Practice Evaluation Survey

LIST OF SERVICES

List of consulting services

15-Minute Practice Evaluation Survey

Practice Evaluation Survey

Progress:

Section 1: Overview:

What are the major needs (at this time) for your practice? (choose all that apply)

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

a) Public Relations

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

b) Practice Website and Software

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

c) Phone Management

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

d) New Patient Marketing / Intake

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

e) Patient Education

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

f) Initial Diagnosis / Education

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

g) Treatment Plan Presentation

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

h) Cash Plan Management System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

i) Patient Tracking System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

j) Recall System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

k) Missed Appointments System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

l) Financing (Billing) & Collections

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

m) Insurance System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

o) Referral System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

p) Patient Reactivation System

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

q) Staff Hiring / Training Systems

Practice Status:

Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

r) Staff Meetings

Section 2: Executive Leadership:

a) Are you satisfied with your income level?

Section 2: Executive Leadership:

b) On 1-10 scale, is your stress level below 3?

Section 2: Executive Leadership:

c) Have you had leadership training?

Section 2: Executive Leadership:

d) Do you have a written practice philosophy?

Section 2: Executive Leadership:

e) Do you create a strategic plan each year?

Section 2: Executive Leadership:

f) Do you have a personal business coach?

Section 2: Executive Leadership:

g) Do you have business marketing training?

Organizational Structure:

a) Does your practice have an organizational chart?

Organizational Structure:

b) Does each staff member have a list of job responsibilities that everyone knows about?

Organizational Structure:

c) Is it easily apparent who is responsible for certain duties and responsibilities?

Organizational Structure:

d) Is your practice prepared to cover for a staff member who leaves unexpectedly?

Organizational Structure:

e) Does staff know who their supervisor is and who is responsible for evaluating them?

Chain of Command:

a) Does your practice have departmental leaders?

Chain of Command:

b) Do members of the leadership team have authority as well as responsibility?

Chain of Command:

c) Do they make, communicate and stand by their decisions?

Chain of Command:

d) Are staff members’ complaints and concerns always addressed to the correct person?

Chain of Command:

e) Are leaders supported by the practice top management?

Decision Making Structure:

a) Is there a clear decision-making process in the practice (e.g., certain decisions are made by consensus, others are made only by dentists, and still others are reserved for “the boss”)?

Decision Making Structure:

b) If a process does exist for making decisions, is it followed each time?

Decision Making Structure:

c) Does staff know how decisions are made?

Decision Making Structure:

d) Are decisions communicated from the practice’s leadership to all staff?

Decision Making Structure:

e) If a staff member has an idea about an improvement or change to the practice, is there a clear process for gathering suggestions and submitting them to management?

Decision Making Structure:

f) Does the practice make decisions quickly?

Decision Making Structure:

g) Is the practice flexible and cooperative?

Decision Making Structure:

h) Do you have methods for communications among all levels of the practice?

Decision Making Structure:

i) Do all providers and employees understand the patient’s needs and place priority on those needs?

Decision Making Structure:

j) Does the practice culture encourage and reward continuous improvement?

Please indicate which of these services your practice now outsource to other organizations:

Interface with Outsourced Services:

If applicable, do you currently have online interface with any of the  outsourced services listed below?

Human Resources:

a) Do you have recruitment and hiring process for your practice?

Human Resources:

b) Is your staff provided with copies of the employee manual?

Human Resources:

c) Do you conduct performance evaluation for your staff on a periodic basis?

Human Resources:

d) Do you have salary administration guidelines and schedules for your practice?

Human Resources:

f) Do you have an active employee incentive plan (bonus system)?

Human Resources:

g) Does your HR department properly document disputes (if any) that occur between staff members?

Human Resources:

h) Do you have a corrective action system?

Human Resources:

i) Does your human resources department have standardized Termination / Separation Forms?

Compliance Plan:

a) Do you have a dedicated staff that handles your regulatory and compliance issues (OSHA, HIPPA, DEA, etc.)

Compliance Plan:

b) Do you have the required CE credit for staff and doctors properly recorded?

Compliance Plan:

c) Do you have a CE calendar for all doctors and staff?

Critical Practice Data Safety:

a) Do you have online backup of all practice computer data?

Critical Practice Data Safety:

b) Are your backups verified daily?

Section 3: Team Dynamics.

a) Do you have written job descriptions?

Section 3: Team Dynamics.

b) Training program for each employee?

Section 3: Team Dynamics.

c) Written system for every procedure

Section 3: Team Dynamics.

d) Written scripts to train new employees?

Section 3: Team Dynamics.

e) Scripts for every routine patient question?

Section 3: Team Dynamics.

f) Written customer service protocols?

