I spent a full day reviewing two practices that on paper should have been producing nearly identical results. Similar metro area. Similar patient demographics. Comparable procedure mix. Staff sizes within one person of each other. Both led by skilled, experienced surgeons.

One was outproducing the other by a six-figure margin per surgeon every month.

The difference wasn't talent. It wasn't effort. It was consistency.

I used to believe practice performance was primarily a function of the surgeon. Better surgeon, better practice. But after years of working across dozens of practices, I've learned that the surgeon is one variable in a much larger equation. The variable that explains the biggest performance gaps between similar practices is whether the work is standardized or improvised.

Standard work is the discipline of identifying every repeatable process in your practice, documenting the best-known way to do it, training everyone to execute it consistently, and then improving it over time. It doesn't eliminate judgment. It eliminates variation in the things that shouldn't vary, so your team's judgment can be focused on the things that should.

Every time a process runs differently than it did yesterday, there's a cost. I call this the inconsistency tax. A two-minute delay in room turnover doesn't feel significant. But across four operatories, five days a week, fifty weeks a year, that's over thirty lost clinical hours annually. At $2,000 per hour in production, that's $60,000 from a single two-minute gap. Now apply that math to every process in the practice.

One of the most damaging beliefs I encounter is the idea that you need to reach a certain volume before process improvement makes sense. This gets the causality backwards. You don't standardize because you're big. You grow because you've standardized. Standard work creates capacity. When your team isn't reinventing workflows every day, they move faster. When room turnovers are predictable, you can schedule tighter without creating chaos. The practices in our network that have achieved the strongest growth trajectories didn't wait until they had volume to build process. They built process and the volume followed.

I asked the lead surgical assistant of the high-performing practice what made their team different. She didn't mention the doctor's skill. She didn't mention the location or the patient base. She said: "We don't have to guess. We know exactly what to do and when to do it. So we can spend our energy on the patient instead of on figuring out the process."

That's the six figure difference. Not talent. Not luck. Not location. Just the relentless discipline of doing the right thing the same way, every time, and improving it continuously.

Your partner in excellence,
Josh Everts, DDS, MD
Chief Clinical Officer, OMS360