Dentistry is in a Period of Rapid Change
Probably what you thought you would do in a dental office and what you will learn to do is not nearly the same thing. Decay is going out of style. People don’t expect to get decay, bleeding, swollen gums, or other problems in order to need to see a dentist. People now want to take responsibility for their own health. They are exercising selecting their food more carefully, and seeking health professionals (and staff!) who can help them achieve a healthier, happier lifestyle.
We can’t make a person healthy by eliminating disease. Health is much more than the absence of disease. Only the client can make him/ herself healthy. Therefore, health centered dentistry is largely a behavioral science in which the responsibility for better health and wellness is transferred from the doctor and staff to the only person who can make that person healthier ‑ the client. Our job, then, is to be consultants to facilitate clients to achieve the level of health that they freely choose for themselves.
How do we go about doing this? First, we must establish a growing relationship between each of us that work together. The doctors can’t order staff around and then expect the staff to creatively take responsibility for running the office. Opinions must be valued. People must be valued. The old “star” system with the doc on top of the pyramid telling everyone what to do must be replaced by helping relationships.
You have chosen us and our group has chosen you. It is now only fair that I tell you of the things we expect so that this cruise may be long, pleasant, and without unnecessary difficulties. Your duties will be interesting and difficult, satisfying and trying. The effectiveness of our office procedures will always depend on each of you ‑your ability to learn proper techniques and use good skills in human relations. All these tasks are important but no more important that your attitude and ability to meet and make comfortable the patients who come into this office. Your total personality must reflect many facets. You are, in fact, a combination of staff member, skin care provider, watch dog, psychologist and hostess. It is you whom the new patient will first contact. It is you, therefore, who will begin to shape this client’s opinion about us and our practice and the type of dentistry we do. You must, therefore, realize that the business side of this office deals with people and that we had better make people our business.
It is expected that your attitude toward life, living, and dentistry will be friendly and enthusiastic, and you will be eager to share your experiences and problems. You must be happy in your work, genuine and appreciative of the wonderful people who come through our practice. You must understand, without question, that your position exists in this office to help people with their dental problems. There is really no other reason for your presence in this capacity. Clients who call or stop in must leave our office with the distinct impression that they are the only clients in our practice. If you can achieve this you will have become what I expect you to be ‑ an outstanding host/hostess.
You must learn further that the trying demands made upon any person in an executive capacity require a healthy life including proper diet and adequate rest. With time you will learn to begin each day with one impending resolution ‑that life is good ‑ that dentistry is a marvelous profession, and that “this will be the greatest day of all.” If your attitude is “top‑notch”, I’ll have no worry about your appearance. I know well that it will be discreet, professional and pleasant. I know further that you will avoid the distasteful and exotic in your attempt to reflect the harmony and well being of our office.
What I have tried to say is this: that being a complete staff member is more than performing certain tasks ‑ you must be the “Dentist’s Diplomat” at all times. Your most precious asset is your smile ‑ use it
You should be:
Learning Names and Faces
To be able to associate hundreds of names with hundreds of faces is, extremely difficult. Yet, it is one of the greatest compliments a person can be paid. It indicates that we are interested in this patient not only as a client, but as a human being. It is most important in this office that we all be able to recognize our clients and call them by name. When clients come in, look up from what you are doing, smile and greet them. At first, you won’t know many people, but check the appointment schedule for who is due and ask: “Good morning, are you Mr. Green?”
Although it is expected that you will become an “emissary of good dentistry” outside the office ‑‑ specific care must be taken to discuss nothing of a personal nature. An excellent rule is this ‑‑ if you mention an interesting piece of dentistry ‑‑ do not name the client. Conversely, if it comes up in conversation that Mrs. Brown is a patient do not, under any circumstances, mention any type of dentistry completed. Remember this also; Mrs. Brown’s idiosyncrasies are her own business. Let us not be “carriers of tales.”
You must want something that you don’t have. You have to pay a price to reach it. You have to set a time limit to reach it. You have to reward yourself, because only you know how hard you had to work to achieve it. The first person who has to believe in you is YOU.
