Improving productivity in the dental practice: a starting point.

Materials, patients, and information flow through the business, but all must pass through the dentist's hands. Thus they are the constraint within the dental practice. Dentists therefore must pay close attention to streamlining and simplifying clinical processes, delegating administration wherever possible, and outsourcing technical services. It is recommended that techniques such as four-handed dentistry, tray-batching of instruments, computerisation of records, and efficient scheduling of appointments, be adopted to improve through-put. Measures used to assess decision-making and performance-evaluation include the use of a computerised cashbook, appointment-book analysis, comparison of actual versus budgeted income and expenditure, net profit, and return on investment. These measurements are, however, an adjunct to intuition and experience. There must be an awareness that, if patient perceptions fall short of their expectations because of the improvement in clinical efficiencies, such optimisation would be to the detriment of the practice. To achieve on-going improvement, the dentist must create a learning environment where motivated team members are willing to engage in systematic problem solving, experimentation, and the learning and transfer of knowledge.

Establishing a competitive advantage through quality management.

The successful dentist of the future will establish a sustainable competitive advantage in the marketplace by recognising that patients undergoing dental treatment cannot see the result before purchase, and that they therefore look for signs of service quality to reduce uncertainty. Thus the successful dentist will implement a quality programme that recognises not only that quality is defined by meeting patients' needs and expectations, but also that quality service is fundamental to successful business strategy. Finally, the successful dentist of the future will realise that the pursuit of quality is a never-ending process which requires leadership by example.

Thoracoscopy: assessment of a physician service and comparison of a flexible bronchoscope used as a thoracoscope with a rigid thoracoscope.

The practicality of physicians performing thoracoscopy for diagnostic purposes was assessed in 30 patients with pleural effusions of unknown cause. A rigid thoracoscope was compared with a fibreoptic bronchoscope used as a flexible thoracoscope and the diagnostic adequacy of biopsy specimens obtained with the two instruments assessed. The two instruments were inserted by a physician in the bronchoscopy suite using local anaesthesia. The procedure proved safe, acceptable, and diagnostically effective. The rigid thoracoscope proved a more satisfactory instrument but the fibreoptic bronchoscope, with minor adaptations, may be used for thoracoscopy.