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The dental corporate bodies currently registered with the General Dental Council (Table 1) carry on the business of dentistry in conformity with Section 43 of the Dentists Act 1984,3 the legal implications of which have been discussed recently within the pages of this journal.4 There is likely to be even more opportunity for corporate involvement in UK dentistry in the near future given the proposed review by the General Dental Council. This will no doubt take into consideration European law, under which the restriction within the Dentist's Act on the number of corporate bodies is likely to be untenable.

Table 1 Table 1
Full size table

It is clear that even from the information presented in the Dentists Register and without accessing other records such as company accounts, not all corporate bodies are equal in terms of size and market share, with over half of the registered bodies (15 out of 27) listing three or fewer practice premises, whereas nine companies have 15 or more and the largest 103.

Despite their growth, little research has been conducted to establish if and how corporate dental groups differ in the way they deliver dental care. This preliminary survey was designed and conducted to determine the approach of the various corporate bodies to the issue of customer focus. It is anticipated that this exercise will help to inform the design of future surveys in this area, not only with respect to corporate bodies but also for all dental practices.

Although little is known of the attitudes of the wider profession to the corporate bodies, it does appear that dentists are split into two camps, namely those who view their growth as a threat to the 'average' dental practitioner:5

'These new names are bringing into dentistry the one thing that has been lacking for the last twenty years – substantial development capital. The talk of millions of pounds to establish large new practices makes the average GDP shiver in his or her shoes'.

...and those who see the growth of the corporate bodies as being an opportunity for the profession in general:6

'...their entry into the market will bring new perspectives on dentistry for both dentists and patients. UK dentistry has been stifled by 50 years of the NHS and there is scope for radical change. The shift to a customer focussed dental service which addresses the needs and wants of patients will be accelerated by the growth of 'corporate' dentistry'.

It is a widely held view that corporate bodies somehow bring special managerial expertise to dental practice and that this, plus the fact that they are in many cases extremely well-funded, would appear to give them a commercial advantage over more traditional dental providers. In the wider management literature it is recognised that one of the main drivers of business success is the degree to which a company is customer focused – in other words, its ability to identify and then match (or even exceed) customers' needs, desires and expectations.7 If the corporate bodies do bring a higher level of business acumen to the delivery of dental care then it is likely to be in such areas as their ability to anticipate, understand and act upon the needs and wishes of their customers.

Method

The survey was conducted in the spring of 2001. A short questionnaire comprising five questions (a mixture of closed and open-ended) was mailed to the 27 corporate bodies appearing on the 2001 Dentists Register (Table 1 – which also includes a record of those companies completing and returning questionnaires) along with a covering letter explaining the nature of the survey and a stamped addressed return envelope. The questions appearing in the survey instrument, all of which were aimed at providing an insight into the respondent company's customer focus, were as follows:

  • Does your company have a mission statement (or similar) with respect to dental care? Yes / No. If 'yes', what is this statement?

  • Do you provide your staff with training in customer care? Yes / No. If 'yes', what does this training involve?

  • Do you measure patient satisfaction? Yes/ No. If 'yes', how is this measurement achieved?

  • Do you have any specific guidelines on how staff should deal with patient complaints? Yes / No. If 'yes', what are these guidelines?

  • What would you say makes the difference between your dental practice(s) and those of other dentists?

Given that only ten of the 27 companies replied on the first mailing exercise, second and then third mailings were conducted at six weekly intervals after the first mailing in an attempt to maximise the final response rate.

Results

Replies were received from 17 of the 27 companies listed with the General Dental Council (a response rate of 63%). Ten replies were received from the first mailing, three from the second and four from the third. Repeated follow-up calls failed to elicit responses from the remaining ten corporate bodies. At first sight this response rate seems rather poor. However, it can be seen from Table 1 that non-respondents comprised those corporate bodies running five or fewer practices and it follows therefore that, although the response rate is rather disappointing, most of the organisations currently viewed as being the 'major players' in the corporate arena (and all of those nine companies running 15 or more practices) are represented in this survey. The responses to the various survey questions are detailed below:

Question 1.

Does your company have a mission statement (or similar) with respect to dental care? If yes, what is this statement?

Yes 13 No 4

Those mission statements that were provided tended to focus on a small number of aspects of dental practice, with the two most common being treatment and patients:

Treatment

'Prevention starts here.'

'...highest quality dental treatment, emphasis on advice and inspirational cosmetic solutions.'

'...providing quality dental care.'

'...consistent standard of care and service.'

'...highest possible standards of dental care.'

'...quality dental care.'

