EGP - March April 2020

Embracing diversity Diversity within DSOs and group practices can lead to greater team satisfaction and better patient care.

MARCH/APRIL : 2020

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Contents >

March/April : 2020

Pulisher’s Note

No one-fits-all solution

How do you do virtual?

Covering the topics you care about............... 2

Gloves today are thinner – and offer greater durability – than their predecessors............ 14

Practical and tactical solutions for working remotely..................................... 30

Facemasks

The OSHA inspection

Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them................ 16

Complacency is unacceptable........................ 34

SEO: The top searched dental term and your digital marketing score................. 4 A meeting place Aspen Dental’s VIBE events offer a venue for practice owners and fourth years to make plans............................. 6

It may fit like a glove… …but is it the right fit?................................. 10

Surface disinfectants As products become more diverse, dental practices must find solutions that fit their needs........................................ 12

EDITORIAL BOARD

Embracing diversity Diversity within DSOs and group practices can lead to greater team satisfaction and better patient care................................... 20

United by their differences When it comes to supporting a culture of diversity, actions speak louder than words..... 24

EDITOR

A.J. Acierno, DDS, CEO, DecisionOne Dental Partners

Laura Thill • lthill@sharemovingmedia.com

Kristine Berry, RDH, MSEC, NextLevel Practice Coach

SENIOR EDITOR

Brad Guyton, DDS, MBA, MPH, Vice President, Clinician Development, Dean, PDS University™ – Institute of Dentistry, Pacific Dental Services Brandon Halcott, Co-Founder and President, Tru Family Dental DeAnn McClain, Executive Vice President of Operations, Heartland Dental Kasey Pickett, Sr. Director, Communications, Aspen Dental Management, Inc Heather Walker, DDS, Mortenson Family Dental

DENTALFACTS EDITOR Alan Cherry • acherry@sharemovingmedia.com CIRCULATION Laura Gantert • lgantert@sharemovingmedia.com ART DIRECTOR Brent Cashman • bcashman@sharemovingmedia.com

The opioid crisis: It’s everyone’s responsibility Mortenson Dental Partners does its part to address opioid addiction................ 43

News..............................................................45 Coming together................................48

ADVERTISING SALES Diana Partin dpartin@sharemovingmedia.com

Graham Garrison • ggarrison@sharemovingmedia.com

MANAGING EDITOR Daniel Beaird • dbeaird@sharemovingmedia.com

2020 OSAP Annual Conference...........................39

VICE PRESIDENT OF SALES Katie Educate keducate@sharemovingmedia.com PUBLISHER Scott Adams sadams@sharemovingmedia.com

Efficiency In Group Practice is published six times a year by Share Moving Media • 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770-263-5257 • Fax: 770-236-8023 www.dentalgrouppractice.com

Efficiency In Group Practice is published six times a year by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media All rights reserved. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.

POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publishers. Publishers cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

Efficiency In Group Practice : ISSUE 2 • 2020

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> Publisher’s Note

Covering the topics you care about

Scott Adams

I am incredibly excited to be the new publisher for Efficiency in Group Practice (EGP).

This has been the fastest growing magazine in the history of our organization. For the past 11 years, I have been the publisher of our flagship title in the healthcare space, Repertoire Magazine.

EGP is a product of Atlanta-based Share Moving Media (SMM). As the owners of SMM, my business partner and I share a common goal with each of our publications: cover the topics our audience cares about and that will help them grow their careers. Our team is dedicated to delivering content to you that will help your career, enhance your work life and, hopefully, entertain you along the way. We will begin doing this through additional vehicles such as podcasts, live events and educational videos.

As you’re reading EGP, please think of topics we need to be covering or ways we can make it better and email me at sadams@sharemovingmedia.com. I look forward to getting to know you over the coming years. Thank you for subscribing to our publication.

Dedicated to Your Success, R. Scott Adams

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Efficiency In Group Practice : ISSUE 2 • 2020

SUPE RIOR T E CHNOLOGY

“

I am very satisfied with the suction that my new Mojave LT3 provides.

My staff and I appreciate how quiet it is, and our patients appreciate it too.

”

- Holly Burns, DDS

“

M A T C H E D

W I T H

My staff loves that AirStar NEO is virtually maintenance free and the smart, state-of-the-art diagnostic monitoring functions.

”

- Michael Brown, DDS

P E R F E C T

S E R V I C E

“

ScanX provides an ideal digital imaging solution for your dental practice. Its wireless, flexible PSPs offer ideal comfort for your patients, while producing high quality diagnostic images in seconds.

”

- George Freedman, DDS

From the Utility Room to the Operatory, Air Techniques Has You Covered.

For more information, to schedule a demo, or to place an order, contact your local dealer representative.

To learn more, visit www.airtechniques.com

> SEO

Growing Dental Practices through Quality Content and SEO The top searched dental term and your digital marketing score

By Barry Nix

For the second consecutive year, the term “root canal” was the most searched dental term for users of the free, healthcare cost transparency website www.fairhealthconsumer.org. FAIR Health Consumer is a national, independent nonprofit organization that allows users to search for typical costs of healthcare procedures in their geographic areas. In 2018 and 2019, the top five dental terms were the same: root canal, crown, implant, orthodontic and cleaning. In addition to its cost lookup tools, FAIR Health Consumer has educational materials, including articles, videos and helpful links to outside organizations. However, the most visited resources were those on costs, state resources, locating providers, insurance appeals and dental.

71% of dentists nationwide have a Yelp profile, but 20% of these profiles were unclaimed by the practice itself.

What does this mean for dental practices and the ability to digitally market themselves? It might come down to a score.

Your DMscore is your digital marketing performance ranking as a business, and the current news isn’t good for dental practices. New research indicates significant performance gaps in digital marketing execution for dental practices, despite billions of dollars in marketing spend.

To get your DMscore, local data is collected, analyzed and validated

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nationwide for dental practices and other professional segments.

It doesn’t paint a pretty picture for dental practices in paid search advertising like Google Adwords, directory presence like Yelp or search engine optimization (SEO). According to a study of 54,000 dental practices conducted in December 2019, based on data collected over the prior two years, 71% of dentists nationwide have a Yelp profile, but 20% of these profiles were unclaimed by the practice itself. And more than 33% of

Efficiency In Group Practice : ISSUE 2 • 2020

dental sites had poor organic search results, ranking 20th or worse in Google search results, which equals lower visibility and business loss.

Rand Schulman, CEO of Palo Alto, Calif.-based DMscore, said it is their mission to make your DMscore as understandable as your FICO score.

“We are analyzing nationwide data sets of millions of professional segments, and today, see the professional marketing trend fast moving to online spend. DMscores change relative to the dynamic complexity of a local market segment. So, a [dental] practice can monitor, track and improve their score, relative to their competition.”

Boosting your SEO ranking may be the most significant improvement your practice can make in its digital marketing effort. Many practices don’t understand the technology behind search results, but they know that search is probably going to play into their potential next patient’s decision to see them or a competitor.

SEO is search intent, plain and simple. It is about understanding what the user is searching for. There are three primary types of search intent, including informational, navigational and transactional. These search intent types will be covered in depth in my next column to help dental practices understand what kind of services they need to feature in their digital marketing and how to position themselves in the market.

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> DSO Profile

A meeting place Aspen Dental’s VIBE events offer a venue for practice owners and fourth years to make plans.

In February 2017, Ryan Evans was just a few months away from receiving his DDS from the UCLA School of Dentistry. Not surprisingly, thoughts about his future weighed on him.

“The hardest part of my job search was the saturation of dentists in Southern California, which led to a lack of opportunities for young doctors,” says Evans, who joined Aspen Dental in July 2017.

“Many associate jobs were only one day a week at below-market daily

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rates, meaning I would be traveling in all different directions, fighting Los Angeles traffic to fill my schedule and not helping patients in the way I wanted to. Considering limited offers and the cost of living in Los Angeles, I knew I had to find other opportunities.”

Efficiency In Group Practice : ISSUE 2 • 2020

An Aspen Dental recruiter invited Evans to attend one of the company’s “VIBE” events in Atlanta.

“I honestly had no specific expectations of the event other than having a good time,” says Evans, who has opened four Aspen practices in the past couple of years, including his new home office in Palm Desert, Calif. “The event exceeded my expectations in terms of the amount of fun I thought I’d have.” That included lectures, workshops, even a NASCAR

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> DSO Profile

race. (Aspen was the primary sponsor of driver Danica Patrick’s car.) “It opened my eyes to the vast network that is Aspen Dental. There were so many amazing people, including clinicians and non-clinicians, at the event, and it really piqued my interest in the company.”

of over 200 practice owners, and with over 50 of them in attendance at VIBE, students and residents have the opportunity to meet many practice owners from all over the country and explore a number of career options, all in one weekend.”

VIBE fills an important role for Aspen Dental owners as they

“ The event exceeded my expectations and opened my eyes to the vast network that is Aspen Dental.”

Ryan Evans, DDS, practice owner of four Aspen practices

Connect and learn Held quarterly since 2015, the Aspen Dental VIBE is geared towards fourthyear dental students and residents who want to connect and learn from Aspen Dental practice owners, career guides and executives from Aspen Dental Management, Inc. (ADMI), explains John Murphy, vice president of talent acquisition. “The purpose of the weekend is to immerse guests in Aspen’s unique culture, understand their goals and career aspirations, and make the message clear that dentists who join Aspen Dental are supported by mentors and an organization that will stop at nothing to enable their success.”

All Aspen Dental practice owners are invited to attend VIBE, but the events are of special interest to those looking to hire associates for their practices, says Murphy. “The Aspen Dental network is comprised

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seek to recruit dentists to offices in federally designated dental health professional shortage areas (DHSPAs), where most Aspen Dental offices are located, he continues. “This is a primary reason that practice owners attend VIBE – to recruit graduating students and residents who are far more likely to consider these locations, where the students can run and own highly lucrative practices.”

DHSPAs represent opportunity, including pent-up patient demand and limited competition, he says.

Overhead costs, such as rent and utilities, tend to be lower. “Meanwhile, you’re helping people who have typically lacked access get back on the road to optimal oral health.”

What’s more, “New dentists desire mentorship, and the owners in the Aspen Dental network can provide it in these locations.”

Efficiency In Group Practice : ISSUE 2 • 2020

Motivating factors “Some of the big recruiting challenges facing practice owners are affording an associate, identifying and meeting the factors that motivate new graduates, and finding doctors who are willing to relocate,” says Katie Heald, DDS, who owns four Aspen Dental practices in North Carolina.

“The ability of a young dentist to buy or start an office right out of school is difficult today given the mountain of debt from dental school,” she says. “Few want to jump right into ownership. Meanwhile, practice owners have to be more aggressive with compensation and therefore more thoughtful if the business can support an additional doctor.”

The factors that motivate young doctors are also changing, she continues. “They want more mentorship, guidance and work-life balance. So, practice owners must think of ways to appeal to and keep associates engaged and satisfied from a financial, personal and professional perspective.”

Finding a new doctor who is willing to relocate can also be a challenge, says Heald, who has recruited at two VIBE events. “Many doctors want to be in a more metropolitan setting, but many communities in need of great dentists also offer a great quality of life. That’s one of the benefits of Aspen Dental. With 800 offices across the country, and more opening every week, new doctors can find the fit that’s right for them and relocate within the network should they want to do so.

“The most important thing is for new doctors to find someone willing to mentor them and help them grow clinically and professionally.”

VIBE has offered Heald the opportunity to tell dental students the benefits of Aspen Dental and how it has changed her life and career, she says. “It’s a great place to talk openly and honestly about Aspen and to dispel the DSO rumors. We are able to show students outside of a school setting how Aspen is solving the accessto-care problem and giving doctors great financial, personal and clinical freedom at the same time.”

