Maintaining continuity during a global pandemic

On December 31, 2019, reports emerged from the Wuhan province of China concerning a cluster of cases of pneumonia – with no deaths – from an unknown cause. By the following week, health authorities had identified the outbreak as a novel coronavirus (SARS-CoV-2) and China had reported its first known death caused by the virus; the disease it causes was eventually named “coronavirus disease 2019” (COVID-19).

COVID-19 diagnoses quickly began to appear across the globe. Nearly one month after the first documented COVID-19 diagnosis, a World Health Organization (WHO) report was released, detailing the first confirmed cases outside China in Thailand, Japan, and South Korea.

Timeline detailing key events for the dental industry during the COVID-19 outbreak:

January 21 – The United States announced its first confirmed coronavirus case.

January 30 – The World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern (PHEIC), as more than 9,000 cases were reported worldwide.

March 17 – The American Dental Association (ADA) recommended all dental practices close to non-emergency procedures.

March 31 The ADA extended the date for the closure of all dental practices for non-emergency procedures.

May 8 – Dental practices were approved to resume normal activities.

Dentistry Policies Changed Throughout the Initial Months of the Pandemic

Information evolved rapidly to inform our understanding of the disease during the first few months of 2020. As each new detail was revealed, policies and procedures continuously changed in this new, distressed system. Taking into account guidance from the WHO, each country (and organization) developed policies to manage the impact of the epidemic, but, ultimately, the information was interpreted in many different ways.

The initial view for most state-level organizations was that dentists and their teams should continue providing care using standard precautions set forth by the CDC, unless patients had symptoms or close contact history to affected areas or people. This advice didn’t seem logical to many practitioners, especially considering the social distancing measures that were introduced to the general population.

Dentists, hygienists and other oral health care workers are considered to be at higher risk for transmitting and contracting the infection than many other professions (Figure 2). Not only are they in close proximity to their patients, but they also handle tools that can disperse germs and drops from the mouth to the air.

covid 19 details

Above: Chart identifying how often workers in a given profession are exposed to disease and infection and how close people are to others during their workdays (The New York Times).

Quickly, the CDC and American Dental Association (ADA) came to the realization that, as an industry, we could, now, only delay the spread of disease. As a result, the decision was made on March 16 to recommend dentists keep their offices closed to all but urgent and emergency procedures until April 6 at the earliest. By April 1, the recommendation had been extended to April 30. Ultimately, offices didn’t open until May 8, 2020.

Oakpoint’s Comprehensive Pandemic Response Plan Had Three Components:  Assess, Assume & Consider

 

  1. Assess

The ADA’s announcement in early April brought with it a wave of uncertainty that shook the industry. Planning for a potential emerging infectious disease pandemic, like COVID-19, is critical to protecting the health and welfare of not only our practices but also our communities.

To examine how dentists were handling COVID-19, the ADA Health Policy Institute (HPI) launched an ongoing biweekly poll the week of March 23, 2020. Preliminary poll results showed 76% of dentists surveyed had closed their offices to all but emergency patients during the COVID-19 pandemic (below).

Poll results HPI

Above: Poll results gathered by the HPI.

As health care professionals, it is up to dentists to make well-informed decisions about their patients and practices. But, as news of extended closures were announced, DHCPs across the nation began to seriously contemplate just how long they could withstand the circumstances at hand. Though fiscal hardships during a shutdown are an unavoidable reality, was there hope for survival? The answer for Oakpoint’s dental group was a resounding yes!

 

Oakpoint began:

  • Real-time monitoring of governmental agencies to ensure the practice was adhering to the proper guidelines
    • Centers for Disease Control & Prevention (CDC)
    • American Dental Association (ADA)
    • North Carolina Dental Board
    • American Academy of Orthodontists (AAO)
  • Enhancing levels of Personal Protection Equipment (PPE) to create a buffer allowing for continuity of the operation upon opening
  • A COVID-19 document resource center was developed and distributed to team
  • Infection Prevention Measures:
  • Established comprehensive infection prevention protocols
  • Sourced Personal Protection Equipment on a proprietary basis through existing network
  • Trained entire team on newly developed infection prevention strategies
  • Overhauled both facilities, implementing more robust safety measures
  • Communicated to both the team and patients about upgrades
  • Invested significant capital to place the group well above the baseline industry standards
  • Communication on enhanced protocols sent to patients

 

2.  Assume

COVID-19 is what economists call a “black swan” — an unpredictable event that has potentially severe consequences. Black Swan events are, by definition, very difficult to anticipate, yet they are a part of risk management. A business’ survival may very well depend on its ability to respond to these events.

