EP 99: How to Recognize and Resolve Capacity Issues in Your Dental Practice with Dr. David Ahearn

In this episode of The Double Your Production Podcast, Dr. John Meis and Wendy Briggs sit down with Dr. David Ahearn, a dentist and the founder of Design Ergonomics and Ergonomic Products, to talk about how to find and alleviate capacity issues in your dental practice.

What we find overwhelmingly with our clients is that doctor-owners often believe they need new patients for their practices to succeed, when in reality, they’re suffering from a capacity problem.

In this episode, you’ll learn:

  • How to identify capacity blockages in your practice
  • How to reduce wasted space in a dental office and get the most out of the space you have
  • Simple ways to improve efficiency (adapted for dental practices from the Toyota Production System)
  • How to increase your capacity with confidence
  • A better way to think about investing in your office capacity

Get Your Resource Package: Design Ergonomics and The Team Training Institute are providing all listeners with a free package of resources to help optimize and improve your practice. Get this resource package by clicking here: https://theteamtraininginstitute.com/designergonomics/

Listen now:

Bio:

“I just wanted to make it easier to provide great dental care.” – Dr. David Ahearn

When Dr. David Ahearn began his career as a dentist in 1983, his mission was simple. He was committed to providing the best care possible for his patients, and to making that care affordable.

His focus was singular — he put the patient first.

In the early 90’s, Dr. Ahearn became convinced that the Toyota Production System could make dental offices more productive, while improving the lives of dental staff and the patients they treated. He thought that if the principles of continuous improvement, right process, and organizational learning transformed industrial production, couldn’t they do the same for dentistry?

He applied the Toyota principles to the design, construction, and management of his first dental office, and the results were dramatic. His practice quickly became one of the most productive in the nation. The dental staff was engaged and empowered. Patients were happy … and happy to refer others. He soon realized that he had refined a process that could help other dentists transform efficiency and patient care in their offices.

He founded Design Ergonomics (www.desergo.com) in 1993 to DesignEquip, and Train the best dental offices across North America. The company has since grown to become the largest independent dental office designer in the United States as it works towards its goal of creating the best dental practice in every town in North America. To learn more about how Design Ergonomics will make your dental office a fun, easy, and productive place to work, subscribe to www.youtube.com/designequiptrain.

 

