When the Same Problem Keeps Coming Back in Your Dental Practice: How to diagnose recurring team problems before you blame the wrong thing
- Sarah Beth Herman
- 46 minutes ago
- 10 min read
By Sarah Beth Herman, MBA, Founder & CEO, Dentistry Support®
There are few things more frustrating in a dental practice than solving the same problem over and over again. You fix the schedule. Three weeks later, the same scheduling issue is back. You retrain the front office. A month later, the exact same communication breakdown appears again. You create a new process for insurance verification. Then somebody skips the process. You address accountability with one employee, only to hire someone new and discover six months later that the same position is struggling in almost the same way.
At some point, repeating the same fix should make us curious. Not angry. Curious. Because recurring problems are rarely asking us to work harder. More often, they are asking us to look deeper.
That is what this week’s Dentistry Support® Free Training is about. Not how to motivate your team. Not how to discipline an employee. Not how to become a better communicator overnight. This training is about learning to diagnose a recurring problem before you decide what caused it.
That skill matters in dentistry because practices are interconnected systems. The schedule affects production. Insurance verification affects patient conversations. Patient conversations affect treatment acceptance. Staffing affects phones, phones affect scheduling, and scheduling affects everything else.
When one part of the practice repeatedly breaks down, the obvious explanation is not always the accurate one.
Recurring Problems Are Usually Bigger Than the Moment
Consider a common example. Your office is consistently running behind. The easiest explanation might be: “The team needs to move faster.” Maybe. But what if the real issue is the way procedures are scheduled? What if the turnover time between rooms is unrealistic? What if emergency appointments are being inserted without a consistent protocol? What if clinical notes are being completed late, pushing everything else behind? What if patients are arriving on time but not being seated because insurance or financial conversations are happening after they arrive instead of before the appointment?
Suddenly, “the team needs to move faster” feels a little less useful. That is why good operational leadership starts with diagnosis.
In healthcare, root-cause thinking has long been used to move beyond the immediate event and identify underlying conditions that contribute to repeated problems. The Agency for Healthcare Research and Quality describes root cause analysis as an approach used to identify system-level contributors to adverse events rather than stopping at the person closest to the error (Agency for Healthcare Research and Quality, 2019).
That same principle can be incredibly useful in a dental practice. Not because every missed callback requires a formal root cause analysis. But because leaders need to resist the temptation to stop investigating the moment they find a person to blame.
FREE TRAINING: STOP ASKING “WHO DID THIS?”
The question “Who did this?” has a place. Accountability matters. But it is often a terrible first question.
Try starting with: “What allowed this to happen?”
That question immediately widens the investigation. Maybe an employee made the mistake. But why was the mistake possible? Was the process unclear? Was there no checklist? Was the responsibility shared by three people? Did the software make the next step difficult to see? Did someone assume another team member had completed it? Was the workload unrealistic that day? Was this truly an isolated mistake, or has the same breakdown happened repeatedly?
The difference between those questions matters.
“Who did this?” looks for a person.
“What allowed this to happen?” looks for the problem.
Sometimes the answer will still be a person who did not follow a clear process. That is useful information. But at least now you know.
Dental Practices Create Workarounds Faster Than They Create Solutions
One thing I have noticed in dental offices is how quickly good employees learn to work around a problem.
That sounds positive at first. Your scheduler notices a process is broken, so she creates her own spreadsheet. Your insurance coordinator finds the software frustrating, so he keeps a separate list. Your assistant knows something gets forgotten, so she starts reminding everyone herself.
The problem disappears. Sort of. It has not actually been solved.
A person has become the solution.
That works until the person is off on Friday. Or leaves. Or gets promoted. Or becomes overwhelmed.
Then the old problem suddenly reappears and leadership says: “I thought we fixed this.”
You did not fix it. Someone was compensating for it.
This is one of the reasons documentation and clearly defined workflows matter so much in dental practice operations. The American Dental Association emphasizes written policies, procedures, and clear job responsibilities as important parts of effective practice management and team consistency (American Dental Association, n.d.).
A strong process should not require one specific employee to remember everything for everyone else.
