Canadian Orthodontics, attached. Prepare your findings and recommendations to the questions posed in the case in a report format for Jayson.

W26090

CANADIANORTHODONTICSPRACTICE:BRACINGFORPATIENTS

Janice Eliasson, Brent Snider, and Peggy Hedges wrote this exercise solely to provide material for class discussion. The authors donotintendtoillustrateeithereffectiveorineffectivehandlingofamanagerialsituation.Theauthorsmayhavedisguisedcertainnamesandother identifying information toprotect confidentiality.

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Copyright2022,IveyBusinessSchoolFoundation Version:2022-04-27

Dr. Jay Jayson sat down in his office, sipping a hot cup of coffee in preparation for what was sure to beanother busy day in his well-established orthodontic practice. He loved seeing the smiles of his patientsgraduallyimprovethroughouttheirtreatmentplans,butheespeciallyenjoyedthefinaltreatmentappointment, when everything was removed and patients saw the finished results for the first time. It wasrewardingtobepartofpersonalimprovementtransformations thatwouldlastalifetime!

Although Jayson was reasonably comfortable with the operations of his practice, his desire for patient-focused care meant that he was always looking for ways to improve Canadian Orthodontics Practice(COP)both from the patients' perspective and from his own. While patient flow and capacity had rarelybeendiscussedinhisorthodontictraining,Jayson'sinterestintheseareashadrecentlyincreased;hehopedto grow the practice and was considering various alternatives that would also help balance his workload.As he waited for his first appointment of the morning, he wondered how he should prioritize the options:hiring more registered dental assistants (RDAs), renovating the treatment area, or even partnering with asecond orthodontist. What results could he expect to see from each option or combination of options?Jayson had been pondering the best way forward almost every morning recently. And just like mostmornings,thefirst ofhis manypatientsarrived beforehe couldevenfinish hiscoffee.

Afterthelastpatientofthedayleft,Jaysondecidedthatsincemorningsalwaysseemrushed,hewouldtakesometimetoorganizehisthoughtsbeforetakinghischildrentotheireveningsportingactivities.Hethoughtit might be a good idea to first go through the treatment process from beginning to end. He knew thereception environment was comfortable, and that the patients felt confident in their treatment and theprocess, but he was concerned about the impact on patients of any delays in care. Occasionally, patientswere late, or processes took longer than anticipated, and this delayed the care of subsequent patients. Heknew that scheduling everything to the maximum was not the best approach, but he also did not want tounderutilizehis RDAsor even himself.It was aconstant balancingact.

PATIENT PROCESS

Most of Jayson's patients brought someone with them to their appointments. The majority of his patients wereyoungteenagers,whowerefrequentlyaccompaniedbytheirparents,butofhisadultpatients(whomadeupabout30percentofthepractice),manyalsobroughtsomeonealong.Hisclinicwaslocatedinamedical

practicesbuildingadjacenttoabusyshoppingmall,soparkingwasfreeandample.Mostpatientscheckedinfortheirappointmentsononeofthewall-mountedcomputersandwaitedcomfortablytobecalled.Duringarecent renovation of the waiting area, the practice had added video games along one wall, a cozy fireplacealonganotherwall,andapopularfreebeveragecentrewithhotandcolddrinkoptions(seeExhibit1a).

After a patient checked in, one of the RDAs came and took them to one of the six dedicated treatmentchairs. A bench adjacent to the treatment chair was available for those who accompanied the patient; thesepeople were also free to remain in the comfortable waiting area (see Exhibit 1b for a picture of one side ofthe treatment area, and Exhibit 2 for a simplified diagram of the full treatment area). The patient's processconsistedof three steps:

1. TheyspentfourminuteswiththeRDA,whopreparedthepatientfortheorthodontist'sexaminationbysettlingthe patient in and discussing any new concerns.
2. They spent up to five minutes with Jayson, who determined the recommended treatment; this couldincludefollow-upappointmenttiming,whichtheRDArecordedonthewall-mountedcomputer.
3. Next, the RDA spent eight minutes implementing the procedures prescribed by the orthodontist: re-attaching the wires to the braces, tightening to the specified target, or showing the patient how to putonelastics.

Jayson'sthoughtsturnedtotheRDAs,sincetheystayedwiththepatientstheentiretime.ForanRDA,theprocess lasted about three more minutes after each patient left while they sterilized the chair and preparedthe working area for the next patient. Throughout the day, each RDA would continue to treat patients at asingleassigned treatment chair.

After treatment, each patient would book their next appointment at the reception desk. Depending on theirtreatment needs, approximately one-third of patients would have three-week recall appointments, anotherthird would be back in a month, and the final third would have six weeks until their next appointment.Jaysonhadsetupthescheduletotrytomakeongoingappointmentsasconvenientaspossible.Thepracticewas open Monday to Thursday, and Jayson dedicated three times during the day to shorter appointments:before work and school, during lunch break, and late in the day. The rest of the day was dedicated to newpatientconsultationsandappointmentstoeitherputonnewbracesorremovebracesafterthetreatmentwascomplete. He was comfortably busy, as patients were scheduled into most of the time slots, four days aweek.Thenewpatientconsultationroomincludedatreatmentchair,soanewpatientcouldbecomfortablypositioned for their initial assessment and then sit comfortably in the chair as treatment alternatives werepresented.Althoughthe primarypurposeoftheconsultationroom treatmentchairwasnewpatientassessment,Jaysonconsideredusingit asa treatment chair forhisregularpatientsif necessary.

