Guest article by Gary Chapman – Portman Healthcare
Could Gordon Ramsay work in McDonalds? Could Michelle Roux jr run a restaurant owned by Burger King? Without knowing either personally I can only guess at the answer, but to me the answer is obvious. Why would a chef who has spent their life focused on quality, customer service and excellence in outcomes work in an environment that is focused on high quantity, low service and big scale? Not only why would they, but how could they? The same question can be asked of corporates that combine both NHS and private dentistry. With such fundamentally conflicted philosophies can the same company address the needs of both NHS and private clinicians and patients? I would argue they cannot, and the move of the large corporates into the private sector, bringing NHS philosophies and operating procedures, spells disaster for the practices they acquire. NHS corporates are focused on ‘servicing’ their customer, which is the NHS contractor, and their shareholders. In simple terms this means doing the most UDAs, in the shortest amount of time, using the cheapest labour. The primary focus is not on clinical outcomes, but on fulfilling the contract and maximising profit. Private dentistry is the inverse of this. Fundamentally it is about achieving good clinical outcomes, and caring for the individual needs of the patients. This requires time, an environment that promotes high levels of care and customer service, and staff and clinicians that have the expertise and resources to operate as they see fit. I would think that all dentists reading this article would agree that the management and customer service that these two types of practices deliver and the way they deliver it is ‘Chalk & Cheese’. What is the reality of trying to blend these philosophies? I believe this can be broken into a three areas. The relationship between the dentist and the company, the relationship between the dentist and the patient, and the long term viability of the practice. To take an American analogy, in the NHS the relationship between the corporate and the dentist might be summed up as white collar / blue collar. The dentist is part of the surgery, the surgery is a productive unit. If there is no dentist then the productive unit does not function. There needs to be a dentist in the surgery, but which dentist matters little. As long as they are qualified, can complete a certain number of UDAs in a specific amount of time then that is fine. As supply of patients is guaranteed the cost of ‘production’ is the key metric. The success of the corporate requires paying the minimum for UDAs completed and limiting the choice of materials and laboratories. In this relationship the dentist wears the blue collar. In the private sector the relationship between the corporate and the clinician is a white collar / white collar partnership. Supply of patients is not guaranteed so the company and the clinician must work together to provide a service that results in the patients wanting to return. The quality of care and customer service are the key metrics. The company must allow the clinician the time to understand the patient’s needs, and the freedom to use the material and laboratories that are most appropriate. The company must provide an environment and systems that focus on looking after the patient and the dentist. It is only in an environment that is empathetic to the needs of the patient and the dentist that a long term relationship, built on continuity of care can be established. It is only where both the company and the clinicians wear white collars that private practices can be successful.
What do these philosophies mean for the relationship between the patient and the clinician? This is self evident, private care is a highly personalised, relationship driven service. In the NHS the relationship is primarily focused on servicing the needs of the contractor, and the shareholder. With such conflicted approaches it is far from clear how a management team can set out to be all things to all men. The result is one of two things. The NHS component is run as a loss leader, as it is in many independent practices, as a means of supporting the private practice that is profitable. Or the private practice is dubbed down to address the needs of the NHS, ultimately becoming an NHS practice in philosophy if not provision. In either event the results can be disastrous for the practice. With such conflicting philosophies and management demands the NHS corporate march into the private sector makes for uneasy viewing. If you are left selling McDonald’s burgers from your Michelin starred restaurant you may be left screaming for Gordon Ramsay’s “F word.”