It’s been several decades since dentistry faced a challenge like COVID-19. Moving forward, our focus must include a devoted adherence to new guidelines and protocols…embracing an entirely new approach to safety in the dental practice.
For centuries, dental patients have worried primarily about comfort, and dental teams have worried about efficiency and productivity. So practitioners put enormous effort into addressing clinical issues like pain control, and environmental factors like creating a welcoming—even spa-like—atmosphere that puts patients at ease. But, in only a few weeks, COVID-19 has turned our focus from comfort and efficiency to safety.
For clinicians, creating a safe environment has meant strict application of the Universal Protocols that prevent patient-to-patient transmission. Those efforts have been remarkably effective; since the introduction of upgraded infection control processes in the 1990s, dental practices have never been implicated in the large-scale transmission of disease. But the introduction of airborne pathogens into the dental setting has changed the game—and not just for patients. Clinicians are now worried about the potential risk to their own health.
Clearly, now is not the time for simply creating new checklists and ticking off the safety boxes one-by-one before moving on. It's a time for rethinking how we approach safety in dental practices worldwide. If that doesn't happen, more patients will put their dental treatment on hold indefinitely—and more clinicians and team members might decide now is a good time to retire, or find a new profession.
It doesn't have to be that way. I believe the answer is to create a safety culture that addresses new realities, because a culture serves as a compass to guide all stakeholders: patients, staff, and you. A culture also unites people behind shared values, goals, and aspirations. Cultures grow, change, and evolve as the people and events around them change. If everyone who sets foot in your dental practice is invested in this culture, they'll gladly assume their share of responsibility. Execute it right, and everyone's attitudes, perceptions and behaviors will adapt in meaningful ways that will benefit dentistry now, and for years to come.
So where do we begin?
First, cultures need leadership; yours will too. It's important because leaders don't merely provide guidance, they're also visible. Patients and team members need to clearly see that someone has taken ownership of oversight, know who that is, and is able to communicate.
Start by appointing one person as the official Safety Czar, charged with monitoring and maintaining a safety culture. The Safety Czar doesn't have to be a dentist. Depending on your practice, it may even be better if that person is not a dentist, since you're already leading so many other things. The Safety Czar can be anyone in the practice with the skills and drive for building a safety culture. That person is also not the sole leader. Other leaders can, will, and should emerge to offer individual expertise and support. However, the Safety Czar is the practice’s #1 commander for all things safety.
In the anxious and uncertain days ahead, creating a safety culture requires empowering every employee to take ownership. That's why you need to create an “Andon Cord” for your practice. Decades ago, Toyota invented the Andon Cord—as a physical cord that employees pulled to immediately halt the production line if an employee detected a safety or quality issue.
Obviously, you won’t need an actual rope in your practice. But you will need a process—as simple as verbally informing the Safety Czar of a possible problem—that rapidly triggers a full stop in the practice when the safety problem is identified and until it is rectified. That's a confidence-inspiring show of your commitment to staff and patients, and a necessity in the current environment. That way everyone shows up at work with the full expectation that they never have to be in a situation where they feel at risk.
One last thing about installing your own Andon Cord: you must make it clear that every staff member is encouraged to “pull” it anytime, without any Monday morning quarterbacking. Don’t be concerned that staff members will overuse it. When staff members feel trusted to take part in safety assurance, it enriches your culture and encourages everyone to own the task of creating a safe environment—and you’ll benefit by ensuring your practice is safe.
As part of your safety culture, get the entire team involved in the other decisions you're making to address COVID-19. For instance, should you reconfigure your reception area? Remember, patients are more concerned about safety than comfort now. But safety is the “new” comfort: a sense of safety will make patients more comfortable than a coffee station or comfy furniture will.
If you're planning on keeping your reception area, there are some things to consider beyond social distancing. Any item that can't be wiped down with disinfectant should probably go into storage, at least temporarily. A fabric sofa, for instance, could be replaced with vinyl-upholstered chairs. Some of today's options even have antimicrobial properties. A wooden coffee table should probably be replaced with something topped with laminate or glass. Durability is key because you're no longer just dusting and vacuuming, but wiping down several times a day at least. Make sure everything looks clean too. Choose products that will hold up, not show any soil, and be easy to clean without a lot of nooks and crannies. Basically, the safest course of action is to buy healthcare-quality furniture.
Certainly, there are ways around using a reception area entirely, but there are also ways to address staff members’ safety if you want to retain the feel of a reception area with few or no people. For example, the people who normally staff your front desk could be relocated and you could communicate with patients via tablets set up for videoconferencing. This way, you retain the familiarity of the traditional check-in and checkout process, but in a way that clearly demonstrates it has been reimagined as part of your practice's safety culture. While you're at it, switch to disposable pencils or pens. Add hand sanitizer or a hand washing station. Obviously, eliminate magazines.
Your safety culture also needs to address how you arrive for work and depart. The days of wearing scrubs to the office are over, at least for now. Clearly implement a clothing policy in which every team member changes into scrubs in a designated room in the office, with a uniform service or washer/dryer. And you’ll probably need accommodations like benches and lockers, and rules around how many people are allowed in at a time. To a large extent, your Safety Czar can make those decisions based on feedback from your team, and then adjust as necessary.
When the workday begins, we typically focus on efficiency. That needs to change starting with your morning huddle. For as long as our heightened protocol lasts, your morning huddle should focus as much on safety as production, and then how to meet reasonable production goals safely. The Safety Czar and you should have a plan in place to adjust how you're using treatment areas, how much time is needed to change over rooms between appointments, whether barriers need to be erected, disinfection protocols and so on. Every office is different, so you should figure out in advance how much pre-planning is required.
While you're working, everyone should be mindful that the perception of safety is as important as safety itself. Everyone should wash their hands frequently and be seen doing so. Keep your hands in your pockets, at least until you get out of the habit of shaking hands or touching objects unnecessarily. Map patient flow and add signage to limit patient interaction, and be sure you adhere to it.
Guidelines for treating patients continue to evolve, and that's the subject for a separate article. Your safety culture right now needs whatever your team feels is reasonable to achieve a high level of confidence. That probably means wiping down packages as they arrive, hiring a deep-cleaning service, and increasing team training on topics like set-up/tear-down of operatories and proper suction techniques—and remember to make the conversations ongoing.
Proper personal protective equipment (PPE) is key to your safety culture. While our knowledge of PPE continues to evolve, we do know one thing: you need to be sure to purchase genuine product from trusted suppliers to ensure you don’t get counterfeit or gray-market product. Just because the box says “3M N95” doesn't mean the product meets the rigorous standards required to ensure your safety. Today, buying genuine product isn’t optional; it’s a decision with life-or-death consequences. Now is no time to take chances. When you buy from an approved dealer, you’ll get product that’s been properly manufactured, transported, stored, and shipped. Safe products are at the core of a successful safety culture.
At least until there’s a cure or vaccine for COVID-19, safety will be a concern of every patient and team member. Be sure that your practice develops a safety culture, starting with a Safety Czar. Your health, and the health of your patients and teammates, depends on it.
Charles Cohen is managing director and third-generation owner of Benco Dental Company, the nation's largest independently owned dental distributor. Founded in 1930 by Benjamin Cohen, Benco serves over 25,000 dental offices and dental laboratories across the United States. The company is based in Northeastern Pennsylvania with locations in 40 states.