Take Charge of Your Emergency Response and Practice Recovery Plan

The forced closure of your dental office has, in many ways, pressed the reset button on your daily operations.Now is the time to restart your practice and take proactive steps to prepare for a full and robust recovery post COVID.

The intent of this article is to provide you with practical recommendations to help you and your teams adjust to the “new normal” and prepare for future growth. This is a dynamic, fast moving situation of which you have no control. You can prepare an effective response to the crisis and use what we have all learned from this to prepare for the future.

Your team needs to feel that it is safe to return to work and know what procedures to follow, as some of their job duties may have changed. Your patients also need a compelling reason to return to your practice feeling confident that all reasonable steps have been taken to keep them safe. Optics will play a major role in your patients’ perception, so if they see the receptionist wearing a mask sitting behind a Plexiglas shield, it will be part of the new normal for the next few month.

As with any recovery process, it will be incremental and your practice will not be running at full speed immediately and possibly for some time to come. There are steps that you can implement now as part of your Emergency Response Plan that will help enhance the recovery process and prepare your practice for a possible second wave. Although we hope that does not come to pass, being prepared is always a good recommendation.

Implement a Team Communications Plan

It is important to prepare your staff for possible changes in their hours and duties when they return to work. Most dental offices will have employment agreements in place that should provide enough flexibility to make necessary changes without violating the rights and protections provided to employees under the Employment Standards Act. If you do not have employment agreements in place, it would be a good idea to consult with an employment lawyer to see what your options are when recalling staff. Your staff will be anxious to return to work, however, it is necessary to follow the guidelines providedby the regulatory bodies and a full return to work for all of your team members will take some time and will likely occur in phases.

Now is a good time to hold a staff meeting through Zoom or Go to Meeting to discuss the changes and start preparing for opening. Holdinga virtual staff meeting will help them to feel connected and engaged in the process. Involve your Health and Safety Representative and/or your Joint Health and Safety Committee. Discuss details of the Emergency Response Plan. Some topics that you may wish to discuss may be:

• Prescreening procedures for staff and patients. What will that look like and who will be doing the prescreening and how will it be done?
• How to maintain physical distancing when checking in patients. How many patients will be in the reception area at the same time?
• How to disinfect the reception area and how often?
• Will you be installing Plexiglas guards at the front desk?
• How patients should be confirmed and prescreened?
• What the schedule should look like moving forward including how much time should be booked for hygiene appointments?
• How should patients be prioritized?
• Post visual alerts (e.g., signs, posters) at the entrance and in strategic places to provide instructions about
hand hygiene and respiratory hygiene and cough etiquette.

Ensure that your infection prevention and control (IPAC) processes are up to date as well as your Occupational Health and Safety program. These are dynamic processes that require continuous updates, review and adaptations to current events. As employers, you are responsible for safe delivery of your services as well as the protection of your staff during these challenging times. Now, more than ever, it is critically important to be compliant with the most current infection prevention and control procedures.

Preparing the Patients – Communications Plan

The flow of good reliable information is more important than ever. Staying in touch with your patients now will help your practice to recover more effectively. This is the time to reach out to your existing patients to let them know how much you care about them and you are committed to their safety and wellbeing. Many patients don’t know what a “true” dental emergency is so this is an opportunity to inform your patients about the difference between a dental urgency and a true emergency. You can also let your patients know how to reach you directly. It would also be helpful to post information on your website and all social media channels.

Provide your patients with information about the steps that you are taking to keep them as safe as possible when they return to your office. Also, inform them about what to expect when they return such as your prescreening process and physical distancing.

Wellness Checks

Reach out to your elderly patients and do a wellness check. They will appreciate the contact.Many of them are isolated and lonely, as well as frightened. Call them on the telephone, don’t rely on emails and text messages because many of them may not have access to technology

Hygienists should call their patients who are in active therapy as a wellness check and to provide advice and support until the patients can return for their appointments. Revitalizing the hygiene columns will be challenging and there are many things to consider such as the use of ultrasonics and the air/water syringe and how much time to allot for hygiene appointments. Scheduling hygiene appointments in the future should include extra time to do an assessment before beginning treatment.

Preparing the Reception Area

1. Disinfect all surfaces in the office including the front desk, telephone, computer, point of sale machine, pens, etc. The Canadian Centre for Occupational Health and Safety recommends that communication devices should not be shared so have disinfecting wipes available at the front desk and wipe down the telephone between users.

2. Thoroughly clean the reception area including the furniture and remember to clean the legs and backs of the chairs. Remove magazines and toys as well as any unnecessary clutter or decorations that could harbour germs. Wipe down all picture frames and clean the windows. This is a great opportunity to do a thorough spring-cleaning.

3. If you have plants in the reception area, thoroughly wipe them down with a damp cloth. Plants are good for air purification and studies have shown that they reduce stress and noise.

4. While your office is closed, it is a great time to do a complete inventory of your supplies. Make sure that you have enough PPEand gowns for when you do open. Check all the expiry dates on products.

5. Order supplies. This is a good time to get the ordering done and you may have to spend extra time shopping around to get what you need. Suppliers will likely be extremely busy filling orders and necessary supplies that are in high demand may be delayed depending on where they are coming from. It’s best to get your necessary orders in early. Try not to over order and remember that everyone is in this together. It is a good idea to check the authenticity of the products that you order and what you receive. There are many grey markets products available, which may not be approved.

6. Restock the operatories. Check all of the surfaces that may require barriers if they cannot be disinfected between patients. Remove as much as possible from countertops and surfaces within 2 meters of potential contact with aerosols.

7. Check all of the equipment to make sure everything is in working order. Now is the time to have any needed repairs done. The dental suppliers are providing checklists that will help you keep your equipment in good working order.

8. Train the receptionist on how to sanitize the work area, how to wear a facemask,(including how to properly doff and don required PPE), how to avoid cross contamination and how to physically distance when checking patients in and out.

Consider a Paperless Environment

If you have been considering going paperless, now is a good time to begin the implementation process. Purchase a high-speed scanner and begin the process of creating e-charts. Scan in all documentation that you need to retain into the patient’s record. Shred any documentation that is not needed following the proper guidelines for recordkeeping. Indicate on the chart that it has been e-charted. Arrange with your software provider training for your staff on how to work in a chartless environment. Most dental software companies have online tutorials or could arrange to train via Zoom.

When it is time to open again – Fitness to Work Policy

Before returning to work, you need to have “Fitness to Work Policy”that will provide you with procedures to follow when bringing your staff back and for the future. Refer to your regulatory body and the Public Health Department for guidance on back to work protocols.

Each employee is responsible for notifying the doctor or his or her designated appointee if they have been in close contact with an individual who is, or is suspected of being, ill with pandemic influenza, (in this case COVID19). A “close contact” is defined as an individual who has cared for or lived with a person known to have an infectious disease or who has a high likelihood of direct contact with respiratory secretions and/or body fluids of a patient known to have an infectious disease. This direct contact would include sharing eating or drinking utensils, and close conversation (within six feet).