‘Loads of clinical experience’ Ryan Evans sees it that way, too. In fact, a year after attending his first VIBE as a graduating student, he

returned as a mentor for prospective new grads.

“Something of great importance for me, especially in the short term while searching for a job, was gaining clinical experience and growing as a clinician,” he says. “For the long term, I was looking for somewhere I could become a multi-practice owner. Aspen Dental provided me with both.

“One of the ways Aspen stood out to me was the compensation model,” he continues. “Not only was there a daily guarantee, but the ability to receive a bonus based on the office’s success, which meant that all doctors,

hygienists and specialists contribute to the same goal. This was awesome as a new grad, because it meant that I had the opportunity to work on some complex cases.” That isn’t always the case at other practices, he adds. “This allowed me to gain loads of clinical experience early on.”

Evans also found himself drawn to Aspen’s culture. “There is a close-knit family feel throughout the company, even though it has over 800 offices in 40-plus states. And the patient experience is the most important focus of an Aspen practice. I’ve found that the systems in place to put patients first are unmatched.”

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Efficiency In Group Practice : ISSUE 2 • 2020

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> Special Focus on Infection Control : Ansell

It may fit like a glove… …but is it the right fit?

Finding the ideal glove comes with its share of challenges. With so many factors at play – from allergies to comfort, fit and dexterity – this certainly is not a one-size-fits-all scenario. But, as glove technology continues to advance, and more options become available, dental professionals are discovering more solutions designed to ensure their satisfaction.

High quality nitrile gloves, such as thin nitrile gloves with high modulus and elasticity, are said to offer excellent comfort, while providing better protection from chemicals.

Neoprene gloves provide a good alternative to latex gloves in terms of great fit, dexterity and wet grip.

Neoprene gloves are well-suited for most dental procedures, but their surface characteristics make them particularly suited for procedures that require good wet grip and fine motor skills (e.g., endodontic procedures, extractions, placing veneers and crowns.)

Nitrile gloves offer good broad chemical protection (e.g., restorative

procedures involving resins, composites and acids, cleaners and disinfectants). Ansell’s range of thin nitrile gloves have great fit, dexterity and tactility and can be used for a wide range of dental procedures.

While the cost of a premium glove can be daunting for some dentists, investing in a high-quality product can have a positive impact on the staff’s

comfort and productivity. In the end, the added benefits may lead to greater savings and enhanced office performance. For instance, stronger gloves are less likely to tear, reducing the overall number of cases of gloves an office must purchase in a given year.

Ergonomically designed gloves are designed to support musculoskeletal health, which may lower costs associated with injuries. Accelerator-free and/or moisturizing gloves help reduce the risk of dryness and skin irritation, helping improve comfort and productivity. And, gloves designed to grip wet instruments help speed up procedures and reduce the risk of accidents. At the end of the day, when the dental team is equipped to do their job well, they – and their patients – are more likely to be satisfied.

Editor’s note: Efficiency in Group Practice (EGP) would like to thank Ansell for its assistance with this article.

Ansell recommends the following as a checklist for dental professionals:

Material

Natural / Synthetic

Glove Type

Advantages

Latex

Natural

> Excellent elasticity and comfort Surgical Gloves > Fairly puncture resistant and Exam Gloves > Durable

Disadvantages > Can cause reactions among both wearers and patients with latex allergies

> Latex-free (reduced risk of allergic reactions) > Good elasticity and comfort (comparable

Neoprene

Nitrile

10

Synthetic

Synthetic

Surgical Gloves to that of latex) and Exam Gloves > Good puncture resistance > Good chemical resistance > Low accelerator levels Exam Gloves

Efficiency In Group Practice : ISSUE 2 • 2020

> > > >

Excellent strength Good fit and feel Excellent puncture resistance Excellent chemical resistance

> Excellent Lower level of elasticity and comfort compared to neoprene and latex

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MICROFLEX® Soft White Nitrile Examination Gloves MICROFLEX Soft White Nitrile gloves go beyond protection to improve skin condition while you work. Made with proprietary HYDRASOFT technology, they help hydrate skin by allowing it to retain 2X more moisture.* Their soft, elastic material offers exceptional comfort and tactile sensitivity, while textured fingers ensure you can confidently grip delicate instruments.

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MICROFLEX Soft White Nitrile. Beyond Protection.

Request a sample at Ansell.com/MICROFLEX *After a 30 minute wear time, compared to an identical nitrile glove without HYDRASOFT coating Ansell, ® and ™ are trademarks owned by Ansell Limited or one of its affiliates. US Patented and US and non-US Patents Pending: www.ansell.com/patentmarking © 2018 Ansell Limited. All Rights Reserved.

> Special Focus on Infection Control : Surface Disinfection with GOJO

Surface disinfectants As products become more diverse, dental practices must find solutions that fit their needs.

Surface disinfectants today offer kill claims and product features unmatched by their earlier counterparts. Contrary to what some dental professionals might believe, however, not all surface disinfectants are alike. “Each surface disinfectant possesses its own set of characteristics and attributes associated with its formulation,” says Joel Rich, national sales director of nonacute, GOJO Industries, Inc. Such features as timing, aesthetics and compatibility all contribute to the overall success and the breadth of use of a surface disinfectant. And, products may differ in their versatility and safety, making it especially important for each dental office to purchase solutions that meet their specific needs.

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Efficiency In Group Practice : ISSUE 2 • 2020

Taking steps to prevent the spread of infection at the dental practice, while not difficult, does require time, effort and mindfulness.

And, unless regularly disinfected to remove germs and bloodborne pathogens, some surfaces – particularly those that are frequently touched or contacted – present a risk of contamination. The good news is

that surface disinfectant manufacturers have begun collaborating with other device and product companies, leaving dental professionals with an increasing number of options for preventing the spread of infection at their practice.

“The versatility of surface disinfectants has increased, enhancing product compatibility and permitting use throughout a facility,” says Rich. “As surface disinfectant manufacturers collaborate with other device and product manufacturers, a synergistic effect has taken hold, leading to new and easier-to-use disinfectants.”

Surface disinfectants today can be used on a wide variety of surfaces, devices and instruments, Rich continues. “Surface disinfectant sprays are often appropriate for both hard and soft surfaces, allowing for much more versatility of use.” By comparison, surface wipes - while also effective - are generally reserved for hard, non-porous surfaces, reducing some of the areas where it can be utilized, he adds. “Wipes and sprays both offer a consistent broad spectrum of coverage, however soft surfaces generally are not approved for wipes, whereas most sprays offer flexibility for both hard and soft surfaces.”

GOJO Industries, Inc. recently introduced PURELL Surface Disinfectant, a broad-spectrum, one-step surface disinfectant and cleaner that features rapid kill and dry times with no glove or rinse requirements on the label, according to Rich. However, proper facility-established protocols should be followed, he adds. It is said to offer 30-second disinfection for MRSA,

“Wipes and sprays both offer a consistent broad spectrum of coverage, however soft surfaces generally are not approved for wipes, whereas most sprays offer flexibility for both hard and soft surfaces.”

VRE and Norovirus, and be effective on most hard and soft surfaces, from plastics and porcelain to metals, laminate, granite, upholstery, sealed wood, vinyl and more. In addition, it has the lowest possible EPA ratings, and as such, carries no precautionary statements or warnings, he points out.

“The Centers for Disease Control and Infection (CDC) guidelines encourage the proper cleaning and disinfection between patient use of shared medical devices and patient-centric areas,” says Rich.

Today’s surface disinfectants make it easier for the dental staff to do so, he adds.

Editor’s note: PURELL Surface Disinfectant spray is a category IV product.

– Joel Rich, national sales director of non-acute, GOJO Industries, Inc.

Safety and toxicity Dental professionals looking to purchase a new surface disinfectant will likely have a few considerations: How safe is a disinfectant? How likely is it to corrode or damage certain surfaces? How toxic is the surface disinfectant?

How likely is it to penetrate gloves and/or irritate skin?

The EPA utilizes four categories of classification to determine safety and toxicity: > Toxicity category I is highly toxic and severely irritating. > Toxicity category II is moderately toxic and irritating. > Toxicity category III is slightly toxic and irritating. > Toxicity category IV is practically non-toxic and not an irritant.

These toxicity categories play an integral role in product selection, when it comes to consideration of gloving, personal protective equipment, equipment compatibility and overall aesthetics.

Source: GOJO Industries, Inc.

Efficiency In Group Practice : ISSUE 2 • 2020

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> Special Focus on Infection Control : Cranberry

No one-fits-all solution Gloves today are thinner – and offer greater durability – than their predecessors.

When selecting the best glove solutions for a dental practice, a lot depends on personal preference. Factors such as flexibility, tactile sensitivity, cost and the potential for allergic reactions to certain glove materials all come into play. “There is no one glove that fits all,” says Alen Kwong, Business Development, Cranberry. “However, all gloves should provide the comfort and protection that allow dental professionals to work safely in their environment.”

The good news is that many gloves today - whether latex, nitrile or another material - are thinner, facilitating greater tactile sensitivity, yet more durable than in years past.

Know your options There are pros and cons to every glove type, notes Kwong. > Latex. Latex gloves have long been considered a trusted glove material for dental markets.

Made from natural rubber latex, these gloves are known for their flexibility and fitment properties, as well as their ability to offer reliable barrier protection.

That said, some practitioners and patients have allergic reactions to latex gloves, widely deterring their use. > Vinyl. A more economical option than latex, vinyl gloves are made with polyvinyl

Never settle with your hands: Inspire Nitrile Don’t settle for just any glove. Cranberry offers a full range of nitrile gloves, including their newest offering: Inspire. Dental professionals will appreciate the great fit and comfort Inspire gloves offer. Weighing only 2.5 grams, Inspire is the lightest nitrile glove available for dental professionals, and features less constraint, more control and greater tactile sensitivity. The glove’s light weight facilitates enhanced fingertip texture, extension and flexion throughout the clinical procedure, while the InSoft formulation minimizes hand fatigue and provides superior grip for increased comfort and better performance.

Source: Cranberry

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Efficiency In Group Practice : ISSUE 2 • 2020

chloride and are free of latex allergens. Glove wearers, however, often feel vinyl gloves do not offer the same flexibility as latex gloves. > Nitrile. Made with synthetic rubber, nitrile gloves offer nearly the same flexibility and durability that latex gloves provide. Not long ago, some doctors considered nitrile gloves too expensive to purchase.

However, newer generations of nitrile gloves have come down in price, and today they are thinner than latex gloves, while retaining their durability. That said, there have been growing concerns over allergic reactions to the chemical accelerators used in nitrile glove manufacturing. As a result, new accelerator-free nitrile gloves are becoming more popular. > Polychloroprene. Due to the growing concerns over allergic reactions to the chemical accelerators used in nitrile glove manufacturing, accelerator-free nitrile gloves – or polychloroprene gloves – have become more and more popular. Not only are polychloroprene gloves not associated with allergies, their synthetic rubber content is said to closely match the flexibility and barrier protection offered by latex gloves.

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> Special Focus on Infection Control : Facemasks with Crosstex

Facemasks Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them.

If you believe dentistry to be a low-risk career, think again. According to a 2018 post by Business Insider, of the top five professions considered most damaging to one’s health, four are in dentistry, including that of dental hygienist and general dentist.

