Archive for June, 2012


If you are a professional, you have experienced the scenario when someone is doing your job instead of you. Here we are not talking about others with equal credentials but about those that do not have them. Good model to explain the issue is relation between general dentists and orthodontists/dental surgeons in which first party plays a role of outsourcer and last one is outsourcee.

Yesterday I attended a meeting of General Assembly of European Federation of Orthodontic Specialists Associations – EFOSA. That body is top organization in Europe that represent orthodontic specialists. Among other topics, we have discussed about dealing with General Dentists that are practicing orthodontics. We have heard that in┬áCzech┬áRepublic orthodontic therapy is protected by the law, but this is not the case in other countries. There are countries where insurance companies do not want to pay orthodontic therapy to others but orthodontists and also those (like UK) where insurance will pay┬áwherever┬ápatient finds a therapist.

We are witnessing that in modern times we are deregulating many things. Perhaps we must not deregulate this issue, but to put it in the protected list you have to find a good reason. In USA, American Association of Orthodontists have done a survey where they wanted to show that the result of therapies done by general practitioners statistically differ from those done by orthodontists. The result showed difference, but without accepted significance. But that does not mean anything because in USA anyone that does orthodontic therapy is very careful because of the American legal system. Doctors that are not┬áofficially┬áeducated in residence programs are very careful: they choose only simple cases, they invest large sums to their education, they follow┬áscientific┬áliterature and they are counselling with orthodontists. All because of fear of mistake and in the end because of legal and financial consequences. We can see that effective legal system protects patients in this matter. In other parts of the world it is more complicated to determine doctor’s responsibility.

My opinion is that┬áthere is no legal instrument that can solve the problem. You can try to solve it by fighting it’s roots: to care about feasibility.

Why/where/when general practitioners are practicing orthodontics or dental surgery? After profound consideration you will see that in every case it is well linked to price levels. Everyday we can see more and more simplified approaches to medical and dental procedures. That is forcefully introduced by sellers of dental materials and equipment because they want to extend number of their customers to a larger group so they want to include general dentists to the business. New procedures help doctors to be quicker and to have better results in the end of any procedure. But, they also help general dentists to perform tasks previously reserved to specialists not because they are mean, but because they want to decrease their costs and to increase income, too.

In my experience, general practitioners basically do not want to do procedures reserved for specialists, otherwise they would finish a residence program. They only want to have excellent interdisciplinary team and not to lose money in vain. Specialists have to be aware that their services are required and that they have to be realistic and to adjust their fees. If your procedures simplify and/or your costs decrease, you have to consider changing of your prices, especially in the time of crisis. You have to be more reasonable and to offer good prices which will satisfy yourself, but which will not attract other dentists to start this unwanted behavior.

Be quick and well-informed. Be ready to make suitable deals for yourself, for patient but also for general practitioners. If you let them do easy procedures reserved to specialists, they will do more and more. That happened with dental implants and now everyone is inserting them. It is hard and very demanding to be a specialist. Specialists were educated to do complicated procedures and because of that they are recognized and well paid. But if they start to be overpaid, their dominion will decrease or in the extreme they will seize to exist.

The same story can occur in every other profession. What will happen if changing the wristwatch strap will cost you 100$ or if newspaper delivery 50$ daily? You know the answer: watch repairers and deliverers will be out of business!

We are frightened and bombarded with news in everyday basis that data collected in medical or dental procedures could be compromised. That is true, but that was also true in the time of paper medical charts. Today, I want to emphasize few important security tips.

When we organize access for doctors, nurses and administrative personnel, we have to select their rights wisely. It is not needed for one nurse to see doctor’s professional memo on patient condition and it is not needed for one administrative officer to see if the patient has genital herpes in the medical history. As a doctor and a professional developer I work on both sides so I see many not needed security restrictions that influence productivity but also many freely available information which is not needed and could lead to data breach.

Many medical and dental programs have a problem with separation of data and data access. In most cases it is because of wrong approach toward planning where developer wants to satisfy all requests. By interviewing users we do collect very important information about needs, but also we can expect from all parties to express their need for accessing all data. Of course that we should take care on user’s needs, but access rights should be properly fine tuned and adjusted by following rules of good practice and after talks and understanding with management.

Second, but not less important is to be aware that there could not be successful separation of rights if we employ people without awareness that they are working with sensitive and confidential data. For example, I have had requests from my managements to limit IT administrator’s rights or to limit developer’s rights, but it is not possible. You cannot take someone without professional attitude and to employ him/her as a chief database administrator and after that to ask if there is any way to limit his/her access to the database. That would definitively prevent him/her to do anything, even good. The same thing is with users like doctors, nurses and administratives.

