CONTENTS

1. Introduction
2. Goals and Objectives
3. Practice Management
3.1. Aspects of interior design
3.2. Equipment
4. Patient Management
4.1. Communication skills
4.2. Medico-legal aspects of patient management
5. Human Resource Management
5.1. Staff recruitment
5.2. Staff motivation
5.3. Staff training
5.4. Delegation of responsibility
5.5. Staff appraisal
5.6. Managing staff absenteeism
6. Financial Management
7. Time Management
7.1. Appointment control system
7.2. Appointment entries
7.3. Organizing the book
7.4. Causes of disruption
7.5. Non-clinical time management
8. Preventing and Controlling Healthcare associated Infections
9. References
1. INTRODUCTION

Nowadays, the dental health care is delivered majority

by the private practitioners all around the globe. Success in dentistry
depends, on the one hand, on the management of clinical aspects, but
equally on the efficient administration of the dental practice. The two
categories of issues must be equally managed equivalent, because
dentists tend to focus on only one category, ignoring the other. A good
dental practice will operate a hierarchical system with patients’
interests and the dentist at the top and other members of the dental
team supporting them and ensuring the practice runs to its optimum
capability. Dental practices must be in compliance with federal laws
that help protect patients from preventable injuries and potential
dangers such as the transmission of disease. World Health
Organization (WHO) defines patient safety as “the reduction of risk of
unnecessary harm associated with healthcare to an acceptable
minimum. For the dentists, understanding the ways of managing is
important to provide a practice environment that promotes patient
safety.
1. GOALS AND OBJECTIVES

Goals
• Attain clinical excellence
• Earn high income
• Gain professional standing
• Improve social status
• Develop a more fulfilling standard of care

Objectives

• Survival
• Profitability
• Evolution
• Professional Development
• Personal Development
2. PRACTICE MANAGEMENT

Good practice design requires a basic understanding of

the Principles of ergonomics. Their aim is to reduce stress,
fatigue and frequency of errors, and to maximize efficiency.

2.1 Aspects of interior design

For the aspects of interior design, following ideal

concepts should be realized.

• Budgetary considerations
• Existing design and layout of the building
• Personal preference

Factors such as color, temperature, illumination, and

noise have all been shown effects on working environment.

Color: the psychological effects of color are relevant in dental practice

and on the patient.

Red - warmth/passion
Blue - cool
Green - fresh
Yellow - cheerful
Grey – dignity/ quietness
White – clean/hygienic

Temperature: Occupational Safety and Health Administration (OSHA)

recommended dental office temperature should be between 68 and 78
degree Fahrenheit.
Illumination: three types of lighting system should be considered.
1. Task lighting – 16000 LUX is recommended to give
optimal lighting in the clinical field.
2. Background lighting – In non-clinical areas, ambient
light level 400 to 500 LUX are acceptable.
3. Decorative lighting – allows the imaginative dentist to
create quite spectacular effect within the practice. Glare
causes the eye strain and can leave to fatigue and stress.

Surgery Design
The design of the surgery should be based on
ergonomic principles and satisfied the needs of the dentist, the dental
assistants and patients. The dynamics of layout should be considered
first. These include:
• Entry point to room for the patient
• Flow pattern for the patient
• Flow pattern for the dentist
• Flow pattern for the nurse
• Instrument retrieval
Sinks, storage cupboard waste bins and sterilizers
should be positioned around these dynamic considerations.

3.2 Equipment
Practice development will involve re-equipping at some
stage. The life span of dental equipment varies from manufacturer to
manufacturer and from practice to practice. Frequency of renewal
depends on;
• The type of equipment
• The intensity of use
 • The frequency of use
• The build quality
• The maintenance and servicing
The purchase of new equipment is one of the largest
capital expenses. The dentist should aware to re-equip for the sake of
patient safety and has two options:
• Integrated equipment package: complete units which
have all equipment items built in.
• Hybrid package: the basic chair can be purchased from
one supplier, the cart housing and the fitting for
preferred handpieces from another sources.

