Hiring People to Solve This Problem

Your dental practice can feel like it’s drowning even when you’re fully staffed and the schedule looks reasonable on paper. The real culprit is often smaller and harder to spot: tiny steps in your systems that get skipped, “just this once,” and then explode into bigger problems for the next person downstream. I’m breaking down how that ripple effect creates the daily feeling of chaos, backlog, and burnout and what to do about it as the leader. 

We walk through concrete dental practice management examples that every team recognises. First, pre-collecting patient copays for larger appointments: when we avoid a brief, uncomfortable money conversation, we often create longer conversations later, more insurance re-checking, slower check-in, and weaker patient commitment that leads to cancellations and holes in the schedule. Then we talk about scheduling hygiene and recall the right way, including the simple commitment question that reduces last-minute reschedules and protects production, team bonus, and momentum. 

We also dig into the front office and back office handoff, and how small documentation mistakes can quietly destroy trust. When the front desk has to keep double-checking what happened in the operatory, it slows everything down and can even lower treatment acceptance because patients feel the uncertainty. The solution is not hiring another person. It’s building clear agreements, coaching the “why,” and creating a culture where each team member asks, “Did I make someone else’s job easier or harder?” 

If you want calmer days, stronger systems, and a team that runs smoother together, subscribe, share this with a practice owner friend, and leave a quick review so we can help more offices. What small step gets skipped most often in your practice?

