May 2019 Volume LIV Number 3


Risk Management

September 2018 Volume LIII Number 5

MedPro Group Patient Safety & Risk Solutions

Collaborating With Dental Staff to Improve Patient Safety, Adherence and Satisfaction

Risk management focuses on preventing errors, misunderstandings and dissatisfaction among patients and staff. Dentists can reduce liability risks by engaging in preventive strategies, such as helping office staff understand the contributions they make to patient safety, adherence, and satisfaction. Educating staff about these issues improves the dentist’s ability to work effectively with team members and the patients they treat.

Below are sample scenarios that highlight opportunities for improving the ways in which staff interact with patients.


Mrs. Green arrives for her first appointment with Dr. Rodriguez. Reception- ist Sarah Adams greets her as she signs in. Once the sign-in process is completed, Sarah gives several other documents to Mrs. Green. They include a medical history, a practice policy statement and a HIPAA policy form.

"Oh no," Mrs. Green says. "Not another HIPAA form!" "Well, I’m sorry, but I do need your signature on it," Sarah replies. "Oh, for heaven’s sake," Mrs. Green laughs. "It’s getting so you can’t even buy a cheeseburger with- out having to sign a contract!" "I know how you feel," Sarah commiserates. "I’m the one who has to file all this stuff!"

If Sarah had understood the importance of the HIPAA policy in the example above, she might have responded differently. Rather than reinforcing Mrs. Green’s negative opinion about HIPAA requirements, Sarah might have said, "Our HIPAA policy does take a few minutes to review and understand, but I will be glad to answer any questions you have about this government requirement, Mrs. Green. It is important that you understand your rights to have your health information kept private and secure."

Responses should always focus on what is best for the patient and lead to better patient understanding. In addition, staff members should emphasize the importance the office places on complying with the law.


Ellen Baker is Dr. Smith’s receptionist. She loves her job and gets along well with Dr. Smith’s patients. However, Ellen is somewhat intimidated by patients like Mrs. Hawkins. When Mrs. Hawkins makes appointments for her children, she "doesn’t intend to waste time or money on unnecessary pictures!" As a result, the Hawkins children have not had X-rays in three years. Ellen is not comfortable confronting Mrs. Hawkins; instead, Ellen notes in the children’s records, "mother refuses X-rays."

In this example, Mrs. Hawkins creates a difficult situation by making firm pronouncements about the treatment her children receive. Unfortunately, her refusal of  X-rays might be harmful to her children’s oral health.

Creating an X-ray policy for patients and informing new patients about the policy are strategies for preventing future occurrences like the one noted in this example. Staff also should be trained to explain and reinforce the value of X-rays and other treatments as part of the dental standard of  care.

Additionally, office policies should clearly define the practice’s approach to other situations, such as missed appointments, failure to follow home treatment protocols, refusal to see consultants/specialists, and nonadherence to medication orders.

Dental staff also should be encouraged to discuss difficult patients with the dentist. Together, they can engage in a discussion with the pa- tients, or with patients’ parents, about office policies and the patient’s specific dental issues. By informing patients about various policies and ensuring staff members all take the same approach, dental practices can reinforce a consistent and quality approach to care.


The Stewart family has four children — all boys. Mrs. Stewart wants back-to-back appointments, which means her children must remain in the waiting room, sometimes for up to two hours. Office manager Patty Lowe fears that the boys are disruptive to other patients and that their behavior may lead to an injury. She wishes that Mrs. Stewart would keep a better eye on the boys.

"Every time they come into the office, one of those boys gets hurt. They’re a big risk to other patients, too. And they set a bad example for other kids." Patty wants Dr. Chen to discharge the family from his practice. But so far he has not done so.

Every dental practice should have a policy regarding unacceptable behaviors. One element that the policy should cover is waiting room safety. The policy should address employee and patient safety — from physical and verbal abuse to roughhousing behaviors.

In most cases, a simple sign reading, "Indoor voices and quiet play behavior are appreciated" will suffice. However, as in the example above, some parents may fail to address the disruptive tendencies of their  children.
In such instances, staff will benefit from knowing scripted remarks to use with children and parents to curtail the children’s rowdy be- havior. Scripted comments should focus on patient safety and not on embarrassing the parent or child. Staff can remind the children to use indoor voices and play quietly.

They might focus on an individual child — "Michael, I’ll bet you are the fastest boy at school. The other kids probably want to follow your example and be able to run really fast. But here in Dr. Chen’s of- fice, I need for you to set an example of how children can play quietly and safely so that no one gets hurt."

Inappropriate behavior should be addressed early. If a parent does not intervene at the first signs of a child’s disruptive behavior, the staff should step in. And, of course, corrected behavior should be com- mended — "Hey, Michael, thanks for your help today."


Periodic office meetings should encourage discussion of any problematic office situations. Staff members play a key role in identify- ing: (a) incorrect assumptions; (b) misunderstandings; (c) unrealistic expectations; (d) refusal to acknowledge boundaries; and (e) clinical nonadherence. Staff meetings are a good time to share these observa- tions and agree on methods for addressing them.

As a group, it is easier to ensure consistency in the way that specific challenges are met. Also, office meetings offer an opportunity to prac- tice challenging conversations — for example, asking Mrs. Stewart if she will encourage her children to have quiet time.

Training programs related to customer satisfaction and clinical standards are available from many dental societies and companies that provide customer service products and education. Doctors also can contact their professional liability insurance companies for guidance on specific patient relationship challenges.


Working out appropriate ways to address office issues will build more effective relationships among staff members and providers, and staff will acquire a better comfort level in their interactions with patients and their families.

Further, developing preventive strategies to meet office challenges can help support patient safety, compliance, and satisfaction. A final benefit is that these skills also may help doctors reduce liability risk.

This document should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if  you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions. MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory approval and may differ between companies.
© 2017 MedPro Group Inc. All rights reserved.

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