No Policy? You're a Prime Target
Ah yes, the holidays, the parties, the festivities, it’s the most wonderful time of the year… for sexual harassment allegations. Parties and social events where everyone is drinking alcohol and having a good time are often where problems begin. Things are said, hugs and kisses shared, and the situation can get out of control. Social events tend to be major culprits in spurring actual or perceived sexual harassment situations.What should you do if you are accused of sexual harassment? First, make sure that never happens. Too often dentists look at human resources policies as an expense rather than a necessary investment to protect themselves and their practice from potentially costly litigation.
If you do not have an employee policy manual you are a prime target for legal action. Experts we talk to on this subject say that plaintiff attorneys will file a lawsuit no matter how weak the case is. The attorney’s reason: how can a doctor hold an employee accountable for anything if there is no employee policy manual? In other cases, a doctor may purchase a practice that has an existing manual and they simply assume it is okay and everything that should be addressed is - until they discover otherwise.
McKenzie Management’s HR Solutions division encourages doctors to work with a professional to create a policies and procedures manual that is specific to the individual needs of the practice. The manual may cover as many or as few issues as the doctor chooses, but would probably serve its purpose most effectively if it included key practice policies, including:
Equal Opportunity Statement - This states that the employee’s religion, age, sex, or race will not influence hiring, promotion, pay, or benefits in any way.
Definition of the Work Schedule - This indicates that all employees are to be at their assigned work areas and ready to provide care for patients at a certain time.
Salary/Payment Policies - This details when the employee can expect to be paid, how wage increases are handled, overtime, etc.Professional Code of Conduct - This section clarifies the practices expectations regarding punctuality, sexual harassment, employee dress, use of tobacco, alcohol and drugs, as well as policies regarding personal phone calls, Internet usage, and personal visits.
Performance Review Policy - This section explains exactly how and when employee performance is evaluated, including samples of performance evaluation forms. It may also spell out the practice’s policy on progressive discipline and unsatisfactory performance, and it may list those infractions that could result in termination of employment.
Every practice, no matter its size, needs to have an employee policies manual. The employees must know what the policies are. They need to be written and communicated, and employees should be trained, particularly in an area such as harassment, to ensure that they understand what might be construed as harassment. Prevention is the best way to protect yourself and your practice.
If you or someone on your staff is accused of sexual harassment, call an attorney or a professional human resources investigator. You, the doctor, need to separate yourself from the situation. The attorney or HR investigator should come in and gather as much info as possible, interview all the parties, and try to frame the situation to determine if there is liability or if other steps need to be taken. The worst thing a doctor can do is ignore the situation or try to handle it him/herself.Keep employee documents in a secure place. This is especially critical in situations where an employee is dismissed and files an allegation of sexual harassment after they are fired. If you are documenting employee performance, action, and inactions and the employee files a complaint, you are in a much stronger situation. An outside attorney or human resources professional will still be required to conduct an investigation, but documentation, in most cases, will save an employer from a frivolous lawsuit.
For more information on this topic, visit my blog: The Lighter Side.
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Let's Make A Plan
Very few dental offices feel that they are dealing effectively with perio identification and treatment. While we know that a large number of adults have some form of perio disease, the fact is we often see our hygiene schedules full of standard prophys instead of perio scaling and perio maintenance. There are many reasons for this. In my opinion, one major problem is patient resistance. Many patients are reluctant to even entertain the concept that they have a condition that would benefit from more appropriate treatment than a “cleaning.” They have “always” had so-called cleanings, they have not lost any teeth yet, therefore a cleaning is all they need. Added to this may be an underlying mistrust of what the hygienist and/or dentist is telling the patient. Patients may fear that the office “just wants money” or is trying to force them into something they don’t really need (which can be magnified by dental insurance restrictions and coverage limits).
Even patients who have faith in the practice may be resistant to agreeing to more than just a prophy. They may not have any symptoms they can identify themselves, so they chalk up our recommendations to over-zealous diagnosis - just as some people will disparage frequent hand-washing at home or the need for flu shots.
As a hygienist who values appropriate perio diagnosis and treatment, (as well as lots and lots of hand-washing), I struggle with patient resistance myself. An office plan for identifying periodontal disease and corresponding appropriate treatment helps. Following the plan allows the dentists, hygienists, assistants and office staff a way to explain and encourage what patients need.
The American Academy of Periodontology literature provides us with guidance, and using their information and our own guidelines and explanations can help us lead our patients to correct care. Each office should decide what their plan will be. Here is a simple example for perio identification:
While there are many other factors that influence identification of periodontal disease, probing depths and bleeding are easy to demonstrate and explain to patients. Full mouth probing at least once a year for prophy patients monitors how your patients are getting along. When they hear the numbers called out to an assistant, or look at the computer print-out showing their results, tangible evidence is presented. Additionally, bleeding can be shown with an intra-oral camera or simply a hand mirror. One of the quickest and most effective demonstrations that I employ uses a hand mirror and a perio probe. I show the increments on the probe, then show the patient where this probe descends in a pocket while they watch in the mirror.
