Reducing Errors in Dental Operations

Yvonne Simmons Howze, PhD & Zina Berry, DDS

Dentistry is a highly respected healthcare field, and dentists are highly-skilled, competent professionals. Dentists seem to have it all together, and to the average eye, their offices run smoothly. However, unbeknownst to most patients, a dental office has a significant number of daily processes that must be followed to minimize the time a patient spends scheduling an appointment, preparing for their visit, receiving treatment, and paying for the service. Thus, this article describes three common clinical and operational errors found in many dental practices, and it makes recommendations for reducing them.

Dental offices can be increasingly more efficient and effective in reducing errors by analyzing the impact of three critical measures of success: accuracy, timeliness, and costs. Figure 1.0 gives a brief definition of each measure.

These three measures, when used consistently, ensure sustainability, reduce staff burnout rate, and keep patients committed to following through on their treatment plans. These measures can be used to both prove and improve the work that dentists do.

REDUCING ERROR RATE #1: PATIENT DENTAL RE-WORK

Typically, when we think of errors in Dentistry, we first think of errors that require re-work. Re-work is waste, and waste within any business can be a costly endeavor. If a dentist must re-do a procedure, the Practice and the patient are affected. For example, in Figure 2.0, a dentist might consider the following when a patient must return for re-work of a root canal: (see Fig. 2.0)

For two hours of re-work, the following estimated costs might be applicable:

Figure 1.0 Measures of Success

Figure 2.0 Example of Waste-Focus on Errors

Hypothetically, if a dental practice has to re-do work for three (3) patients a week at the minimal rate of $460.00, then in a year’s time (52 weeks), the re-work will have caused a potential loss of nearly $70,000. Of course, the biggest cost due to the re-work might be the loss of the patient’s confidence in the dentist.

Additionally, if the patient has to pay out of pocket for the rework, the practice may lose the patient to another dental office. By tracking the number and type of errors, and the potential costs for re-work, it can easily be determined how errors are affecting a practice’s profitability. With that information, the practice gets clarity about the best ways to reduce the error rate (e.g., additional training, scheduling additional time for certain procedures, etc.). It all begins with a simple acknowledgment that an error has been made, followed by a commitment to creating a great patient experience.

REDUCING ERROR RATE#2: THE MORNING HUDDLE

The Morning Huddle is a common activity used by many dental practices to organize staff around the daily clinical and operational goals and to remedy any potential scheduling issues. It is the greatest opportunity for the dental team’s maximum efficiency and success at the onset of the day to ensure each patient has a delightful patient experience.

There are specific activities that can reduce the error rate in Morning Huddles.

First, the huddle needs to start on time. If there is no specified time, then it is likely that staff will be late for the huddle. Once the time is determined and the dental team is informed, the huddle should start on time, every time! A practice can use a sign-in sheet (Appendix A) that specifies date, name of staff, and arrival time to the huddle.

Secondly, the dentist or practice manager should lead the huddle. A process involving a report out for each patient should be developed and used daily. For example, will each hygienist talk about all of their patients or only the ones that are potentially problematic? Does the front desk need to report on patient payment status, such as insurance pre-authorizations returned or not returned? Howze (2013) contends that creating clear process steps so that everyone knows the time, timeframe, and activities to be completed and by whom will ensure that time is spent on goals and outcomes, not on apologizing for being late (timeliness), not having the necessary information so that the dentist can make an informed decision (accuracy), and not on figuring out whether a patient should be re-scheduled because their pre-authorization has not yet returned (costs).

REDUCING ERROR RATE #3: LABORATORY ERRORS

Dental labs contribute to the successful operation of a dental office. Dental labs are suppliers who create products on behalf of dental offices. As such, it is important that a dental lab has a customer-centric focus whereby the dental office’s patients are valued, patient expectations are met, and products for patients are of high quality.

Dental labs customize a variety of products, such as dentures, crowns, and bridges. The dental lab is used to create a solution suited to the needs of each patient based on the prescription from a dentist. Some dental offices have their own in-house lab, but there may still be times when an outside dental lab is used. Either way, timeliness is a critical measure for a dental office using an in-house or outside dental lab because the patient must wait until their product has been received and accepted.

Delays in the delivery of dental lab products may create a potential problem for a dental office. A delayed product may extend the cycle time that a patient may get fitted for the new product, causing a potential patient distrust issue for the dentist. If the product is received and tried but must be returned to the dental lab because it is not the best-fitting product, then there must be a re-examination of whether the prescription was accurate, whether the prescription was followed, or whether the patient is simply dissatisfied with the product based on their assessment of attractiveness or functionality. If the product does not fit and must be re-made, then more time is needed in the dental office as described above for re-work. If the product is a matter of attractiveness or functionality, then the dentist and dental staff must take more time to appease the patient. The matter of appeasement is important, particularly if the patient has paid out of pocket for the product.

The dental lab is a corporate partner with the dental office. Consistent errors in dental products will need to be addressed through an evaluative process. A dentist can develop quality domains to determine whether to continue or discontinue with a lab supplier. Below are measures a dentist can use to determine a supplier’s performance:

1. % of problems fixed the first time

2. Timeliness of completion of the product/appliance

3. Timeliness of arrival of the product/appliance

Mark Graham Brown (1996) recommends the use of a scorecard as a way to assess a supplier’s performance. Figure 3.0 shows an example (Howze, 2009) of a vendor scorecard for a lab supplier. A dentist can identify the vital few key measures to score the lab’s performance by assigning a weight according to its importance to the practice.

Once a satisfaction score is determined, the dentist can decide whether to keep the same dental lab or seek the services of another one. If the target satisfaction score is 80%, then the dentist may want to re-assess whether they want to continue working with this vendor or at least have a discussion with them. This same process can also be applied to evaluate the performance of other suppliers the practice uses.

Figure 3.0 Example of Lab Supplier Scorecard

For every error, there are costs, whether it is in time or money to the patient or to the practice. When a dental office gets it right the first time, gets it done within the allotted time, and gets it done with the least cost in time or money, the patient will be delighted, and they will return and tell others. That means great patient engagement, satisfaction, and loyalty!

References

Brown, M. (1996). Keeping Score. Productivity Press. Howze, Y. (2004). Tips for Success. Unpublished paper.

Howze, Y. (2009). Measuring vendor performance. Presentation to the Texas Comptroller, Procurement and Management Division. Howze, Y. Toolz You Can Use. HowzeNow Press, Jacksonville, Florida.

Howze, Y. (2023). A Systems Thinking Approach for the Education and Training of Performance Excellence: A Pedagogical Approach. Submitted for Publication.

Dr. Yvonne Howze is co-owner of Dental Leadership, LLC, which sponsors the Dental Leadership Academy (DLA) to train dentists and others in the dental profession nationwide. She has gleaned critical insights into dentistry to help Dentists (and their staffs) run their operations with systematic efficiency by teaching them tried-and-true techniques and by training them on continuous improvement principles and tools to reduce waste, work closely with vendors, and improve staff-patient interactions.

Dr. Berry is co-owner of Dental Leadership, LLC, which sponsors the Dental Leadership Academy (DLA) to train dentists and others in the dental profession nationwide. Dr. Berry is a seasoned and savvy dentist with nearly three decades of expertise. She has received many certifications and awards demonstrating her highly successful career as a dentist and business owner. Because of her wealth of knowledge and expertise about business operations and day-to-day management in healthcare environments, she is frequently invited to be a guest speaker.