Post-Pandemic Planning: Strengthen Patient Relationships, Redefine Practice Goals, Improve Treatment Outcomes

The COVID-19 pandemic is one of the worst catastrophes to befall mankind in decades and may be the costliest disaster to impact the overall dental profession. The damage done to the world economy has been terrible, and the loss of life truly tragic. Now, after sitting mostly idle for roughly one quarter of the year, dental practices are being called upon to dramatically pirouette and begin the task of starting operations all over again.

While such acrobatics will be challenging for most practices, the pandemic may offer an opportunity for reassessment. First, it may give us a chance to reassess ourselves, our interactions with others, and our places in the world as sentient beings. Hopefully, the result will be a new appreciation of life. Second, it may provide us the opportunity to reexamine our professional lives. This is a chance for clinicians to strengthen their relationships with their patients, redefine the goals of the private practice, and improve both patient experiences and treatment outcomes.

Communication with patients during this time is critical. All communications with patients should be informative and have a comforting tone. They should let patients know that the doctor(s) are always available to speak with, and that front desk team members are ready to answer non-emergency questions. Throughout the course of this pandemic, the author's practice has categorized past, present, and future emails as those that addressed immediate needs, those that provide continuing reassurance, those that explain the pre-reopening process, and those that discuss the post-reopening phase.

After closing our practice for all but emergency procedures, emails were immediately sent to all of the practice's patients explaining that the office staff, including doctors, were reachable at all times to answer questions. Patients were informed that the practice would expeditiously see and treat any patients with emergencies such as pain, infection, fractured teeth, and so on.

At the same time, we sent emails to our referring partners, other dentists in the area, and physicians, letting them know that we were available and would see their patients at any time.

During the pandemic, as people became increasingly alarmed and worried, emails were sent to all patients every 7 to 10 days. These emails began by acknowledging our shared plight and attempted to counteract some of the more reactionary concerns that people were expressing either online or via phone calls. Overall, we reinforced the fact that the dental team was at the practice ready to respond should they need us, and we ended the correspondences on hopeful notes. We also reaffirmed to our referring dentists that we were available to see their patients for emergencies.

A communication was sent out 10 days in advance of "opening day" outlining the precautions that the practice would be taking to protect patients and their families, team members, and dentists. The letter outlined the protocols the practice would be following and set a positive, hopeful tone, which is indicative of all of our communications.

Here are the highlights of the "pre-opening" letter:

Subject line: "Reopening and Keeping You Safe"

Introductory paragraph: This paragraph should begin with "Dear Patient" and let patients know it will soon be time to seek the dental care they need to maximize their oral health. Identify the date of the planned opening based on what your state governor or the state dental society has announced, and tell patients that the practice will be taking numerous steps to ensure maximum safety for all parties. Let it be known that all clinical and administrative team members will be following appropriate protocols and procedures under the guidance of the agency(ies) or dental organization(s) from which the practice receives direction, and that the practice will be adhering to guidelines for the reopening of dental practices.

Emphasis on safety: Reiterate that the safety of patients and team members is the practice's top priority, and that the practice has long maintained impeccable infection control practices during dental procedures and high levels of cleanliness throughout the offices. Reassure patients that common safety practices are already in place, such as: use of sterile surgical gloves, disposable gowns, surgical masks, and shields during dental procedures; thorough cleaning of surfaces in patient rooms with disinfecting wipes to kill viruses and bacteria; frequent disinfection of commonly touched surfaces (eg, front desk area, pens, reception room seating, etc.); ready availability of hand sanitizer and antibacterial soap throughout the office for patient and team use.

New and updated protocols: Delineate some of the key changes and updates that the practice will be putting in place. These may include the following:

