The Jameson Files — Dental charting
Mary Sue Stonisch of Smile Enhancement Studio and VIP Smile © recently created (and now implements in her practice) a charting system for better recordkeeping.
Featuring Dr. Mary Sue Stonisch
Mary Sue Stonisch of Smile Enhancement Studio and VIP Smile © recently created (and now implements in her practice) a charting system for better recordkeeping. Dr. John H. Jameson speaks with Dr. Stonisch about how this system can provide happier team members, more consistent quality patient care, and less stress.
Dr. Jameson: What was the leading idea behind the development of this patient-management, tutorial system for managing the flow of patients in the day-to-day operations of your practice? What areas of the practice can the system synchronize?
Dr. Stonisch: I was motivated to develop a system like this - not only to simplify my life as the doctor with mounds of paperwork every day - but also to function better as a team leader. I have found that if I don’t lead my team, my staff doesn’t grow. So, I created this system. First and foremost, I wanted to better focus on patient care and not paperwork. Second, I wanted to be a better manager by involving and challenging my staff. We’ve been able to synchronize every department with this chart documentation system.
We started at the front desk. Certainly a patient’s first contact with the practice is crucial! Our system helps to remember this interaction through the acronym FLIRTING. The letter “F” stands for focus - focus on the reason for the call. The letter “L” stands for limitations to treatment. Today, it has become critical to rule out the need for prophylactic antibiotics prior to dental treatment. This can - and most efficiently - should occur during the phone call prior to a patient’s first visit when additional medical information can be gathered, including other current medications. This begins to prepare the office from a medical-legal point of view. The letter “I” stands for insurance information, if applicable. The letter “R” stands for referral source. The letter “T” stands for type of personality. The letter “I” stands for information to improve your new patient’s experience, and to make the appointment more comfortable. For example, this could include the fact that a mother has a new baby at home, and is nursing. If so, she will be on a strict time schedule. This could also include a mother who needs to be finished by a certain time in order to pick up a preschooler at a specified time. Any and all information gathered can work toward the beginning of a successful relationship between you, the staff, and the patients. The letter “N” stands for nickname. Finally, the letter “G” stands for either give or get. To conclude a conversation with a patient, either give a compliment, such as “Thank you for calling; we look forward to seeing you next week,” and/or get some additional information and make a real connection with the patient.
Our system is much more thorough than a set of acronyms. But this gives you an idea of how it helps the staff in dealing with a patient to think through each step, and record helpful information. We began in the front office area, and worked our way to the consultation department. Then, we went through the hygiene department, treatment visits, esthetic treatment, and lab correspondence. We’ve streamlined so much. The real beauty of this is that you can use the system to streamline one or two departments, or as we did, streamline them all.
One thing that really impressed me is that this began not only as just an administrative and management tool - a way to improve upon the economics of the dental practice - but we took that and evolved the system to include a communicative dimension as well. One of the weaknesses we see in many dental practices is that team members don’t know the appropriate thing to say. The team members are not fluent in “Dentalese.”
Dr. Jameson: Your system includes the scripting and tutorial, right in front of them on their monitor, so they can follow through any particular procedure with ease and confidence while focusing on a patient. Is this a real key point of the software?
Dr. Stonisch: Yes, and with a little bit of scripting, even a novice can take this system and implement it in the office. There are ever-changing employee personnel issues. We feel that, by practicing the scripting and giving it attention, everyone can be on the same page. This provides the patient with consistent care. Uniformity is important in every aspect of the practice.
Dr. Jameson: As we look through some of the “tour guides” of your VIP Smile system (see the online demo at www.aVIPSmile.com), you seem to deal at length with guiding the dental team through the consultation process. I’ve always been an advocate of consultation appointments. It appears that this system does an excellent job in being able to give the team a vision about the benefit these consultations have for the practice.
Dr. Stonisch: Yes. Jameson Management has taught me a lot about verbal skills - what to talk to a patient about, how to ask questions, what kind of patient I’m dealing with, using the right timing. These are the kinds of things that need to receive attention. The problem is that, during the consultation visit, there are constant distractions. You’re being called for a hygiene check, your kids or spouse might call to check in, etc. So, a consultation visit scheduled for 30 minutes might last only 10 minutes because I wasn’t using a consistent approach. I saw the value of treatment consultation, but couldn’t make it fit into the day. I wanted to find a common ground, but that always seemed to go by the wayside as I probed directly to determine what a patient’s focus was. This was especially true if I was dealing with someone who wasn’t a very verbal patient. This system has allowed me not to skip a beat. Before a patient leaves the room, I’m able to find something that we have in common so that I can really connect with this person and start building a long-term relationship.
