Using the Baldrige approach to improve your practice

Whew! We did it. Just turned in our 50 page application to the Partnership for Excellence that was due December 1st.

The Partnership for Excellence helps organizations to understand and apply the Baldrige Criteria for Performance Excellence in Ohio, Indiana and West Virginia. The Baldrige Performance Excellence Program, sponsored by the National Institute of Standards and Technology helps organizations to achieve their goals and meet their vision and mission.

The Baldrige Criteria cover 7 areas:

  1. Leadership
  2. Strategic Planning
  3. Customer Focus
  4. Measurement, analysis and knowledge management
  5. Workforce focus
  6. Operations focue
  7. Results

This application process follows several steps:

  1. Read through the application questions (updated every year)
  2. Write your answers to the questions (50 pages maximum) and pay your fee (about $5,000)
  3. Submit your application to your region’s administration for Baldrige (for Ohio,it’s the Partnership for Excellence)
  4. Your company is assigned to a team of Examiners (trained in this Baldrige approach) – they each read your application and meet to discuss it. This is all 100% confidential.
  5. The team comes to your office to confirm that what they read is actually being implemented – and they create a feedback report summarizing your strengths and opportunities for improvement in each of the 7 areas listed above.
  6. You receive the feedback report – and perhaps an award!

You can see that this process is expensive – and time consuming.

So, why would a dental practice apply for the Baldrige award?

In my opinion, it’s the most straightforward way to run a dental practice (or any organization for that matter) I have ever seen. It offers a proven framework for understanding your practice through simply asking questions – and by establishing tracking so you can measure your results, you can continually improve. We use the Baldrige approach to run our practice – and it eliminates making decisions on emotion or reaction.

Let me give you an example. One of the biggest challenges we face is staff turnover (isn’t that the case for most dental practices?). So, I started to measure the turnover – how many staff left each year? How many well-trained staff left vs. relatively new staff? What were the reasons staff left? How many staff stayed each year? As I gathered these numbers and our management team (dentists and team leaders for the assistant, secretary and hygienist teams and me, as the office manager) reviewed them each year – we started to more clearly understand our staff turnover problem. The more we understand the problem, the more we changed our process for hiring, for training, for staff communication, etc. In fact, one major benefit of looking at these numbers was to show that actually our staff retention (staff that stay working for us from year to year) is amazing! We keep 80% of our staff – and the turnover is trying to find the last person on the secretary or assistant team. This helped our staff morale a great deal.

Here’s another example: why should a patient come to you instead of the dentist down the street? Are you friendlier? Is your lobby fancier? So you have newer, more expensive technology – is that why? The results section of the Baldrige Healthcare Criteria asks you for healthcare outcomes measures that are important to your patients compared to your competitors. More plainly, it’s asking the dentist – how do you measure that your patients are healthier coming to you than going to the dentist down the street? How do you know?

When we first faced this question years ago, we had no answer. Now, thanks to our Dentrix software, we have created our own measures to determine if we are actually helping our patients to stay healthy. Here’s how: once a year, we run a report in Dentrix to find every patient that was seen for a dental cleaning in one month. With this list of names, we check their ledger to see – are they a new patient? If so, we delete them from our list. Have they come in at least once a year for the last 2 years? If so, we keep them. Finally, we check to see – have they had restorations placed in the last year or are they treatment planned for restorations? These are our failures – if they’ve come in for regular checkups but still need their teeth restored – then we’re not successfully keeping them healthy and preventing the need for treatment. On the other hand, every patient that has stayed healthy – those are our successes. I’ve run this report once a year since 1995 and we average 85% decay free for adults and children.

We use this measurement in our marketing and as a motivator for our staff training. We provide feedback to each general dentist and pediatric dentist for their individual decay-free rate. We are very clear that helping people help themselves stay healthy is our vision. This makes all sorts of decisions easier when you know your vision. Our staff feels confident that we are truly here to help our patients – and that we take the time to measure our own performance reflects how important it is to us.

Fully half of our Baldrige application this year is graphs – 25 pages worth. We have measures of healthcare outcomes, satisfaction measures, workforce measures, process and operations measures and of course, financial measures. I believe our Examiner team will really get a clear picture of our practice from reading our application – and I’m looking forward to their visit and hearing the questions they ask.

The downside of the Baldrige process is that in dentistry we cannot find competitor data to compare our own performance. Have you ever heard of another dental practice measuring their own healthcare outcomes? How about staff turnover by years of experience? What about measuring total active patients – now, let’s look at that by the number of GP hours worked?

We are hearing that insurance companies want to change their reimbursement structure from paying for fixes, to paying for health. This has been a hot topic in Ohio as the state “Office of Health Transformation” is requiring it’s Medicaid administrators to start this process for it’s physician providers. From attending the Oral Health Institute conference last October, dental insurance companies are asking the same questions – how would they reimburse dentists for keeping patients healthy instead of for removing tooth structure? As we move towards Obamacare, hundreds of thousands of people are going to be added to state Medicaid plans – and our current approach of treating disease just won’t work. There aren’t enough doctors and not nearly enough money.

By measuring our own success thanks to using the Baldrige approach, we feel that we are ready for the future of dentistry. Our swell of new patients in the last 4 months may be a reflection of our success? It would be wonderful to find other dental practices who want to move towards this future of prevention – not by sharing stories but with actual measures of health. We could cooperate together to identify healthcare outcomes that make sense for our field – and then confidentially share results to discover best practices. As a practice administrator with a background in Baldrige, I welcome other dentists and office managers who want to dig into this opportunity.

For more ideas to improve the business-side of your dental practice:

AUTHOR: Jill Nesbitt
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