After the “show and tell” portion of the appointment, my explanation of what is happening and what treatment is recommended can commence. For slight periodontitis, our office has decided to recommend three prophys annually. I explain that insurance will only cover two of these, but that with their increased adherence to the home care routine I present, they will likely find that the tendency to develop a more troubling case of gum disease will be lessened. I explain that if this new routine does not work, isolated areas of scaling and root planing will be needed. For moderate or advancing periodontitis, our office recommends scaling and root planing for the involved teeth and then periodontal maintenance thereafter. This can be 4 or more teeth per quadrant or 1-3 teeth per quadrant as appropriate. I also make it very clear that after this treatment the patient and I will have to be vigilant to prevent the condition from worsening - hence the need for periodontal maintenance three to four times per year. Often I need to take as much as 15-20 minutes to explain what all of this means, with my opinion backed up by the dentist when he comes for his exam.
In practice, this results in a great curtailment of delivering a “prophy” at the appointment, but I am careful to provide some scaling and polishing so that patients do not feel shortchanged. When the patient comes with me to the front desk, the treatment plan is indicated on the routing slip and the treatment coordinator follows up with fees and an insurance estimate. Patients who do not respond to treatment are typically referred to a periodontist.
While this approach does not provide for an initial focus on nutrition, pathogen or DNA testing, irrigation, or prescription meds; these can be incorporated later if appropriate. What this approach does do is identify and help guide patients who need periodontal care to receive that care. And to do it within the restrictive time constraints present in a typical hygiene day.
If patients refuse to pursue perio treatment, do we kick them out of the practice? Of course not. We continue to explain and encourage appropriate care at each and every prophy visit, and we also ask them to sign an informed refusal form so we can document that they have been told about their condition, but have decided not to address it at this time.Identifying and treating periodontal patients is an important task of the dentist and hygienist, and it can also be instrumental in improving practice production. Making a plan to accomplish this is good for everyone involved.
For more information to help with your own plan, check the AAP website.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.Forward this article to a friend
Receive Knowledge for a Practice's Lifetime
You probably have all heard the saying: “Give a man a fish; feed him for a day. Teach a man to fish; feed him for a lifetime.” Lao Tzu was the founder of Taoism, the mystical “way” or “path” that can also be found in Chinese philosophies and religions. He became known for many sayings besides this one, which is renowned. I believe this is a wonderful analogy for today’s modern world of management. It is similar to the fact that one article or seminar can feed you some of the knowledge you need to run your practice for a day, but if you learn how to manage your practice, you will receive the knowledge to be productive for the practice’s lifetime.
The year is coming to a close, and as a practice management expert I am often asked by practice owners: “What can I do to change my hygiene productivity?” or “What can I do to improve my hygienist?” While I could easily give them a quick answer and it might fix the challenges he/she faces for a day, it surely won’t build on the strengths of the hygienist working in the practice, nor will it identify all the opportunities that lie within that hygienist or department/practice.
When we accept a new client, we begin by asking the doctor the following questions: What type of practice do you want to have? What kind of dentistry do you want to practice? What types of patients do you want to have? After they answer those questions, we ask what is holding them back; do they have a plan to get the practice they want? The plan must have specific strategies and accountability. They need a road map.Asking for the following reports from their Practice Management Software allows us to complete a “deep dive” into the current reality of their hygiene department. All reports are for the last 12 months.
From these reports, we are able to uncover the strengths, weaknesses, opportunity, and threats (SWOT) that exist within the hygiene department and practice as an entity. Reports tell a partial story, a story not just about hygiene but many of the systems that help you monitor your practice, thus enabling you to receive some of the knowledge to be productive for a day/week/month in the practice. However, with proper diagnosis of those reports and direction on how to uncover SWOT and implement change, you are able to learn how to use the knowledge to be productive for a practice’s lifetime.For an example within the hygiene department, let’s go a little deeper into SOME reasons why a practice isn’t diagnosing or treating periodontal disease.
1. You don’t know how to tell a patient, who has been coming for years to have you “clean” their teeth, that they now have a disease.
Most practices we work with are competent and try to keep the patient’s best interest as the first priority, yet still some practices can relate to the 5 reasons above. Competency can be broken down into 4 categories.
Unconscious Incompetence - You don’t know what you don’t know. Example: Hygiene production should represent 33% of total practice production; periodontal production should represent 33% of total hygiene production.
Conscious Incompetence - Know that you don’t know. Example: Hygienist may know that the ADA recommends full mouth radiographs every 3-5 yrs but doesn’t know what the doctor’s philosophy is within the practice.
Conscious Competence - Know and have to apply conscious effort. Example: You know the doctor’s philosophy is that all patients have a complete periodontal exam at every visit, to co-diagnose what is present in the mouth before he/she comes in for periodic exam.
Unconscious Competence - Do without thinking. Example: Bite-wing x-rays every year on all patients with teeth based on the ADA guidelines.
So let’s think about Conscious Competence. We know that the surgeon general and CDC say approximately 60%-75% of American adults have periodontal disease and the majority don’t know it because it is usually painless and silent in the early stages. Yet if we were to complete a chart audit in 100 dental offices, 97 of them would not have a full 6-point periodontal probing on each patient in that chart every year. You go into Conscious Incompetence mode knowing that you don’t complete it regularly, but justify “why” with the 5 reasons mentioned above and many more.So as another year comes close to ending, allow us to “teach you to fish so your practice can flourish for a lifetime.” Accept our gift of thanksgiving by requesting a complimentary Practice Assessment today.
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