If the employee reports illness by phone or email the designated Health and Safety Representative (HSR) or doctor should contact the employee by phone and ask if they are exhibiting any of the symptoms listed on the prescreening assessment.

If the employee’s symptoms do not correspond with those on the assessment, tell them to keep in contact and to contact their physician or Ontario Telehealth Network if needed.

If some or all of the employee’s symptoms correspond with those on the assessment, the HSR or doctorshould:

a) Inform the employee that he or she must stay at home until the symptoms abate.
b) If the employee has been in contact with someone who has tested positive but the employee does not have any symptoms, he/she must self-isolate for 14 days. Advise the employee to immediately contact a health professional by telephone.
c) Complete a brief report noting the employee’s condition and any staff and/or visitors the employee has been in contact with.
d) Arrange for the employee’s work area to be cleaned and disinfected.

If an employee reports to work exhibiting symptoms of illness or exhibits symptoms while on the job:

(a) The employee’s symptoms will be identified by their response to the assessment.
(b) The employee should immediately be provided with an approved surgical mask and should put it on.
(c) The employee should immediately leave work and contact a health professional. The employee should avoid public transport when leaving work.
(d) The employee’s work area should be cleaned and disinfected
(e) All contacts of the employee within your office should be advised that they may have been infected and be asked to go home and await further instructions.

Managing Patient Appointments – Pre-screening Patients

Develop a system of telephone triage to determine the nature of the appointment, whether it is a true emergency or urgent care. Doctors and assistants need to work closely with the administrative team to identify the patients who need to be seen first, following the guidelines from the regulatory bodies.

Below is a sample of Prescreening Assessment Questions that you may wish to consider:

• Have you travelled out of the country in the past 14 days?
• Have you experienced the following within the past three (3) days?
• Sudden onset of respiratory illness (e.g., shortness of breath or difficulty breathing, coughing up bloody
sputum, wheezing)?
• Fever greater than 38 degrees Celsius?
• Muscle aches or weakness?

Stagger appointment times and try to see patients in every second operatory, if possible, depending on the size of the office. When the patient arrives at the practice, ask the pre-screening questions again, but do not include the question about travel.

Only allow one or two people in the reception area at a time to maintain physical distancing. Have patients wait outside the dental practice, if necessary, (e.g. in their car) before being seen. When an operatory is ready for treatment, call each patient and repeat screening for COVID-19 with temperature recording, prior to allowing entry to the dental practice. Consider purchasing a non-contact infrared thermometer or have the patient take and report their temperature, with their own thermometer, before they arrive at the dental practice. Accompanying individuals should wait outside the dental practice (e.g. in their car), unless absolutely required, such as a parent accompanying a young child or a patient who requires accommodation.

The reception area should be cleaned and disinfected every 30 minutes, or twice per day at the very least.

Financial Recovery

The Federal Government is providing relief for small businesses that you will be able to take advantage of such as an interest free loan for $40,000.00 with possible forgiveness of $10,000.00 if $30,000.00 is repaid by Dec. 31/2022. They are also providing assistance with rent and wage support that will cover 75% of wages for the employees that you will be recalling to work and, most recently,rent relief assistance of 75%. Take advantage of the assistance that is being provided now as a starting point for full financial recovery.

Looking to the Future – Business Continuity Planning

We have learned a lot from this crisis and that knowledge provides us with an opportunity to be prepared for whatever the future may hold. Protect your business by having policies and procedures in place that enable you to manage the contact, control and monitoring during a pandemic. Pandemic planning policies and procedures are critical components of your health and safety program. It is more important than ever to have protocols and procedures in place which help to protect the health and safety of employees, patients, and the public, to prevent damage to business assets, and to minimize business losses stemming from future unforeseen events, civil emergencies and business interruptions. It is never too late to plan for the future to protect your patients, your practice and your employees. Your Emergency Response Plan will help you to enjoy a robust recovery and be prepared for possible bumps in the road moving forward.

References:

Pandemic COVID 19 Tip Sheets,Canadian Centre for Occupational Health and Safety (CCOHS), 2020. Excerpt reproduced with the permission of CCOHS, 2020

Dental Office Consulting Services, Occupational Health and Safety for Dental Offices, Pandemic Planning
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

Pandemic Practice Recovery Plan

Just like SARS and 9/11, the world has fundamentally changed and we will not experience “business as usual”. This is the first global pandemic that we have experienced in our lifetime, but it may not be the last. Crisis also represents opportunity. Now is the time to plan and prepare your practice for a full and robust recovery.

As with any recovery process, it will be incremental and will not happen overnight. There are parts of your practice that will take longer to recover, like the hygiene schedules, because the services were deemed non-essential during the critical phase of the pandemic. It is important to deploy all resources available to get everyone on your team engaged in the recovery process when you receive the ‘all clear’.

The current situation is very dynamic and can change at any moment. Doing the best that you can with the most current knowledge is a good starting point, but it’s only the beginning. It’s important to implement a long-term recovery program to keep your practice in good health and be ready for the next emergency. Your health and safety program, infection prevention and control as well as your Pandemic Recovery Program are living documents that require continuous updates, review and adaptations to current events.

Here is a step-by-step plan that you can implement now, before you get the ‘all clear’ to open your doors again.

Preparing the Premises

1. Disinfect all surfaces in the office including the front desk, telephone, computer, point of sale machine, pens, etc.

2. Thoroughly clean the reception area including the furniture and remember to clean the legs and backs of the chairs. Remove magazines and toys as well as any unnecessary clutter or decorations that could harbour germs. Wipe down all picture frames and clean the windows. This is a great opportunity to do a thorough spring-cleaning.

3. If you have plants in the reception area, thoroughly wipe them down with a damp cloth. Plants are good for air purification and studies have shown that they reduce stress and noise.

4. While your office is closed, it is a great time to do a complete inventory of your supplies. Make sure that you have enough PPE for when you do open. Check all the expiry dates on products.

5. Order supplies. This is a good time to get the ordering done. Suppliers will likely be extremely busy filling orders and needed supplies may be delayed depending on where they are coming from and the high demand. It’s best to get your necessary orders in early and hope for the best. Try not to over order and remember that everyone is in this together.

6. Restock the operatories.

7. Check all of the equipment to make sure everything is in working order. Now is the time to have any needed repairs done. The dental suppliers are providing checklists that will help you keep your equipment in good working order.

Pre-screening Patients

Patient screening should be done by telephone when scheduling or confirming the appointment and repeated again when they enter the practice. You should ask the patient:

• Have you travelled out of the country in the past 14 days?

• Have you experienced the following within the past three (3) days?

• Sudden onset of respiratory illness (e.g., shortness of breath or difficulty breathing, coughing up bloody sputum, wheezing)?

• Fever greater than 38 degrees Celsius?

• Muscle aches or weakness?

When the patient arrives at the practice, ask the pre-screening questions again, but do not include the question about travel.

