What is the quality experience Patients definitions go beyond the perception of your excellent treatment.

Oct. 1, 1998
3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

What is the `quality experience`

Patients` definitions go beyond the perception of your excellent treatment.

3M Dental, winner of the 1997 Malcolm Baldrige National Quality Award, is proud to sponsor the Dental Economics year-long "Quality Management" series.

Dr. Bruce Waterman

I ate dinner at a restaurant known for its Mexican food. The beef prepared by the world-renowned chef comes from cows fed only natural products, and the vegetables are never sprayed with insecticides. Then why was my meal not a "quality" experience? At this particular restaurant, the reservations were fouled up, the hostess was rude, and the waiter often rolled his eyes while rendering poor service. But the food was good!

In our dental practices, do we ever provide care that resembles this restaurant scenario? We may not intentionally, but offices that have more routine foul-ups generally provide less of a "quality" experience. We may place a crown that is perfect clinically, but if our customer service is poor, the patient leaves with a feeling that may be less than positive. Unfortunately, the bulk of our training is on the clinical aspects of dentistry. We have been left to find our way on the customer service side. Not that clinical excellence isn`t important, but to the patient, quality is the whole enchilada.

What is quality? This is an intriguing question, because it seems that businesses that provide "quality" seem to do well. "Quality" is hard to define but we all know we want more of it as consumers and in our businesses. When I have asked groups what quality is, I have received varied responses such as "the crown fits," "the schedule is accurate," "disease is controlled," or "the patient is happy."

The dictionary defines quality as a degree of excellence. Phillip Crosby of Crosby Quality Consulting defines quality as conformance to requirements. Dr. W. Edward Deming, guru of the quality revolution and Total Quality Management, says that quality is determined by the customer. Quality seems to be a mystical concept - kind of like jazz, you know it when you hear it or see it. All of these definitions are sensible, but we wet-gloved dentists need something tangible, operational, and less philosophical. If you look back at the definitions of quality above, I can tell you that none are wrong. Collectively, all of them are right in one way or another.

From the practical standpoint of our practices, we need an all-inclusive definition. I suggest that quality is, "Meeting or exceeding the internal (dentist and staff) and external (patient) customers` requirements throughout the entire patient experience." It is all the little things that make the big difference.

How can we have more quality?

Every improvement we make in our practices increases quality. If continuous improvement is your core philosophy, then your ultimate result will be continuous quality improvement. The three categories of quality in our dental practices are:

n Clinical quality - Clinical excellence is the foundation on which all other quality is built.

n Customer service quality - We must focus on the needs and expectations of our customers as the guide to our decision making, not just production. If our patients are the emphasis, the production will follow. For example, IBM used to manufacture computers and then try to make customers buy them. Using this production mentality, IBM was losing more money than any company in the history of the world. IBM got a new CEO, and now it`s making millions again. His explanation: "We asked the customers what they wanted."

In our dental offices, attention to the services offered, hours, facility, phone manners, technology, interpersonal skills, and financial options are a few examples of customer service. We must determine what is important to our customers just as IBM did, if we are to achieve a similar profitable revelation.

- Operational quality - The management of daily operations involves doctor and staff. The staff can actively help the doctor to innovate and implement improvements in these areas:

- Revise existing forms, develop new ones to facilitate operations, or buy standardized information systems to increase your efficiency. Every form you have can be improved to become user friendly, practical, and add value to the patient`s experience.

- Training staff, defining and standardizing job functions, and implementing participative management are critical.

- Improving your processes. The multiple steps or transactions that occur in the function of office activities often are the most susceptible to variability. Processes such as emergency patients, new patients, and recall visits are the most common examples. Unfortunately, variability in these processes translates into inefficiency, wasted time, and, consequently, less predictable quality. To increase quality, you must improve your processes.

In my office, we discovered that the variability of needs for new patient exams (NPE) often presented challenges. Unpredictability would often cause scheduling dilemmas relative to the patient`s previous records, X-rays, perio status, or health history. Frustration would surface as the staff would try to accommodate this variability but still keep on schedule.

The clinical team would be in conflict with the administrative team since a lack of information put them in the hot seat. The staff members were less than "nice" in their interactions with each other or the patient if they were feeling stressed. We were falling short of our quality goals when these inefficiencies occurred. Everyone was stressed out and running behind schedule. None of this is where I want to be routinely or on purpose.

The traditional management solution is to blame employees. The traditional approach to my NPE dilemma would be to discipline or fire the staff members that least favorably handled the stress of our inefficient system. But the problem will still persist because it lies within the system, not the people. Employees generally come to work wanting to do a good job. But working in an inefficient system will reduce them to frustration.

So the solution of Dental Quality Management (DQM) is to blame the process and improve it. Dr. Deming found that 85 percent of problems are caused by faulty processes and only 15 percent can be attributed to people. By improving our processes, we become six times more effective than when we blame people.

For my own problem of inefficiency with the new patient exam, we set out to improve the process. My staff and I brainstormed and determined we needed to standardize and identify the critical information, put it into a user-friendly format and devise flexibility in the system to accommodate variability. Collectively, we developed a NPE information form (see related chart). The results were as different as night and day. The form is easy to use, and we know the critical information that enables us to appoint properly for exams and cleaning. It was the same staff, but a much better result. The entire patient experience is now much more likely to be a quality one.

In dentistry, we do not want our concept of quality to be defined by outside forces. For example, one managed care handbook stated that quality is determined by the number of complaints. Instead, let us gain insight and inspiration from a philosophical definition I heard at a meeting of the American Society of Quality: "The true essence of quality is the desire by all people to know that their life efforts have made the world a better place." In dentistry, isn`t that our goal?

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