With his notes on the current facility and processes completed, Jayson began thinking about key questionshewanted answered to help guidehis future decision-making:

• WouldhiringmoreRDAshelphimtreatmorepatients?
• Wasthereaway morepatientscouldbeseenwithoutrenovatingthetreatmentarea?

Jayson realized that the answers to these questions about any actions he should or should not take wouldrequire deeper analysis and reflection. He quickly filled a blank note pad with details about the followingaspectsof his concerns:

ServiceFeatures

Althoughthemostimportantaspectofaprofessionalservicebusinesswasthecompetencyoftheconsultant(e.g., the orthodontist), service industries were often judged by other criteria, as patients could not assesstheir technical quality. What were some key service features currently in place at Canadian OrthodonticsPractice?Were thereanyopportunities forimprovement in theservice experience?

ProcessAnalysis

A process flowchart diagram of the treatment process (see Exhibit 3 for an explanation of key operationsmanagementterms)showingdurationsandresourcerequirementsforeachstep(e.g.,RDA,treatmentchair,etc.)wouldprovideinsightinto somekeydecision-makingmetrics, specifically thefollowing:

• HowlongwastheRDAbusy perstandardappointment?
• Howlongwasthepatientbusy?
• Howlongwastheorthodontistbusy?
• Whatwasthepatient'sthroughputtime(i.e.,theirentiretimeinthesystem)?

RDACapacityAnalysis

A grid-timeline template charting one hour each of some possible scenarios would provide even greaterunderstanding of key capacity metrics. For example, what was the utilization of the RDAs and theorthodontist?Whatwasthecycletime(i.e.,theaveragetimebetweencompletionsofsuccessiveunits/patients)? What was the bottleneck (limiting factor) in the process? What was the capacity (i.e., howmany patientscould betreatedina one-hourinterval)underthefollowingscenarios?

• withonlyoneRDA
• withtwoRDAs
• usingallsixchairs(i.e.,withsixRDAs)(determinedwithoutthegrid)Whatwas the best number ofRDAs to schedule?

Whatweretheadvantagesanddisadvantagesofthatrecommendationfromtheperspectivesoftheorthodontistand RDAs and fromthe perspectiveof the patient?

HiringaSecondOrthodontist

Jayson was considering hiring a second orthodontist, and this possibility had many potential implications.Amongthese, he would need to consider thefollowing:

• Besidescapacity,whatotherfactorswouldheneedtoconsiderbeforehiringasecondorthodontist?
• Whatwouldthesystemcapacity bewithtwoorthodontistsandsixRDAs/treatmentchairsused?
• What would be the capacity with two orthodontists and seven RDAs (using the consultation room as atreatmentchair)?
• Whatweretheadvantagesanddisadvantagesofthesecombinationsfromtheperspectivesoftheorthodontistsand RDAs and fromthe perspectiveof the patient?

EXHIBIT1:CANADIANORTHODONTICSPRACTICEOFFICEPHOTOS

a)WaitingArea	b)TreatmentChairs	c)ConsultationRoom

Source:With permission,companydocuments.

EXHIBIT2:SIMPLIFIEDLAYOUT

Source:Createdbytheexerciseauthors.

EXHIBIT3:TERMINOLOGY

Process: any part of an organization that transformed inputs into outputs (in this case, the output was atreatedpatient)

Processflowchart:avisualrepresentationofaprocess

Bottleneck/constraint: the slowest part of a process, which limited other parts (e.g., the number of patientsthatcouldbe treated)

Cycletime:theaveragetimebetweenthecompletionoftwoconsecutiveunits(e.g.,patientstreated)

Capacity throughput rate, or flow rate: the maximum output in a period; this was determined by thebottleneckprocessinthiscase,theorthodontistortheRDAs,dependingonthechosenclinicconfigurationchosen (assumingadequate patientdemand)

Processingtime:thetimetoproduceanorder(e.g.,apatientarrivingtotheclinicandbeingtreated)

Throughput time: the average time for a unit to move through the system, which was made up of theprocessing time plus delays (which could happen, in this case, if either the RDA or orthodontist got behindschedule)

Utilization: the ratio of time that a resource was activated relative to the available time; a utilization of 100percentallowedfornovariation,andinthisexercise,utilizationvarieddependingontheclinicconfigurationchosen

Note:RDA=registereddentalassistant

Source: Adapted by the exercise authors from F. Robert Jacobs and Richard B. Chase,Operations and Supply ChainManagement:TheCore,5thed.(NewYork,NY: McGraw-Hill,2019).