“This is how we’ve always done it” — The most dangerous phrase in clinical practice

Introduction

This article continues a five-part series examining the systems that influence hygiene performance.

Several months ago, I came across a statement shared by healthcare consultant Mari Robicheau that has remained with me: “The most dangerous phrase in any organization is, ‘this is how we’ve always done it.’”

It is a simple observation — but in clinical practice, it carries significant implications.

In my work across dental practices, this mindset appears consistently. Not as resistance to change for its own sake, but as reliance on systems that have never been critically re-evaluated against current evidence, standards, or outcomes.

The risk of tradition-based systems

Dentistry is not a static profession. It evolves thorough research, evidence, and updated standards of care. What was considered appropriate, even a few years ago, may no longer align with current expectations.

Yet many clinical systems remain unchanged — not because they are optimal, but because they are familiar, efficient, and embedded within daily workflow. Over time, these systems become normalized, even when they no longer reflect best practice.

The issue of defensibility

Clinical decisions must be:

• Evidence-based
• Clearly documented
• Defensible within current regulatory and professional standards

The question is no longer: “Has this always worked?”

The question is: “Can this be defended to a regulatory college, in an audit, and against current evidence-based standards of care?”

When systems are built on habit rather than evidence, they introduce risk —  not only to patient outcomes, but to the practitioner and the practice.

Where this shows up

This mindset is most visible in areas where clinical and operational systems intersect:

• Standard of care – where patients are maintained in a state of “supervised neglect” rather than progressed toward health
• Periodontal diagnosis – where variability between providers leads to inconsistent identification and treatment
• Radiographic protocols – where outdated practices limit diagnostic accuracy
• Documentation – where incomplete records compromise defensibility
• Scheduling models – where time is allocated based on tradition rather than treatment need

In each case, the issue is not the absence of a system. It is the continued use of a system that has not been recalibrated.

The clinical and operational consequence

When outdated systems persist, the impact is cumulative:

• Clinical outcomes become inconsistent
• Disease is under-managed or delayed
• Treatment pathways are incomplete
• Capacity is misaligned with patient needs
• Production appears stable — but remains below potential

This is where clinical and operational breakdowns converge. A system that is not aligned with evidence will eventually create clinical gaps, operational inefficiencies, and financial underperformance. Even when the schedule is full and the team is working efficiently.

These outcomes are not isolated — they are the direct result of systems that have not been recalibrated to current evidence.

Why it persists

This mindset persists because it feels efficient, it avoids disruption, and it minimizes short-term discomfort.

Changing systems requires:

• Re-evaluation of established workflows
• Calibration across providers
• Alignment with updated clinical standards

These are not simple adjustments. However, avoiding them does not preserve stability — it preserves limitation.

Conclusion

Tradition has value, but not when it replaces critical evaluation. In modern clinical practice, consistency must be built on evidence, structure, and accountability instead of habit.

Because the most significant limitations in hygiene are not always visible. They exist within systems that appear to function but no longer meet the standard of care.

This article is part of a five-part series on hygiene systems and performance. The final article examines how to evaluate consulting support and why selecting the right type of consultant determines whether change is sustainable.