Prototype your practice with a procedures manual

April 1, 1998
A practice procedures manual will help assure your practice of a continuing flow of capable team members. Developing a manual is not a daunting task.

A practice procedures manual will help assure your practice of a continuing flow of capable team members. Developing a manual is not a daunting task.

Michael R. Gradeless, DDS

The other evening at a study club meeting, I listened to one of my colleagues as she worried about her assistant. It seems she had a wonderful, dedicated employee who had worked with her for over 10 years. Obviously, his is a problem that we all wish we had. Her concern was that this employee was reaching an age where she would be retiring soon. The dentist wondered aloud, "I rely on her so much I don`t know where I can ever find someone to replace her. The last time I interviewed, I didn`t see anyone who was even close to her abilities." Many of us have such a key employee. We need not live in fear of losing this individual because there is a solution to this problem. A practice procedures manual can be a tool for you to use to virtually recreate your valuable employees after they leave.

It is true that when interviewing potential employees, we see a parade of applicants who have glaring weaknesses and who appear to be nowhere as capable as our best employee. When we do find someone who we think may do the job, he or she wants more money or benefits than we are willing or able to give or the applicant is hired by another doctor before we even get to the second interview. The solution to this problem must be in place before you begin to interview and it will benefit your practice every day even if you are not actively looking for a new employee.

For a practice to maximize its profits and routinely provide excellent patient care, it must not rely on a few very high-quality employees. Instead, a practice must develop its systems of operation in such a way that an average employee constantly can excel. If you rely on one or two individuals to keep your office running smoothly, inevitably when those individuals are ill, on vacation or move out of state, your practice will suffer. Your patients will notice that the practice is not running smoothly. They will notice the doctor is having a tough day. The truth is that great employees are hard to find; they cost too much and they eventually will go to work for someone else. Unless your practice is very different than most, the bulk of your employees are average. To constantly provide excellent patient care on a daily basis, you must make sure that these average individuals can carry the ball when your key employees are gone.

Training of our staff takes thousands of dollars. We may pay for continuing-education courses, consultants or with our own time. Many times, it seems that just as we have an employee trained to the level we want, she leaves to work elsewhere and we must start the training process over with a new employee. The solution is to develop a practice procedures manual. This manual should be specific to your practice and must contain step-by-step directions on how you want employees to handle the tasks they perform.

If you do not have this written plan, you will spend an inordinate amount of time showing or telling people how you want things done. If you do not have a written plan, your staff members will continually find ways to make their jobs easier for themselves. For example, they may decide to clean the trap on the suction only when it becomes totally clogged, not every week as you may want. Once you have such a plan in place, you can tell if someone in the office is cutting corners or even ignoring responsibilities altogether. With a procedure manual in place, your employees cannot dodge the issue by saying something like, "but this is the way we always have done it" or "I thought this was how you wanted it."

Developing the practice procedures manual is not as daunting a task as it may sound. You don`t even have to do most of the work. The first step is to develop a job description for each position in the office, including the doctor. Simply ask each person in the office to make a list of all the tasks for which he or she is responsible. You may tell your employees their responsibilities will be a consideration at their next salary review and, if you do, you probably will be given a very complete list. You must then review and refine these lists. You will notice that there are some tasks that are shared and you also will find there are some tasks that nobody considers to be their responsibility. Refine the lists to make sure that each task has someone responsible for its completion and minimize having two people responsible for one task. Having two people responsible sometimes means neither one does the job.

After you are happy with the job descriptions, it is time to enlist the help of your best employees. These are the people who always seem to know what you will want next and always have their work done right. Once a week, pick a single task and ask an employee to write a short outline of how this task is to be performed. Examples might be: how insurance claims are handled, how the automatic processor is cleaned, how instruments are to be handled and sterilized or what instruments and supplies are to be included on tray set-ups for different procedures.

Review these outlines to make certain the tasks are being done as you want them and to make sure they fit within OSHA guidelines or other state or federal laws. When you approach the process in this manner, you will have very little additional work to do each week and, in a short period of time, you will have a complete office procedures manual. This is a process of prototyping that all businesses must do if they are going to continue to grow.

Prototyping and training are why franchise businesses are the same no matter which part of the country you are in. By prototyping the procedures your staff members are to follow, you have given them the tools to meet your expectations every day. Your patients` expectations also will be met when they receive the same high-quality standards of care every time they come to your office, regardless of staff turnover.

A new employee should be required to study these procedures. This will shorten the time it takes for the new employee to be fully trained to perform as well as her predecessor. Much of this training can be done as independent study, without requiring your valuable time. Prototyping with a practice procedures manual also will increase the value of your practice and make it easier to add an associate. A new doctor considering the purchase of a practice always wonders whether he or she will be able to retain the patients, produce as much as the previous dentist or simply be able to keep up the day-to-day operations of the new practice. When hiring an associate, you always wonder if your philosophies will match or if the new associate can maintain the quality you expect.

A well-written procedures manual will remove some of the guesswork for the new dentist. It certainly is reasonable to expect a new associate to follow the established procedures of the practice. A new owner will want to start with the day-to-day operations being substantially the same since wholesale changes are a big concern for patients in a practice transition. A comprehensive procedures manual will make your practice easier to sell and possibly at a higher price.

Periodically, you or your staff will find a new and better way to do things. If you are happy with this change, you can update that particular procedure document to create a new standard. This also is a valuable tool for improving the profitability of your office. Large corporations continually review procedures to find ways to decrease costs while at the same time maintaining or even improving the quality of their products. You should do this, too. Begin with the procedures that are done most frequently in your office and critically examine them with three main parameters in mind.

The first parameter is time. If there is any way to consistently shorten your procedure, even by five minutes, do it. Your patients don`t want to spend any more time in your chair than they have to and if you cut five minutes from each procedure you do, you should be able to increase the number of procedures in a day.

The second parameter is cost. Determine costs of all supplies, lab bills and staff time for each procedure. If you can substitute materials that may be cheaper or if you can perform the procedure using fewer materials, do it.

The third parameter is combining procedures - usually, services that can be done at the same appointment. For example, make sure that all needed X-rays are taken. In most dental offices, there are many procedures that would be of benefit to your patients that are slipping through the cracks. The responsibility for double-checking that all of these procedures are being done can be assigned to specific staff members in your practice manual.

Your practice procedures manual can be a very valuable tool. All of your employees have gained a great deal of information about your practice. This information must be written down in an organized format or its value to you will be lost whenever an employee leaves your practice.

Create your own practice procedures manual

- Assign all staff members the task of developing job descriptions.

- Choose your best staff members to tell you how they do their jobs. Weekly, ask them to outline the steps of a specific procedure.

- Examine the procedures for compliance with OSHA and infection-control guidelines.

- The procedures must include the actual brands of products you specify, the location where the items are to be found in the office and where to reorder the supplies.

- Require new employees to study the procedures in the areas of their job descriptions.

- Be creative. Use the manual to cross-train your employees or to improve the efficiency of your procedures.

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