PM Ortho 1 PDF

PRACTICE MANAGEMENT CONTENT • INTRODUCTION • PRACTICE MANAGEMENT • ORTHODONTIC OFFICE • MARKETING • ETHICS • CONCLUSION • REFERENCES 2 From the very earliest times, humans have been plagued by dental problems and have sought a variety of means to alleviate them. 3 • The first dental healers w...

PRACTICE MANAGEMENT CONTENT • INTRODUCTION • PRACTICE MANAGEMENT • ORTHODONTIC OFFICE • MARKETING • ETHICS • CONCLUSION • REFERENCES 2 From the very earliest times, humans have been plagued by dental problems and have sought a variety of means to alleviate them. 3 • The first dental healers were the Physicians, but by the middle ages the barber surgeons of Europe had specialized in the care of the teeth. • These practitioners not only learned by trial and error but also by observation. 4 INTRODUCTION • Dentistry :a health care profession • Two fold role : • to provide health care & service • to make profit as a small business. 5 Dental Oath I swear by my conscience, the almighty, and all that held sacred by my faith, to uphold according to my ability and judgement this code and covenant. To regard my duty to the patient as holy and use my art and skill to alleviate pain and suffering regardless of my considerations: to recognize my responsibility to the profession, to uphold its honour and its frontiers: to refuse to use my knowledge to be used in any ways that is contrary to the laws of nature and land and shall obey none but the dictates of conscience and ethics of my profession and to uphold the privileges of confidence and consent of my patients. 8 Open a new clinic Join PG Work in some clinic/ hospital Changed the profession Dr. ANALHAQ SHAIKH 9 Orthodontics ………………….. which attracts the largest percentage of dental graduates…… 8 • Reasons to take Orthodontics and Dentofacial Orthopedics as career Ø Respected Ø Be your own boss ØIt’s a great opportunity 9 Advantages of the orthodontic specialty • Work with patients for extended periods of time • Get to know your patients well • Get to see your patients change over a period of time •Have the freedom to enjoy family, hobbies, and community activities 10 • Many of today’s orthodontists are learning to become great diagnosticians, excellent wire benders, and motivated researchers! • We have all probably heard comments about a medical or dental office where the doctor has good technical skills but displays a poor chairside manner or the office looks good but staff is not friendly and does not seem to care about the patients. Peter Sinclair & Ellen Grady. AJODO 2001 11 Most orthodontic training programs focus on 3 principle areas – 1. The biologic and biomechanical basis of orthodontics. 2. The principles and techniques of clinical orthodontics. 3. Scientific principles and critical thinking. 14 • But the essential 4th element is often missing. P_R A_ _C _T _I C_ E_ M _AN_ A_ G_ _EM_ _E _N T which is not being taught……… this tends to result in well trained clinicians who are poorly trained managers. 15 • Gives a brief overview for clinical setup, run a practice, manage, motivation, marketing. Everyone has a different personality and therefore, would apply these principles differently. 16 PRACTICE MANAGEMENT A TOPIC WHiCH HAS NO “READY MADE MATERIAL”… 15 DENTISTRY/ORTHODONTICS BY CHOICE & NOT By DEFAULT 16 CHANGING SCENARIO Up to 1940s: • Solo practice • One-on-one relationship • Relatively low pressure, and monitarily rewarding • level of dental sophistication • Free to charge 1950 - 70 : • Consumer demand • Population increased and a greater desire • Technical advances 19 Mid 1970’s: • Patients were hard hit • Manufacturers faced layoffs Excessive number of graduates ERA OF COMPETITION 18 Through 1970s and 90’s : • Alternate service providers emerged • Department of health maintenance organizations (HMO) The 21st century: • Change in insurance scheme • Advanced technologies • Demanding conscious consumers 19 Our basic premises are 1. The primary goal is to get satisfactory outcome. 2. Early treatment has to be a part of futuristic orthodontic planning since it is essential to preventive procedures. 3. Orthodontist should be an authority on occlusion, including TMJ function. 20 4. Quantity is not necessarily an enemy of quality, if quality comes first. 5. Orthodontist needs better communication with patients, parents, dentists and the public. 6. Time is one of our most valuable assets. 