Digital Transformation

for a Dental Practice

22/03/2019

Word Count (excl. references and cover page): 2108 words.

Introduction
This report will cover a suggested digital transformation portfolio for a specific dental practice
and the management skills that would be required to implement it, with the aim to increase
its value towards existing and potential customers. As requested by the staff in the
aforementioned practice, its name will not be disclosed, although it is a rather traditional
small size clinic located in the heart of Madrid, the Spanish capital.

In order to develop said digital transformation strategy, as a first step, the background,
current operations and weaknesses of the organisation will be analysed. As a result,
potential areas for development, where digital services or products could be implemented to
increase performance or customer satisfaction, will be identified. Following this, the selected
portfolio will be presented and described, and, on a final note, the management skills
needed for its implementation and the role the author of this report could play will be laid out.

Background of the Organisation

The dental practice is located in central Madrid, a city which has 7,3 million inhabitants in its
metropolitan area (Madrid City Council, 2019), and despite its size, only 7 employees, due to
its situation and quality of service it has experienced a steady and solid demand, with most
of its patients being repeat customers, and while operating at full capacity most of the time.
Its strategy is therefore focusing on its customers and their satisfaction by providing an
excellent service at a friendly and close practice.

The overall industry in Spain has been growing since the financial crisis, although this
increase in demand has mostly been covered by the new brands and franchise chains that
have sprouted over the past year. The biggest names in the sector are Vitaldent, Dentix,
Unidental, and health insurers Sanitas and Adeslas (el Economista, 2017).

With regards to how the practice is organized, in spite of its size it has a 2.5 ratio of non-
dentist staff to practicing dentists, which shows that it is already effective in managing its
operations, as nowadays many of the day-to-day procedures can be carried out by dental
hygienists. The practice therefore employs two receptionists, two practicing dentists and
three dental hygienists or nurses, which help dentists and even carry out simpler
procedures. Additionally, for more complex surgical operations the practice has several
partnerships with specialists, such as a maxillofacial surgeon.

Concerning its digitalisation state, there are several areas for development. First of all, it
relies on an outdated system to manage its patients’ historical records, both within the
practice and from previous or different ones, as it has all of this information on physical card
indexes. Secondly, appointments are managed by the dental receptionists also in an
outdated manner, as they use an internal file which is updated manually and printed weekly
for dentists to know their schedules. And finally, although the clinic has up-to-date
equipment, such as diode lasers or digital radiography, it lacks some further digital tools and
materials that could improve its efficiency and services.

Digital Services
Following what is mentioned above, the proposed digital services to solve those issues
would be the following: In the first place, an electronic dental record system to allow for
historical records to be consulted or modified easily and much faster, also when transferring
them to or from different clinics (referrals or supporting specialists). Currently, these systems
are inexpensive and easy to implement, with the most effective being Eaglesoft, Dentrix or
Curve Dental (Dental Economics, 2011).

Secondly, an electronic appointment scheduling system, which would allow customers to

book appointments online (freeing up resources), while also integrating all appointments
made through other means. This would allow receptionists to manage the process more
efficiently and without errors, and dentists to access their schedules at any given time. One
of the best resources available for this purpose is SimplyBook.me, which not only offers a
booking platform 24/7, but also the possibility of developing the practice’s own website with
this tool implemented in it. Additionally, they provide an online calendar that can also be
used as a system to track working hours, vacations and breaks, automatic message or email
remainders to clients about appointments, and a mobile app to make and consult bookings
in an easier way, all of these features for the derisory amount of 25€ per month (or 200€ a
year).

Other features that could be integrated into the platform could be remote dental
assessments through the app, which through teledentistry would give the practice further
opportunities to increase its efficiency (Philips, 2019), and automatically generated dental
notes through a voice-enabled dental assistant software, which would reduce paperwork and
time while avoiding the possibility of forgetting any required details (Kiroku, 2019).

Finally, to improve its services by enhancing its existing equipment, several opportunities
stand out within digital dentistry, such as cavity detection, shade matching and CAD/CAM
machines and digital 3D printing for prosthesis and implants.

Suggested Portfolio
With both the electronic dental record system and appointment scheduling system having
been defined in the previous section, only some of the subsequent projects would need to be
further detailed. Concerning the teledentistry solution, it would involve an app extension
which would allow patients to send their queries through the app and even pictures or videos
of their teeth when requested, saving time and unnecessary visits. For the automatically
generated dental notes, a software platform, Kiroku, would need to be used, granting access
to an AI program that would record the questions and indications posed by dentists and the
answers given by patients, eliminating the need for paper disclaimers and even reminding
dentists of any further items that should be mentioned.

Finally, with regards to the new digital dentistry equipment, tools such as the DIAGNOdent
pen could help detect cavities earlier, CAD/CAM machines and digital 3D printers would
simplify the manufacturing and design processes of prosthesis and implants, and intraoral
cameras or even a digital camera with a shade guide would reduce the time and resources
needed for the process.