Speaker 1:
Welcome to the Double Your Production podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it or in the trenches who know exactly what you are going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.
Dr. John Meis:
Hey everybody. Welcome to this episode of the Double Your Production podcast. I'm Dr. John Meis here with Wendy Briggs. How you doing, Wendy?
Wendy Briggs:
I'm doing great, Dr. John. Ready for another amazing podcast episode.
Dr. John Meis:
We are so excited to have our dear friend long term friend, Dr. David Ahearn with us from Design Ergonomics and Ergonomic Products. How you doing, Dave?
Dr. David Ahearn :
I'm doing great. Excited to be on with you.
Dr. John Meis:
I know that you're very, very well known in the industry but there's probably a few people who don't know who you are. Dr. Ahearn and I met, gosh, 20 some years ago, both on a quest to figure out how the most productive offices were being productive and how can we make them even better? Dr. Ahearn started studying the principles of the Toyota production system being lean, being able to be very, very efficient so that we can have very predictable and consistent patient experiences. He used that knowledge to transform his own practice, then began to design and build dental equipment, and now designs, builds dental equipment, designs dental offices, and also does trainings on how to make offices more efficient from a time perspective and from an expense perspective. So that's my intro, Dave. Did I hit it okay?
Dr. David Ahearn :
That's a great intro. There's a lot of moving pieces going on on our end, obviously. But that's the essence of it is, is I was getting killed doing industry 20 some years ago, and I knew there had to be a better way. And everything that we've done for two and a half decades is just to simplify the process, make it more predictable and make it easier for people to do great dentistry. That's what we do every day.
Dr. John Meis:
And be able to do great dentistry and to be able to do more of it with less wear and tear and less stress as well.
Dr. David Ahearn :
Yeah. Yep. The funny thing is that they go hand in hand. Doing it harder tends to go ahead and do it less productively at the same time. So that's the great news for everybody is taking less of a beating winds up making you more money.
Dr. John Meis:
Yeah. Yep. Yep. It's an interesting dynamic. Because I guess it's kind of a natural human thing that you think that to do better, you must work harder.
Dr. David Ahearn :
Right, right. That's right. And the irony is no patient ever said, "Can you please take make this take twice as long? I'd like to pay you twice [inaudible 00:03:01] you did." No patient ever said, "Wait a minute, you got that done so quickly and conveniently. I need a discount." It's never happened. And dentists, we don't get that.
Dr. John Meis:
Oh, that's for sure. [inaudible 00:03:15] So one of the interesting things is that the so many so-called experts in dentistry have been talking about, if you want your practice to be more productive and more profitable, all you need is more new patients, and the more new patients the better it's going to get. And it's sure been shown to be a ridiculous fallacy. And I've heard you describe it as doing it the hard way. You want to describe what you mean by that?
Dr. David Ahearn :
Yeah. Doing it the hard way, most dentists, even those that don't espouse to that belief, play catch and release fishing. So they're catching new patients every month. And if they're not expanding at a phenomenal rate in terms of their capacity, those fish are just going back in the pond. Might as well give the thing a kiss and drop it in on day one. And so the amazing thing is the doctor doesn't really pick who they keep. In fishing at least you go like, "This one's going to make a great meal." But here, the fish that stays elects to stay and somebody that maybe you wanted doesn't necessarily stay because you didn't make whatever connection was important to have them become a customer for life. I mean, that's what's so great about what you do in making sure that that customer experience is fantastic and making sure to build the bond. And that's the most important thing. It makes no sense to go ahead and attract an extra a hundred patients next month. I mean, you just took away a hundred hours.
Dr. John Meis:
Yeah, that's right.
Dr. David Ahearn :
I mean, you can argue that more. I mean, depends on how you contribute time to that first new patient experience. And so people are out of capacity, adding a hundred new patients, displacing a bunch of other people that can't get back in for recall, that some of which probably the best ones don't want to wait and go somewhere else. The whole thing is insane. Now I'm not opposed to a large number of new patients, but you got to have room for them.
Dr. John Meis:
That's right.
Dr. David Ahearn :
You got to have room for them soon and then they all have to have that same great experience. And those things all have to go together. And we don't see that often times.
Dr. John Meis:
When we look at the stats of practices that are coming into our consulting group, only about 30% of them can handle the patients they're getting already. And so you can see it in their data. We can see it that their patient retention is poor. We can see that their case acceptance is poor. And we can see their productivity per hours poor because they're hamsters, but they're not making the kind of progress that they could.