21 Weapons in the ORTHODONTIST’S ARSENAL 1. Functional Appliances 2. Orthopedic Appliances 3. Therapeutic Extractions 4. Distalizing Appliances 5. Orthognathic Surgeries 6. Distraction Osteogenesis 7. Implants as an aid to Anchorage 22 • The general philosophy in orthodontics is based on following principle – 1. Effort = Result . The level of effort is the measure of the result. 23 2. It is important to make efficient use of one’s time. We cannot save time, but we must spend it wisely. 3. The team approach is also a component for successful practice management. 4. The better the product (service rendered), the greater the financial reward. 24 The real key to any successful practice is having patients who will cooperate. 25 Why do people seek orthodontic treatment??? 26 Challenges faced by today’s practitioner • Problem of plenty • Price undercutting • High real estate price • Exorbitant inventory cost • High recurring expenditure • Man power problem • Continuous upgradation with knowledge and technology • Over demanding patients 31 Raise the bar 1. Competition proof 2. Recession proof 28 Triad for success • Updated knowledge of success – and putting it into practice • Efficient practice management • Proper finance management 29 PRACTICE MANAGEMENT • Survival Phase 2-5 years • Consolidation Phase approx. till age of 40- 45 • Relaxation (Retirement) Phase 30 Survival Phase • Institution attachment • Visiting practice • Own stationary practice • Combination of two or more of the above 31 Advantages of attachment in a Teaching Institution • Helps to be in touch with the latest developments. • Fixed income. • Can practice after college. 32 Disadvantages of attachment in a Teaching Institution • Loss of efficiency due to excessive travel time • Loss of valuable waiting period time in case the ultimate goal is to start it’s own practice 33 Advantages of visiting practice • Less overall responsibility • More money with less tension 34 Disadvantages of visiting practice • Loss of identity • More tiring and cumbersome after few years • More “SPLITS” in fees, therefore tendency towards short cuts • Less financial gain for the amount of effort put in 35 Own practice • Exclusive orthodontic(speciality) practice • Practice general dentistry along with special practice 36 Advantages of own/rented practice • Excellent way to develop one’s own identity • Real estate appreciation • Less or no split in treatment charges 37 Disadvantages of own practice • Waiting period of approx. 1000 days • Minimum administrative expenses 38 Consolidation Phase 30-45 years • Renovating and updating small clinic • Expanding a small clinic to multiple operatory • Having a dental surgeon or associate • Multispecialty dental clinic 39 ORTHODONTIC OFFICE Transitional office design for Dr. Harry Bussa (2,900 square feet) 45 Transitional office design for Dr. George Adams (4,000+ square feet) Floor Plan for a 1000 square foot office 47 Site Planning • Office Location • Areas demographics • Price of land and overall cost of the project • Legal restrictions • Landscape and greenery • Type of building • Parking space 44 Office location • Choosing an office location can complicated and time consuming. • The most important be Q is – • Where do I want to live ? • Do I want to practice in a large or small town ? 45 Large towns ADVANTAGES ü More privacy ü More things to do ü More chance for association ü More potential for increase in population ü More groups in which to choose friends DISADVANTAGES × Constant influx of competition × Continuing need to promote your practice × Harder to get name recognition × Higher cost of living 46 Smaller town ADVANTAGES ü Fewer orthodontists in town ü Not as much as constant worry about referral sources üOverhead is less, not as much staff turn over üMore flexibility in scheduling ü Greater status in the community. DISADVANTAGES × Fewer groups with which to associate ×Wife may have a career, & have little opportunity × Educational level is usually less 47 Physical Layout • Buildings and alterations are long term investments and physical structures that cannot easily be changed; we need to do some careful research and plan well. • Some times, it is also beneficial to employ the services of an architect. 48 • The ambience and design of the clinic is an important factor in the success of any practice. • The reception room and reception desk make an immediate impact on the new patient’s entry into the practice. Gansberg M. Redesigned office and operatory increase efficiency. J Clinc Orthod. 1973; 8: 508–513p. 49 Analysis of Location…….??? 