clinical practice management of pediatric children

– The clinical practice management of pediatric children is a mixture of

• Leadership

• Planning

• Marketing

• Time management

• Delegation

• Financial management

• Quality

• Patient satisfaction

• Medico-legal aspects

• Communication skills

• Motivation

• Stress management

• (and of course) Related aspects

– Time management has an important role in the success of pediatric dental practice.

– The allocation of time for different dental procedures integrated with child management
protocol, scheduling of appointments, frequency of visits per week, the ‘time’ of the day for certain procedures need to be considered in effective time management.

– Following are the methods of effective time management:

• Spending quality time for achieving co-operation in the initial visits: The time spent on communication and behavior modification is a time investment. Most of the pediatric dental procedures are not really time consuming. ‘Conditioned’ children usually do not require any extra time after first few visits.

• Training staff to deal with children differently; the ‘quick’ and ‘smart’ ways to carry out
a few procedures: Child management is a team effort. The assistant’s job of transferring the loaded syringe to the dentist is as critical as the dentist’s job of injecting. The dentist should prepare the entire team to deal with different situational demands effectively.

• Prior scheduling of all appointments: Patients have to be scheduled in a proper manner. Very young children should not have to wait for long. Also, prior confirmation of
appointments, rescheduling in case of genuine difficulties and reminders to patients are necessary.

• Constant check on schedule: Before starting a procedure, the time allotted and the time expected to accomplish it must be tallied. The appointment slots should have some free slots (as buffers) in order to accommodate the extra time spent in an unusual situation.

• Everything well documented: Appointment cards for patients, appointment diary at
reception, patients’ list in the operatory must be duly filled and updated. Late entries of patients and missed appointments must be properly recorded.

• Efficient, adequate staff: Doctors, assistants, receptionists: it is necessary, at times, to overstaff the clinic in order to compensate for a person’s absence. Also, the auxiliary staff must be trained to exchange the duties if necessary.

• Adequate sets of instruments: All the necessary instruments should be available in excess of the actual requirement. They must be stored well and should be easily retrievable. The cleanliness, sterilization of instruments (autoclaving), appointment confirmation, and equipment-maintenance may preferably be done in non-clinical time (for example, two hours before the clinic hours).

• Saving time: Good chair-side preparation, minimum ‘open mouth time’ of the child,
use of ‘dead time’ of the procedure (using the time when the child is rinsing mouth or when the effect of local anesthesia is awaited) are necessary for efficient child
management. The dental team must learn to work with great coordination for the same. Working 4/6/8 handed, helps save time and are necessary for some procedures.

• Having necessary ‘tea/coffee breaks’: If a 10-minute break can refresh you to work for an additional one hour; it is a time spent productively. The team must remain fresh and motivated throughout the working session. Even the last patient has to be attended with same energy that was there for the first.

• Remaining ‘focused’ throughout the working session: Unwanted phone calls, guests,
medical representatives, dealers, suppliers are not welcome on all busy days.
A separate time allotment may be done for attending medical representatives, dealers,
suppliers. All unwanted phone calls should be filtered at front desk. The dental team must be constantly aware of the task at hand. Even the free time (if an appointment is cancelled) must be spent constructively for work such as assessing feedback forms,
reminding patients for follow ups, etc.

– The ultimate aim of healthcare industry is ‘patient satisfaction’.– It is often said: Whether or not others like us is largely up to us! Hence, the onus of satisfying the customers i.e. patients of healthcare industry, lies with the service providers, i.e. the health professionals.

– Today’s customer has a choice, access to knowledge and information and enjoys the status of being called a KING!

– Also, the industry faces challenges like competitiveness amongst practitioners, price wars, huge investments and recurring expenditure and so on.

– Thus, to satisfy the patients in addition to making profits in the business while maintaining optimal ethical standards of practice must be the focus of each and every unit of the
industry.

– Often, doctors who do not seem to care much about patient satisfaction say: “I am qualified to give good care; therefore, the care I give is good”.

– However, this approach may not go well with most patients of today.

– For quality in terms of patient satisfaction, it must be a balance between what doctors do and what patients feel.