Dr. David Ahearn :
Yeah. And especially, I mean, this isn't a bash on associate doctors, but associate doctors tend to work at a coping level. And so you want to have them produce at a higher number, actually feed them less new patients many times. They get swamped with new patients and suddenly they start their treatment planning-
Dr. John Meis:
That's right.
Dr. David Ahearn :
Drops significantly. We watch it. I mean, in my own practice I watch that.
Wendy Briggs:
Right.
Dr. David Ahearn :
I think we're doing a better job than some practices, hopefully most, but we still see the tendency. We give them more opportunity to have these phenomenal months and then the next month I look at the case average and go, "Oh, that's interesting." Yep.
Wendy Briggs:
I think it's important too for us to illustrate here that we aren't necessarily, even as owner/doctors, really focusing on the production. It's not all about the money to us in our world. It really is about providing optimal care. But one thing we know is when production drops, so does optimal care. So when you talk about case average, when you talk about all of those things, all of that connects back to how well we're caring for our patients.
Dr. David Ahearn :
Right.
Wendy Briggs:
And whether if there's a disconnect, if we don't bond, or if we don't spend the amount of time, patients don't understand the why behind the treatment recommendations that are being made. And that's why the case average goes down. That's why we're not doing as much dentistry. That's why the associates aren't as productive. So our desire in having everybody on the team maximize their productivity is because our number one goal is to optimize patient care. So I just want to make sure our listeners are very clear on that.
Dr. David Ahearn :
And too many patients walking around with the equivalent of pegged legs that don't know that they had other choices. I mean, you can imagine in my practice, I actually have said that. "Would you like a peg leg?" "You're a glass eye? No." Okay. Well, this is kind of the same thing. But that's what we do and we do that by judging patients. We do that by not spending the time to go ahead and connect. I don't know about anybody's economic situation. I just know that they have the right and dignity to be presented the best we know how to do and then work from there.
Dr. John Meis:
Yeah. So we see when we fix patient retention, when we fix case acceptance and put a team case acceptance process into place, and we put the mentality of if it's possible, let's do it today. You do those simple things and all of a sudden, every practice is at a capacity.
Dr. David Ahearn :
Oh yeah. Yeah. Okay. We've fixed all these things and now we've got no place to go. And so we used to have more choices than we have now. We used to be able to go ahead and the hard part is doing what you do. Quite frankly, what I do is not hard. To do what I do well is maybe is harder, but it's not hard. It's math and engineering. So you take all this time to get people to do all those things, to get the whole team aligned to doing that, that's hard work. And we don't know when that tipping point's going to happen in a practice.
I mean, you go into the practice and you work with them and you think they're going to get it. But we don't know whether that's six months from now or a year from now when that's really going to kick in. And so it's not like you can say, "We're going to do all these things. We're going to get you to actually be able to treatment plan and have the customer love you and make sure that we've got retention right, and that means the math is eight months from now, you're going to be swamped."
Dr. John Meis:
Yep.
Dr. David Ahearn :
So everybody gets this capacity problem by surprise.
Dr. John Meis:
So true.
Dr. David Ahearn :
And it's kind of a crisis because then people want to come back and you can't let them back in. And I'm shocked at around the country how long some of the recall delays are. You just got somebody done with perio and now you can't get them back in for 10 months.
Wendy Briggs:
Well, and not even that, Dr. Dave, I mean, I'll hear from some hygienists, say, "We've quit talking about perio," or the doctor will say, "We don't even talk about or promote perio because we don't have [inaudible 00:10:29]." It stops us from providing optimal care because we already know we're at of capacity. That's when it's visible.
Dr. David Ahearn :
And so one of the biggest obstacles to this is purely psychological. Doctors are scarred about spending in general. We're small business people. We're in fear most of the time in spite of prosperity. And so the challenge is I've got doctors spending three or $4 million on new capacity. Well, we've also got doctors that are generating three quarters of a million dollars or a million dollars a month in revenue. If you amortize that expense, it's noise. It's 5% of the practice. People are the expense. If you got the math right, if somebody wants to spend more than 10% of revenue on facility, I have problem, amortized 10%. But if you're spend talking about spending six, 7%, it's crazy not to add capacity. I mean, Starbucks doesn't think that way.
