Dental ‘Cloacopapyrology’ - Playing ‘Zone Defense’ Against COVID-19
By Jeffrey Bonk on May 26, 2020 | comments
This is the second part in Dr. Jeff Bonk's “Dental Cloacopapyrology” series.
One drawback caused by the COVID-19 pandemic is the loss of sporting events. To stop the spread of the potentially fatal virus, close interaction with others must be reduced, leaving no choice but to cancel all sporting events and shutter all sports venues for the time being.
RECOVERY RESOURCES: Available to Spear Online members, the Practice Recovery Program provides a framework with virtual training tools and growth plans that help dental practices stay safe and financially secure in the “new normal.”
The timing of this national emergency couldn't have been worse – just as the NCAA basketball tournaments were set to begin and the NBA was nearing playoff season. Instead, this year, the time I would have spent watching the court sense of college basketball teams play out on my TV screen, I used to strategically think about my practice and the impact COVID-19 will have on it. Then I had an “ah-ha” moment.
I missed hoops so much, I imagined how basketball strategy could help me manage potential viral contamination at the office and control patient fears and anxieties.
A good offense and defense
The spread of this virus has created a new set of infection control concerns and conditions that we must consider to ensure the health and safety of our patients, our teams, and ourselves.
We must be prepared to manage both the clinical infectious considerations and the behavioral aspects of concerned and anxious patients. Our focus for execution needs to occur on both fronts, just like how the offense and defense are considered in basketball. Strategies on both these fronts are crucial in a team's efforts to control the ball, manage the clock, and win the game.
A good offense in basketball means knowing and trusting the players' skills and abilities. Coaches and teammates each need to support each other's weaknesses, know each other's strengths, and provide opportunities for teammates to take the ball, get to the key, and score. Many times, a man-to-man type of relationship is best to achieve the desired outcome.
Alternatively, a good defense must protect the key! Typically, zone defense is utilized. The goal is to not get 3-second violations and prevent the other team from getting in the key. Here is where a dental practice can learn from in this over-simplified basketball scenario.
It's a layout of my treatment room. The 6-foot circle is the critical zone of patient care because it's where the coronavirus can spread, via droplets from breathing, and because of aerosolization. The areas beyond the critical zone are safer.
COVID-19 is a formidable opponent so we must be very protective of our zone defense. How are we going to keep the virus out of this patient care area? It is very important to keep unnecessary players outside of the critical zone. Not even a 3-second violation can be tolerated. Our defensive measures must be airtight.
In dental terms, this means anyone within the critical zone must be fully protected by personal protective equipment (PPE) i.e., masks, gloves, face shields, gowns, etc. The patient must also be defended using eye protection, oral evacuation, rubber dam, etc. All measures must be taken to maintain the 6-foot barrier area of the critical zone. A zero score (i.e., no infection and cross-contamination) is clearly a big win for the team.
Before the COVID-19 crisis, our tub and tray system worked beautifully. Dental assistants could easily access tubs from the cabinet, as essential materials and items were needed during the treatment process. Our systems and processes were seamless and our ability to maintain infection control was effective. Now, this system is no longer acceptable. Assistants can no longer breach the critical zone barrier – otherwise, it's a technical foul! New protocols must be put into place to manage and support the clinical team within the barrier zone.
One solution in avoiding technical fouls, is to create and implement a roving assistant – the teammate off the bench. Much like the circulating nurse of a surgical operating room, the roving assistant is the third hand of the clinical team who remains outside the critical zone. They bring extra needed supplies and hands them off to the chairside assistant within the zone. In this way, cross-contamination is minimized, and the safety of the patient and the team is preserved. The organization, efficiency, and a team approach create the win for safety within this critical zone. The defense is virtually impenetrable.
Man-to-man relationships
Dental health is crucial, especially in this new working environment. Underlying comorbidities, such as diabetes, heart disease, gastrointestinal issues, and certain cancers, are all risk factors related to the potential onset of COVID-19 – and all these comorbidities are related, at some level, to periodontal disease.
Now, more than ever, it behooves us to discuss optimum oral health with our patients and help them understand and value this significant medical/dental relationship. But as much as patients desire safety and infection control measures, there is significant apprehension associated with the sight of a dental team member, in full PPE garb, coming at them with a thermometer and a mask. These barriers make us less empathetic and disassociate us from our patients. This is a very concerning situation. The reality of this crisis is patients will need more TLC and greater emotional support than ever.
Every patient comes with a different level of expectation relative to the infection control and the relationship they desire from the practice team. This is where basketball's man-to-man relationship comes in.
Developing a play, or strategy, to engage patients at a level that provides emotional comfort, combined with clinical precision, needs to be enacted and/or adopted. The entire practice team must be compassionate to the fears and anxieties each patient brings. We need to implement a full-court press to meet the patient at the reception room door with a smile and a friendly, unmasked face.
Social distancing can be maintained by having team members ask pertinent health questions and start conversations that recreate the bonds and relationships that are so important. Connecting and establishing relationships helps patients feel cared for by the team and provides positive support for making good dental health choices.
As the patients are escorted to the clinical space, anxieties are reduced, and fears begin to disappear. The man-to-man playbook works to improve patient confidence and trust in the team. Being on the offense for reestablishing patient relationships goes a long way toward rebuilding a new normal with all patients.
As the U.S. reopens and we transition back to work, expect there to be some new challenges – it's a new ball game. But if we see each patient as an opportunity to win them back as loyal and supportive members of the practice, we will make it through this experience successfully.
We must meet patients head-on with a warm and welcoming man-to-man relationship, implement a zone defense to keep them safe and build team trust and confidence with them. The goal is to win at the buzzer.
Jeffrey Bonk, D.D.S., is a member of Spear Resident Faculty.