Pre-screening Staff – Fitness to Work Policy

Before returning to work, your staff must also be prescreened. In your Health and Safety program you will have a “Fitness to Work Policy” that will provide you with procedures to follow when bringing your staff back and for the future.

The key points in the Fitness to Work Policy are as follows:

Each employee is responsible for notifying the doctor or his or her designated appointee if they have been in close contact with an individual who is, or is suspected of being, ill with pandemic influenza, (in this case Coronavirus).

A “close contact” is defined as an individual who has cared for or lived with a person known to have an infectious disease or who has a high likelihood of direct contact with respiratory secretions and/or body fluids of a patient known to have an infectious disease. This direct contact would include sharing eating or drinking utensils, and close conversation (within one metre).

If the employee reports illness by phone or email:

The designated Pandemic Liaison should contact the employee by phone and ask if they are exhibiting any of the symptoms listed on the questionnaire.
If the employee’s symptoms do not correspond with those on the questionnaire, the Pandemic Liaison should reassure them, tell them to keep in contact and to see their physician if needed.
If some or all of the employee’s symptoms correspond with those on the questionnaire, the Pandemic Liaison should:

a) Inform the employee that he or she must stay at home until the symptoms abate.

b) If the employee has been in contact with someone who has tested positive but the employee does not have any symptoms, he/she must self-isolate for 14 days. Advise the employee to immediately contact a health professional by telephone.

c) Complete a brief report noting the employee’s condition and any staff and/or visitors the employee has been in contact with.

d) Arrange for the employee’s workstation to be cleaned and disinfected.

If an employee reports to work exhibiting symptoms of illness:

(a) The employee’s condition will be identified by their response to the questionnaire.

(b) The employee should immediately be provided with an approved surgical mask and should put it on.

(c) The employee should immediately leave work and contact a health professional. The employee should avoid public transport when leaving work.

(d) The employee’s manager should be informed that the employee has left work.

(e) The employee’s work station should be cleaned and disinfected

If an employee exhibits symptoms while on the job

(a) The employee, or someone who observes that the employee is exhibiting symptoms of influenza at work, must contact the Pandemic Liaison

(b) The employee should immediately be provided with an approved surgical mask and should put it on.

(c) The employee should immediately leave work and contact a health professional. The employee should avoid public transport when leaving work.

(d) All contacts of the employee within your company should be advised that they may have been infected and be asked to go home and await further instructions.

(e) The employee’s manager should be informed that the employee has left work.

(f) The employee’s workstation should be cleaned and disinfected.

Preparing the Staff – Compliance Trainings

This time is an opportunity to ensure that your office is up to date with all of the compliance trainings, especially IPAC and Occupational Health and Safety.
Trainings can be provided virtually and have an office visit scheduled for a later time when your office is up and running again. This would prevent you from having to block off precious production time for trainings and/or refresher courses when your office re-opens. Now, more than ever, it is critically important to be compliant with the most current infection prevention and control procedures.

Preparing the Patients – Communications Plan

The flow of good reliable information is more important than ever. Staying in touch with your patients now will help your practice to recover more efficiently. This is not the time to be worried about marketing your practice and competing for patients. This is the time to reach out to your existing patients to let them know how much you care about them and you are committed to their safety and well-being. Provide your patients with information about the steps that you are taking to keep them as safe as possible when they come back to your office. Also, inform your patients about what to expect when they return.

Reach out to your elderly patients and do a wellness check. They will appreciate the contact. Call them on the telephone, don’t just rely on emails. Many of them are isolated and lonely, as well as frightened.

Hygienists should call their patients who are in active therapy as a wellness check and to provide advice and support until the patients can return for their appointments. Revitalizing the hygiene columns will be challenging. You don’t want your patients’ health to deteriorate.

When Patients return to the Practice Prioritize appointments

Doctors and assistants need to work closely with the administrative team to identify the patients who were in mid-treatment when the shutdown happened. For example, follow-up with patients who were seen as an emergency and have been prescribed antibiotics, or who were prescribed medication for pain control and have had to delay root canal treatment. Also identify which patients are in temporary crowns or perhaps have had to see an emergency dentist. The dentist can determine who should be seen first.

The assistant can determine where are the lab cases. What has been received and what cases are pending. Contact the lab to get a delivery date.

Financial Recovery

Prime Minister Trudeau has been announcing relief for small businesses that you will be able to apply for on April 6. Some of the support will require you to demonstrate that you have suffered financial loss of 30%. Since we know your practice well, I will be happy to do an analysis for you to submit with your application when the time comes and we have more details.

The relief is as follows (this information is as of March 30 and it changes daily):

1) Wage support that will cover 75% of wages. This will prevent you from having to lay off your staff. Even if you have already done so, you can bring them back and apply for this and have the employee cancel the EI benefit. The employee will receive more benefit from this support than they would receive from EI. It’s important to note that they cannot receive both.

2) $40,000 interest free loan for 1 year and $10,000 may be forgiven if certain conditions are met. The details still need to be fleshed out but this could help you get through the next couple of months. The interest rates are very low and the $10,000.00 forgiveness would be helpful as well.

3) Emergency Response cash payment $2,000/month for 4 months. This would apply to small business owners who are not eligible to receive benefits from EI. It is not a huge amount but every bit helps.

4) Loan deferrals for 6 months. Talk to your bank as soon as possible. This is definitely something worth looking into. Your cash flow is important right now. If you have sufficient cash flow to maintain your payments now, which is always best, but ask your banker if the 6-month deferral just means that you have to pay the full 6 months at the end. If that is the case, you might as well continue paying, if you can make it work.

5) Business loans up to $2,000,000 per practice. The details are a little vague at the moment, but have a talk with your banker. Banks want to keep you in business and they want to keep your business. You have the power to negotiate the best deal now and take advantage of the extremely low interest rates.

Looking to the Future

Paperless Office

If you have been considering going paperless, now is the time to begin an implementation process. Purchase a high-speed scanner and begin the process of creating e-charts. Scan in all documentation that you need to retain into the patient’s record. Shred what is not needed. Indicate on the chart that it has been e-charted. Arrange with your software provider training for your staff on how to work in a chartless environment. If you need help with this, DOCS has step-by-step procedures to guide you through.

Complete your pandemic plans and prepare for the next emergency

If you have received Occupational Health and Safety training from DOCS, your pandemic plan and checklist is in your binder and on your USB key. If you do not have a plan, contact us at DOCS and we will be happy to send you the plan.

We have learned a lot from this crisis and that knowledge provides us with an opportunity to be prepared for whatever the future may hold. Have your pandemic plan and policy on contact, control and monitoring ready. When this crisis is over and there is a comfortable flow of supplies, order a sufficient supply of N95 masks, gloves and face shields so if there is another crisis down the road, you will be prepared.

You may also want to set aside a staff recovery fund, instead of providing bonuses. That fund will assist them during the first very difficult week or two until government assistance kicks in.

The DOCS team is here to help you recover from this crisis. We will continue to update you regularly as things change. If you have any questions at all, please do not hesitate to contact us.

