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A Safe Bet to Increase Office Productivity

Wouldn’t it be wonderful to learn that buckling your seat belt could increase your gas mileage? While that is not the case (at least as far as I know!), I can tell you that updating the technology in your sterilization room can dramatically increase the productivity of your entire practice.
I don’t have to tell anyone reading this article how crucial it is for every dental practice to do everything it can to enhance productivity. In North America, more dental procedures are being performed than ever before, yet for years more dentists have been retiring than are entering the profession. The only way those of us still practicing can possibly keep up with this growing demand for our services is to find ways to perform our procedures—and everything we do—in less time, and without any degradation in our clinical outcomes.
Over the years we have made many improvements in the way we operate our practice, but none has had as dramatic an impact on our overall productivity as some recent enhancements we made to our sterilization room and how we manage our instruments. Specifically, we worked closely with Hu-Friedy in adding an instrument management system (IMS), and with Midmark in upgrading our cleaning and sterilization equipment, and we could not be happier with the results.
An instrument management system provides a dental office a safer and more efficient way to process and store its instruments. An IMS eliminates many manual steps, including dangerous hand-scrubbing and sorting of instruments, while increasing chairside efficiencies. An IMS that stores procedural instrument set-ups together through the use of stainless steel cassettes ensures that everything is where you need it when you need it. This eliminates the need to get up mid procedure to find an instrument that should have been there.


Figure 1. Before we instituted the IMS system, the shelves were filled with our instrument tubs and products. Figure 2. Our nice, clean lab space. IMS has made a huge difference in our efficiency.

Figure 3. A typical cabinet, poorly stocked.

Figure 4. A neatly stacked cabinet after the IMS system was in place.

If I knew then what I know now, we would have adopted an IMS much sooner. I had considered it for years, but always resisted because I assumed that adding such a system would require me to knock down walls, expand the size of our sterilization room, and generally wreak havoc with the rest of our office. After all, the sterilization room is in many ways the heart of the entire practice, so I was concerned that major changes required there might force us to remodel the entire office. It turns out that all we needed to do was reorganize, add a few storage cabinets, and get appropriately sized equipment for the practice.
One thing a practice never wants to do is outgrow its equipment, as the resulting bottlenecks can be very costly. We looked at our needs based on our existing procedures and our expectations for the future, and we determined that the Midmark Soniclean M250 ultrasonic cleaner and Midmark M11 UltraClave Automatic Sterilizer would best accommodate those needs. In addition to expanding our capacity, the Soniclean ultrasonic cleaner is exceptionally quiet, and the M11 UltraClave Automatic Sterilizer features both vertical and horizontal cassette racks. The new equipment is now large and efficient enough to process our new cassettes quickly and efficiently. Implementing this state-of-the-art equipment works wonders for staff morale, as it is a clear signal to your people that you value their time and are committed to providing the most pleasant working conditions possible (Figures 1 to 4).


While an IMS clearly represents the state-of-the-art approach to instrument cleaning, practitioners who utilize such a system will tell you that its greatest effect could well be what it does to enhance the productivity of the entire practice. Our practice has experienced productivity benefits in 3 key areas:

  1. Less time cleaning instruments. Before implementation of the new system, the staff handled and scrubbed all the instruments during cleaning and sterilization. This process was time consuming and had risks involved. Today, we save about 5 minutes per procedure by skipping the scrubbing and sorting steps during cleaning. In a typical day, we do 8 to 10 hygiene procedures and 16 to 22 other procedures, which means that an IMS can save staff members more than two and a half hours per day. With this time savings, they can now spend more quality time with patients.
  2. Less time “chasing instruments.” Previously, our staff spent too much time between procedures trying to locate misplaced instruments. Now, with our IMS we know exactly where every instrument
    is. When we finish using it chairside, it immediately goes back into its designated slot in the cassette, and the cassette goes back to the sterilization center, where the instruments stay together through the whole processing cycle. It also has greatly reduced the wear and tear on the instruments.
  3. Less time performing procedures. An IMS makes every procedure much more efficient. The instruments are together in the same place and are lined up in the order of use inside the cassettes, so we know exactly which instrument we need and where it’s located. Plus, having this system means that my staff is more likely to be in the operatories with patients, rather than in the sterilization room cleaning instruments.


