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Efficiency is just about as positive a concept as, say, exercise. But, like exercise, it doesn’t come without some effort.
In striving to create the efficient dental office, dental support organizations and group practices must answer four tough questions:
- What is efficiency?
- How do I get it?
- How do I measure it?
- How do I maintain it?
Building blocks of efficiency
A myriad of factors contribute – or detract from – the efficiency of a dental practice, according to those with whom Efficiency in Group Practice spoke.
“The key metrics to look at are patient satisfaction, treatment plan acceptance and procedures,” say Greg Nodland, COO, and Dr. Robert Brody, chief clinical officer, Great Expressions Dental Centers. An efficient office sees more patients and performs more procedures than an inefficient one – and that’s best for patients. Example: Patient comes in for exam; doctor presents treatment plan and renders services the same day. “This will save the patient a second visit, and free up the doctor and staff to see more patients,” they say.
Morning huddles with the team and high-quality in-office communication are keys to allowing the doctor to see patients throughout the day, continue Nodland and Brody. Building the schedule to maximize the doctor(s) based on types of procedure is another. “This keeps the office flowing, allowing the doctor(s) to see more patients and get the patient the care they need,” they say. Efficient use of technology is also important.
Anna Singh, DMD, vice president of clinical affairs, Heartland Dental, says, “It’s important to know what current industry standards exist and also what your competitors are doing, so that you have benchmarking data to compare your office with. Dentists should also continually evaluate each area of their office – whether monthly or, at least, annually – to determine what’s working well and what needs to be advanced. Team member communication is key to this.
“Understanding how patients feel about your office is vital, and there are ways to measure this,” she continues. Heartland Dental-supported offices use patient-experience consulting firm Press Ganey to survey patient satisfaction. The results are then shared with the offices, so they can pinpoint areas that need attention.
Today, technology plays a huge role in office efficiency and success, says Singh. “In many areas, this has revolutionized how many dental care processes are carried out, and dramatically altered the success rate of these processes.”
Cutting-edge, first-rate technology helps dentists improve their efficiency and reduce patient chair time, says Singh. “More knowledge is available to dentists than ever before as well – more educational opportunities, online opportunities, such as DentalXP, and ways to understand patient need and satisfaction.
“Advanced technology in patient communication and financing options also play a big part in advancing patient convenience,” she continues. Dental services organizations can help offices with support, education, vendor relationships and mentor/mentee relationships, all at once.
“Effective communication with patients will help dentists build trusting relationships with them, and the same can be said for team members,” continues Singh. “Without effective communication between dentists and team members, maintaining an environment of trust, efficiency and high morale will be difficult.
“Team training is also an important factor. Just as dentists take the time to improve their clinical and leadership skills, team members should also be exposed to continuing education.”
Dental practice consultant Jill Nesbitt, Dental Practice Coaching, Nashville, Tenn., says that scheduling, technology and staffing are among the biggest factors affecting efficiency.
“We can go back to the 1970s in dentistry, and the key to efficiency was scheduling, just as it still is today,” she says. “Not just filling holes and handling emergencies, but establishing the structure for each column. What type of appointments belong where and how much time is needed?”
Advances in clinical technology (e.g., digital radiography) have helped offices become more efficient, says Nesbitt. “And from an administrative perspective, the ability to visit insurance websites instead of calling carriers has improved our speed of work.”
Staffing may be the most important factor of all insofar as efficiency is concerned, she says. “We need to have the right number of team members with the right training to be efficient. In fact, a skilled team member can make the most with a poorly structured schedule or limited technology, but those items cannot overcome struggling staff.”
New understanding
Our understanding of efficiency today is different than in years past, says Renee Swank, office manager in the Aspen Dental office in Woburn, Mass. “Measuring efficiency is twofold. It is dependent on the cohesiveness and happiness of the office team as well as the loyalty and happiness of our patients.
“Fifteen years ago ‘efficiency’ was based on production, i.e., how much money can the office generate vs. what they are spending, or how many patients can we get in and out in a day,” she says. “In this era of online reviews, patient satisfaction is even more important than ever before, and there is a heightened sensitivity to making each experience a positive one. People don’t enjoy going to the dentist today any more than they did 15 years ago. Yet today, patients are looking for truth, honesty and understanding about what is going on in their mouths – which is why efficiency has ultimately changed into cohesiveness, making sure the team works together in a way that keeps patients happy but also keeps them engaged and focused on their mission in a productive manner.
