The Role of the Dental Team in Implementing EBD and Communicating the Evidence with Your Patients
The availability of many different treatment choices and access to information has empowered the patients. Today's patient wants to be informed and involved in decision making with regard to their treatment.
Historically, there has been great difficulty in persuading clinicians to integrate current research into their patient treatment. It takes an average of 17 years from initial trial results to application in practice.1 What is the value of research, if unaccepted and unapplied by the practitioners for whom it was intended?
In past years of practice there were few choices and little acknowledgment of patient preferences in treatment. The patients were expected to follow the doctor's recommendations unequivocally or they were not considered “good patients.”
A Modern Dilemma
The abundance of clinical research with relevant findings has overwhelmed practitioners. Keeping up to date is challenging.2 The availability of many different treatment choices and access to information has empowered the patients. Today's patient wants to be informed and involved in decision making with regard to their treatment.3
This dilemma has been addressed on 2 strategic fronts:
1.The creation of the evidence-based approach to health care, which addresses the search for clinically relevant evidence while acknowledging the real-world practice setting of patients' participation in their care.
2.The creation of Practice-Based Research Networks (PBRNs) by the National Institutes of Health/National Institute on Dental and Craniofacial Research (NIH/NIDCR) where practicing clinicians are trained to help develop and conduct clinical research in their private practices, enabling them to address questions of clinical practice that affect them on a daily basis.
These efforts will hopefully improve the quality of patient care and reduce the time that clinically relevant research is accepted and applied by practitioners.
The dental team is now tasked with the challenge of using EBD in the private practice setting: how do we weave EBD into the fabric of our practices for the benefit of our patients?
In defining our roles, I have divided the dental team into its components: the dentist and staff.
The Dentist
The Purpose of Practice
There is a philosophy behind every practice, whether stated or unstated. The first challenge of professional training in dental school involves the development of exceptional clinical skills. For many of us, I believe, our philosophies are shaped by this first experience.
When we open our practices, we bring our nascent philosophy, our purpose of practice, with us. The delivery of clinical care, the integration of procedure, and material for the best clinical result is usually the initial primary concern of most practitioners. Evidence is an essential component of this care, without it our best efforts are compromised.
For the purposes of this conference, the clinicians of interest to us have continued this practice philosophy. We want to provide the best possible oral health care for our patients.
The Patient is our Primary Consideration
I have always considered it a privilege to have a license and try to contribute to the welfare of another person. With that privilege come obligations and responsibilities. I consider it my professional obligation to search for the most clinically relevant evidence and then present treatment options that will maximize safety and effectiveness, and provide long-term value while minimizing risks of harm.4 This will educate patients and enable them to make the most informed choices about their oral health. My responsibility is to provide service excellence. This includes not only clinical service but customer service as well; excellence in both is my goal.
In our practices, it can be helpful to have a mission or a vision statement. Revisit your practice philosophy, refine your vision, and incorporate the evidence-based approach with patient education in order to provide the best possible patient care. This will serve as a focal point for the direction of your practice and reenergize your practice efforts. The benefits will spread through your office and show up in staff interactions and case presentations. Patients will take note and will appreciate your efforts. Excellence in both clinical and customer service will be well served. This will provide both professional and personal satisfaction.
Your practice philosophy must now face the real world. The private practice setting brings real world pressures. Secondary considerations of practice are always present. Philosophy does not pay the bills. The real world produces demands that can pressure, interfere, and subvert the primary consideration of your practice. These secondary considerations must never take precedence; financial concerns must never drive the practice in their direction. If they do, you have compromised patient care.
You cannot operate a professional practice by yourself, a capable staff is required. Along with their support, your staff will present many real world demands requiring thoughtful solutions. Payroll, bonuses, practice incentives, and profitability are a few, to say the least.
The Dental Staff
My vision of practice requires both clinical excellence and customer service excellence. Clinical service excellence is primarily my responsibility; customer service excellence is ALL our responsibilities. We must search for staff that compliment and share our patient philosophy and professional dispositions.
When I select staff, I consider those who will provide exceptional customer service. Enthusiasm, communication, social and emotional intelligence, and the attitude that prospective employees bring to their interview are just a few of my concerns. Do not hire staff in the hope that you can retrain them. I look for staff that already understands my message and has the proper attitude.
