Welcome to the fourth edition of the 'Practical Guide to Compliance' series. This series is intended to act as informal guidance to dental teams working toward CQC compliance. The contents of these articles are based on personal opinion and interpretation of the CQC framework and other relevant legislation. Whilst the author has full confidence in the suitability and appropriateness of the information contained within these articles, the information shall not be regarded as fact and those requiring definitive information should consult the relevant governing body.
Outcome 4 Care and welfare of people who use the service
This outcome is centred around ensuring that you are delivering safe and appropriate care to your patients.
What do the regulations say?
"People should get safe and appropriate care that meets their needs and supports their rights".
- CQC Essential Standards
Compliance with this outcome will be achieved through having systems and procedures in place for managing patient care.
You will need to demonstrate your process for assessing patients prior to treatment, this could be in the form of a written procedure for examinations/assessments, it should detail what the assessment entails, how you involve the patient in the process and how you identify and take into consideration their individual needs and choices.
Every patient should be given a written care plan detailing their individual needs and choices, the detail included within this care plan will depend upon the complexity and nature of their treatment needs however it essential all patients are given a full details of all care and treatment options appropriate to them. The treatment planning process needs to take into consideration a patients indivdual needs and preferences and patient involvement here is key. A treatment planning policy will serve as a means for setting the required standard of treatment planning in your practice. There should be provision within your treatment planning processes for dealing with changes in treatment needs/wishes and how patients are involved in this process. The operation and monitoring of an effective treatment planning policy will not only serve as evidence of compliance to this CQC outcome but will also count towards compliance with the outcomes we have already covered in this series (1, 2 and 3).
Educating your patients about their treatment needs is paramount you must make sure that you have made every effort to support their decisions regarding treatment, this could include discussions, providing further information and resources or even offering alternative option where appropriate. It is important that patients are made aware of the consequences of foregoing a particular treatment.
All care provided should be done so in line with the appropriate clinical guidance for example demonstrating your compliance with NICE recall guidelines would be considered evidence of this. This can be done by having a Recall policy detailing the criteria for recall selection and subsequent recall interval audit to monitor the operation of this policy.
All assessments and treatment planning processes should be operated in line with your practices equality and diversity policy to ensure people are protected from unlawful discrimination.
Having the above processes in place will reduce the risk of patients receiving unsafe or inappropriate treatment. By carrying out a detailed assessment you will be obtaining all the relevant information to ensure your treatment recommendations are the most appropriate course of action to address the patients individual needs.
This outcome also requires practices to plan for any foreseeable emergency situations. To do so you must be aware of what risks exist in your practice, this will be covered in much greater detail in Outcomes 8-10 but in brief you will need to:
· Carry out risk assessments and reflect on the findings
· Show evidence that you have learned from adverse events, incidents, errors and near misses
· Evidence that you operate a being open policy with regards to patient care, if there an error, incident or adverse event has occurred in the course of patient care that has caused or may cause harm, you should offer a full explanation and the appropriate apology.
· Take notice and actions in relation to relevant safety alerts
When planning for foreseeable emergencies it is necessary to think about what could go wrong and how can we minimise the effects of such emergency. For example we all undertake annual medical emergency training (or at least I hope everyone does) and we put into practice what we learn. We keep the appropriate emergency drugs and equipment and know how to identify different conditions and how to provide immediate and potentially life saving treatment before medical help arrives, this is an example of planning for a foreseeable emergency.
Other types of foreseeable emergencies might include fire or major equipment failure, things that may put your surgery/practice out of commission for some time. How do you ensure patients are provided with safe care and treatment and continuity of care during this time? A detailed business continuity plan will help you put plans in place for these situations as well as many others and it is a necessity to achieve full compliance. Once you have a plan it is essential everyone knows about it and what role they play.
Of course the key to all of the above is implementation, team training, monitoring and review. Make sure your team understand all your policies and procedures and are knowledgeable about what their individual role in each process is.
Set up systems for monitoring everything that you put in place for example a record keeping audit will help highlight the effectiveness of a treatment planning policy.
It is important to review the effectiveness of your policies and procedures to make sure you are using the most up to date methods and guidance.
You will now start to see that many of the CQC outcomes are inter-linked in many ways and evidence you have started collecting for earlier outcomes will also serve as evidence for this and others too.
