10.12.07 - Issue # 292 Forward This Newsletter To A Colleague
Digital Patient Forms
Dysfunctional Teams
Informed Consent

Dodging the Digital Age May be to Your Detriment
by Sally McKenzie CEO
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Dental teams, listen up, your 21st Century patients would like you to stop dragging your 20th Century feet and step into the digital age. Although many of you have made huge strides in your use and integration of technology, there’s still a ways to go, particularly when it comes to a few key business systems.

Recent studies only confirm what most of us know to be true, we are a wired society. We not only use electronic communication, we have come to rely on it. Internet usage alone has exploded. According to Internet World Stats, which provides statistical Internet usage data, 70% of the population of North America uses the Internet. Recently, the Pew Internet & American Life Project reported that of the Americans using the Internet at home, 70% use a broadband connection.

Not only are people accessing the Internet from their homes and work, they’re taking electronic information and communication with them everywhere they go. Sales of the $400 Apple iPhone reportedly are at 27,000 per day and are projected to reach 2.5 million by year’s end.

What does all this mean for dental practices? When it comes to the digital age, in many cases, patients are already there and they’re waiting for dental offices to catch up. If you’re not on the drive toward more and greater use of digital/ electronic communication options, you might as well be standing still. Sure, you have the computers in the operatories, the intraoral camera, you’re well versed in digital radiography, and I hope you have a website, but chances are pretty good that you’ve barely scratched the surface of the digital options available to you. Options that will save both you and your patients time and your practice money.

Starting with patient forms. Every new patient has to complete plenty of paperwork. In most cases, they can’t even start that process until they dash into your office at 9:58 for their 10 a.m. appointment, sending your schedule another 10-15 minutes behind.

Like you, busy patients are looking for speed, efficiency, and convenience in every aspect of their lives including their dental appointments. And there’s little that is quick or easy about completing difficult to read dental forms, which are usually printed in 8-point type or smaller and have been photocopied multiple times making them virtually illegible. Even more frustrating, since 70% of the population uses the Internet, it’s very possible that new patients visit your website in hopes of taking care of expected paperwork requirements only to find they can’t complete them online. The patients are frustrated because their time is limited. They want to get in, get out, and get on their way. You and your team are frustrated as control of your perfectly scheduled day is slipping away. You’re wondering why these patients can’t seem to arrive a few minutes early to take care of necessary paperwork. And they’re wondering why you can’t seem to arrive in the current millennium.

Time to go digital – make your forms available online and completely paperless. “But Sally, we need signatures on a lot of these forms.”  Yes, and one of the best systems I’ve found for doing just that is through DentForms. This program has numerous digital options and among those is an online component that allows patients to complete their medical and dental history forms before they arrive at the office. The online forms are then downloaded into the practice’s server, bringing all the necessary information to the practice automatically. The new patient arrives at 9:58 for her 10 a.m. appointment, she’s completed the necessary forms online, signs the digital signature pad in order to enter her signature into the record and is promptly seated in the dental chair. The patient is happy. The practice schedule remains in tact. And the dental team is focused on the patient rather than the paperwork. 

Next week, going truly paperless with ease.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.
Interested in having Sally speak to your dental society or study club? Click Here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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How One Team is Conquering Dysfunction

I recently had the privilege to work with a savvy dental leader and his staff. Although his practice was relatively productive, he wanted to take the business to the ‘next level’. So while the two day retreat was a sizable investment (he brought his team to San Diego from the East coast), he knew that employee performance is directly correlated with practice profitability. In other words, the purpose of training was business-focused, not just a feel-good reward.

Prior to our first meeting, each member of the team, including the dental leader, completed an online survey. This enabled us to ‘benchmark’ the strengths and the weaknesses of the group. Team members also completed a second questionnaire that identified individual preferences and behaviors. During the first morning, we reviewed the detailed report of their team as well as the similarities and differences between team members.

Like it or not, all teams are potentially dysfunctional, even those who are moderately successful. This is inevitable because they are made up of imperfect human beings. So it is extremely rare that a team will score high on the five behavioral challenges that all teams continuously face.

With this particular team, “Trust” was at a moderate level. This was due to their familiarity with one another. Several team members belonged to the same church and attended services together. Others had worked together for many years. All in all, they were like a ‘family’. Furthermore they were kind-hearted and compassionate people who didn’t want to hurt one another.

This conflict-avoidance dynamic was their greatest dysfunction. Stifling conflict actually increases the likelihood of destructive, back channel sniping. Indeed this was the situation. Team members often bickered and griped, wasting valuable energy and time. Instead of addressing important issues directly with one another, they talked ‘behind’ and ‘around’ teammates, afraid that honest communication would be hurtful. Of course the opposite happened. The result was decreased practice efficiency and productivity, as well as diminished initiative and engagement.

During the team building retreat, we also reviewed the unique traits of each team member. There were smiles and head nods as they shared their profiles. The retreat’s outdoor activities highlighted each team member’s special talents. They recognized and embraced the important contributions each team member plays in the ultimate success of the practice. They learned to give supportive feedback to each other. They developed a ‘common language’ by writing two mission statements – one for the office and one for the team. They have a plan to hold each other accountable and drive for results.