Equipment maintenance
There are various reasons why it is re-equipped including:
• Age of equipment
• In-surgery maintenance
• Increased awareness of breakdown and malfunction
• Increasing complexity and sophistication of units
• Increasing variety of hi-tech applications
The increased emphasis on cross-infection control is
leading to an increased incidence of mechanical failure e.g. dental
handpieces. This may be due to poor in-surgery maintenance and also
to the fact that some brands are not able to withstand the temperature
of autoclaving. The practitioners must also aware of regular checks on
autoclaves, compressors, and X-ray units. Many now have service
contracts for their maintenance. If the equipment is damaged beyond
repair, the replacement item is necessary.
Some common examples of accidental damage are:
• Damage caused by equipment falling to the floor
 • Cables being accidentally trapped on the castors
• Damage to the items which are not suitable for
autoclaving.
A simple check list:
1) Dental chair
• Main switch
• Foot switch
• All controls
• Fuse
• Water inlet valves and taps
• Maintenance of upholstery
2) Radiographic equipment
• Switches
• Timer setting
• Maintenance of automatic processors
• Local rules
3) Handpiece
• Types of fittings
• Insertion and removal
• Couplings
• Water regulators
• O-rings
• Maintenance and oiling instructions
• Autoclaving procedures

4) Operating lights
• Control switches
• Control of intensity
• Spare bulbs and how to change
 • Maintenance of glass lens
5) Compressors
• Switches
• Air and water filters
• Drainage procedures
• Oil levels and maintenance
• Pressure gauges
It is important that all those who come into contact with
equipment are shown key aspects of maintenance so that all the staffs
and practitioners should have proper knowledge of how things work.
Effective maintenance is easier if there is an understanding of how
things work and how functions are controlled.
3. PATIENT MANANGEMENT

3.1 Communication skills

The interpersonal-relationship between dentist and
patient relies on effective communication. A good relationship benefits
the relationship by:

• Increasing patient number as a result of

recommendations
• Increasing patient compliance
• Reducing the incidence of complaint
• Reducing the threat of litigation
• Lowering patient anxiety levels.

What makes for a good relationship?

The answer in a word is ‘communication’. There are
many ways in which the dentist and practice communicates with the
patient. These are:
• Verbal
• Visual or non-verbal
• Written
• Psychological or perceptual.

The optimum mix is one which includes all the

elements of communication. More specifically, verbal cues, facial
expressions and vocal characteristics are thought to influence in the
relationship.

Verbal and non-verbal communication

The verbal input communicates factual information and,
to a lesser extent, opinion and speculation. In contrast non-verbal
communication concentrates on emotional aspects of the process
which include anger, sadness, joy, surprise etc. The key difference
between the two is that the former relies on language, but the latter
knows no barriers and the visual cues expressing surprise and sadness
are globally understood. The main barriers to effective communication
in dental practice are:
• Technical jargon
• Background noise
• Poor listening skills
• Lack of feedback from the patient
• Distrust

Those barriers can be overcome in a number of ways which are

mentioned below:
1. Avoid technical jargon in direct communication with the patient.
Choose an appropriate form of communication.
2. Minimize disruptions and intrusion during dentist-patient
communications. Telephone calls, noisy equipment in the
background, interruption by other entering the clinical area are all
distracting influences which compromise the communication
process.
3. Listening skills can be acquired and demand concentration and
interest on the part of the listener. Ways of improving the
listening skills include:
• Let the patient finish what he/she is saying
• Use eye contact and verbal phrases to indicate interest
• If unsure about a statement, ask for further explanation
• Observe body language and facial expressions for
addition clues.
 4. Lack of feedback from the patient may reflect lack of motivation
on the part of the patient. It must be accepted that no amount of
skilled communication can overturn rigid beliefs and attitudinal
differences.
5. Distrust may present as uncertainty of response, especially when
the dentist is asking the patient to consider a particular treatment
option.

The style of verbal and non-verbal communications is a

function of the extent to which it demonstrates the feature of the style
cycle.

Written communications
Written communications to patient include:
• Recall cards and letters
• Advice sheets
• Practice information leaflets
• Notices and newsletter.

