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Integrating checklists into your practice is key to get things right

Time outs are performed minutes before a procedure begins. In dentistry, this is commonly done before an extraction or a root canal. Do I have the right patient? Is the correct radiograph displayed? Is the necessary equipment present? Do I know which tooth? How often do we breeze through this checklist or not read it at all?

Dr. Carolyn Norton

Dr. Carolyn Norton

The Checklist Manifesto by Atul Gawande shows how checklists which identify critical steps or points of failure can make up for our own human inadequacies. Checklists don’t stop at the example above. As the volume of dental procedures I preform increases every day, I have developed my own mental checklists to make sure I’m working efficiently and producing quality dentistry. Even your morning huddle is a checklist.

In 2001, a central line placement checklist was implemented at Johns Hopkins Hospital by critical care specialist Peter Pronovost. Nurses were allowed to intervene if they saw a doctor not following the checklist. After two years of data collection, the central line infection rate went from 11 percent to zero. Dr. Pronovost found that checklists, “establish a higher standard of baseline performance, help with memory recall, and set the minimum necessary steps in a process.”

When the World Health Organization (WHO) contacted Gawande in 2006 to help create a solution to prevent death and/or harm in surgery throughout the world with no funding, Gawande went to visit a master of checklists, Daniel Boorman from the Boeing Company. Aviation heavily relies on checklists. “Only 1 in 500,000 flights ever suffers an accident of any kind.” Was your last flight delayed for 45 minutes due to maintenance? Someone was using a checklist.

Mr. Boorman says checklists must be “precise and to the point. They do not try to spell out everything — a checklist cannot fly a plane.” He suggests keeping the list between five and nine items. It should take no more than 60 to 90 seconds to run the list. “You must define a clear pause point at which the checklist is supposed to be used.” My favorite part of this book: a checklist for making checklists is provided in the appendix.

Dr. Gawande’s WHO safe surgery checklist included seven checks before anesthesia, seven checks before the first incision, and five checks before removing the patient from the operatory. The effect of their safe surgery checklist was studied in eight hospitals around the world. In every hospital, complication rates fell 36 percent and deaths fell 47 percent. Seventy eight percent of hospital staff “actually observed the checklist to have prevented an error in the operating room.” When asked if they wanted the checklist used if they were to have surgery, 93 percent of hospital staff said “yes.”

After reading Dr. Gawande’s book I see checklists all around me, and I believe they work. No one is perfect, and checklists are great tools to help even doctors to get things right. “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

How do you use checklists in your dental practice? Share your best ideas and checklists with us below.

 

Dr. Carolyn Norton is a New Dentist Now guest blogger and a 2014 graduate of the University of Florida College of Dentistry. She is half way through a 12-month general practice residency at the North Shore University Hospital in Evanston, Ill., affiliated with the University of Chicago. Dr. Norton was a contributing editor for the American Student Dental Association from 2012-14.

 

Did Hermey inspire you to be a dentist?

He didn’t want to build toys. He dreamed of becoming a dentist.

According to ADA News, Hermey the Elf continues to do his part in increasing oral health literacy among children and adults — 50 years after the animated classic “Rudolph the Red-Nosed Reindeer” first aired on national television.

Hermey the Elf

Hermey the Elf

The ADA is featuring Hermey the Elf in an online campaign to help promote oral health literacy, stressing nutrition, dental hygiene and dental visits as key factors in preventing cavities.

Through the campaign, the ADA’s MouthHealthyKids.org will feature free downloadable educational coloring book pages featuring Hermey along with the ADA’s tips for maintaining good oral health. The coloring pages will be available for download through the end of December.

MouthHealthy.org will also include a fun dental health quiz for families and a separate sweepstakes drawing to receive a Rudolph the Red-Nosed Reindeer prize package.

In addition, Hermey was designated a DDG, or Dental Do Gooder, by Dr. Maxine Feinberg, ADA president, for promoting good dental health to his friend Rudolph the Red-Nosed Reindeer and everyone in the North Pole.

“Hermey’s passion for dentistry, coupled with his devotion to helping others feel good about themselves inside and out deserves recognition,” said Dr. Feinberg. “I know Hermey the Elf, DDG, will continue to inspire young people and those who are young at heart to follow their dreams.”

The animated special, “Rudolph the Red-Nosed Reindeer,” tells the tale of how Rudolph and Hermey were initially rejected by their peers for being different, yet they go on to triumph when they show that their differences make them unique and helpful to their community. The program airs Dec. 9 on CBS.

Register now for 2015 Give Kids A Smile Day

Registration is open for the 2014 Give Kids A Smile Day. The national celebration is set for Feb. 6, 2015.

