From junior receptionist to administrations manager

Managing clinicians can be challenging, and Danielle Collins describes it as having taken all of her 11-plus years with Smile Solutions to hone the skills involved.

When she started as a junior receptionist in 2004, she never envisaged becoming practice administrations manager.

At the time of writing in 2015, the role meant being the person in charge of some 30 general dentists, 16 Dental Board registered specialists and 14 hygienists and therapists, across four levels of the premises. The current clinical team is listed by name, and dentists and registered specialists explains what the second of those categories means.

What “Dental Board registered specialists” actually means

That phrase is a registration category rather than a description of seniority, and it is worth being precise about, because it is the single largest structural fact in this job.

The Dental Board of Australia states that “there are 13 dental specialties in Australia which are approved by the Australian Health Workforce Ministerial Council” — dento-maxillofacial radiology, endodontics, forensic odontology, oral and maxillofacial pathology, oral and maxillofacial surgery, oral medicine, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, public health dentistry (community dentistry) and special needs dentistry (Dental Board of Australia, Specialist Registration).

Specialist registration requires a qualification in the specialty and all the requirements for general registration as a dentist — and, separately, that the applicant has “completed a minimum of two years general dental practice”. So a registered specialist is, by definition, someone who practised general dentistry first and then trained further. Specialist care lists the specialties practised here, and why would I need to see a dental specialist? explains when the distinction matters to a patient.

The Board also notes how any of this can be checked: Ahpra publishes an online register of all dental practitioners, and that register “also includes details of the specialty or specialties for dentists who hold specialist registration”. It is public, it is free, and it settles the question in about a minute — which is worth knowing whichever practice you attend.

Administratively, the consequence is that the three groups in the paragraph above are not interchangeable and cannot be rostered as though they were. A specialist's list, a general dentist's list and a hygienist's list have different lengths, different equipment, different room requirements and different referral patterns feeding them. Most of what follows is about the consequences of that.

What the job requires

Dealing with the daily demands of clinicians requires:

That third one is the substance of the job. Clinicians are not interchangeable staff on a roster. They have preferences about session times, room setups, nurse pairings and case mix, and the manager who knows those preferences can solve problems that would otherwise become resignations. The Great Resignation in the Private Health Sector covers the wider version of that problem across the industry.

Trust first

Forming trust and credibility in the initial phase of a clinician's employment is essential.

When trust is established, clinicians know that every decision is made with both their interests and the practice's interests at heart.

That is the mechanism that makes the rest of the job possible. A decision that goes against someone lands very differently depending on whether they believe it was made fairly — and that belief is built early, before there is any conflict to test it.

Being a manager means focusing on what matters most for the successful running of the business — eliminating signs of chaos, and being known as someone with the authority to make the right decision for all parties.

Culture is built deliberately

The managing director has put countless hours into nurturing staff so that every employee shares the same focus and direction. What I love about running a large dental practice is that account from the other side of the desk, and what makes Smile Solutions an innovative business? sets out the thinking behind the structure.

A sense of community within the team, with a common goal, is vital to maintaining a well-oiled machine. The Smile Solutions experience and my life as the Smile Solutions Tooth Fairy are two more views of the same culture from inside it — and Watergate: the Smile Solutions fish tank saga is what happens when a well-oiled machine meets a leaking aquarium.

Saying no, usefully

This is the most transferable idea in the piece.

She cannot always fulfil her practitioners' requests. But:

When they are given options to help her agree to their demands — and hence achieve the best possible result — they are more inclined to agree to her requests of them in the future. The net result is mutually rewarding.

A flat no ends a conversation and banks resentment. An option converts the same no into a negotiation — and, over time, into a relationship where favours run in both directions.

“I cannot over-stress the importance of effective communication within our team.” The same principle applied to patients is set out in how important is communication in dentistry? and understanding your treatment.

The rostering problem

One of many duties is making certain the practice runs at full capacity on any given day.

This alone is time consuming, and it is imperative for sustaining the growth of both the practice and the individuals in it. It requires an eye for detail.

The approach: planning rosters well ahead, with ample leeway, which gives clinicians the opportunity to work around extra-curricular activities and meetings, and to pick up additional sessions.

The motto: “You scratch my back, I'll scratch yours.”

Rostering is where the trust and the negotiation actually get spent. A roster built with slack in it can absorb someone's conference, someone else's sick child, and a late emergency patient. A roster built to the minute cannot absorb anything — and every disruption then becomes a confrontation.

