Tag: management

The Dental Office Manager

More and more often we talk about the role of the office manager also in the dental field. But what kind of professional are we talking about? And in which context does the need to train and include in the dental practice a professional figure with such a unique background for the Italian dental business emerge?

The shift in dentistry

Even before the reorganization caused by the pandemic, dentistry presented a scenario characterized by strong dynamics of change. It deals with an evolving market, where offer must keep up with the frequent reorganization of demand and the creation of new standards. 

Dynamics of the dental offer: hypercompetition

The competition is increasingly intense and characterized by two elements:

  • the participation of competitors with a more marketing-oriented approach and organized to pursue profit and scalability goals.
  • foreign investors and funds joining the market.

Different patients and crisis of demand

The demand is also not immune to change and reveals a new patient profile:

  • increasingly solicited by marketing and communication activities
  • informed
  • demanding
  • attentive to the quality of dental services
  • more difficult to attract and, therefore, to build their customer loyalty.   

The dental office’s ability to react: planning and differentiating

From a strategic point of view, the dental practice wishing to react to the changes in market should apply a structured planning and control system: planning and differentiating are the key concepts of the growth process.

It is essential to know that planning does not mean having your own point of view on what will happen and, based on these hypotheses, making strategic decisions related to your business. Predicting is not enough! It is necessary to go further and, once the possible scenarios have been hypothesized, to choose a certain future to pursue and achieve. It is a path that must be built over the medium and long term, through the organization of resources and activities, according to the objectives to be achieved.

The dental offer as a “consumer experience”

In this climate of transformation and adaptation there are now many dentists who feel a certain discomfort, which we could consider as to be of attitudinal type. If the patient evaluates and chooses the practice by looking online or “coming across” the dental office by chance, or after having detected it through a sign or advertising, and not only through traditional word of mouth, the relationship that is being developed with it will be similar to the one with a company (albeit providing health services). In these cases, the dental offer is unfortunately felt according to a “consumer experience” model, typical of a purchase occurring in other sectors and the relationship of trust between patient and professional loses slightly its importance (in the selection phase) in favor of classic brand selection patterns.

Today many dentists therefore find themselves facing this new challenge because the competitiveness of the offer is also based on the patients’ perception (perceived quality), beyond the quality of care received (objective quality), with a greater weight given to interpersonal relationship, extra clinical services, etc.

The value proposition of the dental office

To ensure the social recognition of the practice, it is therefore necessary to define an effective and differentiating value proposition.

The value proposition:

  • is a promise of unique benefits (different from the competitors’ ones)
  • is related to the entire organization
  • can be addressed to the whole target audience or to groups of customers (segments) with similar needs for specific services.

It is a fundamental pillar in the business strategy because it answers the question: “Why should clients / patients choose our practice and its range of services?”.

How to define the value proposition of the dental practice

The steps necessary to define it are as follows:

  • Identify the primary target audienceof the clinic, or the groups of customers (segments) in the case of a specific services range. These target groups are generally characterized by similar clinical needs, but they also look for services in more general terms, positioning, style of perfornance of the treatment, etc. For differentiation purposes, it is essential to define what recipient the offer is addressed to.
  • In order to define a recognizable offer, it is necessary to know the competitors, their offer and the customers they address to, in order to evaluate how competitive the offer is.
  • After having analyzed target groups and competitors,  the overall offer of the clinic  (type and range of services, system of services, pricing policies, performing methods) should be developed with the aim of providing benefits that are an appreciable solution with respect to needs and potential wishes of the target audience and as an alternative to the competitors’ offer.
  • Finally, the value proposition must be formulated clearly, coherently, effectively then, the patients should be made aware of it. Patients must perceive the actual value proposed to them, identifying themselves with the recipient of the offer and recognizing its benefits. The effectiveness of the communication is, in fact, strictly correlated to its consistency with the value proposition and with the selected target.

