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Best Practices

In my capacity as an executive board member of the William F. Ryan Community Health Center, which receives significant federal funding, I recently participated in a re-view conducted by a federal bureau, the Human Resources and Service Administration, of every aspect of our center. The concept of best practices came up often, and our center was benchmarked against best practices used in community health centers throughout the country in the areas of clinical performance, governance, finance, and leadership. This experience has led me to think more about our dental practices.
Would a best practice concept be a helpful way of evaluating ourselves? Of course, there is really no such thing as an average dental practice. Still, it is interesting to think through this concept to see if what follows might function as a “template for excellence” knowing full well that one size does not fit all. Since I cannot begin to know the size and shape of your aspirations and where you might fit into this concept, I would simply like to invite you to read this article and then write down your own ideas.

Explore the Terrain
Ask yourself, what is your process, and think about how you implement changes. Most importantly, inquire how you will evaluate the results of your efforts.
The first and clearly most essential step in any sort of building process, especially for dental practices, is to conceptualize and write down the mission, vision, and goals for your practice. This is the template, developed by you and your team, and it will guide and inform all of the decisions that will need to be made. There are a number of Web sites that should be researched in order to clarify what all of this language means. Do not fall into the trap of thinking that this process is too soft or airy just because it does not involve technical or clinical dentistry. Without this template, you will never know where you are relative to where you want to be. Remember, everything that we are talking about must have metrics attached to them; everything must be able to be measured.

Are You in a Rut?
The next step is to identify the major paths in our best practices quest, and one is obvious: that would be the clinical side—the competencies that we have or want to develop for ourselves and our teams. How skillfully do we perform cosmetic procedures, and what about endodontic and periodontal procedures? What about our hygiene department and the vast and growing arena involving soft-tissue management? What are the benefits of catering to the newly emerging health conscious folks in your practice? And the list goes on and on. The question is, Are we doing what we want and growing as dentists, or have we fallen into the “I always did this or that” rut? Ruts are seductive, because they become almost like comfort food (unhealthy) or mindless and numbing TV shows. Furthermore, getting out of them is not as easy as it might seem. Maybe the challenging question would be, “What are your ruts?” Once identified, they are much easier to get out of.
A corollary to this question of ruts relates to your team. What is the learning edge for each one of them? What new technology and techniques should they be learning about? Are you helping them, or holding them back? Are you a model for learning and growth, or are you doing things that have the opposite effect?
There are best practice models for the financial aspects of our offices. There are compensation guidelines based on job description and geographical area. Do you know what they are, and is your office’s financial structure consistent with them? I don’t believe that these guidelines should preclude individual salary decisions, but we do need to know when we differ from them and by how much. Related to the financial metrics is the question of incentivizing our employees; the bonus question. Many offices do give bonuses, although the way that it is done is all over the place. Personally, I think bonuses are not helpful, and in some cases hurt performance. This is a big discussion and relates to the notion of why people work in general and why they work for us in particular. Not a bad question to ask.

A Model for Governance
The best practice model for governance, across all industries and professions, includes well-run, well-planned, and strategized meetings. I believe that many of us in the profession have deficiencies in our abilities related to meeting planning and execution. I think the reason we don’t have proper meetings is that we have never been taught how organize and run them. We are schooled in how to relate to patients (actually, we are schooled in how to relate to their teeth), but we are far less skillful in the interpersonal leadership and management aspects of our profession. I have written extensively about these topics in many venues (ie, Web sites such as dentalcoachesassociation.org, coachingpractice.com, and den- tistrytoday.com), advocating (daily) morning meetings and regular team meetings.
These meeting models are so crucial because they are barometers not only of practice performance and a social context for reviewing important practice metrics but, perhaps as significant, they are ways that we can monitor the morale of the entire staff. At this point, you might be asking, “We are not psychologists, so why is this so important?” The reason is that the morale of the office, the way that we relate to each other, is a mirror for our patients; know that there is no quicker way to kill a practice than to have low team morale. It is the underbelly of poor practice performance.

Communication: Both Verbal and Nonverbal
There are best practice monitors for the language and verbal skills, and they all involve some core competencies with English. This is a vast area and is probably best handled in the framework of the office meetings.
Below I have listed a few of the areas that I think should be included in a best practices list:

• Telephone Skills
Calls should be scripted and practiced so that they are warm, friendly, and natural. Strategies for each category of call should be developed.

• E-mail Skills
Since so much more of our communication with patients is through the computer, we must develop literacy skills that properly reflect the professionalism of our office. Proper English is a must.

• Interpersonal Skills
The team should have a good working knowledge of the role that body language plays in communication.

• My Pet Peeve
I don’t believe that we can communicate and chew gum at the same time. I go on a rant when I see one of my staff chewing gum. It is absolutely not the message that I want our office to convey.
The best practice concept can also be broadened to include what we wear in the professional setting, and I believe that coordinating the uniforms that your team wears conveys the most professional image. We need to include the doctor’s attire in this evaluation as well.
The best practice also involves the interface among photography, imaging, and insurance filing. This is a very important topic, whether you are insurance-free, insurance-dependent, or a hybrid.
The best practice for the look and feel of our offices goes beyond the waiting and treatment rooms. Clean, neat, and impeccably hygienic bathrooms are absolutely crucial. Important messages, both positive and negative, get transmitted nonverbally to our patients in this way; they are often quite subliminal, but because they are unspoken, they are no less significant. Current magazines, uncluttered tables, and even fresh flowers are noticed. Make the experience pleasant, including appropriate music.

Closing Comments
I believe that we should begin to think about how we could fit into a best practice model. There are many things that we can do to improve our overall practice image and to begin to market our practice in ways that can be easily accomplished even in these economic times. But it is more than the practice image; it is the practice itself that improves. Remember the old duck joke:“If you walk like a duck, talk (quack) like a duck, and look like a duck...guess what —you ARE a duck!”
Remember, the ultimate best practice can become the smile on everyone’s face.

Dr. Goldstein graduated from the City College of New York before receiving his dental degree from the University of Pennsylvania School of Dental Medicine in 1968. He holds leadership positions as well as a mastership with the Academy of Laser Den-tistry (ALD). He is a founding member of the newly formed Dental Coaches Association, a uniquely qualified group of certified dental coaches (located at dentalcoachesassociation.com). He maintains both a general dental practice as well as a coaching practice in New York City. He is a frequent contributor to the dental literature and publishes regularly in the Journal of Laser Dentistry and Dentistry Today and serves on the editorial board of both publications. He is also the former editor of Wavelengths, the ALD’s publication. Certified as a professional coach in 2001, he often addresses audiences on topics of personal effectiveness, fulfillment, and leadership. He presents the use of lasers in dentistry and the areas of coaching/practice management. He can be reached via e-mail at the address This email address is being protected from spambots. You need JavaScript enabled to view it..

Disclosure: Dr. Goldstein reports no disclosures.

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