THE COMPLETE HYGIENIST’S GUIDE TO

PROMOTING A CULTURE OF SAFETY IN YOUR PRACTICEBY ANGIE MICHLIGMANAGER OF CLINICAL PROGRAMS AND SAFETY COMMITTEE CHAIR FOR MIDWEST DENTAL

EVERYTHING YOU NEED TO KNOW TO CREATE CHANGE, FROM EXPERT ADVICE TO BEST PRACTICES AND TEMPLATES

2 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Contents Creating a Culture of Safety

Developing an Effective Clinical Compliance Program

Resuming Safe Dental Care in the Face of the COVID-19 Pandemic

Appendix: Customizable Templates

3 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Creating a Culture of Safety

Hygienists are uniquely positioned to take the lead on safety, able to see and influence all aspects of a dental practice. By stepping up to lead the charge, there is an opportunity for you to make a big impact on the safety culture at your practice.

Secure Safety Buy-In At All Levels To have a high-performing safety culture, you need to integrate safety into all levels of the organization and all aspects of the employee experience.

At Midwest Dental, all practices have a Safety Officer who oversees general safety, including bloodborne pathogens and infection control as well as hazard communications and staff training and onboarding. Each practice also has a radiation safety officer and, for those practices that employ lasers, a laser safety officer. In a small practice, one individual may fill all of these roles, while in a larger practice it makes sense to split up the duties.

In order for these safety officers to be successful, it’s important that they receive ongoing training and support. Midwest Dental utilizes a team of Clinical Leads, made up of experienced dental assistants assigned to each geographical region. This team also handles annual compliance audits in each location, evaluating how the office applies safety procedures in their daily practice.

To arm Clinical Leads with the knowledge and tools needed to support practice safety officers, they in turn receive support from the Organizational Safety Officer (the role I fill at Midwest Dental) and other members of the Clinical Support Team. The Organizational Safety Officer, along with the Clinical Team has shared responsibility for creating a culture of safety which includes safety policies and procedures and keeping up-to-date on relevant trends and guidelines.

Our Chief Dental Officer provides executive-level support, a critical component of a successful safety program. Executive support makes it easier to implement important safety measures, especially when there may be a significant cost associated with them.

Whether you are part of a large organization or a single-doctor practice, assigning responsibility for safety at all levels is crucial. Midwest Dental promotes a co-leadership model, with the doctor, office manager, and designated safety personnel all working together to keep everyone safe. Having your doctor on board is vital, as he or she will ultimately be responsible for disciplinary action for non-compliance.

EXECUTIVE SUPPORT Chief Dental Officer

MANAGEMENT SUPPORT Clinical Programs Manager

REGIONAL SUPPORT Clinical Leads

PRACTICE SUPPORT Practice Safety Officers

4 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Practice Best Practices Once leadership is in place, it’s time to make sure you are following best practices to create consistency across procedures and locations.

1. Create a comprehensive written safety manual. We’ll cover this more in depth in the next section, but make sure to include all Standard Operating Procedures (SOPs) and take into account state-specific requirements for all practice locations.

2. Rely on checklists. There are a number of things in a dental practice that require inspection, testing, cleaning, and maintenance, and the most efficient way to keep everyone on track is through checklists. Checklists also provide consistency for training and audit evaluations.

3. Implement a compliance audit system. Audits should be performed annually in order to evaluate SOP implementation. Results should be shared with the practice with follow-up plans implemented for any action items. Overall trends and lessons learned should be shared across all practices.

4. Augment with technology. Auditing apps allow you to assign tasks, order supplies, request equipment service, add photos, and run reports right from your phone or tablet. Project management software can also be very helpful in facilitating information sharing, storing calendars, to-do lists, and other important files.

5. Form a safety committee. Made up of representatives from clinical teams and HR, plus field safety officers from our practices, Midwest Dental’s safety committee meets quarterly to review accident and injury reports for trends, plan safety initiatives, review current policies, and make recommendations.