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Transcript

Paul Etchison 0:02

Does your practice constantly feel understaffed? I mean, maybe you look at it and you say, I've got enough people on payroll, but somehow everyone in this practice still feels overwhelmed. Maybe your front desk is drowning, your assistants are angry because they're always behind, hygiene's waiting on the doctor, sterilization can't keep up, the patients are waiting, the phones are ringing and nobody's available, and everybody feels busy and everybody is stressed. And at the end of the day, everyone goes home thinking, God dang it, why are we so understaffed? If we just had one or two more people, everything would be kosher. And maybe you've thought that too. Maybe you've thought if you could just hire just one more assistant or if you had one more front desk person, everything would change and it would feel calm at your practice. But what if that's not actually the problem? What if your practice isn't overwhelmed because you don't have enough people? What if it's overwhelmed because every single day there are dozens of tiny little responsibilities that are being skipped? And when those responsibilities are getting skipped, they're becoming someone else's work, but at a much larger scale. That is what we're talking about today. We're talking about the ripple effect of what happens when we skip tiny steps in our systems and how we can approach it with our team so that they understand and do the right thing so that we don't feel overwhelmed and we can finally handle what the day throws at us without thinking we need more people. Now you were listening to the Dental Practice Heroes podcast, where we show dentists how to build a practice that supports their life instead of consuming it. I'm your host, Dr. Paul Etchison. I'm a dentist, I'm a coach, I'm the author of two books on dental practice management, and I'm the owner of a large multi-doctor practice in the south suburbs of Chicago. All right, let's get into our topic today because I know you felt this and I know you want a solution. Here it comes. Now, one of our jobs as leaders of a practice is we have to be the person narrating what's going on every day. We have to narrate what's going well. We have to narrate what's not going well. And sometimes we have to narrate the impact of our team's actions or lack thereof. The thing is, is that most mistakes, most things that we overlook or we don't do, they're small and they don't feel expensive in the moment. They feel tiny. Maybe your team member says they'll just skip this one little thing or no big deal, or they'll make an exception for one patient. But the thing is, is that when we do this, someone else has to deal with the consequences. And often the person that's skipping the step doesn't see how it affects the person downstream. So let me give you an example. Let's talk about pre-collecting. Now, at my practice, we pre-collect to schedule anything that has $400 or more for the patient copay, or it's going to require at least an hour of doctor schedule. So this is our policy. For most people, we can present this in a way that they're okay with it. They have no resistance, they have no objections. But occasionally we get pushback from patient. And occasionally my team folds and they don't follow the system. So they say, Hey, we can collect on the day of. Now, if they would push, if they would be a little bit more strict, if they would just be a little bit more consistent with this patient, saying things like, hey, we want to treat everybody the same. And the only way we can treat everybody the same is to not make exceptions. I hope you can understand that, Mr. Jones. Of course, Mr. Jones doesn't understand it because Mr. Jones doesn't ever listen. Mr. Jones only cares about Mr. Jones and doesn't care about anybody else. But you get the idea. So that might take like maybe 30 seconds to take that payment. Now, when that person takes that payment, the financial part of this transaction is done. We've already gone over what the insurance coverage was. We already talked about the procedure. We already talked about the patient copay, what we expect from the insurance, and we took the payment. So now when it comes to the day of treatment, the patient is going to show up, check in, sit down in the waiting room, and then go get their procedure done. They're not going to have any questions about oh, wait, what did it cost again? Oh, wait, or what was my insurance again? Oh, wait, I don't know if I understand the procedure. Can you explain it a little bit more to me? And they so often do that when we collect on the day of treatment. So that takes extra time. We have to present it again. We have to look and look at the treatment plan and we have to audit it to make sure it's correct so that we're not presenting anything weird. We have to look for special clauses in their insurance, and it takes more time. Now let's look at it from a different angle. When we pre-collect, like I said, the patients nearly 100% of the time show up for their appointments. They're already committed. And now we don't have a cancellation. We don't have a no-show. When we do have a no-show, what do we have to do? Well, we have to try to fill the hole. We have to call other people. We might have less revenue, so it affects us in other ways. We have all these things that come from the hole that was created by the patient not showing up or calling to reschedule. So all of it preventable, all these things, all this extra time is preventable by just pre-collecting, like our system said to do. But it's easy, it's easy to make that exception, right? Because it helps in the short term. It makes that short-term discomfort easier, but it creates long-term pain and it can really bog down the rest of our systems. You see, we've got to, as leaders, we've got to help our people see the dominoes. Our team is not lazy, but they need to understand, and it's our job to make sure that they understand what happens when they hand the baton off to the next person. What is the ripple? We have to narrate that ripple. Instead of saying, hey, you forgot to collect, we need to say, hey, because we didn't collect, this was the impact. This is what happened after. We have to walk through it. We've got to make it visible because our team, they don't want to cause pain for the other team members. They don't want to cause more work for anyone else. That is not their intentions. Their intentions are good, but they just might not understand the full impact. It just seems small in the moment. Now, let me give you another example. Getting commitment from your patients when they schedule an appointment. When you're scheduling your six-month recall with the hygienist, the hygienist mentions, hey, and if for any reason you need to change this appointment, please give us 48 hours worth of notice because we got a lot of patients that we're trying to service and we want to make sure that we have enough time to give it to somebody else if you can't make it. And then they have to ask for the commitment question. Does that make sense to you? Do you understand that policy? Maybe they let them know that if they don't, we're gonna have to charge them $75. But then they have to ask for commitment. Does that make sense to you? Is that all good with you before I lock that in? Do you understand that before I lock it in? And that is how you reduce cancellations. But let's get that cancellation. Maybe we explained the policy, but we didn't ask for commitment. So they didn't really remember it or they didn't think we meant business. Patient cancels. Now the front desk has to field a reschedule call. They have to look for somewhere to reschedule them. That person is now holding time from somebody else. Our front desk is now scrambling to fill the hole. And if we can't fill the hole, the hygienist now has idle time. Our doctors lose momentum, our team bonus might disappear. We might not have enough treatment