Chang Dental Clinic Custom Case Solution & Analysis

1. Evidence Brief

Financial Metrics

• Revenue per checkup: 150 dollars
• Revenue per filling: 200 dollars
• Revenue per emergency visit: 100 dollars
• Hygienist hourly wage: 40 dollars
• Dental assistant hourly wage: 20 dollars
• Receptionist hourly wage: 18 dollars
• Estimated annual gross revenue: 450000 to 500000 dollars

Operational Facts

• Total operatory rooms: 3
• Doctor work hours: 40 hours per week
• Hygienist work hours: 32 hours per week
• Assistant and receptionist work hours: 40 hours per week
• Checkup duration: 60 minutes total room time; 10 to 15 minutes of doctor time
• Filling duration: 45 minutes of doctor time
• Current appointment backlog: 3 to 4 weeks
• Patient base size: Approximately 1800 individuals

Stakeholder Positions

• Dr. Chang: Owner and sole dentist; experiencing high stress and fatigue due to workload
• Dental Hygienist: Works 4 days per week; currently the primary provider for cleanings
• Patients: Expressing dissatisfaction with long wait times for routine appointments

Information Gaps

• Specific variable costs for dental supplies per procedure
• Local market pricing benchmarks for competing dental practices in Toronto
• Breakdown of fixed costs including rent and equipment depreciation
• Patient retention rates over the last 24 months

2. Strategic Analysis

Core Strategic Question

• The primary challenge is a capacity bottleneck created by the misalignment of staff hours and room availability.
• Dr. Chang is performing tasks that do not require a doctoral degree, limiting the time available for high-margin procedures.
• The central question is how to restructure the service delivery model to increase patient throughput without increasing the working hours of the doctor.

Structural Analysis

Capacity analysis reveals that the third operatory room remains empty during the 32 hours the hygienist is present because the doctor is either tied up in fillings or performing the 10-minute exams in the hygiene room. The hygienist only works 80 percent of the clinic operating hours, leaving 8 hours of cleaning capacity unused. Furthermore, the doctor spends significant time on low-complexity exams that could be staggered across two hygiene chairs.

Strategic Options

Option 1: Hire a second part-time hygienist. This would allow the clinic to run two hygiene chairs simultaneously. The doctor would rotate between rooms to perform the final 10 minutes of each exam. This maximizes the utilization of the three rooms and frees the doctor to focus on fillings in the third room when not examining hygiene patients.

Option 2: Implement a premium pricing strategy. Increasing prices by 15 to 20 percent would likely reduce the 4-week backlog by shedding price-sensitive patients. This improves the margin per hour and reduces the stress on the doctor without requiring additional staff.

Preliminary Recommendation

The clinic should pursue Option 1. The demand exists to support higher volume, and the current physical infrastructure (3 rooms) is underutilized. By decoupling the cleaning process from the primary schedule of the doctor, the clinic can increase daily patient volume by 25 to 30 percent.

3. Implementation Roadmap

Critical Path

• Week 1 to 4: Recruit a part-time hygienist for 16 to 20 hours per week to cover the 8-hour gap and provide overlap during peak times.
• Week 3: Update the scheduling software to reflect a staggered exam model where exams occur at the 45-minute mark of a 60-minute cleaning.
• Week 5: Train the receptionist on the new scheduling logic to ensure the doctor is not booked for a filling at the exact moment a hygiene exam is required.
• Week 8: Evaluate the impact on the backlog and the stress levels of the staff.

Key Constraints

• Physical Space: The clinic is limited to 3 rooms; once all 3 are in constant use, further growth requires relocation or renovation.
• Labor Market: Finding a reliable part-time hygienist in the Toronto area may require a higher hourly rate than the current 40 dollars.

Risk-Adjusted Implementation Strategy

To mitigate financial risk, the new hygienist should start on a contract basis. If the backlog does not decrease within 90 days, the clinic must pivot to the pricing strategy defined in the analysis. The plan assumes a 10 percent buffer in the schedule to account for emergency visits and late arrivals.

4. Executive Review and BLUF

BLUF

Hire a second part-time hygienist to maximize the utilization of the third operatory room. The current model wastes 20 percent of potential cleaning capacity and forces the doctor into a linear workflow that creates a 4-week backlog. By shifting to a parallel hygiene model, the clinic can increase revenue and reduce the stress of the doctor without expanding the facility footprint. Immediate action is required to prevent patient attrition to competitors with better availability.

Dangerous Assumption

The most consequential unchallenged premise is that the current patient base is indifferent to the amount of time the doctor spends with them. If patients perceive the 10-minute exam as a reduction in care quality compared to previous longer interactions, retention may drop significantly.

Unaddressed Risks

Unconsidered Alternative

The team failed to consider a specialized focus strategy. The clinic could stop offering routine cleanings entirely and become a referral-only practice for complex fillings and emergency work. This would eliminate the need for hygienists and allow the doctor to bill at a much higher rate per hour, though it would require a total rebranding and the loss of the current 1800-patient recurring revenue stream.

VERDICT: APPROVED FOR LEADERSHIP REVIEW