Episode 477: “If It’s Not Documented…”

Tiff and Brit are taking over the podcast! Tune in to hear the fabulous consultants talk about why documentation and communication matters. The Dental A-Team rule: If it’s not documented, it didn’t happen. Tiff and Brit break down the inefficiencies that happen when proper notes aren’t recorded and how to keep from going down an inefficiency rabbit hole.

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Transcript:

0:00:05.6 Kiera Dent: Hey everyone, welcome to the Dental A Team Podcast. I'm your host, Kiera Dent. And I had this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants, where we have traveled to over 165 different offices, coaching teams. Yep, we don't just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams grow VIP experiences, reduce stress, and create A teams. Welcome to the Dental A Team Podcast.

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0:00:52.2 Tiff: We are so excited to be here. You guys... You know who this is, Tiff. Or, Kiera likes to call me Tiff Tiff, and it's fine, I love it. And I have Britney here with me, and we're on Zoom again, so I get to see her beautiful face, and I love it so much. [chuckle] Even though most of her face is a microphone, it's fine. Brit, how are you?

0:01:09.9 Britney: I'm doing fantastic. So happy to be here. I always love when I get to see your face. And even if it's over Zoom, I'll take it.

0:01:17.9 Tiff: We're gonna go hiking together, I promise.

0:01:19.6 Britney: We are. It's now hiking weather, so it's gonna happen. And Birdy, my little puppy, will come with us. It'll be great.

0:01:25.8 Tiff: Oh, Birdy. I wanna put her in my pocket.

0:01:28.7 Britney: [chuckle] She makes appearances on Zoom as well.

0:01:31.0 Tiff: That's awesome. I love it. I love it. Okay, so I was picking your brain, and you have a ton of coaching call clients and I freaking... I love it. I love listening to what you talk to them about, they love you, we've gotten the best reviews on your clients with your calls and your in-office visits, and I think it's so rad. So one thing that you're mentioning or that I've seen you mentioning is documentation, [chuckle] and I think this is huge, and I think rolling into a new year, new systems, this is a great thing to talk about. So tell me, because this was your idea, tell me where did this stem from? And why is it so important and on your heart today?

0:02:11.5 Britney: Yeah, I feel like sometimes we just have to kinda come back to basics. These topics come up in a few different scenarios, but I think with offices right communication is something that we can always improve upon, it's something that's a constant work in progress, and we need to make an effort on. And I think, particularly when it comes to being able to communicate between clinical team, front office team, the way we document is so important. And no matter if it's clinical, or phone calls and admin, I stick to the rule of, "If it's not documented, it didn't happen." Right? [chuckle]

0:02:46.5 Tiff: Thanks so much. Yes. And I tell people that all the time, and they just don't believe me, so I'm glad you're backing that up. So tell me, tell me what you mean by that.

0:02:56.9 Britney: Yeah, so what I mean by that is, if I have a conversation with a patient and I don't note anything down to know what we talked about, or what happened, we don't even know, it's like it almost didn't happen, because we don't know what we talked about. If someone from the clinical side looked at my notes from admin, like I don't see that a patient called and asked about anything, like, they never called and asked about it. So it's just one of those things where like, if it is not written down to where someone else can see what we talked about with the patient, it literally is like it didn't happen.

0:03:30.7 Tiff: No, I totally agree. So I think that's a great point that you just made, and I think let's break that down a little bit. So I am efficiency thinker, as it's gonna be on my tombstone one day.

0:03:42.4 Britney: I second that. I agree with it. [chuckle]

0:03:45.5 Tiff: Like, literally, it's my biggest pet peeve in life, inefficiencies is my biggest pet peeve. I think it's because I value time so much, and especially time at home with my family. Right, so I'm like, "If you're wasting my time at work and I'm gonna have to be here longer, I will go insane." So let's break down the inefficiencies [chuckle] that will happen from not having proper notes and things that I've seen or experienced. I think one of the biggest pieces is clinical side, making sure that everything's documented, and I'm gonna help Britney go through what that looks like, but I wanna go through inefficiencies first, so you can see how valuable this is going to be.