All written communications should be legible, easily

understood, and given by a source which has maximum credibility.
The primary objective of a written communication is to convey
information. But written communication can also convey all of the
following:
• Care
• Concern
• Quality
• Expertise
• Professionalism
• Image

Consent
Obtaining consent for treatment engages all the
elements of skillful communication and tests professional
communication skills, particularly in complex treatment planning. It
calls upon verbal and non-verbal skills, written communication and an
understanding of human behavior and reaction. A failure in
communication in matters of consent may result in serious allegations
for the dentist.
The process of communication which explain, qualifies
and identifies risk factors associated with particular treatment is
manifestly an exercise in obtaining consent. It may be assumed that
consent is implied if the patient willingly opens his or her mouth and
allows the dentist to proceed with necessary treatment. This approach
however conflicts with the concept of informed consent. Informed
consent is deemed to have been obtained if the patient has been made
aware of:
1. The type of treatment that Is proposed and its likely
effect
2. Risks associated with the treatment provision
3. Alternative therapies
4. The risks of not carrying out the treatment
 It is particularly important to fully explain the nature of
the intended treatment and the likely outcome to new patients to the
practice. The new patient’s perception of procedures will be based on
previous experiences and attitudes and beliefs. The ‘new’ dentist
whose work methods and philosophy may conflict with the patient’s
previous experiences and expectations is especially at risk if he/she
proceeds with treatment without first fully qualifying the necessary
details.

Consequences of not providing treatment

In the event of refusal consent, the patient should be
advised of sequelae of untreated disease/lesions and a note to that
effect should be made on the record card.

4.2 Medico-legal aspects of patient management

Communication skills enhance many aspects of patient
management. They are put to the test in medico-legal matters and
color the style of patient management. In particular, dentists must be
aware of the principles of:

• confidentiality and consent

• clinical record keeping
• negligence.

Confidentiality and disclosure of records

A breach of confidentiality is a serious allegation and
may lead to a charge of serious professional misconduct. All members
of the dental team should be made aware of the potential outcomes of
such a breach.
 Information about a patient may be disclosed to a third
party if the patient's written consent for disclosure has been obtained.
There are circumstances, however, where this consent is not necessary
and the dentist has a statutory obligation to disclose information
concerning a patient, for example:

• the release of records which may help to identify a

driver in a road traffic accident (Road Traffic Act
(1988))
• disclosure of information about a child to the child's
legal guardian

• disclosure in the public interest. The dentist has a duty

to society which may displace duty of confidentiality to
the patient. This may arise if the dentist comes to learn
of certain information about a patient, the disclosure of
which is in the public interest

There are many instances where disclosure does not fall

into a given category and the practitioner is undecided on what course
of action to take. Some examples are:

• employers who telephone the practice and request

information that an employee did attend the practice is a
frequent example. The patient's con sent should always
be obtained before such information is disclosed
• a school may telephone to confirm that a child's absence
was due to a dental appointment. Again, consent should
be first obtained from the legal guardian before such
information is disclosed
Clinical records
The quality of the record card reflects the quality of
treatment as seen by the layperson and gives the all-important first
impression to professional advisers in litigation cases. This association
by perception must not be undervalued. Perception is reality. The
clinical records include:

• written notes - medical history, treatment plans

• radiographs
• photographs
• results of special investigations
• study casts
• laboratory prescriptions
• inter-professional communications, in case of referral.

Above all, clinical notes should be legible and

contemporaneous and should include the following information:

• current medical history - updated at the most recent visit

• patient's comments or observations
• findings on clinical examination
• findings on special tests
• treatment provision
• consents obtained and special warning given pre- and
post-operatively
• details of drugs administered and dosages
• patient preferences, particularly in aesthetic cases
• missed and cancelled appointments
• late arrival and/or dentist running late
• other information relevant to treatment planning or
provision
 • the signature or at least the initials of the clinician
providing the care and treatment.

Negligence
The tort of negligence is the breach of a legal duty to
take care, resulting in damage to the plaintiff which was not desired by
the defendant. It has been said that it is 'not a state of mind, but a
falling short of an objective standard of conduct'. It may also be
defined as 'the omission to do something which a reasonable man,
guided upon those considerations which ordinarily regulate the
conduct of human affairs, would do, or do something which a prudent
and reasonable man would not do'.