It’s Time to Put Your Pandemic Plan into Action Suggestions to Protect Your Patients, Employees and Your Practice During the Coronavirus Pandemic

Now that the Coronavirus (COVID-19) Pandemic has been declared, it is time to put your emergency policies and procedures into place. If you have received DOCS training on Occupational Health and Safety for Dental Offices, you will already have a Pandemic Plan and Fitness to work policy in the materials that you were provided. If you would like to receive a complimentary copy of the pandemic plan send an email to sandie@dentalofficeconsulting.com with the subject line ” Pandemic Plan”.

As this crisis continues to change rapidly, there are some preventive measures that you may wish to take to protect your patients, your staff and your practice. During this crisis, there is a possibility that your patients may wish to cancel their appointments and your employees might also need to stay home if they are not feeling well. The nature of the human-to-human contact in dentistry doesn’t provide the ability for employees to work from home so you may need to make adjustments to your employee policies to encourage employees who are not feeling well, or if the employees have been in contact with someone who has been diagnosed with COVID-19, to stay home and self isolate.

You should hold an emergency meeting with your staff to ensure everyone is as prepared as possible, and also to discuss their concerns. This is a good time to let your team know how you are going to support them through this crisis and encourage your team to be proactive about calling in sick.

Encourage your employees to use paid time off, if possible, i.e. vacation time, if they’re at high risk.  If they’ve traveled to an affected area or taken a cruise, have them stay home for two weeks and self isolate. Encourage them to be vigilant about their own health. If they’re sick and might be contagious, they should stay home. Masks protect the patients, but in the lunchroom, your team can infect each other. You should have a policy that covers fitness to return to work as well as screening for influenza like infections. If you wish to have a complimentary copy of our policy on Contact Control and Monitoring During an Epidemic, please send an email to sandie@dentalofficeconsulting.com with the subject line ” Contact Control and Monitoring During an Epidemic”.

Here is an example of an assessment form (this is a sample only):

INFLUENZA-LIKE INFECTION (COVID19) ASSESSMENT FORM

Have you experienced the following within the past two weeks (14) days or in the past three (3)?

Sudden onset of respiratory illness (e.g., shortness of breath or difficulty breathing, coughing up bloody sputum, wheezing), □ YES □ NO
AND
Fever greater than 38 degrees Celsius □ YES □ NO
AND
Any of the following:
Sore throat □ YES □ NO
Aching joints □ YES □ NO
Muscle aches or weakness □ YES □ NO
Shortness of breath or difficulty breathing □ YES □ NO

IF YOU ANSWERED ‘YES’ TO ANY OF THE ABOVE, YOU MAY NOT BE ADMITTED TO THIS OFFICE.

FOR YOUR OWN SAFETY, AND THAT OF OTHERS, YOU SHOULD IMMEDIATELY GO HOME AND CONTACT YOUR FAMILY DOCTOR.

The Federal and Provincial governments have announced their commitment to “do whatever it takes” to help citizens and businesses during this crisis, but some of your employees may be very concerned about loss of income during this time. Employees may be reluctant to answer the questions honestly, but if they have the reassurance that you will support them by providing them with paid or partially paid leave, it would be reassuring to the staff members affected and you should be able to recover some of your losses once the branches of government provide the help that was promised.

The Provincial government may be willing to provide immediate access to EI benefits during this time, but it is not yet clear how or when that will be done and you will have to make decisions quickly.

Reassure Your Patients
Send out an email blast to reassure your patients that their health and well-being is a top priority. You are likely already receiving this type of email from businesses that you have had dealings with.

Inform your patients about the extra measures that you are taking to prevent the spread of the virus and reassure them that you always follow the most current standards and procedures for infection prevention and control. Prepare them for their visit by informing them of your new pre-screening procedures.

Here is a sample email blast to reassure patients

The health & wellness of our patients and employees is always our top priority. Rest assured that we are taking all the necessary precautions and closely monitoring the (COVID-19) situation with local Public Health Units so that you can receive your dental treatment with peace of mind. We train comprehensively for these scenarios as part of our overall emergency preparedness. Our office has always followed stringent infection prevention and control procedures and will continue to do so.

During this time of heightened concern we want to reach out and make you aware of the extra precautions we are taking to ensure everyone stays healthy. Our office will remain open and we will continue to monitor the situation very closely. We will be prescreening our patients by asking specific questions when we scheduling appointments and making the courtesy reminder call for your appointment.

The questions will be:
1. Have you travelled out of the country to an affected area in the last 2 weeks.
2. Have you been in close contact with a confirmed or probable case of 2019-nCoV?
3. Have you been in close contact with a person with acute respiratory illness who has been out to an affected area in the last 2 weeks?

What you can do:
1. If you do not feel well or feel that you are at risk, call our office we will reschedule your appointment for you
2. Washing your hands with soap and water frequently helps
3. Using hand sanitizer as an extra precaution also helps
4. Wiping down all ‘high touch’ surfaces frequently with disinfectant will help protect your family members
Health officials in Canada maintain there is a low risk of people encountering the virus.  We continue to monitor this situation closely and should emergency directives be issued; we will take appropriate action.  For more information about the coronavirus, including precautions, symptoms and an update on the situation in Canada, please contact PHAC below or your local Public Health Unit.
We will continue to review updates & further recommended guidelines from The Public Health Agency of Canada. Your health and safety is our number one priority. We wish everyone good health and good luck. We will keep you updated on any new information or changes to our plan.
Yours in the interest of continued good health

Screening Patients
You should be screening patients as they enter the practice both actively and passively. At this time, DOCS recommends that you also call your patients and not just rely on emails and text messages. All three methods of contact would be ideal, especially for patients who have appointments scheduled over the next two weeks.

Passive screening
Signage should be posted on entry to the office and at reception areas for patients with symptoms to self-identify, perform hand hygiene, wear a mask, and have access to tissue and a waste receptacle. All patients should be reminded to cover their nose and mouth with a tissue when coughing and sneezing.

Active Screening

When you call to confirm appointments, conduct a screening.
1. Has the patient traveled to an affected country, city in the last 2 weeks?
2. Have they taken a cruise or flown on an airplane?  If so, ask them to please reschedule for a time and date outside the two-week window.
3. Screen the patient upon arrival at the office

Review Hand washing and Sanitation Procedures

Your team knows how to wash hands, sanitize operatories, and protect patients. However, it can’t hurt to review these procedures now. Retrain everyone, and remind them that everything in the operatories should be disinfected after each patient to reduce the risk of coronavirus spread.  Set up a schedule for disinfecting doorknobs, bathrooms, and waiting rooms several times a day.  It may take a little more time, but it can keep your team, your patients, and your community healthier.

Most dental offices are up to date with the most current Infection Prevention and Control (IPAC) procedures, however, if you need help with IPAC please visit our website to learning more about our training and customized manuals.