“The more we can educate the patient, the more they will believe in the treatment,” continues Swank. “This happens by clearly explaining the health of the mouth in laymen’s terms and reiterating it throughout the process, as well as providing handouts and brochures from the American Dental Association.”
A dedicated, engaged staff can have a huge impact on patient care and efficiency, she says. “If the team does not love their jobs, if they do not have empathy, if they do not acknowledge the fears of the patient and address them in a caring manner, then the practice will not be successful or efficient.”
Communication among team members is critical. “Workflow, scheduling, staff meetings, patients charts, accounts payable/receivable, etc., are all intertwined within communication, and work together to make the day efficient. One example is “handoff communication,” that is, communication among active team members when transitioning through a series of patients in the varied functions of the office, she adds.
Technology
DSOs’ current understanding of efficiency has been shaped by advances in technology, materials, training and patient education, say Nodland and Brody.
“Technology has allowed offices to better treat patients,” they say. For example, the office staff can go digital and have all of their patients’ medical histories in one place, vs. flipping through pages. “[Great Expressions Dental Centers] moved our offices to chartless, and it is a huge time-saver, and it avoids the potential loss of patient data should a disaster ever occur,” they say. “We have developed our own practice management software and clinical records software. This has allowed our front office to get better tracking of billing, recall reminders, etc., while the clinical side gets easy-to-read digital records, so they can understand everything about a patient’s history at one time, leading to the most complete care.”
Advances in materials mean there is less need to do multi-step procedures, adds Brody.
Staff training is better today than ever before, due in large part to technology, say Nodland and Brody. “The staff can zone in on specific responsibilities, cross-train and multi-task. This allows the office to perform multiple duties, provide customer service and transition the patient easily from the front of the office to the back of the office.” Great Expressions Dental Centers University (GEDCU) offers opportunities for employee development and continuing education, they add. “GEDCU gives our staff members more flexibility and frees up more time in the office. Things like webinars, videos, onsite and offsite training and our GEDCU portal help our employees and office become more efficient.”
Meanwhile, patient education tools allow the office to regain valuable minutes and improve patient care, they continue. “At GEDC, we help staff educate patients with Expressions TV, which is a TV in the lobby of every office that plays dental education videos plus news, sports and weather, to keep patients engaged while they wait for their appointment.”
E-mail, texting and social media help Great Expressions offices reach the patient in a way most convenient for him or her, and increase case acceptance by explaining dental conditions in a consistent way, say Nodland and Brody. Education materials throughout the office help explain dental conditions and the importance of dental care. These materials emphasize non-threatening dental messages, art that promotes a healthy lifestyle, giving back to the community, and oral care products aligned to the patient’s condition.
Falling short
Building an efficient practice calls for skill and perseverance, according to those with whom Efficiency in Group Practice spoke.
Brody says the most common reasons for practices falling short of the goal are poor leadership, poor in-office communication, and poor scheduling.
Poor in-office team communication adversely affects the “pass off” of the patient, he says. “The more time it takes to transfer the patient from front office to back office or from clinical staff to doctor, the more it hurts efficiency.”
Poor scheduling also adversely affects efficiency, he continues. Overcommitting doctors not only reduces efficiency, but leads to a poor patient experience, which will likely lead to fewer patient repeat visits. “The office will then become concerned with trying to attract new patients; their time and effort will go into those tasks. This is one of the many reasons why DSOs are so beneficial to making an office efficient. The office does not have to worry about things like marketing or building new technology.”
Says Singh, the quality of communication among dentists and team members has a major impact on efficiency. “If no one is on the same page, then maintaining efficiency is next to impossible,” she says. “Lack of training can play a role in this. If dentists and team members don’t take the necessary steps to create good communication, problems will persist. Maintaining team buy-in at that point most likely will not occur.
“Moving forward, efficiency can be negatively affected by increasing costs for offices, reduction in reimbursements, changes in the [number] of insured patients, lack of access to care in certain areas, and lack of education and training. The costs of education can be another factor. It’s important to seek out educational opportunities, but they can be expensive.”
Says Nesbitt, government regulations could be a “wildcard influence” in the efficiency of dental practices. “I know an excellent and very efficient office that primarily cares for Medicaid patients and yet was held hostage for over $50,000 of payments due from a private MCO for months,” she says. “If part of our definition of efficiency includes being paid for the work we do, this behavior can destroy a practice.