Any patient may contemplate an action to recover

damages, but the burden of proof is generally on the plaintiff who must
demonstrate that:
1. the dentist owed a duty of care
2. there was breach in that duty
3. consequential damage was sustained – the nature of the
damage is usually physical, but it may be psychological.

Under The Law Reform (Contributory Negligence) Act

1945, which introduced the concept of contributory negligence, a claim
for damages may be reduced by an extent as the Court sees fit, in
regard to the claimant's share of responsibility for the personal injury.
Contributory negligence may arise when a patient fails to follow post-
operative instructions, or reacts during treatment in a way which
results in injury. For example, sudden movements during tooth
preparation may result in a laceration of the cheek or tongue.
In a successful action, the Court may award monetary
damages. The quantum of damages is the sum of general damages, the
most common being compensation for pain and suffering and special
damages which include cost of remedial treatment, travel expenses,
and the loss of earnings. It is worth noting that although the treatment
which was the subject of the action may have been provided under the
NHS, the patient may elect to have the remedial treatment carried out
by private contract.
5. HUMAN RESOURCE MANAGEMENT

Human resource management (HRM)may be defined as

an aspect of management which deals with the human side of
enterprise and with employee relations within the practice. The success
of a dental practice is entirely dependent upon the efficient use of
available resources and, in particular, human resources.

H R M tends to focus upon the long-term needs of the

practice rather than short-term objectives which are task orientated. H
R M principles propose a bias towards commitment rather than
compliance, and to self-motivation and control rather than external
controls. H R M also differs from traditional perspectives of personnel
management in its trend towards maximum utilization rather than cost
controls. It is a resource-centered approach and embodies general
management principles such as planning, monitoring, feedback and
control. It can be seen that the two concepts share many common
features and differ only in emphasis and focus of activity.

Successful H R M relies upon the integration of several

processes and functions which include:

• staff recruitment
• pay systems
• training and professional development
• employee motivation and rewards
• employee relations
• work conditions.

All these must take place within the framework of

current legislation, including Employment Law, Health and Safety
Law, and the boundaries of professional and ethical guidelines and
regulations.

The performance of the practice is the sum total of the

performance of individual team members. It is incumbent on the
dentist to provide:

• a good working environment

• stable employment
• opportunities for personal development

The Five Rs of Management

Successful management can be attributed to five basic
Rs: responsibility, respect, rapport, recognition, and remuneration.
Individuals can nurture their natural skills into sound management
skills through experience, effort, and learning. An employee should be
delegated all tasks that are legally delegable and for which he or she is
properly qualified. Employees cannot work to achieve their maximum
productivity if they feel they are not given responsibility for which
they are answerable.

5.1 Staff recruitment

The members of the dental team are often the greatest
asset the practice has. Their attitude, commitment and approach to
patients can often mean the difference between a successful and
indifferent practice. Poor selection procedures frequently result in
recruiting less satisfactory personnel. This can cause increased staff
turnover which is costly and inefficient.
Job description
Before advertising the position, prepare a detailed job
description. The job description should provide information under the
following headings:

• job title
• job relationships
• practice location
• salary range
• duties and responsibilities
• team contacts
• special conditions
• signature of employer
• date of preparation of job description.

The job description gives the total requirements of the

position. The job description is usually in the form shown above with
the emphasis on tasks and duties. This can be particularly useful in a
people-centered environment such as a dental practice.

5.2 Staff motivation

Studies of motivation are concerned with why people
behave in a certain way and what factors influence and affect this
behavior. It assumes that there is a driving force which pushes and
directs people to achieve particular goals, fulfil particular needs, or
meet a set of expectations.
A person's needs and expectations at work are usually
based on three considerations:

1. economic - pay, fringe benefits, material gains etc.

2. intrinsic - nature of work, personal and professional
development
 3. social - interactions with others, peer group
relationships.

5.3 Staff training

Staff raining is probably one of the most neglected areas
of practice management today. Staff are the greatest asset a practice
has and investment in training is one of the most rewarding aspects of
practice management. Dentists become involved in staff training at
many levels, from the training of a new and inexperienced dental nurse
to training for promotion.
A training program should follow a logical sequence:

• identify learning needs

• set training objectives
• choose method
• implement performance
• review and modify the process.

