The Business of Dentistry
The administrative professional’s role in the dental office of the twenty-first century is one that will continue to change and be ever-challenging. Although projections by futurists tell us that nearly all purchases will be made virtually and that numerous jobs will be transferred from people to virtual programmers, a phenomenon known as intelligence sourcing, or I sourcing, the dental practice will remain a people-oriented health profession. The person assigned to the administrative role in the dental office must have the ability to achieve the mission of the practice, increase productivity, demonstrate skills in computer technology, and effectively use the most important asset of the practice—its human resources. Indeed this is a time of exploding technology, both in the business office and in clinical treatment areas within the practice. Dentistry as a business must face the same issues as other healthcare and business systems and realize that the world is changing. There is diversity in race, ethnicity, gender, and age, and today’s dental professional must be able to address these issues.
Dentistry is a healthcare profession that has a twofold role: (1) to provide healthcare service and (2) to make a profit as a small business. As a healthcare service, dentistry provides quality care for the patient, following standards of care established by governmental agencies and the profession itself. As a healthcare profession, dentistry embraces the following objectives:
For years dentists have referred to the business office as the front office. This terminology serves to decrease the importance of this area of the practice. After all, there is no “back office.” Dentists refer to other areas of the dental practice according to the work that takes place in them. The clinical areas of the office are referred to as treatment, laboratory, hygiene, or radiographic rooms. The business office should assume its rightful name, since all business activities of the practice take place there, including financial transactions, patient and staff communication, appointment management, recall, inventory, insurance management, and records maintenance.
The traditional education of the dentist has placed great emphasis on developing a highly competent diagnostician and clinician but has often left a noticeable void in the area of practice management. Dentistry in the twenty-first century faces an ever-changing population, a culturally diverse workforce and patient clientele, heightened consumer rights, changing economoy, increased state and federal regulations, an aging population, managed care, satellite offices, expanding group practices, and redefinition of dental assistant and dental hygienist utilization and credentialing. Futuristic-thinking dental practitioners will embrace change as a lifelong, ongoing process for the individual and the practice. The successful dental practice will be led by individuals who look at all situations as opportunities to create excitement and enthusiasm in meeting new challenges. These individuals will realize that technology alone cannot drive the practice, but that employees are a major asset. Therefore a greater emphasis must be placed on practice leadership and management. The administrative assistant or business office manager becomes a vital professional by maintaining records, implementing business systems, managing business operations, and maintaining communication (transmitting information from one person to another) among the dentist, the staff, the patient, and the community.
As modern dentists accept the roles of dentist and entrepreneur, they accept the responsibility of delegating expanded intraoral duties to the appropriate clinical assistants and dental hygienists, more extraoral duties to the laboratory technician, and additional responsibility to the administrative assistant or business manager.
DENTISTRY AS A SERVICE PROFESSION
In the twenty-first century it is evident that the industrial age that dominated the society of our parents and grandparents has given way to a service-oriented age, and dentistry is a major healthcare service. Dental treatment may be the objective for a patient; however, the dental staff must be constantly aware that when patients come to the office to seek treatment or perhaps a restoration (a tangible product), they are also seeking the most important product—service—an intangible product in the form of care. Service is a system of accommodating or providing assistance to another person.
Patients remain with a dental practice only if they are satisfied with the services rendered. Figure 1-1 illustrates the many “ifs” the dental staff will encounter in the retention of a patient in its practice. It is important to remember that patients have choices. If patients choose to come to the office from either a recommendation or random selection, and if they are satisfied with the treatment and care, they may return. If patients are still satisfied at the return visit, they may continue to return. However, if there is dissatisfaction at any stage of the service, patients may opt not to return to the office.
The basis for patient retention is communication, the ability to understand and be understood. A patient seldom leaves a dental practice because of dissatisfaction with the margins of his or her composite restoration. However, the patient may leave because a staff member made it difficult to obtain a completed insurance claim form, was too busy to listen to a concern, made frequent errors on statements, or didn’t communicate the treatment plan in advance.
Service is not a result of clinical and cognitive skills, but rather attitudinal skills that evolve into a commitment to the welfare of others. Box 1-1 lists a variety of activities that indicate a service-oriented office.
The term organizational culture has become well-known in business. Many authors have defined organizational culture, but perhaps for the purpose of dental management it can best be defined as something that an organization or dental practice “is” rather than what it “has.” Organizational culture comprises the attitudes, experiences, beliefs, and values of an organization. It has been defined as the “specific collection of values and norms that are shared by people and groups in an organization and that control the way they interact with each other and with others outside the organization or dental practice.” Some authors even add to this definition the physical being of the organization; dress codes; and office arrangement and design.
• A power culture concentrates on power among a few. Control radiates from the center like a web. Power cultures have few rules and little bureaucracy; swift decisions can ensue. This could be compared with former leadership styles such as authoritarian.
• In the role culture, people have clearly delegated authorities within a highly defined structure. Typically these organizations form hierarchical bureaucracies. Power derives from a person’s position and little scope exists for expert power.
• In the task culture, teams are formed to solve particular problems. Power derives from expertise so long as a team requires expertise. These cultures often feature multiple reporting lines of a matrix structure.
• A person culture exists when all individuals believe themselves superior to the organization. Survival can become difficult for such organizations, because the concept of an organization suggests that a group of like-minded individuals pursue the organization goals. Some professional partnerships, such as dentistry, can operate as person cultures, because each partner brings a particular expertise and clientele to the office.
• The work-hard/play-hard culture is characterized by few risks being taken, all with rapid feedback. This is typical in large organizations, which strive for high-quality customer/client service. It is often characterized by team meetings, jargon, and buzzwords.
• The bet-your-company culture is one in which big stakes decisions are taken, but it may be years before the results are known. This does not apply directly to dentistry perhaps, except in situations of large corporate clinics.