Monday, March 11, 2013

Outside the Box

Once again, I am posting following a weekend. I hope that you are back, feeling refreshed and ready to take on your week. I also hope that you are continuing to encourage your team and give them thanks and appreciation, as last week was Dental Assistants Recognition Week.

If you missed it, don’t panic. But don’t be aloof, either. Maybe order in lunch. Then, program into your calendar for the end of February 2014 to recognize your dental assistants. Call yourself out on your error and recognize the dental assistants that make us who we are. I don’t know about you, but I sure as heck couldn’t do what I do every day without the team that supports me. On that note, don’t forget your business team this April. Having the dental team on my mind, I want to share with you some ideas that you may not have taken into consideration yet.

First of all, look at your team, the entire team. Are they performing the essential duties that you have identified? Does someone possess a skill set that is being underutilized? Are you following the guidelines set forth by your state’s Board of Dentistry? In my state, assistants are either OJT DA (on-the-job trained dental assistant) or RDA (registered dental assistant). Although CDA is a national certification through DANB, the State of Michigan does not apply CDA to any of its state rules and regulations. The key here is to know your state laws. I see this is an opportunity, rather than a restriction.

Evaluate each member of the dental assisting department and let go of your controlled mindset that you are the only one that can do it all. Teach them how you want it completed and go! This is a perfect example of how to maximize expanded functions (again, assuming you have similar laws in your state). Once I have prepared and am ready to restore a composite case, I can call for one of my qualified RDAs to place the rubber dam, matrices, and etch and bond. This gives me the opportunity to jump up and complete a hygiene exam or two. If we are restoring with amalgam, the RDA can place and carve the amalgams. I return to check the restoration and we are done. This allows me to do the dentistry that only a dentist can complete: radiographic interpretation, diagnosis, treatment planning, etc.

Most dentists have told me that they can do it faster so they don’t delegate the duty to the team. This is where I will challenge you. You may be able to do it faster right now. How long have you been doing clinical dentistry? Were you this fast and efficient on your first day out of dental school? Not likely. Your team needs the opportunity to hone their skills to become better and faster. If allowing the RDA to restore will cause a problem in the daily schedule by getting behind (this is rare), I will reconsider. But I normally have “dentist” work to do while those transferred duties are being completed.

Are you concerned that your patients will wonder why the assisting is restoring? Actually, they won’t. It is all about how you set up the scenario. Have you ever had a patient ask you why you were not the one taking the radiographs? I have not, and that is because we are clear with the patient. I will tell the patient that Jane is going to take the necessary x-rays so that I can complete my exam. Or Jane will explain that Dr. DeLacy has prescribed several x-rays to evaluate this area, and once they are completed, she will review them.

The same verbiage occurs when I transfer the responsibility to the assistant. I simply call to find out if they are available. When they arrive, it is a straightforward delegation. “Jane please restore #30 MOD, noting that there are two separate preps.” The RDA will often repeat it for the patient’s benefit and then ask me if there is a need for liners/bases. When that transfer occurs, the patient really has no reason to question it. We have found this to be a critical function of efficiency.

The other side to this coin is that, although you may have a team member(s) that have expanded duty certifications, you still need to evaluate their individual skills. Just as general dentists can legally complete many aspects of dentistry, we know our limitations and only perform those which we feel we will have predictable control over.

Evaluating team skills should be an ongoing process. The same process should apply to registered dental hygienists. Have you sat in their chair for a dental cleaning? If you haven’t, you absolutely should. You need to know how they physically handle a patient. Are they heavy-handed, too gentle, maybe a bit gruff? Also, if your state allows it, have your hygienists anesthetizing your patients. In our state, it has been allowed for at least ten years and it has been a great benefit for our patients. Still though, make sure you are clear on your dosing orders and don’t have your hygienists uninformed of your expectations. Also, have them give you a block so you can make sure you like their technique. I know that working on the boss can create anxiety and fear, but if they can handle you, they can likely handle your worst patient.

Really think about delegating responsibilities. Review your state’s laws. Make sure you aren’t missing an opportunity to have your team work with you rather than for you. Also, really look at each person’s skill set. If you have someone that is great at discussing treatment plans and treatment options, why not have them do case presentations? Do not have blinders on when it comes to your team. If you pigeonhole them into a narrow job description, they may never look around to see that there might be something more that they can do for you and the practice.

Have a great week! And please, share your experiences here as well.

Dr. Colleen DeLacy

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