0:04:18.4 Tiff: So clinical side, not documenting what happened during an appointment. As a front office team member, I get a phone call and the patient says, "Hey, they mentioned that I was supposed to get a prescription" or, "Hey, I was supposed to leave with a bottle of rinse, and I didn't. I don't know what that is," or, "Hey, [chuckle] my tooth doesn't feel like it was actually filled," and I have no notes to go off of. As a front office team member, I used to get so frustrated because now the inefficiency is I have to get up, put this patient on hold, I have to get up, I have to go pull the provider or the dental assistant from whatever they're doing, I have to jog their memory on the patient, we have to look at the notes together, we have to research, now we probably have to find the doctor to get the actual answer, all the while the patient is sitting on hold and I could have been making at least five re-care phone calls in the middle of this, right? A huge inefficiency there. Flip that from front side. So my front office team, as a standard in all of my offices I've ever worked in, knew that notes were everything. Like Britney said, "If you didn't notate it, it didn't happen." I do not want to get a phone call from a patient, and they're like, "Hey, so and so just left me a voicemail, they said I was supposed to schedule something." Guess what? I could schedule that, if I had the notes.

0:05:37.9 Tiff: I could answer the billing question, if I had the notes. I could answer the... "My tooth doesn't hurt anymore, and I just talked to somebody about it, I really need to tell them." I could do that. I could do all of the things if I had the notes to read. Otherwise, the inefficiency piece, "Okay, great. Let me put you on hold." Okay, number one, nobody likes to be put on hold. Okay, think about it. Think about calling your pharmacy, think about calling your doctor's office, or Delta Airlines, or maybe your credit card company...

0:06:05.5 Britney: Yeah... Delta Dental. [laughter]

0:06:06.8 Tiff: Delta Dental. Like, who loves to be put on hold? Absolutely no one. Right. So let me put you on hold. Let me track down who could have called you, 'cause you probably don't remember the name from your voicemail or your conversation, so let me track down who called you, talked to you, let me figure out... Jog their memory, figure out what they were talking about, why this patient's calling. Come on guys, like it drives me insane, because if I had the little snippet of a note, all I have to do is look at the patient's office journal, or comm log or wherever you choose, which needs to be a consistent space, wherever you choose to put those notes, I can look at it and take care of my patient. It's a better patient experience, and honestly and truly, it's gonna make for a happier team member.

0:06:48.8 Britney: So the next point I was gonna make, Tiff, because as a team member, how does that make you feel when you have to go chase someone down?

0:06:56.4 Tiff: Or be the one that's being chased down. I've been a dental assistant that's pulled out of a room, and I'm like, "What do you mean? This is a ridiculous question, how could you not answer this?" And I'm like, "For the love, doctor is over here, hand me the forceps." I'm like, "I can't. I'm answering this question, [chuckle] you're gonna have to get them yourself." So now this appointment is gonna take a little bit longer, doctor is angry because I'm not in there, he doesn't know where the bond is, and I went, "I don't know what patient you're talking about." It's complete chaos. So I think this is huge. Those are my inefficiencies. That's my tangent. So Britney, let's bring this back around because I'm getting all heated, [chuckle] let's bring this back around. Tell us how...

0:07:33.2 Britney: It's a passion.

0:07:34.0 Tiff: It is. I'm so passionate about it. It drives me insane. So bring us back around, though. Tell us how can we keep from going down those rabbit holes, from finding those holes in spaces of life that bring on these inefficiencies? What can we do better? Yeah.

0:07:50.4 Britney: I think one of the biggest things is always thinking about like, "Okay, when I'm writing my note, what is the next person gonna need to know?" So as a hygienist, if I'm gonna see this patient and say, I've never seen them before, "What information would I want to know about this patient so that I can seem like the intelligent person that I am, that I'm on point and I can take great care of them?" So I think that's when we write our notes, a good perspective to come from, and even on the admin side, it doesn't matter what your position is, but same thing, say, I've never met this person before, or I've never seen this account and I'm coming across this note, what information do I need?

0:08:29.8 Britney: So on the clinical end of things like, "Yeah, it's all of your basic information about what you did that day, it might even be reasons why you had to make a certain decision." So it might be a little bit of background, like patient came in with this concern, or there's sensitivity here," and so including all of the details and the information in your notes. So it's not always just like your cut and dry facts, it's anything that also helps you make a decision. Say someone came in for a post-op and they had a concern, and so we didn't end up following maybe normal protocol, make sure all that information is included in your notes, not only for the next person who's gonna see that patient to say, "Why didn't we do it this way?" Also from a legal perspective. We need all that information, so it's documented why we made decisions, should we ever find ourselves in a circumstance where our clinical decisions are being questioned.

