Business protocols for the clinical team
STANDARDIZING OPERATORY PROCEDURES BENEFITS STAFF AND PATIENTSBY GINNY HEGARTYAdministrative organization plans typically conjure up thoughts of the front-office team creating and documenting business systems such as financial guidelines, scheduling and continuing care protocols. Most dental front-office staff have some semblance of an administrative manual; the same can’t be said for the clinical team. It’s high time we expanded that mindset to include the organizational needs of our clinical staff—and there are many.
Hygiene applications
The logical consequence of going through the process of establishing written x-ray protocols is that the level of care you provide patients will most likely be raised as consistency becomes more uniform. It’s a classic triple win. The patient is the beneficiary of better care and the practice earns a well-deserved reputation for the most thorough care. This also translates into business success since financial success is the direct result of serving your patients well. Everyone benefits when the team is on the same page.
If this works for radiographs, it most certainly works in other areas of clinical care. We all know that the practice hygienist provides a valuable service to patients when he or she can alert a patient to a potential concern using x-rays, photos or an interactive tour of their mouth. When highlighting these areas, the hygienist is most helpful if she fully understands the doctor’s philosophy of care.
Does your hygiene team know your philosophy on tooth-colored vs. amalgam restorations? Advanced restorations vs. basic restorations? When you recommend chemotherapeutics? Are they able to prepare the patients for your possible treatment recommendations?Not sure? Schedule another challenge and ask them to write answers to these questions, and then compare them. Create a fully documented protocol of your philosophy of care. Your clinical assistants would also benefit greatly from being involved in the discussions of philosophy of care for both periodontal and restorative guidelines.
Ask the hygiene team to detail the standard adult recall visit step by step. Talk with the team to be certain that all the diagnostic tools you want for yourself and for the patients’ benefit are included in the hygiene plan.
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Create a clinical protocols manual
Getting everyone on the same page will also improve your clinical efficiency. Imagine how much easier it will be to introduce a new hire to the clinical process if you have a bona fide training manual at the ready. To get started, talk with your clinical team and create a table of contents for what you all agree should be documented. Set a reasonable timetable for creating the manual that moves the process along at a good pace but doesn’t stress everyone out.
For example, you can schedule the first meeting to establish a table of contents and plan future meeting agendas. Determine if you will break into teams and divide the procedures to be documented or if you will all work together on each procedure. Review the schedules and highlight the procedures you will photograph so you can be certain to have the digital camera at the ready. If you meet on a weekly basis it may take several months to compete the clinical manual.
Involve the business team While the clinical team is documenting the clinical process, the business team can create the front office skills section. This can include a short version of front office basics, the computer training that will be required of all clinical team members, a statement of insurance philosophy and financial guidelines as well as standard scheduling protocols in place for each provider.
Preparation pays off
Schedule a team celebration to mark the completion of the project. It can be as simple as taking the team out to lunch or you can plan a fun event like a team bowling tournament or pinochle game. Make it something the team will look forward to. However, the real reward will be realized when you see more consistency in each patient’s experience, in the tray setups and when you bring on a new team member with order and ease. Your clinical team needs and deserves to have this resource on hand. According to Aristotle, excellence is a habit not an act. Incorporating excellence into all aspects of your practice will strengthen that habit and will pay dividends for years to come. |
Why do we document protocols?
• To establish standards that when followed create predictability—and the desired results each and every time.
• To provide guidance and a reference source for all employees, including new hires so they can learn the protocols.
• To provide for continuity in performance that exceeds any single employee’s tenure.
Take the x-ray challenge
It stands to reason that if we need this type of organization for our business staff members to learn protocols, we should also provide this level of training and support for our dental assistants and hygienists. Or does it? I’ve had team members tell me they were shocked to find out how little they agreed upon once they took my x-ray challenge.
Want to give it a try? Here it is: gather your clinical team and ask them to write down the practice x-ray protocols. Tell them you’d like to know when you recommend taking a full series, a panorex, bitewings and periapicals. Ask them to include the frequency, number and the type of films in their protocols as well as the patient age at which you begin the protocols.
Chances are you will find many opportunities for clarity. Clinical team members share with me that they didn’t realize their dentists wanted to see periapicals on endodontically treated teeth or that the doctors wanted panoramic films incorporated into the x-ray plan for a patient who required a full series due to periodontal involvement.
Upon discussion, it made perfect sense that the doctor would periodically want the benefit of a panoramic view to complete an oral cancer evaluation. During this challenge, there is typically a good deal of discussion regarding the number and type of bitewing x-rays that are appropriate for patients. When do you prefer 4 horizontal bitewing as opposed to 7 vertical, or 4 vertical and some periapicals films? The potential exists for each provider to have a unique set of protocols. Be certain your team really understands your protocols.
Even though your doctor prescribes x-rays on an individualized basis, it still makes sense to have standard protocols in place as a guide for clinical staff, along with a training system for new hires.
Setting restorative protocols
One recurring theme I hear from clinical assistants is the frustration they experience when they are chair-side with an incomplete or inaccurate tray setup. In many practices the doctor prefers to have the sterilized package opened in front of the patient. This limits the time the assistant will have to verify the accuracy of the setup and can leave them unprepared during the course of assisting the doctor with the procedure.
Most practices have multiple assistants and it’s understandable that many different hands could have contributed to tray sterilization and setup. Taking the time to fully document the tray setup for each procedure, along with taking a digital photo of a proper setup is a simple way to improve the odds that each clinical assistant will learn proper setup and technique. Having these photos prominently displayed in the sterilization area is a great way to provide a quick reference tool for the clinical team.
Protocols for charting, patient record documentation (including how to document next visit), sterilization, debrief and transfer to the business staff are also key areas that need to be standardized and documented.
Team members also appreciate having detailed protocols for standard procedures to assist in creating a predictable and complete experience for all patients. Consider establishing one-sheet protocols for each procedure you perform. Detail what needs to be done prior to the patient arrival, during the patient visit and afterwards. For example, your team may wish to have a one-sheet for minor restorative procedures, emergency treatment, endodontic protocols, advanced restorative, sedation and prescription generation and documentation. Email me at info@ginnyhegarty.com if you’d like a sample copy of my one-sheet.
Ginny Hegarty is a management strategist and the president of Dental Practice Development Inc., a company committed to helping dentists achieve greater profitability and reduced stress. For information on her coaching programs, visit www.ginnyhegarty.com or call 610-873-8404.