In the face of unpredictability, many business owners become overwhelmed with trying to “predict” the outcomes of the event in question. This is the wrong emphasis. The main focus for business owners facing these troubles should be determining the critical impact on the business and its people. As humans, we have a propensity to form assumptions about the way our environment operates, allowing us to make decisions in the face of uncertainty, and operating a business is no different. By pinpointing organizational core assumptions in three areas, we have been able to successfully mitigate the lasting effects of the pandemic.

 

A) Identified Changes & Organizational Response Capabilities

    • All human resources were activity managed
    • We worked directly with each individual employee to ensure success
    • A program allowing team members to leverage Personal Time Off to extend compensation without prolonged disruption was creatively constructed
    • We actively engaged with team members on multiple occasions each week

B) Prepared for Financial Impact

  • Vendor Management
    • All vendor payments managed closely
    • Communicated with all vendors
  • Paycheck Protection Program / SBA Program
    • Researched
    • Paperwork completed
    • Successful receipt of funds in Phase I of the program
  • Capital Sources
    • Institutional capital secured to strengthen balance sheet

C) Strengthened Communication and Marketing

  • Closely managed all digital communication and messaging
    • Including Facebook, Instagram, and website content
  • Patient Outreach
    • Daily “Care” calls established to maintain patient engagement

 

3. Consider

The COVID-19 pandemic is forcing dental practice owners to face challenges they never imagined they would need to be prepared for. This is causing the industry to develop innovative business practices to assuage the otherwise harsh realities of the situation for patients and providers alike. Oakpoint engaged with their teams and continued to offer education and training to keep employees active in the practice.

Engagement:

  • Bi-Weekly video conferencing calls established with the team to drive continued engagement
  • Teledentistry solution was researched, identified and deployed in early April 2020.
  • Deployed video conferencing solution globally across the footprint

Education:

  • Continuing Education solutions were provided to employees before opening practice

Training:

  • Established comprehensive training program for the team to ensure safety
  • Developed Back-to-Work playbook outlining all facets of the practice
  • Trained team on the newly developed patient workflow

 

Staying Strong During the Pandemic and Beyond

 As practices reopened, Oakpoint helped each one set a new standard of safety and cleanliness across the board. Adding extra measures that were above and beyond industry standards are making our practice leaders in safety.

The following enhancements were put in place as a result of Covid-19:

Health Screening

All patients, including new patients, will receive additional health screening questions per CDC guidelines.

Thermometers

The use of no-contact digital thermometers are in use to screen the health of each patient who visits the practice.

Sanitizing Stations

No-Touch Sanitizing Stations were installed throughout facilities encouraging strong hygiene for everyone.

Handwashing Oakpoint

Protective Masks

Teams are using the most protective masks available in the market. They are purchased directly from the manufacturer, removing the chance of counterfeit products which are flooding into the marketplace. Oakpoint’s resource is one of just a few FDA approved suppliers.

Oakpoint Handwashing and masks 2

Plexiglass Protection

Plexiglass was installed at the front desk of each location to provide additional protection.

Keyboards

Antimicrobial protection was placed on all keyboards to better protect teams.

Face Shields

Each clinical team is using face shields along with customized goggles to provide enhanced protection.

Hands-Free Vacuum

One of the most advanced technologies in the market, a dental isolation system providing two channels of continuous hands-free vacuum suction, was installed. The system is designed to isolate two quadrants at once, simultaneously providing tongue and cheek retraction, and continuous suction.

MicroShield 360

The MicroShield 360 system, a multi-step application process that works to immediately kill then prevent future pathogens from living on treated surfaces, was applied. Applying this special coating all over the office provided an additional measure of preventative protection. So far, Oakpoint’s partner Carolina Braces is the only orthodontic practice in the Research Triangle utilizing this technology.

Oakpoint continues to ensure the safety of its practices and their patients by constantly monitoring the latest information surrounding the pandemic and by using the highest-quality technology and equipment. Our strong vendor relationships make it possible to acquire whatever supplies each practice needs. Keeping our team, patients, and everyone else healthy is, and will always be, the first priority. Each practice that partners with Oakpoint will experience this high level of support, during and after the threat of COVID-19 is completely gone.