Dr. John Meis:
Right. Dentists really have not been trained on business principles and so they equate the expense of an investment in their practice to an expense on more supplies or something. They don't understand the difference between basically a balance sheet item and a PNL item. And so they think of them in the exact same way whereas one is an expense, but one has a return so it's not really an expense.
Dr. David Ahearn :
Yeah. And to the emotional trust in yourself to really know, okay, we've made this work, it appears to be really working well. The evidence is I've got people waiting months to go ahead and get in here. I've heard that I can fix this. And actually having the confidence to say, "Yeah, I'm going to spend the money," is a challenge. And most people need to nibble at it first. So half of our design time is spent remediating practices where quite frankly, they should just go ahead and build another one next door.
Dr. John Meis:
Yeah. Yeah.
Dr. David Ahearn :
Level the one they've got. Just open one in the next town close enough that they can move the patients to where the patients actually live as opposed to having to drive over to their office. All the other things would be the logical thing, but most people aren't going to do that at first. They're going to try to squeak out the most they can get out of their own office. Guess who's done that before? He's on the podcast. Me and you. Okay? I'm adding a 10th room into a six chair. It was a six chair, seven chair, and eight year. We made every treatment room into a consult room and we're making the consult room into a treatment. So I'm doing it in one of my own practices. It's natural. I should just move across the street because I look on a pond and it looks nice. Anyway, so that's a challenge that all of us in dentistry face and so there are ways to address that. We've been working on a lot of them.
Dr. John Meis:
No, you have and maybe the first thing that I saw you provide a very creative solution was taking two normally sized ops and converting them into three ops. And you have a name for it. I can't remember the [inaudible 00:14:01].
Dr. David Ahearn :
Yeah. User room pairs. And so here's the funny thing is Wendy, a person that uses hygiene rooms in an assisted function. Room pairs are actually one of my last choices, but it's very commonly a great solution for working out a mature practice to gain more capacity. Because in a room pair where you have a more effective room as hygiene. And the reason I differentiate that is we use those room pair hygiene rooms for dental treatment. We can convert them to dentistry. I just don't want to do sedation in them. I don't want to do crown and bridge in them. But I can do endo in them. I can do fillings in them. I can do all the little things in them. So they're usable that way, but that's one of the choices.
And there's another thing, is so the best thing that somebody can do is not waste space when they build. That's really the most important thing is if you're building something now, the average square foot per treatment room, average out over the whole space, is 450 to 500 square feet per room. So if you build a 10 chair, it's 5,000 square feet you need. We do that all the time in somewhere around 3,500 feet without constraining anything. And that's just the principle if you can make the thing flow faster. Cut in efficiencies anywhere throughout the facility, that's Toyota principles, you can go ahead and reduce the volume of some non-value added spaces. And those are Toyota terms, but that's equivalent. Toyota figured out how to change machinery from one procedure to another in minutes instead of weeks. And so those are the kind of things that go into designing for that. So that's the first thing. Don't waste any space. Even if you've got a big amount of space, you're going to grow into the need for more.
Wendy Briggs:
Yeah. I think that's something that a lot of people don't realize. We often see doctors with big, big visions. So we work with them on a variety of things. We say we've got to focus on the mindset, skillset, tool set. Dr. John's super good at getting them in the right mindset, helping them think differently, knowing the difference between the P and L and supply costs, those types of things that you just talked about. And then we work with them on the skillset, how to get the team knowing how to take patients through. And what I look at is you really work with them on the tool set. Do they have the right equipment? The right space? Are they using their space, their asset they've invested in the most efficient way possible?
How can we redesign the workflow? I mean, I can't tell you how many times I've seen your team go online and somebody puts their new build plans up and they're just awful. And I don't even know what I'm looking at, but I can even tell it's awful. And your team comes in and just a few really awesome comments, all of a sudden, the doctor's like, "Well, holy crap. I got to burn it down and start over." That is not a good place to be but they're so glad they did.
Dr. David Ahearn :