Indeed, when dental professionals neglect to take necessary precautions, they place themselves in harm’s way. For starters, most procedures performed by dental clinicians using ultrasonic scalers, high speed handpieces and air-water syringes are capable of generating contaminated aerosols and splatter, according to Monica Cardona, product manager, personal protective equip-

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ment, Crosstex International Inc., a Cantel Medical Company. In fact, the ultrasonic scaler produces more airborne contamination than any other dynamic instrument in dentistry,1 she points out. Furthermore, dental aerosols can travel up to four feet from the work zone2 and remain airborne for up to 30 minutes, placing the dental team at risk for the transmission of infection.3

Efficiency In Group Practice : ISSUE 2 • 2020

Some dental professionals may not be aware of the various risks airborne contamination poses to their team, says Cardona, who notes the following: > There is an increased prevalence of respiratory infections among dentists, and the symptoms are associated with the highly contaminated breathing zone in the dental operatory.2 > Based on the average rate of respiration at 16 breaths per minute, a clinician has the potential for 7,680 exposures in a workday.4 > With laser dentistry on the rise, dental professionals are facing a new set of occupational health risks – the potential transmission of disease through the laser plume.5 > 95% of laser plume is made up of water, but the remaining 5% contains potentially hazardous bioaerosols, including cellular debris, blood fragments and bacteria.5 “The most effective means to reduce transmission of pathogenic organisms is the use of personal protection equipment (PPE) such as gloves, masks, and eye protection,” says Cardona. “The better educated dental professionals are, the more likely they will be to comply with accepted standards and guidelines,” she adds.

Cardona recommends using the following charts to determine the most appropriate mask rating levels for different procedures:

Face Mask Tests and User Benefits Tests

Test Description

User Benefits

Fluid Resistance (mm Hg)

The ability of a face mask’s materials of construction to minimize fluids from traveling through the material and potentially coming into contact with the wearer. Face masks are tested with synthetic blood on a pass/fail basis at three velocities corresponding to the range of human blood pressure (80, 120, 160 mm Hg). The higher the pressure withstood, the greater the fluid spray and splash resistance.

Helps reduce potential exposure of the wearer to splash and splatter of blood, body fluids and other potentially infectious materials (OPIM).

Bacterial Filtration Efficiency (BFE percent) @ 3.0 µm

BFE is the measure of the percent efficiency at which a face mask filters bacteria passing through the mask by comparing the bacterial inlet concentration to mask effluent concentration. A higher percentage indicates higher filtration efficiency (i.e., a 95% filter efficiency indicates that 95% of the aerosolized bacteria was retained by the mask and 5% passed through the mask material.

Helps reduce wearer exposure to microorganisms.

Particulate Filtration Efficiency (PFE percent) @ 0.1 µm

PFE is the measure of the percent efficiency at which a face mask filters particulate matter passing through the mask by comparing the particulate inlet concentration to mask effluent concentration.

Helps reduce wearer exposure to airborne biological particles, inorganic dust and debris.

Differential Pressure (ΔP mm H2O/cm2)

Measures the resistance of mask materials to airflow, which relates to the breathability of the mask. The values are expressed from 1 to 5; the higher the number, the higher the PFE and BFE.

Provides measure of comfort and breathability.

Flammability (flame spread)

The rate at which the material burns determines the level of flammability; a minimum of a 3.5 second burn rate is required to pass with a Class 1 rating.

Mask materials are flame spread Class 1 rated, meeting FDA recommendations for materials of construction of surgical masks intended for use in operating rooms.

Source: ASTM International (formerly known as American Society for Testing and Materials).

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17

> Special Focus on Infection Control : Facemasks with Crosstex

Face Mask Material Requirements by ASTM Performance Level

Characteristic

LEVEL 1

LEVEL 2

LEVEL 3

80

120

160

Bacterial Filtration Efficiency (BFE percent) @ 3.0 µm

≥ 95%

≥ 98%

≥ 98%

Particulate Filtration Efficiency (PFE percent) @ 0.1 µm

≥ 95%

≥ 98%

≥ 98%

Differential Pressure (ΔP breathability) (mm H2O/cm2)

< 4.0

< 5.0

< 5.0

Class 1

Class 1

Class 1

Fluid Resistance (mm Hg)

Flammability (flame spread)

Source: ASTM International (formerly known as American Society for Testing and Materials).

ASTM Level 1

ASTM Level 2

ASTM Level 3

Ideal for procedures where low amounts of fluid, spray and/or aerosols are produced.

Ideal for procedures where light-tomoderate amounts of fluid, spray and/or aerosols are produced.

Ideal for procedures where moderateto-heavy amounts of fluid, spray and/or aerosols are produced.

> Patient exams

> Limited oral surgery

> Complex oral surgery

> Operatory cleaning/maintenance

> Endodontics

> Crown preparation

> Impressions

> Prophylaxis

> Implant placement

> Lab trimming, finishing & polishing

> Restoratives/ composites

> Periodontal surgery

> Orthodontics

> Sealants

> Use of ultrasonic scalers (Magnetostrictive and Piezo)

> Laser-based applications* * Masks are considered a secondary control and are not meant to replace recommended primary engineering controls for laser plume exposure.

Source: ASTM International (formerly known as American Society for Testing and Materials).

Selecting the right face mask Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them. In addition, it’s important to understand mask ratings in order to choose the appropriate mask protection level for each procedure performed at the practice. Several mask designs are

18

considered to provide exceptional comfort, according to Cardona: > The Ultra Sensitive Earloop Mask with Secure Fit Technology from Crosstex, with an extra soft, white hypoallergenic, inner cellulose layer, will not lint, tear or shred, providing ultimate comfort. > Masks with flat ear loops attached to the outside of

Efficiency In Group Practice : ISSUE 2 • 2020

the mask (as opposed to the inside of the mask) provide a comfortable fit and help eliminate irritation. > Masks free of latex, fiberglass, chemicals, inks and dyes help minimize skin sensitivities. > Masks with anti-fog or fog-free strips on the inner layer block and absorb moisture. They also

form a strong seal, preventing the fogging of eyewear while it cushions the nose ridge. > Some masks have unique vapor barriers on the outside layer, further blocking moisture.

ASTM International is an international standards organization, as well as a globally recognized leader in the development, product testing and delivery of international voluntary consensus standards. The latest version of the standard specifying performance of face masks, ASTM F2100-11, was released in April 2011. Face mask material performance is based on testing for fluid resistance, bacterial filtration efficiency (BFE), particulate filtration

efficiency (PFE), breathability (Δ P) and flammability.

Stay ahead of the game Not only must different face masks be worn for different procedures, they must be a good fit for the wearer.

Contaminants can bypass a mask in several ways; a well-fitting mask that can conform to any face shape or size can greatly reduce the risk of infection. Masks with malleable nose and chin closures allow for a customized fit, increasing the effectiveness of mask protection. Furthermore, guidelines state a mask must be changed with each patient. It’s also recommended that clinicians change their mask every 20 minutes in a moderate-to-high aerosol environment and

every hour in a non-aerosol environment. It’s important to note that the filter media of a mask becomes less effective when wet.

And, the best time to determine whether anyone at the practice has skin sensitivities is before new masks as purchased. Colors and inks made from chemicals and dyes are common irritants to the skin. If the inside of the mask is colored or has a print, this may be the cause of irritation. And while a white mask interior is ideal, not all white mask interiors are the same. A white cellulose interior is recommended for sensitive skin. Ideally, masks free of latex, fiberglass, chemicals, inks and dyes should be worn to minimize potential skin sensitivities.

Secure Fit Mask Technology Crosstex masks with Secure Fit Mask Technology feature flexible aluminum strips above the nose and below the chin, creating additional breathing space and allowing for a custom fit, regardless of face shape or size. This innovative design significantly reduces gapping at top, bottom and sides, increasing the effectiveness of mask protection.

Even if a mask has a high-level filter, the lack of a close circumferential seal to the face will negate filter perfor-

mance, because particles will follow the path of least resistance and travel through the gaps between the mask and the face. Most regulatory and professional organizations recognize the inherent fit issues of masks showing gaps along the cheeks and chin. A recent study evaluating the total leakage through a surgical face mask indicated five to eight percent came from filter leakage, with 25-38 percent coming from face seal leakage.1

Source: Crosstex International Inc., a Cantel Medical Company.

Reference: 1. Grinshpun, S. A., Haruta, H., Eninger, R. M., Reponen, T., McKay, R. T., and Lee, S.-A. (2009). Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration. J. Occup. Environ. Hyg., 6:593–603.

Reference: 1. Chugh, A. “Occupational Hazards in Prosthetic Dentistry.” Dentistry 07, no. 02 (2017).

2. Veena, et al. “Dissemination of Aerosol and Splatter during Ultrasonic Scaling: A Pilot Study.” Journal of Infection and Public Health 8, no. 3 (2015): 260-65.

3. Harrel, S. “Contaminated Dental Aerosols: Risks and Implications for Dental Hygienists”. Dimensions of Dental Hygiene. October 2003;1(6):16, 18, 20.

4. J ohns Hopkins Medicine; Health Library. Vital Signs, accessed December 29, 2014. http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/vital_signs_body_temperature_pulse_rate_respiration_rate_blood_pressure_85,P00866/ 5. Ulmer B C. “The hazards of surgical smoke.” AORN J. April 2008; 87(4):721-734.

Efficiency In Group Practice : ISSUE 2 • 2020

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Embracing diversity Diversity within DSOs and group practices can lead to greater team satisfaction and better patient care.

Just as communities across the country have grown to reflect an increasingly diverse population, so too has the dental industry.

From the dental team to the patients they serve, human interactions must embrace a multitude of experiences and perspectives.

20 Efficiency In Group Practice : ISSUE 2 â&#x20AC;˘ 2020

> Diversity

“At Mortenson Dental Partners (MDP), diversity takes on many different aspects,” says Bryan Hildreth, chief human resources officer at MDP. “It means understanding and valuing the strengths that different perspectives, backgrounds and characteristics bring to our organization, both from team members and patients. It means examining the ways we care for our patients, maximizing inclusivity among our team members and seeking different points of view as a matter of conducting business.”

Enrollment at dental schools is more diverse than ever before, Hildreth continues. “According to the American Dental Association (ADA), in 2018, 50.8% of dental students were women, while 15.6% were from historically underrepresented racial and ethnic groups – both all-time highs,” he points out. The workforce and patient base at MDP reflect these trends. In fact, 89% of MDP employees – and 50% of their doctors – are female. “The changing demographics of our organization require us to evaluate and fine-tune our recruitment strategies, employment practices and benefits programs to ensure we recognize the evolving needs of our team members,” he adds.

Exploring new options For MDP, cultivating a culture of diversity is an ongoing process.

“While diversity has always been a mainstay for MDP, we are in the early stages of formulating new protocols,” says Hildreth. “All of our team members complete diversity training as part of our orientation

and are certified annually thereafter. We are beginning to measure and track diversity indicators to help us assess where we stand and identify opportunities for improvement, such as our diversity in senior leadership. We also are exploring new options to attract more diverse applicants through alternative websites and virtual communities, and we are more intentional about utilizing

diverse interviewing panels in our recruitment process.”

The DSO makes it a point to: > Seek applicants from more diverse sites and partner with professional organizations that cater to underrepresented groups. > Create marketing materials that better reflect the group’s diverse team and patients.

United across differences For Lubbock, Texas-based Abbeville Dentistry, a regional partner of MDP, it’s very important to unite across differences in ethnicity, religion, race and more to provide exceptional care to patients. The group practice is seeing a larger female-to-male ratio graduating from dental schools, along with more dentists from historically underrepresented racial and ethnic groups, according to Dr. Mayada Khater, regional president, and Dr. Britt Bostick, co-founder, of Abbeville Dentistry.

Of Abbeville Dentistry’s 250-plus employees in its region, 60% (including two-thirds of its regional leaders) are from historically underrepresented racial and ethnic groups. “This has had a positive impact on our group,” Dr. Khater and Dr. Bostick point out. “Many of our team members speak multiple languages, which helps us connect with a broader population of patients. We also feel that our team members work better with each other.”

