by Penny Mustard

Remember the famous old Abbott and Costello sketch, “Who’s on First?”? An orthodontic practice can become its very own version of this scenario when a team member suddenly leaves the practice, leaving no replacement, and walks away with many of the daily operating processes in her head.

How do I know this? Because it happens. As a consultant, I have seen offices totally unprepared for this situation, and have seen firsthand the disastrous results that come from this lack of preparation. A practice can become like a malfunctioning garbage disposal, chewing up everything and spewing it back up the drain and all over the kitchen. Everyone runs around trying to pick up the pieces and perform tasks they do not know how to do. Marketing efforts diminish because everyone is just busy getting through the day. Contracts are not entered properly (if at all), and insurance is not filed correctly because no one understands the ins and outs of the financial functions in the software. Morale takes a hit, and no one is excited about coming to work the next day.

A practice’s staff members each have a different function, much like the parts of the human body. But as in the body, all the members have to work together to function as one unit, each knowing what the other part’s function is. When one part of the body shuts down, usually the body adapts and learns to function, sometimes in a different way. When the right arm is broken, the left arm picks up the slack, maybe even learns how to write.

The days when an assistant was an assistant and wasn’t allowed to answer the phone (because it might be a new patient) are gone. The scheduling coordinator not only needs to be proficient at the items on her job description, but perhaps could be cross-trained in the clinic as a chairside assistant for when unexpected patient delays occur. Or she could be available to pop back to imaging and take an x-ray.

Have you considered having an assistant transform into a treatment coordinator in a time of necessity? To help you get started, you should answers three questions: Why would you want to? How do you get there? And how can you make everyone transparent?

You want to because production is the livelihood of the orthodontist and the staff. If you can’t see a new patient or be able to obtain case closure, it will hurt the bottom line.

You want to because keeping the customer happy and providing good patient care keeps patients coming back and referring to your practice.

You want to because your expectations need to equal your staff’s ability to perform with confidence. A happy doctor makes for a happy staff, and vice versa.

You get there by cross-training and then actually expecting the staff to do their new tasks on a routine basis. This means performing those job functions on a daily or weekly time frame to stay proficient. Just knowing how it is done, having the head knowledge, does not mean a team member can actually perform in that position if called upon in a crisis.

You get there by spending time and money. Time to train in regular staff meetings that are scheduled in times apart from seeing patients and specifically designed to teach different software modules, scripting, and clinical procedures. When was the last time a staff person other than the TC ran through the new-patient workflow? I know one office that actually schedules one exam into the clinical schedule each day so each assistant gets the opportunity to see one new patient a week.

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You make everyone transparent when you accept everyone’s input and shortcomings, and work with them to build a team. This means listening to others’ views without condescending remarks.

You make everyone transparent when you accept everyone as being different. Work one-on-one with staff if they are not quite executing tasks at a level that is acceptable or need specific help with verbal skills. Not everyone will be good at everything. This does not make them a less-valued team member.

What if your financial manager went to the doctor tomorrow and was diagnosed with a long-term, life-altering illness and needed to resign immediately? What would you do? What is your backup plan? You have to decide that cross-training is a priority that is necessary for your practice, and then begin implementing it. Start now, because, to quote my husband, “You can’t steer a parked car.”

Penny Mustard has been involved in orthodontics for more than 20 years as an orthodontic assistant, office manager, treatment coordinator, and marketing specialist. She is the founder of Mustard Seed Consulting Group. She can be reached at