I was honoured to be interviewed for the cover feature of this month’s edition of BDJ in Practice, which addresses ‘Behaviour change;...
At the ‘endo’ the day – part one
One dentist’s journey to successfully introducing improved rotary endodontic therapy, with an innovative, cost-effective approach: Ben Atkins relates how he came to the decision to review and standardise the endodontic offering across his practice group.
Balancing the contrast between clinical excellence and business ownership continues to be one of the main challenges facing practice owners like me. Because of this, I am a strong believer in the importance of implementing a robust business strategy. Following a recent review into my practices’ approach to endodontics, I recognised a need to improve this area of the business.
The root of the problem
I am an advocate of prevention rather than cure. I work with my patients to enable them to understand their mouths, and the benefits of preventive regimes and treatments. At Revive we have a motto: ‘Together, we work to understand your smile’.
It is important to me that the team understands what the patient wants and through that understanding we can demonstrate to the patient how we will provide a solution that meets their wants and needs. It is equally important that the patient appreciates the different options open to them (NHS and private) and can make an informed decision about a course of treatment.
There continues to be a real dichotomy between the clinical and the business aspects of dentistry. It is important that a business performs efficiently and effectively, which often means that it acts uniformly. For some dentists, this is sometimes seen as being at odds with meeting the needs of the patient, which can lead to conflict.
This is because we can get stuck in a rut, always delivering one treatment in a particular way, or not at all, and the prospect of change is unwelcome. Where it works best is where practice uniformity dovetails with a cost-effective solution, which also provides the most clinical benefit to the patient. This is why I am such an active campaigner for preventive treatments that will deliver all round better oral healthcare.
I have built up four practices within the Greater Manchester area and have 12 associates, four therapists, and a wider team of staff including extended duties dental nurses. Many functions that I undertook historically are now in the very capable hands of a therapist or an extended duties dental nurse.
With such a solid business structure in place, and having effectively engineered myself out of clinical work, I was at a point in my career where I had the capacity and opportunity to step back and review where the business was and what I wanted to focus on next. First and foremost I’m a dentist – I call myself a ‘dental geek’! But with others doing my clinical work, what was left for me to do, I asked myself?
Part of the answer was endodontics, and was a solution driven by both personal and business objectives. Personally, I have worked as a restorative dentist with special interests and often received endodontic referrals, which in my opinion, were part of general practice. From a business perspective, I was not convinced that Revive were carrying out enough endodontic treatments, nor were we doing them as efficiently and effectively as possible.
Back to basics
The first thing I needed to do was identify the current state of play. I carried out a review across all practices and found some very surprising results.
One of the most staggering findings was the amount of equipment that had been bought over the years and never used. Perhaps it wasn’t fit for purpose, or the purchasing dentist didn’t understand how to use it, or maybe it was simply a reluctance to change how things had been done in the past. I was a clinician who was guilty of this and it’s part of the reason why I decided to work closely with Dentsply Sirona.
Other specific discoveries included one associate who did not undertake any endodontic work, preferring to extract or refer to a specialist instead, while another asserted that she could pretty much root-fill any tooth for her NHS patients. It also became obvious that there was a lack of confidence amongst some dentists in their own ability to carry out effective endodontic treatment and this was leading to high levels of stress.
This situation was leading to a loss of revenue, with cases being referred to specialists, which with the right training could be carried out at practice level. At the other end of the spectrum, in some instances the cost of the associates’ treatments exceeded the amount we were able to claim back from the NHS.
Once these factors had been identified, it was obvious that a single solution was needed across all practices, to introduce a level of standardisation. I also required a supplier that could provide everything we needed, including appropriate training, and with an understanding of what we wanted to achieve.
Choosing the right supplier
We selected a number of suppliers to speak to, many of which didn’t take the time to understand our needs. Personally, I am a patient-led dentist; patients’ oral education is critical, so that they can take responsibility for their dentition. They do not understand terms such as bond strength and cavo-surface angle, so I needed support in educating them. Wendy Sands and the team at Dentsply Sirona understood this, which is ultimately why I selected them. The cost of the equipment is obviously important, but the support I was promised and have received has improved techniques and efficiency within the business. I needed one process which works in 90% of the cases we encounter, with the option to engage ‘dental geek’ if necessary. Dentsply Sirona not only listened, it was able to adapt its offering to provide us with exactly what we asked for. This included the products and consumables, easy adaptive training and an app that helps us work smarter.