The foundations for a solid and lasting future

Formulating the dental practice’s proposal in these terms is useful to:

  • obtain a competitive advantage,crucial for success and prosperity over time
  • gain useful data for the development of operational plans.

Within this context, strategic decisions and entrepreneurial activities range from the coordination of human resources and delegation processes, to the definition of the budget and constant monitoring of the performance, passing through the effective management of patients, collaborators and of the office in general, thanks to the most modern techniques.

Strategic analysis is necessary and based on adequate KPIs (Key Performance Indicators), with the aim of assessing strengths and weaknesses and considering environmental opportunities and threats. To lay the foundations for a solid and lasting future, after the strategic analysis, it is useful to implement an action plan.

The importance of business management, besides clinical quality

From the point of view of growth, the traditional practice should go from being only a place where the dentist provides high-level specialist healtcare, to be an organization where it is acknowledged the importance of the extra-clinical aspects of management, marketing and budget control of the clinic and of the resources.

Of course, except for cases where dentists are particularly interested and work almost “full time” on the subject, it is practically impossible for the dentist to personally handle all these aspects in a constant and structured manner, especially considering the increasingly high standards required by patients and by the organizational system (planning and control), which, as anticipated, are more and more often achieved thanks to two fundamental drivers: clinical quality and business management.

The dental office manager: a unique and complete profile within the dental context

And so here are the dynamics and the scenario in which the need to delegate pure management activities to a specific professional, the so-called “Dental Office Manager”, has developed. 

In fact, this managerial figure represents the operative maker of the strategic decisions in the hands of the dentist-entrepreneur, to whom he reports regularly and with whom he collaborates directly. He is responsible for coordinating the daily operations of the dental practice, focusing on the patients’ needs and company objectives, with the aim of making the business more profitable.

The profession of the dental office manager: duties

The dental office manager is an extra-clinical managerial figure specialized in the dental sector and covering different roles, including:

  • business development in general
  • specific marketing activities for customer retention and acquisition of new patients
  • strategic planning of the agenda
  • organization of human resources
  • planning and control of the dental office as a whole
  • cost and performance analysis of individual professionals
  • management of budget forecast and results.

Training and knowledge of the dental office manager

Generally, the dental office manager attended business schools, but it is not mandatory. The background of this figure must include:

  • a specific training, obtained by attending the numerous courses available, which must however be multidisciplinary (project planning, marketing, analytical accounting, management and HR organization, etc.)
  • a continuous professional updating
  • an in-depth knowledge of the main Office application packages, in particular Excel for all “off-system” processing activity.

This concept of out-of-the-system implies some essential aspects that should be present in every dental practice:

  • the use and familiarity with the management software
  • the quality and completeness of the data entered by the whole team
  • the presence of the data extraction function in the software used: nowadays it is not possible to have a software limited by pre-set statistics, without the possibility of conveniently extracting all the information, in order to re-elaborate it in a personalized way by the user’s analytical intelligence.

The change of paradigm for the post-Covid-19 dental practice

The organizational and economic patterns for the post-Covid-19 dental practice radically change.

For years we have held to be true, rightly I believe, that through the “saturation of the chair time” that is, by using the available production time as much as possible, we would have reached the maximum profitability, within the boundaries set by the business model of the dental practice.

So, if we had managed to get each dental unit to work up to about 85% of the time available (while still leaving space for the management of the peaks), we could have achieved the optimization of the management.

Eventually looking for further improvement in other areas (costs, prices, mix of services, etc.), but no longer in the already achieved ability to make the most out of the structure. Few succeeded, for some it was a kind of mirage. Never as now, the use of the past is more appropriate, a past that will soon be a distant past.

The change of the organizational model

A small, microscopic, biological parasite has changed our lives, all over the world, we will see for how long but in the meantime, to return with our feet on the ground, it has already changed the organizational model of dental offices, and many other environments where waiting times and gatherings were the habit.