Office Philosophy and Aims
Voltaire said many years ago, “He who believes he can ‑‑ can and will.” And this becomes the basic precept of our office ‑‑ that we can and will run a dental office which will not bog down in a maze of confusion ‑‑ that we can and will use our time effectively so that the end result is greater service for a greater number of people ‑‑ that we can and will render the finest possible dental service as gently as possible with fair remuneration to ourselves. The balance of these manuals describes the policies and procedures by which we strive to reach this goal.
Fine dental care contributes not only to the improved health of our clients, but also to their appearance, personality, and out‑look on life. Our work is important ‑‑ not only to our clients but to the general health and welfare of the greatest civilization the world has ever known. We can, therefore, perform our tasks in a happy, pleasant manner, secure in the knowledge that we are performing the most important tasks imaginable ‑‑ that our services are equal to those of any profession.
Our attitudes among ourselves and toward our patients should be relaxed, courteous, and eager to be of all possible service. And like the geometric equation (where the total is equal to the sum of its parts), good little attitudes make good big attitudes ‑‑ good big attitudes make productive men and women ‑‑ and productive men and women make effective dental offices.
We will recognize the fact that “capacity” is a word that cannot be applied to a human. Although we can say that an air rotor is revolving at capacity, that our reception room is filled to capacity (Heaven forbid!), or that an impression tray is filled to capacity, the word applied to persons indicates that they can do just so much. Let me ask this question, “Who can say when we are working to capacity ‑‑ when can we “do” no more?” People cannot be measured as machinery. In no way, shape or manner can any inanimate object be inspired to double or triple its capacity. Man does it every day. Call it whatever you like ‑‑ inspiration, perseverance, and determination ‑‑ the fact remains that when we continually improve ourselves, our production, the quality of our work, and the effectiveness of our practice administration procedures ‑‑we cannot reach capacity. In other words, there is no point in our life where we must put the lid on our precious success and say, “This is it ‑‑ we can go no further.” Because of my feelings on these subjects much more will be expected of you in the future than perhaps will be expected of other dental assistants in other offices.
Eight Rules for Better Living
Philosophy of our Dental Practice
The primary goal for our clients is to help them gain enough information so that they can set the goals that they want for their dental care without feeling fearful or forced. The primary goal for my staff is to provide them with the means to achieve the goals that they have chosen through a career in dentistry. The primary professional goal for the doctors is to provide a useful service, make a good living, while enjoying the staff, clients, and dentistry. The emphasis will be on preventive dentistry. I believe patients will have better comfort, function, and looks at less expense with their own healthy teeth than any substitutes.
Capsule Course In Human Relations
General Rules of Office Conduct
Many people today want an 8‑5 job. Our staff doesn’t have this. They have a profession. Take a good look at yourself. You are part of the first impression a client has of our office. Are you dressed appropriately? Is your hair neat? Are you smiling and happy most of the day? Do you sound like a monotonous record when talking with someone? Don’t bring personal problems or moodiness into the office. You must have and use a good sense of humor. Don’t be “bossy.” It is very important to overall efficiency that the staff gets along well together. It is your job to promote togetherness, gain the respect of others. Lead by example. Offer help whenever possible. Look at the office. What can be done to make it more pleasant ‑ plants, pictures, mirrors, a macramé hanger, a new lamp? Give me your ideas. I expect you to have ideas and share them with me.
Changes always changes! Just when I get comfortable with something it changes. What can I do? Remember organizations, like people, change or die ‑ and we’re not going to die professionally! Your best approach is to learn to enjoy change. Here are some ideas to make changes easier for you.
In many parts of your life, failure is bad. Others make you feel stupid. We expect you to make mistakes. You can’t learn new skills and get it right every time. As long as you don’t make the same mistake over and over, don’t worry! Keep learning! Here are a couple poems that express how we feel about developing a career in dentistry.
I Saw ‑ He Saw
I saw a tooth that needed to be filled.
He saw a child of His whom needed to be comforted.
I saw a dead tooth in front that would look better with a crown.
He saw a young girl who was shy and would feel better about her.
I saw a boy who wiggled in the chair and was difficult to treat.
He saw a young soul who needed to be shown firmness through love.
I saw a man with an abscessed tooth that he insisted be pulled.
He saw a discouraged man with low self‑esteem who could not love himself.
I saw teeth to fill, teeth to clean, x‑rays to be made, bridges, partials, and dentures to be fitted.