on the schedule because we didn't see enough hygiene patients. And it all started with that one little commitment question that was so easy to ask, but it was also so easy to not ask. So what we need to do as leaders is we want to constantly narrate this ripple effect and show our team members that the great team members they think about the next person. I really think that is the focus that we should have to do is that we're thinking like a team, we're working like a team. What about an operatory? This was something that happened at my practice a number of years ago, and it drove us all crazy. The assistant would complete the procedure, make sure the treatment plans right, schedule the next visit, whatever, and then they would send them to the front, and then the front would do the checkout, maybe they're taking payment, maybe they're scheduling the next one. I don't know. But the person at the front then looks at it and says, Man, that's not what we planned on doing today. Or that doesn't seem right. They're working in different quads. This doesn't look like it goes together. And then they have to get up from their desk, walk back to the back and say, Hey, is this right? Was this right what you completed in here? And now the assistant has to stop, go look at it and say, Oh, yeah, that was right. Oh my gosh, I'm so sorry, that's not right. And then what does that create? That creates a lack of trust. We're looking at it and say, there's a lack of trust there. We now our front can't count on the people in the back to complete the right procedures or put the right things into the computer. So now in the future, not only did that one time that person had to walk back and double check it, now they're always questioning it. Now they're wondering, is this correct? And then when they're presenting to the patient, that unsurety that might come off to the patient, that might lower treatment acceptance, that might make it look like we don't know what we're doing. It might make it look like we don't have our stuff together, and it might decrease the trust that the patient has in us. So big ripple effects there that affect case acceptance, that affect how busy our schedules are, that affect our production, our bonuses. All these things stem from that one thing, which really just comes back down to systems. Having systems in your practice so that everybody knows what they're doing and everybody can rely on each other. And if that's something you're struggling with at your practice, that is exactly the type of stuff we help in our coaching program. Please reach out to us, set up a strategy called dentalpracticeheroes.com slash strategy. I'll walk you through what our program is and how we train your team and teach you how to lead a team that runs your practice for you so that you can focus on whatever it is you like to focus on. So, what did we do in that specific situation with the front being confused whether the assistant put the treatment in right? We tried to come up with some different solutions, maybe double checking things, maybe writing it down on the routing slip. But what we eventually came down to was that this has to be correct. And when it gets to the front desk, it is correct. The front desk has to assume everything is correct. They are not to go in the back and ask. And the only way that we can make it work is the assistant had to slow down and say, Am I doing this 100% correct? Because if I don't, I understand the ripple effect that's going to happen downstream. And I don't want to do that to my teammates. So you are the leader of this team. You are responsible for this. The strongest teams, they don't just ask, Did I get my work done? They ask, Did I make somebody else's job easier or harder? Did I make it easier for my teammates? And that question changes everything. Because when each department starts thinking that way, the ownership and the accountability in your practice goes up, the frustration goes down, and people stop blaming and pointing fingers and getting mad at each other and building this silent resentment that eventually leads to more turnover, needing to train more people, needing to hire more people. So you see how having an unsystematized practice and not having these agreements in place can cause all sorts of problems in your practice that are much more removed from the actual problem itself. They're like a bunch of dominoes. One thing causes another, one thing causes another. So here are your tactical takeaways from this episode. If you want your team to start thinking this way, here's three things I want you to do this week. One, start talking about the downstream impacts of everything. Instead of just correcting a mistake, you need to diagnose and explain the ripple effect of those mistakes and how they create problems for the rest of the team. Two, during a team meeting, I want you to ask your team a simple question when you're talking about something that goes wrong or maybe a step in a system. I want you to ask who is affected when this step gets skipped, and what else is impacted by that as well. So not just that one little thing. Like you gotta think bigger. It's case acceptance, it's trust with the patients, it's trust with each other. What we're trying to do is train our teams to think beyond themselves. And three, celebrate the people who make everybody else's job easier. Ownership is not just doing your own work well, it's doing it consistently, it's setting up the next person to win. And when you recognize that behavior publicly, your culture can start to shift. So it seems like a small thing to do what you're already expected to do, right? Big deal. Why should we celebrate it? But when we celebrate those small things, it makes it one, so much easier to have the coaching conversations because we're celebrating and we're encouraging most of the time. We're not just always pointing out difficulties, but two, we're pointing out what's important to us as a brand, as an office, as a culture. What is important for team members who are part of this team that work in this office? And if you're listening to this thinking, my team works really hard, but they just don't think this way yet. Well, that's exactly the thing we will help you do with dental practice heroes coaching. We have built such a comprehensive coaching program that teaches you how to lead and also trains your team in the mindsets that they need to be successful. You notice how this episode, it was all about mindset. It was about thinking about the ripples. That's what all of our teaching and all of our resources are about. And if you've been operating your practice like this for the last maybe year or two or or five years, or maybe since you opened the practice, you've been doing things this way and you know it's a problem. What are you waiting for? Why aren't you doing anything about it? We can help you. It's so easy. Let us show you what's possible. Set up a strategy called dentalpracticarals.com/slash strategy. And if you've gotten value from this podcast, man, I would so appreciate that small favor if you would take a minute just to leave us a review wherever you listen. Do that right now. Don't do it later. Do it now because I know if you go to do it later, you're gonna forget. And man, don't you want to do something nice for me? I would just so appreciate you. And it would make my summer. I mean, honestly, if you took the time to leave a review right now, my summer would be complete. You could say, hey guys, I completed Etch's Summer because I took time to write a review, and I am such an awesome person. Seriously, though, it does help the show grow. It helps us help more people. That is our goal. So thank you so much for listening. We will talk to you next time. You have a great week at the office. And don't be scared to talk about everything in your practice. The more communication, the more conversations you as a leader bring into light, the better your culture is going to be. We'll see you next time.