In the specific case of the dental practice, the issues of waiting and crowding in the waiting room, the punctuality of operators and patients, the efficient organization of appointments, had long been on the agenda of things to improve, and for someone the improvement project was already well advanced.

Clearly, we are talking about dental practices in full activity, not those (about 30%) in the decline phase and with a demand that is progressively decreasing, often in parallel with the progressive increase in the age of the owner, who accompanies himself and his study towards a logical and biological quiescence.

But the central theme of this radical change is the organization of the working model. It is not only in the specific topic of the patient gatherings, easily resolved with an improvement in the management of the agenda, but the great problem also lies above all in the change of clinical and extra-clinical protocols, which will forcefully reduce the objective production capacity of the dental practice.

The Italian situation

All this already seems very clear in the mind of Italian dentists, who, interviewed in the last week of March (in collaboration with IDI Evolution for the activity of the collection of the questionnaires), as part of Key-Stone research, declare in 41% of the cases that the most likely possibility (the question was a single choice to indicate the most relevant aspect) is that they will have to transform clinical protocols and, in 35% of the cases, to improve the management of the appointments.

Only 15% focused on the increase in costs for the greater use of PPE (Personal Protective Equipment) and 9% of dentists (which doubles for those over 55) think that in the end it will not change much compared to their previous daily practice.

Although the data collection method (online only) could contain some possible systematic error, the sample size, made up of 1,028 dentists, encouraged us to publish the survey, which is believed to be reliable.

Clearly, these are points of view, moreover at a particular time, knowing perfectly well that mood and awareness change day by day during this interminable lockdown phase. Until official protection guidelines for operators and patients are published, objective conclusions cannot be drawn. Only then, it will be possible to make real and reliable calculations of times and costs of this sort of Copernican revolution of dentistry.

Personally, I believe that the real big problem of the coming months, or maybe years, will not be so much that of the demand for treatments, or rather the economic power of the families, instead, the objective capacity of the dental practices is the focus, because there is no doubt that, for the same working hours, fewer patients can be accommodated.

The concept of “dilution”

And here comes the concept of “dilution”.

It will not be so much from the ability to saturate the practice that efficiency and profit can be achieved: this would only produce chaos, conflict and health insecurity.

The key factor of success will be the possibility and ability to dilute in an optimized way the practice activity.

Everyone will find their own solutions:

  • longer appointments to perform more treatments at once
  • the extension of opening hours
  • the use of digital technologies also to reduce delays and risks in the supply chain
  • teledentistry for the development of some remote services
  • serious and rigorous engineering of the workflows
  • the elimination of some operatory units to increase the waiting spaces
  • the reduction of the staff if the unsustainability of the fixed costs, compared to the demand that can be granted, is ascertained.

The competitive scenario

The competitive scenario may also change, with the possible closure of a significant part of dental practices (already stated in the same survey by 14% of the sample) and the likely unsustainability of some low-cost models.

But all this will, paradoxically, only exacerbate the problem of a possible excess of demand compared to the capacity and, incredibly, the real criticality could be the production capacity in a business model that must in any case generate a correct profitability.

The choice, on the other hand, to reduce the priority on prevention, hygiene, check-up visits, by someone ventilated since they would produce a reduced unit value, would be a misfortune for the entire system, for the organic expansion of the patient base and for the dental health of citizens.

We can only trust in the balance of the guidelines defined by the competent authorities, which take into account the health of operators and patients, but also the difference in risk of the different treatments and the indispensable economic sustainability of the dental practice.

Then, it will be the vision, intelligence, and entrepreneurial ability of those who will have to reorganize their profession to make the difference, and it is not said that the competitive advantages achieved in the past are a sure factor of success for the future.

The article has been published on Dental Tribune in Italian, English and French.