Indeed, when they recruit new employees, Dr. Khater and Dr. Bostick make it a point to hire the absolute best candidates without regard to ethnicity, race, religion, sexual orientation and gender. “When we take the time to learn from, understand and accept others, we remove barriers,” they point out. That said, hiring is only the first step in creating a culture of diversity, they note. “The second step is to learn more about the culture of your new hire and [incorporate this in] onboarding. Some ways an organization can promote diversity include answering questions such as, ‘Are there dietary restrictions connected with certain team members’ cultural or religious beliefs?’ This is a respectful consideration when a meeting includes food. Another question might be, ‘Are there particular holidays associated with team members’ culture or beliefs that should be acknowledged in some way?’ Ultimately, we want our dental practice and DSO to mirror our communities and embrace diversification.”

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21

> Diversity

> Expand eligibility for bereavement leave to reflect a broader and more inclusive definition of family. > Incorporate many different backgrounds and perspectives into its cross-functional work teams.

That said, changes such as the above require buy-in from leadership, notes Hildreth. “Our leadership team is the linchpin to the ultimate success of our diversity efforts,” he says.

“We depend on them to collectively and consistently apply the principles of diversity across the organization.”

“ According to the American Dental Association (ADA), in 2018, 50.8% of dental students were women, while 15.6% were from historically underrepresented racial and ethnic groups – both all-time highs.”

– Bryan Hildreth, chief human resources officer, MDP

22

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As with other operational initiatives, Hildreth believes it’s equally important for the entire organization to embrace the principles handed down by leadership and follow through with best practices.

“In the case of diversity, if we fail to properly embrace best practices, we may find ourselves at a competitive disadvantage – not only with respect to other DSOs but also other businesses in the communities we serve.” Indeed, by incorporating a broad spectrum of backgrounds and perspectives, DSOs can more closely understand their patients’ needs and provide better care, he adds.

At the end of the day, team members are likely to feel more engaged in their work and identify more closely with their DSO’s mission, he continues. “Two of the key drivers of workforce engagement are the degree to which individuals identify with the purpose of an organization and whether they see a connection between what they do and the ultimate success of the company. People increasingly identify diversity as an inseparable element of purpose. They also want to know that their perspectives – and that of people like them – are valued as part of this connection.

“As our industry matures, I envision diversity and inclusion becoming foundational elements of DSO cultures,” says Hildreth. “Organizations that embrace diversity and inclusion have been shown to consistently outperform their counterparts in the same industry. We must adapt in order to harness the collective knowledge, ideas and opinions of our team. We will all be better for it.”

Unmatched Unmatched clinical clinical autonomy. autonomy.

The The support support of of a a group. group.

Whether youâ&#x20AC;&#x2122;re a doctor looking for Whether youâ&#x20AC;&#x2122;re a doctor looking for employment, or are thinking about selling your employment, or are thinking about selling your practice but want to maintain the benefits of practice but want to maintain the benefits of ownership, Mortenson Dental Partners may be ownership, Mortenson Dental Partners may be the place for you. the place for you.

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> Diversity

United by their differences When it comes to supporting a culture of diversity, actions speak louder than words. :

BY LAURA THILL

At Aspen Dental Management, Inc. (ADMI), diversity isn’t driven by protocols. Rather, it’s what drives the organization. “It’s part of our organization’s DNA,” says Dr. Arwinder Judge, chief clinical officer at Aspen. From the time he joined ADMI 15 years ago, he has witnessed a broad representation of dentists and staff from different nationalities and cultures, he notes. “Our diversity brings a richness to our corporate culture and helps us thrive,” he says. “It makes our organization special. And, despite out differences, we are united by a passion for what we do. It’s about breaking down barriers to ensure patients get the care they need.”

Indeed, the industry as a whole has grown to include more women and underrepresented minorities, particularly as dental schools create programs designed to attract these groups, Dr. Judge points out. “It’s great to see these changes taking place in a profession I’ve dedicated my life to,” he says, particularly in light of his own background. “I am of Indian descent, I was raised in Canada and I attended dental school in New York City.”

Fresh points of view In Dr. Judge’s experience, by bringing together dental professionals from a multitude of backgrounds, cultures, nationalities and ethnicities, ADMI and its affiliate practices benefit from different perspectives and fresh points of view. “This has enabled us to see things from a holistic perspective and arrive at solutions we may have overlooked if we were a more homogenous group,” he says. “The impact of our diverse workforce plays out every day.” This, in turn, can be helpful to the equally diverse group of

24

patients they treat, he continues. “It can put patients at ease to see their own diversity reflected in the faces of the dentists, hygienists and team members who treat them,” he says.

Furthermore, he believes a lack of diversity at ADMI’s affiliate practices would be a turn-off for prospective team members. “There’s a saying: ‘You can’t be what you can’t see.’

I think all of us on the ADMI leadership team, along with the dentists whose practices we support, feel a real responsibility to help candidates who are considering joining Aspen Dental understand exactly what’s possible when you’re committed to

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doing what’s right for your patients and your team members. I think one of the reasons that we’ve been so successful with our Practice Ownership Program, for example, is because doctors can see themselves reflected in the existing group of owners, and know that the opportunity exists for them, too.”

It takes a conscious effort to foster a truly diverse corporate culture, he continues. “Several times each year, ADMI holds Aspen Dental VIBE Sessions, which are designed to help graduating dental students and residents understand what life at Aspen Dental is all about, and to connect them with Aspen Dental practice owners who are hiring new doctors,” he explains. “It’s really special to see a student connect with a successful practice owner who might be from a similar background, and get a glimpse of what their own opportunity looks like at Aspen Dental. We’re mindful of making sure that the practice owners at our VIBE sessions demonstrate the diversity that characterizes our organization.

“I think the trend toward diversity in dentistry will continue to accelerate over the next decade,” says Dr. Judge. “It’s incumbent on industry leaders to support this shift – not simply with words, but with actions.”

Judgement-free zone Dr. Kimberly Haynes, the owner of four Aspen Dental branded locations

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> Diversity

in Central Texas, understands that a dental office can be a scary place for some patients. So, it helps to have a diverse staff who can relate to a broad spectrum of backgrounds and perspectives, she says. “Given the unique patient population we care for in Central Texas, our offices see patients of different nationalities, ethnicities, socio-economic status and genders,” she explains. “As with our patients, our staff is equally diverse.” When the staff and doctors can relate to their patients, it helps put them at ease, she notes. Even more importantly, dental patients want to be accepted, not judged, she points out, and having a dental team who can relate to their patients enables the practice to provide a judgment-free zone.

“I believe it is the professional responsibility of a business owner to recognize diversity and create an office culture that promotes acceptance,” Dr. Haynes continues.

Dental offices incapable of providing an environment of acceptance will likely face challenges recruiting and hiring new staff, she points out. “Acceptance is a basic human desire,” she says. Ultimately, staff turn-over due to an unaccepting environment can compromise the patient experience, she adds.

“I always say, to whom much is given, much is required. In my practices, we take time to embrace holidays, local festivals and hold lunch-and-learns about the unique differences that exist between our staff members and our patients.”

In fact, the group practice recently accepted an invitation from one of its hygienists to participate at a local

26

religious and community events, including an MLK March, Mouth Mobile to support our veterans and more. We are a close-knit group and we look forward to events and activities that embrace our personal and cultural differences.”

A team effort

Dr. Arwinder Judge

Dr. Kimberly Haynes

Hindu Temple for Dasara Mela. Dr. Haynes brought her family as well.

“We had a wonderful time,” she says.

“Interestingly, when this hygienist was hired, she gifted me an outfit – a salwar kameez – from India. The expression on her face was priceless when I showed up to the festival wearing it!”

In addition, Dr. Haynes makes it a point to give her staff religious holidays off, even when they aren’t recognized as national holidays.

“Those of us that enjoy reading have shared books that address topics about customs to various family traditions,” she says. “We also support our patients by attending local

Efficiency In Group Practice : ISSUE 2 • 2020

Creating a culture of diversity cannot be accomplished in a vacuum, notes Dr. Haynes. “Without my team’s support, it would be difficult to obtain the results we desire,” she says. “If my staff isn’t equipped to embrace cultural differences or they lack exposure to diverse groups of people, it will be difficult for them to treat and help our diverse patient base.”

Having the support of a culturally and ethnically diverse organization such as Aspen Dental Management Inc. is equally important, Dr. Haynes points out. “The management at ADMI is as diverse as the dental staff and patients that visit our offices,” says Dr. Haynes.

In fact, it’s a good feeling to see how comfortable her office team members are when attending ADMI business-support or practice owner meetings, she adds. “I truly believe ADMI makes a conscious effort to ensure providers and their team members feel included,” she says.

“As an African American female business owner, I have been able to network and maintain relationships with individuals who come from different countries and backgrounds. ADMI has helped drive these opportunities, as well as assisted me in hiring staff who embrace a judgement-free office zone for my patients.”

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> Diversity

Dr. Haynes anticipates the dental industry will continue to reflect the growing number of female and otherwise underrepresented professionals and patients over the next decade. In addition, socioeconomic factors will continue to impact how well dentists and caregivers can treat their patients. “In recent years, I have seen greater socioeconomic similarity across various populations of patients under our care,” she says. “Finances

can be a barrier to patients receiving the care they need, regardless of race, gender, nationality or ethnicity.”

Dental insurance often helps level the playing field for most patients, she says. Still, more and more patients depend on savings, flex-spending or alternative payment options to get themselves healthy. “In some cases, I have seen patients seeking care from doctors in other countries to help resolve

urgent dental care needs due to financial constraints,” she adds.

“My personal goal will be to continue to grow clinically, spiritually and personally, and to be the leader that my office staff and patients need,” says Dr. Haynes.

“I also embrace opportunities to educate, train and mentor dental professionals to help our industry become more rooted in that most basic human desire – acceptance.”

Advancing diversity Henry Schein chairman and CEO Stanley M. Bergman is honored for advancing diversity and inclusion in dentistry.

Stanley M. Bergman, Henry Schein’s chairman of the board and chief executive officer, was honored at the President’s Luncheon during the 2019 Greater New York Dental Meeting (GNYDM) for his leadership in advancing diversity and inclusion in dentistry. Bergman was presented with a Presidential Citation by Dr. Chad Gehani, President of the American Dental Association (ADA), and a special recognition award by Dr. Lauro Medrano, GNYDM’s General Chairman.

“I am honored to accept these awards on behalf of Team Schein and the countless colleagues in the dental industry who have been strong allies in fostering an environment in which diversity and inclusion are woven into the fabric of the dental profession and our industry,” Mr. Bergman said.

“As a result, we have seen the profession expand to more fully reflect the ever-growing diversity of our country, to strengthen the practitioner-patient relationship, and to improve public health. I speak for all of Team Schein when I say thank you to the ADA and the Greater New York Dental Meeting for this honor.”

To demonstrate its commitment to diversity and inclusion, Henry Schein’s Women’s Leadership Network joined several industry partners to host the Women Dentists Leadership Conference during the GNYDM. Featuring women leaders from dentistry and other

28

Efficiency In Group Practice : ISSUE 2 • 2020

key stakeholders, the program aimed to empower and mentor current and future women dentists to utilize their talents and reach their full potential.

“It is fitting to present Stanley Bergman with this award at the Greater New York Dental Meeting, in a city where diversity is valued and cultural differences are celebrated,” said Dr. Medrano. “Congratulations to Stan and all of Henry Schein.

With your leadership we have spent years opening doors and expanding opportunities to ensure that our industry reflects the populations and communities we serve.”

Henry Schein has helped drive this conversation for more than two decades. For example, the company was one of four founding corporate sponsors of the ADA’s Diversity in Leadership Institute, which was created to foster leadership training and a corporate mentoring network within the dental industry in order to improve the business management skills of dentists from racial, ethnic or gender backgrounds that have been underrepresented in such roles. Henry Schein also provides financial and logistical support to many outreach missions within the U.S. and abroad.