• All team members will wear masks in all areas of the office.
• All surfaces in the lobby and reception area, including chairs, counters, etc., will be wiped down after every patient. 
• All patients will be prescreened on the telephone when their appointments are confirmed. Any patient who has a fever or who has been exposed in the past 3 weeks to anyone who has tested positive for COVID-19 will be rescheduled for a later date.
• Questions regarding insurance coverage, timing of follow-up appointments, or other concerns will be answered on the telephone prior to the appointment, so as to minimize patients having to stop at the front desk.
• Follow-up appointments will be scheduled on the telephone.
• All patients will be asked to fill out necessary paperwork online prior to their scheduled appointment. If patients do not fill out their paperwork in advance, they will be given the paperwork in the lobby of the office and asked to fill it out in their car.
• All patients entering the building will be met in the lobby. If there is no lobby, the patient should be met at the door before they enter the office. At that time, their temperature will be taken and their COVID-19 contact history will be reviewed. Any patient with a fever or positive COVID-19 contact history will be rescheduled for a later date without having entered the office.
• Patients entering the lobby with protective gloves will be asked to discard them in a receptacle in the lobby and will be given new gloves if they so desire. 
• No patients or anyone else will be allowed to remain in the lobby or enter the office without a facemask.
• Spouses, friends, or anyone accompanying patients to their appointments will be asked to remain in their cars unless the patient is a minor or requires physical assistance.
• Patients will be brought to the treatment rooms as expeditiously as possible to limit any gatherings in the reception area.
• Treatment rooms will be rotated to allow ample time for extra wiping down and cleaning. 
• Teledentistry and video conferencing will be used to make treatment easier for patients and reduce the number of times they need to come to the office. Consultation and emergency patients will be able to speak with the dental team via teleconferencing prior to their appointments to ask questions and discuss their needs. In some cases, this may circumvent the necessity of a consultation visit. Many postoperative visits after surgery can be conducted through teleconferencing, which can include examination of a digital photograph(s) of the treated area sent by the patient.
• Payments for treatment will be made either by providing credit card information to the administrative team via telephone, scanning a credit card at the front desk in a touchless procedure, using a prewritten check, or transferring money with a mobile payment service such as Venmo or Zelle. 

If applicable, inform patients that the practice will be installing state-of-the-art equipment to help eliminate aerosols through air exchange andimprove sterilization practices with ultraviolet (UV) light.

Conclusion: Reaffirm that the practice will be trying to reduce the amount of time patients spend at the front desk or in the reception area as much as possible. Also, reassure them that, while this has been an unsettling ordeal for everyone, the dental practice is willing to work diligently to help everyone get through this together.

(Note: A similar pre-reopening communication was sent to our referring doctors, other dentists, and physicians in the area, documenting the steps we are taking to help ensure everyone's safety.

After reopening has begun in earnest, further communications will be sent to patients reinforcing both the fact that the practice is open and the steps we are taking to keep everyone as safe as possible. These emails will go out at the end of our first week, and monthly thereafter through the year.

Additionally, emails will be sent throughout the year to our referring dentists, non-referring dentists, and physicians in the area, both outlining the above and discussing the potentially expanded applicability of therapies dentists can perform to help address patients' stress levels and sleep problems, which may be increased due to the pandemic. Comprehensive practitioners should be able to offer such services, whether they deliver therapies themselves or refer patients to practitioners more experienced in these areas.

At this time, dental practices need vision-not one that merely gets the practice back to where it was. Rather, it must be a vision that redefines a "normal" clinical practice-a transformational vision that includes the entire dental team. Successful practices in the future will demonstrate many of the characteristics of a meritocracy, not an aristocracy.

Team members, especially hygienists and assistants, are understandably concerned. Many are worried about their safety and health. The issue of safety is readily addressed through establishment of appropriate protocols, provision of effective personal protective equipment (PPE) to everyone, and installation of necessary infection control equipment. Our practice, for instance, is installing lights in each operatory that utilize UV and efficient air exchange to help kill and remove airborne viruses and bacteria while still providing illumination. These light units are identical to those found in many hospitals and fit easily into a fluorescent light panel. State-of-the-art air exchange systems are being installed in key locations in the office for the protection of everyone. These small, relatively inexpensive units are available from a company that has developed technologies used by NASA.

Despite these procedural and technological advances, the underlying challenge is one of trust. Dentists must communicate the steps they are taking to keep the team safe, and demonstrate that they legitimately care about the health and well being of every team member. The bond of trust between doctors and team members is the sine qua non of a comfortable and productive working relationship.

The task of reopening can feel overwhelming; it seems there is so much to do to protect everyone from COVID before reopening, and there are ongoing financial concerns about the business. Combining an honest assessment of your situation and innovative approaches, practitioners can make this is an opportunity to recalibrate the practice and improve efficiency. The following suggestions may help dental practices move forward:

• Assess your team members' duties and make modifications as needed for efficiency; this needs to be done carefully without overtaxing them or sacrificing quality of care.
• Evaluate patient needs and rebuild your team gradually, as needed.
• Improve sterility procedures and overall safety, implementing strategies suggested above.
• Fully integrate teledentistry in to your practice. This can help increase practice efficiency, lessen the number of in-person office visits, increase case acceptance rates, positively impact patient safety, and improve treatment outcomes.
• Spend more time with patients you see, do more through examinations (including carefully listening), formulate more complete diagnoses and treatment plans, and perform truly comprehensive care.  
• Become more involved in the patient's overall health; be a doctor among the patient's team of doctors. 

Simply returning to the way your practice was before will not be good enough. Take advantage of this unusual opportunity to transform your mission, your practice, and your life.

ABOUT THE AUTHOR
Paul Fugazzotto, DDS
Co-founder, DMD Consortium; Private Practice, Milton, Massachusetts