No Time for an Emergency : Identifying Scheduling Problems
At 6:30 am on Monday morning, Brian sat at his office computer, eager to start the assignment Rich had given him. During the past few months he had found it difficult to get up and go to work every morning, with a motivation level that had him arriving at 8:30, barely in time for his first patient. He had gotten to a place of hopelessness from which he could see no way out. Today, he found himself invigorated because he had opened his mind to change and finding a way out of the misery caused by previously insurmountable challenges.
It was blessedly peaceful lounging in his black leather chair early that morning, a latte steaming on his desk. Brian opened his new diary to the first blank page and wrote, “July 29th,” and below it, “Effects of Staff Shortages.” As he searched his online practice management system, the first thing he noticed was the amount of open time in the schedule over the past month, particularly in July. Of course, early summer was usually a little slower, but not this slow. He pulled up last year’s July schedule for comparison, and sure enough, he was down 25% in booked appointments from a year ago! How had that happened? he wondered, dumbfounded.
Brian began furiously shuffling the papers on his desk until he found the last American Dental Association newsletter. He quickly reread the article “US and International Trends in Dental Demand,” which claimed that there were shortages of dental health care providers throughout the country. If that were true, why were his appointments down?
Panic started to set in, consuming the positive energy he had begun the day with. If he let this feeling take over, he might fail at Rich’s plan before he even started. But his thoughts centered on the 25% cut in booked appointments, which meant a more than 25% cut in his profit share because his overheads were also up this month. The lab charges were increasing, salaries were going up, courier charges were through the roof—he might have to give up the cruise he had planned for his and Jen’s anniversary in December.
While combing his brain for some inspiration to reinvigorate his attitude, he recalled a technique preached by the Toyota leader Taiichi Ohno. He said that whenever he wanted to understand the reason for a problem, he asked “why” five times. Brian had discussed the program with Rich, who was not only aware of Ohno but a passionate follower of his principles. Rich had later given Brian a couple of books on the Toyota Production System and Lean thinking.
In desperation, Brian started to apply Ohno’s technique. In his mind, he stated the problem first: We are down 25% in booked appointments from a year ago. Why? His gut reaction was anger—if he knew, then he wouldn’t have let it happen. But maybe he did know. That made him angrier. Brian tried to take a step away from those feelings, remembering that the answers you’re supposed to seek are much simpler than you would think. You’re supposed to look for the immediate and most obvious reason why.
Brian tried again. Why are we down 25% in booked appointments from a year ago? This time, the answer came without effort. It’s probably because our receptionist booked 25% fewer appointments for this month. Duh, he thought to himself.
Feeling a bit skeptical at the absolute simplicity of this answer, Brian nevertheless asked himself the second why. Why did our receptionist book 25% fewer appointments for this month? Most of the appointments for this month were booked over the past two months. It couldn’t be because of Sharon’s accident—that was just last week.
He thought back further in time. Sarah had taken sick leave a few times several weeks ago. She had caught the flu, and then her son had gotten the flu. Because Brian had no notice of Sarah’s illness, he had no receptionist the first day. And the second day, the temp arrived late, leaving Brian no time to explain the computer system and office procedures. By the afternoon of the second day, Melody and Sharon were both climbing the walls. It was Sarah’s job to do the paperwork, bill insurance, record new appointments, etc. Instead, it seemed like everything that Melody and Sharo/>