The Secret to a Smooth-Running Dental Practice: SOPs

Also, when you have a checklist, people can initial that they did it. So there's some sort of accountability built into that, right? And this plan also helps for turnover because a lot of times there is one person on the team and they haven't looked at it as a team sport. So when Cherie left the office, I'm not there to train the new person coming on, right? And then nobody knows how to do it. Welcome to the Phil Klein Dental Podcast. So today we're going to talk about why every practice needs well-documented, easily accessible SOPs, and why it's not just about writing them once and forgetting about them. SOPs need to evolve with your practice, and while updating them is a team effort, there must be a single point of accountability to ensure that they stay relevant and useful. We'll also explore how SOPs reduce chaos during staff turnover, time off, or sudden absences. We'll talk about the risks of not having your SOPs clearly documented or accessible on demand and whether they belong in binders or digital systems. And if you're thinking of purchasing SOP templates, should you? And if you do, why customizing them to your office's unique workflow is so critical. If you're looking to strengthen your systems, protect your practice, and empower your team to thrive even when someone's out, this episode is for you. our guest is Sherrie Busby, she has extensive experience and education in dental assisting and is one of the foremost experts on the topic of sops in a dental practice before we bring in our guest i do want to say that if you're enjoying these episodes and want to support the show please follow us on apple podcasts or spotify you'll be the first to know about our new releases and our entire production team will really appreciate it Sherrie it's a pleasure to have you on the show Hi, thank you for having me. I appreciate it. Yeah, we're very happy to have you on the show. And, you know, we hear a lot about SOPs, standard operating procedures. And there's a million things that go on in a dental office to keep it running. And you are certainly an expert on this stuff. And that's why we're glad you're here. Tell us about the critical aspect of SOPs. Why are they so important? And what kind of systems do they actually affect in the practice? Everything, everything that the office does from waterline maintenance all the way down to billing, right? Everything should have a system of how you train people and how you hold them accountable. The other thing about why they're important is actually reads to that also, because if you need to have things written down. in order for people to be able to follow them right, they need to be scalable. And if it's not written down, then it's not scalable because it's always something different, right? Also, they also need to be written down so that you can hold people accountable. You can't hold somebody accountable if they don't know what they're supposed to do, right? What do you mean by scalable? Give me an example. An example would be, let's say you have a new hire. You want everybody to be trained the same way. There's a consistent process all throughout the office. So anybody coming in should be able to pick up this waterline testing and run with it without a whole lot of additional training. Okay, so you're talking about scalable from the standpoint of HR. Yes. And of course, that's great if someone quits or if someone's ill or if someone goes on vacation, right? I mean, having it... documented is very important now when you talk about sops it doesn't mean that it has to be this incredibly lengthy bureaucratic document right i mean it could be somewhat of a short sop but at least it's documented and available somewhere convenient where someone could look at it right is that what you That is exactly right. And you don't want a long, lengthy document. For one, people are not going to read it. For two, they're not going to remember what they read and then they're not going to follow it. Right. So having things that are customizable to your office and that are easy to understand, readily available for the team members, anybody can find where they are and then have them accessible at all times. Those are the the big key points about SOPs. If you had a person who. was employed by a dental practice and they got something in their eye some material they're not really sure what it is and there's an eye wash you know within 50 feet of where they're sitting is there an sop on handling an eye injury like that Absolutely. And that falls under their exposure control plan. So when your exposure control plan will say, hey, in the event of an emergency, here's where the eyewash station needs to be. Here's the steps that you would follow all the way down to how to go seek medical attention. All of those things need to be outlined in your SOPs for your team members to follow. Just to keep things reasonable, when you think about how many different systems exist in a dental practice. If there's an SOP for every single system, that could be an inordinate amount of material laying around the office. So how do you decide what absolutely needs to be in the format of a standard operating procedure that's documented and something that you may not need to have? Well, they need to cover everything, but everything doesn't need a separate plan. Right. So as an example, we just used somebody got something in their eye and they had to run to the eyewash station. Right. So your exposure control plan is going to cover things like PPE. It's going to cover things like laundry. It covers things like this incident report. All these things are in one plan, not