Resolutions
January is a great month to share practice goals with your Team.
Hang up a poster sized post-it pad.
Designate a Team member to do the writing.
List all of the things you currently offer your patients that make it easy for them to do business with you and what you offer your employees that make them like to be a part of your business. This gets the creative juices flowing and serves as a good starting point. We call this the "We continue to provide..." section.
Next, move on to what you want to add to your practice in the future, such as equipment, a new position, an out-of-town CE course, etc. Do this for the upcoming year, or better, for the next 5 years.
Each January you and your Team will be pumped-up to cross off the goals you achieved the year before.
Make January a time to celebrate past resolutions and challenge yourselves to set new ones.
Happy New Year. _______________________________________________________________________________________________
December 31, 2011
Trivia
Did you know your Down Syndrome patients have a higher incidence of periodontal disease than the general population? The prevalence increases with age and the primary dentition is involved in 36% of these patients. _______________________________________________________________________________________________
November 29, 2011
School Absences for Dental Care
Here is the letter I use to ensure my patients will be allowed to be absent from school. You may use my letter or modify it for use in your practice.
To whom it may concern:
Molly Gunsaulis, DDS
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October 23, 2011
Help the Public
Join me as a Sharecare contributor to help increase public knowledge of oral health. Sharecare.com is a new online resource founded by Dr. Oz and Jeff Arnold, the founder of WebMD. The public submits health-related questions and individual health professionals, such as yourself, as well as leading professional organizations, such as the ADA, provide the answers.
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October 23, 2011
Oral Health Care Products
More than 300 oral health care products display the ADA Seal. Patients can search online at ADA.org/Seal for products by attributes, like fluoride, gingivitis control, and sensitivity control, and compare product features. Share this information with your patients to help them make the right decisions before they get to the store.
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September 25, 2011
Tooth Trivia
Did you know that premature teeth erupt prior to 3 months of age?
Natal teeth are present at birth and are more common than neonatal teeth which erupt after birth and before age 1 month. 90% of premature teeth are true primary teeth and many are poorly formed. These teeth can be associated with Riga-Fede's disease, ventral tongue trauma from feeding, and cleft lip and palate.
If premature teeth are an aspiration risk due to excessive mobility or interfere with feeding, they need to be removed.
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September, 25, 2011
Conflict Resolution and Your Team
Since your Team is your biggest asset, investing in keeping the Team healthy, efficient and capable, goes without saying. Ideal communication is a huge part of that investment and it wouldn't be complete without including conflict resolution. Your patient's can sense when there is a communication breakdown and they know it will interfere with the care they receive. Therefore, it is essential that the doctor and the Team have a way to handle internal conflict.
When I was working for the Community Health Association of Spokane, 2000-2005, I learned of the Cares Model. I changed it slightly to adapt to my Teams needs and placed it in our employee manual. All new hires must sign a form that they have reviewed the employee manual and the employee manual is reviewed annually as well.
Here is my adaptation of the Cares Model that you may use or borrow from while addressing conflict resolution with your Team.
Cares Model / Conflict Resolution within our Team
1. You may not share your negative feelings about a Team member(s) with anyone except the Team member(s) in question. This prevents speculation, assumptions and gossip while keeping everyone on the Team honest.
2. You are expected to approach the conflicting Team member(s) within 72 working hours or forever let it go. If you do not approach the Team member(s) you cannot bring it up in the future because the Team will not allow it. Conflict with a Team member(s) over 72 working hours old, never happened. (Conflict does not include: illegal activity; any observance of illegal activity supersedes the Cares Model and the Team member is responsible to report it to Dr. Gunsaulis or the Practice Administrator ASAP.)
3. All Team members must agree to abruptly stop a Team member from sharing their negative feelings regarding another Team member(s). It is strictly forbidden to allow a fellow Team member to negatively communicate to you about another Team member(s). This includes: joking in a negative manner, negativity masquerading as concern or sympathy, and negativity that is repeated second or third hand called “gossip”. (In this case, all Team members mentioned need to be brought together ASAP.)
