Why (some) Dental Practices Fail

As with all businesses providing services to the Public the Patient Base of a Practice sits at the very core of the business, but all too often effective management of this vital data resource is lacking or even absent.  Where Practices continue to struggle to maintain their competitive advantage, information becomes the vital component.  

Understanding the relationship between data sets and how they interrelate to provide real-time visibility enabling better decision making, higher process efficiencies and tighter overall financial controls must be a Key objective. 

In today’s technology driven world it is somewhat surprising to see so many Practices still operating fully paper-based Patient records systems.  When the reasons are probed there is a strong perception that change will put the business at risk, staff will not be able to cope with the technology and cost benefits will not be realised.  However, the reality is that paper-based Practices suffer from limited data visibility, analysis is very time consuming and often inaccurate, if indeed it is ever undertaken, and the overall financial value of a Practice is reduced.  It is also worth noting that in the event of a disaster such as a serious fire where paper records are destroyed, in most cases the business would be exposed to a potentially catastrophic failure.

Without doubt those Practices who operate computer driven Patient Database Systems have the advantage over paper-based organisations.  With so many proprietary systems on the market it is important that the right choice is made based on Practice requirements.  As it will undoubtedly involve a significant financial investment it is paramount that the right decision is made, but what are the considerations that will ultimately lead to your final choice?

Without doubt those Practices who operate computer driven Patient Database Systems have the advantage over paper-based organisations. 

Here are some of the Key areas for consideration;

• Reputation of the Vendor – We all like to choose service providers and products based on reputation, but always consider, quality of service or product, price, technical support and acceptable response time 
• Cost of System licences – The more computers the greater the cost.  Does the vendor offer a charging cap on the number of licence fees payable i.e. above a certain number any additional licences are free?
• Will you have to pay for future system releases, not to be confused with service packs and bug fixes etc?  Many vendors charge for new version releases thereby introducing significant additional costs to those clients wishing to upgrade, but what benefits will you be getting?
• Reliability of software – Does the software have a history of stable operation, is it crash free with minimal software bugs?  Another point worth considering, is has the software package been built on an older legacy system with cosmetic changes that still retains some of the inherent issues
• Functionality of software including data interrogation, analysis and report generation – This is crucial since the software package will become your most important management tool
• Data Security and Backup – A critically important process that must be without question reliable at all times
• Hardware specification, cost, installation and support – When the hardware specification and installation is arranged by the Software Vendor does it meet existing and future requirements? Under specification is very common and nearly always results in performance issues and additional costs to the customer.  Don’t forget to factor in hardware support costs?
• End user experience including training – When introducing a new software solution to a Practice albeit to replace a manual paper process or an existing Patient system, any stress to end-users should be minimal. The scope and quality of user training undertaken by the provider must result in appropriate levels of competency being delivered.  To assist this process consider your needs and questions prior to training
• Technical Support performance – A test of any Vendor is the client’s accessibility to help and speed of issues resolution.  You will always get through to Sales, but can you get through to technical Support without a long wait?  Is support UK based or overseas?

Having chosen a system, implementation must be supported by a clear project plan including training.  To ensure optimum performance with trusted data, regular data maintenance including accuracy checks must be undertaken as this will ensure that you have the best information on which to base business decisions.  The true values are contained in the ability to measure and manage the patient base activity, growth, revenue generation, financial forecasting and future business planning.  Now your Practice can become pro-active instead of reactive.

All Practices need solid foundations that underpin their operation which is achieved by the implementation of well considered operational Policy and Procedures.  These must be clear, concise, legally correct and easy to follow. All too often we find businesses operating on customer and practice with evidence of poor compliance, resulting in avoidable risk and loss.  As a consequence they are exposed to both legal and financial impacts.  

Practice owners have a clear duty of care to ensure that all aspects of their business are managed to the highest standards and their environment is safe for all those who enter their premises or use their services.  Far from being a cumbersome or negative process the introduction or update of Policy and Procedures presents a positive opportunity to instil legal and operational compliance, accountability, best practice and of course a first class patient experience.

There are a number of organisations offering off-the-shelf procedural packages, but these tend to be of a generic nature and are not tailored to the individual needs of a business.  It is therefore essential that Policy and Procedures match all aspects of the operation, with revision and issue controls, also reflecting the brand of the Practice. 