necessarily individual plans. Your housekeeping plan would be where your waterline maintenance would fall underneath, right? Some offices have its own binder for its waterline because of your reports that you get back. right, when you send it off. But other offices keep it all within one binder. So you should only have about maybe five or six binders that are separated out by categories. That's the easiest way to keep track of them. Are there digital copies of this as well, or is it strictly sitting in a hard copy binder? You can keep either one. But here's the deal. Digital copies are great because they're easy to update. You don't have reprinting. They don't get lost in the closet, in the break room, right? I love a digital copy. However, you have to be able to produce that digital copy at any given time. And let's go back to the example of the emergency with the eyewash station. So you have to be able to go and go to the SDS for whatever product that was and find out what is the emergency response for that product. Now, if you have a digital copy and what if somebody doesn't know the password? What if they don't have access to the computer? What if the power is out? right so so you you there's a give and take for both of those ways i do know that inspectors when they come into the offices they tend to want the paper because they want people to go bring them the binder you know what i mean yes but either way Either way is a legal way to do it. And you just have to choose for yourself and your office what way works best for you. So with these SOPs in place, and you said an office could have maybe six or seven. Is that what you mentioned? Something like that? Seven categories? Yeah, seven different categories. All right. How do you keep them current? Or how does the dental practice owner feel confident that they are up to date? Well, I think the first thing and the most important is you have to have a champion. Like you have to have an OSHA coordinator slash infection control champion, safety officer, whatever you want to have them. You need to have this person in place. And that person's responsibility is the one to go and review the plans often. They have to be... at least annually, right? And then if there's any changes, this person also has to be empowered with the authority to teach the team and hold the team accountable, right? So keeping them current, it could be a job in itself, but one person doesn't have to do it, but you do need that one person that's the bottom line. This is the one responsible to make sure that it gets done. That's the very best way. Yeah. So if you have an infection control coordinator, someone who's not a dedicated ICC, but someone who may be a dental assistant or maybe a dental hygienist who also takes the role of an ICC, they would essentially be held to account to manage, if that's the case, whatever SOPs are in place. That's reasonable to do that. That is reasonable to do that. But here's the key, right? Compliance is a team sport. One person, it's a full-time job. And in 99.9% of the offices, a clinical team member is the one who has this responsibility. They're also seeing patients. They're also running sterilization. They're keeping the laundry done, right? So assign team members to help with it, right? Because it needs to be a team sport. And we can use an example that's just in my brain right now of water testing, of testing the water and doing the waterline maintenance, right? talked with an office yesterday they have 16 operatories there's no way there's no way on the planet that one person could go and put the line cleaner through 16 operatories and then go back and rent 16 operatories in time for patients to start that morning right there's no way but would it make sense Sherrie for an individual assistant to just manage their own operatory and each assistant carries the responsibility of their own space And that distributes the workload or is that too fragmented? No, I would fragment it. It would be that if you predominantly, like let's say assistants primarily don't have an operatory per se, but they have a group of operatories where their doctor works out of, right? So these two assistants or that one assistant would be responsible for those two to three operatories. A hygienist would be responsible for their operatories, right? That way it doesn't become a single burden. on everybody. And here's the deal. This goes back to the SOP. Those people have all got to be doing it the very same way, right? Consistency, without a doubt. You've got to have consistency. Otherwise, if things are not good done, consistency, that can cause false positives or it can cause errors within the program, right? So you have to have consistency. But once again, one person can't do it. Compliance overall is a team sport. Does the SOP include the materials that you use? For instance, you talked about waterline management. And I know Salmedics has a whole system, the Citrusil system. Let's just use that for an example. And I know you approve of that system. But that would be included in the SOP? So they're all using the same manufacturer's guidelines to follow through with waterline management? Correct. Correct. And you need to, like your SOPs would say, all right, we are going to shock monthly using Citrusyl tablets. We are going to do daily maintenance using either the Sterosyl straw or the Citrusyl. One or the other we're going to use. So you would put these products that you're going to use. And now if and when you say, okay. we got new equipment or the manufacturer recommends another product, whatever that would be, right? Whatever the change. Then you have to go back and update your SOP so that