4. After you have stopped a Team member from continuing to say negative things about another Team member(s) you are expected to immediately (unless patient care is underway, in which case you must do this as soon as patient care is finished) take the complaining Team member to the Team member(s) there is conflict with and stay to make sure the parties engage in discussion aimed at directly resolving the conflict.
5. If you have conflict with another Team member(s) and you do not feel comfortable approaching that Team member alone you must pick another Team member to be present and mediate the discussion within 72 working hours.
6. If the Team members do not work toward resolving the conflict you are expected to go to the practice administrator or Dr. Gunsaulis to explain the conflict and name those involved. Dr. Gunsaulis and the Practice Administrator honor the Cares Model and are held to the same standards as is every Team member, regardless of title or education.
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August 7, 2011
For Parents
The KidsDoc Symptom Checker is available on HealthyChildren.org, the official American Academy of Pediatrics’ website for parents, at www.healthychildren.org/symptom-checker.
Parents can enter their child's symptoms into the interactive tool and receive up-to-date advice about how to treat minor illnesses at home, or when to call the doctor immediately. A great resource to share with your patient's parents.I was happy to see a mouth and teeth section including this advice for teething: Caution: Blaming teething for fevers can lead to a delayed diagnosis of ear infections, urinary tract infections, meningitis and other infections.
July 12, 2011
Mama Bear
My Team and I know that to prevent oral disease and maintain good health we need our young patient's parents and guardians to know we are their allies.
I explain to my Team that parents, especially mothers, need to know that we have their child's best interest at heart at all times. If they don't, parents and guardians instinctively react as does a Mama Bear that feels her cubs are being threatened (this is not good) and it is no one’s fault but the agitator (my Team and I).I find that sharing my blunders as a young, inexperienced resident with my Team is often all that is necessary to ensure they don't make the same painful mistakes. My Team knows my collective stories as theMama Bear stories and they all focus on how to build allies, create trust, and most of all, how not to upset Mama Bear.
Without boring you with my stories, let me sum up the morals:
1. Direct eye contact with parents and guardians.
2. Listen.
3. Use names. Do not say "Mom" or "Dad" when referring to a parent in your presence, ever.
4. Body position lower than the parent, especially the mother, when giving any advice.
5. If you are a female provider (sorry but this is my only perspective) and you are talking to a male and female guardian, most of your positioning and eye contact must be directed to the female to show respect.
6. Nonjudgmental language, tone and attitude. We are in this together.
7. Explain - Ask - Do, but only with permission. This applies to everything, absolutely everything.
Parents and guardians are part of our Team and we want them to know it every step of the way.
June 10, 2011
New Children's Oral Health Website
This June, the AAP has launched its new Children’s Oral Health website. This site now offers improved navigation and new resources to elevate the awareness of oral health in the pediatric practice. http://www.aap.org/oralhealth
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June 10, 2011
New Fluoride Rx Guidelines
In December, 2010, the ADA published new clinical recommendations on the prescription of dietary fluoride supplements. Due to known increases in exposure to multiple fluoride sources, the panel now recommends the prescription of dietary fluoride supplements only for children who are at high risk for developing caries and whose primary source of drinking water is deficient in fluoride. You may access the full report and download the chair side guide at: http://ebd.ada.org/ClinicalRecommendations.aspx
May 14, 2011
Isolite for Children
Isolite for Children
Isolation is critical when performing surgery in the mouth of anyone, but especially on
a child with a small airway. For this reason I decided to incorporate Isolite, an isolation system for dentistry, into my practice.
To give you an idea of how well this new system has gone over in my practice here are a few examples: My Team has requested T-shirts that read “I Heart Isolite” and a mother asked me if I would do her dentistry because it looked more comfortable than what her dentist uses.
We started using Isolite for all restorative procedures over a month ago and what a difference. No more rubber dams, cheek pads or cotton rolls – all of which pose as aspiration risks and quite frankly don’t taste very good. Most of our young patients happily accept Isolite and my Team and I are amazed by the compliments we get from our young patients and their parents. 2 year olds accept it too, and as with any isolation system for toddlers and the very young child, I recommend at least using nitrous oxide to help minimize gag reflex and discomfort.
