Parallax View is an editorial series presented for educational and discussion purposes only.
The opinions expressed are those of the authors only, and by no means is any anti-trust action implied or to be inferred.
WHAT IS THE
"STANDARD OF CARE", REALLY?
Over and over again in this series you will read original thoughts. Very few of them are mine. I am an integrator, not an innovator.
Especially on this issue. As we all know, the standard of care has already been defined.
The standard of care is the level at which the average , prudent provider in a given community would practice. If treatment for which a recognized specialty exists is in question, then the standard of care is defined by the level at which an average, prudent specialist would practice, even if the treating doctor is a generalist.
Or is this really the definition? It is the legal definition, but 99% of the dentistry performed in this country is never reviewed in a court of law. Ninety-nine percent of the dentistry performed in this country is accepted by dental consumers but is never benchmarked, is never judged, never graded on its technical merits. As a colleague once quipped, "Our patients judge us only by the experience." Is there a more valid means of discussing Standard of Care?
The American Independent Dentist’s Association, (AIDA), has proclaimed its Mission to be:
To Close The Gap Between The Standard Of Care And Optimal Care in Dentistry. |
AIDA wishes to highlight, in all of its educational materials, a consumer driven model of dental organizational theory. Dentistry as an institution has two consumers—patients (external) and dentists (internal). Consideration of any issue of import to dentistry must recognize the positions, perceptions, and needs of each of these markets to achieve organizational effectiveness.
So, how does AIDA define the concept of Standard of Care, and why has it pinned its mission on this concept?
In his excellent book, Healthcare Marketing in Transition, (Irwin Professional Publishing, 1995, 1-800-634-3966), author Terrence J. Rynne has pegged the "true essence" of Standard of Care, and in a manner that clearly defines the paradigm under which today’s healthcare leadership has been functioning. I quote:
Healthcare Organizations are Expert Oriented
Healthcare organizations are classic examples of expert-driven organizations. Healthcare providers think they know their business. They know what’s good for the patient. They know what quality is. They know how to evaluate good from bad providers of healthcare. The marketplace doesn’t. Their skills and their high technology are what are important. One doesn’t listen to the marketplace, one "educates" it.
This cluster of beliefs keeps healthcare organizations from the surprises and successes that come from approaching the customer as the font of marketplace success. The marketing concept reverses the dictates of the expert-driven organization. "Quality is whatever the customer says it is. A good service is defined by the customer in a much broader way than the expert provider defines it. Quality services begin with the customer and their needs, not with the skills and technology of the provider."….
….it takes … great creativity and tenacity to work a cultural transformation in organizations that are as embedded in a reverse posture as are most healthcare organizations.
Therefore, the "true essence" of the Standard of Care as seen from outside of our profession is that it is whatever the public will accept.
Doesn’t that burst a lot of bubbles? How many of you are still working on that concept of, "If you build it, they will come."? (Big business has dropped this premise, by the way, many years ago.) How many of you are taking the courses, investing in the technology, changing management experts, redecorating, and all of those other customer-experience things? They all work, don’t they, to a certain extent? But have you seen a fundamental, earth shattering change in your practice because of these changes? Have you seen fundamental change in your industry? Has there been a mass effect in raising the public’s IQ with the advent of intraoral cameras? Do you have patients calling up asking for crowns because they noticed a fracture line across a marginal ridge, although asymptomatic? We as a profession have done a lousy job of educating our patients. In marketing parlance, we have not created value. We have over-concentrated on adding value to services which themselves are not understood. Picture the executive using his new dental plan, "just to check it out", and realizing that, "Well, the staff didn’t offer me a cup of coffee, but the cleaning was free, and it sure didn’t take very long. I got back to the office fast!" Patients have not been educated to value our services as they should.
The cynical among you are now asking, "OK, Market Man. So what is the answer?" And, like most awesome endeavors, the answer is not easy or well defined. But we can learn together how to address the dilemmas posed by educating patients to demand Optimal Dentistry. Let’s examine patients’ belief systems about dentistry. Let’s see how the True Essence of Dentistry is defined, in the minds of patients.
The true essence of our profession is defined by public opinion, which in turn is formed by:
1) Today’s Media
The essence of dentistry may only be directed by understanding and addressing each of these seven factors. Organized dentistry may or may not understand this, but has been remarkably reactive, rather than proactive, in all of the biggest issues to come before dentistry. Consider the AIDS crisis, the amalgam question, handpiece and waterline safety, OSHA, decline of the traditional doctor/ patient relationship, the malpractice crisis, the Reader’s Digest article, etc. To think that you define your own essence is a basic but common organizational flaw. Dentistry exhibits this flaw. Customer (patient) perceptions define the true essence of dentistry.
AIDA has action plans to address each of these perceptions, in the form of what we refer to as Templates for Success. AIDA does not have all of the answers; we’d be worried if we felt that we did. What we expect is that our organization will start a cascade of synergy which will bring new tools and new ideas back to us to be developed as further Templates, as well as experience with existing Templates so that they may be modified, adapted, improved, or scrapped.
Do your part to increase the standard of care in dentistry. But also understand that your part should not be confined to the chairside aspects. If you demand a practice of excellence in dentistry, your wish cannot and will not be achieved without organizational excellence in dentistry. If you expect it, and vote so with your hearts and your wallets, then it will be so, sometime. If you vote with your time and your talent, it will be so in your lifetime.
Stay Informed for Personal Success!
Get Involved for Organizational Success!
K. Randall Groh, DDS
Acting Chair
The American Independent Dentist’s Association
336 Alhambra Circle
Coral Gables, FL 33134
E-Mail feeforserv@aol.com
June 30, 1997© K. Randall Groh, 1997
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