He saw people, people who hurt and needed to be loved and hundreds of ways to help them in my dental practice.
Lord; let this be my prayer today. Let me see what you see in my patients.
Stephen D. StanleyDDS
Finally, I’d like to share with you an article that was written for another dentist ‑ I wish it had been written to me! In any case, the ideas that Mrs. Stanley expresses are the heart of what we are about here.
My Dentist . . . My Pastor by Ruth K. Stanley
I was six years old and it was time. My mother said that it wouldn’t hurt and that we could go out for an ice cream sundae afterwards. When I got in the chair, the dentist said that it wouldn’t hurt either and he let the drill make a little pattern on my thumbnail. But they were both WRONG! It did hurt and when the rotund little man who was my first dentist put that hot drill on my tooth it wasn’t any fun at all. And so began the yearly visits to the pain man.
When I grew older, I would be dropped off at the office of the dentist and waited alone while Mom ran other errands. I used to sit in the dark waiting room, paging through ancient magazines; not paying any attention to what I was reading, but instead silently praying. . . Oh God let me not have any cavities. I even devised a Gideon’s fleece system ‑‑ if that bird on the tree sits there for two minutes, that will mean that I won’t have any cavities!
Unfortunately, that bird never would sit or if he did, the cavities were still there when my time in the chair came!! It was a relief to find in the 1970’s a missionary dentist in India who actually could work on my teeth without causing me a lot of pain. He froze them! That was something new for me. . . my old dentist never used that system. I just hung onto the arms of the chair. That changed my perspective on dentists somewhat, but I still entered a dentist’s office with fear and trembling for I never knew whether he would be another fat little man or someone comparable to the missionary dentist.
One day, sitting in Steve’s operatory, waiting for him to come in the first time; I felt the familiar stirrings of blind fear. When I had admitted to a former dentist that I was fearful and that I didn’t like dentists, he had responded by saying, “Well, it’s been my experience that people who fear dentists have low moral character.” And THAT hadn’t helped me at all! I was on the verge of hopping out of the chair and fleeing when I raised my eyes and saw the sign . . .WE CATER TO COWARDS. For me, that was my day of rebirth as far as dentists were concerned. And Steve continues to save, for me, the person who calls himself DENTIST. How is he doing that? I think that everyone would agree that the science of dentistry itself has made advances and that has helped with my rethinking of dentists. The hot drill that my first dentist used has been replaced by a faster one that is cooled by water. The “freezing” of teeth that I experienced for the first time with the missionary dentist is a common occurrence. Steve even “freezes” the place to be pricked and has a monologue about cold snowstorms in Michigan that goes along with the needle. Fillings are different. My last one was something called a helio‑bond and was white instead of the usual silver color. X‑rays that take pictures of your whole head are available. And I am sure there is much more that could be mentioned.
But the main reason for turning me around is his attitude to me and to all the other people that come to him. First of all, he pays attention to the first impression. From the minute I open his office door, I feel welcomed. The waiting room is bright and open and comfortably furnished. The seats are soft. There is a cup of tea or hot chocolate for me to drink or an apple to munch on. The magazines are not ancient, but current and interesting and helpful! There are health pamphlets that tell how to avoid a lot of sugar in your diet . . .some articles about how to deal with stress . . .some recipes to make healthful snacks. Steve actually doesn’t want me to have trouble with my teeth! I used to work up my courage just to ask my dentist if the toothpaste I was using was satisfactory. Now, my dentist Steve is willingly telling me what I can do each day to make the next few days I come to see him free of pain.
Another thing I notice and appreciate . . .the room is not jammed with people impatiently waiting their turn. People come and go in orderly time frames. Hey, this dentist knows that my time is as valuable as his is. He also knows that it is hard on the nerves of a first‑time patient to wait. Far better to have that person in the chair at once than to leave them time to imagine horror waiting for them. And once in the dentist’s chair, I am impressed that Steve looks at my tongue, my throat and the sides of my mouth for signs of disease. Does he remember that once I had cancer and am always just a little fearful of having it again. He is interested in everything in my mouth, not just the teeth that might be less than perfect.