6. Take time for training. For safety plans to be effective, employees need to be properly trained. At Midwest Dental, that means new hire training plus an annual refresh and remediation as needed. By offering training and safety-support roles at every level, we also provide opportunities for growth and career advancement.

7. Reward and recognize. To make sure that safety becomes an integral part of your organization, it’s important to incentivize good behavior. Midwest Dental has implemented what we call FLOSS: Facilitating Leadership and Optimizing Safe Service, where each quarter a winner is recognized for their work in promoting safety culture.

My best advice when working to create a culture of safety is to remember that continuous

improvement is always the goal. You may not be able to change everything right away,

but small steps in the right direction make a big difference. Focus on coaching and

mentorship, track and follow up on your data, and build in multiple levels of support

and responsibility. Safety is a choice everyone can make every day!

5 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Developing an Effective Clinical Compliance Program

Having built an ingrained culture of safety, you can turn your attention to ensuring you have thorough written policies, plans, and procedures. These should be available for anyone at the practice to reference anytime.

Written Policies and Procedures First, some definitions: A safety plan is your overall, high-level approach to safety as an organization – your destination. A safety policy is part of that plan and provides a general approach directly related to the goals of the organization – the compass. A safety procedure is the part of the plan that provides step-by-step instructions – the map. [Find a customizable sample policy and procedure in the appendix.]

Sometimes written plans are required by regulatory agencies, but even when they’re not, they provide consistency, clarity, and accountability for staff and make sure everyone is on the same page.

overall strategy to achieve a specific result

PLANrules and regulations, guiding principal of an organization;

a component of the plan

POLICYguide for action;

a reflection of policy; a component of the plan

PROCEDURE

• Bloodborne Pathogen Exposure Control Plan

• Hazardous Chemical Plan

• Radiation Safety Plan

• Infectious Disease Pandemic Plan

• Medical Emergency Plan

• Tuberculosis Exposure Control Plan

• Ergonomics Plan

• And more

Creating a Safety Plan For most practices, a complete safety program will include:

6 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Occupational Safety Health and Administration (OSHA): focuses on the safety and health of employees and sets standards for employee protection. Dental practices fall under the regulations for General Industry, which include among others, the bloodborne pathogen and hazard communication standards.

Centers for Disease Control and Prevention (CDC): provides guidelines for the prevention of disease. The 2003 Guidelines for Infection Control in Dental Health Care Settings are the most current guidelines for practices, though in 2016, the CDC released a Summary of the Guidelines that expanded on or clarified some recommendations. Reference the CDC for guidance on infection control, hand hygiene, Hepatitis-B exposure prevention and management, and HIV exposure prevention and management. BONUS TIP: The CDC Dental Check app is a great tool if you are just starting an infection control plan.

Association for the Advancement of Medical Instrumentation (AAMI): oversees the development, management, and safe use of healthcare technologies. AAMI produced the comprehensive standard guiding sterilization of instruments.

Environmental Protection Agency (EPA): provides guidelines on waste disposal and radiation protection. See Dental Effluent Guidelines.

American National Standards Institute (ANSI): develops voluntary consensus standards for products, services, processes, and systems. This is where you find guidelines on dental materials and tools, dental implants, and rotary tools.

Food and Drug Administration (FDA): is responsible for ensuring the safety, efficacy, and security of drugs and medical devices. Guidance from the FDA will pertain to product use and reprocessing.

State and Local Regulatory Agencies: State and local regulatory agencies include your state dental board, health department, department of natural resources, and OSHA. These agencies provide guidance in areas such as record keeping, delegation, sedation, and infectious diseases.

State requirements vary and can be stricter than federal standards, so don’t assume that by following federal regulations you will be compliant across multiple locations.

MN

WI

IA

CO

NM

IL

MOKS

IN

MI

OHPA

NY MA

CT

NH

NJ

But where do you get the information to include in each plan? To do this, you’ll need to wade into the “Alphabet soup of clinical compliance.” Each of the agencies below provides guidelines that contribute to your plan development.

7 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Creating a Safety Procedure Procedures provide step-by-step details on exactly how to execute your safety plans, focused on what employees “will” do rather than what they “should” do. They also help standardize your process to make it clear, trainable, repeatable, and consistent.