Postpone travel to conferences and CE seminars, as well as community clinics.
You have already likely postponed any unnecessary travel, because as you know, travel makes it more likely someone in your office will catch COVID-19.  For now, postpone travel to conferences and seminars. If team members need continuing education credits, find online options so that you can minimize the spread of disease.

Whether the news media recognizes it or not, Dental Offices are on the front lines for Coronavirus exposure.  Take steps now to protect your patients and your team, so that you can continue to function in the coming months.

How to Prepare Your Practice When it’s Time to Sell

After investing many years in building and growing your practice, you have decided that it’s time to sell. It’s not easy letting go, but when you are ready, here are some tips on how to prepare for the sale. Here are ten points that would be attractive to a purchaser from my perspective.

1. Practice Efficiency

An efficiently run practice should be using benchmarks and have an operating budget in place. Apply strategies for continuous improvement so the purchaser knows that the practice has not become stagnant and the staff have not become complacent. Look at how treatment planning is being done and the percentage of cases presented compared to those that are booked. Is the practice insurance driven or patient centered?

The repairs and maintenance should be 1% or less. If they are higher it could indicate aging equipment or inappropriate care of the existing equipment.

Dental sundry supplies should run at 5% of production or less. If the metric exceeds that, it could be the result of over-ordering, inefficient inventory control or improper allocation of expenses. Sundries must be limited to consumable items that are used up in the course of treatment in your office. Equipment or items that have longer-term value for the practice may have a depreciation value.

2. Human Resources Management

Is the staff under contracts? If not, they should be. This reduces the liability of the new owner in the event that he/she has to terminate a staff member. Without contracts the new owner will assume the length of service that the employees have worked with the previous owner. Contracts will limit the liability of the new owner to the minimum standards in accordance with the Employment Standards Act.

A lawyer who specializes in employment law should prepare contracts. The office should also have an employee policies manual that outlines the terms of employment at the office as well as job descriptions and a system of regular performance reviews.

3. Staff Costs

The staff costs should be 22 – 25% or lower. Inefficiencies in appointment scheduling will cause the staff costs to be high. Look at the number of no shows and short notice cancellations. If this is occurring on a regular basis, there are likely inefficiencies in how appointments are being scheduled. Are patients being allowed to cancel at short notice? If you would like a sample appointment scheduling protocol, please send an email to sandiedocs@gmail.com with the subject line “appointment scheduling protocol.”

4. Continuing Care System

How many patients are on active recall? Do you have periodontal program in place and are patients keeping their appointments? The patients must know that this is an active disease that requires active therapy. Many offices schedule perio patients according to their insurance benefits plan instead of their clinical needs. You must treat the patient and not the insurance plan. Also, look at how the hygienists are billing for their treatment time. The scaling unit is total treatment time, not just scaler to tooth time.

5. Accounts Receivable –A/R

What is the quality of the accounts receivable? Many assignment practices usually have a poor quality of A/R. Most insurance companies are paying the patient (or subscriber), not the dental office, making the money more difficult to collect.

If there are outstanding accounts over 90-day accounts that indicates patients are allowed to leave without paying. If the patients haven’t paid for the services that they received 3 months ago, they have no intention of paying at all. It is the quality of you’re A/R, not quantity that is important, especially to the bank manager.

6. Computer Software

Does the software need to be replaced? If so, the buyer would have to look at performing a chart purge and then incurring the costs of upgrading the computers, purchasing the software, converting the records and training the staff. This would result in reduced production and higher expenses. The selling dentist should invest in upgrading and conditioning the records for the new owner to make the conversion to a new system easier.

7. Renovations

Don’t spend a lot on renovations, but it wouldn’t hurt to freshen things up with coat of paint and having a more up to date look. The new owner will likely have his/her own ideas about the decor. Just like when you sell a house, reduce the clutter, have everything clean and organized and fresh in appearance.

8. Flow of New Patients

You should have a good flow of new patients, even if you are slowing down. Look at how new patients can find your practice. The staff that stays with the new owner must have excellent communication skills to make the transition go well. Patients need to be reassured that everything is going to be o.k.

9. Transitioning the Patients

Be willing to stay on for a limited period of time and begin transitioning the patients to the new owner. You should make the introduction of the new owner to the existing patients and reassure the patients that they are in good hands.

10. Quality of the Patient Base

Goodwill is one of the highest costs to the purchaser, so part of their due diligence will be examining the quality of the patient base. How many active patients are truly active? Is the patient base aging? Are there more seniors than young families? If the buyer is looking to perform implants, then an older patient base would be perfect, but if the buyer is looking to treat young families or upcoming professionals then an older patient base may not be ideal.

It may not be easy letting go, but if you prepare your practice in advance of the sale, there is a greater chance that you will receive full value for your practice and make the transition to retirement as seamless as possible. Enjoy your retirement with the peace of mind knowing that your practice and your patients are in good hands.

Is Sterilization a Hot Topic at Your Office?

By now, most dentists and denturists have read the story that was reported on CTV news about a Burlington dental office being temporarily closed down by Public Health due to sterilization concerns.  Letters were sent to the patients encouraging them to get tested for HIV and Hepatitis. Although the shutdown was temporary, the long-term effects of such a closure can be devastating to a dental practice and create collateral damage to the rest of the dental community.

Does your office have an infection control Officer?

Patients and employees are only safe from infectious processes when everyone consistently follows good infection control protocols. The purpose of the Infection Control Program (IPAC) is not to reduce the individual responsibility that each healthcare provider has, but to provide leadership for all employees throughout the office. Through policies, procedures, and evaluation processes, the Joint Health and Safety Committee (JHSC) or Health and Safety Representative (HSR) must act as a central contact point for all infection control information and channel that information in a manner that will create the safest environment.

It is recommended to select a clinical staff member to become the Infection Control Officer to be the contact person for the JHSC or HSR. The Infection Control Officer would be responsible to maintain written infection control procedures, which should be available to all employees. The JHSC or HSR would provide guidance for the prevention of incidents through other established informational channels within the dental office, such as email communications, posted memos and staff meetings. When problems arise, the Sterilization Officer should provide specific direction to a department or departments that details corrective actions that are deemed necessary. The JHSC should meet regularly, and maintain copies of the meeting minutes. If a Ministry inspector does comes to your office, provide him/her with a copy of the minutes.

The purpose of the Infection Control Officer or Committee is simple; to prevent and control infection. The Infection Control Officer/Committee is designed to provide clear direction to help everyone create and maintain a safe environment. When writing your procedures, determine which areas require only cleaning and which require disinfection. Train staff on the difference between cleaning and disinfection. Audit the disinfection and cleaning systems and make changes as needed. Once you have chosen the cleaners and disinfectants, ensure that staff read and follow all label directions.  If you have questions, contact the chemical manufacturer.

Planning

Successful prevention and control of infection requires careful planning. The Infection Control Officer/Committee should be actively involved with the planning and implementation of new procedures that pose a potential infection control risk. For example, provide guidance for the implementation of a new procedure. Its role in the planning process is to examine the proposal, identify potential areas of concern, and recommend a course of action that provides the best method of infection control.