An abnormal crisis

Previous international crises, and the 2008–2013 crisis in particular, have arisen from the collapse of the economic or financial system at the macroeconomic level, having an impact on businesses (for example, through the resulting credit crunch) and society, especially as a consequence of the resulting rise in unemployment. It is quite evident that all this has an impact on the real economy, or the purchasing power of families, creating a sharp drop in demand. All of this happened in the Western world in the 2008–2013 period. However, in the current case, it is different.

A crisis of interconnections

The economic and financial systems in Europe and the US were rather solid before the SARS-CoV-2 outbreak, being in full economic recovery and boasting positive fundamental indicators. What suddenly emerged with the pandemic was a crisis of interconnections or the impossibility of supplying and selling products and services owing to the need for physical distancing. In the lockdown phase, every country halted about 60% of its productive activity, causing an enormous economic shock, the magnitude of which is proportional to the lockdown duration. However, the origin is exogenous to the system, a sort of huge economic downturn that has struck the world.

It is precisely for this reason that, at the beginning, many economists thought that, when the external cause ceased, that is, at the end of the respective lockdowns, the economy would recover quickly. Experts call this a V-shaped recession, which is characterised by a rapid initial collapse, followed by a rapid subsequent recovery, and it was expected that the impact would have been limited as a direct consequence of the lockdown period. However, this was a rash and probably superficial evaluation because it did not take into account that the handling of the endemic phase would still have required a very long period of physical distancing, having evident consequences for the purchasing power of families and consumption.

Figure 1: Critical factors of an economic crisis

In addition to the economic and financial problems that have affected and will affect the production system, and small and medium-sized businesses, in particular, the methods of socialization have radically changed. On the one hand, we need to maintain a certain physical distance, and on the other, attitudes, behaviors, and prejudices are changing, and these will possibly result in an increase in social unrest. Given that this new way of life will partly reduce consumption owing to incapacity and production saturation, what interests us in this context is the possible transformation of the perception of dental practices and dental care by the population.

Dental practices situation

There has been clear and peremptory guidance for dental practices from competent institutes. We think that implementation of these principles, which provide for certain clinical protocols, patient management and the use of personal protective equipment, may be quite demanding in organisational and financial terms, but we believe that all practices will adopt them in order to guarantee the safety and health of their staff, collaborators and patients.

In all sincerity, we must always keep in mind that dentists have always worked in almost totally aseptic conditions. It is true that, in this case, we are dealing with pathogens that circulate by air, while dental practices have evolved to prohibit cross-contamination through blood, but the protective measures employed by dental professionals are already very high. The culture of protection and asepsis is already innate in the professionalism of workers in the dental field, and we firmly believe it will come naturally to employ more rigorous procedures.

As for patients, given that the relationship with a dentist is based on trust, we think it is very important to explain the procedures and devices adopted with available objective data while confirming the requisite behavior, focused on everyone’s safety.

Our qualitative research indicates that, when a dental expense exceeds about €1,000, it is no longer the individual choice of the patient, but enters into the basket of various family expenses. The expense is then evaluated and ranked according to other family needs, which are not always related to health. Clearly, non-urgent and higher value-added services, such as orthodontics and prosthetics, could more easily be postponed, but, according to dentists interviewed in April, treatments for aesthetic purposes will suffer above all, while those that solve functional problems may be less affected.

Given that all of this will have to be demonstrated, there is no doubt that, in a Maslowian theory, on a hypothetical scale from pain to pleasure (for socialising, a sense of belonging and esteem to others and to oneself) in the case of reduced financial possibilities or psychological resistance, therapies aimed at aesthetics will be the ones that may initially be reduced, because they are less compelling (Fig. 1).

What practice should do is learn how to sell. This is not unethical; we must put aside all the false prejudices related to semantics which could generate negative reactions. Learning how to sell signifies the greater effectiveness of transferring value in the proposal of treatments so that the patient clearly understands the importance of the treatment being proposed and fairness concerning the treatment cost. There are too many instances in which families postpone dental treatments in order to prioritize other non-health-related expenses in the hierarchy of family expenses. Even consumer credit, carried out with the support of credit institutions, is a good opportunity for encouraging access to patient care.