– “People don’t care how much you know until they know how much you care!” (Stephen Covey) The patient-care, must therefore have patient satisfaction as a primary objective.

– The word ‘satisfaction’ broadly means fulfillment of expectations.

– The expectations of people from the service-providers are ever-increasing!

– The service industry heavily depends on the customer and is obsessed about the customer.

– For a long time, the healthcare industry enjoyed a unique position in the service industry, and did not succumb to the demands of the customer.

– However, times have changed! the customer.

– In healthcare industry, the patient-care is as important as patient-cure!

– Assessment of patient satisfaction is an important aspect of healthcare as it helps the service provider improve his patient-care and in turn, the overall quality.

– There are several aspects of patient-care such as:

• Promptness of attention received from the doctor and/or the staff

• Efficient appointment system

• Minimal waiting time

• Facilities such as proper seating, entertainment, wash-rooms, etc

• Front desk services including the manner of communication

• Fee-structure, mode of payment

• Information and knowledge provided to patients regarding their care (therapeutic as well as preventive) through consultation, reading material, presentation, notice boards, etc.

• Continuum of care—a follow-up system

• Overall satisfaction

– Although expectations of people may differ and there can never be an agreement about
‘satisfaction’ in general, some of these parameters can be used to objectively assess patient satisfaction.

– The assessment of patient satisfaction can be done with following objectives:

I. To assess the overall satisfaction of patients objectively by questioning parents

II. To evaluate satisfaction of patients pertaining to individual parameters
such as appointment system, waiting time, reception and facilities, information received by them regarding treatments and preventive care, fees and mode of payment, reminders for
follow-up, etc.

III. To find the key areas where improvement is needed.

– The same can be done by letting parents fill up the ‘feedback forms’ and periodically
assessing the feedback forms to identify deficiencies in the system and scope for
improvement.

– Also, such studies done over a period also, help the dentist learn the ‘trend’ in patient
satisfaction.

– An example of such a feedback form is given below (the one currently used in the author’s clinic – Little Smiles):

– Those who always opt for short term goals in practice may enjoy success only for a short term!

– The practice philosophy must be developed for long term success.

– An active interest on the part of the dentist in the overall well-being and progress of the child and the family underlines the fact that the dentist is also a well-wisher of the family.

– A dentist frequently sees the same children again and again as dental patients.

– Children grow up, enter higher grades in schools, develop different interests, and acquire newer skills.

– Also, the family members of these children have their own achievements in life that may not be known to the dentist.

– These children or these families keep coming to the clinics/doctors over years; with a lot of trust and familiarity.

– A few simple gestures such as wishing them on their birthdays or on festive days are
meaningful for both the dentists and the patients.

– This relation once built goes a long way in contributing to the success of a practice.

– Dentistry has limitations, and certain failures are inevitable in practice.

– Crown de–cementation, a fractured restoration, post-operative pain after a certain
procedure, etc. may mislead a patient and doubts may cloud the patients’ minds over the dentist’s ability and intentions.

– The dentist must claim responsibility for the problem, explain to the parents about the same in a reasonable manner and assure them that the best possible efforts will be spent to take care of the problem.

– Also, the dentist must explain the parents that there are pre-existing limitations regarding
different procedures, materials and the results of certain treatments, and even child
management techniques are not entirely predictable.

– However, if the doctor-patient relation is healthy, these issues may not have a negative
impact on the practice.

– ‘Quality’ is never accidental. It comes out of healthy intention, genuine efforts and perseverance to strive for it.

– The 5 Ms that are necessary for delivering optimal quality are: Men, Machines, Motives,
Materials and Management.

– Effective child management is an important prerequisite for optimal quality in clinical
practice.

– The practical success is inherently dependent upon good child management that is integrated with other aspects such as use of appropriate equipment and materials, updated and
evidence based knowledge and skills, and thoughtful budgeting and financial planning.

– Most parents wish to give their best for the upbringing of their children, at times even if they cannot afford it!

– A dentist practicing pediatric dentistry is their partner in the esteemed process and shares the responsibility of giving the best possible dental care to the child.

– Hence, the importance of optimal clinical success need not be overemphasized.

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