Top 10 Things Your Hygienist Thinks You Should Know

From RDH Volume 29 Issue 11 – November 2009

An American journal but relevant here.

This survey was constructed in a two-phase approach. First, I asked the readers in September to email me “things” they thought their doctor/employer should know. The second phase was the compilation of these suggestions into a list of 25 items and then asking the readers to pick their top 10. This was a popularity contest, sort to speak. We did not ask the readers to rank their top ten, only to choose 10 out of the list of 25 “things your doctor should know.”

The results reflect the percentage of hygienists who chose these particular statements. Overall, 1,451 participated in the survey. Thank you! On average, the respondents chose 9.5 answers, so it worked out to very close to what was requested.

Before I get to the answers, I first want to mention that I think there is a lot of information in these 11 statements, and a lot that you, as hygienists/employees can do, no matter what your position is within your practice. You are a team member, people interact with you, count on you, rely on you, and so your contribution makes a difference. And by contribution, I mean, not the work you produce, but also the support, encouragement, loyalty, creativity, and overall value you bring to the table.

You may not be in a formal leadership role, but you can still be a positive emotional leader (the colleague, for example, people go to when they need an injection of positive spirit), a team builder (someone, for example, who makes sure everyone gets heard), and/or an energy creator (someone who sees when a peer needs support and offers it freely).

So as you read the following results, please remember that real change, behavioral change, takes time and may require your own self-reflection and accountability for your actions and to offer others encouragement, give gratitude, and even laugh.

Lastly, I believe it’s everyone’s responsibility to make your work environment more positive, so please remember to read “Survey results: Now what?” for additional tips on the next steps to your positive transformational communication.

Survey Reveals …

Top 10 Things Your Doctor Should Know

1. Compensate me well for my efforts. I help build your practice. 68% selected this answer

2. Say “thank you” when team members work hard, maybe even give them a reward. 65% selected this answer

3. A doctor should back up the hygienist in discussing periodontal recommendations and perio findings with patients. 61% selected this answer

4. (tie) Dental personnel need to be shown they are appreciated! 50% selected this answer

4. (tie) Not all hygienists are created the same. 50% selected this answer

6. A dental hygienist is part of the team. 48% selected this answer

7. (tie) Talk to your team to see where there might be problems. 47% selected this answer

7. (tie) A dentist should treat the staff with respect; many dental hygienists feel that their employers treat them like “they are just making you money” or are “production girls.” 47% selected this answer

9. The dental hygienist should play a key role in identifying and diagnosing periodontal disease. If the dental hygienist isn’t current on this information, spend some money on CE courses as these will be worth it for the office. 44% selected this answer

10. (tie) Reward us just like you want to be rewarded … that’s all we ask. 42% selected this answer

10. (tie) A dentist should not humiliate employees in front of patients. 42% selected this answer

Kristine A. Hodsdon RDH, BS
Director RDH eVillage

www.rdhmag.com/articles/article_display.html?id=370783

The BDA Fights Back

Fresh on the heels of the editorial in the current BDJ come two releases which signify a sea change in the way the BDA will be perceived by the membership and hopefully by the DoH too.

Perhaps as a response to Tony Kilcoyne’s letter to the BDJ the BDA have again asked that the new decontamination regulations be evaluated by NICE. It strikes me that the 60 references apparently supporting this edict are as difficult to find as the evidence behind the WMDs that led us into the Iraq war.

Next a rejection of the “new” version of the 2006 contract, the so called Warburton or PDS+ contract.

BDA calls for NICE evaluation of decontamination evidence base

The British Dental Association (BDA) has today called once again for a full review of the evidence base for the HTM 01-05 guidance document on decontamination in dental surgeries. The BDA has written to the Department of Health (DH) renewing its 2007 call for a National Institute for Health and Clinical Excellence (NICE) review of the evidence, after it emerged that three areas of the guidance have already been amended before the document is even printed.

The three changes to the guidance that have already been made are:

The use of potable water for the rinse stage of decontamination is now permitted. This is a climbdown from the previously intended requirement for reverse osmosis and freshly distilled water, after studies showed low concentrations of endotoxins in England’s potable water supplies.

The period for which instruments can be stored after they have been processed in a validated vacuum sterilizer has been increased from 30 days to 60 days.

The revision of the requirement for two sinks for decontamination to allow the option of two bowls incorporated into a single unit instead.

Concern about these changes has been heightened by a consistent failure by the Department of Health to publish the references that they say form the evidence base for the document, despite repeated requests by the BDA for it to do so.

Calling for the guidance to be referred to NICE, BDA Executive Board Chair Dr Susie Sanderson said:
“It is telling that changes to the content of HTM 01-05 have had to be made already. The changes expose the uncertain evidence base on which the document is founded and will be a cause of great concern to dentists. These doubts can only be exacerbated by the failure of the DH to publish its evidence base for the document.