0:09:19.0 KD: Hey Dental A Team listeners, how was your 2021? Have you reflected back? Where did you really win? Where did you really not win? If 2021 was a year of years, "Congratulations." I am celebrating with you, and I would love to invite you to take it to the next level. If 2021 wasn't quite your year, hey, it's alright, I'm there for you, and I would love to invite you to make 2022 the year for you. That's right, guys. If you're ready to take massive action, if you're ready to take your practice and your team to the next level, increase your profitability, yeah, guys, through an easy way, get your entire team aligned, and you're ready to just have your life be different. That's right. Team development, top to bottom; system development, top to bottom; changing and shifting your culture, improving your team morale. If that sounds like what you're interested in, guys, I'd love to invite you to join us in our Dental A Team platinum group. It's the exclusive group where we physically fly to your practice, we give you insider tips, we share with you, we have a quarterly newsletter that goes too, that shares all the updates we're coming up with. And we share it with our platinum group.

0:10:24.9 KD: We'd love to have you, and I would like to invite you, because, guys, remember, you're always one decision away from a completely different life. So reach out, guys. I'd love to chat with you. I'd love to see if you're a great platinum client, or what works best for you. Email me, [email protected], and I can't wait to welcome you as our newest platinum client. Take massive action. This is your year. Let's make sure 2022 is your year. [email protected]. Can't wait to welcome you.

0:10:50.9 Tiff: I love that, and I love that you brought up that post-op, because I don't know how many times I get into offices when I go consult, I'll pop open a note, and I'm like, "Oh, post-op completed. Cool."

0:11:00.7 Britney: Great. [chuckle]

0:11:01.1 Tiff: So, for what tooth, what area of the mouth, what happened, what did it look like, what instructions did we give the patient, when does the patient come back for the implant placement or whatever is next? Great, post-op was completed. That's fantastic. But that's the point right there that I think Britney is making, is if you're not documenting what actually happened, what transpired during the appointment, to me, I'm like, "What's the point in your notes, because I can look at the ledger and see that you did a [0:11:30.7] ____ filings in a periodic, I got that. Or, a post-doc. I've got that, I can see that. [chuckle] But what actually happened in the appointment, I think that's huge. So Britney, I think maybe updating templates, right? Note templates or having note templates in general, that do take you through all of the things that you did. So yes, I want you to notate what you physically did in the appointment, but then also diagnosis.

0:11:55.2 Tiff: I've seen that a few times where it says like DX with the little colon, and it'll say decayed or broken tooth. We need to know why does this tooth need to be fixed? What happened? I know when I was chairside, my doctor loved it because I just transcribed a little [0:12:13.0] ____. I was in the jury room transcribing everything he said, because it was important. And I'm like, "If this patient calls, and I have to answer the phone, I need to know what I'm talking about," because if I don't write these notes and they have a question, now I gotta go get doctor, and he's gonna look at the x-rays again. So think that's huge. And so maybe updating templates to make sure that it asks those questions so the team members are prompted to do the notes.

0:12:38.7 Britney: Yeah, and I would say getting team input also on that template, and if you think you're a [0:12:43.8] ____, and you don't have input on those notes, oh no, you should be definitely having some input, because how nice is it when I need to go and get a narrative for a claim that I can go straight to that diagnosis in their notes and pull that information for my claim. So all of these things just build into the efficiencies of how everybody's job can run smoother, but all our communication is super clear, and I think team members can also... Not only templates, but also some examples, like what does a really good note look like? And make sure our team members know what that is, so they know what they're shooting for.

0:13:17.0 Tiff: Yeah, absolutely, and I think that's important, what you said about our billing department and making sure that they're getting what they need, and I know... I've been on both sides, we've been on all the sides. That's why... That's why we can do what we do. [chuckle] I've been the dental assistant, that's like, "For the love, what else do you want from me? I don't have time to do this." But then two weeks later, when the claim gets denied, and she's like, "Listen, I didn't have proper documentation," I'm like, "Oh, now you're bothering me by taking me out of this appointment to figure out why this crown was needed, now I see." So if I can take the 15 seconds in the beginning, give you what you need, you're never gonna talk to me about this tooth again, I can handle that. So I think...

0:13:58.7 Britney: I'd prefer that actually. [chuckle]

0:14:00.2 Tiff: Exactly. So I think maybe seeing that perspective too, because I know it is frustrating on the team member side where... The back office side, where we're just running around chickens all the time, we're like, "I don't have time for all this," but you like to say, choose your heart. [chuckle]

0:14:15.5 Britney: Yes.