In fact, he is interested in more than just mouths and teeth. He has asked my opinion about office procedures and is interested in my suggestions. It appears that I am a cooperating partner in this dentist thing! At one visit he interviewed me, slowly and carefully, as if I was the only person in the world that mattered at that particular moment. And afterward, Steve gave me a sheet of paper that listed several of my good qualities that had showed up in the interview. That made my day shine! After all, in this day of rush, rush, and rush ‑‑ catch you later, who wouldn’t like to receive a message that says, “I care.”
But, there is more. It is the basic foundation that has changed. Instead of an Old Testament approach, there is now a New Testament approach. The Old Testament approach said, “Thou shall take care of thyself or suffer the consequences.” And even if I did take care of myself, there were holes in my teeth anyway. The dentist treated me the same. It was my fault! Small wonder then that my early encounters with a dentist made it easy for me to ignore him when I wasn’t sitting in his chair. After all, he hurt me, laughed at my concerns, and berated me for errors made and then collected my money with a flourish.
Once when I returned from three years overseas, I was having my teeth cleaned by a dental hygienist. She clucked and complained about my teeth . . .”you have so much plaque on them”. . . and proceeded to remove the plaque with a vengeance that plainly said to me “why don’t you take care of your teeth?” She didn’t give me a chance to explain that dental treatment was not available to me those three years. On the contrary, now my dental hygienist hands me a dental tool as I leave the country. “If you use this while you are gone, WE will have a better time of it when you return.” (Message: I am interested in you even when you are not in my office!) The New Testament approach says, “When you fail, if you make a mistake, you are forgiven, and I will help you to start again.”
With Steve and staff using the New Testament approach, I am enabled to use it too. When he says my fillings are getting too big and I need a crown, I listen to him. We can discuss together what that means and how soon we must do it. When he fills my tooth and leaves one edge too high, I can come back and say . . .”I don’t think you got that quite right, but I know that you will be happy to work on it until it feels just right to me.” When the receptionist reminds me of an appointment, I’ll work to be there on time because I don’t want to cause a problem to the staff or other patients.
My dentist says that how I feel about my mouth and teeth is tied in with how I feel about myself. He says that a lot of things besides cavities originate from my mouth. Does my “TMJ jaw” ache more when I have been gritting my teeth? Aha, I grit my teeth when my son is behaving badly and I feel like I am a failure as a mother. Do I eat sweets unwisely when I am troubled? Well, clear up the problems first and then we won’t have to treat the teeth. Do I fail to smile at people because my bottom teeth are stained? Then, let us treat the teeth and get rid of the stain and then I am freed to be more friendly. There are other connections . . .who else do you get to see twice a year, year after year. Your dentist can be a lasting friend that you enjoy seeing because he understands you. A dentist would do well to develop a file on his patients and not just a file that lists cavities and crowns. Why not a file that notes comments about family members, or jobs, or patient interests in sports or books or pictures? A file that reminds the dentist to ask about the daughter that just left for college or about the scout trip that was held last Saturday. The whole dental staff could review these files just before the patients come in. The dentist also has the wonderful advantage of being able to talk while his patients can’t! But, please, use that time for saying things that don’t require an immediate answer!
The dentist can speak words of encouragement when he sees the person in the chair needing them. He can be a friend to someone who maybe doesn’t have many friends. He can encourage referrals to other professionals if there is a need. The whole dental staff can participate in this. The receptionist can alert the dental assistant and the dental assistant can pass on hints to the dentist when they see that the person who just came in the door needs something more than a tooth job.
Perhaps, a stack of pamphlets can be in the waiting room on a variety of subjects. . .teenage suicide, pregnancy, abortion, job or family stress with a list of crisis numbers to call. The visit to the dental office is not the only chance for witness. Dental newsletters, special greetings, school presentations, dental conventions and retreats all give opportunity to practice New Testament philosophy. My background is Dutch and in the religious history of my church which came over from the Netherlands, the head of the church called himself, and asked the congregation to call him, DOMINEE.
The pulpit also was set up high and the DOMINEE ascended the stairs and every Sunday looked down on the people and told them where they had erred. Now, my brother is a pastor and his congregation calls him Rog and on Sundays, he stands with the people and they all ask forgiveness together. Dentistry has come the same route. The old way was for the dentist to be the DOMINEE and have the patients come and creep before him and he told them just what they had done wrong. They were scared of the DOMINEE‑DENTIST. Now, my dentist is my pastor. He gently leads me in the right way and stands with me on my level and we ask forgiveness together and we both try to be all that God wants us to be.