Share your philosophy with your staff. They will welcome practice direction and purpose. Take the time to educate and update your staff with the concepts of the evidence-based approach. Be certain they appreciate clinical decision making with EBD's 3 concepts:
•Best evidence
•Clinical expertise
•Patient values and preferences
Show your staff how you combine the best clinically relevant evidence with patient education so the patients can make well-informed choices about their oral health. Ensure that they understand the patient is your primary consideration and you put the patient first in all of your treatment considerations.
Reinforce this concept of putting the patient first in all aspects of staff-patient interactions, not only in clinical concerns but in customer service issues as well. Staff can be easily distracted by secondary responsibilities (eg, leaving a patient waiting inappropriately in a room) and must be continually reminded of customer issues. Evidence will change over time but the considerations of office hospitality are a constant! The concept of hospitality is as old as history itself and is universal involving all cultures. Treating our patients with kindness and consideration and making them feel comfortable are among our best instincts. The terms customer service and patient management are 20th century derivatives for one of mankind's best behaviors. Practice professional office etiquette and your patients will feel like valued guests.
Staff and Their Importance to Your Practice
The most effective leaders lead by example. Be prepared to do everything for your patient that you recommend your staff do. By leading you will set an example for patient dedication that your staff will follow.
Your efforts will ensure trust in you and your practice. Your staff will appreciate your dedication and begin to understand the depth of consideration you have for your patients. Their attitude will better represent your message of patient care. Your staff will have more confidence in patient communication. This will increase treatment acceptance and create more patient referrals. Providing customer service will be in the forefront of their minds and as ambassadors of your practice, they will present the special qualities of your office.
Clinical and customer service excellence compliment each other. The benefits of patient trust and confidence are important and can be inspired by a properly motivated staff.
Customer service excellence combined with clinical excellence will provide that truly exemplary practice that we all aspire to have.
Communicating the Evidence
The Consultation
By the time your patients have made consultation appointments, they have already evaluated your office and your staff. Your attitude, responsiveness, reliability, and empathy have been noted and they frame your treatment consultation. Has your practice answered their nonverbal questions? Will your practice reassure the patients and gain their trust and confidence?
In my practice, I benefit from my patients' knowledge that I am a member of the PEARL Network and participate in clinical research. They know I am interested in the most current techniques and try to provide the best patient care possible.
The evidence is the centerpiece of my presentation. I emphasize treatment that
•uses the most clinically relevant evidence
•maximizes safety and effectiveness
•provides the best long-term value
•minimizes risk of harm
Patients always take note of treatment choices and risks. Choice enhances treatment acceptance. Once you have discussed their treatment choices in the EBD context, they feel you have their best interests at heart.
The Patients
Patient values refer to the unique preferences, concerns, and expectations each patient brings to a clinical encounter and these values must be integrated into clinical decisions if they are to serve the patient. 5 This last concept of EBD certainly tests the effectiveness of the patient education part of my practice philosophy. Patients may not choose in their best interests. What do you do with patient preferences that are not supported by evidence? I would advise handling them on a case-by-case basis.
In conclusion, my experience with EBD suggests a benefit for all involved. The practice thrives and serves as a resource for patient, staff, and dentist. The patients are secure in the knowledge that they have been well cared for, that dentist and staff went to great efforts for them.
The staff feels it has been involved in a positive effort providing better patient health and all the while, earning a living.
In the past few years, I have experienced a satisfaction and a sense of fulfillment that was imperceptible to me as I struggled through my middle years of practice. The dental care I've provided, along with the confidence and trust that my patients have in me, emerge as my greatest rewards.
References
1. 1Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics. 2000;65–70.
2. 2Forrest J, Miller SA. Enhancing your practice through evidence-based decision making. J Evid Base Dent Pract. 2001;1(1):51–71.
3. 3Kravitz RL, Meinikow J. Engaging patients in medical decision making. BMJ. 2001;323:584–585.
4. 4Merijohn G. Implementing Evidence-Based Decision Making in the Private Practice Setting. Why do it?'' J Evid Base Dent Pract. 2006;6(3):206–208.
5. 5Committee on Quality of Health Care in America, Institute of Medicine . Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The National Academy of Sciences; 2000;http://books.nap.edu/p. 157. Available at: URL: books/0303072808/html/index.html. Accessed March 30, 2008.
PEARL Network, College of Dentistry, New York University, New York, NY, USA
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