0:14:16.0 Tiff: So now, I think it's like, choose your time management. Where do you want to spend your time? Do you wanna spend it on the front end, for those extra 15-20 seconds of typing out the why, or do you wanna spend it on the back end for five minutes talking to a frustrated billing representative, trying to get the information, jogging their memories? So I think that's huge. And like you said, on a legal standpoint, if those notes get pulled, all the documentation is there, you just have to submit it. And typically, cases get dropped and claims get paid.

0:14:45.8 Britney: Exactly. Yep. It's huge. So from the clinical side, I think definitely having a template so that all the team knows, having a clear expectation of what needs to be in there, getting all the input, making sure billing... Make sure everybody gets the information that they need, and then I think even on the admin side of things, like all those conversations that you're having, [chuckle] documenting things well. And this uses a little bit of your judgment, but highlight the important things. Patient concerns, always important to add into a note. Billing concern is always important to add into a note and make sure we've got details. So just starting to really figure out what are the important things that need to be in there. Yes, I need to document every conversation, but what are the key points I need to make sure I hit? And you start to use your judgment and make sure you're hitting those key points.

0:15:30.4 Tiff: Yeah, I think that's huge. I think when I was upfront as an admin team member, I used to... I used to think, okay, like you said earlier, if I wasn't making this note and I had to read it later, what is gonna help me the most? So I wanted to make sure I was saving, you know, Trisha and Trista next to me, whoever's gonna answer the phone next, I wanna save time for them, because if they take this patient call, I don't want them to be having to research and dig, and I also don't want them to have to put the patient on hold to wait for me to be available, because now I'm the only one who knows. It's not fun being that person, it feels great for our egos, to be the only one who knows, the only one who can help someone, but guess what, at the end of the day, it's the patient's experience and your team member's experience. So I think that's huge. So I think actionable, we always wanna be super actionable, so I think maybe for back office, figure out your templates, what are you gonna add to the note templates that you're already using. If you're not using note templates, figure out how in your system, you can do it. You can always reach out to us, [email protected].

0:16:34.8 Tiff: I just got so lost. I was thinking so many things so fast. That's my brain going... [email protected]. And reach out to us and let us know what template help you need. So find your templates, if you don't already have them. If you have them, update them. What can you add in there that's gonna help your fellow team members and help legally. So back office, update those templates, work together as a team. I'd love to see those done in the next two weeks. I'm gonna give you a deadline for that. And I think front office, or admin side, where are you going to put your notes? So I think that's huge. I wanna harp in on that for the admin team. The consistency is key. If you're making notes, but no one knows where to find them, why did you make the note, okay? It's pointless. We're still digging. So figure out where all of your notes will go. I know in Dentrix, we use Office Manager. I think Eaglesoft, and I wanna say Open Dental both have a comm log area where the notes should go or are easily found.

0:17:33.7 Tiff: Sometimes people use the family file in the Dentrix modules. I don't really care where it is personally, just make sure it's easy to find. Office journal, I like, 'cause you can title it. I'm gonna put my two cents in there. Back office, figure out what those templates are gonna look like, how can you add to them or create them. Front office, where are you gonna put your notes so that they're consistent and easy to find? And then Let's hold a quick note meeting, and... In your offices, if this is an issue for you, I want you to hold a quick notes meeting. It could be 15-30 minutes. Let them know your expectations, where to find the notes and what that looks like, right. You got anything you wanna add to that?

0:18:08.5 Britney: Yep. And then I say Just as team members, we commit to the consistency, and we commit that, yes, it does help if we're all writing notes in the same format, in the same way, 'cause again, it just makes it easier, so we all know where to find the things that we need. So I think as team members, we just commit to it and commit to be consistent, document everything.

0:18:25.4 Tiff: I love it, I love it. Thank you so much. That was a huge... I think that was a huge win. That was a good, good thought. Thank you for bringing that. Britney has a brilliant brain. If you guys need to ever pick it, don't worry. She is out there with offices all the time, she travels the country, and she does a ton of video calls and coaching calls from home. We all do, but Britney rocks. So let us know how we can help. Again, don't get confused, it's [email protected]. Let us know how we can help you the best, go rock out some documentation, and we cannot wait to provide you some more information next time.

0:19:04.3 KD: And that wraps it up for another episode of The Dental A Team Podcast. Thank you so much for listening, and we'll talk to you next time.

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