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Go Beyond Accommodating: Working with Extra-Needs Patients by Christine Hoxha

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Header: Go Beyond Accommodating: Wroking with Extra-Needs Patients

How accommodating are we really?
In the realm of customer relations, words and phrases such as "accommodating," "accommodations," and "willing to accommodate," have become quite common.

You hear them everywhere: from school grounds to medical facilities; from restaurants to movie theaters. It's evident that the dental community, particularly pediatric dentists and orthodontists, have embraced these terms as well. Perhaps it is because we hear shocking statistics, such as how one in 68 children are now diagnosed with autism, or that one in 20 children may be affected with some form of sensory-processing disorder.

These statistics tell us that clearly there is a large population of children who could benefit from special accommodations. However, in an environment where everyone is competing to deliver the best possible service, it is time to go beyond just "accommodating" and begin delivering the unprecedented higher level of patient care that these children deserve.

As a dental and orthodontic practice consultant, I have observed several practices that proudly state they accommodate patients with extra needs. They advertise it on their websites, tell new patients on their initial call and even network with other providers who also treat extra-needs patients.

Yet, after observing their practice operations, it is evident to me that what they consider accommodations are truly nothing more than a minimal standard of care that has become commonplace in so many competitors' practices.

Some practices feel that, because they offer restraint systems or even sedation options, they are being accommodating. Yet they don't employ even simple behavior-management techniques that have shown to be both more effective and less traumatic for these patients. I have even witnessed practices that state they are ADA compliant, but their space is on a second floor with no elevator. Many have never had a true ADA audit. How is this delivering accommodating patient care?

Available resources
Let us use these examples as an opportunity to find the higher level of patient care that extra-needs patients deserve. It all begins with awareness. You and your team should be educated regarding the true needs of the extra-needs patients in your community. Thankfully, we live in a world where we have immediate access to abundant resources through the Internet. Autismspeaks.org offers a wide variety of tools that can help educate your team.

Consider bringing in health-care professionals—such as an applied behavior analysis (ABA) therapist or an occupational therapist—to share their knowledge and help identify key areas where your practice could improve to meet the needs of these children.

The practice environment should be audited to see if you are equipped to meet all of your patient needs. Educate yourself on alternative techniques, such as behavior management. Utilizing tools like positive reinforcement, the tell/show/do technique, and strategic distraction can create a much more relaxed and enjoyable appointment. Once you have gained the proper knowledge, you can start implementing appropriate changes.

A good starting point
The new-patient phone call sets the stage for a successful patient experience. This is a vital time to begin building the trust a patient will have in your practice, but it's also an opportunity to give your team the information they will need to help provide amazing patient experiences. Develop a new-patient phone call script that asks direct questions. Instead of simply asking the parent if there are medical conditions or concerns, take it a step further and be specific with examples like these:
  • "How does your child typically behave at other doctor appointments?"
  • "What have you found that helps your child feel comfortable during appointments?"
  • "Are there any sensory concerns for your child?"
Parents are the best advocates for their children and it is important that they feel you are truly invested in the delivery of care to their child.

Fully explain what to expect at the first appointment and always ask if the parent has any further questions or concerns. Finally, end the call by obtaining referral information. If it is a doctor referral, be sure to contact the referring practice to obtain all pertinent information. Remember, direct questions will give you the responses you need in order to formulate an appropriate appointment for the patient.

Once the new-patient call has been completed, it is time for scheduling. Specific strategies need to be employed when scheduling the extra-needs patient. These strategies create an environment that is not only comfortable for you and your team, but also comfortable for the patient, his or her parents, and other patients in your practice.

For children who are sensitive to stimulation, a busy waiting room that is brightly lit, colorful and loud can be chaotic and can lead to a spike in the child's anxiety levels. The goal is to maintain a peaceful environment. Keeping distractions—such as music, phones ringing, and bright lights—to a minimum will encourage a more desirable behavior from patients. Create blocks in your schedule around the typical quiet times of your day, and reserve them for your extra-needs patients. For most practices, these quiet times are first thing in the morning or right before lunch.

You may also try creating field-trip appointments: a patient is brought in during nonpractice hours to take a tour and get an idea of what the first appointment will be like. These can be fun appointments for the team as well as the patient. Studies show that anxiety is typically reduced by as much as 75 percent if the patient is already comfortable with his or her environment.

All patients value consistency of care and knowing what to expect when they visit a doctor's office. This is even more critical for special-needs families.

The first appointment
Preparation for the first appointment is also key to creating an excellent patient experience. Many successful practices have found that a patient-grading system, which helps identify the severity of the extra needs, is effective. This grade, which could either be a color, a letter or even an animal, is clearly highlighted in the patient chart. During morning huddle, the new patients are discussed, along with the specific requirements for the extra-needs patients. Ask the team, "How can we help this child achieve the best possible patient experience today?"

Allow the team to help develop an action plan around each individual patient. Assigning a specific liaison to the patient is great way to keep consistency of care.

This liaison is responsible for greeting the patient, bringing the patient back to the clinic area, and staying with the patient during each and every appointment. This team member can take it a step further by including a follow-up call after the appointment. Patients appreciate familiar faces and spaces.

During the appointment, it is important to remember that some children suffer from language disabilities that make them unable to understand inferences. For this reason, it is important to speak to children in a very clear and concise manner. When describing the use of specific equipment and instruments, try to be as precise as possible.

For instance, if you tell a child to have a seat in your special spaceship chair, she may actually believe it is a chair capable of taking her into space. Because these children don't always verbalize their concerns, during the entire appointment she may be fearful of the chair and feel anxious.

Most children on the autism spectrum are especially sensitive to time and structure. For this reason, it is very important to let the child know how long the procedure will take and what is happening each step of the way. You can ask if he would like to hold a watch or a clock on which he can focus. A timepiece sometimes provides a greater level of comfort than a toy can.

Often, providers have good intentions of trying to reduce fear by not telling the patient what they are about to do, but a lack of knowledge about what's going on often makes the extra-needs child more frightened. Also, try not to allow too many distractions in the clinic area. Children are very receptive to what is going on, and if they overhear a conversation or another child who is having a difficult appointment, they may begin to hyperfocus on that.

Above all, as a provider you should remain confident, calm and composed during the appointment. If an extra-needs child senses any level of stress from you or your team, she or he will often mimic the behavior.

Taking the time to develop a team protocol for the extra-needs patient will not only result in happier patients, but also in a happier team and overall, a happier practice. The number of children who will require this level of care is expanding, so now is the time to take a look at your current systems and ask yourself if you are doing enough.

By fully embracing the intricacies of extra-needs children, you will be prepared to make the necessary adjustments to your practice operations. These changes will result in increased referrals. They will also give you a reputation in your community as the practice that truly understands how to care for all patients.

Simply adopting the attitude that you will deliver unprecedented, high-level care to every single patient will begin to create an environment that goes well above the low bar of just being "accommodating."

Christine Hoxha is a practice consultant who brings extensive experience in the oral health industry to OrthoSynetics. With more than 16 years of industry experience, she has gained valuable insight into the operations of some of the most successful medical and dental practices in the country. Prior to joining OrthoSynetics, Hoxha developed and managed one of the largest hospital-based multispecialty dental practices in the nation. She lives near Boston with her husband, five children and two bulldogs.



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