Another thing we teach is the importance of a morning “huddle” or morning team meeting. Two of the things we discuss at this time are the patients who we will be treating on the hygiene side that day as well as those who are on the doctor’s treatment schedule. The system’s menu is tailored to both of those areas so we’re able to record and manage the details that will help to best maximize these two types of appointments. This information also then can be incorporated into the next phase of treatment.
This is part of our vision - to begin a relationship and maximize our care. If we’re not all on the same page with how we’re going to do care for our patients, things easily can fall through the cracks.
Dr. Jameson: I believe every patient should have a restorative and esthetic-cosmetic opportunity or treatment plan. Your software allows every patient to experience the VIP Smile of the esthetic treatment. Tell us about this.
Dr. Stonisch: It begins the first time we see the patient. It’s our first and perhaps our only opportunity to gather information about how we can change, correct, or modify a patient’s appearance and oral health. We try to take advantage of this first opportunity to evaluate appearance.
Dr. Jameson: How does your lab correspondence work?
Dr. Stonisch: We have acronyms that give us a checklist to ensure we collect the correct information in the correct order. For example, we need to collect the stumpshade before cementing temporaries, and make sure we’ve taken appropriate bite registration before cementing the temporaries.
As the doctor, this helps me to handle interruptions while still being consistent and not missing steps or creating costly mistakes. It also provides a checklist for our assistants so all necessary elements are included in the lab case and nothing is forgotten. Thus, we’re better able to pay attention to detail and eliminate error. This system has simplified my life so I can focus on patient care. Following the checklist gives me great peace of mind, but this system also challenges staff members to be involved. They can feel as though they are involved in the details. It raises their awareness to the next level. They’re such an integral part of the team, and this system affirms that fact. Staff members need and want continual challenge and self-improvement.
Dr. Jameson: This system does involve some change. Tell us about the learning curve in implementation.
Dr. Stonisch: The learning curve has been simple. Once I review the system with the staff, things just click. It’s easy! Here’s an example. In my office, the hygiene department was the most difficult to staff and regulate. Various factors such as part-timers, maternity leave, and spouse transfers played a role in this difficulty. On top of that, patients wanted to be able to see the same hygienist. That’s just not always possible. We learned that if each hygienist uses a checklist and offers treatment in a consistent fashion as his or her counterparts, patients feel like they’re receiving consistent care. Each hygienist can deliver treatment in a similar fashion simply by asking questions in the same manner, and doing steps in the same order. We found the system very simple to implement! After just one patient, hygienists felt as familiar with the system as they did the back of their hands. The system helps with staff morale by allowing team members to know what’s expected of them, to feel like they’re accomplishing those expectations, and to know that they’re contributing to a patient’s quality of care. They feel a sense of accomplishment, and feel good about what they are doing. That’s part of having a successful team. Staff members need to know what’s expected of them, and be able to meet or exceed the challenges put before them. With this system, staff members are able to do just that. Patients are happy, case acceptance increases, productivity is up, and the team feels the personal satisfaction of making that happen.
Dr. Jameson: It appears that this system would help control stress since you don’t have to second-guess yourself in the midst of all these interruptions, and make sure that you have thought of everything. You just trust the checklist, enjoy a conversation with the patient, and team members move on through the day. You don’t have to worry about consistency.
Dr. Stonisch: It has taken stress off me, the front desk personnel, and the hygiene department. I don’t have a stack of charts waiting for review. The charts are completed as we see patients, and they are completed more thoroughly than was the case previously. It is really a relief.
Mary Sue Stonisch, DDS, FAGD, is an esthetic dentist who maintains a Smile Enhancement studio in Grosse Pointe, Mich. The practice, limited to comprehensive restorative care and esthetic dentistry, creates smiles by an artist’s eye. For more on Dr. Stonisch’s dental charting system, visit www.aVIPSmile.com. For offices interested in VIP Smile, technical support, at no additional fee, is available at (877) GR8-NEWU (877) 478-6398.
Dr. John Jameson is chairman of the board of Jameson Management, Inc., an international dental consulting firm. Representing JMI, he writes for numerous dental publications and provides research for manufacturers and marketing companies, as well as lectures worldwide on the integration of technology into the dental practice, and leadership. He also manages the technology phase of the consulting program carried out by JMI consultants in the United States, Canada, and Europe. He may be reached at (877) 369-5558 or by visiting www.jamesonmanagement.com.