Take an inventory of your team.

  • Do team members openly and readily disclose their opinions?
  • Are team meetings compelling and productive?
  • Does the team come to decisions quickly and avoid getting bogged down by consensus?
  • Do team members confront one another about their shortcomings?
  • Do team members sacrifice their own interests for the good of the team?

Although no team is perfect and even the best teams sometimes struggle with one or more of these issues, the best dental practices constantly work to ensure that their answers are "yes." If you answered "no" to any of these questions, your team may need some work.

Facing dysfunction and focusing on teamwork is critical for the dental leader. He /she sets the tone for how all employees work with one another. The team with whom I recently worked showed tremendous courage and discipline, and I commend them. I know they are on their way to extraordinary levels of success! I’ll be sure to keep you posted.

Next article: The five important behavioral challenges that all teams face.

Want to unlock the power within your team? Contact Dr. Haller at coach@mckenziemgmt.com. She’ll help you take your practice to the next level.

Interested in having Dr. Haller speak to your dental society or study club? Click Here

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Carol Tekavec, CDA RDH
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Aspects of Informed Consent

Informed consent laws vary from state to state, however parameters concerning what constitutes consent are fairly consistent.  According to the ADA Division of Legal Affairs in the Journal of the American Dental Association November 2005 issue, “more than 15 states obligate dentists to obtain informed consent before placing patients under certain forms of anesthesia.” Some states specify by statue or regulation that the consent should be obtained in writing.  Even, if it is not mandated by jurisdictional law, a written informed consent form can be an effective risk management tool for your dental practice. 

It is important to remember that having a patient sign a written consent form does not excuse the dentist from the responsibility of having an adequate discussion with the patient about proposed treatment and explaining the risks of, benefits of, and possible alternatives to the proposed treatment.” 

Consent might more correctly be described as a process rather than just a form.  Discussions and explanations are crucial to fulfill the dual goals of understanding by the patient, and protection for the dentist.

According to the American Medical Association the first cases involving informed consent were based on a tort (which is a statute involving a “civil” wrong), of battery.  Under a battery tort, there is frequently a liability for un-permitted touching. While it is conceivable for dental treatment to come under a “battery” allegation, consent now primarily centers around whether or not a patient was provided with sufficient information to give permission for a procedure on his/her body.

Since informed consent lawsuits are typically based on negligence (negligence to inform), a dentist’s liability insurance generally covers such a claim.  Conversely, a battery claim would likely not be covered under liability insurance.

What standards, if any, exist about the quantity and quality of information that needs to be provided for a patient to give “informed consent”?   Most literature indicates one of three “standards”.

  • Reasonable physician (dentist) standard:  What would a typical dentist explain about the treatment and how it was to be performed? (Usually not considered as desirable as the reasonable patient standard  because the focus is on the dentist, not on what the patient needs to know).
  • Reasonable patient standard:What would the average patient need to know in order to be an informed participant in the decision to accept a certain service?
  • Subjective standard:  What would this particular patient need to know and understand in order to make a decision? (This standard is difficult  since it requires tailoring information to each patient individually and implies that the dentist has more than a typical knowledge of a patient’s ability to understand).

Based on these standards, and specifically the reasonable patient standard, current thinking for informed consent suggests separate, treatment specific forms rather than simply a general treatment consent form. Forms should not be too long or use overly technical language.  The idea is that a patient should be given the proper information, should be able to understand that information, and give an educated consent.  This is why single sheet, single treatment forms are good.  Easy to read—easy to understand. 

 Forms should follow accepted consent guidelines which are;

  • treatment recommendations,
  • risks of that treatment,
  • alternative treatments and the risks of these,
  • consequences of doing nothing,
  • fees to be charged,
  • a statement indicating that the patient’s questions have been answered and no guarantees offered.

It is essential for the patient to sign and date the form. The patient keeps a copy and the dentist retains one in the record.

While obtaining a signed informed consent form is important in backing up the consent process, it does not mean that a dentist may not be sued by a patient.  Patients can always say that they did not understand their treatment or what they were signing.  However, when documentation exists showing patient consent, it becomes more of the patient’s problem to prove he/she did not understand, rather than the dentist’s problem to defend the treatment.  As always, the patient record is the key to any defense.

Now that we know that informed consent is important, what treatments or services require informed consent?  One attorney has described this as  treatment that is not “commonly done or easily understood”.  However, this  might cover any treatment offered by a dentist.  How can the staff know what the patient understands?  Who decides what treatment frequency makes it “commonly done”?  Guidance from the “Ethics in Medicine” website offers this: “surgery, anesthesia, and invasive procedures" require a signed consent form.  Many dental services would apply under this definition.

Carol is the author of the Informed Consent Booklet of 31 treatment specific consent forms available from McKenzie Management. They can take the guess work out of setting up the consent process.

Carol Tekavec CDA RDH is a practicing clinical hygienist, the president of Stepping Stones to Success, 11-year insurance columnist for Dental Economics magazine, and a speaker for the ADA Seminar Series.  Contact her at : carol@steppingstonestosuccess.com or 800-548-2164.

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