“My largest concern with efficiency in groups is that we lose our way,” Nesbitt continues. “Efficiency is important, but it’s not a vision. Groups need to be careful to avoid sacrificing quality care and relationships to the god of efficiency. Even in a two-dentist group, it is faster for the senior dentist to just hire a young dentist and begin taking more vacation. However, if this young dentist needs training and support handling new patients and presenting treatment, but ends up handling most of the fillings for the practice, this is not only inefficient, but bad news for all involved. Patients may not receive the care they need, staff become critical of the young dentist, the senior dentist hears the negativity and avoids conflict and says nothing to the young dentist, who now is struggling to earn enough money to pay on her student loans.”
Reason for optimism
All those caveats aside, Nesbitt sees many reasons for optimism. “I am most optimistic that technology will help offices become more efficient,” she says. “Teenagers and younger children seem to simply know how to work with technology, so even without specific training, staff just figure it out and make it work. As new technology becomes less expensive, dentists will be able to add more tools into their practice and the staff will quickly adapt.”
Group practices, meanwhile, understand the need to help their teams develop new skills, and are investing in organized training programs. “As group practices continue to grow in dentistry, more team members will have access to training, and they will turn around and improve the efficiency of their practice,” she says.
“I also see groups having the bandwidth to more efficiently manage the support side of dentistry, especially from a vendor management perspective. Whether it’s the administrator for a privately owned group who has the knowledge and time to work with vendors, or the DSO corporate office handling this for several offices, this allows the dentist to care for patients, confident that vendors are being handled effectively.
“With strong clinical leadership for dentists and dental teams, we all can be inspired to care for patients and impact our community, while having the tools to coach and guide our professionals throughout their careers,” she says.
Singh says a more educated patient population will ultimately result in more efficient patient care.
“Advanced technology is making it easier to communicate to today’s ‘dental consumer,’” she says. “Today’s patients are more educated than ever before, and expect more out of their dental care. This is causing more and more dental offices to take the necessary steps to meet the needs of modern patients – advanced marketing techniques, patient communication, etc.
“With increased patient expectations and increased access to more providers due to online communication, competition between dental offices will also increase – which will only result in more effective, efficient patient care,” continues Singh. “In addition, with more offices being supported by DSOs, they are offered access to advanced technology, vendor relationships and overall relief from non-clinical responsibilities, so they can focus on patient care.”
Says Rich Beckman, CEO, Great Expressions Dental Centers, “The ability to better train your staff, more leadership experience [on the part of doctors] and the further advances in technology will help provide better care to the patient and make the office even more efficient.”
Communication
“Communication hits every level of ‘efficiency,’” says Swank. “From scheduling to payments to workflow …. good communication drives it all. If people do not communicate, then the day will fall apart.
“A good practice has morning huddles and monthly touch bases. We do both in our office. Each morning we recap the previous day, share an inspiring word or focus, and go over the schedule. It gets everyone on the same page and prepares us for each patient who will be coming in.
“Monthly touch bases are done with myself and each person, one on one. Each month I give a ‘question’ to be addressed, like ‘What role do you play on our team?’ or ‘What does ‘professional’ mean to you?’ In the touch base, it allows us to tackle the topic but also opens a safe environment for issues or concerns to be addressed or new ideas to be shared. It keeps the team motivated and cohesive, and it allows me to view the efficiency from each of their points of view.
“The only thing that could hinder efficiency in the next few years would be lack of concern about patient satisfaction and hiring to fill a spot on the team instead of hiring the right person for the job,” she says. “Patient satisfaction has to be in the forefront, we cannot lose sight of this.”
That said, Swank is optimistic “that the cohesiveness and happiness of teams are truly what will stand out in efficient offices down the road, particularly when it comes to patient education and satisfaction.
“Offices are all aligned and can help the doctor deliver the best care we can to the patient in an efficient way.”
How efficient is your office? Questions to ask.
- How visionary is your leadership?
- Do you hold morning huddles with team members?
- How happy are your patients?
- How committed to patient care are your team members?
- How current is your technology? What opportunities are you missing by failing to replace old equipment?
- How good is communication among team members? Among team members and patients?
- Do team members have ample opportunity to receive continuing education and improve their skills?
- How well do your patients understand the treatment they are receiving? How well do they understand the basics of good oral health?
- How frequently does your scheduling lead to “overcommitted” doctors and staff?