“Stanley Bergman and Henry Schein have been a driving force in expanding opportunities in dentistry for years, and our industry is stronger for it,” added Dr. Gehani.

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> Operations and Development

How do you do virtual?

Practical and tactical solutions for working remotely :

KRISTINE BERRY, RDH, MSEC

We are living in a world of rapid digitization and disruption. Two decades ago, each dental practice was largely constrained to one geographic location. Each practice was also mostly relegated to one office and was running operations in a face-to-face context. Technology has made the world a smaller place, yet most dental organizations are still facilitating conversations, learning and team development events using old methodology. This article highlights communication channels and effectiveness, as well as six foundational components designed to create engaging and effective virtual conversations.

Learning and leadership Professionals of all stripes work virtually and remotely – from regional and district leaders within a dental service organization to dentistowned multi-location dental practices, sales professionals and practice management consultants. Given that there is such a wide definition of what it means to work virtually and remotely, you are encouraged

to approach this article through the lens of what makes sense for you (regardless of whether you are a team leader, regional manager, CEO, CFO, entrepreneur, internal coach or trainer, sales professional or part of an interdisciplinary healthcare team), as well as your groups or teams.

Two areas that are rapidly changing are learning and leader-

30 Efficiency In Group Practice : ISSUE 2 • 2020

ship. Virtual and remote teams can be defined as global, or as spanning a big urban center, state or region. A lot of organizations must look at how they do virtual, including how they can boost the virtual team’s effectiveness, engagement and/or presence and the organization’s bottom line. This leads to new challenges, such as the Zoom call, where employees and leaders find themselves dialing from one call to another, often being talked at rather than conversed with. Many see this as a chance to multitask, placing one meeting on mute while catching up on the to-dos assigned from another, as overwhelmed team members juggle a load of competing priorities that all need to be done immediately, across multi-locations and regions.

Gallup has found that in most North American workplaces, employee engagement numbers haven’t changed much since 2000; today, only around one-third of employees are engaged. Consider that 11 billion meetings take place every day, with a third of them noted to be ineffective, and $37 billion is wasted every year on ineffective meetings. This leads to new challenges and principles for creating engaging and effective virtual meetings. As more organizations and professionals start to operate in the remote and virtual domain, it is vital

to develop skills and confidence that help build connections with remote team members, facilitate meetings and help transition most activities to the virtual realm.

Engaging conversations in virtual meetings – defined as impactful, intersecting, interactive, important and meaningful – invite the participant to be present and participate in dialogue, shape discussions and move the initiatives and topics forward. Effective suggests relevant, practical, implementable, accountable and sustainable results, which often are missing from virtual exchanges.

As someone who has worked remotely since 2004, it’s been amazing in the last 16 years to see how quickly things have changed.

Communication in the remote ecosystem Understanding effective communication in the remote space is vital. Why? The answer is found in a quote

by Kim Krizan from the movie Waking Life: “Language comes from our desire to move beyond our isolation and have some sort of connection with one another. Words by themselves

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> Operations and Development

are lifeless, they’re inert. They’re nothing more than symbols. So much of our experience is intangible; so much of what we perceive cannot be adequately expressed. And because of that, when we communicate with one another, and we feel we’ve connected, that we’re understood – it’s almost like having a spiritual communion with that person.”

We all want to connect with one another. When we connect, we feel a special affinity with the person who we believe really understands us.

Communication is how our message is delivered and how it is received. It is two-way, involving both the sender and the receiver. The ecosystem of virtual conversations includes: > Phone and/or text. > E-learning; synchronous or asynchronous training. > Visual education events that are instructor/facilitator led through webinars, e-leaning and webcasts, teleseminars. > Video-based calls/learning. > Virtual meetings (formal and informal). > Goal-setting via strategic planning sessions and virtual retreats. > Mentored conversations.

Experienced professionals can be partnered with those with less experience. > Group or team coaching focused on implementation, awareness, goal setting and ongoing responsibility and accountability for sustainable results. > Virtual team development, from virtual team meetings to virtual retreats and team coaching.

32

> Peer-to peer learning with masterminds and breakouts.

What virtual teams and leaders need to consider is that effective communication involves not only words, but their body language, the voice they use and their ability to really listen.

Understanding virtual and remote work requires a different set of skills for different types of remote leaders and teams.

Research shows that: > The words we use contribute 7% to the effectiveness of our message. > The quality and tone of our voice make up 38% of the message we send. > Body posture, facial expressions and gestures contribute to 55% of the message we send.

Our beliefs are conveyed more clearly through our body posture, facial expressions and gestures than our words. As a result, context and emotions are frequently missing or

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misinterpreted, depending on the mode. During phone-based conversations, we lose the visual signals and consciously or unconsciously focus on the words and the pitch of voice we hear (especially when we multitask). When talking on the phone, our tone plays a key role, as well as how quickly we speak.

Many of us overlook this in our daily conversations. Yet, this is where we, as listeners, turn to get our cues.

Many of us live in a never-ending email, text world or application, such as WhatsApp. In 2015, WhatsApp surpassed the number of texts per day: 30 billion texts from 750 million users. It is estimated that in a single day, the average North American sends five times more texts than the number of phone calls they make. When using these modes, we often lose context and miss cues that define the sender’s meaning and intent. This naturally creates challenges. Hint: Face to face conversations or video chats are recommended when an emotionally charged message (positive and negative) needs to be delivered.

Communication is a foundational skill in personal and professional domains.

Asking the following questions can help you evaluate your current communication style and improve discussions with your remote team: > How developed is your team’s communication skills? > What areas need attention? > What can you accomplish through effective communication? > What formal and informal communication channels exist?

> What different types of modalities do you use or consider using?

> Determine how you do things at your organization.

> Develop clear reporting rela-

Five virtual team basics Supporting the remote team member or team begins with defining what overall success and wellbeing looks like for remote workers, and ensuring they feel supported within the organization. Yet, how do we become successful given the reality of distance, culture and time zones?

Following are five basic skill sets virtual teams need to ensure sustainable, engaging and effective virtual conversations: 1. Create the context and culture. > Build trust and create safety; build relationships or connections. > Recognize opportunities for development and learning.

In a virtual world, we need to cultivate core skills to create context, communication, process, emotional intelligence, tools, group development and troubleshooting skills – not just tactical abilities.

2. Set people up for success. > Focus on process and co-create expectations. Develop a clear understanding of what is expected in regard to work (i.e., hours, approaches, breaks, how to log on and share work, etc.).

tionships, roles and responsibilities. Who do team members report to, and on what issues? > Determine when reporting is required. > Determine whether you have clarity, agreements and by/whens.

3. Micro-moments. > Focus on micro-monitoring vs. micro-managing. > Be aware of your priorities. > Determine what is and is not working. > Know what support and resources are required to achieve the intended results.

4. Community vs. island. > Whether we work alone or as part of a team, it takes a community to be successful in the remote space. > How do you support trust, create psychological safety, and connect with a team or across the organization? > How do team members see each other and connect with one another? (This may include regular virtual lunches, where the team connects for a meal from each of their locations; daily virtual huddles at a time that is convenient for

all zones; and/or face-to-face time, either every quarter or more regularly.)

5. Clarity on how to flag issues.

Be aware of: > The issues to raise and when to raise them. > Who team members should flag issues to. > When team leaders are available and how can team members can reach them. > Available means to facilitate confidential conversations to make important decisions.

Change and disruption are a constant. Understanding virtual and remote work requires a different set of skills for different types of remote leaders and teams. This article has reviewed the basics in communication and the distinctions in a remote ecosystem, as well as five virtual team elements that provide a self-assessment for virtual and remote needs. It presents questions to support one’s call-toactions for creating environments that engage impactful, interactive and meaningful virtual conversations. I encourage you to share this article with your colleagues, or with someone in your network, so that you can implement a new methodology in your virtual and remote workspace.

Kristine Berry is an international speaker and performance coach specializing in the areas of group coaching and team development, enhancing group practices. Looking for a speaker or coach? She invites you to contact her via email at kristine@kristineberry.com or visit her website www.kristineberry.com.

Bibliography: Britton, Jennifer, (2017) Effective Virtual Conversations. Potential Realized Media.

Https://www.potentialsrealized.com/teams-365-blog/teams365-897-teamwork-foundations-communication. Accessed January 2020.

Https://www.potentialsrealized.com/teams-365-blog/category/virtual-facilitation. Accessed January 2020.

Efficiency In Group Practice : ISSUE 2 • 2020

33

> Infection Control

The OSHA inspection Complacency is unacceptable.

By Katherine Schrubbe, RDH, BS, M.Ed, PhD Dr. Katherine Schrubbe, RDH, BS, M.Ed, PhD, is an independent compliance consultant with expertise in OSHA, dental infection control, quality assurance and risk management. She is an invited speaker for continuing education and training programs for local and national dental organizations, schools of dentistry and private dental groups. She has held positions in corporate as well as academic dentistry and continues to contribute to the scientific literature.

Dr. Schrubbe can be reached at kathy@ schrubbecompliance.com.

A surprise: Something that makes a strong impression because it is so unexpected; it can also be amazement, astonishment, shock, startlement.1 In many cases, surprises are positive events, such as a surprise birthday or anniversary party, a surprise bouquet of flowers, or a surprise visit from a dental colleague bringing treats for the office team. Other surprises may not be viewed as positive – for instance, an unexpected visit from an Occupational Safety and Health Administration (OSHA) inspector.

Section 8 of the OSHA Act addresses inspections, investigations and recordkeeping.2 It’s uncommon for OSHA to inspect a dental practice. Federal OSHA is a small agency that includes 10 regional offices and 85 local area offices; with state

34 Efficiency In Group Practice : ISSUE 2 • 2020

partners, there are approximately 2,100 inspectors responsible for the health and safety of 130 million workers employed at more than 8 million worksites around the nation. There’s roughly one compliance officer for every 59,000 workers.3

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> Infection Control

It is quite obvious that OSHA does not have the manpower to check up on every healthcare facility. Regardless, complacency and lack of adherence to set standards in any dental practice setting is unacceptable. And remember, if there is a legitimate worker complaint, an OSHA compliance officer inspector may appear at the practice.

In 2016, OSHA proposed fines of almost $54,000 to a dental practice in Illinois. Inspections stemming from a complaint alleging violations of OSHA’s bloodborne pathogen exposure standards following a worker who suffered a sharps injury.

Upon inspection of the practice sites, the Chicago North area OSHA office found the employer failed to: > Establish a bloodborne pathogen exposure control plan and hazard communication program at either location. > Require the use of appropriate gloves and personal protective equipment. > Provide medical evaluation and follow-up to employees after an exposure incident. > Make the Hepatitis B vaccination series available to employees. > Educate workers about chemical and bloodborne pathogen hazards and train them on necessary precautions to take.4 Similarly, a complaint initiated a few years earlier led OSHA to propose fines of over $61,000 to a dental practice in Washington DC. The cited violations included workers’ exposure to bloodborne pathogens

36

without an exposure control plan or proper training; workers lacking proper eye protection when using chemicals to sanitize medical instruments; egress issues; exposure to electrical hazards; and the use of inadequate personal protective equipment. Additionally, the company failed to provide workers with Hepatitis B vaccinations within 10 days of employment, provide an adequate hazard communication program and training, properly label chemicals and maintain material safety data sheets for chemicals used on-site.5 In another instance, a dentist in Boston told employees to remove the protective caps of needles before disposing them into sharps disposal containers, allegedly to fill the containers with more used needles and reduce the frequency and cost of their disposal. One of the dental assistants was concerned that she and her co-workers could be exposed to needle stick injuries and the risk of infection from bloodborne pathogens, so she raised the issue with the dentist. When he dismissed her concern, she filed a complaint with OSHA. An OSHA inspector visited the dentist, who then fired the dental assistant. A whistleblower investigation followed and the Department of Labor sued the dentist in court, charging him with violation of the anti-retaliation provisions of OSHA. The suit eventually went to trial, where the judge ruled in favor of the department and ordered the dentist to pay the dental assistant $85,000 ($51,644.80 in back wages amd $33,450.26 in compensatory damages). The judge ruled

Efficiency In Group Practice : ISSUE 2 • 2020

that the dentist’s firing of the dental assistant shortly after OSHA began its inspection was both retaliatory and a violation of section 11(c) of the OSH Act.6

Regardless of practice size/setting and the type of violation, OSHA fines can be significant. As of January 10, 2020, OSHA increased penalty fines by almost 2 percent, setting the maximum amounts as follows: Type of Violation

Penalty

Serious, other-than serious, or posting requirements

$13, 494 per violation

Failure to abate

$13, 494 per day beyond abatement date

Willful or repeated violation

$134,937 per violation 7

The following standards, in order of frequency, were most often cited

by Federal OSHA between October 2015 and September 2016: > 1910.1030, Bloodborne pathogens. > 1910.1200, Hazard communication. > 1910.132, General requirements (Personal protective equipment). > 1910.133, Eye and face protection. > 1910.151, Medical services and first aid. > 1910.22, General requirements. > 1910.1096, Ionizing radiation. > 1904.29, Forms.

