Upholding DSO Clinical Standard of Care with Provider Autonomy

9 Steps to Ensure DSO Congruency Between Clinical Best
SOC (Standard of Care) and Provider Autonomy

Understanding provider autonomy

We like to think we can attract great dentists/providers by assuring them of clinical autonomy. We certainly want to extend as much clinical independence as possible to our doctors. But what can you do when provider clinical work is substandard?  Poor dentistry will eventually catch up to diminish your company brand and reputation, not to mention your patient care and team support.  Like anything, prevention is better, easier, and ultimately less costly, than correction. Here are nine steps to ensure your providers (dentists & hygienists) are providing the best clinical care congruent with your company’s clinical best standards.

  1. The importance of culture and core values.

Commit to a culture of CANI as a core value.  CANI is an acronym for “constant and never-ending improvement” popularized by Tony Robbins in his book Personal Power.

This core value can be highlighted in everything your vision and mission represent, including recruiting, interviewing, job descriptions and training. It can permeate everything about your culture so that you attract like-minded providers who also value, appreciate, and want to participate in your CANI focus. This first step is critical to attract team members who are already primed to want to excel to excellence. Next, how do you support your providers/employees to constantly improve?

  1. Defining expectations

It is imperative to define your DSO’s clinical Best Practice standards of care (SOC). These will become your clinical processes or systems – the nuts and bolts of dentistry. “Best Practice Guidelines” are an excellent way to position your clinical protocols.  It acknowledges that there are different ways to do dentistry (clinical autonomy) and share observations from the absolute best practices. It presents an expectation of excellence in a positive framework, of clinical autonomy within Best Practice Guidelines of CANI.

  1. Defined, written, documented protocols and systems

These guidelines should be written/documented and stored for access in your company SOC manual. These Best Practice protocols will undoubtedly be updated continuously (CANI), but there needs to be a base line and written expectations for reference. Some examples of Best Practice clinical protocols are: Elements of Comprehensive Evaluation, Radiographic, Periodontal, Restorative, Case Acceptance,  to name just a few.

  1. KPIs -Key Performance Indicators

Best Practice protocols can often be connected with KPIs.  While metrics alone are not, and should not be, the only measure of clinical excellence, KPIs can be extremely helpful to measure clinical effectiveness.  This is best done when clinical KPI benchmarks are determined by clinicians themselves. Dentists should create the benchmarks for dentists, and hygienists should create the benchmarks for hygienists. And they should work together to support each other. Most importantly, all KPI benchmarks must always connect to the highest level of patient care.

  1. Performance Improvement Management

How is provider performance reviewed, corrected, improved for clinical compliance with your best practice guidelines – your Standard of Care/SOC?  Start at the Beginning.

Provider excellence starts with the onboarding process, which can take a day to a week (sometimes longer). The new provider should be introduced to the various departments that will impact their work. This will include an in-depth review of clinical protocols and expectations, and should include new hire inter-action and feedback. Onboarding also may include several hours or days of shadowing an experienced provider to observe best practice clinical and team dynamics in action.

The goal is to set up the new hire for success from the start. Then give them a slow schedule to start with. Dumping a new provider into a new office with a full schedule creates undue stress and does not provide a good learning experience. Better to start slowly, learn the practice, team dynamics and logistics, create a strong foundation, and then build upon quality patient care. Next, a full schedule and healthy production can follow based on your Best Practice Guidelines for quality patient experience.

  1. Continued Support

Quarterly reviews should be standard protocol for all.  Include random chart audits and case reviews.  These visits should never be viewed as punitive, selective, or negative.  These visits should always be presented in a supportive and positive manner, and as a value-added component of the company commitment to CANI. Additionally, as your group develops, ongoing training for all team members will support your systems and protocols for ongoing and improving clinical Best Practice performance.

  1. The Clinical Board

So, who does this- who manages the reviews?  It is important that dentists and hygienists get their support from someone with whom they can relate clinically – another dentist or hygienist. While “Operational Managers” may be responsible to guide, manage, oversee practices to ensure their bottom line for their region, crucial clinical conversations are best had with clinicians. So who will these “clinical advisors” be?  Ideally, there will be some sort of clinical board. There are as many different business models for this as there are DSOs. In a perfect world you would have (titles will vary) a structure something like this:

  • Chief Clinical Director/Officer – (Dental Director=Dentist, Hygiene Director=Hygienist)
  • Clinical Regional Directors
  • Clinical Trainers
  • Clinical Mentors

As a DSO grows, this list can morph in many directions. For example, the number of regional directors will obviously be dictated by the number and size of regions. Sometimes these titles combine, as in trainers and mentors. And in the early days, one dentist starting with three practices may well be filling all positions!  The important thing to remember is to be aware of how big you want to grow, and know that ultimately you want to merge in this direction of a good clinical Board to manage and support clinical excellence. Just forecasting this structure mentally will help you begin to consider clinicians in your organization who may be candidates, for leadership and career development, as your future clinical board develops. Furthermore, you may eventually recruit externally, from outside your company.  While some DSOs prefer to recruit and  promote strictly from within the company, a mix of internal and external clinical board members offers varied perspectives.

  1. But what if…?! Breaking Up

In my coaching experience I have observed what legendary GE CEO Jack Welsh called, A, B, and C players. A players are passionate about their work and committed to making things happen (your potential leaders). B players are good employees who lack passion, but are coachable and can become A players. C players don’t get their job done, drain other people’s energy and are not coachable. Jack recommended helping these C players find employment elsewhere.

Sometimes things just don’t work out.  Despite all of your best intentions, recruiting for philosophical alignment, training, support and CANI, you may be confronted with a provider (or any employee) that does not want to live up to their best CANI, which negatively impacts your practice, people, patients, and company reputation.  This is where it is imperative to have solid HR (Human Resources) approved performance improvement protocols (and employment contracts).  Verbal and written comments and recommendations should be documented appropriately according to protocol.  Breaking up is hard to do.  So make it quick, carefully planned, and compliant.

  1. Connecting the dots

All corporate cares about is numbers.”  Unfortunately, this is the refrain we hear from providers when we have not properly “connected the dots” between KPIs, the numbers, and clinical care. Coaching from the numbers should always be based on patient care.

“Production is a product of patient care.

Increase your patient care and you’ll increase your production.”

A good coach will connect the change in behavior to that person’s personal and professional values. Then they own it! Ultimately, you want your teams to be able to self-manage.  They can only do this by learning to interpret their own KPIs, and then understand how to improve them. Great coaching sees the potential in each mentee, and then guides them to empower themselves for their own improvement, their own CANI -Constant And Never-ending Improvement.

Support your providers to support your patients to support your brand. Utilize CANI planning and protocols.  Provider clinical autonomy and Best Practice Standards of Care can absolutely exist together happily and simultaneously, providing mutual benefit for all. 

Written by Janet Hagerman of DSOs Done Right℠ (www.janethagerman.com). An an international consultant, speaker and author, Janet is a DSO development expert helping DSOs and dental groups establish a foundation for scalability with profitable, consistent clinical and business systems. For speaking, coaching, training or a free copy of Janet’s Culture Clarity Process℠, contact janet@janethagerman.com


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