“This guidance will apply to family dentists and public dental facilities alike, so complying with it will cost both dental practice owners and the taxpayer significant amounts of money. The dental profession is absolutely committed to the highest standards of patient safety and is happy to invest in pursuit of those standards. But the investment has to be in changes for which there is a robust evidence base. To establish that evidence base the BDA believes the guidance must be looked at in detail by NICE.”

Link to press release here.

Dental access contract still unsuitable as changes do not go far enough says GDPC

The unnecessarily complex contracts for dental access funding make them risky and inappropriate for dental practice, despite some changes made by the Department of Health (DH), the BDA’s General Dental Practice Committee (GDPC) has said today.  The final version of the ‘PDS+’ agreement developed for the current round of dental access procurement has been published today by DH.  It runs to nearly 50 pages and 17 schedules.

John Milne, Chair of GDPC, said:

“Although it must be an individual business decision, we advise dentists to think very carefully and seek advice before taking on one of these contracts as the dangers of breach are rife, and the consequences of breach may be very damaging to practices.”

The GDPC, advised by specialist lawyers, has spent more than four months explaining in detail to DH why its proposed contract was unsuitable, one-sided and unsafe for practitioners. The first version, based upon a medical model, was wholly unacceptable and we advised members not to sign it.  While DH has made some significant changes, we still do not feel that the contract is acceptable.

The main reasons are:

  1. The requirements are one-sided, leaving all the risk of a complex and untried payment mechanism with the dentist.
  2. Fundamental new provisions, such as the payment mechanism, the need to comply with new key performance indicators and the ‘dental care assessment’ of patients should have been developed and piloted in conjunction with the wider profession through the implementation of the Steele review.
  3. The contract is over-specified and a large majority of the controlling provisions remain, leading to intrusive micromanagement. Practices will need to devote considerable resources to managing the contract and ensuring that the requirements are met.  For most practices, this will require a dedicated contract manager and for the contract value to reflect the risks and extra work required.

Members are advised to take specialist advice if considering bidding for access contracts.  The contract, which DH says is not actually mandatory for PCTs to adopt, is on the BDA’s website here. BDA guidance notes are available here for BDA members.

Link to the press release here.

BDJ Editorial – Well Said Stephen Hancocks

These are strange times in Dentistry. Government apparatchiks have dabbled with NHS dentistry since 1990 and none of their changes have improved much, if anything, for the poor patient. Persistent interference and change has led to a dental work force that is low on morale, and even lower in confidence in politicians. Since 1997 there have been increasing attempts to bring the dentists to heel, at my most paranoid I wonder if Dr John Reid saw the an opportunity to do to the profession what Mrs Thatcher had done to the miners.

Amongst this the British Dental Association, trying to represent the interests of every dentist in every branch of the profession is an easy target for those who want to snipe. The fact is that dentists are such a disparate bunch with such a panopoly of opinions that the BDA would sometimes be better off trying to herd cats, bottle smoke or nail jelly to walls.

Through these times the editorial of the BDJ remains a refreshingly independent read and the current edition is no exception. I have been a member of the BDA since student days and still serve as a section officer, I came close to resignation in 1990 when there was a complete failure of leadership  but I preferred to remain within the tent. I suggest you read this piece by Stephen Hancocks.

British Dental Journal 207, 405 (2009)
Published online: 14 November 2009 | doi:10.1038/sj.bdj.2009.1008

The artful science of politics
Stephen Hancocks, OBE1

Editor-in-Chief
Send your comments to the Editor-in-Chief, British Dental Journal, 64 Wimpole Street, London W1G 8YS e-mail: bdj@bda.org

Introduction
The current controversy over the sacking by Home Secretary, Alan Johnson of the chairman of the Advisory Council on the Misuse of Drugs, Professor David Nutt will doubtless pass fairly quickly into the history book of minor public skirmishes. Apart from the significance of the Professor’s view of the classification of drugs the other notable aspect was the vehemence with which the decision was defended. It serves to highlight the serious disconnections that exist between scientific fact (evidence base) and political dogma, the assessment of risk and the application of policy, and the practice of defensive public strategy. Such inconsistencies are well known to us in dentistry.

It was Professor Nutt who caused earlier controversy by suggesting in a comparison of relative risks that drug harm can be equalled by other aspects of life that involve risk-taking behaviour; likening the dangers of taking ecstasy to those of horse-riding. Howls of indignation went up at that time from the then Home Secretary Jacqui Smith (perhaps statistically, losing a job as Home Secretary is a greater risk still) declaring that the claim trivialised the dangers of the drug. Yet I suspect it was the social gradient of the comparison that caused political correctness to come into play. The sordid drama of collapse through ecstasy, tinged with crime, in a sweaty inner city night club probably seemed more immediately socially relevant than the trauma from a riding accident in a leafy country setting, despite both being tragic in their own terms.