that reflects that this is the new system and the products that we're using. Yeah, and that would probably apply to, correct me if I'm wrong, to testing. There's third-party testing and then there's also in-office testing. That all needs to be in the SOP, right? It does. It does. And because people don't know, they'll go in and say, well, I don't. know how you guys tested the last time. And the team is like, well, we don't know. Sherrie went and did it all the time. You know what I mean? So you have to have it written down. If you're going to use mail off testing. then that's written down. If you're going to use in-office testing, that needs to be written down. The procedure for in-office testing, because let's face it, in-office is a little bit more challenging to do, right? Because you have your own record keeping, whereas when you send it off, then you get a report. So it's a little trade-off for those, right? Either way. The results of that testing, Cherie, don't go into the SOP folder, though. That's a separate document. That is a separate document. And that's why a lot of offices are putting their dental unit waterline, making a binder so that the SOP is in the front of this binder. Then all your test results stack up behind it, right? So everything is together. It's really the easiest way to do that. And that binder should probably be near the, I mean, in this case, we use the Citrusole system. It should be near the materials, right? As you grab the tablets. the binder should be fairly near that area so they could just administer the tablets and then fill it i mean you tell me you're the expert i would say i would say something like that however most sterilization labs which is where I'd go in and I'd have my spare bottles or I'd have my tablets, whatever. Those sterilization labs are smaller on the smaller side and the cabinet space is at a premium, right? Because it's got full of instruments and supplies. So a lot of offices will have their binders in the break room or in an office. area location right um only because of space because of space and and come on we are we all work in dentistry we know that if there's enough room to put another operatory versus a closet we're sticking an operatory there right yeah no absolutely no space is always a premium especially space is always a premium if you're working in an urban environment in a high rise or something like in Manhattan, it's ridiculous. Even more, even more, right? Even more. So they may or may not be together. But here's the deal. Since the testing is monthly, it doesn't put a big burden on somebody to take their test result and then go stick it in the binder. And they're in the same office within the same area, right? So it doesn't necessarily mean that it's extra steps. to go to the break room to get the binder or or to go to the computer that's holding the digital copies so if you're doing sops in a digital fashion then you would have a folder that says dental unit water lines. And then in the subfolders, you would have your SOP, and then you would have your test results that fly in there into another subfolder, right? So you have to keep them separated so that they're easy to find. Because in my life, and I'm sure I'm not the only one, digital files are also harder to find than paper files, right? Yeah, no, no, without a doubt. It's not just that we're over 18 years old. That's not the only reason. No, it's not. It has nothing to do with that. Nothing to do with that, yeah. That's why they made a search, right? So what does the office manager have to do with SOPs? What's their role? So their role is to manage the managers, if you will, right? So the office manager and the doctor would get together and they'll say, okay, I feel like that Cherie has the ability to take care of the SOPs. And so do you agree we'll ask Cherie to do this job? And so they asked me to do the job. And then I'm going to report back to the office manager who reports back to the doctor to tell them that everything is fine. And a lot of times that communication right there gets broke down. And then the doctor may assume that everything is fine until it's. not because they had a breakdown in that communication. So it's really vital that the office manager and their infection control champion to have a really good, tight relationship that they can speak freely back and forth and then inform the doctor of where you are. Is infection control the most important category to have an SOP for? Absolutely. Absolutely. And it's required too, right? So talk about the requirement. You know, OSHA doesn't really surprise offices too often, but it does happen. It does happen. You also have the disgruntled employee that will drive something like that. So there's a lot of risk for the practice not to be up to date with an SOP, I would assume. I'm going to ask you that question. What is the risk? even though the offices don't they don't get pop inspections or anything like that very often right however the health department is the ones who come in not necessarily osha themselves so the local health department will come in and maybe they're coming in this time because they're checking your radiation equipment Right. They want to go and make sure that everything's working properly, that you have your registrations, all those kind of things. They may be just coming in because it's time because there was a boil water advisory and they're in the neighborhood and they want to come in and make sure that you have followed the boil water advisory protocol for your office, whatever that would be. And this really the boil water actually really. affects offices who are using city water, their direct plum, not