1. Visibility 2. Traffic count 3. Access from Street 4. Dentists willingness to Refer 5. Cost of Land 6. LOGO & NAME 50 • A warm atmosphere and decor go a long way toward establishing a comfort zone for both parents and patients, who are often anxious about the initial examination. 51 The 3A’s • Accessibility • Availability • Ability 52 Waiting area • Cleanliness • Fragrance • Music • Audio visual aids 53 RECEPTION AREA Phone call • Courteous • Fix appointment suitable for both 55 • Receptionist is the person who makes the first office contact on phone, so these most important auxillaries should have following qualifications;-----------1. Dental auxillaries experience 2. Good telephone voice 3. Physical appearance - according to what our patient will accept and be pleased with. 56 1. Phone must be answered promptly. 2. Answer with pleasant and concerned voice. 3. Listen carefully and obtain all the information before closing the conversation. 4. Never discuss fee or financial arrangements over the phone. 57 First visit at clinic • Large reception if possible • Reflect the attitude of the people working • Information regarding chief complaint • Referring doctor/patient if any • Distribution of educational material 58 Body language • Positive attitude with enthusiasm • Proper dressing • Proper footwear • Mild perfume • Apron • Soft music • Proper pen and writing material at specific place 59 Operatory Area • There can be 2 separate operatories – • One for adolescent patients • The other for adults • Adult room : It is decorated primarily in subdued and relaxing colors. Hanging plants may be present. A separate adult tooth brushing area is provided. There is an adult on-deck area where coffee and the morning newspaper are available. 60 • Children’s room – operatory It is much larger and colorful room than the adult area. The child has various entertainment choices to help him enjoy the time when he is not actually being treated. 61 • You cannot rely on the patient’s ability to judge your skill and quality of care. • An exceptional office environment and a warm, caring staff are fundamental if you want to improve your case acceptance rate Hamula W. Orthodontic Office Design. J Clinic Orthod. 2000; 34(3): 145–146p. 62 Office Personnel • Office manager • Receptionist • Chair side Assistant • Lab technician 63 • The members of the office are critical to the performance of a practice. • Anything done by any staff member is a reflection on the doctor. • Therefore, it is most important for the practitioner to surround himself with individuals he can rely on, who can share his same basic philosophies. 64 Staff • Neatly dressed • Apron • Etiquette in telephone conversation • Delegation of specific work to each Dr. ANALHAQ SHAIKH 65 Consultation appointment • Consultation not on Dental Chair • Consultation in non operatory area • Emphasize the benefits of treatment • Professional presentation with audio visual aids • Show results of similarly treated cases by you to induce confidence • Confidently discuss charges looking straight into the eyes 66 Consultation Room 67 68 • One more advantage is the racial mix of people, so that each patient has to be analyzed and diagnosed on his or her own merit. 69 APRil 19 MARKETING 71 • In general marketing is most often the focus in highly competitive environments. • Also general economic situation will always affect the number of patients seeking orthodontic treatment. 72 • Comparing the number of orthodontists 10-20 yrs ago, there are more number doctors practicing every year. • The patient pool is also affected orthodontists practicing orthodontics. by non73 • Marketing is a process that enables us to better understand the needs and wants of our patients. • Marketing encourages people to want our services as opposed to someone else’s. 74 • Offering or promoting a service or product usually new or out of the ordinary that we want our consumer to receive. ! ADVERTISING MARKETING • Offering or promoting a service or product that consumer already perceive as desirable. It is giving them some thing they already want or enjoy. 75 Marketing Techniques • INTERNAL MARKETING • EXTERNAL MARKETING Dr. ANALHAQ SHAIKH 76 Internal Marketing • Internal marketing plays a vital role in any practice. No orthodontist can survive without it. It is one thing to produce quality results. 