Checklists Can Help Build Effective Teams

Given the complexity of today’s fast-paced dental offices, there exists a fundamental confusion within modern dentistry—an individual is seeking your care, and in order to help that person, you have to make sure that the multitude of daily tasks, hundreds of materials, and countless instruments are handled correctly despite the phone ringing off the hook, despite the 2 hygiene checks you are behind in seeing, despite your assistant telling you that the crown you are about to place has not made it back from the lab, and despite your receptionist interrupting you to let you know that the computer just shut down and he or she would like to know how to proceed. Every day in every office there exists complexity on top of complexity.

In a complex environment, dental teams face 2 main difficulties. The first is the deficiency of the human memory and relatively short attention span, especially when it comes to routine and mundane matters that are easily overlooked in the face of more pressing matters.

The second difficulty, and perhaps just as insidious, is that our teams can lull themselves into skipping steps even when they know what to do, fully aware that they are venturing into a complex situation where certain steps matter most. To demonstrate these difficulties, the clinician should think about the last routine chairside procedure that was done and remember how many times the assistant interrupted the process to retrieve something that should have been set up prior to seating the patient. This creates frustration, stress, wasted time, prolonged procedures, inefficiencies, and poor customer care. Complex environments can give way to inefficiencies and dysfunction within our team and offices, and managers often seek to solve these problems by either replacing capable team members or adding people to the team to compensate for the inefficiency. In reality, these 2 strategies may only increase the dysfunction and inefficiency within the office.

THE SOLUTION
While there are many ways to cultivate your team for success, few strategies will be of significance unless you motivate and empower your team members rather than point a finger at any one individual or add size to the already out-of-control, snowballing dysfunction within the office. Instead, as a solution to create an efficient team, managers would be well served to implement checklists into the daily routine of their team members. Checklists provide protection against the deficiency of our memories and attention spans within a complex environment. They remind workers of the minimal steps necessary and make these steps explicit, allowing capable workers the ability to succeed and feel good about being accountable for their actions. Ultimately, when created and implemented properly, checklists instill discipline and higher performance within each individual team member resulting in a stronger office as a whole.

Checklists Strengthen Communication
Checklists are about dictating instructions to workers to ensure they accomplish tasks to the standard that management expects. Uncertainty about a consistently successful outcome of a particular task should not depend on the judiciousness of a single individual; rather, success should depend on the judgement of the entire team. In any dental office, it is not just individuals checking off tasks that creates efficiency. In order to achieve a high level of efficiency, workers must balance task completion and communication among each other and within and among departments. Rarely does any task initiated only involve one individual. Take, for example, the patient who needs to be premedicated prior to his or her appointment. Think for a moment how many people, departments, and steps are involved within your office for this simple task to have a successful outcome. Who in your office is accountable for this process to be completed successfully from start to finish?

To be able to strike the balance between task completion and communication, checklists must embody 2 almost opposing forms: they must supply a set of checks to ensure the mundane but critical tasks are not overlooked, and they must supply another set of checks to ensure people communicate to coordinate and manage responsibilities. This balance empowers team members to manage the nuances and unforeseeable occurrences within a given task.

Effective Teams
The most common obstacle to creating an effective team is not the occasional instrument-throwing, fire-breathing dentist (although some may be out there). No, the more common barrier to building an effective team is the silent disengagement of a team member. The “that’s not my problem” attitude is possibly the worst behavior a member of the dental team can exhibit, regardless of whether that person answers phones, sets up the operatory, or directly works with the patient alongside the doctor or as a hygienist. While everyone is a specialist within his or her own department, individuals need to see themselves not just preforming their isolated set of tasks well but also as helping the group achieve the best possible results. This requires finding a way to ensure that the group lets nothing fall between the cracks, and that everyone works as a team to solve any problem or to properly address any situation that might arise.

Building Good Checklists and Teams
In order for a checklist to be effective, it must be brief, precise, practical, and succinct. It must be created by someone with awareness of the situations in which they are to be used. A good checklist must not concentrate on the minutiae; instead, it should provide reminders of only the most critical and important steps, especially the ones that even the highly skilled team members could miss. Everyone on your team should understand that the power of checklists is limited. Checklists can help individuals remember the steps in managing a complex process, and they can make priorities clearer and prompt team members to function and communicate better as a whole; however, in and of themselves, they cannot force anyone to follow or use them.

Efficient, highly productive offices use checklists consistently for 2 reasons. First, it is part of their DNA. Everyone on the team is trained to do so. Individuals understand that their memory and judgement are unreliable, and the efficiency of the office depends on them recognizing this fact. Second, teams understand that checklists work. They are a proven way to decrease the stress, mishaps, and inefficiencies in the office and increase production for everyone.
There are 2 types of checklists that are useful in the dental environment. The first is the “Memory-Pause” checklist. Team members perform their jobs from memory, but then they pause to look at the checklist to confirm that everything that was supposed to be done was done. This pause should take 30 to 60 seconds at most. The second is the “Task-Check” checklist. Team members carry out the tasks as they check them off. It functions like a shopping list. When creating checklists, you should decide what type of checklist makes the most sense for the situation.

A good rule of thumb when creating checklists is to keep the list between 5 and 9 items, which is said to be the limit of the working memory. Any longer and the checklist tends to become a distraction and people start to “shortcut,” missing steps. Concentrate on including what are referred to as “Stress Steps,” including only the steps that are oftentimes overlooked and cause the most inefficiencies and frustration when missed. Create communication points within a checklist when more than one person may be involved in the process. A good example of this would be when an assistant is getting an operatory ready for treatment, there should be a communication reminder to check with the front desk to gather the latest health history update prior to bringing the patient back to the room.

Checklist Caution
Understand that introducing a checklist for the first time may prove to be a cultural change within your office as well as a shift in authority, responsibility, and expectation about team member duties. Be watchful of buy-in amongst team members. If one person on your team does not see the value in following the checklists, then the chances of checklists being effective for the entire team will decrease dramatically.

Creating checklists for the day-to-day tasks (and even for the not-so-common occurrences) can prove to be a powerful tool in your office. While it may be attractive to start producing checklists quickly for every individual in your office, a good strategy is to introduce the checklist to just one area at a time and slowly work out the bugs. Let the team see the benefits of a thoughtfully prepared checklist so that they will want to participate in putting together one of their own. You may be amazed by the enthusiasm demonstrated by team members who want to help create more checklists that will help the office run better.

CLOSING COMMENTS
The checklists that you create will be unique and should meet the needs of your specific office requirements. Checklists are not comprehensive how-to guides; rather, they should be thought of as quick and simple tools aimed to support the skills of your team. Also, on your team, be sure that everyone knows that the checklists can be reconsidered, revised, and/or amended, should it prove necessary. A checklist can be a powerful tool, when created and managed correctly. It can help to engage and empower individual team members to make decisions, reduce stress, increase efficiencies, and to create accountability. Done correctly, they will be a boost to the entire team and help you create that next level of efficiency and exceptional customer care!


Dr. Simos maintains private practices located in Bolingbrook and Ottawa, Ill. He received his DDS at Chicago’s Loyola University and is the founder and president of the Allstar Smiles Learning Center and client facility (Bolingbrook), where he teaches postgraduate courses to practicing dentists on cosmetic dentistry, occlusion, and comprehensive restorative dentistry. An internationally recognized lecturer and leader in cosmetic and restorative dentistry, he can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or by visiting allstarsmiles.com.

Disclosure: Dr. Simos reports no disclosures.

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