The paradigm of reopening

It is fundamental to accept that we will no longer be able to return to the dental profession as it was back in March. The organizational system will be different, patients will be different and certain costs will inevitably increase. If we cannot endure the acceptance of this change, this veritable rebooting of the dental profession will prove difficult.

Figure 2: The strategic path to reopening dental practices

The dental practice has three important assets:

  • its clinical expertise
  • its organization (understood as structure, technologies, group of people, processes)
  • its base of patients; ideally, all the patients treated in the last three to five years represent a referral source for a conventional practice. However, it is different for corporate dentistry, which is more oriented towards the use of marketing to attract new patients.

Nowadays, just over 75% of the turnover of a dental practice that has been open for at least five years is generated by “known” patients, that is, those who have been treated in the past and their relatives. Therefore, it is necessary to maintain and retain the great value represented by patients treated in the past.

Following this logic, there are three phases to reopening (Fig. 2):

  • resist
  • relaunch
  • redesign

Resist

The real problem with this first phase of the crisis is the lack of liquidity, which arises from the lack of revenue in the previous months and the impact of fixed costs in this period. Let us try to rationalize this situation. In Europe, dental procedures valued at more than €7 billion are performed per month. During the lockdown phase, treatments worth at least €12 billion have been suspended, not canceled, because millions of patients under treatment have been asked not to visit their dentist (according to Key-Stone surveys, the average duration of dental treatment is about 112 days, orthodontics excluded). They were undergoing treatments that must be resumed as soon as possible and in total safety. Then, millions of patients suffer oral health problems and they will have to visit a dentist in the coming months. Net of a possible reduction in spending power and patients’ increased fear of the dentist, dental treatments are not consumable; they are not meals that were not consumed in a restaurant or nights not spent in a hotel. The population will return to the dentist, but timelines and ways will change.

For a dental practice that has not collected revenue during the lockdown period and does not have variable costs (such as laboratory, materials and medical collaborators), but has had to bear fixed costs (such as rent, utilities and staff), the latter is the true problem. In addition to supporting his or her family, the owner of a dental practice has had to cover the fixed costs.

Given that social safety nets, such as the use of lay-offs, can help reduce staff costs, we suggest classifying fixed costs into three categories:

  • costs that are indispensable and for which payment cannot be postponed
  • costs for which payment can be deferred
  • non-essential costs that can be eliminated during this phase.

Costs do not include investments, which are essential for improving a practice’s effectiveness and efficiency, which will eventually play a strategic role in the coming months of recovery.

With regard to revenue, another important operation during the resistance phase is to create a prevision of the treatments, considering those suspended, those that could be fulfilled from proposals that had been made to patients and are pending a response, and new visits planned, not to mention all the patients to be re-contacted for hygiene visits and check-ups, children under orthodontic monitoring, patients for whom implants have been fabricated and who require prostheses, and so on.

A prevision must be updated every month, but allows one to know in advance, net of all variable and fixed costs, the probable financial requirements. These are requirements to be met by resorting to bank loans and/or personal assets. Non-financing during this phase of the crisis means heading towards a possible closure, an eventuality declared in 14% of the sample of dentists interviewed in recent Key-Stone research (in Italy and Spain), a percentage that rises proportionally with the increasing age of the practice owner.

In addition to securing the dental practice from a financial point of view, it is essential to guarantee safety and health security to patients and collaborators, but this will certainly become an obligation and, therefore, a prerequisite. What will make the difference is a practice’s ability to organise the workflows and processes to avoid mishaps, such as overcrowding, but also excessive downtime resulting from an excess of caution without proper planning.

Relaunch

Returning to the issue of the great patrimony of the practice, represented by patients treated in recent years, it is essential to look after it through an organised system of direct communication. It is very important to have a well-managed patient database, allowing segmentation of patients by age and treatments carried out, among others. It is just as essential that the management of this database complies with the requirements of the new European General Data Protection Regulation.