5.4 Delegation of responsibility

What is delegation?
Delegation can be defined as the shifting of authority by
a supervisor to a subordinate. It is an essential feature of large
corporations in which senior managers cannot possibly control all their
subordinates. It relies on concepts of:

• authority
• responsibility
• accountability.

Delegation of authority confers the right of decision

making. The decision making process carries an element of
responsibility to ensure at least mini mum standards of performance.
Responsibility is the consequence of authority, although it must be
remembered that although the managerial responsibility is carried by
the subordinate, the ethical and clinical responsibility of many
delegated tasks ultimately rests with the dentist. Ultimate responsibility
cannot be delegated.

Dentists delegate for different reasons. Many dentists

would prefer to maintain overall control if they had time. But most are
full-time clinicians who slip into the managerial role in their leisure
time, or when there is an unexpected ten-minute slot between patients.
Time can be set aside for supervisory duties, but how much can the
dentist afford to 'lose' to this essential task? The answer, of course, is
very little.
Some of the most successful practitioners manage to
combine a successful general practice career with a host of other
activities. Their ability to pack so much into a working week comes
not only from disciplined time management, but from their mastery of
the art of delegation.

5.5 Staff appraisal

The appraisal process begins when the dentist and
employee arrive at a mutual understanding of what needs to be
achieved in the organization. It is an essential activity in practice
management and in human resource management.
The advantages of carrying out performance appraisal
benefit the practice and the employee. They can:

• identify strengths and weaknesses

• reveal barriers to efficiency
• improve communication and problem solving
• reduce tension
 • improve practice morale
• provide information for practice development.

It is well recognized that people are likely to achieve more if they are
given:
• goals and standards to work to
• feedback on performance
• an opportunity to participate in goal setting.

5.6 Managing staff absenteeism

Employee absenteeism may be the result of:

• job dissatisfaction
• poor attitude to work
• conflicting interests
• poor interpersonal relationships
• emotional disturbances.

No-one can deny that absence as a result of illness is

always excusable, but the less motivated employee can, through his or
her persistent absence with out good cause, destabilize practice morale
by putting other staff under excessive stress. If an employee has too
much to do in too little time dissatisfaction can result.
The tendency is to focus attention on the absent
employees, but some con sideration should be given to how the
absence affects the remaining team members. They have to cope with
additional pressures, and cope with patient demands in the usual way.
The effects of repeated absenteeism on staff morale should not be
ignored.
 Absenteeism may, in extreme cases, necessitate
rescheduling of patient appointments causing inconvenience to all
parties and affecting practice fee income.
6. FINANCIAL MANAGEMENT

The principles of financial management require the

dentist to have a working knowledge of:
• cost analysis
• financial ratios
• cost control and budgets
• fee setting
• cash flow and debt control

Cost Analysis
Costs may be conveniently categorized into overheads
and direct costs.
Overheads (fixed cost) - one which accrues over time and which,
within certain limits of output and turnover, tends to be unaffected by
fluctuations in the said output or turnover. Examples are rent or
mortgage payments, gas and electricity costs, some staff salaries and
equipment leasing costs.
Direct cost (Variable cost) - are incurred in direct proportion to
turnover. Examples are laboratory fees, dental materials and some
staffing salaries.
Some practices may offer incentive payments to salaried technicians in
the form of performance related pay (PRP). The technician's basic
salary is treated as a fixed cost. If performance targets are met,
additional payments in the form of PRP are recorded as a variable cost.
Financial Ratios
Financial statements and accounts give absolute figures
which reflect in numerical terms income and expenditure within the
practice.
Some useful financial ratios include:
 • Gearing
• current ratio
• return on investment (ROI)
• return on capital employed (ROCE).
(i) Gearing
This is a measure of the extent to which assets are
covered by liabilities. Gearing ratios reflect the level of financial risk.

(ii) Current Ratio

This is a measure of liquidity. Liquidity refers to the
ease with which a practice is able to obtain cash for business or
operational purposes. The current ratio is a ratio of current assets to
current liabilities.