A Standard Operating Procedure (SOP) should include the following components: title, tracking ID number, created date/ revised date, purpose, scope, impacted employees, PPE requirements, definitions and abbreviations, and resources for more information. To build your own SOP, use the template in the appendix. Keep your language clear and concise, and remember to review SOPs periodically to keep them up-to-date.

Putting Plans into Action With your policies and procedures finalized, it’s time to implement them, starting with existing employees. Be sure to express the organization’s commitment to safety and stress the importance of gaining their commitment as well. Ensure all new employees are trained on safety processes right away and that all staff understand how compliance issues will be handled. Keep an eye out for complacency or shortcuts, which can creep in over time.

My best advice when it comes to employee buy-in is, given the choice between commitment and

compliance, aim for commitment! Compliance aims to meet a minimum requirement

out of obligation, but commitment inspires people to go above and beyond and

innovate because they’ve become invested in the results. As we say at Midwest Dental,

we want to “commit to being compliant.”

8 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Resuming Safe Dental Care in the Face of the COVID-19 Pandemic

2020 brought some unexpected surprises in the realm of practice safety, so let’s dig a bit deeper into some of the unique challenges brought on by the coronavirus pandemic.

Midwest Dental made the decision to suspend non-emergent care briefly in the spring of 2020 in order to assess conditions and make a plan for addressing safety going forward. Our first step was to assemble teams to address the specific needs of reopening practices and providing patient care safely. One team was dedicated to sourcing and acquiring supplies, including PPE, while another worked on developing new protocols and systems for practices. We were constantly monitoring new reports from the CDC as well as information coming from the ADA and other dental associations.

Then, we turned our attention to the following questions:

There were four main aspects of dental care impacted by COVID-19 that needed to be adapted: PPE enhancements, use of dental aerosols, disinfecting schedules, and social distancing.

WHAT DO WE NEED TO DO DIFFERENTLY?

Some of these issues required developing full SOPs, while others could be handled via simpler guidance documents. In all cases, we found checklists to be a helpful tool to support employees as they were learning new systems. The goal with all of these references was to provide employees with resources that they always could refer back to. Moving forward, some of these changes will likely become permanent, while others will revert back to how they used to be once the pandemic subsides.

HOW ARE WE GOING TO DO IT?

Midwest Dental used a number of different approaches to make sure all employees got up-to-date information as quickly and painlessly as possible. This included opening practices in waves rather than all at once, holding town hall meetings before reopening each practice, building a website to keep employees posted on new developments, and creating an automatically updated pandemic documentation folder on all staff computers. Then we dedicated the whole first day a practice reopened to team training, allowing plenty of time for learning and questions.

HOW WILL WE GET THIS INFORMATION TO OUR STAFF?

9 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

Preparing a Pandemic Response Plan Next, we prepared our written Pandemic Response Plan, based on a template provided by the Minnesota Department of Health, the most important components of which are outlined below. You can create your own plan from the editable template in the appendix.

• Prioritizing treatment: As we reopened, it was important to determine how best to prioritize patient care and treatment, a big piece of which relied on clinicians’ professional judgement. We took into account patients’ medical history, postponing treatment if possible when the patient had higher risk factors. We also evaluated how high the patient’s need was, the rate of COVID-19 instances in their geographical area, PPE availability, whether treatment had already been cancelled or postponed, and whether teledentristy was a viable option.

• Infection control processes: We had to quickly re-evaluate both our clinical and non-clinical infection control procedures. For clinical settings, we continued to follow pre-COVID-19 CDC infection control guidelines, adding interim CDC guidance as it was released. This included changing clinical gowns more frequently (or installing washers and dryers where disposable gowns were not sufficiently available), use of N95 respirators (including fit testing and reuse optimization), and use of face shields. We also closely monitored state guidance in all of our operating locations. Aerosol management provided its own set of challenges, which we addressed by removing non-essential items, installing surface barriers and air filters, use of dental dams and high-volume evacuation, and employing our best clinical judgment. In non-clinical settings, staff and patients were required to wear masks and provided with hand hygiene stations. We increased high-touch surface disinfecting and added physical barriers or face shields, where barriers weren’t possible. Water and coffee stations were removed from public areas, and health and safety postings from the CDC were prominently displayed as reminders.