> 1910.37, Maintenance, safeguards, and operational features for exit routes.

> 1910.141, Sanitation.8 If dental practices follow OSHA standards and the workplace is safe, it is unlikely team member employees will have anything to complain to OSHA about. In the rare case of an OSHA inspection, however, dentists should be aware of – and prepared for – the OSHA inspection process and the rights an employer, dentist or practice owner has.

OSHA inspectors – also called compliance safety and health officers – are experienced, well-trained industrial hygienists and safety professionals. They may appear at the workplace without advance notice to conduct an OSHA inspection.9 When an OSHA inspector arrives at the practice, the employer has the right to ask the inspector for credentials and inquire as to the basis for the inspection before agreeing to allow it to proceed.9,10 If it involves an employee complaint, the employer is entitled to receive a copy of the written complaint (without the name of the complaining employee), as well as information on the specific programmed inspection that the inspector is relying upon.10 Under the Fourth Amendment, employers are free from unreasonable searches and seizures, which includes inspections by OSHA. In other words, OSHA may not inspect a workplace unless the Agency has administrative probable cause to believe that a violative condition exists.

Accordingly, employers have a right to demand an inspection warrant that establishes OSHA’s probable cause to inspect; but in most cases, cooperation and allowing an inspection to take place on a voluntary basis is a more productive option.11 The first step in the inspection process is an opening conference. The inspector explains why OSHA has selected the practice for inspection, and describes the scope of the inspection, walkaround procedures, employee representation and employee interviews.

The employer/dentist should select a representative to accompany the inspector during the inspection.9,10 If the representative is not onsite, the inspector is required to wait a “reasonable time period” before commencing the inspection. An authorized representative of the employees, such as a practice manager or compliance officer,

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> Infection Control

also has the right to accompany an inspector. And the inspector has the freedom to speak privately and question a reasonable number of employees during the inspection.10 The walkaround is the next step.

Following the opening conference, the inspector and the representatives will walk through the areas of the practice covered by the inspection, assessing for hazards that could lead to employee injury or illness.9 The inspector should not be allowed free reign of the dental practice; rather, the inspection should be contained to areas related to the complaint or safety issue presented.10 At this time, the inspector reviews worksite injury and illness records, as well as the posting of the official

OSHA poster, making a case for dental practices to maintain accurate and current records at all times.

During the walkaround, inspectors may point out some apparent violations that can be corrected immediately. While the law requires these hazards must still be cited, prompt correction is a sign of good faith on the part of the employer.9 The final step is the closing conference. After the walkaround, the inspector holds a meeting with the employer/dentist and the employee representatives to discuss the findings. The inspector discusses possible courses of action an employer may take following an inspection, which could include an informal conference with OSHA or

contesting citations and proposed penalties. The inspector also discusses consultation services and employee rights.9 When an inspector finds violations of OSHA standards or serious hazards in the dental practice, as a regulatory agency, OSHA may issue citations and fines. Citations describe OSHA requirements allegedly violated, list any proposed penalties and give a deadline for correcting the alleged hazards.

When settling a penalty, OSHA’s policy is to reduce penalties for small employers and those acting in good faith. However, no good faith adjustment is made for alleged willful violations.9 Although it may be unlikely that an OSHA inspection will take place in your dental practice setting, why risk it? The stakes are quite high for a negative impact on the practice if there are known OSHA issues, citations and fines. The practice can be deemed an unsafe workplace and seen as careless; general reputations are at risk. Dental practices must always follow OSHA standards and best practices to ensure team – as well as patient – safety. Doing the right thing will not only lessen the stress of an unexpected OSHA visit, it’s the right thing to do!

References: 1. Miriam Webster. Available at https://www.merriam-webster.com/thesaurus/surprise. Accessed January 22, 2020.

2. U.S. Department of Labor. Occupational Safety and Health Administration. Section 8. Available at https://www.osha.gov/laws-regs/oshact/section_8. Accessed January 22, 2020.

3. U.S. Department of Labor. Occupational Safety and Health Administration. Commonly used statistics. Available at https://www.osha.gov/data/commonstats. Accessed January 22, 2020.

4. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA News Release – Region 5. Available at https://www.osha.gov/news/newsreleases/region5/07052016. Accessed January 22, 2020.

5. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA News Release – Region 3. Available at https://www.osha.gov/news/newsreleases/region3/07162013. Accessed January 22, 2020.

6. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA News Release – Region 1. Available at https://www.osha.gov/news/newsreleases/region1/04082015. Accessed January 23, 2020.

7. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA Penalties. Available at https://www.osha.gov/penalties. Accessed January 22, 2020.

8. U.S. Department of Labor. Occupational Safety and Health Administration. Dentistry. Available at https://www.osha.gov/SLTC/dentistry/standards.html. Accessed January 23, 2020.

9. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA Fact Sheet; OSHA Inspections. Available at https://www.osha.gov/OshDoc/data_General_Facts/factsheet-inspections.pdf. Accessed January 23, 2020.

10. L ies, M. EHS Today. OSHA Inspections: What to Expect as an Employer. January 1, 2009. Available at https://www.ehstoday.com/standards/osha/article/21912000/osha-inspections-what-to-expect-as-an-employer. Accessed January 23, 2020.

11. Epstein, Becker, Green. OSHA Law Update. What Are Employers’ Rights During OSHA Inspections? Available at https://www.oshalawupdate.com/2013/10/10/what-are-employers-rights-during-osha-inspections/. Accessed January 23, 2020.

38

Efficiency In Group Practice : ISSUE 2 • 2020

> Safest Dental VisitTM

2020 OSAP Annual Conference The Organization for Safety, Asepsis and Prevention (OSAP) – a community of clinicians, educators, policy makers, consultants and industry representatives who advocate for the Safest Dental Visit™ – will host its 2020 OSAP Annual Conference May 28-30, 2020 at the Hyatt Regency Minneapolis in Minneapolis, MN. The conference is expected to bring together the most innovative thinkers in dental infection prevention, occupational health and patient safety, and will cover a wide variety of topics relevant to dental infection control, including evolving guidance, compliance, and emerging infection prevention and safety issues. Topical and authoritative information will be provided on the most relevant science, policies, procedures and resources for patient and provider infection control and safety.

After attending, participants will be able to: > Describe current and emerging issues related to infection prevention and safety in oral healthcare settings. > List new resources, tools and networks to optimize compliance. > Identify important attributes to develop and enhance global leadership for the optimal delivery of infection prevention and The Safest Dental Visit.

The target audience will include: > Clinicians. > Educators. > Infection control coordinators. > Consultants and lecturers. > Compliance officers of state dental boards. > Risk managers. > Policy makers. > Sterilization technicians. > Hospitals and Federally Qualified Health Centers (FQHCs) with dental clinics.

> Companies engaged in infection control and safety products and services.

This year’s Zapp Lecturer (keynote speaker) will be Dr. Matt McCarthy. A New York-based infectious disease doctor and New York Times best-selling author, Dr. McCarthy most recently published his third book, Superbugs: The race to end an epidemic. In addition, he is an associate professor at Weill Cornell Medical College. Dr. McCarthy will bring a different dynamic to the conference: After playing baseball at Yale University, he played minor league baseball for one year. After he was cut from the minor leagues, Dr. McCarthy went to Harvard for medical school. For more information visit www.drmattmccarthy.com.

Pre-conference course A pre-conference course – The Basic Training – Dental Infection Prevention and Safety Course – will be offered May 27-28, 2020. The

fast-paced 1.5-day course will be presented by national and international experts in dental infection prevention and patient safety, and will provide a comprehensive review of the basics in dental infection control. Participants are expected to leave with new information and resources to help them better address their infection prevention and safety challenges, as well as meet new colleagues who share their interest in this critically important topic area.

This course offers 11 hours of CE credit plus a copy of the newly updated OSHA & CDC Guidelines: OSAP Interact Training System – 6th Edition workbook ($175 value), checklists, tools, and much more.

Successful completion of the Interact workbook and corresponding assessment counts toward the education requirements for two certifications: > OSAP-DANB Certified in Dental Infection Prevention and Control (CDIPC) - A clinically focused professional certification. > OSAP-DANB Dental Industry Specialist in Infection Prevention and Control (DISIPC) - An industry-focused professional certification.

The target audience for this course includes Federally Qualified Health Centers (FQHCs), Indian Health Services (IHS), public health departments, and others. To learn more visit: dentalinfectioncontrol.org.

Efficiency In Group Practice : ISSUE 2 • 2020

39

> Safest Dental VisitTM

As of press time, the pre-conference agenda will include the following: WEDNESDAY, MAY 27 TIME

SESSION

6:30 – 7:30 AM

Registration/Check-In and Refreshments

7:30 – 7:45 AM

Course Overview and Greetings – LCDR Matthew R. Ellis, MPH, CIC, REHS and Joyce Moore, BSDH, RDH, CRCST

7:45 – 8:45 AM

Introduction to Patient Safety – CAPT Stephen “Miles” Rudd, MD, FAAFP, CPPS

8:45 – 9:15 AM

Principles of Infection Control – Shannon Mills, DDS

9:15 – 9:45 AM

If Saliva Were Red Exercise Eve Cuny, MS

9:45 – 10:15 AM

Refreshment Break with Exhibitors

10:15 – 11:00 AM

Infection Control Coordinator Regulatory Guidance & Standards Overview – Kathy Eklund, RDH, MHP

11:00 – 11:30 AM

Sharps Safety – Eve Cuny, MS

11:30 – 11:45 AM

Panel Questions and Answers – All speakers from morning

11:45 AM – 12:45 PM

Lunch with Exhibitors

12:45 – 2:00 PM

Sterilization & Disinfection of Patient Care Instruments – Eve Cuny, MS

2:00 – 2:45 PM

Personal Protective Equipment, Respiratory Hygiene/Cough Etiquette and Hand Hygiene – Kathy Eklund, RDH, MHP

2:45 – 3:15 PM

The ABC’s of Infection Prevention in Dental Settings – Diane Cullen, RN, MSN, MBA, CIC

3:15 – 3:45 PM

Refreshment Break with Exhibitors

3:45 – 5:00 PM

Surveillance & Breaches in Infection Control in Dentistry – Patty Montgomery, MPH, RN, CIC

5:00 – 5:15 PM

Panel Questions and Answers – All speakers from afternoon

THURSDAY, MAY 28 TIME

SESSION

6:30 AM - 5:00 PM

Check-In/Registration

6:45 – 7:30 AM

Refreshment Break with Exhibitors

7:30 – 8:30 AM

Dental Unit Waterlines – Shannon Mills, DDS

8:30 – 9:15 AM

Environmental Infection Control – Eve Cuny, MS

9:15 – 10:00 AM

Immunizations and Work Restrictions

10:00 – 10:30 AM

Refreshment Break with Exhibitors – Shannon Mills, DDS

10:30 – 11:00 AM

Preview of the OSAP-DALE Foundation Dental Infection Prevention and Control CertificateTM Program – Eve Cuny, MS and Kathy Eklund, RDH, MHP

11:00 AM – 12:00 PM

Leading Your Team to The Safest Dental VisitTM – Eve Cuny, MS, Kathy Eklund, RDH, MHP, LCDR Matthew R. Ellis, MPH, CIC, REHS, and Shannon Mills, DDS

12:00 PM – 12:15 PM

Closeout/Panel Questions and Answers – All speakers from morning

1:00- 1:30 PM

OSAP First Timers Orientation – Michelle Lee, CPC

1:30 - 2:00 PM

OSAP Membership Business Meeting – Michelle Lee, CPC

2:00 - 3:00 PM

Do You See What We See? Common Accreditation Findings in Dental Clinics and What You Can Do to Prepare – Diane Cullen, RN, MSN, MBA, CIC

3:00 - 4:00 PM

Amalgam Separator Rule – Fred Eichmiller, DDS, MS

4:00 - 5:00 PM

Surface Disinfectants – John Molinari, PhD

6:00 - 9:00 PM

Welcome Dinner – Included in “Annual Conference ONLY” and the “Basic Training and Annual Conference” registration fee. Guest tickets are available for an additional fee.