Give Kids A SmileRegister online by Nov. 10 to be considered for free product donation. The ADA will post a list of product recipients on the website in December, and recipients will receive their products the week of Jan. 19, 2015.

Give Kids A Smile is made possible through the generous support of corporate sponsors, Henry Schein, Colgate and DEXIS; dentists; and other oral health care professionals who volunteer their time and services to provide needed oral health care to underserved children.

For more information, email gkas@ada.org or call 312.440.4600.

Have you participated in Give Kids A Smile programs in the past? What was your experience like? Share in the comments.

Building Trust with a New Patient

The 28th New Dentist Conference is in full swing right now in Kansas City, Missouri. A number of CE programs are taking place right now, including Take This Job and Love It! presented by Dr. Mark Hyman.

Earlier this year Dr. Hyman spoke with ADA New Dentist News about people skills new dentists can use in the practice. Here’s one suggestion that stood out for us:

Dr Mark Hyman

Dr. Mark Hyman

“Dentists don’t do themselves any favors by spending the first moments with a new patient asking about insurance coverage,” Dr. Hyman observes. Instead Dr. Hyman thanks the patient for choosing his practice, and asks about the patient’s goals for her smile, her teeth and her health. And, unless the patient is new to the community, he asks why she is no longer seeing her previous dentist.

“The answer might be, ‘He was always pushing me to get a crown.’ So I would reply, ‘do you think you need a crown?’ And I would follow with, ‘as I examine your mouth, if I find evidence of dental disease, do I have your permission to tell you?’ And that takes it out of the realm where I’m the expert here to diagnose and deliver bad news. My approach builds trust because it puts us on the same team working towards the same goals. Once you have truly heard the patient’s goals, the more quickly you can build trust.

You can find more of Dr. Hyman’s tips from ADA New Dentist News here.

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Dr. Hyman will be presenting Drill ‘Em, Fill “Em and Thrill ‘Em in one of the courses offered in the New Dentist Track of CE options at ADA 2014. New dentists (those who graduated from dental school in 2005 or later) receive a 20% discount off of the fee courses that focus on a mixture of business, ergonomic and clinical topics that have been curated by new dentists.

See the entire new dentist track and register for courses here.

What to do when Delegating Goes Wrong

NegotiationWhen we talk with new dentists, one challenge comes up frequently — the difficulty in getting comfortable with delegating. But whether you own a practice or work for one, there is simply no way to do it all yourself.

Over at the HBR blog, Elizabeth Grace Saunders has a series of suggestions for how to delegate effectively. Here’s a tip that caught our attention:

Once you start to let go of control, inevitably there will be a time when something doesn’t get done in the way that you would prefer. Your gut reaction will lead you to blame yourself for letting go — “Why did I ever let anyone else do this?” – which typically manifests on the surface as anger toward or frustration with others. But instead of immediately putting the work back on your agenda, transform this situation into an opportunity for learning. First, evaluate whether you could do anything differently in the future. Second, help the people who did the work understand what they need to know to complete the work successfully next time. Often you don’t know what went wrong until you really dig in.

What is your best advice for someone new to delegating tasks? Share your answers in the comments.

Create a User’s Manual about Yourself for your Team

Young girl using tabletWe’ve written before about using employee agreements to clarify expectations between the practice and the dental team. So we were interested when we read on The Build Network about a corporate strategist who developed a one-page user’s manual to help his new employees understand how to work with him effectively.

Check out the original post for a series of questions to ask (and answer) for developing a user’s manual:

  • What are my expectations for commitment to the job beyond conventional work hours?
  • What are my idiosyncrasies—that is, what are the individual quirks that anyone working with me should know about?
  • What weaknesses of mine should the team know about — and how can they help me improve?
  • What is my process for handling conflicts?
  • When it comes to mistakes, what’s the best way for employees to come forward?

Seems like this could be helpful when it comes to bringing new team members up to speed with your working style and preferences. After all, over time it becomes second nature to know how different personalities interact, but a shortcut could accelerate that process.

What about you — what has been your approach to letting the dental team know how you prefer to work? Leave your answers in the comments.

Negative Feedback and the Performance Review

NegotiationIt’s December and for many organizations, that means performance reviews and appraisals. If you are the boss, this might be the time of year when you provide feedback to your team. And if you are an employee, this might be the time when you are on the receiving end of an evaluation.

Over at the Fast Company blog, Celia Shatzman has posted 8 Questions to Ask your Boss that can Make or Break your Career. The post draws heavily from the book Great on the Job: What to Say, How to Say It: The Secrets of Getting Ahead by Jodi Glickman. Question #8 attracted our attention:

“I’m sure that I’ll have some additional thoughts and questions as I digest all this information. Could we schedule a follow-up conversation in a few days?”