(iii)Return on Investment
This is the financial benefit derived from the investment
made and is expressed as a percentage of a specific investment.

(iv) Return on capital employed

This reflects the financial benefit derived at the practice
and is expressed as a percentage of the capital employed in obtaining
it.

Cost Control and budgets

(i) Cost Control

Cost control is achieved by direct or indirect methods.

Direct Methods (form of cost reduction or elimination of waste)
Include:
• monitoring prices to see where savings can be made
 • eliminating resource wastage
• budgeting.
Indirect methods (Indirect cost-cutting measures should aim to identify
aspects of business performance which can be enhanced and so reduce
the hourly rate of overheads)
Include:
• identifying under-utilization of resources
• reviewing business loan rates
• reviewing work methods
• identifying new opportunities

(ii) Budgets
The word 'budget' is used to describe a business plan
expressed quantitatively.
Budgets serve three important business purposes.
a) They set targets to be achieved, and more importantly,
allow a comparison between actual and expected
results. A results comparison from one year to the next
will provide the basis for cost control for the future.
b) They are indicators of likely outcomes of business
plans.
c) They are also vehicles for cost controls.

The business of dentistry

The business of dentistry involves:
1. Cash flow
2. Fee collection
3. Recording the payment
4. Credit control
1. Cash Flow

'Cash is King' continues to be another guiding principle

of successful business management.
Cash Flow - flow of funds in and out of practice.
A positive cash flow indicates that the fees received
exceed the outgoings and negative cash flow is said to result when the
practice out more than it is receiving.
Negative cash flow in dental practice may result from:
• reduced workload
• poor business performance
• high gearing or heavy borrowing
• inadequate control
2. Fee Collection
The four Es of fee collection:
a) Establish a policy
b) Explain it to staff
c) Execute the policy
d) Evaluate the procedure

Timing and Quantum

Questions to consider are:
1. Should a fixed percentage of the total estimated fee be charged
at the first visit?
2. Should patients pay for all treatment at the first visit?
3. Should patients pay only for the treatment provided at that
visit?
4. What fees are payable for missed appointments and how are
they calculated?
5. Should patients have paid the full fee for laboratory work items
prior to fitting the work?
The answers to these questions should form the framework of the
practice policy.

Methods of Payment
Patients should be able to pay by a variety of methods.
The options are:
• Cash
• Cheque, supported by a cheque card
• Credit card
• Switch, and
• Other currencies

Fee collection is usually carried out at the reception

desk and some training will be required to familiarize the team with
practice policy. Asking patients how they would like to pay for their
treatment rather than they would like to pay is a good starting point!
Electronic funds transfer at point of sale (EFTPOS) is another
alternative and the 'Switch' card is an example of this facility. A charge
of 2-3% of the value of the transaction is usually levied for credit
cards, but the EFTPOS option carries a fixed fee per transaction.

3. Recording the payments

Clear and accurate financial records are essential for:
• Accounting and book keeping purposes
• Recording dentist-patient transactions
• Providing statistics to generate business reports
• Monitoring cash flow
• Observing trends.
 Patient payments should be recorded on some type of
daily journal. The style of recording can be varied to suit the needs of
the practice Example is shown in Figure Below.

4. Credit Control
Credit control is time consuming and costs money.
Poor credit control can lead to:
• Poor cash flow
• Poor use of staff time in following up accounts
• Legal action

Authority to proceed to collection should be sought

from the clinician or other nominated authority. It is important that this
stage of the process is sanctioned by a senior member of the team as it
can create ill-feeling between the practice and the patient if there are
valid reasons for non-payment. A procedure should be established to
prevent embarrassment.
Reminder letters can provoke a hostile reaction from
some patients or a claim that the treatment provided was unsatisfactory
or perhaps even negligent. In some cases, a counter claim may be
served by the patient. The practice must be prepared to deal with these
queries and threats.
7. TIME MANAGEMENT

Time management is concerned with making effective

use of time. The processes of achieving effective time management
rely on:

• prioritizing
• distinguishing between urgent and important tasks
• having a routine
• getting into the habit of making lists and using a time
management system
• eliminating time-wasting activities
• delegation
• developing better communication skills
• maintaining physical energy and fitness
• minimizing non-productive time.