Following this, in order to carry out the implementation of the proposed projects, they have
been categorized into two different programmes, the first one comprising the electronic
systems and the second one the digital dentistry tools. These two digital transformation
programmes and their subdivisions are shown in the below figure.
Programme 1 should be given priority and be the first to be implemented, as it involves a
lower investment and its benefits far outweigh its risks. Within this programme, the electronic
dental record and appointment system projects should be carried out in the first place and
should even be considered essential for the practice to operate efficiently in the near future.
The costs associated with both projects should not surpass the thousand yearly fee, with an
initial investment of up to 5000€ for record migration, and these costs would clearly be
recouped early on each year by savings from file and file cabinets, overtime pay to
receptionists, poor scheduling, time-consuming record transfers and loss of patients.

Alternatives such as Eaglesoft, Dentrix or Curve Dental include both electronic dental
records and appointment scheduling systems, with fees having to be negotiated for each
specific case, depending on the package needed. In the case of SimplyBook.me, its irrisory
costs and extra features, such as the development and maintenance of a website and a
mobile app make it an excellent option, with the only drawback being that another platform
for record keeping should be sought. The recommendation here, given the practices size
and the fact that most features included in the more expensive complete packages would not
be needed, would be to select the cheapest option for the migration of dental records (given
the number of total patients the cost should be well below 5000€), with an easy to use
platform and low maintenance costs (again, expecting monthly fees below 100€), and then
contact SimplyBook.me to implement its software solutions. Only considering the savings
from overtime by receptionists, these projects would already prove profitable:

The remaining projects in programme 1 are suggested to be implemented after these

systems are fully integrated in the practice, the teledentistry project would only require a
minimum investment for an extension to the app and the automated dental notes software
can be tested for free, as it is in development stage.
Finally, for the digital dentistry equipment, investments would be sizeable, and returns would
depend on patient satisfaction, either with keeping the current ones or even attracting new
ones. The following table illustrates expected figures for the cost of implementing this tools
and devices and a conservative estimate of returns they could generate.

Therefore, although the projects would be attractive from a financial perspective, they would
still be less profitable than the ones in programme 1 and would imply a higher risk. The risk
profile of both programmes against their IRR is shown in the graph below, adapted from
Turner 2008.

Management Skills
As mentioned at the beginning of the report, the management of the dental practice is
already efficient for the services it currently offers, as it operates at close to full capacity
most of the time and employs a high number of non-dentist staff, which allows the practice to
manage its resources adequately (with practicing dentists’ time being the most important).
However, if the new digital features and tools were to be implemented, additional
management skills would be required.
According to Turner and Cochrane 1993, depending on the project type a set of leadership
and management approaches should be followed. These project types can be seen on the
figure below, which will be used as a guideline to classify each project and identify the
required management skills to implement it.

On the one hand, with regards to the electronic dental record and appointment schedule
systems, clearly for both projects the goals and the methods would be properly defined,
therefore implying they would concern internal IT and require a rather more bottom-up
approach, in which the systems should be implemented beginning with easier and less
complex versions which would then build up to the definitive product. In order to carry out
these projects, a specialist on the matter should be tasked with its implementation, as he
should know the necessary techniques, but would also need to know how the organization is
structure to adapt to its requirements.

On the other hand, regarding new digital dentistry equipment, although goals with these
projects would be defined, the methods would not be as clear, as most of these new
technologies would require specific training to be carried out by dentists and hygienists in
order to be properly operated. These projects would therefore be a new product or service
implementation, which should be carried out by multi-disciplinary teams, as for example,
employing a 3D printer or CAD/CAM programs would either require an employee with such
knowledge or significant training to the existing ones.

Finally, evaluating my role in the digital transformation of this business, my background as

an engineer would make me an ideal candidate to take care of the 3D printer and the
CAD/CAM modelling programs, as I have the required knowledge. I would be able to
implement said products and run them until a specific hire is employed, with a dental
hygienist with said abilities not being difficult to find as the use of these programs is growing
more common in universities. Additionally, with platforms such as the ones mentioned above
(Eaglesoft, Dentrix, SimplyBook.me, etc.), their customer support teams would assist the
practice in the set up process and I could also be of help in that phase, due to my IT skills
and knowledge of how the practice is run, being also able to train the staff there until they
are fully accustomed to these platforms.

Conclusions
As a result of this report’s findings, it seems clear that both programmes should be carried
out by the dental practice, as through their implementation it would not only achieve the
necessary digital transformation the practice will need to tackle the near future, but also
attractive financial returns at acceptable investment risk levels. Moreover, the practice will be
able to further increase its efficiency and management of resources, while also providing a
higher quality of service.

With regards to the programmes’ implementation timeline, as mentioned above, the practice
should begin with programme 1, specifically the electronic dental record and appointment
scheduling systems, which should take a short period of time to be executed and would be
fully implemented within less than a semester. For the following projects, the timeline should
be decided depending on cash availability, but would not take longer than another semester,
meaning the complete digital transformation programme could be implemented within one
year.
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