The Officer/Committee also may provide input into the selection of chemicals used to manage the environment, such as detergents and disinfectants. It may also provide input into the selection of equipment used to process instruments and accessories.

Monitoring

The Infection Control Officer/Committee also monitors infectious processes within the dental office. They track infections and incidents that have the potential to cause infections. They review infection control statistics in an effort to minimize risk, identify problem areas, and implement corrective actions.

When infections do occur, the Officer/Committee should undertake investigations to determine the cause of the problem and recommends the necessary education or changes in protocols.

Evaluating

Along with monitoring specific incidents, the Infection Control Officer/Committee also looks at the bigger picture as it continually strives to improve processes within the facility. This is demonstrated by the regular review of infection control procedures for all departments. The Officer/Committee may also be called upon to evaluate procedures and provide input regarding products and protocols.
Updating: Perhaps one of the biggest challenges that all Infection Control Officer/Committees face is keeping current. The constant advancement of medical technology introduces changes at all levels within the dental office, new bacterial strains complicate and challenge older infection control practices, and new research often requires re-examination of established procedures. The Infection Control Officer/Committee’s purpose is to provide guidance and leadership through these changes. This requires that all members of the team strive to keep abreast of changes within their area of expertise. By keeping current, they can assist the Officer/Committee as it works to manage its facility’s infection control policy.

Educating

Finally, as an integral part of its leadership, the Officer/Committee must take an active role in staff education. The education process should address at least two specific areas. The first area should be that of general infection control education. This is usually accomplished through an annual education program designed for all employees. This program is designed to provide the groundwork for general infection control protocols, which create a safe environment for both patients and employees.

The second educational need that the Infection Control Officer/Committee addresses is the need for updating. In the constantly changing healthcare arena, the Officer/Committee must find a way to communicate changes and updates to the other staff members. This is usually done through staff meetings, or published Officer/Committee communications like meeting minutes. Whatever the method, the goal must be to create a smooth flow of information to all employees. Both of these educational roles should focus on creating awareness of infection control and developing the appropriate skills necessary to function effectively on the job.

At DOCS we have recently updated our Infection Control Policies and Procedures (IPAC) to be compliant with the latest protocols. For more information feel free to contact us by email at sandie@dentalofficeconsulting.com or susanmcdocs@gmail.com
or call us at 905-332-2326.

Office Staff

Does Your Office Have an Infection Control Committee or Representative?

Everyone knows that infection control is the responsibility of all dental office staff. Patients and employees are only safe from infectious processes when everyone consistently follows good infection control techniques. The purpose of the Infection Control Program (IPAC) is not to reduce the individual responsibility that each healthcare provider has, but to provide leadership for all employees throughout the office. Through policies, procedures, and evaluation processes, the Joint Health and Safety Committee (JHSC) or Health and Safety Representative (HSR) must act as a central contact point for all infection control information and channel that information in a manner that will create the safest environment.

It is recommended to select a clinical staff member to become the Infection Control Representative to be the contact person for the JHSC or HSR. The Infection Control Representative would be responsible to maintain written IPAC infection control procedures, which should be available to all employees. The JHSC or HSR would provide guidance for the prevention of incidents through other established informational channels within the dental office, such as staff meetings. When problems arise, the committee should provide specific direction to a department or departments that details corrective actions that are deemed necessary. The JHSC should meet regularly, and maintain copies of the meeting minutes. If a Ministry inspector does comes to your office, provide him/her with a copy of the minutes.

The purpose of the IPAC Infection Control Committee or Representative is simple; to prevent and control infection. The Infection Control Committee is designed to provide clear direction to help everyone create and maintain a safe environment. When writing your procedures, determine which areas require only cleaning and which require disinfection. Train staff on the difference between cleaning and disinfection. Audit the disinfection and cleaning systems and make changes as needed. Once you have chosen the cleaners and disinfectants, ensure that staff read and follow all label directions. If you have questions, contact the chemical manufacturer.

Planning: Successful prevention and control of infection requires careful planning. The IPAC Infection Control Committee should be actively involved with the planning and implementation of new procedures that pose a potential infection control risk. For example, provide guidance for the implementation of a new procedure. Its role in the planning process is to examine the proposal, identify potential areas of concern, and recommend a course of action that provides the best method of infection control.

The Committee also may provide input into the selection of chemicals used to manage the environment, such as detergents and disinfectants. It may also provide input into the selection of equipment used to process instruments and accessories.

Monitoring: The IPAC Infection Control Committee also monitors infectious processes within the dental office. They track infections and incidents that have the potential to cause infections. They review infection control statistics in an effort to minimize risk, identify problem areas, and implement corrective actions.

When infections do occur, the Committee should undertake investigations to determine the cause of the problem and recommends the necessary education or changes in protocols.

Evaluating: Along with monitoring specific incidents, the IPAC Infection Control Committee also looks at the bigger picture as it continually strives to improve processes within the facility. This is demonstrated by the regular review of infection control procedures for all departments. The IPAC Committee may also be called upon to evaluate practices and provide input regarding products and protocols.

Updating: Perhaps one of the biggest challenges that all IPAC Infection Control Committees face is keeping current. The constant advancement of medical technology introduces changes at all levels within the dental office, new bacterial strains complicate and challenge older infection control practices, and new research often requires re-examination of established procedures. The IPAC Infection Control Committee’s purpose is to provide guidance and leadership through these changes. This requires that all members of the team strive to keep abreast of changes within their area of expertise. By keeping current, they can assist the Committee as it works to manage its facility’s infection control policy.

Educating: Finally, as an integral part of its leadership, the IPAC Committee must take an active role in staff education. The education process should address at least two specific areas. The first area should be that of general infection control education. This is usually accomplished through an annual education program designed for all employees. This program is designed to provide the groundwork for general infection control protocols, which create a safe environment for both patients and employees. Information such as standard blood borne pathogen education, etc. is covered in these programs.

The second educational need that the IPAC Infection Control Committee addresses is the need for updating. In the constantly changing healthcare arena, the Committee must find a way to communicate changes and updates to the other staff members. This is usually done through staff meetings, or published Committee communications like meeting minutes. Whatever the method, the goal must be to create a smooth flow of information to all employees. Both of these educational roles should focus on creating awareness of infection control and developing the appropriate skills necessary to function effectively on the job.

Bullying and Harassment

Zero Tolerance for Workplace Bullying and Harassment

We hear a lot about bullying and harassment these days, especially when it involves cyber bullying using social media. We also know the devastating effects that may result from excessive bullying. As the victim of workplace harassment, I know firsthand how bullying can affect your life and your health. At that time, I was not aware of my rights and felt powerless as it was a David vs. Goliath scenario. Now employees have the right to feel safe at work and it is a mandatory requirement for employers to prevent violence and harassment in the workplace.

According to the Ontario Ministry of Labour, this winter there will be more targeted safety blitzes at workplaces. Workplace Violence  is targeted for February and March 2013. Given the significantly increased likelihood that your office will be met by an OHSA (Occupational Health and Safety Act) investigation, it seems prudent for you to be aware of your obligations, and to ensure that your policies, procedures and practices are up to date. The fines for non-compliance are hefty and in some cases can lead to prosecution.

