Podcast: Quality Assurance and Quality Assessment In Your Dental Practice

Tonight’s podcast is one of many podcasts based on the business of dentistry. There’s always been a theme, as we approach our 75th podcast, in how do we relate the clinical aspects along with the business aspects of medicine and dentistry. I had mentioned in a previous podcast the importance of training, continuing education, knowledge, role playing. But one of the things that we had talked about in previous podcast were the use of audio and video in the office, not just for surveillance, not just to protect us from break-ins, but to use so team members can be trained. So you see how they operate, how they interact with patients and other staff members and then those video/audios can be reviewed, edited for training. Nothing is so powerful as seeing how you react in front of team members and your patients.

This podcast has a similar message and it’s something that I instituted at my company over 15 years ago and I refer to it as Quality Assurance and Quality Assessment. No matter what size your practice, no matter how many team members you have, I can tell you through firsthand experience that my company sees in excess of 116,000 patient visits in a 12-month period. That’s through 14 dental offices in western Massachusetts. And what I’m constantly looking for is something that’s repeatable, something that’s inexpensive, and something that, most important, is effective.

The quality assurance quality assessment forms can be done in many different ways. In today’s day and age, an electronic signing pad is a nice, efficient and effective way, but the most important thing are the questions associated with the quality assurance and quality assessment forms. Basically, question one is;

1. Was your patient happy with the care and service? Yes or No.
2. Was your provider on time for your care and service? Yes or No.
3. Did your provider discuss various options and fees associated with your care and treatment? Yes and No.
4. Would you refer a family member, friend or associate to this practice? Yes or No.

And then there’s a few lines for comments. I cannot tell you how effective and efficient this is to improve the quality of care and service in either your medical or dental practice.

In the beginning, we simply used small 4 by 3 tear off pads. At the end of each procedure, the patient was given this to fill out and the role playing would be something like this; Mr. or Mrs. Smith, I know you’re very busy, but if you wouldn’t mind filling out these four questions, we would greatly appreciate it. I would tell you that over 99 percent of the time the patient or client is willing to fill out the short quality assurance, quality assessment form.

The other option is to use an electronic pad and the patients fill out the same yes and no answers. The advantage of your electric pad is it’s immediately scanned and accessed into your patient chart if you’re computerized. When you do it on the tear off pad or paper situation, it is imperative that at the end of the day, those are scanned so that this information and data is in the computer.

I’d like you to think about the power of this. Again, with 116,000 visits plus each year, if we have a 95 percent success rate where patients are happy and satisfied, and five percent of our patients aren’t, that’s over 5,000 complaints in a 12-month period. That’s unacceptable, it will tear down your business and the results can be catastrophic if they’re not addressed. It is extremely difficult for Mr. or Mrs. Smith to bring you to litigation, to ask for money back, to bad-mouth you on social media when you can show that each time Mr. or Mrs. Smith came to your office they registered on the quality assurance and quality assessment pad that yes, we were on time, yes, they believe we solved their problem, yes, they would refer family and friends, and yes, we explained and introduced them to different options and fees. The power of that to protect you and your team members and to establish goodwill is critical.

If we look at it from the opposite end of the spectrum, when we do get a negative comment, and we certainly do in our business and I believe all businesses do, I can only tell you in my experience of a fulltime practicing dentist for 35 years and still practicing fulltime at this time, that the single biggest complaint that I have seen over my 35-year career is not being on time and keeping your client or patient waiting. Nothing is more frustrating and aggravating to not just your team members, but to your patients and clients than being kept waiting.

We all know in the health services that sometimes this can’t be helped, but my personal opinion is if you’re scheduling effectively and efficiently, and you manage your time effectively and efficiently, you can eliminate or significantly reduce this particular problem. When it can’t be helped, a simple straightforward, “Mr. or Mrs. Smith, I know your time is valuable. I’m so sorry I’m running behind. I will try my best to make it up to you. It just couldn’t be helped.” Acknowledge that you’re behind. Let the patient know that you’ll be with them. Don’t leave them in the exam room unattended. Don’t leave them so that they think that they’ve been forgotten. It’s a simple straightforward solution, just simply explain or have one of your team members explain the doctor is running behind, we’re so sorry and we will do our best to make it up to you.