77 • Workmanship • Salesmanship 78 Equipments • Proper sterilization protocol • Use of distilled water whenever indicated • Regular oiling of equipments as per manufacturer’s instructions • Show any equipment which is exclusive n your clinic 79 m 80 81 • When people come into the office, they must believe that they are coming to a highly qualified practitioner. • The patient, the parent, and the referring dentist must be convinced that this office will take proper care. • If that image can be created, the practice will stay busy. 82 • Internal marketing starts with the patient/parent first visit. • Doctor should sit down and talk one-on-one, explain the problem, and discuss exactly what treatment is proposed. • This quality time which allows the patient and parent to develop confidence in the doctor. 83 • As treatment progresses, it is important to continue setting and reaching various treatment goals. This reinforcement technique prevents patient burnout. • However , no matter how enthusiastic the patient is in early in treatment, after 2 years, he is usually tired of being lectured to by his parents and orthodontist. 84 • Therefore, that special day, the day braces are removed, should be treated as a very important day. • The patient is now prepared for the most beneficial type of internal marketing. • After the braces are removed the patient and parents are shown the pre treatment photos and models and comparison are made. 85 • Parents are extremely happy to see the results ……. • After seeing the comparison of before and after treatment, the family will walk out of the office and want to tell their friends about their successful orthodontic experience. 86 • Responsibility • Recognition • Rewards 87 You don’t get a second chance to create a good first impression • Phone call • Interaction with receptionist • First interaction with Orthodontist 88 Time Management • Punctuality at clinic • Time efficient treatment protocol (SL brackets) • Work delegation both to clinical and non clinical staff • Finish maximum work for a particular patient in one appointment whenever possible 89 Unproductivity at clinic • Mobile phones • Gossips • Idiot box • Browsing net and social sites 90 Constant UPGRADE • Upgrading knowledge • Equipments • Record keeping • Clinic • Standardization of clinic (certification) 91 External Marketing • This simply means by media advertising. • PDA, ADA and AAO disapprove of paid advertising, which is considered unprofessional. 92 External marketing • Showmanship (achievements) • Practice name (branding) • Publications • Mailers • IOS Web site • Public awareness (radio) 93 94 In Greek, ethos The disciplined study of morality. Dr. ANALHAQ SHAIKH 102 • As early as 5th century B.C : "Primum non nocere" ("First do no harm"), attributed to Hippocrates. The main principle we should have “voluntary written consent ” regarding participation in treatment. 96 • Main purpose of written consent is to provide documentary evidence, that explainations of proposed treatment was given and consent was sought and obtained. • Information to be explained in consent form 1. Benefits 2. Drawbacks and Risks 3. Cost . 97 3 basic ethical principles 1. To do no harm Respect for persons Justice Beneficence 2. Promote good 3. Maximize benefits, minimize risks • Every doctor starts from the bottom unless he is joining an existing practice, or continuing his parents practice. 99 • The orthodontist who begins his own solo practice has no patients, no income, & a mountain of debt and doubts. 100 SERVICE v/s BUSINESS As a health care service: Provide quality care for the patient, following standards of care established by government and the profession itself. As a business: An enterprise in which one is engaged to achieve a livelihood, be productive & create a profit. Future of speciality practice • Solo practice • Group practice • Dental / Orthodontic CE programmes • Dealer / manufacturing Dental materials • Dental and Orthodontic lab 109 Patient’s mental attitudes – They are willing to accept the judgement of their doctor without Question. They accept their doctor will do best that can be done. Ideal attitude for successful Rx PhilosopDhr. AiNcAaL l They have little appreciation for the efforts of doctor & offer Rx because of insistence of their families. They require more time for adjustment. Indifferent These group are those who find fault with everything. They are never happy, & firm control of these Pt is essential. Succesful Rx can be most Rewarding Critical These Pt’s are those who had bad results with previous Rx, and are therefore doubtful that anyone can help them. Skeptical 110 • Effective patient management is the key to a successful practice. • But if patient becomes dissatisfied with the way he is managed during treatment, he will develop a negative attitude. 