Statistically, the highest risk of data breaches occurs because of users. It cannot be eliminated, but it can be effectively decreased by security controls, by logging and by assigning of patients. For example, doctor needs to see data only for patients that he administers. When patient arrives the receptionist assigns him/her to first available doctor and from that time doctor sees all data related to that patient. There is some modern ideas that the system should not be very restrictive on access rights but to inform all employees that everything done is logged and to monitor their activity in regular intervals. That could be even more successful than restrictions without logging.

To summarise all: you cannot project a secure system if it will be used by people without any trust from the management. If you do have some level of trust, you have to adjust personal access level accordingly to that trust and to person’s professional needs.

 

We can read every day that there is a great discrepancy between creation of new professionals and demand. It is one of most influencing factors responsible for this slow crisis resolution.

In the United States there are many extremely good and very attractive programs that produce innovative young engineers such as Massachusetts Institute of Technology, California Institute of Technology and many others. But, today we see that there is a problem because many employers cannot find them enough. Why to oppose the idea to find them outside USA?

There are some countries with long experience in education of highest educated professionals. In many such countries that individuals cannot find appropriate employment and are thinking to emigrate. If they are not seeking a job in their region, the first distant site for the most of them is USA. From outside perspective, USA are impenetrable for skilled highly educated professionals of any type. No one knows why. In the other hand, we see in everyday basis that successful multinational companies are opening corporate offices in India, China, Hong Kong, Russia, etc. The first reason is because they cannot find enough needed professionals and the second is that in the most cases they can pay them less.

There is something that is unknown to many US employers. In many countries people have cheap but good education system. The example is Croatia (Europe) a home of many leading institutions of higher education in Eastern Europe. In the other hand, all education is totally free for all citizens. I do not want to enter into details, but the known fact is that Croatian system of higher education have produced many largest ships captains, many chief engineers on many projects in Latin America, Northern Africa, Singapore, Middle East, etc.

If you are a recruiting officer or manager in the USA, you should ask yourself why you do not use a personnel from a country like Croatia, a personnel without any bonds or loans? A personnel from a country with long European culture, very creative, well-educated and very talented. Croatia is only one example, and there are many countries alike, especially in Europe. Today we see that trends are in opposite direction: USA need more educated professionals and in the same time they fortify their immigration rules.

I like USA, especially its idea of free business, but as time goes by I see that USA are going far from its roots, far from something that made USA so attractive to all people. To paraphrase President Reagan’s sentence from Berlin: “President Obama, tear down this immigration wall!”

Whatever you do or sell you will have somebody unsatisfied with your performance or product. That complaint must not be on real basis, but you should know how to react. What to do specifically after customer tells you that he/she is not satisfied with your performance or your product?

Prevention is the most helpful thing. You should not think: “I will promise everything and I will deal with problems in the end”. When you take the order, you have to detect what a customer wants and that must not be equal with what customer says he/she wants. To deal with that, learn from the best and try to practice it in every occasion. Do not force customer to take what he/she does not want. Instead, try to develop a need for something in customers perspective. That is a good practice.

If a customer comes with a complaint, first do not panic! At first, listen carefully all that other party is trying to say to you. You should detect is there objective reasons for a complaint. Sometime you will find it, sometime you will not.

The worst thing you can do is to argue with a customer. Even if a customer elevates his voice you should rest calm. Why? Because if you adjust your voice with a customer you help development of the affect inside his head and the main reason to even talk with a patient is to decrease or to eliminate that affect. In psychology, affect is short-term emotion caused by something. People think much different in the state of affect and are ready to do many things that they will not do without it.

If a customer has no objective reason for a complaint, you have to try to explain whole process and to try to find potential other reason for that complaint. We can see often that after we do our business correctly, our customer tries to avoid paying or to get lowered price. Of course, if you have done your job professionally the only reasonable time for price negotiation initiated by customer is before any procedure. If you are forced to negotiate price after procedure it should be only damage control negotiation because it is better to get anything rather than nothing.

If a customer has objective reason for a complaint, first tell that you will try to investigate what happened. If it is your fault or not, next thing you must do is to apologize and to say that you will do anything possible to quickly correct the problem and if it is not possible that you will find the way to compensate him/her. In this case you should think about something. This customer is not satisfied with your performance because you have done something wrong. Here you should try to decrease negative advertisement and not to be tight on compensation because customers love to see that if it was your fault you are ready to play fair. It was your fault and it is cheaper to pay slightly higher compensation then to have person that will share his experience wherever he/she can.

One additional thing: In whole conversation you have to take care on many nonverbal messages you are giving. If a customer does not want to feel your sentiment he/she will send you a written complaint. But you will see that among all complaints oral ones are the most frequent. Why? The customer is trying to detect whether you understand his/her problems and how you will take it seriously. If you succeed in that interview you will leave good impression toward a customer and that will be the strongest impulse that will cancel any further problem.

Do not misunderstand me: you must not be a good man if that is not your style, but this kind of behavior is good for a business and positive cash flow which is in the end very important!