The aim of audit is to use your results to improve efficiency and therefore your bottom line, and to make the working life of you and your staff better. To do so, have the results of your audit ready to present to your next practice meeting, or if you work for one of the Bodies Corporate to their management.
The long term aims of audit and any necessary management action can be:
- Saving time and money
- Reducing stress
- Improving your working environment
- Increasing turnover
- Reducing staff turnover
- Reducing patient complaints
- Justifying expenditure on better materials and new equipment
- Improving the overall quality of your dental care
- Maintaining and developing patient confidence
You could also post your results on the practice website to show your patients that you are really looking to enhance the quality of their experience at your practice. But be prepared, the results of your audit may not be what you expect. If you have met your standard
- Was it set too low?
- Can you maintain that standard?
- Should you improve the standard?
If you have not met your standard
- Was it set at too high a level?
- Should you re-determine your standard and re-audit – the easy option?
- Should you changes practices before re-auditing – the hard option?
I suggest you consider your audit results in a different way, both for internal factors in you practice which you can change and external factors which are imposed on you.
Internal factors include, clinical techniques and lost clinical time, direct and opportunity costs (see Effectiveness and efficiency) staffing, your training, equipment, materials, time management and complaints.
External factors include, Education and training, National Dental Health Strategies, research and new products and techniques, peer review, and lastly but not least CQC.
I suggest that you do not look at your audit results purely from the perpective of dentistry, but carry out a detailed business analysis of what went wrong not just what went right.
Let’s look in detail at perhaps the most common audit carried out, reviewing the quality and usability of intra-oral radiographs. The standard says 90 per cent should be clinically useable first time. You have 91 per cent, so you can rest on your laurels and do nothing until your next audit. I suggest not! I was always taught that you improve your performance by eliminating the things that went wrong, in this case the 9 per cent and consider just what this error rate has really cost us.
Investigate and detail the errors.
Was it positioning of the film? If all 9 per cent failures were do to this then you really have to invest in a set of film holders. Too expensive I hear you say, but consider the time you have lost retaking radiographs, the cost of the films themselves, processing chemicals, your nurse’s time processing and your time waiting around for the result. Remember opportunity costs. Time lost is always at least double your hourly charge out rate (See Effectiveness and Efficiency).
Was it a failure of processing if you are still using a wet system? I well remember feedback at one of our audit courses where colleagues, who were working for a body corporate had reported about 40 per cent of radiographs were being ruined in an automatic processor. Their request for a replacement had been turned down by management. However, using the cost of films, materials and staff and their own time, they were able to show using opportunity cost business principles just how much money was being lost to the organisation from this one source. The story had a very happy ending and they soon had their new processor.
Do you have to share an xray machine with other colleagues in your practice? How much time are you spending walking to the machine, waiting your turn, and walking back. If your radiographs are for endodontics and you do not use rubber dam routinely, how can you be sure the canal has not become contaminated? If it is treatment time will at least double and the prognosis fall, so think about how much time you would need to spend rectifying that situation and the cost to use.
Are you using digital processing? The results are virtually instantaneous when compared with wet processing. Think of the time you will save during endodontics alone when you want to check the diagnostic length, pre-cementation and post-cementation positions of the GP point.
Does your practice take radiographs of patients for processing later on in the day, with your patients asked to return for another appointment to discuss the results. How much time are you really wasting? Consider what you might want if you were the patient. You want an early diagnosis, not waiting around for however long it is to your next free space. What if they do not return?
It follows that, using a detailed analysis along the lines described you should not just put audit results away, as a tick in a box, but carry out a detailed analysis of your failures, remakes, number of denture eases etc. What are your current practices really costing you? When you analyse the result you may well have a shock!
Remember opportunity costs and the double jeopardy of lost professional time.
You can also use audit results to support business development plans, borrowing to improve efficiency, staff development and training and staff satisfaction with their work.
After all, nobody likes to fail, and in the current environment of recovery from a long and deep recession, efficiency savings in general dental practice are well work the time spent. Obtain the information through audit, then use it to benefit you, your patients and your practice.