Dodging the Digital Age May be to Your Detriment
Dr. Nancy Haller
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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.
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 firstname.lastname@example.org. She’ll help you take your practice to the next level.
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Carol Tekavec, CDA RDH
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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”.
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;
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 : email@example.com or 800-548-2164.