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Art vs. Science

When you consider the orthodontic specialty, do you consider it more art, or more science? An artistic process is often based on individual judgement and highly variable. It is necessary in a changeable environment and a unique service where all patients do not want the service performed in the same way. It is generally desired in a highly variable, high value business environment.

Low value, low variability business processes are best approached from a scientific process. This incorporates more systemization and standardization that lends itself to mass customization or mass production. These two processes leverage economy of scale. If a customer does not value a process significantly, turning that process into a standard system is the best course of action. This allows for more time and effort to be applied to the more artistic components of orthodontic practice.

Where does art add value for patients vs. where do scientific standards make sense to gain efficiency and predictability?

In an orthodontic practice, what aspects are an art? These are processes that are suited for an artistic approach that produce unique or tailored results. These include customer service, business development, smile design, and leadership training. Many other processes can be approached from an artistic standpoint in an orthodontic practice. Smaller practices tend to apply artistic systems to highly customize the experience, but as a practice grows, these systems become unsustainable. Taking an unbalanced approach with highly artistic processes in a practice is often not efficient nor effective when patients do not value the artistic value of certain processes within a practice.

In the converse, scientific processes can be standardized and mass produced in a predictable, reproducible manner. Creating a scientific process that systemizes certain aspects of orthodontic treatment greatly increases productivity and reduces variability. A consistent and effective bonding protocol is an example, where gaining almost 0% bond failure is highly desirable. Office systems to standardize the bonding process and reduce operator variability are highly desirable. This example shows how a technique sensitive process such as bonding should take advantage of the predictable and consistent standardization process to improve a practice’s performance. The risk as a practice grows and implements many standard systems, is that employees can switch to autopilot, and although that may benefit bonding technique, excessive systemization will discourage employee engagement in the areas that are best approached from an artistic standpoint.

As an orthodontic practice grows. It is important to develop effective systems that lead to success. This requires an effort in the practice to determine which category of management those systems are best suited. This balance of an artistic and scientific approach allows for business growth while maintaining systems for quality treatment and a positive patient experience. These include the industrial standardized process, mass customization and art systems.

Industrial Standardized Processes

These processes are best used for work that is done best by doing it exactly the same way each time. Incorporating the type of consistency of a standardized process pays off big time because it reduces time spent on work that’s best done without a lot of variation, and reduces waste so that resources can be applied in other parts of the practice that can benefit from more creativity.

Technology often aids in making the process more standard and reducing human error. Following best practices of mass production can benefit a practice develop production systems for better performance. Often touted as a great example of this process is the Toyota Production system.  Production systems are very useful when implementing technology, but I caution that technology is the means and not the end.  We should always consider that we interact with people and the effect with have with them.

Mass Customization

Mass customization applies to work that is done in large quantities but cannot be made exactly the same way every time. This is a large part of orthodontic treatment. Where appliances, such as aligners, brackets or retainers, can be made in exactly the same way almost with industrial standards, except for the fact that each patient’s dentition is different and requires a custom design.  Tooth anatomy or dental arch form have some common threads amongst people, but each individual has a unique aspect that must be compensated for.

Our business relies on a biologic process. That innately prevents several parts of what we do from being exact. This is a great challenge in the clinical research we rely on to make treatment decisions. So many variables can affect the outcomes we would like to predict every time, that some customization to individual response becomes a reality in providing treatment. Orthodontic appliance manufacturers often play in this space. Bracket design, custom labial or lingual appliances, and aligner systems leverage incredible systems in mass customization. The growth of the 3D printing market offers most practices an added entry point into mass customization systems.

Art Systems

Orthodontics relies on working with people. That in itself adds so much variability that customer service interactions are more an art than a science. The challenge in orthodontic treatment is the high variability in physiologic response and the high dependance on patient compliance. Patient compliance, therefore, incorporates a high tendency for artistic systems since human behavior is not always predictable. These are areas of practice that have a high degree of variability and require custom approaches to leverage our humanity in making a connection.

How can art be trained? While the science of orthodontics can be taught by the literature and scientific body of evidence gathered over the decades, the art of orthodontics is more of a challenge. That is where master clinicians and KOL’s come in to lecture, teach, mentor and share their artistic talent on how they manage all the situations that are beyond the standards. Nurturing an artistic culture can be done by apprenticeship from a master clinician and another method comes from storytelling. With new technology, forums, study clubs, blogs, journals, webinars, live lectures, etc. more can be inspired to build on the art of orthodontics.

How do you measure success in an art system?

The simple, internally focused metrics for a scientific process, designed to make sure everyone executes it the same exact way, will not work for art. An artistic process has to rely on external measures of success. Artists need continual exposure to customer feedback, which prevents them from constructing their own idiosyncratic notion of quality.” Hall & Johnson

The artistic approach is a humanistic approach.  The journey is what matters in orthodontic treatment when it comes to the patient experience and their desire to recommend it to others.  The artist should be careful to avoid false patient experience assumptions and be careful of habituation by adapting to changing shifts in culture.

Orthodontics is both art and science.  The art is more human, while science is more machine.  As I have suggested before, our future is not so much human vs. machine, but human enhanced by machine. Like many areas of life, a good balance of both acts helps to design a model that gains in efficiency AND experience. We should design specific standard processes that are rather rigidly used all the way up to the final “artistic” act. This allows for efficiency to free up time for the artistic aspect. In the common case of service the efficient standards would aid in the actual interaction with the patient. By making the system as consistent as possible in the early stages, we’re able to minimize any unnecessary variability and bring us to the moment of more complex interactions in great shape.