• Screening for symptoms of illness: We needed processes to help both patients and staff screen themselves appropriately for symptoms. For patients, we implemented pre-screening 24 hours before an appointment (sent via text with a link to an online questionnaire) then followed up with a temperature and symptom check in-person the day of their appointment. Staff monitored themselves for symptoms each day at home, then underwent temperature and symptom screens upon arrival at the practice, which were recorded in a daily log.

• Social distancing: To accommodate social distancing recommendations, all practices implemented restricted entry policies, with patients coming alone (or minors with a parent) and waiting in the car or outside to be called for appointments. Waiting room seating was separated, and floor markings were added as guides. Staff lunches were staggered and 6-foot distance was maintained in common areas such as break rooms.

• Infection control: While safety plans are covered more thoroughly elsewhere in this guide, make sure you have a written infection control plan and that all staff are trained on it and review it with regularity.

• Reduction of care: Finally, you need a plan for what to do if you need to reduce care again in the future. For Midwest Dental, this would be triggered by either an extreme increase in COVID cases in an impacted area or a PPE shortage.

Please stay 6 ft. away from thefront desk.

PLEASE STAY

6 FT APART THANK

YOUSTAYSAFE

10 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

My best advice for keeping patients and team members safe,

having safely navigated the successful reopening of all of our practices, is to stick with

the basics. Social distancing, masking, and hand hygiene, while simple, truly are the

most important actions you can take to prevent the spread of oronavirus.

Learn more at midwestdentaljobs.com/hygienists

Case Studies To see how this plays out in real life, read more about how these Midwest Dental hygienists are making an impact on safety at their practices:

“I get to work with other hygienists locally and with more experienced hygienists on the regional level.” - Anne K.

Read Anne K.’s Hygienist Story

“My heart is for the patient, our doctor, and our staff, and my job is to do everything I can to increase safety for everyone.” - Christine D.

Read Christine D.’s Hygienist Story

“I feel very confident telling patients that it is safe to come in when they ask.” - Bobbi F.

Read Bobbi F.’s Hygienist Story

READY TO CONSIDER A CHANGE?

11 The Complete Hygienist’s Guide to Promoting a Culture of Safety in Your Practice

About the Author

Angie Michlig is the Manager of Clinical Programs and Safety Committee Chair for Midwest Dental, managing OSHA, infection control, and continuing education programs for the organization. She holds a certificate in Dental Infection Prevention and Control from OSAP and the DALE Foundation and is a member of the Organization for Safety, Asepsis and Prevention. With over 29 years of industry experience, Angie works to develop and implement policies, procedures, and training programs to help practice teams create a culture of safety and compliance.

About Midwest Dental

Midwest Dental is a Dental Support Organization (DSO) with a 50+ year history of safety and compliance reaching across over 200 practices in 17 states. We’re always hiring talented and passionate hygienists, so if you’re ready for your next move, check out open opportunities here.

1. Sample Safety Policy pdf A policy is a short statement that gives an organization general direction and provides the guide for action as set by upper management. (Company Name) is committed to providing a safe and healthful work environment for our entire staff. In pursuit of this goal, the following exposure control plan (ECP) is provided to eliminate or minimize occupational exposure to bloodborne pathogens in accordance with OSHA standard 29 CFR 1910.1030,“Occupational Exposure to Bloodborne Pathogens.”

2. Standard Operating Procedure Template https://midwestdentaljobs.com/wp-content/uploads/2020/10/Standard-Operating-Procedure-Template-Fillable-1.pdf

3. COVID-19 Response Plan Template https://midwestdentaljobs.com/wp-content/uploads/2020/10/COVID-19-Response-Plan-Template-editable-1.pdf

Appendix: Customizable Templates