by Dr. Fred Banks
It is a scenario guaranteed to discourage even the most sanguine of dental practitioners -
The patient shows up for his dental appointment to cement or insert a new crown, but the crown hasn’t arrived from the dental lab. Or, worse still, the assistant remembers the crown coming in, but it is nowhere to be found, despite an all-hands search that disrupts the rest of the office. Finally, the office has to re-appoint the patient. The patient’s time has been wasted with a concomitant loss of office productivity ... and some credibility.
Not all gut-wrenching missed opportunities involve patient care, as I learned from this dentist’s story -
A woman, without any provocation, suddenly quit her job at the practice, then told Employment Security officials she had developed a medical condition and had left the job because of stress in the office. She asked for unemployment benefits. The dentist would have been able to contest that request, but the notification letter got lost in the flurry of papers in his office. The result: The woman collected unemployment she didn’t deserve and the rate went up for the office’s unemployment insurance.
There are common threads to these two anecdotes and countless other unfortunate stories from dental offices: disorganization and lack of communication. It should be noted that these stories represent breakdowns in both the clinical and business areas, yet there is much overlap of their implications. In fact, many dental offices experience conflict and communication difficulties between the “back” clinical area and the “front desk” business area.
These difficulties reflect an increasingly complex challenge for the dental team: how information and documentation are structured, stored, accessed, shared, and used within a particular organization. This challenge of managing the “content” of the modern dental office is complicated by strict information, regulatory, and documentation requirements. The crux of the matter is how we handle the myriad of externally and internally generated content. Therefore, content management becomes a key element of a well-run practice.
Dentists and many of their staff members tend to concentrate on managing the clinical parts of their practices. The same cannot be said for the front office experience in many dental practices, which should have a degree of focus on an equal level with that of the clinical area. Whether it is scurrying about to locate a referral pad or a frantic search for a particular instrument, these situations have a harmful and stressful effect on the practice.
More important, if a search party or other disorganization causes the clinical or business area to neglect, forget, or disregard an important function such as an informed consent form or procedure protocol, it can be devastating. It could even rise to the level of an emotionally debilitating and financially destructive legal conflict or lawsuit. Imagine not having the correct information or not concentrating because of distractions that result in restoring or removing the wrong tooth. Similarly, not having a sense of order and calmness can cause the doctor to be distracted and cause harmful stress that patients can sense while they are in the office. It can affect the doctor’s ability to focus and take proper notes. Since the dentist assumes 100 percent of the risk for everything associated with the practice, it is of paramount importance that a comprehensive and organized flow of information exists.
Dental professionals are well aware of the importance of delivering dental treatments in a timely manner and an organized, comfortable environment. Great emphasis is placed on tray set-ups, instrumentation, advanced materials, equipment upgrades, and proper cleanliness in the operating areas. The dentist, in particular, has a keen interest in the operating room environment. There are good and justifiable reasons for this interest because a lot of time is spent chairside.
Yet, the health of the business side of the practice greatly affects its general health. It is important to look at the whole office situation and organize a treatment plan for the whole office, just as you would develop a treatment plan for the whole patient.
There is so much focus on clinical technology and database charting, etc., that no one seems to be paying attention to putting the whole thing together and including more mundane things such as equipment maintenance and personnel management issues. Also, some dental computer management products out there are not necessarily user-friendly. Some actually inhibit good treatment planning, patient education, and patient flow.
A fellow dentist told me recently that a popular dental software program he uses is really disorganized and difficult to work with. It does not handle the record keeping or the all-important treatment planning functions very well. Using this software is a haphazard, disjointed process that is detrimental to good patient care. In this age of technology, there is a temptation to think that every problem can be solved if we can just find the right computer program. Indeed, there are several companies that provide excellent software and hardware products to dental offices.
In my opinion, a hybrid model using the most effective systems available makes the most sense. This approach includes a combination of technology - electronically generated forms and documents as well as traditional paper forms.
As businesses begin to pay more attention to content management, various types of software systems can be designed to help. They could be classified as follows:
▲ Level 1 content-management software would simply be electronically stored forms and documents such as patient records, patient education materials, and even such things as third-party contracts and equipment maintenance manuals. This would eliminate the need for some office storage space or furniture and the ubiquitous patient-education “literature rack.” Additionally the time, energy, and resources to order, stock, and maintain these items are greatly reduced.