Section 3: Team Dynamics.

g) Customer service training program?

Section 3: Team Dynamics.

h) Do you have a self-managed team?

Section 3: Team Dynamics.

i) Would you consider each member of your team to be a 7 or above on a scale of 10?

Section 3: Team Dynamics.

j) Is there any individual team member with whom you truly dislike working?

Section 3: Team Dynamics.

k) Does staff function like a team with each person having a stake in the success of the practice?

System Review:

a) Do you have a KPI (Key Performance Indicators) System?

System Review:

b) Do you have a Personalized New Patient Experience?

System Review:

c) Do you have a Non-Surgical Perio Evaluation and Treatment System?

System Review:

d) Do you have a TMJ Evaluation System?

System Review:

e) Do you have a Reconstruction Checklist?

System Review:

f) Do you have an Ortho Evaluation System?

System Review:

g) Do you have an Implant Evaluation System?

System Review:

h) Do you have a Cosmetic Analysis and Planning System?

System Review:

i) Do you have a Smile Analysis Form?

System Review:

j) Do you have a Staff Bonus System?

System Review:

k) Do you have a Team Results System?

System Review:

l) Do you have an Office Maintenance System?

System Review:

m) Do you have a Medical Emergency Plan of Action?

System Review:

n) Do you have an Employee Hiring System?

System Review:

o) Do you have an Employee Firing System?

System Review:

p) Do you have an Inter-office Communication System?

System Review:

q) Do you have a GAP Analysis System?

System Review:

r) Do you have a Photo & X-ray Assessment Form?

System Review:

s) Do you have a Funnel Marketing?

System Review:

t) Do you have a ROI (Return on Investment) Analysis System?

System Review:

u) Do you have a Doctor Compliance System?

System Review:

v) Do you have a Marketing Action Plan?

Communication:

a) Does your orientation process include communication of the “unwritten rules”?

Communication:

b) Are experienced staff members asked for their ideas and opinions on how things may be improved?

Communication:

c) Are staff members comfortably communicating both successes and failures?

Communication:

d) Do all team meetings have agendas, notes, follow-ups?

Communication:

e) Is there an organized way in which feedback is obtained from staff members?

Mission:

a) Does your practice have a specific written vision statement, mission statement, and culture points?

Mission:

b) Do staff members know what the mission is, their role in achieving it?

Mission:

c) Is your practice organized around the practice vision, purpose and mission?

Standard Operating Procedures:

a) Does your practice have policies and procedures (P&P) that describe “how things are done”?

Standard Operating Procedures:

 b) Are policies and procedures up-to-date?

Standard Operating Procedures:

c) Is there a process in place to ensure that policies and procedures are regularly updated?

Standard Operating Procedures:

d) Does your team have a written copy of your policy & procedures?

Standard Operating Procedures:

e) Is someone in charge of drafting, updating and approving policies and procedures?

Standard Operating Procedures:

f) Do P&P meet the test of 4 Es: evidence-based, effective, efficient and entirely clear?

Standard Operating Procedures:

g) Do you have a uniform dress code/grooming protocol for the staff and doctors in your practice?

Practice Work Flow:

a) Have you moved from a paper to digital records?

Practice Work Flow:

b) Do you have a written, clearly defined workflow that every staff understands?

Practice Work Flow:

c) Has your practice established a commitment to re-evaluate and optimize workflows?

Camaraderie:

a) Do you know your staff and what is important to them?

Camaraderie:

b) Is the practice set up to promote good relationships between staff members?

Camaraderie:

c) Are there a sense of loyalty among staff and an assumption of good will?

Camaraderie:

d) Do staff members enjoy time together outside of work?

Camaraderie:

e) Have you had a team function after work within the last 6 months?

Employee Fringe Benefits:

Do you provide any of these benefits to your employees? Select all that apply.

Employee Fringe Benefits:

s) Are employees given a total benefits statement annually?

Employee Fringe Benefits:

t) Do you know what percent of practice overhead are employee benefits?

Practice Overview Statistics:

a) Has your annual practice revenue grown at least 7% for the past 3 years?

Practice Overview Statistics:

b) Are you collecting 98% of your production on an annual basis?

Practice Overview Statistics:

c) Are 90% of your active patients currently scheduled for their next hygiene or restorative appointment?

Practice Overview Statistics:

d) Is hygiene responsible for at least 30% of your practice production?

Practice Overview Statistics:

e) Is your overhead 60% or below?

Marketing:

a) Do you have dedicated sales staff or marketing coordinator for your dental practice?

Marketing:

b) Do you have a practice website?

Marketing:

c) Have you published a book or an eBook?

Marketing:

d) Are you using your website to generate new patients?

Marketing:

e) Please select all that apply

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