'...highest quality of care through sophisticated treatment modalities.'

Patients

'Putting patients first.'

'Dental care with you in mind.'

'...emphasis on patient satisfaction.'

'...first class service.'

'...emphasis on excellent patient care.'

The following topics were also mentioned by some respondents:

Practice environment

'...supportive environment.'

'...friendly and relaxed environment.'

'...state of the art practices.'

Market share

'...market leader.'

'...national accessibility.'

Staff issues

'...the personal development of our professional team.'

'...efficient and highly focussed management team.'

Cost

'...affordable.'

Question 2.

Do you provide your staff with training in customer care? If yes, what does this training involve?

Yes 15 No 2

The responses to this question can be classified as follows:

What training is provided?

'Group sessions providing feedback from patient research.'

'Specific training in customer focus, company policy instructions, consumer management courses, communications enhancement.'

'Full governance procedures.'

'Programme of customer care, communication and teamwork skills.'

'Managing patient expectations.'

How is this training provided?

Most commonly by other staff personnel, for example:

'Hands on training with experienced staff members.'

'Individual one to one discussions.'

'In-house training by experienced staff.'

When is the training provided?

'...weekly.'

'...every six months.'

'...from time to time.'

In addition, three organisations mentioned the use of 'induction courses' for example, '...prior to new staff going live'.

Question 3.

Do you measure patient satisfaction? Yes / No. If yes, how is this measurement achieved?

Yes 11 No 6

Of those organisations answering yes to this question, 'in-house' questionnaires were the most commonly used way of gathering feedback from patients, for example:

'Periodic patient questionnaires and telephone surveys where applicable.'

'Patient satisfaction questionnaires.'

'Post-treatment questionnaires (al-though not to all patients).'

'Regular feedback forms.'

Two companies described the use of externally administered surveys:

'Independent assessment by a recognised body'

'Third party questionnaires as part of the Denplan Excel accreditation programme'

Other methods also mentioned were verbal feedback and complaint monitoring.

Question 4.

Do you have any specific guidelines on how staff should deal with patient complaints? Yes / No. If yes, what are these guidelines?

Yes 14 No 3

It is clear that a majority of respondents have established formal protocols for dealing with complaints although two were keen to report that such complaints were uncommon occurrences:

'No complaints received in last 12 months.'

'Not a very common problem.'

There is some uniformity in approach to dealing with patient complaints. This usually involves the complaint being dealt with at both 'local' and 'head office' level: '...the escalation process' as one respondent described it. Additionally, one organisation offer complaining patients: '...in house and independent second opinions' with the objective being 'damage limitation'.

Question 5.

What would you say makes the difference between your dental practice(s) and those of other dentists?

This question produced a wide range of responses, ranging from no responses in two instances, through 'None' and 'Impossible to answer' in two more, to the following more detailed replies:

'We provide more treatments on the NHS than most town-centre practices.'

'We have not forgotten the word 'care' in healthcare'.

'Inform before perform, listen to patients' needs, involve patients in decision making'.

'Accessibility, peace of mind, choice.'

'An accommodating approach, long operation hours.'

'Encouraging practice at the highest level, while providing incentives and opportunities for growth within the group.'

'As a dental body corporate we have a continuing programme of investment into our practices which covers areas of training, postgraduate education, computerisation, new equipment, branding, marketing etc. All of this results in an environment which is both professional and welcoming to staff and patients alike.'

'Distinctive brand, alternative therapies, corporate discipline, customer focussed, life-style approach, state of the art equipment, patient comfort and much more!!'

'As a group we pride ourselves on providing quality dental care. The emphasis is placed on 'quality' and 'care'. Our practices are audited by our clinical audit team. We have introduced mystery shopping at our practices and extensive patient research. We are actively talking to our patients to gain a better understanding of their perceptions of 'quality' and 'care'. We constantly strive to achieve the best possible levels of service and care, and promote the ease of access for patients to care services to receive their ongoing comments.'

'Team-based philosophy (both clinical and practice management teams). Practice environment designed by patients for patients. Latest technology. Emphasis placed on time spent with patients and understanding their needs (trust, listen, choice). In-house regional centres of excellence for specialist referrals.'

Discussion

Before discussing the results just presented, it has to be accepted that this survey does have a number of limitations. The rather low response rate has already been discussed; additionally, the results reflect what organisations say they do and this may not necessarily be what they actually do in practice. Finally, while the questionnaires were sent to the person(s) listed in the Dentists Register as 'managers' or 'directors', respondents were not asked to specify who in the organisation actually completed the questionnaire. Depending on whom this latter task has been delegated to, it is possible that the responses do not accurately represent management views. It will become apparent reading the ensuing discussion that this survey ends up posing almost as many questions as it answers. It is, nevertheless, felt to be a useful first step in determining the attitude of the corporate bodies currently operating in the UK to various customer care issues.