▲ Level 2 contains all the features of level 1, but forms and documents interact with a data base to be used, manipulated, and “filled out.” Level 2 addresses not only the storage of blank forms, but also the organization, storage, and access of “used” forms and documents.
▲ Level 3 interacts with other office technologies such as imaging systems or other computer programs.
▲ Level 4 puts it all together under one “umbrella.”
It is helpful to think of dentistry not as a series of procedures that need to be done perfectly, but as a process or evolution seeking constant improvement. The same can be said for content management.
There are many areas in the dental office that could be streamlined by having documents available and accessible in a timely manner. A few minutes each hour earns significant business and clinical productivity time. Examples of management areas for time saving, improved care, and stress relief are:
- “Pre-packaged” registration kits with office policies clearly stated
- Prepared referral forms neatly arranged or electronically stored
- Patient education materials available or electronically accessed
- Lab prescription forms “prefilled in” as appropriate and electronically stored
- An established protocol for patient flow through the practice.
An organized system to move patients through the business and clinical processes is a cornerstone of a thriving dental practice. From the dental patient’s perspective, seeing a neat, clean, organized operation inspires confidence and encourages referrals. From the practitioner and staff perspectives, a well-run office and a prepared team facilitates patients flowing through the practice faster, in a relaxed fashion, and with quality treatment.
A generation has come and gone since the days of “drill and fill” dentistry, when a practitioner’s role was almost one of crisis intervention. Today, we know that the secret to healthier patients (and healthier dental practices) is to view the patient as a long-term project, not a one-time episode. We try to go beyond just treating the presenting condition, and work with our patients to develop a treatment plan for the whole patient.
Yes, we can generally solve the immediate problem. But then we go further, to help the patient understand the underlying causes of that problem, to identify other possible problems and their solutions, and put together a long-term plan that will lead to better health for the patient over a long period of time.
That same approach will work in the dental office. Making the business aspects and the clinical aspects of your practice work together effectively takes the same kind of disciplined, long-range thinking as comprehensive treatments plans for patients.
Several good database software programs exist for such things as patient billing, insurance coding, and electronic charting; however, the efficient dental office cannot live on databases alone. Many of my colleagues have tried this, and ended up drowning in a sea of information, inadequate documentation, incompatible programs, nonfunctioning equipment, and task-specific systems and procedures that are counterintuitive and hard to master.
The first steps toward developing a total office management plan are the same as the first steps toward developing a treatment plan: listing conditions and deciding what needs to be done. It can help to focus your planning by outlining your office needs in four main categories or systems:
- Business management
- Records and treatment planningCommunication
- Patient education and informed consent.
This segmentation will provide a structure and sense of control and give you a handle on what needs to be done, who needs to do it, and how it meshes with the other aspects of your office.
Business management, for example, would be subdivided into planning, accounting and analysis, personnel administration, inventory and ordering, and protocols. Each of these subdivisions would be broken down into elements.
Planning elements would include a business plan, list of services and fees, planners, schedules, calendars, and coding menus. The records category can be subdivided into diagnosis and treatment planning, transactions, and tracking and recall. Communication would include operations communications/letters, treatment support communications, reference materials and scripts, and HIPAA compliance. The patient-education category would include information about treatments provided and informed consent forms, as well as any audio/visual aids or computerized presentations.
The bottom line with any system or element is that it works. If you’re not using a particular computer system feature or you can’t keep your literature rack stocked properly or it just collects dust, then it is not working and therefore is not effective.
Getting control of content management takes time and patience. It won’t happen overnight, and you can’t find the total solution in one software package (although there are some good software programs that will help with many parts of the total need).
If you focus on these four categories - really focus - then you will have a good start on managing the content of your practice. It will involve some trial and error to optimize your results.
Total office management needs a comprehensive approach that may appear daunting at first. But the effort pays off in an organized, neat environment that will be reflected in a less-harried staff, lower employee turnover, and reduced training costs - all of which add to increased patient satisfaction and practice growth.Immediately out of dental school, Dr. Fred Banks built a highly successful multi-lingual practice starting with an empty office space and no patients. In addition to having 26 years of private practice experience, he authored “How to Make Your Dental Practice Thrive in the 90’s,” scientific publications, more than 500 dental office forms, and has developed innovative software. Dr. Banks currently practices dentistry and develops programs to benefit the dental profession. Contact him by e-mail at [email protected].
