The Safety Net Dental Clinic Manual
Presented to the National Primary Oral
Health Conference
November 3, 2009
John F. Neale, DDS, MPH
www.dentalclinicmanual.com
This manual was a collaboration among the
Ohio Department of Health
The Indian Health Service
And The Association of State and Territorial Dental
Directors
The website is hosted by the National Maternal &
Child Oral Health Resource Center
Dr. Mark Siegal served as project director.
Ms. Beverly Isman was primary editor and project
manager.
The primary authors of the manual are:
Dr. John F. Neale,
Dr. R. Frank Martin,
Dr. Jay Balzer,
Dr. Mark Siegal,
Ms. Cathy Raymond, and
Ms. Beverly Isman.
The development of this manual was supported by the
federal Maternal and Child Health Bureau, Health
Services and Resources Administration, through
Ohio's Title V Maternal and Child Health (MCH)
Services Block Grant (Grant Number: 6 B04 MC
00312-06 Q4) and Community Integrated Services
Systems Grants (Grant Numbers: 5 H47 MC 0001103-01 and 6 H47 MC 00011-04-01) as well as through
a cooperative agreement with the Association of
State and Territorial Dental Directors (Contract
Number: 5U93 MC 0017703).
The Manual is currently set up as a series of
questions and answers. Simply click on
the question in the left hand column, and
the information will come up in the center
of the screen. Links to additional
information are provided and are updated
several times each year.
Chapter 1, Partnerships and Planning
This chapter discusses two phases for
establishing a safety net dental clinic:
– Building Partnerships/gaining support, and
– Strategic Planning
Section 1, Building Partnerships/Gaining
Support
• How do I start building partnerships?
• How do I describe the problem to convince
potential partners of the need?
• Who are potential Partners?
• How do I gain support from potential
partners?
• How do we establish a task force?
Section II, Planning
• What kind of planning is necessary?
• How will the clinic’s mission and goals affect
access and financial sustainability?
• How do we assess the need for a clinic?
• How do we decide if a clinic is feasible?
• Whom do we want to serve?
• What level of service do we want to provide?
• What role can volunteers play?
Section II, Planning, cont.
• Should we apply for a Federal Dental Health
Professional Shortage Area (HSPA)
designation?
• Is a fixed dental health facility what we need?
• What agency or organization will own and
operate the clinic?
• How do we become a private, non-profit
organization?
• How is facility location determined?
• What’s the bottom line – clinic or no clinic?
• What are the alternatives to a clinic?
Chapter Two
Facilities and Staffing
Chapter 2 provides vital information for
organizations that have determined a need
for a fixed dental clinic facility to best serve
their target population.
Sections of Chapter Two
• Facility Design and Construction
• Equipment and Supplies
• Staffing
Section I. Facility Design and Construction
• What are basic costs for a fixed dental clinic, a
mobile clinic, and a clinic using portable
equipment?
• What should be considered when selecting a
location for a fixed clinic facility?
• What factors should determine the size of the
dental clinic?
Section I. Facility Design and Construction,
cont.
• How much space (square footage) will a clinic
require?
• How should we prepare for the clinic
construction?
• What are the key design principles that we
should incorporate into a fixed clinic?
• What are the design options and floor plans for a
fixed dental clinic?
Section I. Facility Design and Construction,
cont.
• How should operatories be separated?
• How is a dental operatory laid out?
• What rules and regulations do we need to
consider in facility design?
• What are clinic construction specifications?
Section I. Facility Design and Construction,
cont.
• What does it cost to construct/remodel a fixed
dental clinic (interactive spreadsheet)?
• What are "ergonomics" and how does it affect
the construction of a dental clinic?
• What are the design considerations for mobile
and portable clinics?
Section II. Equipment and Supplies
• What are the different delivery systems for
dental care?
• What are considerations for selecting major
dental equipment?
• Should used dental equipment be considered?
Section II. Equipment and Supplies, cont.
• What are some computer system
considerations?
• What supplies, instruments and small equipment
are needed for a dental clinic?
• What is needed for building and equipment
maintenance and repair?
Section III. Staffing
• What is a required staffing size and mix for
clinical care?
• What is the value of hiring experienced dental
staff?
Chapter 3
Finances
• Financial Feasibility - Getting to the
“Bottom Line”
• Managing Clinic Finances
• Grants and Fundraising
Section I, Financial Feasibility--Getting to
the “Bottom Line”
• Can we predict if the dental clinic we have
planned will be sustainable?
– Interactive Budget Planning Worksheet
Section I, Financial Feasibility, cont.
• What does it mean for our clinic to “achieve
balance?”
• How do we estimate clinic revenue from all
sources?
• What are sources of patient care revenue (e.g.,
Medicaid, SCHIP)?
Section I, Financial Feasibility, cont.
•
•
•
•
How should we estimate patient care revenue?
What factors affect patient care revenue?
How do we determine patient charges?
