Dentistry with a Vision: Building a Rewarding Practice and a Balanced Life by Gerald I. Kendall and Gary S. Wadhwa is a Theory of Constraints business novel, this time focused on dentistry practice. Kendall is a long-time TOC practitioner, and Wadhwa is a dentist who has had great success implementing these ideas. As with many of these books, putting the story into novel form allows the ideas to develop and a “guru” to provide guidance in a more visceral form than one might get from a textbook or workbook. And in this case, it felt like the guidance from the guru provided good starting points for further investigation to someone who might want to try the ideas in practice.
Theory of Constraints applies to many situations, though it is usually larger organizations that get the notice of consultants and books. But a business like this - physicians, lawyers, architects, furniture repair, etc - makes perfect sense. And the key constraint or limiting factor inside the business should (always) be the doctor / lawyer / expert repair person. The book also talks about having the right mix of work - work that brings the most profit per hour for the dentist (in this case) as well as work that enables long term stability and growth for the business. And, as with other types of business, it could be that the dentist isn’t currently the limiting factor in growing the business. It could be other specialists or available space as the current bottlenecks. Once you’ve decided where you WANT the constraint to be, there are decisions to be made on how to make that happen and then on how to continue exploiting the constraint (getting the most value from it).
Of course, it is not just Theory of Constraints that applies in making any improvements, though this book (and a lot of my work) uses TOC as an organizing principle. Where is the best place to make improvements? Start with the constraint. Improvements elsewhere only benefit if they help the constraint (step 3 of the five focusing steps); improvements without this knowledge can actually do damage, which the book gives a few examples of. The authors bring in several TOC concepts along with Lean, Six Sigma and others. It was interesting that the “human side” of change management was the topic that came last. The authors acknowledged that while change doesn’t happen without the people involved, sometimes it is difficult to get people motivated to consider those aspects until they see some of the potential effects on personnel and their colleagues.
I could have used more in the telling of the story in this book about how they implemented a shift from the dental assistant as the constraint to the dentist as the constraint. There was a lot of conversation about the impact of “cost cutting” or “cost control” measures that end up causing damage to the business: the dental practice couldn’t take on as much work and keep the dentist active on dental work when there is no protective capacity in the other roles in the business.
Dentistry with a Vision has a lot of similarities with Graham Scott’s more recent Practice Makes Profit (my review) - TOC applied in a medical practice (dermatology instead of dentistry). Scott’s book was much shorter and focused on the first three elements of the Five Focusing Steps: identify the constraint, decide how to exploit the constraint, and subordinate everything else to the above decisions. Kendall and Wadhwa’s take expands the story to include more thinking around how to implement a larger solution.