Evidence exists – if required!

It does leave one wondering about the government’s attitude to decontamination. We have had the imposition of single-use endodontic files because of a ‘theoretical’ risk of cross infection control by prion proteins, yet no scale of evidence has been forthcoming to allow a judgement on how theoretical or otherwise the risk may be. We now also have the edicts of HTM 01-05 which require the use of, amongst other things, washer-disinfectors in primary dental care and an assurance in a letter to this journal by the Chief Dental Officer of England that it is evidence based.1 Somewhat disingenuously one feels, the letter also states that ‘over 60 references to the published scientific and clinical literature were used in its compilation. A list of these references is currently being compiled for publication if required.’ If required? Surely this is in jest? If they are already published how long does it take to compile a list? No research paper submitted to this or any other reputable journal would be considered if it arrived with a statement that the references would follow in due course ‘if required’, let alone one which had such far reaching practical and economic consequences as HTM 01-05. Despite a promise to the BDA, at the time of writing the elusive list has still not been received.

We therefore have to take someone’s word for it. It might, of course, be sensible guidance but how are we able to judge? Without our knowing it might also be politically expedient guidance based perhaps on the defensive premise that if it isn’t enforced and a patient contracted an infection as a result of dental treatment the government might be culpable. Yet how many cases of MRSA, for example, are traceable to dental practice as compared with hospitals? We are not told but the belief is none. In contrast, the recently published report from the National Creutzfeldt-Jakob Disease Surveillance Unit2 makes interesting reading. It details that between 1995 and 31 December 2008, a total of 167 cases of definite or probable vCJD had been identified in the UK. Devastating for those individuals and families involved but hardly what one could term a public health crisis. Comparisons might be odious and possibly inappropriate, but by the time you read the next issue of the BDJ two weeks hence, about the same number of people will have been killed on our roads in a fortnight as contracted CJD in 13 years.

So what am I trying to say? In the first instance I am asking for some honesty about whether an evidence base exists or not, and if it does some further educated discussion about the seriousness of the risks. But I believe that we also need some clarity in thinking between the application of science, the estimation of risk and the formulation of public policy. Cost benefit is always a harsh term to introduce when health is concerned but to put the argument back into a road safety context, the likelihood of eliminating fatal accidents at railway level crossings could be achieved by building a bridge over each and every one in the country; but at what price?

No one would ethically suggest that we abandon cross-infection control, or indeed expose our patients, our teams or ourselves to unnecessary risk of microbiological contamination. However, equally, no one in practice for the public good should be compelled to implement guidelines, the evidence for which has not been published in the accepted way, that have not been openly risk assessed and that smack of a political expediency removed from the reality of that which other evidence suggests is prudent. It takes at least two parties to cross-infect, the same number as it does to establish trust.

References

Cockcroft B. A legislative requirement. Letter. Br Dent J 2009; 207: 303. | Article | PubMed | ChemPort |
The National CJD Surveillance Unit. Seventeenth Annual Report 2008: Creutzfeldt-Jakob disease surveillance in the UK. Edinburgh: NCJDSU, 2009. www.cjd.ed.ac.uk

James Hull – ups and downs.

As David Brent famously announced to his office staff – “one day you’re the pigeon, the next day you’re the statue.”

James Hull 13th October 2009: news.bbc.co.uk/1/hi/wales/8303743.stm

James Hull 15th October 2009: business.timesonline.co.uk/tol/business/industry_sectors/health/article6917214.ece

I have never met James Hull, I respect what he has done, no matter how you define success he has achieved it. I applaud his efforts, the wealth he has created and the energy and drive he has brought to dentistry. I am sure that there are people who will revel in the story of his removal from (his) office, they are usually the people who happily kiss backsides and then enjoy stories of others’ fall from grace whilst rarely creating anything original of their own.

So don’t dwell on the words of the odious Brent but on Kipling:

If you can meet with Triumph and Disaster,
And treat those two imposters just the same.

I have no doubt that James Hull will return.

The Monday Morning Quote £62

“The bitterness of poor workmanship remains long after the sweetness of low price is forgotten.”

Longfellow

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The Weekend Read – Ping by Alan Stevens

413OlRkdKIL._SL125_My clients, like all owners of professional businesses, are aware that they need to promote themselves and their businesses; although in most cases the two are synonomous. But where to start? Newspapers? TV? Radio? and what about the apparently overwhelming number of social media opportunities. Where do they fit in with Facebook, Linkedin, Twitter and the rest?

