To: Dr. Lori Evarts
From: Samira Zahedrozegar
Date: 10/01/2023
Re: Report of Needed Changes
Enclosed, please find some suggestions for changes in the clinic; also the clinic’s flow chart and organizational chart and some supporting details in the appendix. 
Outline
As you may be aware, the process of visiting patients in the clinic is divided into walk-in patients and patients with appointments. Each doctor is responsible for his/her patients from the first visit to the end of the treatment. (The organizational chart and fellow chart of the clinic can be found in the appendix)
As we are almost the only clinic in this area, we are facing some problems that we can put effort into enhancing the situation for the purpose of CQI. The problems with the priority are:
1.	A high load of visits for each dentist results in a decrease in time specified for each patient
2.	Not contributing to oral public health duty as healthcare professionals
To address these problems, I recommend some solutions as follows in order:
1.	Hiring two more dentists. Therefore, decreasing the load of visits for each doctor by delegating some number of patients to newly hired dentists.
2.	Impose an organizational policy for delivering oral health education to all the patients in oral and dental examination sessions. 
Description of the problems and suggested solutions
Decreasing patient load and imposing limitations on the number of patients seen by each dentist daily is one of my recommendations. I completely understand that we are the only dentists in this area but visiting more than 10 patients in each shift would eliminate the perfection of the treatment for each patient, and by arriving at more than 5 patients, the dentists’ concentration would be decreased gradually. In other words, I suggest covering the same number of patients daily by adding two new dentists. As we have the facilities needed to employ two more dentists, it would be the most sufficient way to maintain our patients while increasing the quality of treatments by increasing doctors’ concentration and time to visit patients. By delegating some number of my patients to another doctor, I would have more peace of mind to allocate more time to each patient therefore, I would be able to talk more to my patients to make sure if there are any other concerns. Also, I would have time to allocate to oral hygiene instructions. By doing so we won't miss any loyal patients or new patients because we will decrease each dentist’s load, and we would help dentists to increase the quality of treatments which is in line with our organizational vision. (add standard number of patients evidence) Also, we will be able to prevent conflicts between patients and doctors by having more time to discuss all of the treatment options and the patient pick his treatment with full understanding and consent. As we had some unpleasant happening regarding this issue, and most of them needed the manager’s mediation. (In the appendix, you can find an evidence-based study discussing determinants of dentist productivity)

We are responsible for patients not only for treatment but also for prevention and increasing overall oral hygiene. We, as healthcare professionals, are responsible for public health, and oral health instructions are one of the steps we can take to do our bit. As you may know, educating people about brushing and flossing methods sufficient for them is one of our greatest responsibilities as dentists. In other countries, this task is done by oral hygienists who are responsible for delivering primary oral health care. But in Iran, we as dentists should deliver those important tasks. By doing so, the level of patients’ oral health would increase and would help us to get better results for our treatments. 
So the other suggestion that I would like to share is that you can impose a policy that makes each dentist educate his/her patients about oral and dental hygiene and deliver needed instructions to them as a part of the oral and dental exam session. By doing so, both patients and dentists would benefit from it. Studies have shown treatment outcomes are significantly different in patients with oral health literacy (in the appendix, you can find two articles regarding the effect of oral hygiene on patients’ health and treatment outcomes). 
We are grateful for your role as a decision-maker in the clinic and hope to help you at the beginning of your partnership. Please let me know if you have any questions or concerns about each aspect of these documents.
Sincerely,


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Enclosure