104 THE ART OF DENTAL EXAMINATION • This simply thorough. means being • A complete and thorough examination will not only enable us to deliver the best possible treatment but will also help to prevent the malpractice suits. 105 • Actual examination should follow after the consultation which should be extra oral and intra oral. • Consider every aspect of dentistry when examining the patient. • Expertly record the results of the consultation and examination. • Inform before you perform. 106 • It is important that both the parents be present at the consultation. They are made to realize it is a team effort and also we should make them comfortable and relaxed enough to ask questions. 107 • The first requirement for creating a compliant patient is that the clinician must believe in his or her technique, “Your beliefs are the most powerful motivational tool - if you can just learn how to use them.” • Keeping treatment simple and executing a step-by-step plan will make explanation and monitoring easier. 108 • After preliminary diagnosis – 4 items are always covered: 1. It is an extraction or non-extraction case 2. Expected length of treatment 3. Estimated fee range 4. Next appointment for diagnostic records. 109 • Generally the patient would like the treatment to be completed as painless and comfortably as possible and quickly and efficiently and with the least expenditure of time, effort and money. “MAXIMUM DENTISTRY IN MINIMUM VISITS” H 110 • When the patient/parent agrees for the treatment, the fee is collected. • If the patient requires any restorative procedures, prophylaxis or periodontal therapy, it should be performed prior to the onset of the orthodontic treatment, and appropriate instructions is given to the patient. • The new patient card is then delivered, this serves to remind the patient of his next appointment time. 111 Patient appointments - • There is an old aphorism about appointments which holds true : “you run the appointment book, or the appointment book will run you.” • If the patient can choose any day he wants to for his next appointment, the practice loses control. 112 • This method of scheduling one day at a time also provides control over the number of patients seen at each hour of the day. OVER SCHEDULING DOES NOT BENEFIT THE PATIENTS OR THE PRACTICE 120 Debonding appointment • It is the highlight of the day and one of the most exciting times in a patients life. Dr. ANALHAQ SHAIKH 114 • At this time, any frustrations encountered by doctor and patient during treatment are forgotten. • Here the emphasize is that the doctor, patient and parent all are succeeded. 115 • The post treatment review wonderful experience for doctor is the 116 Child Orthodontic Patient 117 • “SUCCESS IS PATIENCE WITH PATIENTS” • Orthodontist must be patient with those young people who have a difficult time following directions. • Child patients are young and developing, they are by no means perfect. 118 • The doctor cannot give up on them. He must continue to encourage, motivate, and praise, even when the patient makes it difficult. 119 Orthodontic management of medically compromised patients 121 • Orthodontic procedures generally perceived to be among the least invasive and physiological benign of any in the dentistry. • However it must be evaluated for potential risk for medically compromised patients and orthodontists must be comfortable with being able to identify patients at risk and to treat them appropriately. 122 Many of the behaviours associated with non-compliant orthodontic patients are Poor oral hygiene, Chronic complaining, Easily fatigued jaw muscles, Inability to open their mouths wide, Frequently broken appliances, Refusal to use appliances, Frequent missed appointments. 123 • Rather than considering these patients as having character defects or poor attitudes, orthodontists should view them as “turtles without shells”. 124 Major risk for medically compromised orthodontic patients associated with bacteremias, are caused by • Band placement and band removal. • Bleeding and infection cause by mucosal and gingival irritation. • Ability of patients with some conditions to tolerate treatment. 125 Management • Communication with patients physicians. • Aggressive pretreatment and intratreatment oral hygiene maintenance. • Prudent use of prophylactic antibiotic therapy. • If diagnosis of leukemia or aplastic anemia is made, removal of existing orthodontic appliance is mandatory to minimize the risk of gingival or mucosal irritation ,bleeding or infection. • Elastomeric modules are preferred to wire ligatures. 