by Gordon Burgett, CEO, Dental Communication Unlimited


Every dental office already has a procedures manual in a raw, unrefined form: its those snips of paper taped to the x-ray machine, cabinet doors, and telephone pad that remind the person how a procedure is best done.

The missing link between those memory jogs and a dozen benefits for the dentist, a healthier bottom line, and far less stress that an usable manual brings is commitment, a reason to do it, and the time needed to convert tradition, hand-me-down processes, and common sense into such a cohesive system.

The magic word and salvation is SOPs, friend of any military recruit trying to reassemble their rifle or make a bed. Standard operating procedures are no less vital to busy dental offices, particularly where personnel turnover, vacation fill-ins, scattered supplies, and the need for legal consistency are the ruleand overwhelming chaos eternally threatens.

Ive yet to meet a dentist who didnt want a dependable, reliable process in place and on paper, says Marsha Freeman, author of Standard Operating Procedures for All Dentists. But theyre busy and think they must write it themselves, when in truth they have little ideanor should theyabout the minutia of the front office. The whole thing seems overwhelming, so it never gets done.

The quickest way to start is to gather up every one of those helper notes, copy them or tape them to sheets of paper, and put them in a three-ring folder.

Then have the staff sit down and draw up a task sheet for every department: front office, back office, hygiene, ... List every task that needs to be done. Then prioritize them: those you need immediately, those that would be very useful now, and those that can wait.

Start with the urgent ones. Set an hour a week aside for the staff to write down the best way to do the most needed things. Dont worry much about the form at first, just so the points are clear. Pass the sheets around so the others in that department can add, modify, or question the contents. When the process is hammered out, check the spelling, type it up, and put it in the book! A few months of this and everything needed will be on papercreated by the very people who know it best and will use it!

Theres a key element still missing that makes a procedures manual doubly important to the dentist.
At some point most dentists envision a dream practice: a way they could uniquely serve, an ideal relationship between themselves and their patients and staff, a place where they would enthusiastically go to work. Yet the reality never seems to match that ideal.

SOPs can provide a basis and means, however, for that dream (or those expectations) to take form.

The steps to tie a smoother-running office to both the dentists dream and a standard of care, service, and performance required for legal protection are straightforward, and can be implemented by standard operating procedures.

But first the doctor must put that dream into words. What they want their practice and office to be like must be converted into a Mission Statement, a paragraph or two (or many) that clearly defines how the dentist wants his or her practice to look and act.

Without such a statement, a dental practice is like Alice in Wonderland who, when asked where she was going, said she didnt know. Then any road will get you there!

The dentist must first select and define the road, the verbal direction, through a Mission Statement. (Input from staff, spouse, and friends is encouraged, but the final vision in statement form must describe the dentists dream.)

Once done, then every SOP starts with a Desired Outcome and a Measurement.

The Desired Outcome must be in concert with and support the Mission Statement. What does the doctor want to have happen when the patient checks in? The Desired Outcome might read The patient should be warmly greeted and brought back for treatment within five minutes of arrival. Is that consistent with the doctors dream or expectations?

How might that be measured? Observation and feedback. How would you measure Tray Setups? By observation, plus the number of times you must leave your chair to get something forgotten!

Creating the actual step-by-step SOP makes more sense when you have a guideline, a desired outcome first established. If your SOP is for Bleaching and your desired outcome is to return post RCT teeth that have discolored back to their natural shade, the rest is putting down, in order, how that is done.

I suggest a simple E-D-I-T process, says Marsha, who developed her original Standard Operating Procedures for Pediatric Dentists book while creating procedures manuals as a consultant in the San Luis Obispo, California region.
After they have a task list for each department and a Mission Statement for guidance, they gather up the SOPs they have and (E) edit each makeshift SOP so that it describes the task in a way that meets the doctors needs or they (D) delete what they have and (I) insert a completely rewritten version. The new or edited SOPs are then subject to (T), team review. That is, all to whom that SOP pertains read and correct it. From those modifications and comments each final SOP is prepared.

A full procedures manual also includes job descriptions, evaluation forms, and task sheets, plus tray layouts for clinical use. (Trays laid out in desired form can either be photoed, with the photos inserted in the manual, or the instruments can be set on the copier in the proper order, the light shield carefully laid on top, and copies made, to be inserted.) Many copies of the final manual are produced, one each to be kept in the various departments, one for the office manager, and one for the doctor.

We find it much easier to start with Marshas Standard Operating Procedures for All Dentists book, then adapt it on the accompanying computer disks to meet that offices Mission Statement and specific peculiarities or needs, says Robyn Hayes, one of the 29 Certified SOPs Consultants trained by Marsha.

If the doctors in a hurry, we zip right in on the six or eight key SOPs most needed now, then we work outward until the project is finished. The SOPs Implementation Video Guide for Dentists is particularly useful if the doctor wants us to get them started, then they want to complete it on their own. It breaks the process into seven sections that they can plug into their video for guidance.
The value of having a SOPs manual completed and current?

Beyond creating the dream practice that allows excellent dentistry to be practiced without the constant intrusion of managerial hassles and procedural questions, it provides an ideal starting point for vacation fill-ins or new staff members to carry out daily activities in the best and preferred way. All the office manager does is clip the pages of the processes most performed by that person, explain where the forms, supplies, and machines are, and the learning curve is reduced from months to days!
The doctor and the staff know where things are, procedural questions are minimized (Its in the book!), consistency rules (the same function is performed correctly time after time), and legal protection is possible because the processes are defined in detail in print.

Theres a bonus for doctors who hate the semi-annual or annual job evaluations as much as I do, Marsha confides. The SOPs provide a key measuring tool that helps the doctor evaluate the persons performance. Together they define the SOPs the person uses, and each independently appraises how well the tasks were performed. Focus falls on the areas where the appraisals differ, and improvements are based on bringing the weaker areas into line. It takes the guesswork out of it and at least establishes a starting point for a true evaluation.

Who needs SOPs most? Those with the greatest urgency are new dentists, who immediately benefit from the structure; practices that are growing and adding staff; those bringing in a new associate (so a standard of operation exists between two strong personalities), and certainly those planning to sell a practice (so there is an office structure that will survive the absence of the original dentist).

In truth, says Marsha, every dental office needs a procedures manual to help them operate more efficiently, happily, and productively. With SOPs, everybody winsthe doctor, each member of the staff, and particularly the patient.



From Concepts, Burkhart Dental Supply Company, Spring, 1998, pp. 22-3.


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