Dental practices are exposed to a variety of risks. "Operational risks" include over-investment in equipment, victimization of wind reviews caused by patient complaints (rumors, online postings), generation of accounts receivable, and information leakage problems.
"High risk" includes medical malpractice, medical equipment failure, natural disasters, and crime. Nowadays, it is more and more important for us to take measures against these risks.
1. Types and contents of business risks
2. Complaint risks and countermeasures
(1) Risks arising from complaints Complaints can generally be used as a valuable resource of information to improve the institution's system, for improving medical services, ensuring safety, etc. However, in recent years, there has been an increase in the number of instances of malicious complaints, and cases of foul language and violence that have a significant impact on business.
The inappropriate demands, bad language, and violence of some of these malicious visitors, represented by "oddball patients," pose a significant risk to dental providers.
Bad language is defined as slander (e.g. "quackery"), verbal abuse, sexual harassment, and other words that disrupt the mood of other patients and staff, or have an impact on the business, not only verbally, but also in the form of flyers and online postings.
In response to the above, we need to think of measures in advance just in case.
(2) How to deal with malicious complaints (Society) The Medical Management Countermeasures Committee of the Sapporo Dental Association has released a pamphlet for members called "A guide to dealing with emergencies". Some of the contents are described below.
※The Emergency Response Kit (Excerpts from the kit issued by the Sapporo Dental Association)
● When a person is judged to be a malicious complainant because he or she repeatedly makes inappropriate requests, is considered to be mentally challenged, is motivated by money, or is cyber-victimized, etc.
How do I respond to a complaint? Response process?
①Director of the clinic will respond to the request and confirm the details of the complaint (medical records and a detailed list of payment for treatment)
②Apply audio and video recording when the request is made, as appropriate
③Apply to the dental association, a lawyer, or the police
●When you are subjected to violence
Don't try to stop it easily, but run away from the person who is causing the violence (it's also very effective to set up the emergency bell) and call the police. (setting up an emergency bell is also effective), and call the police. Collect testimonies from patients, employees, and other relevant people who were present at the scene, write down the date and time, and get all the witnesses to sign to make it into evidence. Surveillance installed in a conspicuous place where it can be seen at a glance can act as a deterrent and reduce violence and bad language. As long as you put a warning sign at the entrance that says, "In order to prevent illegal and criminal behavior, there is a surveillance camera in the yard that records images," you will not be violating the Personal Information Protection Act or privacy issues.
●Can you refuse to treat a "difficult patient"
Article 19(1) of the Dentist Law states that the hospital has a duty to treat, but if the hospital determines that it is a nuisance, or if the patient is intoxicated, or if the hospital is unable to respond appropriately, the hospital will be considered to have a valid reason for refusing to treat the patient. However, the hospital shall not refuse treatment on the grounds that the patient does not pay for treatment.
In addition, some clinics have made manuals of responses to street talk and online postings.
■Specific examples of manuals
●When a request is judged to be inappropriate, the place of the interview is designated by us. (Ideally, it should be in a room with posters such as "Violent Eviction" by the police, a larger table, and two entrances.)
●The person who is ultimately responsible, such as the dean, will not respond directly, but will respond with more people than the other party.
● Divide the time to respond.
● Record the conversation. (Some attorneys do not need to tape inform.)
● Avoid misleading expressions, speculative statements.
● Do not stamp, sign, or submit documents lightly.
3. Risks of information leakage and countermeasures
(1) Risks to personal information
There are many opportunities for oral healthcare providers to know personal information. Starting from the production of medical records to the taking of X-rays to save film or data. In addition, personal information is also provided when submitting an itemized statement to the organization that examines and pays bills for medical treatment, when providing information to other operators, when conducting a health diagnosis, when sending a notification of the results of an employee's health diagnosis to the workplace (operator), and when sending a letter of instruction for a technician to a technical laboratory. Recently, many problematic cases have broken out, such as disclosure of medical records and lending of X-rays, which require extra caution.
As mentioned above, there are various situations in which dental care providers come into contact with personal information and provide it to others. This will inevitably lead to risks of violation of law, breach of trust, and damages caused by information leakage. As medical professionals, we need to strengthen our awareness in this area, and properly manage medical records, consultation and treatment remuneration details, photographic film and other items (paper, data, film, etc.) to prevent the leakage of the information obtained.
(2) Countermeasures for the protection of personal information
With the enforcement of the Personal Information Protection Law in 2005 and the amendment of the Medical Care Law in 2007, dental medical institutions have been given the obligation to establish measures for safety management and measures for nosocomial infections, and the necessary measures for the protection and management of personal information are described below.
