The Business of Dentistry


FIGURE 1-1 The service concept.

The basis for patient retention is communication that involves 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 financial statements, or did not communicate the treatment plan in advance.

 

image Practice Note

The basis of patient retention is communication.

Service is not a result of clinical and cognitive skills but rather of 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.

 

Box 1-1   Activities That Promote Service

• Maintaining regularly scheduled office hours
• Providing emergency care during the dentist’s absence
• Maintaining the appointment schedule without delays
• Maintaining professional ethics
• Practicing quality care
• Recognizing the patient’s needs
• Taking time to listen to the patient’s concerns
• Respecting the patient’s right to choice
• Informing patients of alternative treatment plans
• Allaying fears
• Hiring qualified employees
• Assigning only legally delegable duties to qualified staff
• Seeking staff input during decision making
• Encouraging an environment of caring
• Updating procedural techniques, equipment, and office decor regularly
• Maintaining office equipment
• Maintaining professional skills routinely
• Operating safely
• Maintaining quality assurance
• Attending risk-management seminars
• Participating in community services
• Being genuine and honest

Cultural Competency

The word culture comes from the Latin root colere, which means “to inhabit, to cultivate, or to honor.” In general, it refers to human activity. Culture is a shared, learned, symbolic system of values, beliefs, and attitudes that shapes and influences perception and behavior as an abstract “mental blueprint.” Cultural competency in dentistry refers to the ability of the system to provide care to patients with diverse values, beliefs, and behaviors, and it includes adapting treatment delivery to meet the patients’ social, cultural, and linguistic needs.

The dental professional’s work in the dental office is affected by culture when working with both patients and staff. People who grew up as part of a certain generation experience different situations during their formative years than do people who grew up in a different generation. Likewise, individuals who grew up in different cultures and with different languages often attach meaning to verbal communication in vastly different ways. Consequently, the dental staff must be aware of how to successfully communicate with members of different generations as well as members of different cultures. Culture makes a significant difference in communication. We learn to speak and give nonverbal cues on the basis of our culture. There are several issues that affect communication in the dental office.

First is the use of nonequivalent words. It is difficult to find a word in one language that is exactly equivalent to a word in an unrelated language. The use of technical dental terms makes this activity even more difficult. A good example of a nonequivalent word is demonstrated by an Eskimo individual, who has several names for snow, whereas a North American individual has only one: snow.

Another factor that affects communication within various cultures is silence. The United States is referred to as a talk or verbal society. For a North American, silence is often uncomfortable, and it is usually not considered appropriate in the American workplace. For example, if an American is criticized in the workplace, the person is allowed to respond verbally to show that the criticism has been understood and to explain how he or she will avoid making the mistake again. In the Philippines, however, the worker more likely would apologize with an action such as extending a favor to the one who has been offended but saying nothing.

Mexico is geographically close to the United States, but culturally it is much different from its northern neighbors. Mexico has a separate history and thus a different culture and different ways of doing and looking at things. The beliefs, expectations, ethics, etiquette, and social conduct of Mexicans are so different from those of Americans that Mexicans may almost seem to be from a different world. Thus, when treating Mexican patients or communicating with a Mexican staff member, one must be aware of the cultural differences and seek to understand how to most appropriately explain the method of practice in the dental office.

Many references are available for translating information into the languages of patients or staff members within the office. For instance, if the office has a significant number of Spanish-speaking patients, all efforts must be made to provide literature, health forms, questionnaires, and other communication in both English and Spanish. Spanish Terminology for the Dental Team is a small book published by Elsevier to help in this scenario. It is worth the effort, too, for the staff to enroll in a short course in the language that the patients or staff may speak.

British linguist Richard Lewis plots the culture of different countries as it applies to the following three categories:

Linear-actives: Those who plan, schedule, organize, and pursue action chains, and do one thing at a time. Germany and Switzerland are in this group.
Multi-actives: Those lively, loquacious peoples who do many things at once and who plan their priorities not according to a time schedule but according to the relative thrill or importance that each appointment brings with it. Italians, Latin Americans, and Arabs are members of this group.
Reactives: Those cultures that prioritize courtesy and respect, listening quietly and calmly to their interlocutors, and reacting carefully to the other side’s proposals. China, Japan, and Finland fall into this group.

Thinking about these categories may be helpful for the dental professional who is presenting proposed treatment to a patient or discussing job tasks with a staff member; it will help him or her to better understand the potential reaction of the person to whom he or she is speaking. Figure 1-2 demonstrates how you may be able to examine the reactions of persons of various ethnic backgrounds using the Lewis model of linear-active, multi-active, and reactive variations (Box 1-2).

