Turbo charged

shutterstock_149235410Is your practice in need of a fuel injection? Seema Sharma explains how to boost and then sustain growth and improvement

There is always scope to boost performance, and it’s up to a good leader to identify and eliminate the bottlenecks that hinder progress.
In his book, The Goal, Dr Eliyahu M Goldratt puts forward the ‘theory of constraints’, setting out a formula of five focusing steps to identify and overcome the bottlenecks that get in the way of business goals.

The people/process balance

For a business to be efficient and profitable it needs effective, productive people and efficient, profitable processes.
It can be overwhelming for a practice owner or manager to try to address what appear to be a multitude of operational issues that hinder implementation of the practice’s strategy. However, it is worth remembering that a leader’s vision is just a daydream if the implementation processes are a nightmare.

Five focusing steps

The five-step process discussed in this article will help you to take ownership of the problems you face by working on the things you have the authority and the ability to change.
It is important that:
•    Your goals are clear from the outset
•    You know what is within your ‘circle of influence’ – don’t be derailed by things you cannot change
•    You know how to measure the amount of valuable output you produce. The theory of constraints calls this the ‘throughput’ of the system.

Step one: find the greatest bottleneck

Constraints can be internal or external and can involve information, people, supplies, skills, premises, equipment, government policies and even internal policies. A chain is only as strong as its weakest link, so this is where you need to concentrate your efforts.
There may be more than one bottleneck, but they should only be addressed when they themselves become the weakest link, because others that were weaker before have since been strengthened.
After many years of supporting dentists to run more successful practices, I have found that there is one bottleneck that comes up time and time again – lack of the business knowledge and skills required to make savvy business decisions within a myriad of sometimes conflicting commercial and professional requirements.
The only real way to deal with this is to develop the knowledge and skills through a formal work-based training programme that combines theory with practical application. I am certainly finding that the MBA programme I am on at Imperial College London is transforming my own thought processes in a way that could never have been done with evening and weekend courses.
For the purposes of this article, assuming you know the basics of managing money, people and processes, let’s look at some of the other bottlenecks.
The bottleneck should be easy to spot at the start of an improvement process. One of the most common ones is the dental practice owner/manager or associate who is:
•    Always busy (because they are maximising that precious resource – time)
•    Always behind (work piles up in front of them)
•    Underutilising other downstream resources (trying to do everything themselves).
If your bottleneck isn’t immediately obvious to you, conduct a team survey to ask others where they see problems, and then see which issues come up.

Step two: optimise the bottleneck

Start by maximising the output of the bottleneck itself. This usually requires no additional investment and only involves working on one resource (a high productivity clinician or an overloaded manager, for example).
There are several ways in which efficiency can be improved. Working at a steady pace and minimising interruptions will help you to give adequate time to each task you undertake. However, to-do lists can be endless, so delegating work that does not add value will help you to prioritise the tasks that are most important.
Use tools that improve efficiency – there is no point in spending hours on a paper-based cashflow forecast or a Care Quality Commission audit when a digital tool such as Excel or bespoke software will give you all the results at the press of a button.
Smooth the bottleneck path by filtering and ordering tasks, and providing training, tools and support for those focused on the most productive jobs.

Step three: use excess capacity to support the bottleneck

Any resource that isn’t a bottleneck has, by definition, some excess capacity. Utilise that to support the bottleneck by passing required but ‘low-value adding’ work to non-bottlenecks.
As the leader in front of the bottleneck:
• Keep the bottleneck’s ‘in-tray’ full, but not overloaded
• Maintain some capacity of your own to handle variations in its outputs.
As the leader of those behind the bottleneck make sure:
• They only pass important work to the bottleneck
• They work at the pace of the bottleneck: no faster, no slower, to avoid overloading it.
Creating the right infrastructure around the bottleneck requires no extra cost or investment and still only involves a few resources, typically those that interact directly with it.
Remember, while a bottleneck resource (such as a highly-productive clinician or a highly-skilled manager) should be fully loaded, non-bottleneck resources (such as less productive clinicians or trainee administrators) must have the time and capacity to be able to support the bottleneck and deal with fluctuations. Do this by ensuring some of their work is ‘nice if it gets done, but not essential or time-critical’, so it can be put aside to step up to help the bottleneck.
This may seem counter-intuitive at first, as the aim is to improve productivity of all clinicians and staff, but remember you should deal with one bottleneck at a time – their time will come as and when bottlenecks ahead of them are eliminated.
This really is true teamwork!

Step four: elevate your bottleneck

Increasing throughput of the bottleneck should be considered as they limit the outputs of the entire system. You can elevate your bottleneck by:
•    Changing over to a faster process, or technology
•    Buying more – or better – equipment
•    Putting in another production unit, such as another treatment room
•    Hiring more staff (if your budget allows it).
Elevation requires investment, can take time to produce results, and may even be a hindrance in the early stages. Those who have to support new team members, for instance, will see a drop in their own output for a while, and a heavy investment may have a significant impact on cashflow.
Often, the untrained businessperson will do this too quickly – remember to do the free stuff first!

Step five: find the next bottleneck

When you’ve solved the problem of one bottleneck, go back and find your next weakest link, then the next, and then the next.
Whether it’s another human resource issue, a physical resource issue (such as limited room for expansion), a time issue (such as diary space) or a financial issue (such as a small NHS contract), apply the same principles, maximise the throughput through the bottleneck and then decide if additional investment is required.
Soon you’ll be on a roll and your business will be on a steeper path to success.


Seema Sharma is honorary lecturer in entrepreneurship and management at the Dental Institute, King’s College London. She is also founder and CEO of Dentabyte Ltd. For further information, visit www.dentabyte.co.uk


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