The prospect of direct access has dominated the dental news and chatter lines, understandably. Whilst most of the attention has been on ‘who can do what, when and to whom?’ – there are other, potentially equally important issues for dental practices to start thinking about.
I’ve had direct personal experience of what a fragmented team can look like. When the thinking’s not joined up, the team members themselves become unsure of their roles, boundaries and interactions, and the situation can look even worse from the point of view of the ‘customer’.
Given the current imbalance between the numbers of registered dental hygienists and therapists in contrast to the number of registered dentists, you don’t have to be a genius to see that the effects of the latest changes will be some time in becoming apparent. That gives us a breathing space to plan how things should work – and work properly – when their full impact begins to be felt. However, for some practices, there may be little or no time at all, if they are already benefiting from an existing skill-mix in their business.
The workflow, or patient journey, in most practices in general has followed a common theme. The new patient’s first contact is with the reception or administration team who make the initial arrangements for a comprehensive dental examination with a dentist. This then results (hopefully) in an agreed treatment plan which may cover weeks, months or in some cases, years ahead.
The patient may then be referred to a hygienist or therapist as required, with treatment phased between each and the dentist acting, if you like, as the clinical ringmaster and providing continuity at recall intervals determined by the patient’s condition.
In the future, however, the new patient may be allocated directly and initially to a clinician who may be a hygienist, therapist or dentist. They will examine and determine whether the patient’s needs are within their competency, and may either carry out the treatment or refer internally to colleagues.
I mentally envisage a hallway with a reception desk in the middle, and patients moving in and out of a variety of doors and in some cases having an established relationship with a single clinician alone, who may or may not be a dentist.
All this is quite probably no detraction from the quality of care that a patient will receive, and if properly managed, has the potential to raise the efficiency of the practice and to ensure that the patient receives the most appropriate treatment with the least delay and at a proportionate cost.
However, my concern is what happens to the team? There is no longer the assumption (and in reality there has never needed to be such an assumption) that the principal dentist or partners are the ‘team leader/s’. There are already a few very effective practice structures where this is already not the case.
This diverse patient flow and treatment management approach will place a much higher emphasis on excellence in leadership, management, communication and external marketing. The alternative is that a practice will become a true ‘polyclinic’ with little in the way of efficient business control.
A new perspective on leadership and management training will have to evolve. This is already available from some providers who are experienced in and attuned to the particular needs of primary dental care, but more practices will have to take this seriously.
Communication, covering both interpersonal exchanges and data flows will have to be structured differently. If the standard of care and the effectiveness of the practice is to be monitored and maintained, a much more structured and considered approach will be needed.
Finally, if the business is to be recognised as excellent, and differentiated from its competitors, then the external marketing and branding will become, in my view, a much more significant part of the strategy for success in many practices for which it has been rather a hit-and-miss component up to now.
Direct access is about much more than who does what. In the longer term it will change the way we do business, as well as the way we provide health care and treatment for our patients. Together, the successful practice will become even more so. If we work apart, the outlook will be far less predictable.