If you’d like to know more about how Practice Perfection can help you with CQC compliance please get in touch at email@example.com or call 07703627873
We all send out recalls, traditionally by letter but hopefully now most practices have embraced modern methods of communication such as SMS and email, but what happens next?
Do you send out your recalls, sit back and hope for the best or are you proactively working to convert those reminders into appointments?
The first step in an effective recall system is encourage the patient to book an appointment before they leave the building, however I hear 2 main objections to this, these are as follows:
· The patient does not have their diary, its too far ahead for them to plan for it
· They book but then we get loads of late cancellations and FTA’s causing lost time in our appointment book
I believe the answer to the above objections lies within the communication skills of your team. If your team can effectively communicate and answer these objections with an effective response usually its problem solved! Role play and scripting is a great way to get your front of house team to communicate effectively with your patients. They will learn what to say, how to say it and to feel comfortable handling any objections.
You will however always get those patients who do not want to book their next appointment too far in advance and will always prefer to be sent ‘a reminder’ closer to the time. So how do you make sure that each and everyone of those people books an appointment when that time comes?
The second step in an effective recall system is the wording of your communication, whether by letter, SMS or email, the message should be the same. Keep it short and to the point with a direct call to action. For email reminders I recommend giving the patient the option to request an appointment by reply, this saves them the time and effort of calling you directly. It is very effective and very simple to do. All too often I see recall letters/emails that are so long winded and give the patient a full lecture about the importance of regular dental care- this is not necessary, the patient is unlikely to read it and it distracts them from the call to action ‘BOOK AN APPOINTMENT’.
Recalls are a great marketing tool, whether you attach a flyer, a link to a webpage or social media site you can very simply get a marketing message out to your most captive audience and best of all its usually FREE!
So you’ve sent out recalls, some people have booked their appointment but others still haven’t been in touch, what now?
The final stage in an effective recall procedure is Follow Up. I recommend leaving a period of 2 weeks between the first and second reminders, you don’t want to seem pushy but equally you want the reminders to arrive a short interval apart thus keeping you in the patients mind. The second reminder should be very informal, reminding them that they are due to see you and telling them the ways in which they can book an appointment.
If after a further 4 weeks the patient has not been in touch we make a courtesy phone call. Now here the communication skills really are the key to success. We don’t want the patient to feel like we are harassing them into booking an appointment and that is not your aim. Your aim is to make the patient feel like we are offering a wonderful service, we’re worried that we’d not heard from them and we wanted to make sure everything is alright. Often patients ignore recall reminders for the following reasons:
· They can’t afford treatment right now
· They have not had previously recommended treatment and are worried about the consequences
· They are scared
· They (or a loved one) is in ill-health
· They have more important things going on- marriage, divorce, travel, change in career etc
· They have been dissatisfied with previous treatment or service but have not told you
Whatever their reason this call is all about learning what is stopping them from making an appointment and offering up solutions to overcome whatever it is that is holding them back. This is a great way to build relationships with your patients and to really make them feel like you are going the extra mile and often because you have taken the time to call them and listen to their objections and offer up practical solutions you can end the call with an appointment in the book.
If the patient still doesn’t want to go ahead and book their appointment, the best thing you can do is tell them you will amend your records and contact them again in a few months time or a time you agree with the patient. This way you are not repeatedly contacting someone who does not wish to book, keeping them happy and allowing you to concentrate your time and energy on something more productive.
All too often the importance of a recall system is overlooked, practices spend all their time concentrating on converting new patients and promoting cosmetic procedures as a way to increase productivity and ultimately profit however it is important to remember that a robust recall system helps to nurture ongoing patient relationships and help keep the flow of existing patients moving through the practice, generating treatment and income as they pass through. Routine appointments form the ‘bread and butter’ of most practices income and its easy to overlook the value that these appointment bring to your business. According to SOE during their webinar last week the average recall retention rate is 46%, with this system my practice continually achieves a recall retention rate of between 83% - 92% so its definitely worth investing some time and energy getting it right.
If you would like to learn more about improving, creating or implementing a recall system for your practice or help with team training and scripting techniques to improve the effectiveness of your existing system please contact us firstname.lastname@example.org or call 07703627873.
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