Yeah. If you think about it, we've got a huge problem in dentistry because nobody in dental school learned... I had three days of quote business management dental school. They were useless but I had three days of them. A slick, general dentist came in. He had nice clothes. But it was three horrible days during finals sort of thing. I had no days of knowing how to make it dentistry productive. I mean, I had a minute of that. There was nobody that inhabited the entire university that understood that.
And so dentists look at a plan. I mean, I don't want to criticize that much, but most people don't know how to read a plan even. I mean, it's not reasonable if they would. How do you translate that into visionless? You've built a whole bunch of stuff. And yeah, so they can't know. And that's, I think for us, the biggest challenge and why we like to see opportunities where people with a hands on things. Because once they put the hands on things, they go, "Oh, I get it." Unfortunately there's not much substitute for that to really get them to go ahead and see forward.
Dr. John Meis:
So you started out with these room pairs, but very quickly I realized, okay, for someone maybe nearing retirement who wants to just get just a little more fluid through the straw, maybe that makes sense. But practices that have a great patient experience who have the right mindset, the right skillset, so practices just grow very rapidly. So it almost is that putting your toe in the water instead of just diving in and making it happen. And the other thing is, and maybe you feel differently about this, but with the room pairs, the rooms are not totally universal. And I think there's a benefit to universality-
Dr. David Ahearn :
That's right. That's absolutely right. So that's why it's not my first choice. It's an economical choice. 60% of a general practice ought to be hygiene by volume, not necessarily dollar volume, but by volume. That's where it should be. So I'm okay to go ahead and have a certain number of those rooms be mostly that most of the time. I'm okay with it. But for a little bit of extra real estate, 5%. So if you're in a new build or an addition, for five to 10% extra space, you can go ahead and build universal rooms across the board. This is going to sound funny. It won't hurt hygiene that much. Universal rooms are actually not more productive for hygiene.
They're easier to schedule to. They're easier to flex. If you want to go ahead and use a system where you dedicate certain times of day to hygiene in an increasing volume, you can do that kind of thing. If you want to have a day, that's all operative, you can go ahead and do that easily. And doctors use different strategies on that. We don't use them as much. I try to have the days be the same, the hours be the same. But everybody's got a different thought on how we do that. And universal rooms just make it easy to go ahead and do that. Anybody learns how one room set up is, where everything is. So it's preferred to do that. And no reason not to if you have the space.
Dr. John Meis:
Yep. So next topic I want to get your thoughts on is when we think about capacity, what is your favorite measure of efficient use of capacity? Do you have a metric that you look at that you like for that?
Dr. David Ahearn :
Production per hour is the thing that we watch. I've found that it's the most practical metric to use. It's just easy to go ahead and measure. We can compare it across doctors. We can coach to it. We can coach it back to treatment plan and we can coach it back to just mental focus. We can coach it back to the number of columns that somebody's able to handle. That's why we use that. There are a bunch of other metrics that people use, but I think we both share that that's a very useful one for us.
Dr. John Meis:
Yeah. That's my favorite. And it doesn't matter how awful your practice management software is. That's a number you can get.
Dr. David Ahearn :
Yeah, you can actually calculate. [inaudible 00:22:21] Because some of the things that people want to go ahead and pull, you can't pull from certain softwares. You never get it.
Dr. John Meis:
And so as your capacity starts to fill, your productivity per hour goes up. And at some point it crosses a line, and this is one of the red flags of your out of capacity, at some point, you realize that, "Well hey, if I do this procedure, there's an opportunity cost. Because if I did this procedure in the room, it would be a higher productivity per hour."
Dr. David Ahearn :
I mean, this is a appropriate care challenge. I mean, this is a moral statement. We should be able to do whatever the patient needs and not have to worry about the compromise. And if you are at grossly inadequate room count, you're trying to avoid dentistry that needs to be done. We'll talk later about a strategy where it might be appropriate in transition to actually intentionally do some of that. But as a general principle, no, you need to be able to do whatever. Now simultaneously, we as a profession think that a filling isn't productive and a crown is. And a lot of that is because we are what Toyota refers to as zero changeover we're not good at. So if we're not good at getting started and getting done with a small procedure, then the solution is to only have bigger procedures.
