Here’s why quotas are bad for dentistry — or any healthcare setting

Using a quota is bad for your dental or medical practice. 

In the past, I’ve argued that using them is one of the greatest faults in some traditional DSO models. This is still my stance — in fact, it’s more stringent than ever. But here, I’d like to offer some guidelines as to how data and KPIs (not quotas) can improve care at a practice. 

Data is a tool. Use it wisely. 

A medical practice likely uses statistics to show what success looks like. These are the practice’s key performance indicators. A key performance indicator may have to do with revenue — and how much is needed to pay for expenses. Those are okay, and there’s nothing unethical about them. It’s how a practice keeps the lights on.

But sometimes, those KPIs get turned into quotas for providers. If we say to a provider, “You need to do X numbers of this procedure in this time period,” that is now reaching into the provider-patient relationship. That shouldn’t happen.

So, whether you’re a solo practitioner or multi-site operator, I would challenge you to keep a safe distance from your key performance indicators. Be intentional with the feedback you actually provide to the providers themselves. And don’t turn them into direct quotas. 

KPIs can be used to assess performance and provide opportunities for improvement. That’s different from a quota.

If you have a provider that’s underperforming in any capacity, you can have a conversation where you share best practices with them. You can make sure they’re meeting your mission around the type of care you set out to provide. But don’t set a hard goal for performing a set number of procedures. 

You shouldn’t tell a dentist to do a set number of crowns per month. You might use KPIs to say, “On average, our dentists are doing 10 crowns per month. And this provider is doing only one.” That's a reason to ask some questions to work respectfully and compassionately with that provider. See if there are some roadblocks. Maybe the provider struggles with diagnosis or with case presentation. It provides an opportunity to build that person's skill set and improve care.

But we're using those KPIs as a means of checking in, not as a directive. 

KPIs can be used to get a sense of quality of care. 

There’s a certain rate of periodontal disease in every local community. Maybe roughly 30% of new patients that come into your practice are likely to have a level of periodontal disease that requires treatment. 

If you have a dentist and hygienist team that diagnoses 5% of their patients as needing periodontal treatment, there’s a discrepancy there. It’s worth looking into, because there may be people going undiagnosed and untreated. 

Don’t come in directively and say, “Get those numbers up next month, or else.” That's unethical. And it's not very inspiring as an employee, by the way. Instead, find out why that discrepancy is happening, and figure out how you can best support your provider in sharpening up their skills (if need be).

We need to make sure conversations about performance don't become directives.

If performance conversations become directive, it might lead to that provider doing unnecessary treatment. That’s unacceptable, in any medical practice. 

You need to make sure that providers are confident, comfortable and calibrated to the diagnosis and treatment planning philosophies your business holds. There are providers that are too proactive in their treatment of disease. And there are providers that are on the opposite end of the spectrum and are too passive, allowing disease to flourish when it should be stamped out. 

The key is to calibrate providers in that middle sweet spot. Data can help in that regard. The goal is not to “produce more,” the goal is to have calibrated providers giving the right level of care to their patients. 

If you need to enter into a conversation with a provider over their KPIs, do so compassionately and with curiosity. Use the data to help guide that conversation. Assess if and how they need to grow their skillset — or become better attuned to how the rest of the practice operates. 

Compassionate leadership is required in the healthcare industry. Setting a quota is not only uninspiring — leading to turnover and burnout — but it can also be highly unethical.