THE “HERO EMPLOYEE” CAN HIDE A BROKEN SYSTEM
Most dental offices have had one. The person who knows everything. Everyone asks them questions. They remember what happened with that patient six months ago. They know which insurance company requires the weird attachment. They know where the password is. They know why that report never works. They know which provider likes the schedule built a certain way.
That employee feels invaluable because they probably are. But there is a risk.
If critical information exists only inside one person’s head, the practice does not really own that knowledge. The employee does.
That creates operational fragility.
A healthy practice should absolutely value experienced employees. It should also continually move essential knowledge out of individual memory and into systems the team can use consistently.
That means SOPs. Clear ownership. Documented exceptions. Training. Cross-training. And periodic review of whether the process people are actually using is the same process leadership thinks exists.
FREE TRAINING: MAP THE ACTUAL PROCESS, NOT THE IDEAL PROCESS
Choose one recurring problem in your practice. Maybe claims are not followed up consistently. Maybe future appointments are not confirmed properly. Maybe unscheduled treatment is falling through the cracks. Maybe calls are being missed.
Now ask the employee who actually performs the work: “Walk me through exactly what you do from beginning to end.”
Do not hand them the SOP first. Listen.
You may discover the real workflow bears very little resemblance to the written one. Maybe three extra steps have been added over time. Maybe a software update made an old procedure irrelevant. Maybe leadership thinks one person owns a step that another employee believes belongs to them. Maybe the process is so cumbersome that employees have quietly developed a shortcut.
That does not automatically mean the employee is wrong. It means the actual system needs to be visible before it can be improved.
Look for Friction
Recurring problems often live where there is friction.
Friction is anything that makes the correct action unnecessarily difficult.
In a dental office, friction can look like information stored in multiple places, duplicated data entry, complicated logins, unclear handoffs, poorly defined responsibilities, a process that requires constant interruptions, or a task assigned to someone who does not have the authority to complete it.
Research on job design has repeatedly shown that work characteristics such as autonomy, feedback, task significance, and clarity influence employee motivation and performance (Humphrey et al., 2007).
That does not mean every inconvenient process destroys performance. It does mean environment matters.
If people repeatedly fail at the same point in a workflow, examine the point.
Sometimes leadership keeps trying to improve the person when the easier fix is improving the path..
Do Not Confuse Training With Repair
Retraining has become the universal answer to almost everything.
Someone makes a mistake? Training.
Process breaks down? Training.
Communication problem? Training.
Training matters, but training only solves a training problem.
If someone understands exactly what to do and the system prevents them from doing it efficiently, more training is not the answer.
If two departments have conflicting expectations, more training will not solve the conflict.
If nobody knows who owns the final step, training five people may actually make the confusion worse.
Before scheduling another training, ask:
What specific knowledge or skill is missing?
If you cannot answer that question, you may not have a training problem.
THE FIVE-WHY EXERCISE FOR A DENTAL PRACTICE
One simple root-cause technique is often called the Five Whys. You start with the problem and keep asking why until you reach something more useful than the original symptom.
For example: Problem: The patient arrived and the benefit breakdown was not ready. Why? The verification was not completed. Why? The employee did not see the patient on the verification list. Why? The appointment had been moved. Why did moving the appointment remove it from the workflow? Because the verification list was created manually several days earlier and was not updated after schedule changes.
Now compare the first conclusion: “Someone forgot to verify the patient.” With the deeper conclusion: “Our process does not reliably capture schedule changes after the verification list is created.”
Those require different solutions. One requires coaching an employee. The other requires changing a workflow. You cannot know which one you have until you investigate.
FREE TRAINING: THE RECURRING-PROBLEM SCORECARD
Take one recurring issue and score it in five areas.
Clarity: Does everyone involved know exactly what should happen?
Ownership: Is one person clearly responsible for the outcome?
Process: Is there a consistent workflow that can realistically be followed?
Resources: Does the person have the information, time, access, and tools needed?
Follow-through: Is anyone checking whether the process actually worked?
If four categories are strong and one is weak, you have somewhere useful to start.
If all five are weak, replacing the employee may not solve nearly as much as you hope it will.
Watch the Handoff
Some of the most expensive problems in dental practices happen between roles rather than inside them.
Clinical hands something to front office. Eligibility hands something to treatment coordination. Treatment coordination hands something to billing. Billing needs information from the clinical record.