We are: A dedicated team of professionals continually striving to provide quality care with genuine concern in a friendly personalized manner.
Your Health Is Our Goal!
Our Vision: (What our 10-20 year dental practice ultimate goal is)
Dental Hygienists: WE EXIST TO PROVIDE HIGH QUALITY GENTLE, PREVENTITIVECARETO HELP OUR CLIENTS HELP THEM SELVES.
Dental Assistants: OUR MISSION IS TO HELP OUR CLIENTS EXPERIENCE A SUCCESSFUL VISIT BY PROVIDING ASAFE, STERILEANDCOMFORTABLE ENVIRONMENT FOR TREATMENT.
Administrative Assistants: TO PROVIDE SUPPORT, PROMOTE HARMONYANDUNDERSTANDING, COORDINATE THE NEEDS OF OUR CLIENTSANDHEALTHCARE PROVIDERS FOR A SMOOTH, PRODUCTIVE PRACTICE.
Our Code of Conduct
First and foremost, we are dedicated to the health and well being of our clients.
Our Mission: (How we intend to accomplish our vision)
Ideas for resources to help set Vision, Mission and Goals:
Accreditation Association for Ambulatory Health Care (AAAHC)
The AAAHC is a national organization focused on clinical care standards. You can find out more at: www.aaahc.org. The AAAHC was formed in 1979 to organized and develop a peer based assessment education, and accreditation program for health care professionals that provide ambulatory health care. The AAAHC operates in the same way as the JCAHO (Joint Commission on Hospital Accreditation) for hospitals. It reviews how we assess clients, treat client (treatments, medications), educate clients, respect clients’ rights and provide continuity of care. All of these processes produce safe and effective client care and client satisfaction. The AAAHC focuses on in-depth analysis of our client-centered processes while the Baldrige focuses more broadly on how the organization processes work together to create a successful organization.
Dentistry is very complex, has many variations in even the simplest client treatment procedures, and is completely dependent on staff decision-making. All these factors increase the chance of human errors. The answer is to make the system as trouble free as possible and reduce variation, establish common goals, consistent practices, consistent documentation and these improvements reduce the risks to clients. Each year ambulatory health care changes and the standards are set higher.
The AAAHC is not a negative, confrontational organization. They want us to learn how to meet all their standards and apply them to provide the very best care for our clients. While every hospital must be accredited by JCAHO in order to maintain it’s contract with the Center of Medicare and Medicaid (which are the largest payors to hospitals), dental insurance doesn’t currently require this standard. However, more and more, larger dental groups are seeing this accreditation process as a means to constantly improve.
The process to become accredited by AAAHC is to fill out an online report and pay the fee (sliding fee scale depending upon the size and breadth of procedures offered in the practice). An auditor (a dentist trained by AAAHC) will be assigned to your practice and will contact you to come out to perform the review. Usually it will take him about 1 day to perform the onsite audit. During this review, the auditor will check charts, ask to see some of your emergency policies and generally look to see if your practice is following proper protocols for the safety and security of patients. Auditors are generally friendly, knowledgeable and helpful – feel free to ask them questions and recommendations for improvement. The auditor will create a report for your practice and recommend a level of accreditation.
As of 2011, there are tiers of accreditation:
To maintain a 3 year accreditation, you must have another audit performed before your certificate expires. When an examiner is present help him. Receiving our accreditation is nice, so you might think it’s a good idea to hide potential problems. WRONG! The real value of our participation with AAAHC is to receive the feed back report to improve ourselves. Be sure to tell the examiner exactly what we are doing and discuss any areas you have concerns and what ideas you have for corrections. Achieving and maintaining AAAHC accreditation is a great way to accomplish a vision/mission of providing high quality clinical care to patients.
Evidence Based Dentistry
Every dentist has his own way of doing treatment. There are many dental manufacturers making hundreds of dental products. Starting in 2002 a national effort began to make sense of all these products and techniques to decide which ones were the best. There is a national organization to support evidence-based dentistry: http://www.cebd.org/. You can subscribe to their journal and stay aware of worldwide activities and research here. The ADA has also created a website devoted to evidence-based dentistry: http://ebd.ada.org/. Reading and practicing evidence-based dentistry can be another way to accomplish clinical vision/mission.