7.1 Appointment Control System

Appointment control systems regulate the way in which
clinical time is used. An organized appointment book is the
prerequisite for clinical efficiency and business profitability. The
purpose of an appointment control system is to:
• maintain an orderly and predictable flow of patients
• minimize the waiting time for patients
• accommodate emergency cases with minimal
disturbance to the rest of the schedule
• ensure that patients are seen on time
• increase profitability
• maximize efficiency.
Disorganization can result in:
 • stress on the dental team
• anxiety among patients
• a reduction in productivity and profit
• poor staff morale
• frustration
• compromised clinical standard

7.2 Appointment Entries

The entry in the appointment book should record:
• the patient's name
• the planned procedure
• the duration of the appointment
• notes and memoranda relevant to the appointment

7.3 Organizing the Book

Most appointments are made on the basis of mutual
availability. A more structured approach to organization of the
appointment book is the concept of sessional booking. Sessional
booking may be patient-based or procedure based.
Patient-centered sessions - Certain days or sessions can
be allocated for private or NHS patients or those under a private
capitation scheme. A sessional booking system will only work
effectively if it is seen to be limited and dedicated. It should be limited
to those who subscribe to the selected option, and dedicated to the
extent that it is not open to invasion by other patients. These concepts
imply that an incompletely booked session should be allowed to
remain partially unfilled, which can be difficult for the dentist to
accept. The advantages of patient-centered sessions is that a single
routine or protocol can be established for that session. The major
disadvantage is that patients cannot always come on the dedicated days
or sessions and it becomes difficult to enforce the concept of
limitation. The patient with a relevant medical history who is seen at
the end of the day is a special case within this category.
Procedure-centered sessions - These sessions are
reserved for certain clinical procedures. A session may be reserved
exclusively for examinations with patients scheduled at chosen time
intervals. No treatment is carried out at these sessions and those
patients who require treatment are asked to return on a day where
general treatment is carried out. Dentists with a special interest in a
particular branch of clinical dentistry may choose to allocate sessions
for particular clinical procedures. This is common practice with oral
surgery, for example. The surgery can then be set-up to accommodate
the special needs, equipment and materials for example, of that
particular session. The advantages of procedure sessional booking
arrangements are that they are generally considered to be more
productive and efficient than random booking arrangements. The
disadvantage is that they do not offer variety for the dentist and
introduce an element of repetition and routine to the session, but this is
not necessarily a problem if the number of such sessions is restricted.
Random booking sessions - This is perhaps the most
common system in practice. The random system accommodates
patients at the first available time. The main advantage of this system
is that it is totally flexible and gives the patient maximum choice. The
disadvantage is that randomly scattered short appointments can often
make it difficult to schedule a long appointment of, say, two hours for
a patient. Random systems should aim to accommodate patients in
such a way so that their distribution is a little less random and more
orderly.
7.4 Causes of Disruption
The following suggestions are some ways to minimize
the effects of disruptive influences.
- Plan treatment with time blocks in mind and schedule
accordingly.
- Identify patients who persistently miss appointments. Use
colored stickers on cards or an appropriate flag on a computer.
Telephone or write to these patients to confirm their
appointments.
- Avoid booking long appointments for patients with a history of
poor attendance, until they have been proved to be reliable.
- Do not squeeze patients into time reserved for others, except in
emergencies.
- Encourage advance payments. This is an effective incentive for
patients to attend for their next appointment.
- Avoid qualitative and quantitative overload. Qualitative
overload occurs when insufficient time is allowed for a
complex procedure to be performed to the desired quality.
Quantitative overload occurs when a dentist tries to do too
much work in too little time
- Unscheduled emergencies can then be accommodated in
sections of the appointment book where there is an abundance
of minus entries.
- Maintain a list of local patients who wish to be notified of any
cancellations and other short-notice appointments. This ensures
that unexpected vacant time blocks have some chance of being
filled.
7.5 Non-clinical Time Management
Many dentists are involved in professional and other
activities outside their immediate sphere of practice. A practical
method of carrying out tasks is to use a time-management diary system
which encourages the user to:
• prioritize workload
• list activities
• schedule activities
• set daily, weekly and monthly goals.
Avoid activities which can waste time. For example:
• Telephone calls.
• Paperwork.
• Travel time.
• Poor time keeping.
• Over-commitment.
 8. PREVENTING AND CONTROLLING
HEALTHCARE ASSOCIATED INFECTIONS