That slack is also what a patient is relying on without knowing it. It is why emergency dentistry can see someone the same day, and why why choose us in a dental emergency? turns on capacity rather than on clinical skill. Is a bigger dental practice better? Part 1 and Part 2 make the structural version of that argument, and everything under one roof — we do it all at Smile Solutions describes what it means for a patient who needs more than one kind of clinician.

Where a case needs several specialists in sequence, the scheduling problem becomes the clinical problem — see complex dental cases: what happens when multiple specialists need to collaborate and complex dentistry.

Recognition

Acknowledging a clinician's dedication to the team is crucial. It is always nice to be recognised for effort that goes above and beyond usual duties.

Short, and easy to skip past. It is also the cheapest retention tool available, and the one most consistently underused. Smile Solutions wins on service excellence and our team celebrates our Telstra Business Award win are the public version of the same thing; the awards page lists them.

“Keeping my 60-odd clinicians happy and motivated is a challenge that I take much pride in.”

If you are a clinician or a graduate reading this rather than a patient, careers, the graduate program and the dental internship are the pages to look at next.

Common questions

The article above is written for people interested in how a practice runs. These are the questions a patient tends to have after reading it.

My dentist has left, or is away. What happens to my treatment?

It is a fair question, and the thing to establish is not sympathy but sequence.

The practical points to raise, in this order:

The Dental Board's Code of conduct, which binds every registered practitioner, carries specific sections on effective communication, informed consent, minimising risks to patients and health records. A handover that leaves you unsure who is responsible is not meeting that standard, and saying so is reasonable.

Several clinicians are involved in my plan. Who is actually accountable?

Ask, plainly, who is leading the case — and get the answer written into the plan.

Where a treatment plan crosses more than one field, there is usually one clinician holding the overall sequence and others contributing a stage each. That is the arrangement the article above is describing from the staffing side. From the patient's side the important things are that somebody owns the whole plan, that you know who it is, and that each contributor knows what the others have done.

The regulatory backstop here is consent. The Dental Board and Ahpra's guidance to practitioners is explicit that before treatment a practitioner must ensure the patient understands the risks and has reasonable expectations, and “must have and document their informed consent, including financial consent.” Financial consent is the part people most often skip: in a multi-stage plan it is worth asking for the total, itemised by stage, rather than approving one appointment at a time.

Three questions that settle most of it: who is leading, what is the order of the stages, and what happens if a stage does not go as planned. Understanding your treatment covers how the plan is set out.

Who will be cleaning my teeth — is a hygienist a dentist?

No, and that is by design rather than by shortfall.

The Dental Board of Australia registers dental practitioners in distinct categories. Dentists sit in the division of dentists; dental hygienists, dental therapists and oral health therapists are registered in their own right, with their own registration requirements and their own scope of practice. All of them appear on the same public Ahpra register, so you can look up whoever is treating you regardless of category.

What that means in a practice: a hygienist is a registered health practitioner doing work they are specifically trained and registered to do, not an assistant standing in for a dentist. Scope of practice is the phrase that governs it — each practitioner works within what they are educated, trained and competent in, and refers on where a problem falls outside it.

If you are unsure what the appointment you have booked involves, ask what category of practitioner you are seeing and what they will and will not be doing. What does a dental hygienist do? and dental cleans and hygienists set out the ordinary version of that appointment.

Can any dentist provide sedation?

Not as a matter of course. Conscious sedation sits behind a separate hurdle on a practitioner's registration.

The Dental Board of Australia publishes an endorsement for conscious sedation registration standard, alongside conscious sedation competencies — meaning it is an endorsement recorded against registration rather than something included in general registration. Because endorsements appear on the Ahpra public register, this is another thing you can check yourself rather than take on trust.

What that does not tell you is whether sedation is the right choice for you, which depends on the procedure, your medical history and your medications. Sleep dentistry describes what is involved, and sleep dentistry costs covers what it adds to a bill — worth reading before the appointment, because sedation also brings its own instructions about fasting, driving and having someone with you afterwards.

If the obstacle is fear rather than the procedure itself, sedation is one option among several and not automatically the first — how can I ease my anxiety about visiting the dentist? and dental anxiety cover the others.

Related reading

Practical details

Written by Danielle Collins, Practice Administrations Manager.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 7 May 2015. All team figures quoted are as at that date and are historical statements rather than current numbers. Registration requirements, the list of approved specialties, the practitioner categories and the conscious sedation endorsement are quoted from the Dental Board of Australia, and the consent requirement from the Dental Board and Ahpra fact sheet for practitioners; all are current as at the date of this update. Confirm any individual practitioner's registration on the Ahpra register. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.

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