Dental hygienist and practice manager Rachael England describes the challenges of setting up a new dental clinic in Dubai, where she has lived since 2013.
A new challenge
After working in dental clinics for 20 years as a dental nurse and then as a dental hygienist I didn't think there would be much more to know when I took on a practice manager's role in 2015. I was invited to join a startup clinic in Dubai wearing multiple hats: hygienist, manager and patient care coordinator. The clinic build had been completed and the licensing process started for the joining clinicians, however, I would be tasked with establishing the operating procedures, ensuring Dubai Health Authority (DHA) and municipality regulations were met.
The clinic owner, Dr Banker is very focused on a preventative care clinic, something which is lacking amongst the glitz and glamour of the many cosmetic providers in Dubai. With her support and blessing we have worked with Philips and the DHA to introduce the Dubai Smiles Healthy campaign (www.nature.com/articles/bdjteam201774), supervised tooth brushing in schools and regular community activities.
The support staff were mostly in place and two general dentists, but we needed patients.
Patients are not so easy to find; after reading just about every Chris Barrow and Sheila Scott article online, I endeavoured to begin networking. What I discovered over the next ten months is that in expat communities, word of mouth is king. The Medical Director Dr Neil started the snowball with friends and patients who had followed him from his previous clinic. Our first ten delighted patients spread the word and we quickly began to gain traction.
Closely monitoring patient source, we realised that our spending on social media and pay per click was creating brand awareness but not bringing new referrals. We are now using a dedicated patient care coordinator and ensuring the patient journey is smooth and they feel truly cared for; nurturing these relationships has ensured the continued good word of mouth and we are registering over 100 new patients a month.
Dubai is a very seasonal city, despite it not having a winter as such. We can expect the diaries to become quiet through July and August and around the school holidays when the expat community head home to escape the heat. We have tried to limit the impact of this on the clinic by emphasising the importance of booking recalls and ensuring patients book ahead. Initially our receptionist was telephoning all recalls, which showed a very poor uptake. Introducing email and text message recalls has ensured at least a 50% recall success so far. Our goal is to increase this to at least 70% but with such a transient community you can never be sure if people are even still in Dubai.
Dealing with regulations
Dealing with the regulations in the UAE [United Arab Emirates] has taught me levels of patience on a par with Mother Teresa; for example: to have radiography equipment we needed a licence from the Federal Authority for Nuclear Regulation, whose offices are two hours away in Abu Dhabi. After sending a driver to collect the licence and returning it with the clinic name spelled incorrectly, he returned to Abu Dhabi, only to come back with the name spelled wrong again! The daily running and standards set by the DHA aren't published in great detail, so we opted to establish all the protocols in line with HTM 01-05 best practice.1 This also involved many hours of staff training but during the formative months we had time and the hard work was worth it when we passed our DHA inspection with flying colours.
Technical and cultural challenges
Other challenges arising have mostly been technical with website errors, undelivered emails, and changed servers. Knee-jerk reactions from the web management team and failure to accept responsibility has caused many hours of frustration and changing of supply contracts. I've learned a whole new vocabulary relating to search engine optimisation (SEO), pay per click (PPC), long and short tail keywords and Meta analytics… Google is my new best friend!
I thought managing staff would be easy; after all, I've managed patients for the last ten years! However, although we all have dentistry in common, the staff at our new clinic are from such a variety of backgrounds and nationalities, culturally we are very different. I found it very hard to assert myself at first, and really it took about eight months to actually feel like a manager and deal with both welfare and disciplinary issues in a confident way.
A learning experience
Despite all this, I have thrived on the difficulties. Every day has been a learning experience and I've harnessed my inner geek to digest as much new information as possible in order to get the best results for our investors. I encourage the staff to reach their potential and reward those who bring in new ideas and exceed my expectations. Seeing the clinic thrive and feeling exhilarated when we hit our targets has been amazing and I'm so proud of everything we have achieved in the first year.
Looking to the future, Dr Banker has plans to expand to at least seven clinics. We have agreed that buying existing clinics rather than starting from scratch would be less of a headache, but I am prepared for a whole new set of problems...