by Cathy Sundvall

Advice for orthodontists and the clinical team

Delegating tasks in the operatory is one of the ways in which an orthodontist or clinical supervisor can draw on the strengths of the entire clinical team to manage patient flow, increase efficiency, and reduce overall stress, while providing exceptional customer service.

Delegation is also a way to empower clinical team members. When the orthodontist delegates responsibilities to team members, it demonstrates a confidence in their skills and supports their professional development.

One reason that orthodontists don’t always delegate specific tasks is the issue of accountability with regard to clinical assistant licenses. This legal aspect requires the orthodontist/supervisor and clinical team members to be knowledgeable about a state’s clinical assistant guidelines as well as each assistant’s skill level and competency. Even with these challenges, learning the skill of delegation, training your clinical team, and trusting that they will fulfill their roles are necessary ingredients for today’s orthodontist practice, especially as the practice grows.

Trust is a Must

Have you ever delegated a procedure to a clinical team member, only to check the patient and find yourself looking at something very different from what you prescribed? Or maybe the results were not up to your standards?  Due to this phenomenon, many orthodontists sometimes feel it is easier to do the work themselves. As an example, say you go to check bands that have been fitted by an assistant onto all of a patient’s molars. The distal lingual portion of the lower right second molar band needs to be seated more, and the lower right first molar’s buccal tube is sitting too far mesial. You struggle with the decision between making the necessary adjustments yourself or having the assistant refit the bands. At that moment, you don’t trust the skills of the clinical team member and decide to make the necessary adjustments. Ideally, the clinical team member should have done the adjustment, freeing you for procedures that cannot be delegated. 

If you struggle with a low level of trust in your clinical team member’s ability and want to raise it, start gradually. Presenting someone with a difficult procedure when they are not used to such a challenge will be extremely stressful for both of you. Successful delegation starts with easier procedures and allows confidence levels on both sides to grow. Then, you can assign another procedure that builds on the first one.

Here is a series of steps to take to make the process of delegation easier and more effective:

? Understand that the goal of delegation is not just to get rid of the work; nor is it just to keep the clinical team members busy. The ultimate goal is to increase the productivity of the clinical team members and the practice while delivering exceptional customer service to your patient family.

? Do not fall into the “I can do it quicker and better” syndrome. Of course you can do it quicker and better—you are the expert. If you do fall into this syndrome, you are not delegating; you are doing the work while they watch. You will be stuck in a rut and will keep your clinical team members in a rut, too.

? Meet with your clinical team members and describe the desired results of the various clinical procedures performed in the practice. Be very clear about what you expect as the end product.

? Make sure that your clinical team members understand each step of the procedures by asking them effective, open-ended questions such as, “Can you explain to me how you would go about bonding a partially erupted lower right second molar?” Or ask the team members to write out the protocol for handling the procedure. Save the protocols in a training manual for future training, review, and updates.

? Get a buy-in from each clinical team member that they are up to the tasks. If they do not feel capable, consider further training and coaching. Develop a checklist of all clinical procedures, and test your staff’s abilities regardless of their tenure. Areas of expertise include sterilization procedures; polishing techniques; isolation techniques; bonding procedures; fitting bands; mixing and recementation of bands; fitting headgear; fitting, delivering, and adjusting appliances; mixing and taking impressions; archwire bending and placement; and ligation techniques.

? Make your expectations clear, and ensure that the clinical team members know what their jobs entail. Do each of your chairside assistants have a detailed job description that includes side duties, secondary assignments, or special tasks that are clearly prioritized and understood by all team members, including your administrative staff?

? Support your clinical team members by providing resources for the continuation of their learning. Ask them what resources they will need, and provide them. What training tools do you have available? Have they been updated, and are they accessible to the clinical team members? How often do you block out time in your schedule for training sessions?

? Share the task of reading orthodontic publications and journals with your clinical team members. Tip: Assign each team member a publication, and ask them to read and clip articles that would be pertinent to the continuing education of the staff. Have each clinical team member give the highlights of their articles during your monthly staff meetings.

? Empower your clinical team members. Let them do the work, but agree upon legal limitations of procedures; and develop checkpoints along the way so that both you and your team will know how it is going.

