Musculoskeletal pain is common in dentistry. A 2022 meta-analysis found that about 78 percent of dentists and dental staff experience it, mainly in the neck, shoulders, and lower back.
The irony: Dentistry has known how to reduce the strain for decades.
By the 1960s, dental schools were teaching “four-handed dentistry,” with an assistant handing over each instrument so the dentist does not need to twist and reach. Other attempted solutions followed yet ultimately failed to fix the problem, including saddle stools that support an upright spine and magnifying loupes worn on glasses. Studies show that these tools do reduce some strain, but the injury rate has barely changed.
After more than half a century, the equipment is available to fix the pain, including “chairs” that lay flat like beds. But the problem remains.
Why? The challenge is getting an entire industry to change when no one controls all the levers.
The problematic dental chair kept improving
Dental chairs have evolved for more than 200 years. As strange as it may seem, dentistry emerged from “barber-surgeons” who pulled teeth between haircuts. Early chairs were ordinary furniture with an attached headrest.
In 1790, Josiah Flagg created the first chair specifically for dentistry by adding a headrest and instrument arm to a Windsor writing chair. James Snell introduced a reclining back in 1832. In 1877, the Wilkerson chair added a hydraulic pump to raise and lower patients.
Each generation improved the chair. Yet dentists continued getting hurt. The industry was optimizing something fundamentally broken.
Change requires “three yeses”
So how do you change a system where dentists, equipment providers, and patients all expect the “right way” to do things is sitting in a chair?
First, the dentist has to change. French ergonomist David Blanc argues in Dental Tribune that poor posture begins during dental school training. The damage develops over decades.
Second, many dentists worry that the fix – patients lying flat – will make patients feel uncomfortable, either physically or emotionally. They worry that patients already experience anxiety, so changing their setup may cause undue additional stress. But according to David Blanc, patients are just fine lying down, as long as they’re the ones in control of getting into the position of lying flat, like they do when they get into bed each night.
Third, the dental equipment dealer is used to selling chairs. It’s easier than trying to convince dentists to change their setups to tables or beds. Henry Schein, for example, dominates dental equipment distribution with nearly 47 percent of dental equipment sales. Dentists often use the same representative for years. A channel with loyal customers has little incentive to promote alternatives, especially when dental schools and patients expect the typical chair.
The ecosystem stale mate
The dealer offers the standard chair because dentists keep ordering it. Dentists order what they learned to use in school and what patients accept. Patients accept the only setup they are given.
Each decision makes sense on its own.
Together, those choices create a system that keeps producing injured dentists. Try changing only one part and the other two parts reinforce the old model.
The same pattern exists in business
This dynamic appears when one person buys, another uses, and a third sells.
Real estate, for example, followed this pattern for decades. Listing agents required a standard commission, and sellers paid it because that was the accepted practice. Buying agents received part of the commission. But the National Association of Realtors recently agreed to a $418 million settlement and changed the rules to shift the structure. One year later, buyer-agent commissions had barely changed. While the formal rule changed, the rest of the system maintained the established practice.
Your organization may have its own version of the ecosystem stale mate. To break the loop, consider three strategies:
- Identify all required yeses. Before redesigning the workflow or business model, name every party that must support the change. Identify their incentives and objectives and engage them in co-creating the model that works for them, and the other players.
- Change channel economics. A seller with loyal customers needs a larger opportunity or the fear of a credible competitor before changing course. Help reveal the revenue opportunity of transformation. Or find a strong new competitive entrant to upend the current market.
- Coordinate the switch. Engage the parties together through collaboration. Give the most hesitant group permission with withdraw if needed, while at the same time revealing the upside of migrating to the new opportunity.
These strategies go beyond dental equipment. Choose one improvement your team supports but still has not adopted due to stakeholder complexity or push-back. Identify the buyer, the user, and the group who gains from the current approach.
A dentist can purchase the best new dental chair and still end the day in pain. A better solution will fail when the surrounding system stays in place. That’s your innovation opportunity.
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