The other issue that is critical is not only were we not on time, but the second biggest complaint that we get is no one discussed the fees. I cannot tell you when you’re seeing the volume of patient visits that we do, and quite honestly, it doesn’t matter what size your practice is, any problem that creates a negative review will have a negative influence on your overall bottom line, your personal stress level and a reflection on your team members and your organization.

When the patient says to you, “No one explained the fees or options,” that is a direct reflection on your organization that you have some serious communication issues. Many of the practitioners listening to this podcast will automatically assume that they being the doctors do not have to discuss fees. They will leave that to their front desk personnel. I cannot tell you that when you leave it to your front desk personnel, in many cases, the treatment and procedure has already been performed and at that point, it’s actually too late.

An example I use quite often during my training and coaching sessions is after the bottle of wine has been uncorked and you find out that that bottle was a couple hundred dollars, it’s really too late. You’d be much wiser, much better off, mostly likely not embarrassed and certainly, financially better off, if you knew before the bottle was uncorked that that wine was $200.

The analogy that I’m making here is what I see in office after office is procedures and treatments are completed and the fees are discussed afterwards. Never should that occur. In my opinion, it is a break of trust, it creates hardship and it creates problems for your team members and your organization. And in many times in my 35 years of experience of coaching and mentoring, in most cases, the owner doctor has no idea that this has actually even occurred.

The best way is ideally, Mr. or Mrs. Smith know before they’re scheduled what they’re coming for, how long it’s going to take, what the fees are associated with those services and procedures and the finances are taken care of before they’re ever appointed. However, in the real world, we all know as health care providers that things occur on an emergency basis. Things occur that we didn’t necessarily expect. We’re preparing a crown and we find out that the tooth needs a root canal in a buildup. We’re providing a root canal and we find out the tooth may be unrestorable and we’re doing an extraction, a bone graft and potentially, an immediate implant.

All of these potential clinical scenarios create financial hardship for patients and difficulties in the management of these financial arrangements because the services have already been started and in many cases, these services are irreversible, the patient is left with a bill that you may or may not know. But in most cases, they will be upset and unhappy because they weren’t aware of the overall cost and out of pocket expense to them. I strongly suggest that the individual, whether it would be a dental hygienist, a dental assistant, or preferably, in my opinion, the dentist or health care provider, simply explain to Mr. or Mrs. Smith the fees for these procedures are going to be X.

Again, in my own experience, looking at literally hundreds of different practices over 35 years, I don’t understand why providers don’t assess and give an estimate that’s higher. I have never, in my 35-year career, had a person complain that I quoted them one fee and I charged them something lower than that fee. However, almost on a day-to-day basis, I can find complaints in my own organization where someone was quoted at a fee of $105 and the bill came to $135 and the patient is aggravated and upset. And typically the response is, “If I knew it was going to be that much more money, I would have selected a different treatment or I wouldn’t have done the treatment at all.

For those individuals who are not doing quality assurance and quality assessment, I would strongly recommend that you check my website www.ascent-dental-solutions.com and take a look at some of these forms. Also you can find them in the three books that I’ve published along with my electronic books, this information is there. You can customize this to fit your own needs, but in my opinion, if it’s going to take Mr. or Mrs. Smith more than 30 seconds to a minute to fill it out, you may find that it may not be as effective. I can tell you with almost 99 percent assurance, our quality assurance and quality assessment forms get filled out. And I can tell you at the point of service to solve the dissatisfaction is absolutely imperative.

In some cases, because of time constraints, procedures that we’re doing, we can’t always, at the point of service, resolve Mr. or Mrs. Smith. But I can tell you, practicing 35 years, an evening does not go by where I don’t make a phone call to Mr. or Mrs. Smith and the phone call goes something like this, “This is Dr. Coughlin. I’m very sorry to bother you. I noticed your quality assurance and quality assessment form was less than ideal. I want to first say I’m sorry and I apologize for the dissatisfaction. If you have time now, I’d like to discuss it. If not, we can make a time or an arrangement later on during the week to address it. I want you to know you have my severe apologies and I will do everything in my power not to let it happen again.”

I hope you’ve enjoyed this podcast. You’ve been listening to Dr. Kevin Coughlin, my company, Ascent-Dental-Solutions, with a focus on education, knowledge, training and development. I look forward to speaking to you soon. And my special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard, for his expertise in creating this podcast, and Mr. Aidan Crawford and his company Short Circuit Media for making this material available on my website www.ascent-dental-solutions.com.

Thank you, again, for listening and I hope you have a pleasant evening.