? Energize your clinical team members. When they complete the task or procedure, acknowledge their effort and provide instant feedback.

Delegation Do’s and Don’ts


? Assess the patient situation and procedure first.

? Know the skills and comfort level of the clinical team member to whom you are delegating. If you don’t know, ask them.

? Give simple, clear instructions. Share your expected outcome.

? Give the timing for the procedure/task.

? Follow up with the clinical team member.


? Grab back a task or switch clinical team members during  the procedure.

? Delegate only tasks you dislike.

? Delegate a task that is beyond the clinical team member’s  skill level.

? Delegate a task at which you are not proficient.

? Reverse-delegate by doing the job yourself.

Delegation and Learning

A word to clinical team members: If you seek more delegated tasks, you must be committed to being the best at what you do. You must have the knowledge, skills, and common sense to carry out the patient’s prescribed treatment and be willing to give your best effort every day. You must be highly trained and understand your practice’s treatment philosophy.

Here are a few ideas on the training experience. All clinical team members will attend a training class sometime soon. It may be a 1-hour lunch review on the theory of a certain appliance, a half-day class on patient motivation, or a weekend retreat away from the office with the goal of revamping your schedule. It may be something for which you are paying, or it may be something in which your practice is investing. Regardless of who is paying the bill, you are making a considerable investment of your time, energy, and attention to participate. Here are some ways to improve the experience:

? Have a goal. The first thing you should do is set a learning goal. If you are already knowledgeable about the topic and have specific things you want to improve, setting your goal should be easy. If you are not too excited about attending this training session, or are unclear about its topic, you can still set a goal such as, “Learn one new thing I can apply at work,” or “Learn one new shortcut to increase my efficiency.” Beginning your session with a specific goal, and writing it down, keeps you focused and will help you gain practical value from any learning situation.

? Learning is up to you. Take responsibility for your own learning experience. The training session may not be the most engaging one you have ever attended, but that is OK because you have a goal in mind. Make that your focus. Perhaps the trainer is not going to cover that topic exactly. That is OK; use their expertise. Ask them during a break, and probe for other resources. Stay focused on your goal. Your learning is in your control. Take responsibility for getting from the experience what you want and need.

? Raise your hand and ask questions. Do you not understand something? Is the information not clicking for some reason? Ask for clarification. Do you need a little more practical, hands-on experience? Ask for it.

? Learn from everyone. There are more people to learn from than just the speaker. The other staff members in the room can be great learning resources. Tap into their experience and knowledge. Talk to the team members at your table or around you. Think of them as your peer coaches. These team members can help you learn during the session, and they might become great resources for information once the training is over.

? Create an action plan. At the end of the training session, review your goal(s) and build a plan to implement what you have learned. Reflect on what you learned, and resolve that you will apply those ideas to your daily tasks. If the training has been valuable, you may have several ideas. This is great, but be realistic about how much you can apply at a time. Build your plan recognizing that you may be able to implement some things tomorrow, but you might need to spread out other things over the next week or more.

? Become the trainer. One way to solidify what you have learned is to share what you have learned with someone else. Talk to a team member about it, or demonstrate the specifics of a procedure back in the office. Not only have you helped the other person, but you have also increased your knowledge and skills.

? Review and practice. If you want to really retain what you have learned, set up a series of dates to review your notes or practice the procedures that you learned. Review them the evening after the training. Review and practice them the next day—and the next day. Then, put a reminder on your calendar to review them 1 week later and 1 month later. Each review only needs to be few minutes long. You are simply trying to build the concepts in your mind through repetition and give your mind a chance to spark new connections and new ideas.

In the end, the rewards of highly trained clinical team members and the orthodontist’s ability to delegate include the cultivation of a practice that consistently develops great clinical team members and provides ample time for critical tasks and thinking for the orthodontist; motivated clinical team members who are allowed to grow professionally; and more “creative time” to devote to new projects and goals.

Cathy Sundvall has combined her practice-management and clinical expertise to consult, coach, and train staff members in the areas of clinical efficiency, new-patient processing, marketing, customer service, and team performance. She lectures nationally, has published numerous articles, and has developed training manuals. She can be reached at (863) 427-4346 or [email protected].