Making Sense of Dental Practice Management

Raj Rattan, Kevin Lewis

• Éditeur: CRC Press
• Année: 2017
• ISBN:
  9781315346038
• Édition: 1
• Sujet: Medicina
• Sous-sujet: Medicina clínica

Managing a dental practice has become increasingly complex in recent years, after changes within both the National Health Service and the private sector. Modern dental practice requires that dentists meet demanding business and management challenges as well as employing their clinical expertise. However, most dentists receive little or no formal training in practice management. In this book established management principles are applied specifically to dentistry. It shows how to best serve the interests of patients by effective management of staff, finances, premises and resources. It assumes no prior knowledge, is concise and offers clear, practical advice. It is the definitive guide for dentists, vocational trainees, dental students, practice managers and administrators, and a useful reference for those undertaking the DGDP and MGDS examinations.

PART 1
Introduction

1
An introduction to practice management

The earliest writings on management date back to the late nineteenth century, when management doctrines evolved, shaped by the observations of the era. The fundamental tenets of management remain concerned with controlling human, fiscal and material resources in order to achieve defined objectives. No single approach or theory of organization and management applies universally.

Modern dental practice, with its emphasis on quality in all activities, demands a quality-centred approach to management as dentists continue to acquire new clinical skills and help shape the future of professional care.

Management challenges which affect dentists at the present time include:

1. ■ changes in NHS dentistry
2. ■ developing the private sector
3. ■ managing social and regulatory changes
4. ■ professional development
5. ■ financial performance
6. ■ promoting quality in practice
7. ■ health and safety legislation.

The future always promises new and more demanding professional challenges fuelled by the speculative changes to the NHS, EC legislation and directives, the development of career pathways and continuing professional training.

The business challenges of dentistry are concerned with the creation of wealth, and the function of business management is to control costs, manage human resources, take decisions and monitor performance. The conscientious practitioner must be committed to this function of management because only through the creation of wealth can practice development and growth take place. Remember the old adage –no profit, no practice!

Efficiency and effectiveness

Two concepts which are frequently discussed in this book are those of efficiency and effectiveness. Efficiency is a measure of doing things right in an appropriate time scale and effectiveness is concerned with doing the right things. Efficient practice results in:

1. ■ optimum use of time
2. ■ reduction in wastage of resources
3. ■ a balance between time spent and results achieved.

Effective outcomes manifest in:

1. ■ improved performance
2. ■ increased profitability
3. ■ attainment of goals
4. ■ proper use of resources.

Management theories

A detailed review of management theories is beyond the scope of this text, but a discussion of some of the leading theories and how they relate to modern management thinking is fundamental to understanding how they have shaped the processes and systems involved in modern management.

FW Taylor (1856-1917)

Taylor’s scientific approach made certain assertions, namely that manual workers were solely motivated by financial reward, and this led to a payment method which was in direct proportion to work output. One hundred years after his proposals, the piece-work system of pay remains popular today. Indeed the NHS remuneration system for general dental practitioners was 100% dependent on this approach before October 1990 and 80% dependent on it since.

The basis of his ‘scientific approach’ reflects Taylor’s view that work methods should be studied and analysed to improve speed of output in carefully controlled environments. The role of management was to provide the conditions for optimum performance and Taylor’s approach left little to the discretion of the workers.

Taylor’s views were adopted in the United States and parts of Western Europe but, interestingly, not in Japan. The consequences of this were much in evidence during the 1970s and 1980s when the Japanese approach to management was carefully studied by the West and many of the principles were then adopted and adapted by these countries.

Taylorism is still studied today, and many of his principles continue to colour the fabric of today’s management principles. The theory can undoubtedly be applied to the practice of dentistry as it is carried out in general practice. Manual tasks often of a repetitive nature lend themselves to this approach but there are disadvantages. These are:

1. ■ work simplification routines may mean that new skills and techniques are not developed
2. ■ the emphasis on speed of output is inappropriate for a professional person. Efficiency in work methods is more appropriate
3. ■ the work atmosphere can be dehumanized, focusing on levels of activity other than total patient care
4. ■ clinicians and administrative staff do not discuss aspects of management together and this can alienate members of the dental team.

Henri Fayol (1841-1925)

Fayol dissected five types of functions which he believed to be common to all organizations, irrespective of the nature of their business. These activities were identified as:

1. ■ technical
2. ■ commercial
3. ■ financial
4. ■ security
5. ■ managerial.

He further sub-divided the management activity to include planning and forecasting, organization, command, co-ordination and control.

Fayol’s approach was entirely different to that of Taylor. Whereas Taylor focused on output and activity, Fayol preferred to look at organizational aspects of the workplace, and in this respect his approach complements Taylor’s scientific theory.

The functions of management can be easily applied to the modern dental practice, and indeed the format of this book, with its sub-sections, owes much to how Fayol saw the prime functions of management.

Mary Parker Follett (1868-1933)

In the 1930s, Mary Parker Follett was a prolific writer and researcher into management in the UK. Follett adopted a holistic view of management, placing emphasis on human relations within the workplace and the management of conflict.

Follett coined the term ‘the law of the situation’ where ‘orders’ became part of the product and part of the situation so that individuals did not feel that someone was giving commands and someone else was receiving them.

This approach can be beneficial when small teams are closely involved in working together for a common goal –a typical scenario within a practice. If unforeseen conflicting situations arise, then procedures and ‘rules’ automatically kick-in without the team leader necessarily giving a command. It reduces perceptions of hierarchy and subordination and creates a more harmonious team spirit.

Tom J Peters (b. 1942) and Robert H Waterman (b. 1936)

Best known for their work In Search of Excellence, Peters and Waterman set out to investigate what made companies successful.¹ They studied 43 of the leading and most successful US organizations to ascertain what factors contributed most to their successes. They concluded that successful companies had several common characteristics.

At the head of the list was a commitment to carrying on the business that they were best at. The authors used the expression that the firms ‘stick to their knitting’. Other characteristics included:

1. ■ simplicity of corporate structure
2. ■ overriding concern for customer care
3. ■ policy to encourage entrepreneurial activity
4. ■ hands-on management where senior management is personally involved at all levels
5. ■ productivity through people; that is focusing on the team as a resource for quality and productivity.

A survey of some of the country’s most successful practices reveals very similar factors. Interestingly, the authors’ perception that the secret of success is to ‘stick with one’s knitting’ is well supported by a number of accountants specializing in dental practice a...