40 Efficiency In Group Practice : ISSUE 2 • 2020

FRIDAY, MAY 29 TIME

SESSION

7:00 AM -5:30 PM

Check-In/Registration

7:00 - 8:30 AM

Refreshment Break with Exhibitors

8:30 - 9:30 AM

Dr. John S. Zapp Global Lecture- Superbugs: The Race to Stop an Epidemic – Matt McCarthy, MD

9:30 -10:00 AM

Opening Ceremonies and Awards – Michelle Lee, CPC

10:00 -10:30 AM

Refreshment Break with Exhibitors

10:30 -11:30 AM

Eye Protection Panel Discussion – James R. Harris, PhD, PE, and James Mace, DDS Moderator: Shannon Mills, DDS

11:30 AM - 1:00 PM

Lunch with Exhibitors

12:00 -1:00 PM

Abstract Poster Presentations

1:00 -2:30 PM

State Waterline Regulations Panel Discussion – Matthew J Arduino, MS, DrPH, FSHEA, M(ASCP)CM and David L. Carsten, DDS Moderator: Shannon Mills, DDS

2:30 -3:00 PM

Refreshment Break with Exhibitors

3:00 -4:00 PM

The Role of Bacterial Biofilms in Compromised Cleaning and Sterilization Failure – Greg Whiteley, PhD Danger Things: Patient Safety Hot Topics – Jen Hawley Price, MS, Ginny Jorgensen, CDA, EFDA, EFODA, AAS and Michele Lash, RDH, BA – Space is limited.

Creating a Culture of Safety in Dentistry: One Specialty’s Journey – Paul S. Casamassimo, DDS, MS Update in Dental Traumatology – Juan Yepes, DDS, MD, MPH, MS, DrPH

4:15 -5:15 PM

TB Program Management – Sapna Bamrah Morris, MD, MBA

6:00 – 8:00 PM

Reception and Live Fund Raising Auction!

SATURDAY, MAY 30 TIME

SESSION

6:30 AM - 5:00 PM

Check-In/Registration

7:00 - 8:00 AM

Refreshment Break with Exhibitors

8:00 - 9:30 AM

CBCT: Good, Bad and Sometimes......Ugly! – Juan Yepes, DDS, MD, MPH, MS, DrPH

9:30 -10:30 AM

Occupational Exposures – Brie Blackley, MS, PhD

10:30 - 11:00 AM

Refreshment Break with Exhibitors

11:00 - 12:00 PM

Antibiotic Stewardship – Sanjay Chand, MD The Role of Bacterial Biofilms in Compromised Cleaning and Sterilization Failure – (Repeat) Greg Whiteley, PhD Danger Things: Patient Safety Hot Topics – (Repeat) Jen Hawley Price, MS, Ginny Jorgensen, CDA, EFDA, EFODA, AAS & Michele Lash, RDH, BA Space is limited.

Update in Dental Traumatology – (Repeat) Juan Yepes, DDS, MD, MPH, MS, DrPH

12:00 - 1:15 PM

Lunch

12:15 - 1:15 PM

Breakout Discussion: Update on ADA, AAMI and ISO Standards – Fiona Collins, BDS, MBA, MA and Shannon Mills, DDS Breakout Discussion: How to Handle a Breach – Patty Montgomery, MPH, RN, CIC

1:30 -2:30 PM

Dental Unit Waterlines - All the Options – Shannon Mills, DDS

2:30 -3:00 PM

Stretch Break

3:00 – 4:00 PM

Hidden Dangers in Dental Patient Safety – Steven Yun, MD Antibiotic Stewardship – (Repeat) Sanjay Chand, MD Make Your Safety Message Stick: Top 5 Strategies for Building Safety Culture – Kandis V. Garland, RDH, MS Space is limited.

Balancing Infection Control and Clinic Efficiency: Finding the Sweet Spot Where Risk Mitigation Meets Profitability in the Dental Clinic – Olivia Wann, JD

4:15 -5:15 PM

Opioid Safety and Alternatives in Dental Pain Management – Steven Yun, MD

6:00 -9:00 PM

OSAP Saturday Night Social – River Cruise – Not included in registration – additional fee required.

Efficiency In Group Practice : ISSUE 2 • 2020

41

> OSAP

Registration OSAP member registration fees apply to all membership levels above Basic. Members must log into their OSAP account to receive the member rate. The Welcome Dinner will be included in the Annual Conference and Basic Training/Annual Conference registration fee only. It will not be included in the Basic Training/ Dental Infection Prevention and Safety Course fee. However, guest tickets are available for purchase.

In addition, conference participants will be able to purchase tickets to a Saturday Night river cruise.

courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Participants requesting professional continuing education credits will receive a CE verification form to record the CE numbers for the specific courses they attend. To receive continuing education credit, participants must sign in at the conference, attend the sessions, record the assigned CE number for each lecture attended (note: CE verification numbers are announced at the end of each session), and complete the required evaluation forms. Attendees

Conference rates are as follows: Early-bird Rate Regular Rate On-Site Rate (by 3.31.20) (by 5.14.20) (after 5.14.20) Annual Conference ONLY $645 $725 $805 Annual Conference ONLY - Additional Attendee $545 $625 $705 Basic Training: Dental Infection Prevention and Safety Course ONLY $345 $345 $345 Basic Training + Annual Conference $845 $845 $845 Welcome Dinner - Additional Guest (per person) $100 $100 $100 Saturday Night Social - River Cruise (per person) $100 $100 $100 *Those with Basic (online membership) will receive Non-Member pricing.

OSAP Member *

Note: Students please contact OSAP for the student rate.

Early-bird Rate Regular Rate On-Site Rate (by 3.31.20) (by 5.14.20) (after 5.14.20) Annual Conference ONLY $800 $880 $960 Annual Conference ONLY - Additional Attendee $700 $780 $860 Basic Training: Dental Infection Prevention and Safety Course ONLY $345 $345 $345 Basic Training + Annual Conference $845 $845 $845 Welcome Dinner - Additional Guest (per person) $100 $100 $100 Non-Member *

Saturday Night Social - River Cruise (per person)

To ensure they can accommodate everyone’s needs, OSAP requests registrants indicate any requirements on the registration form. Questions may be directed to OSAP at Office@OSAP.org.

OSAP is an ADA Continuing Education Recognition Program (CERP) Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual

$100

$100

$100

maintain their CE verification form as proof of participation in the educational programming.

Cancellations, refunds and substitutions All registration cancellations and refund requests must be made in writing by May 14, 2020. An 80 percent refund of conference fees will be given for cancellations received

by March 31,2020. A 50 percent refund of conference fees will be given for cancellations received

42 Efficiency In Group Practice : ISSUE 2 • 2020

between April 1, 2020, and May 14, 2020. No refunds will be granted for requests postmarked after May 14, 2020. Submit all requests to OSAP via email at office@osap.org. OSAP regrets that refunds will not be given for no-shows. All requests for exceptions to the cancellation/refund policy must be submitted in writing by the registrant with appropriate documentation no later than May 14, 2020. After that time, no refund considerations will be made.

Substitutions within this program are gladly accepted. A substitution of one’s full registration is permitted prior to the conference by submitting a written request to office@osap.org.

Onsite transfers are not permitted.

The individual submitting the substitution request is responsible for all financial obligations (any balance due) associated with that substitution before the change can be made. Badge sharing, splitting and reprints are strictly prohibited.

OSAP is not responsible for airfare, hotel or other costs incurred by participants in the event of a program or registration cancellation. As added protection against unforeseen circumstances, OSAP suggests travel insurance.

OSAP’s Code of Conduct outlines OSAP’s expectations for anyone attending or contributing to an OSAP meeting or educational activity, as well as the consequences for unacceptable behavior. If one is the subject of unacceptable behavior or has witnessed any such behavior during conference events, please contact Michelle Lee, OSAP’s Executive Director at 404-944-4824 or MLee@osap.org.

> Executive Opinion

The opioid crisis: It’s everyone’s responsibility

By Dr. Britt Bostick

Mortenson Dental Partners does its part to address opioid addiction.

The misuse of opioids — including prescription pain relievers, heroin and fentanyl — has become alarmingly common in recent years. According to the Centers for Disease Control and Prevention (CDC), opioid-related deaths surged between 2000-2017, and the National Institute on Drug Abuse estimates that more than 130 people die each day as a result of an overdose. The debilitating effects of the epidemic have become so devastating that the U.S. Department of Health and Human Services declared a public health emergency in 2017.

What role has the dental industry played in the growth of this national epidemic? A recent study published in JAMA Network found that dentists wrote more than 11.4 million opioid

prescriptions in the United States alone in 2016, accounting for 22.3% of all U.S. dental prescriptions.

Moreover, the National Institute of Dental and Craniofacial Research

(NIDCR) found that dentists were the highest opioid prescriber group for patients between the ages of 10 and 19 years. Clearly, the dental industry has an obligation to do all it can to help mitigate this crisis.

Mortenson Dental Partners (MDP) is one of the largest groups of privately-owned dental practices in the United States. We have a responsibility to our patients to carefully consider the risks and benefits of any medications we prescribe. In recent months, MDP formed a committee

Efficiency In Group Practice : ISSUE 2 • 2020

43

> Executive Opinion

comprised of executive and business intelligence team members to tackle this important issue.

As a result of the committeeâ&#x20AC;&#x2122;s research and deliberations, MDP is pleased to announce three primary initiatives for helping to prevent opioid addiction: > Standardize the pharmaceuticals lists across all offices. > Continue to monitor prescribing habits of doctors. > Support the national effort to reduce narcotic dependencies.

The first of these initiatives will help to provide a more accurate picture of all prescriptions being dispensed

by MDP providers. Standardizing the pharmaceuticals lists will allow us to better track all scripts to compare and educate across all regions.

As we closely monitor trends across MDP regions, we are seeing great progress in our efforts to minimize opioid prescriptions. We are happy to report that between 2016 and 2019, the total number of narcotic pills dispensed by MDP providers dropped by 48%. Our doctors are also writing 31% fewer scripts than in 2016, with the average number of pills per script falling from 16 to 12.