When to ask: At the end of a not-so-great performance review or any conversation wherein your boss gives you valuable, if not altogether positive, feedback.

Why it’s important to ask: It’s hard to think on your feet and ask constructive questions when you’re feeling beat up. By asking for a few days to collect your thoughts, you’ll have time to reflect on your boss’s words and brainstorm ways to move ahead. “The last thing you want to do is lose your cool,” says Glickman. “Remember, the goal of feedback is not to make you feel good. It’s to make you better at your job.”

Seems as though this would also apply if you were the one delivering the negative feedback—you might propose that the two of you meet again in a few days for a follow-up conversation.

What has been your experience with negative feedback, either on the giving or receiving side? Share your observations in the comments.

Developing a Written Employee Agreement

The ADA Center for Professional SuccessIf you are the owner of a dental practice, you might already have an employee agreement for use in clarifying expectations between the practice and the dental team. If you don’t have an agreement in place, consider Preparing Written Employee Agreements. As the title suggests this brief document is not a substitute for legal advice, but it is a helpful list of topics that are customarily included in an employee agreement. For instance:

  • What are the expectations around uniforms?
  • What is the arrangement for professional liability insurance?
  • What are the policies for continuing education?

…and more. ADA members can get the complete story at the ADA Center for Professional Success. And while you are there check out the other resources including Be a Great Boss, Checklist for Terminating an Employee and Using Flexible Benefit Plans in your Practice.

Protecting Against Embezzlement

Embezzlement is different from ordinary stealing. An embezzler, by definition, is someone you trust, such as an office manager or a valued employee. A 2007 study by the ADA found 17.5% of the surveyed dentists reported that they were aware their primary practices had been embezzled.

An embezzler, by definition, is someone you trust

An embezzler, by definition, is someone you trust

The ADA publication Protecting Your Dental Office from Fraud and Embezzlement contains several steps you can take to protect yourself and your practice. Here’s three of the steps:

Maintain Separation of Duties Don’t concentrate too much control over cash into the hands of one person, such as using only one team member to issue checks, record deposits and reconcile the bank statements.

Instead, divide these tasks among multiple employees, or between the employee and yourself to create a cross-check where unusual activity is more likely to be noticed.

Use Random Monitoring Let your team notice that you are keeping an eye on the details. Monitor some reports every day, including every patient visit, every payment, and every EOB. Other checks, such as payroll and inventory, should happen randomly, without prior notice.

It’s easier to “beat the system” if the embezzler knows that as long as everything looks good by the end of the month, no one will be the wiser.

Keep Valuable Documents and Materials Locked Up Reduce temptation — keep blank checks, payment receipts, prescription pads, and accounting records out-of-sight and locked up.

Consider securing valuable supplies, such as whitening materials or toner cartridges, which can be easily re-sold outside the practice.

In addition to tactics that may help prevent embezzlement, the publication also addresses the actions you should take if you believe you may have been a victim. From working with attorneys to termination issues unique to suspected employees, Protecting Your Dental Office from Fraud and Embezzlement addresses a plan of action that can mitigate losses and minimize hassles.

Prepare for a Successful Practice Partnership

Practice Partnership

Practice Partnership

Whether you are looking to become an associate or take on an equity stake in a practice, successful partnerships don’t just happen—they take effort and planning. Here are four tips adapted from ADA New Dentist News:

Check for Shared Philosophies Managed care or fee-for-service? Limited hours with lots of flexibility, or an intense schedule with patients from dawn to dusk? Excellent dentists vary in their approaches to delivering quality patient care, so make sure you and your potential partner are on the same page.

Have a Trial Period If you are looking to buy or build a partnership as equals, use your initial meetings to gauge your compatibility—does agreement come easily or do you differ significantly even in the planning stages? For employer/employee relationships, like an associateship, 90 days is a typical time period for both parties to get to know each other and have the opportunity to reconsider the arrangement if necessary.

Identify How You Want to Approach Decisions While you can’t predict tomorrow, you should assume that the future will bring change, and it’s helpful to have a framework in place for how you will handle those changes, especially those that could impact the income of the practice. What will you do if only one partner wants to decrease hours, buy the latest technology, or stop practicing altogether?

Communicate Expectations for the Whole Team The staff might be concentrating on keeping one dentist busy, rather than all of the partners—not a good idea! Especially when there is a partnership between a seasoned dentist and a newer dentist, it’s important to clarify the chain of command in the practice. For instance, “On the days when I’m out and Dr. Smith is in the office, she has the authority to modify the work schedules for the team.”

What about you — is there something you wish you had considered before forming a partnership? Leave your suggestions in the comments.