THE OPTIMIZED REFERENCE –TEAM

- a model for “BEST PRACTISE”

May be taken into use in parts and step by step.The word “reference-team” is used to indicate you may compare your team with this. 

All elements of optimized reference – team, described below,  is integrated in the courses. 

“The optimized reference-team” is a working “unit, where all “elements”, dentist, assistants, ergonomics, working methodes, unit,  assistant working places, practice organization are optimized and elements and functions unnecessary are avoided.

All these elements are well tested in many thousand excellent dental practises and are conform with what we can describe as “BEST PRACTISE” 

However are these “golden principles for best practice” unknown to very many dentists and dental teams.

These excellent practices are mostly found in countries like Germany, Schwitzerland, Denmark,  Holland and and Italy.

For readers outside these countries the following may be felt like quite a challenge. In some countires even working with chair side assistant are not usual and may be a majority don’t know the principles. 

HERE ARE THE PRINCIPLES FOR “OPTIMIZED REFERENCE- TEAM” 

Dentist and one assistant work always fourhanded where dentist has full and undisturbed attention towards the working task in the mouth of the patient.  Always chair side assistant. 

The fine-motoric, for precisionwork of the dentist (using rotating instruments or handinstruments) are highly trained as techniques of 4 handed dentistry.

Turbine (airrotor) is substituted by a second micromotor.  This means there on the unit is no turbine but 2 micromotors – one with blue contraangle and the other with red multiplication high speed contraangle (using turbine burs and diamonds) 

Unit is placed in central position over the brest of the patient so it can be used of both assistant and dentist. Assistant has aspiration-tubes placed 10 cm from the 3 function syringe placed at her side of the unit. 

Both dentist and assistant are highly trained in 4 – handed dentistry. 

Assistant has handinstrumenttable placed behind ad at assistant side of the patients head.The table/surface for work and preparation is immediate beside the handinstrumenttable. 10 cm above is the most important drawer of the practise placed. Here is placed 60 – 80 small materials incl composite all in small compartments. Above this is the tabletop for large materialtray in working position.

Materials for  endodontics  or crown and bridgeprocedures or for temporary crowns are placed in large materialtray so preparations for these procedures can be made in seconds by placing a megatray. 

Handinstruments are organized in ”instrumentclips” Handinstruments are visually controlled and cleaned immediately after use  - in operatory.

Rotating instruments are organized in burstands (with a refill burstand easy to reach)Handinstrumentclips burstands etc etc are placed and stored in stainless steel cassette. Handinstruments in clips, cassettes etc are washed and cleaned in an instrumentwash- machine  (ex Miele Thermodesinfector) Cleaning and initial disinfection of contraangles etc are done in an “assistina” or alike’Type C pre and post vacuumautoclave is usedS

torage of some instrumentcasettes in operatory easy to reach for assistant.

Materials and instruments organized so all treatments exept surgery, can be preparet and performed without the assistant has to leave the workplace by the patient. 

Dentist and assistant work on stools constructed for balanced sitting position with inclined upper legs. Saddelstools are not used for men.

Digital X ray and digital patientcard, appointmentbook etc. 

TEAM:

1 DENTIST AND 2 ASSISTANTS flexing  the tasks, so both assistants has same competences.  2 FULLY EQUIPPED WORKPLACES.

One assistant as permanent chair side assistant with highly trained 4 handed dentistry

All working methodes are performed according to PROCOCOLS, which all members in the team know and use.

The other assistant prepare treatments in the other operatory, go to waiting room and ask next patient to come to the operatory, take care of the patient and have a relaxed introduction, take Xrays, gives instructions about prevention of caries, periodontics etc, controls hygiene, use disclosion solution when indicated, make sealings, take alginate impressions, write almost always dentists cards after the treatment, confirm ivoice with patient, gives information to patient, write prescriptions and important takes care to give the patient a fine service. 

PATIENT SERVICE IS HIGHLY TRAINED to insure the visit at the clinic will be a nice and positive EVENT.

Delegation of other clinical procedures (in countries where this is allowed like Scandinavian countries, Germany and Holland) is not performed, because there is no time to this. The       2 assistant are already fully busy.

 HOW MUCH TIME IS SAVED. (compared to an “average” practice without optimization)           2 treatment rooms with organizing materials and instruments as described    ca 20 %

4 handed dentistry  ca 20 %

Optimized finemotorics of dentist ca 10 %

Individualized methods of supragingival scaling and polishing 10 % (in countries where appointments mostly are recalls like Nordic countries) 

If the dentist is working alone like in ex France or Belgium there may be saved more time. 