While we are grateful to have made these strides, there is still

more work to do. We continue to educate our team and encourage our doctors to prescribe alternatives to opioids, such as nonsteroidal anti-inflammatory analgesics, as the first-line therapy for acute pain management. Our doctors also adhere to CDC guidelines and use the lowest effective dose and quantity whenever they do consider an opioid prescription.

The health and safety of our patients is of utmost importance to the entire team at MDP. We are committed to supporting the national effort to reduce narcotic dependencies and are doing whatever we can to help end this terrible epidemic.

Narcotics Trending

*2019 Annualized 157,166

159,648

150k

Dispensed

102,587

100k

81,731

50k 0k 10k

9,965

10,564

8k

Scripts

7,731

6,851

6k 4k 2k 0k 16

15

Dispensed Per Script

15 13

10

12

5 0 2016

2017

Dr. Britt Bostick, executive vice president and vice president of clinical affairs, Mortenson Dental Partners

44 Efficiency In Group Practice : ISSUE 2 â&#x20AC;˘ 2020

2018

2019

> News

Dental News : DSOs, Dental Providers and Insurance

Marquee Dental acquires practice in Alabama Marquee Dental Partners (Nashville, TN) announced it has acquired Dr. R. Scott Gamble, Cosmetic and Family Dentistry. Dr. Gamble has practiced in the Dothan, Alabama community for over 15 years. This partnership enables him to focus on serving his loyal patients and the growing number of new patients seeking his services, Marquee said.

MB2 Dental opens 200th practice MB2 Dental (Carrollton, TX) announced that it has added three new partners and expanded into Connecticut. The new additions bring MB2’s office count to 200 practices across 13 states in the U.S. New MB2 Doctor Owner, Dr. Glenn Vo was the official 200th practice and is also known for his dental discounts website, Nifty Thrifty Dentists, a resource for dental professionals, along with his Nifty Thrifty podcast and Facebook group where he interviews fellow dentists and industry experts.

Pankey Institute names Brady president, CEO The Pankey Institute promoted Lee Ann Brady, DMD, to the role of president and CEO. Brady was the Pankey Institute’s first female resident faculty member and later was promoted to clinical director. She will continue in her role as director of education while serving as president and CEO.

Bellevue Orthodontics launches same-day clear aligners using 3D printing

W. Randolph St., where it opened an office in 2018.

Bellevue Orthodontics (Bellevue, WA) announced that its patients can now get clear aligners for teeth-straightening on their first appointment.

Patients have access to fully customized clear aligners such as “Movement Aligners” and customized product packaging.

Mayo announces pilot dental services for children

Marquee Dental Partners solidifies growth through refinance Marquee Dental Partners (Nashville, TN) recently refinanced its existing credit facility, securing a commitment from Crestline Investors, Inc. (Fort Worth, TX) to support its ongoing growth initiatives. The new structure provided capital support in Marquee’s close of seven recent acquisitions in 2019. The company says the funds will further be used for additional acquisitions, de novos, and general corporate operating expenses. Terms of the deal were not disclosed.

Aspen Dental signs deal for new lease in Chicago, will expand workforce Aspen Dental Management (Syracuse, NY) has signed a lease for roughly 200,000 square feet at a 19-story office building under construction at 800 W. Fulton Market (Chicago, IL).

The deal also includes 8,000 square feet of retail space in the building.

The new space will be a large expansion from the 50,000 square feet the company occupies nearby at 1040

Mayo Clinic Health System (Mankato, MN) has announced a pilot project that will expand preventive dental services for children at Eastridge Clinic. The announcement coincided with National Children’s Dental Health Month in February. Funded through grants from Mankato Area Foundation and Delta Dental, several dental services are now being offered to children up to the age of 18, including oral exams, dental cleanings, X-rays and application of fluoride varnish and sealants. The expansion of services aims to help address the wide disparities in oral health care access for vulnerable and underserved populations.

Bright Now! Dental opens new office in Los Angeles Smile Brands Inc. (Irvine, CA) announced the opening of another affiliated Bright Now! Dental office in Los Angeles, CA. The newest Bright Now! Dental office provides full-service general dentistry, as well as orthodontics, Invisalign, oral surgery, periodontics, endodontics, and implants. The office will be led by Dr. Jereme Berryhill.

ADA announces new SVP of operations The American Dental Association (ADA) has promoted Robert Quashie to the role of SVP of operations.

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45

> News

In his new role, he will oversee the ADA’s technology division, along with its member and client services division. The technology division enhances the association management systems, which support ADA and local dental strategy, while the member and client services division works to expand the organization’s membership. Prior to his promotion, Quashie was VP of business operations and strategy for the ADA.

Texas awards new contract to DentaQuest for Medicaid, CHIP Texas’s state department of Health and Human Services recently awarded DentaQuest a contract to

continue providing dental managed care to enrollees in Texas Medicaid and CHIP programs. DentaQuest has been a partner to the State of Texas since 2012, providing Medicaid and CHIP dental benefits and currently serves about 1.5 million Medicaid and 229,000 CHIP beneficiaries throughout the state. Operations for the new contract begin Sept. 1, 2020.

ADA amends religious diversity policy to be more inclusive The American Dental Association (ADA) in an effort to advance it’s diversity and inclusion efforts, the ADA House of Delegates voted at its

meeting in September to rescind the policy titled “The Dentist’s Prayer,” used by some state and local dental societies during their meetings, and amend its policy on recognition of religious diversity. The ADA Board of Trustees had charged its Diversity and Inclusion Committee with considering the role of faith and religion in the Association, as well as The Dentist’s Prayer, following a House vote in 2018 referring the prayer for further study and report.

In amending the recognition of religious diversity policy, the House resolved that Association meetings may begin with “a personal moment of reflection or silent prayer.”

Market Research and Trends

the profiles are “unclaimed” by the practice, and > Over 33% of dental sites had poor organic search results, resulting in lower visibility and business loss.

National study finds dental practices do poor job of using internet marketing resources New research released through DMscore indicates significant performance gaps in digital marketing execution for dental practices, despite billions of dollars in marketing spend.

Digital continues to be under-utilized throughout SMB professional marketing channels, including paid search advertising like Google Adwords, directory presence like Yelp and search engine optimization (SEO). The recent DMscore study reveals that few dentists optimize their practice’s marketing efforts.

For example: > Nationwide, 71% of dentists have a Yelp profile, but 20% of

“Root Canal” listed as most searched-for procedure on cost-compare website Healthcare cost transparency website, FAIR Health Consumer, has released year-end statistics for 2019 that shed light on how a healthcare cost transparency site can attract a broad range of users as well as results on what medical and dental procedures site users were most interested in looking up. The site includes medical and dental costlookup tools that it says allow users to

46 Efficiency In Group Practice : ISSUE 2 • 2020

search for typical costs of healthcare procedures in their geographic areas.

For both last year and 2018, the top five dental terms searched for with FAIR Health Consumer’s medical cost lookup tool were: > Root canal > Crown > Orthodontic > Cleaning > Implant

Sale of .org domains could have big impact on healthcare The Internet Society in November announced its intent to sell control of all .org domains to private equity firm Ethos Capital for $1.1 billion.

The sale and its implications have generated outrage and worry among

.org users – including the many healthcare nonprofit organizations that would be affected.

Since 2002, domains ending in .org have been purchased through an agency called the Public Interest Registry, which is owned by the Internet Society, a well-regarded nonprofit working to expand access to the internet across the world. One worry of the proposed sale is that Ethos, to make the .org top-level domain as profitable as possible, will rapidly raise prices for its customers.

Currently, .org is an open domain, so anyone can register a .org domain, and there are more than 10 million registered worldwide. But

the Public Internet Registry has the authority to suspend domain names for illegal activity, and one of the concerns raised in a public letter opposing the sale is the potential for governments to target NGOs by accusing them of illegal activity and pressuring the Public Internet Registry to take down their domains.

This could have serious implications for the many healthcare nonprofits who use .org addresses.

Large number of Americans willing to go out of country to get lower cost care One-fifth of people enrolled in a health insurance plan are willing to

travel outside of the U.S. for care, with 60% of them already having done so for dental treatment. A recent survey has found that nearly 20% of Americans enrolled in a health insurance plan are willing to travel outside the U.S. for care – and that nearly 60% of them have already done so. Nearly 74% of respondents cited the possibility of lower costs as the reason for their willingness to travel. A total of 1,860 responses were tabulated in a voluntary survey of eHealth consumers who purchased Medicare plans or individual and family plans under the Patient Protection and Affordable Care Act.

U.S. Government and Regulatory News

Lack of access to dental care causing oral health epidemic in Oregon Oregon is facing a dental health epidemic, and a lack of access to care is at the root of the problem for many children, rural residents and low-income families. Legislators will consider improving access to education and services in schools, as well as creating licensing for a new type of practitioner who can complete many of the same tasks as a dentist, but at a lower cost.

In the House, the Oregon Community Foundation has partnered with state Rep. Cedric Hayden (R-Roseburg) and Rep. Alissa Keny-Guyer (D-Portland) to pass the “Healthy Teeth, Bright Futures” campaign. The

program would direct Oregon school districts to include age-appropriate dental health instruction as part of their health education.

Maine considering bill to abolish insurance waiting periods for children Members of Maine’s state legislature’s Committee on Health Coverage, Insurance and Financial Services have discussed an issue brought up by pediatric dentists around the state. Many of the dentists say they’ve had children whose dental care had to be delayed because of insurance waiting periods.

A new proposed bill (LD 1975) would abolish insurance waiting periods for anyone under the age of 19, with an exception for orthodontic care.

U.S. Congress members write letter to FDA, FTC regarding SmileDirectClub The American Association of Orthodontists (AAO) (St. Louis, MO) announced that, on Jan. 6, nine members of the U.S. House of Representatives authored a letter to the FDA and FTC “to express concern regarding SmileDirectClub.” Additionally, the Congressmen expressed their “strong support of the FDA and FTC investigating the practices of SmileDirectClub to ensure that it is not misleading consumers or causing patient harm.”

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> Editor’s Note

Coming together

Laura Thill

The world is an interesting place, and we are the reason why. As our communities and professions have grown to include broader, more diverse groups of people, we have learned to share new and different perspectives and experiences. In fact, for many of us, diversity is what drives and defines some of our closest relationships. Not surprisingly, the dental industry reflects this “I believe it is the professional responsibility of a business owner to recognize diversity and create an office culture that promotes acceptance,” says Dr. Kimberly Haynes, the owner of four Aspen Dental branded locations in Central Texas. “Given the unique patient population we care for in Central Texas, our offices see patients of different nationalities, ethnicities, socio-economic status and genders,” she explains. “As with our patients, our staff is equally diverse.”

When the staff and doctors can relate to their patients, it helps put them at ease, she continues. In fact, dental offices incapable of providing an environment of acceptance will likely face challenges recruiting and hiring new staff, she points out. “Acceptance is a basic human desire. Having a dental team who can relate to their patients enables the practice to provide a judgment-free zone.”

For Lubbock, Texas-based Abbeville Dentistry, a regional partner of Mortenson Dental Partners, it’s very important to unite across differences in ethnicity, religion, race and more to provide exceptional care to patients. “When we take the time to learn from, understand and accept others, we remove barriers,” says Dr. Mayada Khater, regional president, and Dr. Britt Bostick, co-founder, of Abbeville Dentistry. “Ultimately, we want our dental practice and DSO to mirror our communities and embrace diversification.”

The year is young and the decade is new. Our shared – Dr. Kimberly Haynes, owner of four Aspen Dental branded locations in Central Texas differences will continue to unite us in 2020.

“ I believe it is the professional responsibility of a business owner to recognize diversity and create an office culture that promotes acceptance.”

48 Efficiency In Group Practice : ISSUE 2 • 2020

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