Employers have the responsibility to provide a safe workplace for their employees under the requirements of Ontario’s Occupational Health and Safety Act (Bill 168). Amendments to this act help protect workers from violence and harassment in workplaces. The amendments to this act require us to do the following:

  • Develop and communicate workplace violence and harassment prevention policies and programs to workers
  • Assess the risks of workplace violence, and take reasonable precautions to protect workers from possible domestic violence in the workplace
  • Allow workers to remove themselves from harmful situations if they have reason to believe that they are at risk of imminent danger due to workplace violence

Employers should not tolerate the harassment or degradation of another employee by an employee or the employer. This may include:

  • any type of degrading comments about any staff member a form of direct harassment
  • rudeness, neglect or indifference by any member of the staff.
  • threats of physical violence
  • bullying
  • intimidation of another worker
  • the use of profanity in any professional setting is unacceptable

Your employee policies manual should include a statement like the following

“The harassment or degradation of another employee by an employee will lead to disciplinary action, up to and including immediate termination for just cause on the grounds of gross misconduct. We consider gossip and any type of degrading comments about any staff member a form of direct harassment and it will not be tolerated. The use of profanity in any professional setting is unacceptable. We will not tolerate rudeness, neglect or indifference by any member of the staff.”

Workplace violence is interpreted as unacceptable behaviour includes any incident in which there is:

(a) the exercise of physical force by a person against an employee, in the workplace, that causes or could cause physical injury to the employee,

(b) an attempt to exercise physical force against an employee, in a workplace, that could cause physical injury to the employee,

(c) a statement or behaviour that it is reasonable for an employee to interpret as a threat to exercise physical force against the employee, in a workplace, that could cause physical injury to the employee

(d) an attempt to threaten or assault a client or visitor to the workplace while on company premises; or

(e) an attempt by an employee to threaten or assault a client, co-worker or other individual in circumstances relating to the employee’s execution of his or her duties, whether on or off company premises.

““Unacceptable Behaviour” means physically or psychologically aggressive behaviours including but not limited to:

  • hitting, kicking, punching, pushing, shoving, slapping, pinching, grabbing, biting

  • carrying or brandishing weapons of any sort

  • throwing objects at an individual with a view to cause physical injury or fear

  • destruction of workplace or co-workers’ property

  • threats of violence

  • intimidating behaviour that causes the recipient to have a fear of physical violence

  • obscene or harassing telephone calls.

These are just some of the examples that need to be considered when establishing a policy against Workplace Violence and Harassment. All employers in Ontario should have a Workplace Violence and Anti-Harassment Policy in place and your policy must be posted in a visible area of your office for your employees to see. If you would like more information about this or would like a sample policy, please feel free to send me an email to sandie@dentalofficeconsulting.com, with the subject line – Workplace Violence.

Why do you need a Workplace Violence and Harassment Policy? Because it protects employees and employers.

Author: Sandie Baillargeon

Insurance-Fraud

Who Are the Victims of Insurance Fraud?

Victim #1 – The Patient – (who is victimized twice)

The patient is victimized by his/her insurance benefits sometimes being maxed out. If a patient realizes that something is wrong with their insurance benefit entitlement and it is the result of what is happening at your office, they will blame you, because you are the dentist. The victim will not know, or care, that you have had a dishonest employee working for you who did these acts without your knowledge or consent.

Over-utilization of insurance benefits will result in employers not purchasing dental benefits for their employees. Dental insurance is the most costly component of a group insurance benefits plan. If the costs for the premiums rise due to the inflated utilization rate that was created by false claims, employers are likely to drop dental benefits from their employee benefits packages. When employers are faced with economic stresses, paying premiums for dental benefits become too cost prohibitive to sustain. The patient is now victimized a second time because they lose their employer paid benefit.

Victim #2 – The Doctor – Guilty Until Proven Innocent

If insurance companies launch an investigation and the doctor is aware of some problems that exist, but does not act on them, he/she is considered the prime suspect. In other words, the insurance company will assume that the doctor is responsible and his hands are dirty. Some insurance companies can, and will, deny any future claims that come from your office. You are considered guilty until proven innocent and even then, you are still guilty.

The doctor will also be expected to pay the insurance company back all payments that were received from fraudulent claims. That can become an administrative nightmare to sort out which claims were legitimate and which were not , costing the doctor both time and money.

In some cases the doctor may have his/her license suspended or revoked if they knowingly allowed insurance fraud to occur and did nothing about it after it was discovered. You are responsible for the actions of your employees because it is assume that they work under your direction.

Victims #3, 4, 5… – Collateral Damage

If the doctor and or hygienist loses their licenses, who will treat the patients? Also, the jobs for the remaining staff are in jeopardy making them victims as well. A lot of honest, hard-working people can become the collateral damage of the perpetrator’s misguided actions and the doctor’s career can be ruined.

What should you do if you suspect or detect fraudulent activity? The most important advice that you can receive is get professional help – don’t try to do it all yourself.

Author: Sandie Baillargeon

What to Expect if Your Office is Inspected for Compliance with the employment Standards Act (ESA)

The Employment Standards Act, 2000 (ESA) is a that law establishes minimum employer obligations and employee rights with respect to rates of pay, hours of work and overtime, vacations, public holidays, leaves of absence and more. Every province has similar laws in place to protect employees. The ESA applies to all employees and employers in Ontario and compliance with this law is mandatory..

The ESA is enforced by employment standards officers who visit businesses throughout Ontario to help educate employers on their obligations and ensure that employees’ rights are being protected.

Employment standards officers proactively visit businesses even if no complaint has been filed by an employee. These officers will help you correct areas where your business is not complying with the ESA.

Employment standards officers usually provide advance notice of a visit. They will review your records and speak to you and your employees. If there are issues of non-compliance, they will discuss these with you and depending on the nature of the violation, they may provide an opportunity to correct them before taking enforcement action.

Each year, hundreds of prosecutions are brought against employers for violating the ESA.

Some prosecutions have resulted in fines and/or court orders of tens of thousands of dollars or more.

Where the employer is an individual, rather than a corporation, he or she can also face jail time. In addition, directors of corporations can be held personally liable for their company’s violations and can also face monetary penalties and jail sentences. In the long run, these penalties cost businesses much more money than compliance. Some names of convicted employers and directors are posted on the Ministry of Labor’s website.

The role of an Employment Standards Officer is to conduct inspections and investigations.

Employment Standards Officers travel all over the province to inspect workplaces. These inspections make sure employers are complying with their responsibilities under the Provincial Employment Standards Act. Officers focus on standards such as:

Posting the Employment Standards poster in the workplace and distributing it to employees,

Ensuring that wage statements are timely and accurate with no unauthorized deductions

Accurate record keeping

Proper hours of work and eating periods

Accurate overtime pay

Adherence to minimum wage

Public Holidays and Vacation Pay standards

Restricting Temporary Help Agencies from charging fees to employees.