126 Patients with Asthma • It has been suggested that orthodontic induced external root resorption occurs with greater frequency in patients with asthma than in nonasthma population. • Therefore it would seem prudent for orthodontist to disclose the increase risk of root resorption to patients before initiating the treatment. 127 Patients with diabetes mellitus • Orthodontic treatment should be avoided when diabetes is poorly controlled. • When diabetes is under control, treatment can be carried out but periodontal health should be maintained. • Proper oral hygiene instructions should be maintained. Dr. ANALHAQ SHAIKH 128 • Duration of treatment should be reduced. • Effort should be made to avoid any form of gingival or mucosal irritation. • Aggressive pretreatment and intratreatment oral hygiene maintenance. • Prudent use of prophylactic antibiotic therapy. • Elastomeric modules are preferred to wire ligatures. • Fixed retainers over removable retainers. Dr. ANALHAQ SHAIKH 129 Risk of bacteremia • But how orthodontist is related ? 130 Endocarditis Damage to the endocardium Adherence of platelet and fibrin to subendothelial layer Development of nonbacterial thrombotic vegetation Bacteria Adherence of bacteria to the vegetation and further increase in the size of thrombus Multiplication of the bacteria Local & systemic complication 131 Orthodontic considerations • Band placement and band removal. • Bleeding and infection caused by mucosal and gingival irritation. • Scaling procedures. 132 Motivational Approach 1. Always remember or have a way of reminding yourself of patients’ names, especially nicknames. 2. Bring up things about patients’ lives at their visits— not just hobbies and interests, but current events. 3. Treat all children and adolescents as if they were adults., Don’t demand cooperation; ask for it. 4. When a visit is over and the patient is dismissed, give him or her a genuine smile. 133 Treatment Overruns 1. Poor cooperation 2. Broken appointments 3. Appliance breakage 4. Altering the treatment approach in midtreatment 5. Treatment started too early 6. Abnormal eruption of second molars 134 7. Adult occlusion 8. Open bites with unresolved tongue thrusts, macroglossia, or skeletal dysplasia can have greatly prolonged treatment times. 9. Some impacted teeth 10.Birth defects. 135 136 ULTIMATE GOAL • OWN GOOD CLINIC • OWN GOOD HOME • LEAST TRAVEL TIME 137 138 Conclusion • Clinical practice is a balance of experience, and our intuitive clinical experimentation, an evolving process which shape up our philosophy of treatment. • When a good result is achieved, it can be exhilarating. When good results eludes us, it can be quite frustrating. 139 • While there has always been a difference between success and greater success in practice, i.e., “ONLY THE FITTEST SURVIVE” • Competition from other orthodontists and general dentists doing orthodontic treatment has added to the struggle for survival. 140 • The key to successful practice of orthodontics is reexamining our treated patients, carefully evaluating the results, and then incorporating our diagnostic skills and treatment mechanics to minimize the magnitude of relapse. • Practice management is not a single exercise. It is an ongoing procedure – a planning cycle. 141 “Managing a practice is an art in itself which everybody has to master it so as to lead a comfortable, satisfied life.” 142 The heights the great men reached and kept were not attained by sudden flight. But, they were toiling upward in the night while their companions slept. - H. W. Longfellow 143 REFERENCES • Warren H. Orthodontic office design. J Clin Orthod 2000;34:15-8. • Warren H. Orthodontic office design. J Clin Orthod 2002;36:701-6. • Warren H. Orthodontic office design. J Clin Orthod 2003;37:533-40. • Howard I. Management and marketing. Orthodontic office design. J Clin Orthod 2003;37:485-9. 144 • Gupta A et al. Practice Management-Are You Really Doing Well? International Journal of Advanced Health Sciences, November 2014, Vol 1 Issue 7: 24-29. • Kulshrestha R. Clinical Practice Management in Orthodontics: An Overview. Research & Reviews: A Journal of Dentistry Sept 2016; 7(2): 7-17. • Al Atta. Total quality management in orthodontic practice. Am J Orthod Dentofacial Orthop 1999;116:659-60) 145 • Sinclair PM, Grady EM. Preparing to practice and manage: A program for educating orthodontic residents in practice management. Am J Orthod Dentofacial Orthop. 2001; 120: 2–8p. • Melvin M. Management and marketing. Orthodontic offi ce design. J Clin Orthod 1997;30:153-62. • Choosing an office location. JCO - 1986 146