A review of 'Teamwork Five – Practice Management'

  • P S Rothwell &
  • M Seward
, Joint Directors and Editors Teamwork Publications, Sheffield price £75, book and CD-Rom ISBN 0-9521225-4-5 | ISBN: 0-9521225-4-5

The dilemma for authors in producing a volume such as this is at what level to pitch it. I would be surprised if there is a general practice in this country that will put in place all the recommended procedures and protocols included in this work. On the other hand, if a practice is aware that it needs to become more organised and systematic, there is everything here from which to choose. A more philosophical question is 'what is management?' Is it documents and procedures or is it people?

This £75 volume sets out in stark detail the sheer weight of obligation, regulation, documentation and the resultant bureaucracy of recent increments of legislation affecting dental practices. No doubt every item is justifiable, but the fainthearted might balk at items such as the advice to 'consult ACAS before issuing a disciplinary warning'.

The content of the handbook largely mirrors that available in other collections focussed on clinical governance or dental quality systems. There are the expected hard-copy templates for forms and checklists, warnings and notices, also formatted on the accompanying CD-ROM. This is fairly straightforward to access, even though the instructions seem to vary between the CD cover and the text. I got through on my third attempt. I have not played yet with the pages where you peel off little stickers and put them on plans of the practice to show where the Health & Safety poster or other features are, but I expect that to be easier.

A lot of very basic information is included eg the glossary tells us 'an incisor is a front tooth for biting through food'. Clearly only a trainee nurse could conceivably need this definition and there are more suitable and accessible sources for such a person than a handbook on management. I suspect that purchasers using their own money would be happy to dispense with items like this, and the batch of heavy empty plastic wallets embossed with the Teamwork logo, in favour of a more modest price.

The people-management sections include descriptions of the various roles and list training pathways to and on from them. There are helpful contact lists. There are brief sections on practice meetings, recruitment and performance reviews. Disciplinary and grievance procedures are covered. The emphasis, perhaps understandably, seems to be on avoiding litigation. The human, interpersonal skills needed to run a team get less attention than detailed descriptions on the maintenance of equipment. There is a wealth of management literature on the way that teams work and individual talents flower, but little of that is referred to or referenced. If the people doing these tasks are not committed to their jobs and internally motivated even the most prescriptive systems will fail.

In such a comprehensive work there are few areas not adequately covered. There is a good section on tracing work leaving the practice and being received from the laboratory. However, the trace really needs to extend into the periods before and after this, when mistakes can still occur. For an increasingly female workforce a handbook such as this could easily have avoided 'chairman' and 'man-hours'. The check-list for the examination of a new patient is very good, but hard to achieve on the NHS fee scale. Computers are mentioned here and there as the alternative to paper records, but there is no treatment of the opportunities they give for more sophisticated analysis of a practice's functioning. There is an excellent section on domiciliary visits, written with a rare sense of humour

Amongst the 'essential' criteria specified for the recruitment of dental nurses is 'non-smoker'. Obviously smoking is not acceptable at work, and personal hygiene must be adequate, but many in the pool of potential employees will be smokers. The educational experience of working in a smoking-aware practice, and suitable advice, can often help such employees to give up successfully. They are then excellent supports for patients trying to quit. An even more optimistic nurse requirement is 'to understand the different bonding agents', the ambition of many a perplexed dentist!

There is a certain amount of discrepancy about leadership and decision making. In the suggested questionnaires for dentists and staff the issue of the dentist being 'the boss' and 'making the final decisions' is posed and options from agree to disagree are offered. In 'Management Procedures' the prescribed system is for the team to identify desired outcomes, decide who acts, set action into motion and record outcomes including failures. However, the legal responsibility and risks of failure are borne not by the team, but by the principal or partners in a general practice. Hence, whilst the skills and opinions of the team will be greater in sum than those of any one or more dentists, some awareness of ultimate control is needed.

Some of the topics covered seem unduly prescriptive in matters that are style rather than management. Suggestions that appearances are important are helpful, but whether reception staff 'should appear different from clinical staff', is a decision to be posed, not imposed. Likewise telephone answering modes. There are many styles and one size does not fit all. The instruction that one should always speak 'as slowly as possible' could cause problems in a busy practice. There is a suggestion that staff meetings should be tape-recorded. There could be difficulties in doing this adequately, and there may be thought to be advantages in having paper Action Notes produced which can be widely circulated, easily accessed and simply stored. There will be few GDS practices that can afford staff time to run 'incoming letters registers' and 'outgoing mail registers'. This section ends with the helpful suggestion on outgoing mail, 'take to post box'!

The problem for any editor of such a compendium is keeping it up-to-date. The section on advertising does not warn about the Advertising Standards Authority's stance on the use of the title 'Doctor'. This probably post-dates the printing. Detailed descriptions of equipment or systems are similarly vulnerable. The section on 'Nurse Duties – Endodontics' includes a list of instruments, some of which may already be a little outmoded. Some of the latest techniques are not included. This is where management and dental nurse textbooks meet and, in this case, unnecessarily overlap.

You may feel there are not enough hours in the day to follow this system completely, but it contains a wealth of material for staff training and selective implementation. It is not a complete guide to the human aspects of management, but there are other, more general, sources for this information.

[BR384]

Elinor Parker