A time travelling practice manager from 1993 would find it hard to recognise the dental practice of 2013. As ADAM (Association of Dental Administrators and Managers) (formerly the British Dental Practice Managers’ Association) celebrates its 20th anniversary this year it is a good time perhaps to reflect on what practice managements should be looking forward to with anticipation and excitement or trepidation in the years to come.
Back in the early 1990s we were still getting to grips with a new NHS contract and many practices had taken steps, some tentative, towards becoming private. Managers were more used to dealing with staff and team issues rather than any compliance issues, and the employment law landscape was rather simpler. Patients too were different back then, and the General Dental Council (GDC) had just relaxed some of the rules and regulations governing advertising. The internet and email were only just entering dental consciousness and the use of social l media as we know it today was unheard of. There was no compulsory continuing professional development (CPD) and of course nurses did not have to be registered with anyone. The role of the practice manager too was a fledgling one and the nature of their role and the responsibilities varied greatly from practice to practice.
Fast forward 20 years and our manager from 1993 might be understandably bewildered by the range of management activities demanded by successful practice today. Many of his or her peers today will be the practice’s CQC registered manager with the responsibilities and accountabilities that this brings. Even if they are not a registered manager the chances are that they are responsible for quality and audits, safety and the maintenance of equipment, making sure staff are fully trained, and of course ensuring that there is a regular conversation with patients to ensure high levels of satisfaction. On top of that they have been managing a new NHS remuneration system for the past seen year based on units of dental activity (UDAs) or units of orthodontic activity (UOAs). Managers now have to be expert in a wider range of activities than ever before.
So if a practice manager today stepped into the same time travel machine and fast forwarded themselves another 10 years what is likely to have changed in that time? Well more stringent compliance measures may be the order of the day following the Francis Report and less amenable public attitudes to health care professionals. The practice manager of 2023 may well be managing more complex teams of dental care professionals (DCPs) and more complex methods of public access to dental care with the advent of direct access. They will also see an even more competitive dental practice environment with practices working harder to differentiate themselves from the competition in order to win patients. The practice manager may well have different titles to emphasise their role – compliance manager for example or business development manager. Those with NHS contracts will need to be highly skilled in the management of those contracts if feedback from the current pilots is anything to go by.
The manager is and will be a key person in the practice. However the truth is that the role of the manager still varies widely from practice to practice. In many ways the main challenge many practice managers still face is having their role clearly defined and understood. It is not now and will not in the future enough to ‘pick the job up as you go along’. Managers need to be trained in the fields we as dentists and practice owners expect them to be responsible for, so that we can all have confidence that managers are working efficiently and effectively. Many dentists do not a have a clear idea of what management actually entails, and therefore because of that many are unaware of what they can and should realistically expect of their manager. Managers must be given the tools, resources and authority to manage, and clear meaningful job descriptions and lines of authority are still all too often lacking. It is not uncommon to hear of managers recruited on the basis that the job will ‘evolve’ which can be a dangerous path to follow. In turn managers need to take responsibility and be accountable for their actions and judgment.
The value of management competences is huge in providing a blueprint to inform managers and practice owners alike of what management involves. We need however to look at not just what a manager needs do or know, we also need to think about the following:
- Attributes such as self-confidence, mental toughness and the ability for example to be organised or work logically.
- Attitudes or how you respond to certain situations or core values you hold such as a commitment to customer service or ethical behaviour.
- Knowledge or what you know.
- Skill or how well you apply the elements listed above in your work.
It must be said however that there can sometimes be challenges in interpreting competences. Working out at what they actually mean in terms of the levelat which managers (and in fact dentists with management responsibilities) should be operating within the practice environment, and the real scope of their responsibilities, can be difficult. This is especially true when you are the only manager in a practice and it is difficult to benchmark your job with others in a systematic way. Different people will interpret the terminology differently which can lead to confusion.
As we move into a new era of dentistry it is crucial for managers and dentists to address the issue of the role of the manager. Management is no longer a secondary function as it might have been 20 years ago in a practice. It is the platform on which good profitable dentistry is delivered to happy and satisfied patients and we need to get to grips with what managers do and make sure we provide access to training in analysis, planning, human resources, marketing, contract management and compliance to ensure they are both competent and confident in their roles.