 

Box 1-2   Suggestions for Communicating With a Diverse Population

• Be nonjudgmental. Do not judge an individual’s values, culture, appearance, intelligence, attitudes, or other characteristics.
• Respect the other person’s time by being prompt. Hard as it may be, demonstrate patience with patients who do not understand the American value of time. In some countries, the concept of “time is money” is not common. After you become familiar with a patient, try to make adjustments in the schedule so that you can be productive if you have to wait for this patient. You may even list an earlier time on their appointment card than you do on your own schedule to ensure that they will arrive to the office on time.
• Speak standard English. Avoid using slang terms.
• If the office is located in a multicultural area, consider having bilingual signs and business cards. This idea can extend to health questionnaires or other educational materials to be given to patients.
• A smile is a generally acceptable gesture in most cultures.
• Several cultures are offended by people standing with their hands in their pockets.
• Be aware of your gestures. Cultures vary with regard to the interpretation of many gestures, including the following:

 In China and Japan, hugging and kissing when greeting are uncommon.
 Persons from both China and Japan avoid prolonged direct eye contact.
 In the Philippines, shaking hands is a common custom for both men and women.
 Filipino and Taiwanese individuals consider speaking in a loud voice to be rude and ill mannered.
 The Taiwanese society is not touch oriented, and public displays of affection are rare.
 In Taiwan, the open hand is used to point.
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FIGURE 1-2 Lewis model of cultural types. (Copyright © 2014 Richard Lewis Communications.)

Organizational Culture

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 location of the organization, its dress codes, and the office arrangement and design.

Organizational culture can become very complex. However, the following list describes common organizational cultures that can be applied to a dental practice:

• A power culture concentrates the power among a few. Control radiates from the center like a web. Power cultures have few rules and little bureaucracy, but swift decisions can ensue. This could be compared with an authoritarian leadership style. In this culture, one person—the dentist or the practice owner—makes the decisions and seeks little or no input from the staff.
• In the role culture, people have clearly delegated authority within a highly defined structure. Typically these organizations form hierarchical bureaucracies. Power is derived from the individual’s position, and little scope exists for expert power. This term could be applied to a large organization or a clinic in which there are several different specialty clinics, each of which has a specific person in charge.
• In the task culture, teams are formed to solve particular problems. Power comes from expertise as long as the team requires expertise. These cultures often feature multiple reporting lines and a matrix structure.
• A person culture exists when all individuals believe themselves to be 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 are pursuing the organization’s 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 of which involves rapid feedback. This is typical in large organizations, which strive for high-quality customer service. These organizations are often characterized by team meetings, jargon, and buzzwords.
• The process culture occurs in organizations in which there is little or no feedback. People become more concerned with how things are done rather than with what is being achieved; this feeling is often associated with bureaucracies. Although it is easy to criticize these cultures for being overly cautious or bogged down in red tape, they do produce consistent results, which is ideal in certain circumstances (e.g., public services). This type of culture may apply to public dental clinics.
• The blame culture cultivates distrust and fear. People blame each other to avoid being reprimanded or put down, and this results in no new ideas or personal initiative, because people do not want to risk being wrong. This type of culture can be very detrimental to a dental practice staff.
• Multidirectional culture cultivates minimized cross-department communication and cooperation. Loyalty is only to specific groups or departments. Each department becomes a clique that is often critical of other departments, which in turn creates a lot of gossip. This type of culture could exist in a large clinic or a dental school with multiple departments.
• A live-and-let-live culture spurns complacency. It manifests mental stagnation and low levels of creativity. Staff members in this culture have little future vision and have given up on their passions. There is average cooperation and communication and things do get done, but staff members do not grow professionally. People in this culture have developed personal relationships and decided who to stay away from; there is not much left to learn.
• In a leadership-enriched culture, people view the organization as an extension of themselves. They feel good about what they personally achieve through the organization, and this promotes exceptional cooperation. Individual goals are aligned with the goals of the practice, and people do what it takes to make things happen. As a group, the organization is more like family; it provides personal fulfillment that often transcends ego so that people are consistently bringing out the best in each other. In this culture, every individual in the organization wants to do a good job. This is an ideal culture to promote in a dental practice. In dentistry, it is likely that a multifaceted culture could develop (e.g., leadership-enriched culture combined with task culture).

What does organizational culture mean for a new employee or an interviewee looking at a prospective job? It is not easy to identify the type of culture during an hour-long interview, but, if a working interview is possible, the type of culture may soon be identified. This allows prospective employees to see whether the “hum” is there and whether the ethos of the practice fits with his or her individual values, beliefs, attitudes, and emotions.

Types of Dental Practices

In a solo practice, a dentist practices by himself or herself and is responsible for both the business and clinical components of the practice.

Alternatively, a group practice may be formed by more than one dentist either via a legal agreement with each other and managed by themselves, or it may be formed with a dental management company that manages the business aspect of the practice. In this case, the clinical portion of the group is governed by the dentists themselves. It is also possible for a group practice to be managed by an outside company that controls both the business and clinical components of the practice. However, each state does have responsibility for specifying the limitations of practice under that state’s dental practice act.

One of the primary differences between a large group practice and a traditional dental practice is ownership. Dentists in these settings may have an ownership stake or part of an ownership stake, but many are employees of the practice. The American Dental Association noted that, from 2010 to 2011, the number of large dental group practices had risen 25%.

General Dentistry

A dentist who practices all phases of dentistry is referred to as a general dentist. This person will have completed a specified program of study accredited by the American Dental Association’s Commission on Dental Accreditation. Depending on the school from which the candidate graduates, he or she will receive a DMD degree or a DDS degree. DMD stands for “Doctor of Dental Medicine,” whereas DDS

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Mar 21, 2015 | Posted by in General Dentistry | Comments Off on The Business of Dentistry
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