The 2 treatmentrooms gives a great flexibility, efficiency and a relaxed workflow.

Short controls are easy to make, emergencies disturbs the time plan much less. Patients can have an anastetic 15 min before treatment.

Delays are more easy to reduce and one assistant can in the free operatory take bitewings, Xray status, intraoral digital photos, BOP index, Biofilm index, give instructions, train the patient in mouth hygiene etc.

 The timesavings are used for individualized length of the recall appointsments 

The flow of the patients for the optimized reference-team will  (specially in countries with appointments dominated by recalls – Scandinavia) be so high that he capasity of the instrumentwashingmashine is fully in use. (instrumentclips and cassettes)

The capasity of the vacuumautoclave is too fully used (good planning is necessary)This means there is NO free capacity for instrumentwashingmashine and autoclave.                   This means that there are NO LARGE-SCALE ADVANTAGES IN THE STERILISATION ROOM in practices with more teams.

THEREFORE HAS EACH OPTIMIZED REFERENCE TEAM OWN SMALL STERILISATION (decentral in large practices) ideally placed between the 2 operatories so the distance to the sterilization is minimal.

If the optimized reference-team is a part of a larger practice is there no large scale advantages by a central sterilization. Other disadvantages is that the instruments and burs, diamonds etc from the different teams are mixed and time is used to sort this out.

Materials and instruments are organized according to the PROTOCOLS OF THE TEAM including refill stations for cassettes, megatrays and drawers.

A decentral sterilization for the reference-team is supereffectiv, distance minimal, use of time minimal, assistant can easily flex between the different task and all 3 parts of the team can hear eact other and talk with each other.

The time used in the sterilization can be minimized and more ressourses set free for the patient. 

The optimized reference-team work with individiualized length of appointments for recalls. This will be administrated by one of the assistants who write informations at the card of the patient independently or after dictate, and print the invoice so it can be given to the patient immediately after he/she leaves the patientchair.  Details in the invoice will be explained by the assistant. When necessary the assistant write priceestimatis to the patient. 

If the practise consists of 1 optimized reference-team with the assistant (if she is very well trained) receive payments, take care of bookkeeping, recall ect.

In practices with 2 or more team this may be done in a central reception.

Telephonecals  can be directed to the reference-team or may be it had own telephone number.

The target is an optimal coordination between the members of the team, organization, protocols, service and individualization. AND that the patient and the members of the team get to know each other well.

The reference-team has its own decentral  minireception best very close to sterilisation the distance for the assistant in minimal. (gloves off and assistant is in minireception 

WELL TRAINED FOURHANDED DENTISTRY SAVES MUCH MORE TIME THAN IF AN ASSISTANT ”LEAVES THE REFERENCE- TEAM AND MAKE CLINICAL PROCEDURES (in countries where this is allowed)  - because the assisstant is no more available and a operatory is occupied. 

The reference-team may be expanded with a hygienist if a third operatory is available. In this case the organization of sterilizing procedures must be strict, there must be enough instrumentcasettes so the vacuumautoclave will not be a “bottleneck” for the flow.

May be the hygienist use handinstruments stored in steribags to save place in the autoclave. 

THE OPTIMIZED REFERENCE-TEAM is a very well tested “model” with superfunction and is for the courses a blueprint for optimal function, and for benchmarking of practisedevellopement.

OF COURSE ONE CAN CHOOSE TO TAKE PARTS OF THE “MODEL” INTO USE, MAY BE STEP BY STEP. 

FLEX TEAM MODEL -Sometimes I have experienced this model taken into use.

2 optimized reference-teams work each 6-7 hours pr day an share the 2 operatories with sterilization etc.

The practice is open 10 – 11 hours a day (7 to 18) with an overlap with 2 teams  2 hours at midday. Pause for lunch is taken by each team after each other.  In the overlapping time there is placed long treatments (1 hour or more) so the disadvantage by 2 teams at the same time during these 2 hours is reduced.

Holidays are taken “on shift” so the practice always is open.

This model gives the absolute best use of resources.

(I have seen sometimes the model is used for a marriage couple, where both are dentists. Then one of the parts are always at home by their small children)

 

THE DISADVANTEGES BY LARGE PRACTICES CAN BE REDUCED BY DIVIDING IT IN OPTIMIZED REFERENCE TEAMS.

This allows too the teams to devellop in different directions and with different levels of activities avoiding the conflict between different teams often seen.