using bottled, right? Not using contained. So those inspectors will come in periodically just to check those things out. And then they spring the question on you, could I take a look at your standard operating procedure? Every single time. That is the first thing that they want to know is where's your SOP? What is your, where's your plan, your written plans? And that's why it's so important that you have to be able to put your hands on them in a flash. And I've seen offices who the office manager had them on her computer or his computer, and then they're not there and their computer's password protected so nobody can get to them. Right. Yeah, that's not a good scene. That's not a good scene. Yeah. When you hire a new person in an office, how fast do you... Expose them to the SOPs and get them trained on it like there's you're saying there's maybe five to seven categories of these SOPs What's the process of getting that new employee to be familiar with them and really follow them closely? Well, OSHA states a patient are employees need to be trained on the job that they're going to do you know within 10 days they should be trained before they're actually picking up sharp things and touching patients right right they really should be trained on that process so um i'm a firm believer myself that onboarding has got to include this training. And the best way to train somebody that's the most consistent, that's scalable, that everybody gets the same training is to go to those SOPs. We can use water as our example. So let's say this person is not going to be responsible for the waterline safety in the entire office, but they will be responsible for it in the operatories that they predominantly use, right? So you want them to be able to follow the steps steps that are written there. So I would say that you need to expose employees to the SOPs within that first 10 days. Because like I said, compliance is a team sport. Everybody has to know, right? Generally speaking, do you think offices are documenting processes in a way that is consistent and compliant? I'm going to say it's a hit or miss. How bad is it out there? Well, I have been into offices where their SOPs hadn't been updated since 1995. Or they can't find them. People have written, sent me an email, hey, where can I buy a OSHA binder? You know, that's what everybody refers to it, right? It's an OSHA binder. Where can I buy this? And what do I do when I get it? And I've got friends, compliance consultants that have been into offices, and yeah, they have this binder, but it still has the plastic covering it. Yeah, so they're templates, right? Correct. So they'll get them, but they have to be part of the law is your SOPs or your template, your written plans have to be customized. So if you buy something and it's still in the plastic or the plastic's off, but it's not customized to your office, that's a flunker. You are going to get nailed to the wall for that. They know you just went through the motion of getting a template and it's not even being looked at. So let's say an associate comes in and then their plan is to purchase the practice. The person who currently owns it is close to retirement, and they got nothing. I mean, they just are running that practice like 1957. Where does someone begin? That associate has a lot of things to do. Absolutely. Updating equipment, fixing leaks, and looking at the patients of record. What's the best way to begin developing SOPs for the practice? I would purchase a template because years ago I created templates for heartland dental and i wrote 300 pages there is no way somebody can do 300 pages you know what i mean they you don't have time you don't you don't have the um i don't want to say the ability but it's really about time to go and do all the research that it takes to create your own that's an inordinate amount of work it's a crazy amount of work and it took me months to do that right so So I would advise that you buy a template. And there's lots of places you can get. I mean, the ADA has a book that you can buy from them. There's other companies. Compliance Training Partners is another one. Right, Compliance Training Partners. I know the owner of that. Very good company. I actually used one of their binders as a guide when I was running my stuff. Because I wanted to make sure I had stuff in there. Yeah, Compliance Training Partners is great. By the way, you said you did something for Heartland. a thousand offices or more. So you standardized these SOPs for all these offices that were like all over the place that they've acquired? Wow. And even though they're all different and operating under different conditions, your template applied to most of them? Absolutely. It applies to everybody, but it has to have customization. As an example, You have to have like our office uses this PPE, this PPE, this one, this one, and this is where it lives. And then this is how we take care of any reusable PPE, right? You have to standardize it into your, not standardize it, you have to customize it to your office, no matter what the template says. And I don't care where you buy one from. It doesn't matter where you get the template. The customization is what you need and what is required by law. So when it comes to equipment, Cherie, and let's talk about, let's just say autoclave. There are different autoclaves on the market. And depending on which office you're working in, your autoclave has a certain manufacturer's instructions and so forth on how to use it. Does that get incorporated into the SOP, for instance, for instrument sterilization, which falls under infection control? you should have an overarching sterilization template right