How do we establish a non-discounted (full) fee
schedule?
Section I, Financial Feasibility, cont.
• How do we establish a sliding fee schedule
(SFS)?
• How do we implement the SFS?
• How can we use payer mix to increase patient
care revenue?
• What do we need to know about the Medicaid
and State Children’s health insurance (SCHIP)
Programs?
Section I, Financial Feasibility, cont.
• What should we consider before entering into a
contract to provide dental care?
• What are other sources of revenue besides
patient care?
• How do we estimate clinic expenses?
• How do we establish reasonable and
competitive salary and fringe benefit packages?
Section I, Financial Feasibility, cont.
• What are typical fringe benefits?
• How can the use of volunteers reduce
expenses?
• How can we lower dental equipment and supply
costs?
• What are lab fees and how can we manage
them?
Section I, Financial Feasibility, cont.
• How do we estimate administrative
expenses?
• What are fundraising expenses?
Section II, Managing Clinic Finances
• Where can we get expert assistance in the
financial management of our clinic?
• What do we need to know about developing a
budget?
• What role do financial reports have in program
planning and management?
• How do we assess financial sustainability?
Section II, Managing Clinic Finances, cont.
• How can a business plan benefit our clinic?
• How can I learn more about non-profit
organization budget planning and management?
• What is an independent audit and why is it
necessary?
Section III, Grants and Fundraising
• What is the difference between a grant and a
contract?
• What are different types of grants?
• Who provides grant funding?
• How do we start our search for grant
opportunities?
Section III, Grants and Fundraising, cont.
• How can we learn more about foundations?
• What are some examples of corporate funding?
• How can we access funding from state and local
government?
• How do we find out about federal funding
opportunities?
Section III, Grants and Fundraising, cont.
• What do we need to know to write a grant
proposal?
• What should we know about grants?
management if a proposal is funded?
• How do we develop a fundraising plan?
Chapter 4, Clinic Operations
This chapter covers the management and
operations of a safety net dental clinic.
Sections of Chapter 4
•
•
•
•
•
•
Policies and Procedures Manual
Personnel/Human Resources
Malpractice, Risk Management, and Insurance
Health Records
Purchasing and Inventory Management
Patient Scheduling and Consent for Care
Sections of Chapter 4, cont.
• Billing and Collections
• Infection Control, Environmental Health and
Safety
• Clinical and Prevention Information Resources
• Dental Office Technology
Section I. Policies & Procedures Manual
• What is a Policy and Procedures Manual?
• What policies and procedures should be in place
when the clinic opens?
• What format should be used for policies and
procedures?
• What topics should be covered in the P&P
manual?
Section I. Policies & Procedures Manual
• What are Practice Guidelines or Clinical
Protocols?
• What is a “time-out” policy and does the clinic
need one?
• Does the clinic need policies and procedures
covering surgical removal of teeth or other hard
tissues?
Section II. Personnel/Human Resources
• Should we develop an employee/staff
handbook?
• What are professional standards of conduct?
• What are Position Descriptions?
• How do salaried employees differ from
contractors and volunteers?
• How can we recruit staff for our clinic?
Section II. Personnel/Human Resources
• What do we need to know about interviewing
potential employees?
• What do the terms credentialing and privileging
mean?
• What is the National Practitioner Data Bank?
• How should we orient new staff?
• What are some strategies for staff retention?
Section II. Personnel/Human Resources,
cont.
• How can we offer training and continuing dental
education?
• What laws relate to disciplining or terminating
employees?
• Where can we find information on state dental
laws, rules and regulations, dental boards, and
licensing requirements?
Section III. Malpractice, Risk Management,
and Insurance
• Why is malpractice insurance important to the
clinic?
• What is risk management?
• What are incident reports and how are they
used?
• What kinds of insurance are needed for a dental
clinic?
Section IV. Health Records
•
•
•
•
Why does a dental clinic need health records?
What clinic forms do we need?
What should the record contain and not contain?
Why is confidentiality of health records
important?
• What is HIPAA?
• How do we handle health records in special
circumstances?
• Is there a web-based resource for dental
charting abbreviations and terminology?
Section V. Purchasing and Inventory
Management
• Who should be responsible for purchasing
supplies?
• Do we need a system to purchase and stock
supplies?
• How can we track and manage inventory?
• Where can we purchase dental supplies?
• Should we stock and dispense medications?
Section VI. Patient Scheduling and Consent
for Care
• What is an appointment system?
• How should appointments be scheduled?
• How far in advance should we schedule
appointments?
• How do we handle broken appointments?
• How do we manage dental emergencies using
an appointment system?
Section VI. Patient Scheduling and Consent
for Care, cont.
• What should we do to avoid wrongful termination
or abandonment?
• What is a preventive recall program?
• How do we manage continuum of care?
• What are patients rights and responsibilities?
• What is informed consent?
Section VI. Patient Scheduling and Consent
for Care, cont.
