Business of Dentistry

Effectiveness and Efficiency

It may seem strange to begin a series on clinical tips with some thoughts about effectiveness and efficiency, the Cochrane principles, but do please read on.

Effectiveness asks the question does the treatment work? Surprisingly, only about 20 per cent of all treatments have been ever subjected to the gold standard test, the double blind cross-over trial. Whilst this may be more relevant to our academic and our medical colleagues, there is a place in dentistry for such data, especially in the treatment and prevention of both caries and periodontal disease. As clinicians, we apply the results of this research to improve the care we give to our patients, and it is quite rare, but not unknown, for general practitioners to participate in such trials.

The efficiency question is far more relevant to our everyday clinical practice.

Efficiency asks the questions:

How well do we carry out any given procedure?
Does it work first time?
How long do we take?
Do we have to repeat stages?

It also begs the question ‘is there a better way of doing x’? We will be exploring that in more detail in future articles. The principles include the concept of continual professional improvement together with better care for our patients. As human beings we all look for something better when we purchase any product or service, and this is the same for dentistry. Perhaps we should call, at least our private patients, ‘customers’ because they are purchasing our professional services commonly for elective procedures. As customers, if you or I cannot deliver what the customer perceives as the service they require, then they are likely to seek an opinion and treatment from other colleagues (or competitors?). They might complain, or even seek legal redress. However, whatever the pressures, if a potential patient/customer asks you to carry out a procedure that in your opinion is against their best interests or your experience and skill, you will save money in the long run, your sanity, and the time of your Protection Society by declining to carry out that treatment. Advise a referral!

Compared with the more leisurely days when I first commenced general dental practice, there are many more pressures and time demands from regulators, costs, and the business of dentistry, and keeping abreast of the many new techniques that have been developed and introduced.It follows that our professional time is perhaps the most valuable commodity we have, and we therefore need to use it maximum advantage.

For arguments sake, let us consider that your earnings are £60 per hour, or a pound a minute. I know that for many that will be a serious underestimate of hourly earnings, but it makes the maths simple. You are making a set of complete dentures and you have to change both the mould and the shade twice before your patient (or customer) agrees that the prostheses can be processed in acrylic resin ready for fitting at the next appointment. It has taken you 30 minutes more than you expected, and indeed gave a fixed quote for. How much have you lost on this case? When routinely I ask this question of delegates to my hands on courses, nearly all use simple maths and say 30 minutes at £1 per minute equals £30. But is this correct? The answer is emphatically NO. You have spent 30 minutes and lost that time when you could have been earning further fees for 30 minutes, so the true cost is at least double your hourly rate. In my example £60 or more depending on any extra laboratory costs! In business terms, this is known as a lost opportunity cost.

With this concept in mind, and with the agreement of our Editor, in future articlesI shall be exploring how many of the little niggles that result in unexpected loss of professional time can be avoided. This will often involve process re-engineering, another term from business, where every stage of a process is analysed to eliminate material waste and loss of working time.

From my experience, if I can save each of my colleagues at least a minute per day, that will be its own reward.