As dentists and practice owners scramble to keep up with an influx of high-tech hardware and software solutions, it’s important to reflect on how all of this exciting innovation impacts the health and quality-of-life of patients. You can flip through any current dental-related publication to see evidence of how technology is transforming both the clinical and business activities of dentistry. Adding “shiny new toys” to your practice can be exciting and may create the illusion that you are improving your patient care or practice performance. However, it takes careful research, patience, and even some trial-and-error to find the tools that will measurably impact the health of your patients and practice.
So where do you start? In this article, I share three principles that we’ve used to help hundreds of clinicians identify technology that has made a real difference in their practices. To understand the ways in which these principles can translate into actions, we’ll explore how a dental practice owner in Texas applied them to address several problems relating to patient care and team performance that he had struggled to overcome for some time.
Although he loved dentistry and especially the work of caring for his patients, this doctor realized that he dreaded going to work—not because he was tired of his patients or had a difficult team member, but because he had grown increasingly frustrated with the business side of owning a dental practice. He knew there were issues in a number of areas—including a high percentage of unscheduled patients, a team that struggled to understand what performance indicators they were supposed to be paying attention to, and an overall lack of team collaboration and energy—yet he felt helpless in being able to address them. He also felt a constant tension between practicing dentistry and managing a business—an experience practice owners describe to us again and again. Other team members felt similar frustration. They didn’t know where to get the important information they needed in order to improve, and even when they were able to find it, they weren’t trained in how to interpret and act upon the data.
This doctor wasn’t interested in just implementing another tool or software or process—he wanted to make changes that would be compatible with his patient-centered approach to dentistry. The solution needed to directly impact the health of each patient, which he felt confident would happen as he and his team improved their business systems and processes. He took inspiration from how large corporations—“real businesses,” as he called them—used data to identify what was happening and also to develop systematic approaches to improve performance.
Principle 1: Spend time identifying what your current key issues are. Don’t focus on a solution until you have sufficient data to validate your concerns.
In its 2016 Guide to Quality Measurement, the American Dental Association recognized the value of collecting data in improving healthcare: “Healthcare providers work hard to deliver skilled, thoughtful care. Measures pave the way for providers, showing where systems are breaking down and where they are succeeding to help patients get and stay well. Measurement forms the basis of evaluation and has become one of the foundations of current efforts to improve healthcare quality.”1
When something isn’t working, our natural instinct is to seek a quick, easy, and affordable solution. No one wants to spend a lot of time and money fixing something that’s not working. However, such solutions rarely exist. For this doctor, the process of discovery came through the following sequence, which required patience and rigorous effort:
- Facts. Identifying where his practice was performing well, and where the team was falling short. This provided him with a position on a map—he knew where he was! He had the facts.
- Meaning. He then needed to determine what these facts meant in relation to patient health and practice performance. If patients were cancelling scheduled appointments and not rescheduling them, what did that mean for their well-being, and how did that impact the health of the practice?
- Feelings. Using this data as a starting point, the doctor and his team discussed how they felt about where they were and what it meant. This dentist understood that in order for anything to change, he and his team would need to make an emotional connection to what was happening, and then decide what needed to happen.
Although the process of discovering the cause of his problems was at times unpleasant, the doctor recognized that it was a critical part of finding real solutions. He also knew that things needed to change in order for him to provide better care for his patients. Instead of focusing only on what had happened, which he couldn’t change, with our help he began to formulate an action plan for how he would reach his goals. This doctor had taken an important first step in examining his practice’s current performance before proceeding to find a solution.
Principle 2: Evaluate solutions through the filter of patient care. Ask “how will this new device or software help me to improve the health of my patients?”
After completing his practice evaluation, this dentist was finally in a position to discover the gaps between his team’s goals and current outcomes, and he quickly realized that if something isn’t measured, it doesn’t grow. For owners who are also practicing clinicians, it can be challenging to separate those duties, especially for a solo practice. The pressure to pay attention to everything is constant. Having a data-driven solution that removed this hurdle and empowered the doctor and his team had an immediate impact on the health of every patient.
What solutions did he find? One of the areas where the team saw how metrics could have a huge impact on patient care was in their daily huddle. As they began using the morning huddle that we designed for them, the team was able to see not only who was on the schedule for each day but also to diagnose treatment that wasn’t scheduled, or family members that didn’t have a scheduled next appointment. Tracking this data daily allowed the team to have healthy conversations around how they were performing and then discuss what they could do to positively influence the health of these patients.
By seeing these key performance metrics each day, team members gained new insights into what was actually happening in the practice.
Having all of their practice data aggregated and knowing how to accurately interpret and then act on what they were seeing had a measurable impact on their patients. By seeing these key performance metrics each day, team members gained new insights into what was actually happening in the practice. For example, as they were reminded daily about key metrics relating to practice profitability, they were more likely to focus in on collections.
The lead hygienist told us that ever since they began holding an effective morning huddle, they could see where they were doing well and where they might still be struggling. This was very empowering. Their morning huddle became much more patient-focused as they saw more clearly what each patient needed. Team members could now see all of the needed treatment in one place, enabling them to think about treatment planning, case presentation, and so forth for that day instead of trying to locate that information, often without success or with a lot of frustration.
Principle 3: Implement your chosen solution and then commit to frequent, thorough evaluation of how it is impacting patient care and team performance. Understanding which performance metrics matter and why they matter is especially important.
Another way this practice saw an impact on their patients was from assigning follow-ups to specific team members. As they took ownership of these follow-ups each day, individual team members saw how those actions correlated with the number of patients on the schedule and the type of treatment they provided to those patients.
Instead of trying to find unscheduled patients in their practice management software or recording and tracking them manually, they now had an easy-to-use, intuitive system for following up with patients. Before implementing this system, they had been using a manually created unscheduled treatment list, which meant patients sometimes waited weeks or even months to be contacted for a new appointment. This new system allowed them to schedule the exact date on which to follow up with each patient and also made it easy to involve more team members in that follow-up. This made everyone accountable and also allowed them to capture what was discussed with the patient each time someone spoke with them.
Sometimes dentists may disengage when they hear someone talking about data, numbers, KPIs, and metrics, thinking “What does any of that have to do with the health of my patients?” This is understandable. But as this doctor and his team discovered, knowing what was really happening in the practice and which patients were falling through the cracks directly impacted patient health and team performance.
Measuring numbers in your practice is important, but that alone is insufficient. As this dentist learned, data may tell you how many of your new patients have rescheduled treatment, but it won’t explain what can be done to improve that metric—just as you may know that case acceptance is low but not what can be done to increase it. The insights happen when your team discusses the meaning of the information, how you feel about it, and what your plan should be for acting on the data. This is when the value of those metrics is fully realized.
What are the numbers in your practice that most need attention? Do you know? Are you paying attention to those metrics and, more importantly, focusing on a plan for improving them? Rather than trying to fix everything at once, start with one or two things that you can measurably impact. Spend a few minutes each day looking at them, discussing them as a team, and planning for how you will improve. Setting goals around these areas is also a wise approach. Metrics matter because those numbers represent patients. It’s as simple as that.
To gain an understanding of your practice’s “actionable data” or to schedule a practice evaluation, please contact me by calling 801.717.2777 or email me at firstname.lastname@example.org.
- Dental Quality Alliance. Quality Measurement in Dentistry: A Guidebook. Chicago: American Dental Association, 2016: 4. http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/DQA_2016_Quality_Measurement_in_Dentistry_Guidebook.pdf?la=en. Accessed 18 December 2018.