Since we started using an IMS, our patients have been amazed how much less time their procedures are taking. These productivity gains also enable our staff to spend more time explaining procedures to patients chairside, as well help out at the front desk and keep up with continuing education.
An IMS also offers a significant financial advantage: the stainless steel cassettes protect and preserve instruments. In contrast, we previously bagged our instruments, which caused them to bang against each other and get dull and damaged. In fact, we used to average 3 to 5 broken instruments per month when we were bagging. Now, our instrument management system is adding years to the life of our instruments, and that adds up to significant cost savings. In addition, it keeps our instruments sharper, which means faster and more successful procedures.


Another huge practice management advantage of an IMS is that it allows you really to wow your patients with your chairside presentation. There is a huge difference in professionalism between dumping a bag of clanging instruments onto a tray and opening a high-quality stainless steel cassette containing perfectly organized instruments. In fact, at our practice we bring the cassette into the operatory still wrapped in the sterilization paper. This allows us to “unwrap” the cassette and give patients a sense that these instruments have been specially prepared just for them. Anything you can do to make a patient feel special is a good idea, and an IMS certainly is that. In addition, our sterilization center is something to be proud of. With our new equipment and system in place I would be proud to give anyone a tour of our sterilization area.


All of the staff members love what we have done with our sterilization room. You can actually see the difference in their faces since we added our instrument management system and the upgraded equipment. They hated the process of cleaning and bagging instruments by hand. Not having to do those things frees them to do the things they really enjoy, such as spending more time talking to and caring for our patients. They also no longer have to worry about getting sharps injuries while hand-washing instruments. And the higher-capacity equipment means fewer trips to the sterilization room and fewer cleaning and sterilizing cycles. I honestly cannot think of any other change to our practice that has had such a positive effect on staff morale as updating our sterilization room.


When I first started talking to my staff members about adding an IMS, I was quite surprised at how much initial resistance I met. They assumed it would take forever to install, and that it would take too long to learn the instrument management process. In short, they thought such a system would be a pain. Nothing could be further from the truth. The training required was very straightforward and took relatively little time. And now, there is no way they would ever let me eliminate our instrument management system.


Having had our state-of-the-art sterilization room for several months now, it is hard to imagine how we ever got by without it. It has profoundly changed the way we operate our practice, and that has definitely been a change for the better.
As you contemplate whether to add an instrument management system and upgraded sterilization equipment to your practice, you should not think of this as a purchase. Rather, think of it as an investment—an investment in improved infection control, in greatly enhanced productivity, in healthier staff morale, and in better patient care.
True, it may not increase your gas mileage, but it just might help get you into your car a little earlier for your drive home each day.

Dr. Malcmacher is a practicing general dentist in Bay Village, Ohio, and an internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for Clinicians Report (formerly Clinical Research Associates), Dr. Malcmacher has served as a spokesman for the AGD and is a consultant to the Council on Dental Practice of the ADA. He works closely with dental manufacturers as a clinical researcher in developing new products and techniques. For close to three decades, Dr. Malcmacher has inspired his audiences and consulting clients to truly enjoy doing dentistry by providing the knowledge necessary for excellent clinical and practice management. His group dental practice has maintained a 45% overhead since 1988. He can be reached at (440) 892-1810 or This email address is being protected from spambots. You need JavaScript enabled to view it., and his lecture schedule is available at commonsensedentistry.com, where you can find information about building the best dental team and sign up for his monthly consulting programs, teleconferences, audio CDs, and free monthly e-newsletter.


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