The inspectors will typically give an employer 10 days written notice when that inspection will take place. This gives the employer an opportunity to make their records available. It also gives the Ministry of Labour time to do their preparation. They will check the legal name of the business, whether it is still active, and look at their claims and inspections history. They will also check to see if the workplace is unionized.

Workplaces are selected through a variety of methods. These may include third party information, local intelligence, or just through random selection as part of a sector-specific enforcement blitz. In some cases they may also re-inspect a workplace to ensure that past violations have been corrected.

What should you have prepared?

During an inspection the Employment Standards Officer will take a look at a number of records which may include; schedules, time sheets, payroll ledgers and wage statements. The notice that they send out to employers also indicates important information about the Employment Standards poster.

What to expect during the inspection

The procedure is that they arrive at the workplace and meet the employer or their authorized representative. They review a variety of documents that relate to the Employment Standards Act. Beginning with an employer interview to determine compliance with the ESA. The inspector will take time to answer any questions an employer may have about their responsibilities.

During the inspection, they will ask the employer to show them where in the workplace they have posted the Employment Standards poster to make sure the poster is correct and it’s in a conspicuous place for the employees to see.

Employee Interviews

The inspector will also interview employees selected at random. If the inspector has reason to believe that there is not going to be adequate privacy to properly interview employees, he/she will make that known to the employer and let the employer know that they require a place that is comfortable, and that is isolated from the rest of the workforce or work environment.

Documents needed

During the inspection some documents are going to be required from the employer to prove the various standards are being complied with. The inspector will then use the documents provided by the employer to perform a test audit. The test audit involves the selection and review of payroll and other records. They randomly select employees to determine that at least the minimum standards are being met.

When the test audit is finished, if they find there is compliance with all standards that were inspected, they will then issue an inspection report which outlines the steps that they took and the findings they have made. The file is then closed.

What if problems are discovered?

If problems are found at the inspection and if it’s been found that an employer has contravened the Employment Standards Act, a full-audit or self-audit may be conducted for a set period of time.
If it is determined that the employer has contravened the ESA they may take enforcement actions such as: issuing a ticket, issuing a Notice of Contravention or in some cases recommending a Part Three prosecution under the Provincial Offences Act.

When the audit is completed, the employer is asked to voluntarily comply and correct any of the issues that were identified during the inspection. If wages are owed to employees they will ask the employer to pay those wages. If the employer does not comply voluntarily, they will issue an order to pay for the amounts that are outstanding.

When the inspection is completed, the officer will provide the employer with an inspection report which is required to be posted. The employer is asked to complete a Notification of Compliance indicating the dates upon which compliance has been achieved. When the notification of compliance form is returned to the officer the inspection is closed; however, the employer can be identified for a re-inspection at a later date to still ensure compliance.

To learn how your dental office can become compliant with the ESA, Henry Schein is sponsoring a free seminar on November 17, 2015 at the Scican Learning Centre, 1440 Don Mills Rd., Toronto beginning at 5:30 pm. To register for the free seminar please contact Susan McGuire at susanmcdocs@gmail.com or speak to your Henry Schein rep.

source: Ministry of Labor website

Author: Sandie Baillargeon

Hygiene Schedule

What to Do with Downtime in the Hygiene Schedule

Dental hygienists have a strong relationship with your patients and although there is an abundance of hygienists who are looking for jobs, it is important that dentists don’t take for granted the value of the patient- hygienist relationship. In most cases, the patients will see the hygienist more often than they see the dentist and for a longer period of time. There is more time to develop a relationship and patients become loyal to their hygienist based on trust. This is the type of relationship that you want your hygiene team to develop and maintain.

Some dentists pay their hygienists for their downtime and some don’t. Dental hygienists, like all employees, have financial obligations, like mortgages and living expenses, and they require a predictable and dependable income. The doctors who don’t pay anything for downtime can be assured that the hygienist is likely spending her downtime looking for another job or thinking about how to set up her own dental hygiene clinic and be her own boss.

Imagine if hygienists do set up their own independent practices, dentists could see 30% of their revenue walking out the door. In addition to this, studies show that 65% of restorative work is generated from the hygiene department. There is nothing that would stop an independent hygienist from opening a practice one block away, and although she would be restricted from directly soliciting patients, it wouldn’t take long for patients to find her. You may be able to replace the hygienist, but how do you replace the patients that could follow her? Think about how much time and money that would have to be invested into marketing and advertising to rebuild from the patients that you lost. Losing customers is economic suicide because you would also lost any potential referrals .

If a patient cancels in the middle of a day, there is very little that a hygienist can do to prevent that from happening or controlling it. It is not fair for the hygienist to have to suffer financial loss because she cannot control the behaviour of the patient. This does not, however, mean that you need to pay an employee to do nothing during the downtime. There are a lot of activities that can keep her busy.

Start by implementing a hygiene downtime policy and provide your hygienists with the tools to get the job done. The policy should provide one hour of grace time at full hygiene rate . Clinical rate may be paid up to a maximum of 1 hour of time in an 8-hour day where patients have short cancelled/schedule is not filled. This time is to be used productively, i.e. sharpening instruments, restocking operatories, making whitening trays, etc. If you there is more one full hour of downtime, the hygienist may be offered an administrative rate, such as half of their regular rate to assist in calling patients to schedule appointments or do administrative tasks as directed in order to be eligible to receive the compensation. If she does not wish to participate in administrative tasks, she may opt out of these duties and the downtime in excess of one hour would be unpaid. The administrative tasks would include calling patients on the continuing care list to make sure that the days are fully scheduled and confirmed. It is important to provide the hygienist with specific telephone skills to assist her with her calls. Remember that dental hygienists are trained in clinical skills and don’t usually learn telephone skills in school.

Here is some suggested verbiage:

“”Mrs. Smith, this is Sandie from Dr.Smith’s office. You are due for your dental hygiene appointment and I’m calling to schedule that for you. When you get this message, would you please call me back at ___________. I look forward to speaking with you. Have a great day. “

Prescheduling hygiene appointments in such a way that reduces the likelihood of short notice cancellations can help to avoid this problem. If you wish to receive a copy of Appointment Scheduling Policy and Procedure, please feel free to send an email to sandie@dentalofficeconsulting.com with the subject line “appointment scheduling policy.”

It’s in everyone’s best interest to keep your hygiene team productive and happy. Give your hygienists the opportunity to build and maintain their own schedule and provide them with the time, tools, training and technology to get the job done.

Do not refer to a dental hygiene appointment as a ‘cleaning’. By referring to the appointment as a “cleaning” it minimizes the value of the therapeutic service that you provide and it becomes less important to your patients. As valuable members of your dental health care team, dental hygienists have a distinctive clinical and educational role to play in promoting good oral health for a lifetime. The relationship that your hygienist establishes and maintains with your patient is the foundation of a successful practice.

Author: Sandie Baillargeon