Upstream Thinking in the Dental Practice

February 5, 2024 Leigh Ann Faight

Upstream Thinking in the Dental Practice 

Leigh Ann Faight, RDH 

In my years of working with dentists and teams, I have noticed that leaders tend to address what is directly in front of them. They are simply too busy to notice that the issues of today will likely be back tomorrow, and the next day and so on if they don’t find the root cause and build systems from there.  

My favorite book on this subject is Upstream by Dan Heath. I was so impressed by it that I named my dental coaching company Upstream Dental Practice Coaching. The idea of the book is to help us stop reacting to problems and instead look for ways to prevent them in the first place. 

In the book, Dan Heath recalls a quote from Paul Batalden: “Every system is perfectly designed to get the results it gets.” I love this quote; it is as exact as it is simple and begs the follow-up question: Are your systems working to get you the results you want? 

I’m not writing this with just dentists in mind. I recommend that all dental team members appraise together how well your systems are working and think about where the lack of systems is causing stress. As you meet as a team and pull back the layers of your processes, do you discover barriers that get in the way of moving upstream? As a team, you can intentionally rebuild your systems to remove the barriers and prevent them from rolling back into your stream. 

Fixed thinking gets in the way.  

As I coach, I see three behaviors that get in the way of improving the many systems operating in dental practices. 

Problem Blindness 

This is the belief that negative outcomes are natural and inevitable. We treat these problems like we treat the weather, as something out of our control. We normalize problems and even stop seeing them. Teams tell me, “That’s just how it is here.” This finite thinking is one of the first challenges we uncover when I work with teams on intentionally “going upstream.” 

Lack of Ownership 

If an issue arises and no one claims ownership for fixing it, the problem will persist. To really develop upstream thinking you need someone who will say, “Even though I did not create this problem, I will lead us to find a solution.” 

To create a culture where teams have ownership over decisions, leaders must trust the team to make decisions on behalf of the group. On the flip side, the team must choose to take charge of issues as they see them.  

Tunneling 

Tunneling is exactly like it sounds. You focus on short-sighted problems and have reactive thinking. You get stuck in a routine of short-term decision-making and are unable to move forward. You think, “I can’t deal with that right now.” 

The more problems you are juggling at once, the harder it is to solve them all. If you can’t solve problems systematically you will stay in an endless cycle of reaction, because tunneling begets more tunneling. Compound tunneling with stress and scarcity, and you get stuck. 

“Getting Unstuck” is the name of the game. 

You might want to take your team offsite for a day to talk about what isn’t working in your dental practice. What are the big problems they and you see? Talk about the common human responses of problem blindness, lack of ownership, and tunneling. Talk about upstream thinking and proclaim, “Today is the day we become unstuck.” 

In helping teams find ways to make their systems more successful, I have often found that small changes can make a big difference. If you add target metrics to your systems, “the team” will more likely see and remove barriers that have gotten in the way, redesign systems, and work as a united group to improve the outcomes.  

In the Pankey course held February 2024 — The Pankey Hygienist: Where Clinical & Behavioral Science Unite – The Pankey Institute, we focused on “the flow” of the hygiene-restorative partnership, leading patients toward higher comprehensive care, and getting clarity around the why and how of optimal behavioral and clinical methods. We took a critical look at the habits and assumptions we have developed. We applied upstream systems thinking with the goal of collaboratively achieving with our patients greater oral and systemic health.

Related Course

The Pankey Assistant’s Experience

DATE: June 12 2025 @ 12:00 pm - June 14 2025 @ 7:00 pm

Location: The Pankey Institute

CE HOURS: 17

Regular Tuition: $ 2050

Single Occupancy Room with Ensuite Bath (Per Night): $ 345

This “can’t miss” course will empower Dental Assistants to bring their skills to excellence! During this dynamic hands-on course, led by Pankey clinical team member, Sandra Caicedo, participants will learn…

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Leigh Ann Faight

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What I Brought Back from Napa (and it wasn’t wine!)

February 2, 2024 Robyn Reis

What I Brought Back from Napa (and it wasn’t wine!) 

Robyn Reis, Dental Practice Coach 

A while back, I made a business trip to Napa Valley. I was enjoying lunch on the patio of the Ottimo Café which is attached to a shop featuring wines, gourmet provisions, and culinary tools. It was a lovely day, and I was out in the beautiful California sun by choice. A nearby covered area provided shade, and there were multiple diners inside the shop waiting for those shaded tables. 

The maître d’ had given me a choice of tables and made sure I was comfortable. The food, wine and service were excellent. 

A family of four wandered over and sat down at an empty table in the sun. One of the waiters approached them and must have told them there was a line inside because they got up and went into the building. A few minutes later, they came out escorted and sat with menus at the same table they had left. There was obviously a system in place and it was working. Not long after, the two children became unhappy sitting in the sun. 

Being a parent myself I empathized with the parents as they struggled to keep the kids entertained. The little boy put his shirt over his head to block the sun, and I watched the dad looking at the covered area to monitor those shaded tables. As people from the shaded area got up, the tables were cleared, and the maître d’ seated more people.  

There was a lag between one table being bussed and people being seated because in a flash, the family left their table and sat down at a shaded table. The maître d’ approached them again. The family was speaking a different language and the father was using hand gestures. Obviously, communication was difficult. Ultimately, the family remained seated at the shaded table. There was no doubt that “good” customer service for this family was out of balance with “good” customer service for the people inside waiting to be seated. 

It was fascinating to observe the maître d’ having a conversation with the waiter who had been serving the family. My guess is that he was saying something like, “Hey, stay alert to maintain the seating system.” The waiter only nodded. It reminded me of a dental practice where you may have a patient in the hygiene chair and think to yourself, “Oh, it’s a small filling. Let’s go ahead and take care of that today.” Unbeknownst to you, someone may have walked in the front door hoping to be seen, and the front office thinks the walk-in can be accommodated based on the schedule.  

In both situations, it’s best not to make assumptions and communicate, communicate, communicate! In the back, check with the front to see if that filling can be done now. In the front, check with the back to see if the walk-in can be accommodated now. And in the case of a scheduled patient waiting in reception, you don’t want to keep them waiting unless it is really unavoidable.  

Sometimes we’re going to disappoint someone, however, we want to plan our schedule so no one is left waiting. We’re not in the restaurant business where customers are willing to wait in line for a seat at our table. Despite a fine reputation, if you cannot see new patients within a reasonable timeframe, they are going to call elsewhere.  

Look at your own schedule and converse with your team. Do you have an adequate number of new patient appointments available? Are you allotting sufficient time for each type of procedure? How good is your back-to-front and front-to-back communication? Do you keep patients waiting? 

My meal and business trip were a success in Napa. And while I didn’t bring back any wine, I did bring back the importance of having systems in place to ensure a great experience for every patient at every visit. 

Related Course

The Pankey Assistant’s Experience

DATE: June 12 2025 @ 12:00 pm - June 14 2025 @ 7:00 pm

Location: The Pankey Institute

CE HOURS: 17

Regular Tuition: $ 2050

Single Occupancy Room with Ensuite Bath (Per Night): $ 345

This “can’t miss” course will empower Dental Assistants to bring their skills to excellence! During this dynamic hands-on course, led by Pankey clinical team member, Sandra Caicedo, participants will learn…

Learn More>

About Author

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Robyn Reis

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

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