In this phase, it is important to maintain relationships through WhatsApp, email, videos, calls, and social networks. But what is important is the content of this communication aimed at informing patients, reassuring them about everything that is being carried out regarding their health and safety, and giving practical suggestions for oral and general health and for living a healthy lifestyle. While it is absolutely not recommended to generate communications aimed at selling services or treatments—it is not the opportune time for sales—it is the time, the opportunity, to strengthen your relationship of trust with patients. Similarly, it would be useless to produce information aimed at promoting services which, during this emergency phase, could appear anachronistic or not suited to the current priorities of the population.

Another important time is reopening. When a dental practice is ready to assist new patients, it would be opportune to communicate this and, in this case, even encourage visits. In this regard, in addition to revenue suspended during the lockdown phase, a very serious aspect to consider is that, during this period, new patients have not been acquired and new treatment plans and new treatment plan proposals have not been realized. This is a problem that will be felt in the coming months, even in this autumn season. For this reason, practices must absolutely maintain a space for the creation of new visits, although they may possibly find themselves in a crowded situation due to treatments that were left uncompleted or suspended.

Similarly, during the relaunch phase, once a practice has reopened, it becomes a priority to return to pending treatment plan proposals, for which is essential to obtain the highest possible acceptance rate. While considering possible demotivation by some patients, we suggest not soliciting responses to suspended proposed treatment plans with simple phone calls but inviting the patients to come back, to carry out a new motivational visit that serves the purpose of renewing awareness of the need and the reduction of any prejudices in order to favor the acceptance of the treatment plan.

Redesign

New organizational protocols will deeply change the organizational model of the practice, and this is precisely the time to collect data and information, consider your practice’s strengths and weaknesses, and evaluate opportunities and threats. It is also time to consider what emotional, organizational, and financial resources are available and which may be necessary with the goal of structuring a virtuous business model for dentistry to come.

Asking questions about changing the competitive system, re-evaluating the positioning and pricing policy, and deciding what your practice should look like in the future are fundamental steps and must be thought through calmly, reasonably, and creatively.

The dental practice owners need to consider for reopening the following factors:

  • Treatment demand
  • Regulatory compliance
  • Personal Protective Equipment (PPE) procurement
  • Workflow organization
  • Staff: commitment, motivation, conflicts
  • Impact on timeline
  • Saturation and productive potential
  • Functional investments
  • New composition of the revenue account
  • Pricing and cost policies

We believe that the truly great problem in the coming months, or perhaps years, will not be so much that of demand for treatment, nor the purchasing power of families, but that of the objective capacity of dental practices because there is no doubt that fewer patients will be able to be accommodated within the same number of work hours.

Planning the future

In order to survive this first stage unharmed, we must start to think about 2022. While the present year is economically lost, we can use it to plan for the future. Next year will also be difficult because we will most likely still be bound by physical distancing and rigid protocols in patient management. Even the economic and social crisis may continue to have a long and clearly visible tail. However, there is a great opportunity to return to performing excellent and successful dentistry in a new competitive context and with the payback of the trusting relationship. Everyone must have his or her own vision of the future and commit to fulfilling it with confidence and trust.

We would like to offer just one suggestion: do not make hasty decisions. Use the next few months, at least until the end of the summer, to collect information, taking note of problems, flaws, and areas of improvement. Use this period as if it was a beta phase for the practice. First, we need to fully understand, then design, and then build. If we change the order of these factors, the risk of failure increases.

During this time, we have come to realize that the key is not hope but trust. The first refers to something that should come to us from the outside, while trust derives from that intimate feeling that whatever happens it will be faced in the best possible manner, for we believe in ourselves and we have used a rigorous method of strategy development.

The article has been published on Dental Tribune in Italian and English.

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