however The autoclave, if you're talking equipment, then you're going to follow the manufacturer's guidelines, the instructions for use from the manufacturer. And using the autoclave example, some autoclaves you put your pouches paper up, some of them you put paper down, right? And it just depends on the manufacturer's instructions. So here, let's use a stereocil straw as an example for this. So stereosil straw, you open the box and the first thing you should do is you pull out the instructions for use. Because part of that instructions for use, it may say you have to remove the straw before you put the liquid ultra through there, right? So you have to follow the manufacturers for use. Now in your SOP, you would say when it comes to water. management or it comes to autoclave management, follow the manufacturer's instructions for use. And it doesn't matter if you have what brand of autoclave you have because you're not going to necessarily put the brand name in your SOP. You're just going to say steam sterilization. What do you do to prepare? What does an office do to prepare for and establish a plan for absences, vacations, or turnover? And we're seeing a lot of turnover right now. There's a shortage of staff. Everybody is experiencing that. So what do we do to prepare for that regarding SOPs? Well, my best advice is, remember, it's a team sport, right? So everybody can do the same way at the same time. And I'm a big fan of checklists. i i love me a good checklist so you can make a checklist that says you do these things daily you do these things weekly you do these things monthly right and then Most dental assistants, that's where the biggest turnover is, is in our DAs, right? So most dental assistants come with some experience, but then somebody can say, okay, here's what we're supposed to do every day, and then here's what we're supposed to do every week, and here's whatever. Also, when you have a checklist, people can initial that they did it. So there's some sort of accountability built into that, right? And this plan also helps for turnover because... A lot of times there is one person on the team and they haven't looked at it as a team sport. So when Cherie left the office, I'm not there to train the new person coming on. Right. And then nobody knows how to do it. So the very best way is just to keep it with everybody knows how to do things. It's written down. You've got a way of checks and balances. You've got a way to hold people accountability. And then it just seems to run like a well-known machine. So as we wrap up this podcast, I do want to ask you, is it beneficial to a dentist who's not interested? in all the details and nuances of SOPs and bureaucracy and documentation and updating all the SOPs to sell off to a DSO and let the corporate headquarters handle it for their office? Or are they still basically responsible for the same thing anyway? I'm going to tell you that in my experience, like I said earlier, I came from Heartland Dental. The doctor's name is on the door. They're still responsible. They're still responsible. Their name is on the door. And even though... I provided all kinds of compliance, and then the compliance team took that over, so I didn't really do it too much anymore. But there's support within the DSO, but yet the doctors, the names on the door, those are the people who are ultimately responsible. So selling to a DSO essentially doesn't get you off the hook from creating, managing, and updating all your SOPs. Well, it's going to help your issue though, right? Because now you have a whole compliance team at your beck and call. You just call them up and say, hey, this inspector came into the office. Can you walk us through this? Can you help us do that? When you are independent, then you don't routinely have that person that you can call. But ultimately, your name's on the door, dude. Yeah. Do you have any last thoughts or recommendations to our audience regarding SOPs? I would make sure that everybody on the team is familiar with what is in the SOPs, right? Create them and then make them reasonable. You know what I mean? Make them reasonable, make them easy to read. And then everybody that's on the team has to be familiar with those. I would say put the books out on the desk. If you are coming into a practice, then ask them where are their binders, wherever they are. digital, whatever. How do I get to them, right? But be familiar with what the plans cover. And then if you have any turnover, you want to ensure that those team members are trained properly, having the knowledge that this is what's in our SOP. This is how we do things. And here's manufacturer's instructions for use, right, to follow that. And then once again, you have to really make it a team sport. Don't have one single person responsible. Just like my example earlier of them having 16 operatories, right? You need help. You can't do it all. And when you have multiple people that are trained the proper way to do things, then when you do have turnover, somebody's out, you have a maternity leave, right? For three months and then they come back, right? So you have that turnover or that vacations in your practice. Things don't fall through the cracks. Very good advice, Cherie. Thank you very much for your time today. And we look forward to your webinar coming up on Viva Learning. It's titled Enhancing Operational Readiness, Optimizing SOPs, Documentation, Continuity Planning. That's on September 18th, which is about 10 days from now, 7 p.m. Eastern, 4 p.m. Pacific. And you just go to vivalearning.com to register for that. Sherrie , thanks again. Really appreciate your time. Have a great evening. I will. Thank you, you too.