Everyone can perform their individual job correctly, and the overall process can still fail if the handoff is weak.
That is why I want dental leaders paying attention to the spaces between people.
Ask: What information has to move? Who sends it? Who receives it? How do they know it arrived? What happens if it does not? Who closes the loop?
A process is only as strong as its handoffs.
Data Can Keep You From Solving the Wrong Problem
Dental leaders have more data available than ever, yet it is surprisingly easy to make decisions based on impressions.
“It feels like we're missing more calls.” How many?
“Insurance is taking forever.” Which carriers? What is the average aging?
“Patients aren't accepting treatment.” Which treatments? Which providers? Has case acceptance actually declined?
“The front office is overwhelmed.” At what points in the day? Which responsibilities are causing the most pressure?
You do not need a forty-page dashboard. You need enough information to determine whether the story you are telling yourself matches what is actually happening.
Track the problem for two weeks. Count it. Look for timing. Look for frequency. Look for who is involved. Look for exceptions.
You may discover the problem is completely different from what you thought.
A PRACTICE CAN OUTGROW A PROCESS THAT USED TO WORK
This is especially important for growing dental practices. Something can have been an excellent process three years ago and be a terrible process today.
Maybe you used to have one provider. Now you have four.
Maybe the owner used to approve everything because there were five employees. Now there are twenty-five.
Maybe one person could comfortably handle eligibility verification when the office saw forty patients a week. That is no longer the practice you are running.
Processes have capacity. So do people.
Growth eventually exposes systems that were being held together by proximity, memory, and goodwill.
That does not mean growth caused the problem. Growth revealed it.
Your Free Training Assignment
This week, pick one recurring dental practice problem.
Not the biggest one. Pick the one that annoys you because it keeps coming back.
Then do three things.
First, map what actually happens, not what the SOP says should happen.
Second, identify where the breakdown occurs. Is it clarity, ownership, process, resources, or follow-through?
Third, resist solving it for twenty-four hours.
That last part matters. Do not immediately announce another meeting. Do not rewrite the SOP while you are irritated. Do not decide someone needs to be replaced.
Collect enough information to understand what is happening first.
You may still reach exactly the conclusion you expected. Or you may discover you have been trying to solve the wrong problem. Either way, you will make a better decision because you diagnosed before you prescribed.
Continue the Conversation Monday
This Free Training intentionally stops here.
Because Monday's Episode 139 of No Silver Spoons takes the conversation somewhere different.
Today, we looked at how to investigate a recurring problem in a dental practice without immediately blaming the person closest to it. Monday, I want to talk about what happens when the investigation gets more personal.
The episode is: The Human Side of Leadership™: What If You're the Problem?
And there is one line from that conversation I will give you now:
“What if there is something I am doing, allowing, communicating, avoiding, rewarding, tolerating, or creating that is contributing to the very problem I keep complaining about?”
I'm not answering that question for you here.
That's Monday's conversation.
But I do want you to arrive there having completed this training, because once you've learned to examine the problem, the next question is whether you're willing to examine every part of the system surrounding it.
Including the part with your name on it.
Episode 139 releases Monday.
And after that, we have only one episode remaining in The Human Side of Leadership™ Summer Series before we close Season 5 and begin preparing for Season 6. For now, don't diagnose the person. Diagnose the problem.
Sometimes the most expensive mistake a dental practice makes is becoming very efficient at solving the wrong thing.
References
Agency for Healthcare Research and Quality. (2019). Root cause analysis. Patient Safety Network.
American Dental Association. (n.d.). Managing the dental team and dental practice. American Dental Association.
Humphrey, S. E., Nahrgang, J. D., & Morgeson, F. P. (2007). Integrating motivational, social, and contextual work design features: A meta-analytic summary and theoretical extension of the work design literature. Journal of Applied Psychology, 92(5), 1332–1356. https://doi.org/10.1037/0021-9010.92.5.1332
Mertens, S., et al. (2020). Leadership in dental practice: A three-stage systematic review and narrative synthesis. Journal of Dentistry, 102, 103480. https://doi.org/10.1016/j.jdent.2020.103480
Disclaimer:
To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website
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