■Improvement of organizational system
①Establishment of Personal Information Protection Committee
②Appointment of Personal Information Protection Manager
③Improvement of the window function for handling complaints related to personal information
■Improvement of regulations related to personal information
①Designation of the Personal Information Protection Guidelines
②Designation of regulations for the personal information ①Establish personal information protection policy
②Establish personal information protection regulations
③Regulate the process of disclosure of personal information
④Establish the process of responding to the leakage of personal information (handbook)
⑤Establish the process of handling personal information complaints (handbook)
⑥Establish the provisions of the labor contract and other provisions relating to the duty of confidentiality, including the aftermath of separation from the company
⑦Enter the contract of outsourcing of business to include measures for safety management, obligations of the contractor, etc.
■Disclosure of medical records and lending of X-rays
In principle, it is important to respond to requests for disclosure of medical records as soon as possible.
①Require the submission of a "Request for Disclosure of Medical Records, etc.
②Require the submission of a "Power of Attorney" in the prescribed format when an agent, etc., requests disclosure
③After confirming the "Request for Disclosure," deliver a "Reply Letter" in the prescribed format for a quick response
④Keep all the records related to disclosure
. 4, accounts receivable risk and countermeasures
(1) Accounts receivable placement risk
For oral health care institutions, a small amount of accounts receivable continue to accumulate after the clinic will also bring risks to the operation. Accounts receivable are mainly "window burden of unpaid and underpayment", once generated, it is difficult to recover. Patients who have already finished their treatment will be resistant to paying for it later, and it will be difficult for the hospital to recover it from them, and the prerequisite for recovery is to urge the patients to come to the hospital.
(2) Countermeasures for accounts receivable
①Preventive measures for accounts receivable
The basic countermeasure for accounts receivable is to pay more attention to preventive measures than recovery. It is important to establish a mechanism to collect accounts receivable when they arise within the institution in advance.
■New payment options
●Collecting deposits
If you are planning to receive a high-cost treatment such as an out-of-coverage treatment, you can collect 5,000 to 10,000 yen at the time of the start of the treatment
●Adopting a payment system in installments
For patients worried about their finances, you can make a proposal for paying in installments at the consultation counter for medical fees
●Introducing credit cards and debit cards
●Introducing a credit card and debit card for medical services. Credit and debit cards
■Adequate provision of information
●Proactive communication by clerks based on the contents of the consultation
At the time of billing, we ask, "Do you have any questions or don't you understand anything?"
The doctor confirms the contents of the consultation and treatment that is to be carried out afterward, and explains them adequately
Privacy protection
We have also introduced a system of installment payment for patients who are worried about their finances
. p> ●Privacy protection
Payment is a sensitive topic, so it is important to have a private space, such as a counseling room
②Methods of collecting accounts receivable
●Collecting accounts receivable directly or over the phone
●Communicating the meaning of a general letter of urging
●Sending a letter of urging through a mailer with a warranty of the contents of the letter
●Sending a letter of urging under Article 382 of the Civil Procedure Code
●Completing a letter of urging through an e-mail with a proof of contents
. To follow the urging procedure according to Article 382 of the Code of Civil Procedure ? Civil Litigation
When recovering accounts receivable, you should avoid escalating the situation into a doctor-patient dispute. Especially in recent years, there has been an increase in the number of cases in which patients intentionally fail to pay for treatment, and the amount of each account receivable has increased. If payment (accounts receivable collection) is not treated in the right manner, it may affect the patient's mood and lead to negative word of mouth, so we need to recognize the type of patient who is late in paying as early as possible.
5. Countermeasures against over-investment and investment risk
(1) Equipment investment risk Recently, there have been various forms of dental care that have been hailed as "advanced". The evolution of technology has easily made the impossible possible. The evolution of regenerative medicine and low invasive medicine has been particularly rapid. Starting with lasers, the digitization of x-ray devices, and the development and distribution of dental CTs, dental MRIs, and other devices.
However, over-investment in equipment can hit clinic operations hard. An imbalance between revenues and expenses can lead to deterioration of cash flow and ultimately the risk of closure. It is important to consider the clinic's approach to treatment, fully explore the current demand for treatment and the cost-effectiveness, and then determine the investment in equipment on that basis.
(2) Countermeasures against investment risk For dentists who are committed to providing better care, "state-of-the-art" medical equipment is a dream come true. Among them, there are standardized equipment with high treatment success rates and treatment scores. However, medical equipment that has come onto the market in the past two to three years is expensive and will only increase the burden on clinics and even lead to an operational crisis.
"Advanced" for medical professionals has yet to penetrate the hearts and minds of patients. "Patients do not realize that installing expensive equipment can dramatically increase the success rate of treatment, and that this kind of dental institution is very reliable. Because at this stage the success rate is still largely dependent on the knowledge and skills of the operator.
Competition among dental practices will continue to increase. It is dangerous to consider investments based on steadily increasing projections of operating values. It is best to exercise discretion and judgment as to whether you can buy and should pay at this time.
■Considerations when investing in equipment
● Is it in line with the clinic's treatment policy?
● Does it meet the needs of the clinic's patients?
● Have you considered cost-effectiveness?
● Will the payment have any future impact given the current financial situation?