The most amazing thing, besides the fact that children accept it so well, is that I can now perform most procedures without a dental assistant's direct involvement. The Isolite makes everything safer and faster and helps keep our costs down which further benefit our patients.
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May 14, 2011
Making Changes
Growth is change in action and it is as essential to your good health as it is to the success of your business.
My Team and I recently took two days away from the office to attend the Inland Northwest Dental Conference. Before the conference I told my Team that at our next Team meeting we would be sharing 2 things we learned at the conference that could positively impact our practice. Not only did everyone have at least 2 things to share, but many had ideas on how to implement them as well. Wow! My Lead Dental Assistant, Rose, brought an entire laundry list. We assigned implementation dates to the ideas we liked and for the others we decided to have the Team member who submitted it prepare a list of 'pros and cons' to share with us at the next Team meeting.
One of my favorite ideas which we implemented immediately was to give each Team member a handful of our practice pens once every 2-3 months (they weren't doing us any good sitting in the cupboard awaiting our next marketing event); these pens have our Practice name and logo printed on them. The Team member leaves these pens in establishments around town where they do business. We started this last month and have distributed around 150 - 200 pens. A friend and colleague called me last week to tell me he was given our pen with his receipt at a local steak house.
The action we collectively decided to make, which was a change for us, is now working to make us better known in our community. ________________________________________________________________________
May 14, 2011
Oral Health Text Messages to Moms
An educational program of the National Healthy Mothers, Healthy Babies Coalition called text4baby delivers health tips via text message to those who need it most. Women who sign up for the service by texting BABY to 511411 receive 3 free text messages every week timed to their due date or baby's birth. A variety of topics critical to maternal and child health are sent such as birth defect prevention, oral health (American Academy of Pediatric Dentistry is now a partner) immunization, nutrition, seasonal flu, mental health and safe sleep. Text4baby messages also connect women to prenatal and infant care services and other resources.
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April 4, 2011
American Academy of Pediatrics
I am always very proud to be a member of the American Academy of Pediatrics, but especially this month because the spotlight is on oral health.
The Oral Health Initiative, a program of the AAP, was established to decrease the prevalence of early childhood caries by addressing children's oral health issues through the development of training materials, communication outlets and educational programs.
A Pediatric Guide to Children's Oral Health was recently sent to all AAP members. I am impressed with the comprehensiveness and simplicity of the guide and believe it will be a valued part of well-child visits.
Additional AAP oral health supportive material can be found on the AAP web site at www.aap.org/oralhealth
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April 4, 2011
Templates for Electronic Records; Foundation of the Successful Practice
I recently came across this quote by Peter Drucker and Warren Bennis, "Management is doing things right; leadership is doing the right things." It made me realize that micromanaging my Team is the least effective way to run my pediatric dental practice and yet it is the most temping to do on a day-to-day basis.
Stephen R. Covey, one of my favorite authors wrote "...the rapidly changing environment in which we live makes effective leadership more critical than it has ever been...we are more in need of a vision or destination and a compass (set of principles) and less in need of a road map."
Thankfully one way I've been able to step back from micromanaging my wonderful Team (in order to have time and gain insight on being a better leader) is by way of establishing templates for our patient's electronic records, the foundation of every successful practice.
While creating templates was initially time intensive, it has saved me more hours than I care to count. The templates are set up to mimic every type of patient encounter possible. They are categorized generally, such as Clinical Exams and Restorative Procedures, and then furthered subdivided in the order they are most commonly used and associated, such as Emergency or Trauma Examinations and Operative and Sedative Procedures, etc. Templates minimize charting errors and save everyone time. Templates remind the busy health care professional what to record, capture, render, treat, explain, recommend and how to reschedule in order to ensure our patients receive an ideal health care encounter. While it sounds like unvarying care, it is anything but standardized. The more you know about yourself, or in this case your practice, the more you are able to customize care to the individual patient while remaining true to the practice's philosophy.