These dilemmas face me too. As the owner of a small coaching, consulting and training business I depend on good communications to spread the word and promote my services.

Alan Stevens, the media coach, is a veteran of the world of media and public relations. In this book he passes on the wisdom of more than a quarter of a century of the benefits of an integrated PR campaign which he defines as one which “delivers a single core message , using both traditional and social media.”

Delivered in short, easily read chapters with concluding 30-second summaries, this book can be devoured in a single sitting or dipped into and returned to regularly.

Chapter headings include Social Media Principles, How to Get into Print, Audio and Podcasting, Ezines and Blogging.

In summary – an excellent guide to the world of PR and communications that should be necessary reading for all professional business owners.

Available from my Amazon bookshop here.

Imagine – The Brave New World of NHS Orthodontics

A posting from Ortho-UK.

Imagine

Imagine you work  for a  PCT that feels the need to impose a central referral service without running it past the MCN the OHAG or any other orthodontic representative body.

Imagine the first you hear about it is when a circular comes round advising all dentists that all referrals must be made to that service or they will not be funded by the NHS (you are a referral practice that has invested and continues to invest in its practice, works hard for its patients and has full liability for its business – AND whose life-blood is its referrals).

Imagine that the PCT recruits DwSIs (no problem with that –  this is not a rant against DwSIs but is  a reflection on what being a specialist in the NHS amounts to). But further imagine that those same DwSIs will become referral practices from 31st March 2010.

Imagine that you have a representative body (lets call it the BOS) that produces a timely document advising on referral guidelines and I will quote from appendix 3.

Where to make an orthodontic referral

Specialist Orthodontic Practice:
Cases that require routine orthodontic treatment including crowding, increased overjet, increased overbite especially with evidence of gingival trauma, posterior and anterior crossbites with displacements and mild hypodontia (missing no more than one tooth per quadrant)

Dentist with Special Interest in Orthodontics:
Treatment, as above, but often in conjunction with a consultant’s treatment plan

Imagine the implication that as a specialist you of course offer no benefit over a DwSI. In fact it appears that you do not even have the benefit of endorsement of a consultant treatment plan. Sweet.

Imagine  a disciplinary body that is considering limiting the display of letters to primary dental qualifications.

Imagine in the meantime a proliferation of MSc’s and Diplomas in orthodontics representing various levels level of attainment.

Imagine that the referral service goes live within 2 weeks of the circular.

Imagine your previous colleagues with whom you had a working relationship are ringing you up to find out what is happening but you cannot tell them.

Imagine you have no idea how it is going to work but that every time you ask it is slightly different. Firstly letters are merely going be logged then forwarded to the addressed orthodontist, then next they are going to be advised of their options a la “ choose and book” based on waiting list and proximity (not bad options the patient may think). Ultimately it is intended that there will be triage – cost? Effectiveness? Piloting?

Imagine that three weeks after the inception of the service you have had no referrals. But there is no service level specification you can measure it against or contact point that you can (Heaven forfend) complain to.

Imagine how much worse it would be if specialist practices had fixed term contracts. Oops.

Imagine the relief you feel when your PCT reassures you that it has “no wish to destabilise existing providers”.

Imagine ……………………………… all the people living life in peace…………………………

I prefer Johns version.

You may say I’m a dreamer…………………………………………………………………………………………………………………………………………………… But it’s a bit of a nightmare really.

I prefer not to imagine – which is just as well under the circumstances.

Choose your customers, choose your future – from Seth Godin’s Blog

Choose your customers, choose your future

Marketers rarely think about choosing customers… like a sailor on shore leave, we’re not so picky. Huge mistake.

Your customers define what you make, how you make it, where you sell it, what you charge, who you hire and even how you fund your business. If your customer base changes over time but you fail to make changes in the rest of your organization, stress and failure will follow.

Sell to angry cheapskates and your business will reflect that. On the other hand, when you find great customers, they will eagerly co-create with you. They will engage and invent and spread the word.

It takes vision and guts to turn someone down and focus on a different segment, on people who might be more difficult to sell at first, but will lead you where you want to go over time.

To sign up to Seth’s regular Blog click here.

A Diversion …..

During 2008 I was involved with a business that had “corporate” aspirations. Unfortunately most of those were realised by pretty colours, poor financial management, a culture of blame and death by email.

The last straw was a meeting where the phrase “going forward” was used over 20 times in two hours (yes I was counting, but stopped at 20).

If you’re looking to use some bs, sorry jargon, then perhaps this generator might help.

The Monday Morning Quote #61

“When written in Chinese the word “crisis” is composed of two characters – one represents danger and the other represents opportunity.”

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