Having implemented your procedural package it is then vitally important that they are accessible to all members of the team. This can be achieved by producing hard copies which are then made available or, if an appropriate IT infrastructure is in place, they could be published on the internal network. It goes without saying that the process will need to be carefully managed and an appropriate person should be appointed to control this process.

The mechanism for recording and controlling financial activities is often fragmented across various software and paper-based systems, thereby restricting immediate visibility and ease of reference.  It is hard to imagine how some Practices even attempt to operate without any formal accounting arrangements, but these businesses do exist albeit very precariously.  Financial management including forecasting efforts, budget setting and accounts preparation are affected as a direct consequence of process deficiency.  In addition measurement and management capability are compromised. 

In these difficult financial times many Practices are finding the going tough and those without appropriate financial management processes are being hit hardest of all.  Regaining control of the money can seem a daunting task, but with the right accountancy support including a suitable accounts software package recovery can be achieved.

You should ask the following questions;

Q. Is your Accountant proactive and working to ensure your interests are protected?
Q. Are you able to manage your Tax payments?
Q. Are your borrowings bleeding the Practice dry?
Q. Do you operate a Profit and Loss Account and if so, is it based on realistic forecasts?
Q. Has your Accountant helped you to develop a financial recovery plan?

The goal must be to restore financial management and visibility that will help reduce debt, establish cash flow and support future growth initiatives.  Being a big negative for many Principals this is in fact a huge opportunity to become proactive and regain full control of the business and its future.

The Practice Team constitutes the most valuable resource any business has and it is vitally important that every individual performs their duties within a cohesive and structured framework.  Where suggestions and concerns are raised they should be considered positively and responded to as appropriate.  However, all too often lines of communication in all directions are deficient, resulting in instances of misinterpretation and unnecessary conflict within the team.  The overriding cause of this is the lack of direction, no formal structure and an absence of Management support or accountability.  No Principal can hope to run a successful Practice without the full engagement and support from all employees

Staff management is often regarded as an inconvenience that detracts from the daily delivery of dentistry, but this is far from being the case, as positive team management should be recognised as a major opportunity that will contribute greatly to the delivery of a first class Patient experience and increased profitability.    

How does this compare with your Practice? 

Ask yourself the following questions;

Q.  Are the team managing you?
Q.  Are they adequately trained to perform their contracted duties?
Q.  Are they fully engaged?
Q.  Do you keep your team fully informed through regular staff meetings?
Q.  Does every team member have a Contract and an appropriate Job Description?
Q.  Do you conduct regular staff appraisals supported by appropriate training and development arrangements?
Q. Do you reward your team for their efforts?

If your answers to these questions indicate that you are not effectively managing these aspects, you have a positive opportunity to address these areas for the benefit of all.  Tackling each subject in turn will make the process manageable and return control to the Practice Principal.

Remembering the old adage ‘You only get one chance at making a first impression’ how does your Practice measure up? Striving to offer a first class experience each and every time for both new and existing Patients, should be the overriding goal.

Here are some of the questions you may wish to consider;

Q. Does your Practice present a friendly and comfortable environment for all patients and visitors?
Q. How good are your telephony arrangements i.e. do your staff demonstrate good telephone answering skills and do they posses the knowledge to answer patient enquiries and engender confidence?
Q. Are your patients aware of what treatments and services are on offer and do these meet their expectations?
Q. Do you keep your patients fully informed throughout their course of treatment?
Q. Do you publish periodical Newsletters including feature articles and the latest Practice news?
Q. Does your Practice have a well designed and informative website with Patient interactive capabilities?
Q. Have you considered asking your patients through a well constructed survey, to critique their experience’s, you may be surprised by the responses?

As a result, you might discover that your perception in relation to performance is not the reality, which can in the first instance be de-motivating. However, a clear set of issues will emerge which will highlight significant opportunities for improvement.

Taking this one step further, it is well known that actually asking your existing Patients to refer their friends and family has the greatest impact on new patient acquisition and is a clear indication that you have made the experience “enjoyable” enough to want to return. The added bonus is that patients are then willing to recommend your services to others, resulting in valuable free advertising for the Practice.