The intention of this study is to minimize the risk for

patients in acquiring preventable infections and to use evidence-based
strategies to effectively manage infections when they occur. To reduce
infection, prevention and control program requires leadership and
support from practice owners, senior dentists or the dental service
executive.
A risk management approach provides a framework to
access risks identified in the dental practice so that strategies and
resources can be prioritized.
A successful infection prevention and control program
is comprised of the six criteria.
I. Governance & systems for infection prevention control and
surveillance
II. Infection prevention & control strategies
III. Managing patients with infections or colonization
IV. Antimicrobial stewardship
V. Cleaning, disinfection and sterilization
VI. Communications between patients and careers
These should be considered as part of the overall risk management
process.

I. Governance & systems for infection prevention control and

surveillance
To identify risks and decide how to prioritize actions,
you can:
- Train dental team members in infection prevention and
control system
 - Monitor infections associated with dental care
- Review the infection prevention and control system to
see if there are areas that could be improved
- Develop a plan to address these areas
II. Infection prevention & control strategies
To monitor the use of measures to prevent and control
infections, activities such as hand hygiene, use of protective clothing,
environmental cleaning, waste management, instrument traceability
and cleaning, disinfection and sterilizing procedures can be reviewed.
These activities include:
- Observing practice
- Monitoring trends in infection rates
- Reviewing infection control incidents
- Checking for patterns of incidents
- Discussing with dental team members how infection
control and prevention activities can be improved
- Documenting improvement activities
III. Managing patients with infections or colonization
Dental care can be provided through:
- Emergency dental appointments, or
- General scheduled appointments (often with significant
time between the booking and actual appointment time),
or
- Spontaneous presentation
You should ensure systems are in place to address the
different risks depending on how patients present for care:
- In emergencies, it is important the dental practice has
systems to manage infections transmission and risks to
dental team members and other patients and carriers.
 - For general scheduled appointments, treatment would
ideally be undertaken when the patient is well and at
low risk of having an infection.
IV. Antimicrobial stewardship
Processes in place for regular education relevant to role
and responsibility about antimicrobials, guidelines and antimicrobial
stewardship include:
- Medical, nursing and pharmacy undergraduates
- Pharmacists
- Rural nurses who take a role in pharmacy management
- Nurses in all facilities responsible for administration at
antimicrobials
- Junior medical officers and career medical officers
- General practitioners, visiting medical officers (VMOs)
and staff specialists
V. Cleaning, disinfection and sterilization
The scope at this criterion includes maintenance and
cleaning at the buildings and infrastructure, waste and linen handling
and management.
This criterion also includes cleaning disinfection and
sterilization activities for reusable equipment and instrumentation used
in the health service organization.
Procedures for environmental cleaning that address the
principles of infection prevention and control are implemented,
including:
- Maintenance at building facilities
- Cleaning resources and services
- Risk agreement for cleaning and disinfection based on
transmission-based precautions and the infectious agent
involved
 - Waste management within the clinical environment
- Laundry and linen transportation, cleaning and storage
VI. Communications between patients and careers

Information on healthcare associated infection is

provided to patients, careers, the public and other service providers.

Patient infection prevention and control information is

evaluated to determine if it meets the needs of the target audience.

Patient education materials that may be considered

include:

- Public health information

- Publications that provide information of infection rates and
risks
- Website information.

It is important that health service organization

management oversees the systems and processes for the maintenance
at a clean, hygienic environment.
9. REFERENCES

Das M, Pradhen D, Sharma L, Sinha PK, Mohanty S, Todkar M (2018)

An Insight To Dental Practice Management A Literature Review
international journal Oral Health Medicine vol:5 (issue 1) 54-56

Ratton R (1996) Making Sense of Dental Practice Management, 1st

edition, Raddiffe Medical Press UK