Creating templates clarifies the doctor's values and principles.
Templates allow me to be a solution seeker not a problem solver.
To borrow heavily from another of Stephen's quotes I can say "I'm convinced that too often doctors are trapped in the management paradigm, thinking of control, efficiency, and the rules instead of direction, purpose and the feelings of their Team."
I use Dentrix Software in my practice because of the ease it allows me to customize and create templates of my own; freeing me from the oppressive management paradigm.
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April 4, 2011
Show and Tell
Effective communication relies on show and tell.
My Team and I recently asked our patient's families to share their brushing and flossing tips with us in a video format so we could share their tips with others. We had a lot of great responses!
Visit our web site's home page to see our favorite video and from there you can visit our You Tube channel and Face Book page to view the rest of our video submissions.
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March 8, 2011
Wanting to Invest in Good Health
"No one likes to be sold anything, but they like to buy", says Jeffery Gitomer. How do you get parents to invest in preventive care for their children and themselves? Create a demand for that care, but first:
Make it easy to do: (great parking, great hours, great location, great Team, friendly Team, knowledgeable Team, online practice access, text and electronic appointment reminders, online payment options, third party financing options, etc)
Be available to your patients and their families: (24/7 emergency care, social media, business cards for each Team member to give along with post op instructions, follow up phone calls from Doctor and Team, Birthday greetings, sell the products you recommend, give samples of products you recommend, etc)
Remind busy patients and their families when they are due for preventive care: (System in place for reminder phone calls, e-mails, texts, letters, etc)
Create a demand: Educate patients and their families regarding treatments and products that maintain, enhance or regain good health. Educate patients and their families about the positives of preventive care: preventing pain and infection are much more comfortable and cheaper than emergent care and allows parents to schedule at their convenience and avoid time conflicts that arise with emergent care.
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March 8, 2011
Simplify Meetings
Keeping the Team all on the same page can be tough. Sometimes I wish I could make announcements with a blow horn just to save time; but I wouldn't sink so low because my Team has earned my highest respect.
Delegating Team leaders for office meetings is ideal but I believe there are a few exceptions. Since the doctor is ultimately responsible for all things clinical, I believe that the doctor, to be an effective leader and reduce risk, must be in charge of the Clinical Team Meeting. My employees are my greatest assets and I owe it to them to make these meetings effective and efficient.
Once a month I block 30 minutes from patient time to hold our Clinical Team Meeting. In order to create structure and yet allow open discussion too, I start each meeting by handing out a questionnaire with the instructions to complete individually before we discuss as a group. During the preceding month I jot down specific concerns, problems, new products, etc that I'd like to address with my Clinical Team and I accept the same from my Lead Dental Assistant, Rose. It takes only a few minutes to turn these into questions. I hand out the questionnaire at the beginning of the meeting because it gives me a few minutes to finish up any last minute loose ends before I return to discuss the Clinical Team's answers. It is amazing how many "Ah, Ha!" moments my Team and I have during these meetings because of this question format (creates a new way of looking at the same things) and I know we operate better because of it; I wouldn't change it for anything.
Another way I've simplified running this meeting is by keeping an agenda that is easily modified from month to month. I give myself a few minutes after each meeting to update old and new business, save the new agenda under the name of next month and I'm good to go.
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March 8, 2011
Painless Dental Care for Children
After awaiting results of a recent randomized trial, my Team and I are happy to announce we are now offering a better solution to drilling and filling.
In order to stop the progression of tooth decay we will now offer ICON, a filling delivered via a unique paint-on technique. ICON is simple and painless for the patient and gentle on the tooth just like a traditional sealant but with the advantage that it soaks into small cavities or areas that are starting to become cavities. ICON allows dentists to offer another tool against tooth decay.
