What patients say about Quality

Oct. 1, 1999
The authors` study shows that dentists believe they must walk a tightrope to maintain productivity while providing treatment in a caring manner.

The authors` study shows that dentists believe they must walk a tightrope to maintain productivity while providing treatment in a caring manner.

Scott Trettenero, DDS, and

Gregg Martin, Ph.D

As consumers, we hear about it all of the time and experience it almost daily. As dental professionals, we provide it every day as we see our patients. It is called customer service. True, we call it providing dental care. But are we ignoring what our patients want most ... quality service?

If you were to ask dentists to evaluate how they practiced, a large number of them would say that they perform quality dentistry. If you were to ask dental patients what they wanted from their dental teams, most would say quality care provided in their best interests. They want a doctor who "looks out for them" while rendering quality care.

Obviously, quality means different things to different people. It is important that dental professionals are able to understand what their patients want when it comes to delivering quality dental service.

In 1997, we conducted an extensive research study of service quality from the patient`s point of view. We gathered and examined the responses of 6,500 patients from 88 dental practices across the country. Using a computer loaded with an assessment instrument called S.O.A.R. (Service Oriented Accredited Research), we developed a baseline of data on service quality indicators in dentistry in five specific dimensions:

(1) Tangibles - equipment, organization, cleanliness, accuracy;

(2) Reliability - on schedule, things are done right the first time, error-free records;

(3) Responsiveness - accurate information on treatment, prompt service, never too busy to respond to requests or questions;

(4) Empathy - individual attention, convenient hours, response to specific needs; and

(5) Assurance - trust in the staff, fair fees, professionalism and friendliness.

With this data, we conducted a comparative analysis of different practice-management methodologies as they related to the patient-satisfaction survey results. This information provided us with the viewpoints of the patients and how they feel about the quality of the service they were provided by their dental teams. But how do dental professionals view quality service? Do we understand what our patients feel is important and what provides them a quality service experience? We felt that the next step was to find out what dental professionals thought about the care they provide and what they consider to be the most important aspects of service for high-quality care. This information could then be compared to the data provided by patients.

Dental practitioners were asked open-ended questions about quality service in the same five dimensions. This provided them the opportunity to list aspects of their jobs that they feel most affect the patients.

This study was conducted via one of the National Dental Network`s video staff meetings. During these meetings, held by the subscribers of this service, a discussion of service quality was conducted by dental teams across the country. They were provided an instrument for organizing and gathering their feedback about their views of service quality. Supporting print materials were provided to facilitate workshop participants returning their opinions about how they could influence patient satisfaction.

The practitioners believed their practice performance, as seen by their patients, was most affected by the following aspects of practice management:


Of all the tangibles involved (e.g., equipment, elite addresses, facilities, parking, music), the one that was identified most frequently as extremely important was good, old-fashioned cleanliness. A clean office and well-groomed dental professionals was seen as the most important intangible in providing quality experiences for patients. Cleanliness of staff and facilities had the highest correlation to total service quality among the 6,500 patient responses.


The practitioners believed the reliability of their practices to be most affected by on-schedule treatment. Patients, however, felt that error-free records, both treatment and financial, were most important to service reliability. Patients also felt that on-schedule performance was important for overall service quality. Under the pressure to produce, dental professionals feel that being on time is crucial to quality care. However, those who await service, the patients, are accustomed to some inconsistency and some waiting.


Dentists believed that their practice`s level of responsiveness was most affected by listening to patients and fielding questions. Secondary to listening, practitioners felt that accommodation of individuals` needs was important. But, the patients felt that the dental team`s willingness to respond to and accommodate their individual needs was the most important. It could be that practitioners realize that sometimes meaningful discussion is all that is possible, while health-care recipients choose to believe a unique solution or immediate action is always possible.


Practitioners believed that their expressions of empathy for their patients are exemplified by individual attention to patients (remembering the names of patients and their family members, hobbies, and occupations). Patients also reported that individual attention is important to overall service quality.


The assurance practitioners provide patients was reported to be most affected by warm, friendly, open behavior. Interestingly, many practitioners feel that they need to let patients know a limited amount about their own personal life in order to establish a level of trust that would assure patients of "mutual patient best interest." Patients do not understand, nor do they care to understand, the clinical skills their dentists possess. They gain trust by getting to know the people, their approach to dentistry, their passion for their work, and their concern for their patients.

To provide quality dental care, it would appear that practitioners believe they must focus on the here and now, bouncing between machine-like behavior that maintains productivity, and parental-like behavior that listens and explains in a caring manner. The dental environment calls for seemingly opposing forces, structure and flexibility. Quality of service depends on practitioners walking a tightrope.

For the most part, patients agreed with practitioners and provided evidence that practitioners are savvy to what satisfied patients. But being able to provide patients with what they want is easier said than done. Each morsel of technical proficiency must be used with full explanations of patient benefit. Warm and fuzzy must be balanced with precision and timeliness. Technocrats must learn to effectively converse and take time to listen to their patients. Relationship-oriented team members must pay attention to technical details and productivity.

Practitioners need to focus on that which can be most easily perceived by the patient, and that may not always be what they believe the patient wants or needs. Always keep in mind what your patients want. They desire a clean office and a dental team that is neat, orderly, and well-groomed. They also want accurate financial and treatment records. Most importantly, your patients want to know that their individualized needs are known and responded to by the dental team. Finally, sincere warm and friendly behavior, combined with the other elements outlined above, will instill a trust that will bring your patients back and will encourage them to refer friends and relatives to your practice.

Patient-satisfaction surveys are a great way to find out what your patients really think about your quality of service. On-going surveys are a must for the dental practice committed to continual service improvement.

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