So a lot of the folks that are in consulting that are like, "Oh, you got to do big procedures," when I've gone and inadvertently studied their practices, I didn't intend to discover this. I actually wound up doing some design work for some consultants. And they were the small office, big fee consultants. I was horrified at how long it took them to go ahead and actually start a procedure. The amount of time it took to get the patient to wind through this whole thing, to actually get the thing done. And so they gave up many of these not particularly product profitable practices because they gave up so much in inefficiency. So I hate to see that. Capacity can challenge that. I guess we can talk about the subject. What if you've brought them to success? Patients want into this practice. They want to stay at this practice. They want to bring their relatives in, be customers for life, and you're out of space and you intend to fix that. What if that's a six month problem?
Is it reasonable to not do a procedure today that is not as essential? Something we don't as a professional like to talk about. But if you think about it, I think that it is potentially okay. And here's why. If you don't spend the time building the bond with the patient, because you're spending all your time drilling little holes, then the patient doesn't stay. And if you believe that you're the best practice. I mean, it takes a commitment to be the best practice.
If you are the best practice, then somebody should be okay in a situation where if you think about it in hygiene, we've got somebody with incipient decay and we need to stop the decay entirely or else they're going to get more incipient decay. So which is appropriate? Is it appropriate to treat the incipient decay and then prevent future decay or prevent future decay and then six months from now treat the incipient decay? I think either of them is okay. And if either is okay, then when you're out of capacity, it would be okay in my mind for six months to go ahead and go heavy on every kind of prevention you can load knowing that in six months, some of those are not fully arrested and will need to be treated.
Dr. John Meis:
Yeah. And you have that commitment for a certain period of time.
Dr. David Ahearn :
But it's a certain period of time. You can't keep kicking that can down the road. That's not okay. And so for me, that timeline is somewhere in the six month, maybe eight month timeline, but you got to get on with it. You got to figure out, you got to solve capacity by one of the various ways. It used to be that the first cheat was expand hours. I call it a cheat. We have evening hours. We have weekend hours. We always have. I think it's important. But it used to be that you could slam that to pretty severe limits. And I'm sure you're seeing across the country, there's a places you go like, "Well, welcome to join us as a hygienist. We'd like you to work two evenings a week and Saturdays." Good luck with that.
Dr. John Meis:
Good luck. Yeah. Particularly.
Dr. David Ahearn :
And it's the right thing to be able to bring to your working class customers who need that service. But it's not a tool that we can use as often as we used to. So, I mean, that's a big handicap in terms of capacity. You had folks they didn't really have capacity. If they were already doing evenings and weekends, they were already out of capacity. So let's get clear on that. But they had that and now they lost it during COVID. And now all those patients want back in and the patients that can't get into the other practice. I mean, that's the storm that we have now. And so anybody that's listening, this is the greatest thing that ever happened to you, dentist. I mean, this is amazing. This is a magical time. I know we're all scarred from what this two years. But magic is happening. If you've got customers that are dying to get into your practice, get them the capacity. And no, you can't probably add Sundays. You probably can't do it. Maybe your town can, but [inaudible 00:29:12]-
Dr. John Meis:
Most places can't.
Dr. David Ahearn :
Yeah. Most probably can now. So that was a big flex because you used to be able to at least flex that in. You could pay people to go ahead and expand that time, promise them that you were only going to do that for a certain period, and then add new employees and not have people with no chance you had to work three evenings a week, whatever it was. So that's just the tough one. And you add to that, get a contractor. Not the easiest time to do either. But it is what it is and oh, it's more expensive. Yeah. What's the lost opportunity cost? How much extra production can you add? You could add $200,000 a month, but you don't want to spend in one month, and you don't want to go ahead and spend an extra $200,000 because lumber went up. I mean, I am buying a lumber mill, small one because I am annoyed by lumber prices, but I'm not going to stop.
Wendy Briggs:
Right. Well and how many times have we seen, in the many years that we've worked together, doctors who took that leap. And we kept saying, "If you build it, they will come. You've got the mindset, you've got the skillset. Now we need to expand the capacity and get you better efficiencies and really focus on that missing piece, that tool set." And then literally a year later they're like, "Oh my gosh, we're out out of capacity in our new 12 op location." It happened so fast, but you're right. So often we get paralyzed by fear. What if? Or it's too big. Or I don't have the confidence to do it. But how many times in the many years we've been working together have we had the opposite [inaudible 00:31:03]?