When preventive products like fluoride are not enough; we can now offer ICON to stop the cavity progression in the early stages, instead of waiting until a filling or another restorative material is required. For a demo visit: http://www.drilling-no-thanks.com/en/demonstration.html
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February 19, 2011
The Energy Audit 
Creating team unity and united purpose is a constant quest for us as leaders in our practices. What can we do to add energy to the people on our teams? Find out by taking Tony Schwartz's Energy Audit. It was very informative to me personally and as a boss. I plan on having my Team each take the audit at our next Team meeting.
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February 19, 2011
Comprehensive Pediatric Dentistry for the GP
Here is a course sponsored by the American Academy of Pediatric Dentistry which will allow you to provide the best care for your young patients. A broad array of topics will be presented by experts in pediatric dentistry using lectures and panel discussions. Participants will have additional opportunities for discussion and one-on-one learning with the experts during the included luncheons and breaks. For more information click here.
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February 19, 2011
Healthy Living for your Family
There are a lot of things families can do to be healthier and it can be overwhelming trying to decide where to start. But it is important to remember that small changes can make a big difference. The American Academy of Pediatrics recommends starting with one of these behaviors:
· Limit sugar-sweetened drinks.
To start, families can pick one of these behaviors and set specific goals to improve their health. In addition to the above goals, families can make small changes in their family routines to help everyone lead healthier active lives. Science suggests these activities can help prevent obesity and oral disease:
· Eating a high fiber diet.
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February 19, 2011
Aspiration
Providing surgery in the oral cavity on young awake patients is not without risks. Having a patient aspirate or swallow surgical materials or instruments can and does happen even when every possible precaution is taken.
It is critical that you are able to recognize the signs and symptoms of aspiration while attempts are made to retrieve the item. The common triad of presenting symptoms in an aspiration is coughing, choking and wheezing. Other signs include acute dyspnea and diminished breath sounds.
Inform your patient and their guardian what has happened. Ask your patient if they are experiencing any difficulty breathing or swallowing and, if the patient is too young to understand, simply observe while recording vitals. If your patient is without respiratory distress and your provisional diagnosis can't exclude foreign body aspiration it is best to phone a local hospital radiologist and inform her of your suspicion, and provided her with a concise history of the preceding events followed by a verbal request for a chest and abdominal radiograph. A duplicate sample of the foreign body, if possible, should accompany the patient to the radiologist. In order to ensure that the patient is taken straight to the hospital without incident, you may elect to have a Team member trained in basic life support follow the family to the radiologist and assist with check-in. If, however, your patient is experiencing respiratory distress call 911 immediately while providing 100% oxygen.
Here is the sample letter that I have ready to accompany a patient and any duplicate foreign body. I find it is always best to be prepared for the unexpected.
Dear Radiologist’s Name,
I have referred Patient’s Name to you for an abdominal and chest x-ray. While placing an intraoral space maintaining appliance the metal loop portion became disengaged from the appliance and was not able to be recovered.
Address
Phone
Date of Birth
Gender
Enclosure (see yellow envelope)
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January 8, 2011
Child Advocate
Pediatric dentists are advocates for children. Our clinical decisions, first and foremost, are made with our young patient's best interest in mind. Occasionally these clinical decisions run counter to what a parent or referring provider desires. Pediatric dentists walk a delicate path but we hold our heads high when we stay true to this singular mission and take the time to explain our planned course of treatment. Not an hour goes by in a pediatric dentist's day without at least one dental surgery being preformed; and yet even with a full schedule my Team and I take time to educate and provide an explanation of the necessary treatment. When we take time to align ourselves with parents and referring providers our young patients are one step closer to achieving optimal oral health. Call us today if you have any questions or concerns because we are always happy to share our knowledge and experience.
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January 8, 2011
February
Remember, next month is National Children's Dental Health Month. If you need any supplies or ideas please call me and my Team.
This year the Spokane District Dental Society received $1500 dollars from Washington Dental Service Foundation. WDSF's mission is to eliminate oral disease to improve overall health for everyone. The SDDS gave that money to Eastern Washington University's Dental Hygiene School to provide educational material and oral hygiene products to Head Start children in honor of Children's Dental Health Month. Way to go WDSF, SDDS and EWU faculty and hygiene students!
