We are blessed to live in a dynamic age. Those who have been involved in dental careers since the early 1970s and beyond have seen our country’s economic, business, and manufacturing climate through many major evolutions.
After World War II and during the 1950s, the U.S. economy unequivocally advanced in manufacturing, product design, and development. Whatever we built we sold, particularly in the automobile industry. During that time W. Edwards Deming went to Japan to help them improve their manufacturing processes.
Today the Japanese are famous for “Kaizen,” or the act of continuous improvement. Deming, in concert with the Japanese, developed statistical measurements to get accurate data to analyze virtually every variable available in the manufacturing process.
Deming also recognized the importance of quality control and quality assurance, which are a function of systems. He developed and initiated a cycle that involves four steps: Plan, Do, Study, and Act. His findings revealed that if manufacturers implemented this cycle repetitively, they would eliminate waste in time, effort, resources, money, remakes, etc., and this would build in quality and raise productivity. It came back to haunt U.S. automotive manufacturers in the 1970s and ’80s.
The parameters Deming developed and studied are referred to as benchmarks. He was responsible for determining what a benchmark is, as well as the best possible result that could be obtained from using the benchmarks.
I cannot think of any significant industry that hasn’t universally accepted the benchmarks that almost all successful operators in that industry know, study, and base constant and never-ending improvement on.
Such benchmarking also exists in health care. It reassures me that oncologists know the five-year survival rate of every mode and combination of treatment known for every cancer and patient type. That information is available to and reported by every significant cancer treatment site in the United States. Cardiologists know all of the benchmarks and key metrics to analyze the probability of outcomes for their various treatment options as well.
With this as a premise, it makes sense to apply that same benchmarking philosophy to dentistry. Benchmarks for a myriad of metrics have been studied for years in many of the most progressive private and group practices in dentistry. Insurance providers have been profiling and examining data on the profession as well as on individuals for a long period, so we can rest assured that they know what benchmarks or key metrics work best for their industry.
Therefore, now is the time for dentistry to openly accept the need for, establish, and distribute the benchmarks or key metrics associated with the best practices in the United States.
Dentists could benefit by looking at benchmarks to support their practice philosophies because these benchmarks provide guides to achieve goals. Let me offer some basic examples. A significant percentage of the adult population has some form of periodontal disease. The Academy of General Dentistry says it is the major cause of approximately 70 percent of adult tooth loss affecting three out of four people at some point in their lives. There are numerous studies to support this, and most of these studies indicate that a first phase of treatment of early to moderate periodontal disease is scaling and root planing.
If our goal is to provide the best patient care possible, a first step would be to measure the units of scaling and root planing in our practices. At Heartland Dental Care, we would measure the number of units of scaling and root planing compared to the number of adult new patients. Out of 100 new patients, the number of quadrants needing treatment could be 30, 40, 50, or more. While we could argue about what the statistical optimal percentage of units of scaling and root planing should be, we also could agree that a practice with fewer than 5 percent of their patients needing scaling and root planing per 100 adult new patients would be statistically improbable given the fact that we know a majority of adults have some form of periodontal disease. This difference should prompt us to take a closer look at our protocols so we can make improvements. This is how benchmarking can help our profession connect the dots.
This example is only one of nearly 50 benchmarks we at HDC use in our efforts to provide patients with quality, lifetime dental care. This is not done as a quota, obviously, but rather as a discussion among peers - to have the results of our practices actually measured or have some semblance of statistical compliance with what we philosophically believe.
Through my experiences in growing our company and talking with many doctors who join HDC, I as well as others find that most dentists generally believe and support our philosophy of lifetime care - that our patients, their needs, and their optimum oral health are our first concern. Sometimes, however, our benchmarking reveals that a dentist’s philosophy and his or her actions do not always run parallel.
For instance, most doctors would agree that all adult patients should have a current set of full-mouth X-rays because they offer the best diagnostic tool for us to provide the highest standard of care. Nevertheless, we have discovered from doctors new to benchmarking that a surprising number of their patients have never had full-mouth X-rays taken in their practices. Doctors are often amazed at the number of patients who enter their practices as emergency patients and end up being treated without receiving a full-mouth series.
When data is objectively demonstrated to doctors and their teams, they can reassess their systems and plan improvements to achieve their previously stated goals and philosophies of care. This is done using our Measurement and Performance System, or MAPS, which is made up of the numerous benchmarks to which I previously referred. These doctors are intrigued and anxious until the next week or month to see if the new system they implemented achieved better results than before. Using MAPS gives value to the results because it provides measurements that are more consistent and provide a more standardized quality approach to dental care. It also enables doctors and teams to offer their patients the most modern and up-to-date, life-saving treatment options available.
For example, oral cancer is a serious disease that affects our patients; roughly 30,000 new cases are diagnosed each year, according to the American Cancer Society. While early detection is important to saving lives, statistics reveal that approximately 70 percent of new cases are detected in the later stages of the disease. If our goal is to do a better job in offering oral cancer screenings and improving the quality of care we provide, doesn’t it makes sense to incorporate new technology such as ViziLite® as part of our preventative care protocol? But, if we only offer ViziLite to patients we believe to be at high risk, are we accomplishing our previously stated goal of improving the quality of care we provide or are we missing opportunities to save lives? Ultimately, does this action follow our philosophy of offering lifetime care to all of our patients?
Our many different benchmarks promote discussion among our colleagues of how to objectively develop and implement high-quality, standardized, quality-assured dental care. Reviewing our MAPS gives us a guide to where we might be missing those opportunities that align with our goals and philosophies of care. This beneficial tool ensures that we are staying true to our goals and adds value to our patients in the quality, lifetime care we provide.
I understand that some reading this might say, “But my practice or area is different.” Our experience tells us that practices and patients are more similar than we think. If they are different, this also is helpful to benchmark to show what results can be obtained from special practices and populations.
Objective data is not the only answer to predictable, quality care and assurance. It can, however, be difficult to consistently measure quality care without the repeatable, predictable, and transferable use of objective data. As Deming said, “Measuring productivity doesn’t do anything about it.”
According to Deming, the measurement just serves as feedback so that action can be taken. If there is no action, there is no improvement. Data is only information.
To provide feedback on benchmarking or for additional information on how to participate in our benchmarking service, call Heartland Dental Care at (888) 999-3661.
Rick Workman, DMD, is president, CEO, and founder of Heartland Dental Care in Effingham, Ill. He has more than 25 years’ experience developing, acquiring, and managing dental practices. With more than 170 practices in 11 states, his efforts garnered him the 2003 Ernst & Young Entrepreneur of the Year Award in the Masters Category, and Excellence in Dentistry’s 2004 Dental Executive of the Year Award. Reach him at (217) 540-5100, or at [email protected].
