A system that manages time

Aug. 1, 1998
Several years ago, HMOs and PPOs initiated major efforts within the United States to penetrate the dental and medical marketplaces. One of the primary economic goals of this nationwide venture was to reduce benefit costs incurred by insurance companies, thereby enhancing profitability for the health-insurance industry.

Efficiency, focus and predictability are the cornerstones of the modern dental practice.

Joseph J. Massad, DDS, and

William J. Davis, DDS, MS

Several years ago, HMOs and PPOs initiated major efforts within the United States to penetrate the dental and medical marketplaces. One of the primary economic goals of this nationwide venture was to reduce benefit costs incurred by insurance companies, thereby enhancing profitability for the health-insurance industry.

Many dentists who joined various HMOs and PPOs found it extremely difficult, if not impossible, to maintain their previous income levels while still attempting to provide high levels of quality, comprehensive care for their patients.

This caused many dentists to leave these HMOs and PPOs and get back to giving independent fee-for-service care for their patients. After joining one of the first HMOs, one of the authors stayed in it for only about three months before realizing that there was no possible way of maintaining the high level of dental care that his patients deserved while remaining in the HMO environment.

To improve profitability while maintaining a fee-for-service private practice, it is important for all of us to better utilize effective time-managment principles that we can learn from other businesses or services. Analyzing operational concepts of several Fortune 500 companies - such as Arby`s, McDonald`s, and Burger King, for example - provides insight into how dental practices might operate more efficiently.

These corporations have to deliver a quality product quickly and regularly, while staying within a competitive framework, to provide a reasonable profit margin. They have to identify certain problems (diagnose the problems) and plan how to solve these problems (treatment-plan the problems).

For example, in the case of French fries, it took awhile to determine the size and weight of the fries, prepackaged formulations, type and temperature of frying oils, and cooking time. In similar fashion, these corporations looked at the meats they were using - trying to centrally locate the buying of high-quality meats in uniform prepackaged units so that they could be cooked properly and efficiently in a short period of time and with minimal handling.

Initially, it took much more time for these companies to get their programs uniformly set up and systematized. But, once they were focused and had everything in a system, the whole process usually went like clockwork.

Highly efficient time-management systems are the name of the game for these companies. Dentistry is no different, except that we are treating patients with dental problems rather than cooking French fries and hamburgers. In our combined 60 years of dental practice, we have found the most important principle of time management in the dental office to be case diagnosis and the formulation of a well-thought-out treatment plan.

In dentistry, by concentrating on doing a precise diagnosis and developing a comprehensive treatment plan, which is discussed with and understood by the patient, a lot of valuable time may be saved. By proceeding with such a process, we quickly can determine if our patient will accept the treatment recommendations. If the patient initially is hesitant about a treatment plan, or is not satisfied with it, there is no sense in going forward. Perhaps the patient did not understand our treatment plan and its benefits or cost was an issue. If the patient accepts treatment recommendations after effective explanation, then it is much easier to go forward.

Remember, the majority of problems resulting from patient dissatisfaction stem from inadequate understanding of proper diagnosis and treatment planning.

When discussing removable prosthodontics, be sure to answer all questions related to the diagnosis of the patient`s case and present a treatment plan, including options such as implants and/or fixed bridges. Be sure the patient has a clear understanding of the best care for him or her prior to commencing treatment. Once you have care acceptance and financial arrangements have been completed, there should be no obstacles or distractions as you focus on the treatment.

Positive communication with your patient can be accomplished with a Treatment Summary Option Form. After you and your patient have discussed the best option, this form outlines the treatment the patient has selected, as well as reviews fee considerations. This enables the patient to commit both psychologically and financially. This form also will provide a measure of informed consent (see Figure 1).

Regardless of the kind of dental treatment, if the dentist has a plan before beginning and there is a clear understanding with the patient about what will be accomplished, the service will be completed with a high degree of quality. Now, you, the dentist, must become focused on each stage of treatment to accomplish the treatment plan with both excellence and time-saving efficiency. Visualize the end result before you start.

Better quality comes, in part, from having everything available before beginning a procedure. It is extremely difficult and embarrassing for a dentist to fumble around trying to find different instruments during a clinical procedure. Efficiency is decreased and the service delivered to a patient is reduced.

To stay focused, try using simplified note forms. They offer a simple checklist and a means for detailed recording of steps, stages, findings, and outcomes of different procedures that are performed.

A simplified note form makes it easier to become systematically focused on procedures and enhances overall efficiency, speed, and predictability - all leading to better results in a shorter period of time. The form keeps the dentist and staff focused on what is to be done, while following various stages of dental rehabilitation in an accepted treatment plan. It also helps to ensure accuracy and precision. The form helps a dental assistant have correct instruments and materials on hand and ready before the doctor starts any treatment. With this form, the assistant can monitor procedures with ease and make sure all steps and data acquisition are completed.

Even though a patient may have been told what was going to be accomplished at each appointment, it always is appropriate to reiterate what was done. Then, doctor, prepare and instruct the patient about post-operative concerns that might arise. A patient might be made aware that there could be discomfort post-operatively and that such discomfort should be managed in certain ways. If a prescription for antibiotics or appropriate pain-relieving medication is indicated, then this would be the time to make sure that the patient understands the purpose of the medication and how to take it properly. This caring attitude assures the patient that you are watching over him or her and is very important in building a strong bridge of trust between the patient, doctor, and staff - especially if any complications arise.

We all know that there are certain cases that seem to be magnets for treatment complications. However, when a systematic approach to dental care is pursued and fully explained to the patient, the potential complications are reduced or even eliminated in the majority of cases. The treatment session will be less stressful for the patient, doctor, and assistant.

Efficiency, focus and predictability are the cornerstones of dentistry in the 21st Century. With today`s new techniques, instrumentation, and improved biomaterials, dental practice has become more predictable than 20 years ago. Despite ever-increasing regulatory controls and paperwork, systematizing your practice can make it more rewarding financially and a lot of fun!

The authors wish to thank Dr. Kenneth R. Goljan of Tulsa, Okla., for his assistance in the preparation of this article.

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