What is clear from the results is that for most of the corporate bodies, customer care is an important issue. This can be seen by examining the various mission statements. Although such statements are decried in some quarters, they do provide an insight into an organisation's focused thoughts and aspirations regarding the core elements of its business. It is therefore interesting to note that treatment quality and patient care appear in a number of statements whereas the cost of treatment appears only once. This suggests that, in general, the corporate bodies believe that quality of service is of greater importance to their patients than the outright cost of that service. This view reflects recent research which suggests that many patients are just as concerned about how and when the cost implications of treatment are communicated to them as they are about the actual cost of that treatment.8

Given the importance attached to service quality by the corporate bodies, the perceived need for a well-trained staff should come as little surprise. Indeed, it is one of the cornerstones of modern management practice that high levels of service quality cannot be delivered without the presence of well-trained, motivated staff. The results of this survey indicate that most of this training is carried out in-house by existing staff members, although it is not clear from the various responses who trains these 'trainers'. A number of respondents emphasise the ability of a larger organisation to offer career pathways to its staff.

The mission statements along with the approach to staff training give some insight into a company's organisational culture – 'the way we do things'. It can be argued that the 'wished-for' practice culture is much easier to develop in newly-developed practices as compared with established practices that are taken over by parent corporate bodies. While the results of this survey do not indicate whether or not this is recognised as being an issue for concern, it is interesting to note that the most comprehensive explanations of staff training programmes tend to come from those companies involved in developing new dental practice sites.

A relatively small number of respondents state that they do measure patient satisfaction (11 out of 17), with the questionnaire being by far the most favoured method. Despite the popularity of the questionnaire the results seem to suggest that the information subsequently gathered is not widely used to provide feedback to staff members. Further investigation is necessary to determine if this is indeed the case.

Closely linked to the subject of satisfaction measurement is that of handling complaints with one of the respondents stating that the monitoring of complaints was their way of assessing patient dissatisfaction. A considerable majority of respondents indicate that they do have in place specific guidelines regarding the handling of complaints and this is clearly one area that has been given considerable thought by these corporate bodies. The guidelines described conform closely to widely accepted principles of creating an opportunity for patients to complain at a local level, establishing recovery procedures, acknowledging the complaint, apologising when indicated, showing empathy, taking swift action to rectify the problem and finally follow-up, often from head-office.

Lastly, it is interesting to see how the various corporate bodies view themselves in comparison to other dental care providers. The two nil responses may again simply indicate that senior management of these respective organisations did not complete the forms, maybe the person filling in the form simply does not know what makes their company different to other practices. On the other hand, it is perhaps more than surprising to find one company effectively saying 'there is no difference' and another saying that this was 'impossible to answer'. It would seem to be a pre-requisite of success to know just where your particular strengths lay in comparison to your competition (what is often referred to as a firm's unique selling proposition or USP) and this fact is underlined by the more considered answers of the other respondents. Again, the results indicate that the majority of corporate bodies 'sell on benefits and not on price'. Clearly, each of these latter corporate bodies feel they offer a unique service in the area of the benefits offered to patients. These benefits again revolve around the quality of treatment provided and the associated service quality, in other words the way they care for patients as people. Once again this reflects what an organisation says it does, but what happens in practice?

A number of respondents also stress the importance placed on providing state of the art environments within which this care is delivered, a reflection perhaps of the high levels of investment currently evident in the corporate sector.

All these observations return us to the sentiments expressed in the various mission statements and suggest that these are not idle pronouncements but rather real attempts to provide a guiding philosophy.

Conclusion

While nothing is ever certain in life, one thing does seem clear and that is that the influence of the corporate dental groups is set to grow considerably in the future. It is likely that these organisations will set trends, some of which may be seen as having a beneficial influence on the rest of the profession (eg a better understanding of patients' expectations) some of which may not (eg less continuity of dental personnel). This growing influence makes it all the more important then that these organisations are studied and laid open to scrutiny from outside. By no means does this survey give an exhaustive view of the attitudes of corporate bodies to customer care. It does however provide some insight into how the different companies perceive this issue. As has already been mentioned earlier a number of questions arise out of this study and it is anticipated that these questions will be addressed, along with the various limitations detailed earlier, in future studies.