Dr. David Ahearn :
I can think I can think of two doctors in total that have said, "I really built bigger than I needed to." And when we actually studied those, because I took that as a mortal indictment. I mean we've designed thousands and thousands of offices, but I know of two. And in both those situations, I think the doctor was right. But it had nothing to do with patient demand. Patients wanted in, they were just happier having a puny practice. Now the practice that had gone from five chairs to 10 chairs. Over the decade that they concluded that they would rather have a small practice, they made the money that made it possible for them to think that the smaller practice was better. That's ironic. Because if they had never built it, they wouldn't have the income. They'd still be grinding away in the five chair, hating dentistry.
Wendy Briggs:
So really, to me, that's just a symptom that the systems weren't sorted out in those two incidents. Because Dr. John, I always say that bigger is actually easier than many people think because there's so many more opportunities that exist there. Bigger is actually easier with the right systems in place.
Dr. David Ahearn :
Right.
Wendy Briggs:
That's what we've seen, too. And like I said, we have so many clients who bring Dr. John the plans or on a hot seat, and they say, "Here's our plans. We're going to build this many ops." And literally the whole room is like, "You got to go bigger."
Dr. John Meis:
"Not enough."
Wendy Briggs:
"Not big enough." And we're not talking 30 ops or anything ridiculous, but it's amazing how often you just can't see that from the inside.
Dr. David Ahearn :
Well, the common thing is, I mean, John and I have joked for years, it's two more ops. Everything would be fine with two more ops. If you come to the conclusion that you need two more ops, you need way more than two more ops. Usually we just look and already the math is they're already full. I mean, you can't see it, but they're already full. So then what Absolutely that's a challenge. And I hate to do that, but it's pretty common that I'm okay if you're doing the two ops within the confines of what you already have. That office that you hang around in, you really shouldn't be hanging around in.
Go home. And there's somebody else to administrate the whatever paperwork you're doing in there, you shouldn't be doing it anyway. There's somebody else to do it. I haven't done paperwork. I mean, God bless if we had me doing paperwork. It'd be terrible. But I haven't done paperwork for 20 years. I mean, a treatment plan. That's it. And so you don't need a big space to go ahead and do that. And if you're sitting in that big space, you're not doing what we actually get paid to do. And if somebody else has managed the paperwork and you're not doing dentistry, maybe go home.
I mean, I told you, Nicole took my office away.
Dr. John Meis:
You don't need it.
Dr. David Ahearn :
I don't need it.
Dr. John Meis:
You need someplace with a chair and a computer.
Dr. David Ahearn :
Yeah, that's right.
Dr. John Meis:
And maybe not even a chair. You just need a place with a computer and that's it.
Dr. David Ahearn :
when I go visit the practices, this is an aside, I go to the customer care center, what somebody might call a call center, but that's where I find out what's going on. Just watching the traffic in there and then I'll kind of scan the treatment rooms, but all that data comes from at the end of the month how the doctors are doing. And so, yeah, no, you don't need much of an office. So there are places we can go ahead and capture rooms for many, many offices, but there are a whole bunch of folks that just have to bite the bullet and do the right thing. The other thing that can be done though right now is we watch offices in room turnaround.
Dr. John Meis:
Yeah.
Dr. David Ahearn :
And they'll spend 15 minutes to go ahead and set up for a surgery case. So there's a room that's being set up for an extraction and the extraction may take three minutes of doctor time. Okay. That's great that the doctor's got it down and the doctor time's only three minutes, but the room was killed for 45 minutes for that. Or an implant, folks charge a lot for implants and have learned to be incredibly ineffective at getting the service delivered. I studied with some of the really great implant docs and I was just horrified at how long set up and breakdown took considering how quickly they could do the procedure. And so if you can reduce that, you can then change how much time you've allocated that room to that procedure. And sometimes you can double the productive output of a treatment room simply by changing that. A lot of the work we do with the rapid carts to convert rooms for different uses come from that. And again, that's Toyota principles. They proved that out decades ago.
Dr. John Meis:
Yeah. Yeah. I'm glad you brought those up because those are two big time and time is capacity. If you're running shy of treatment rooms, then the amount of time a treatment room is blocked as you mentioned, and that setting the treatment room up ahead of time now takes it out of the rotation for same day dentistry. So you're not going to be able to pop something in there quickly to do it. If you can't mobilize the equipment, now you have to move the patient. You don't necessarily have to move them to next Tuesday, but you have to move rooms. And now you've killed some more time. Cause you've got tear down in one room and you set up in another room, so now you've built up cost and expense and time that really is providing no value for the patient whatsoever.
Dr. David Ahearn :
Right. And patients love to go ahead and get something done now. We're all too busy. It's easy to make the decision. Once you've decided that you need it, you want to get it off your list. And the incremental cost of adding that in right now, especially in the same room, if it's diagnosed in hygiene and moving the hygienist to somewhere else that is identical so that becomes easy, so the doctor can sweep in and complete the treatment, it's a godsend to patients and it's the best revenue of supplement for the dentist. There's no loser in that equation. And so for us, the other part of that is you need to make sure that the consultation component of that room's capability is really good. It's one thing if I have a broken tooth kind of obvious. But it's another thing if it's I think there's something wrong with that tooth that you need to show and explain. And so again, I want to have monitors right there. I want to have the ability to scan and pay for treatment right there.
I want to have those rooms certainly not be open hauled so there's noise between operatories. And we still, even during the pandemic, we swept nonclinical folks into rooms to go ahead and do that universal precautions, the same as everybody else, but bring them to the patient. There are many things that I was criticized for saying 20 years ago. And one of them was that the last choice of where I want to consult a patient is in the consult room. I don't want to drag them from one room to another room to go ahead and talk about what I was already talking about. The issue was if the room's terrifying or noisy, then you got to get them out of the room.
If you don't have enough rooms, then you've got to get them out of the rooms. If you get enough rooms, then you should be able to have them comfortable there and bring the person to the patient. A study was done probably three years ago, not in dentistry, where they had somebody trying to make a decision and then they moved them to another room, and then they put electrodes on them and saw what their brain was doing, and as soon as they got up out of the one room, their brain was on shopping lists, what times [inaudible 00:40:04]-
Dr. John Meis:
They'd left the building already. [inaudible 00:40:07] Dr. David Ahearn :
They're gone. And so to bring him to the front desk is bad. I mean, just try to bring me to the front desk and have me in line two deep, numb, and tell me stick around. We want to talk about your next appointment. No. I'm a dentist and you will never get me to stay there. There's no chance. And so people are willing to, because they're good people, but it's not because they like it nor is it effective. So again, that creates another capacity potential theoretical problem on your treatment rooms. Because if you need to be able to do that, that may be 10 or 15 minutes of presentation there.
But remember, we made something called the consult room of the future. I don't know. You may not have seen that. That fully converts from a lounge room to a treatment room instantly. So it's backwards. So you consult in it. There's no scary technology of any sort showing, and it's made for compact spaces like your consult room, smaller than a normal treatment room. So there's a place that folks that are out of capacity might be able to get a room right now.
Dr. John Meis:
Right.
Wendy Briggs:
Awesome.
Dr. John Meis:
Awesome. Well, we could talk for another two hours and we have. But before we started recording, Wendy, Dr. Ahearn and I put together a package of stuff from the Team Training Institute and a packet of stuff from Dave's companies. And so in the show notes, there's going to be a QR code, and go ahead and click on that QR code and that will put in place a process that will get you these materials that we'll be talking about, some of these fundamental things that Dr. Ahearn has been developing and perfecting for decades now. And it'll talk about some of the things that we do when it comes to mindset and skillset that allows people to have big jumps in productivity to be thinking about what a bigger future could look like and how we get from here to there. So we'll put those things together. Dr. Ahearn, thank you so much for being with us today. It's always a pleasure. And Wendy, great job today.
Wendy Briggs:
Always great having these conversations and like Dr. John said, we know you could go on for another few hours, and maybe schedule another return visit because I'm sure our listeners were eating it up as well. So thanks again.
Dr. David Ahearn :
Look forward to meeting with you again soon. It's always a pleasure to go ahead and share our ideas with you. Thank you so much, guys.
Dr. John Meis:
Thank you.
Wendy Briggs:
Thanks.
Dr. John Meis:
That's it for this episode of the Double Your Production podcast. We'll see you next time. Thanks everybody.
Wendy Briggs:
Thank you.

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