• What are policies and procedures around
informed consent?
• How do we obtain consent for minors?
• Can patient consent be withdrawn?
• What is informed refusal?
• Do we need written follow-up instructions for
patients?
Section VII. Billing and Collections
• How do we set up a billing and collections
system?
• What is a superbill, charge slip, or encounter
form?
• Who needs to be involved in the billing and
collections process?
Section VIII. Infection Control,
Environmental Health and Safety
• What is infection control, and how is it
regulated?
• What regulations govern hazardous materials
used in dentistry?
• How should the dental clinic handle mercury?
• Are there standards for using nitrous oxide?
• What standards cover radiation health and
safety, including x-rays?
Section VIII. Infection Control,
Environmental Health and Safety, cont.
• What guidelines are available for dental
radiology?
• How are work related accident reports handled?
• How should the clinic prepare for medical
emergencies?
• How should the clinic handle compliance with
Life Safety Codes?
Section VIII. Infection Control,
Environmental Health and Safety, cont.
• What should the clinic do for emergency
preparedness?
• How should clinic security be handled?
• What are some other clinic safety issues and
resources?
Section IX. Clinical and Prevention
Information Resources
• What are some good sources of dental, medical,
and pharmaceutical information?
• Where can we find information about treating
patients with compromising medical conditions?
• Where can we find information about clinical and
community-based prevention strategies?
• Where can we find information about clinical
diagnosis and clinical technique?
Section IX. Clinical and Prevention
Information Resources, cont.
• What are some sources of information about
behavior management of the fearful or
apprehensive patient, including the use of
restraints?
• What is conscious sedation and when should it
be used as a form of behavior management?
• Where can information be found an the
treatment of patients with disabilities or other
special health care needs?
Section X. Dental Office Technology
• What is dental office technology?
• What are information systems and information
management?
• What considerations are important in computer
hardware and software selection?
• What is technology integration?
• Should our clinic consider using digital
radiography?
Section IX. Dental Office Technology, cont.
• Should the clinic consider purchasing a
DIAGNOdent® to diagnose dental decay?
• Should we consider purchasing an intraoral
camera?
• What is air abrasion and should we be using it in
our clinic?
• Is a dental laser needed to perform quality
dentistry?
Chapter Five
Quality Assurance/Quality Improvement
Sections of Chapter Five
• Quality Assurance, Quality Control, and Quality
Improvement Defined
• Accreditation
• QA/I in the Dental Clinic
• An in-depth look at QA/I in healthcare
Section I. Quality Assurance, Quality
Control, and Quality Improvement Defined
•
•
•
•
•
How is Quality defined?
What is Quality Assurance (QA)?
What is Quality Improvement (QI)?
What is Quality Control (QC)?
Which approach should your clinic adopt?
Section II. Accreditation
• What is accreditation, and who are The
Joint Commission and AAAHC?
• Is accreditation appropriate for our clinic?
Section III. QA/I in the Dental Clinic
• How do we apply QA/I principles in our clinic?
• Why and how should we assess the quality of
the clinic’s administrative functions?
• Do we need patient satisfaction surveys?
• Do we need staff satisfaction surveys?
• How can we measure clinical quality?
• What is peer review and how is it done?
Section III. QA/I in the Dental Clinic, cont.
• How can we tell if the clinic is meeting the
community’s needs and our mission?
• How should productivity be measured, and how
is it part of the QA/I program?
• What are some practical applications of these
concepts?
• What quality control activities should the clinic
perform?
• What should we do with the results of our QA/I
activities?
Section IV. An In-depth Look at QA/I in
Healthcare
• What is the Quality Improvement process
(PDCA cycle)?
• How should we collect data for the QI process?
• How do we analyze the data we collect?
• What are some specific ways to share the
results of QA/I activities?
• How do we develop, administer, and analyze a
patient satisfaction survey?
What’s New and What’s Coming?
• New partnerships to improve and increase
the utility of the Manual
– NNOHA
– DentaQuest Institute’s Safety Net
Solutions
What’s New and What’s Coming?
• Links among the following:
– Safety Net Manual,
– Mobile/Portable manual,
– NNOHA’s Practice Management Resources,
– Ohio Dental Safety Net Information Center
What’s New and What’s Coming?
• Re-write of the financial sections of
Chapter 3 with improved interactive tools,
flowcharts and spreadsheets
• New Chapter 6, to be titled “Clinic
Sustainability,” based on what has been
learned from the Ohio Oral Health
Capacity Building Project and Safety Net
Solutions
What’s New and What’s Coming?
• Revision and updating of the sections on
computers and practice management
software
What’s New and What’s Coming?
Re-design of the Safety Net Dental Clinic
Manual
– Elimination of “frames” in the layout will allow
easier searching of the website
– Updates and additions will be easier
– Information will be brought closer to the front
rather than being buried, making the site more
user-friendly
Questions?
Suggestions for new or
improved content for the
manual?
Thank You!