The Baldrige Award
The Baldrige National Quality Program was passed by Congress in 1987 as a response to the high quality of Japanese products that were taking over our country. http://www.nist.gov/baldrige/index.cfm The Baldrige Award is available to any organization (manufacturing, education, churches, healthcare, etc.). The purposes of the Baldrige are:
Most states have a state-level Baldrige organization – in Ohio it’s called the: The Partnership for Excellence. http://www.thepartnershipforexcellence.org/ The Partnership is an organization made up of mostly volunteers that are trained in quality management and help organizations improve. They hold an annual application process for any organization that wants to improve their organization. To apply, we rate our organization in terms of 7 areas: leadership, strategic planning, customer focus, information analysis, employee focus, process management, and business results – against the national Baldrige Criteria. The Baldrige Criteria are a set of questions based on these 7 areas that help an organization to determine that they are providing the highest quality product or service.
We would write a 50 page application that answers these questions and send this application to the state level organization for Baldrige. They organize a team of trained quality experts to read and score our application, then they will come to our office in order to confirm that we are practicing what we preach (do we really do what we say we do?). Then they will put together a feedback report for our office and the judges will determine a final score.
Based on our score we will be recognized at some level of achievement. In the Partnership there are 4 levels of achievement – #4 is the highest. The reason to apply to a state level Baldrige program is not as much for the recognition as to receive the feedback report – which is excellent feedback on how we are doing in those 7 areas and often full of ideas on how we can improve our practice. The Baldrige Award is anything but a contest, although many of the applicants treat this process as a contest. We do fill out an application. We will be judged. We will be awarded a plaque that recognizes a certain level of achievement that we have attained. So what? If we need more recognition, there are many easier ways to achieve it. For example, I could go to a trophy store, buy a trophy, and have anything engraved on it I want. Okay, so we’re not going to put in several hundred hours of our time to win a prize, then, what kind of reward does justify such a huge outlay of time?
Improved Client Satisfaction
Dental offices believe clients should be happy to receive “quality” treatment (fillings, crowns, cleanings, etc.). However, clients judge us on thousands of very inconsequential (to us!) “moments of truth” such as a smile, knowing their names, cleanliness, etc. Dentistry is a hands on helping profession. We deal with alleviating pain and improving the health of people within our community. However, we are also a business, and businesses stay in business by satisfying clients. Dentists provide their best service to their clients through long-term relationships that foster good health practices. Businesses are most successful also through long-term relationships with their customers.
Leadership used to be simple. You were on top. You told someone what to do. If they didn’t do it, you’d fire them and replace them with others that would. Today, leaders are always looking for tools to help them improve their organization in a world of constant rapid change. Improvements demand change and changes are traumatic to organizations. Change requires information and an understanding of the processes of the organization. Next comes a strategic plan, training of employees, involvement of suppliers and finally, implementation of the change. These (7) steps are required for every change. The leaders task, with the Baldrige’s help, is to structure the systems of the organization so clearly that everyone understands what is happening.
To effectively lead an organization, the leader must be able to see the big picture – how all the pieces fit. The organization fit together to provide for the satisfaction of its customers. This vision not only determines the leader’s actions, but also justifies the actions of everyone else in the organization. Here are the 7 sections of the application.
Writing a Baldrige application forces the leader to do an in depth self-assessment of the organization. Any organization that writes a Baldrige application should:
What you will gain:
This application takes a lot of time and energy. Various people may write various sections, but ultimately the management must do the final draft. On a more practical note, as a small organization, we can’t afford to make big mistakes. They could be so costly that we could go out of business. If we were a large company, we could probably weather the expense, so the advantage of writing the application changes. In a large organization there are at least (3) very sharp business minds. If you want to remain the leader, you had better make sure you are the one with the clearest, most complete picture of the organization. Becoming involved with your state-level Baldrige program will help you to regularly identify opportunities to improve your dental practice. You will begin to understand how your organization works and how you can best lead it, set goals, measure your success, gather feedback and move toward your vision.
Review Questions (write your answers on a separate sheet of paper)