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KEYS TO SURVIVE AT THE DENTAL OFFICE AFTER THE COVID-19 

Agustín Sánchez Durán

Consultant in the Dental & Pharmaceutical Business
PhD in Biochemistry, Master in General Management and Business Administration


Why do I think this article can be of interest for the majority of professionals in Dentistry in Spain?  Because I have reviewed and compiled all recommendations and knowledge of the SARS-Cov-2, its impact and medical consequences, as well as its social and economic impact, and how all the above will have an effect on the outlast of the dental office. Also, the actions to be taken to be reinforced, and being a biochemical with wide experience in Microbiology at the University of Valencia, and also, a leader in the Dental and in the Pharmaceutical Business with a deep knowledge of the dental sector, I am sure, I am the right professional to present it. 


In this article we will describe:

·       Why patients and staff at the dental office have so many uncertainties  

·       Different sceneries of the evolution of the pandemic, how to recover the habits and lifestyle of the population.

·       The economical consequences 

·       How these economic consequences impact the demand for dental treatments.

·       Strategies to execute to face and overcome the impact in the most efficient way (cost-effectiveness).


There are many different courses and seminars that show and train us on how to objectively value the current and future problems. A traditional example is the Dale Carnegie one, named How to Stop Worrying and Start Living. He proposes recommendations, among others, as to write in a white sheet all the aspects that we worry for and to think on the worst possible scenario. Once we have recognized it and become conscious of what can happen, he recommends an action plan to avoid it to happen. With this simple exercise, we can rid worries, circumstantial anxieties and subjectivities, and we can focus in what is really important.

 

That is the first recommendation that dentists- entrepreneurs that are currently in a confused, restiveness situation related to what could happen to their dental offices because of the SARS-CoV2, have to consider.  

 

Reasons why Dentists worry as a result of the SARS-CoV-2.

 

1.     Disease

To understand the scope, risks and needed measures to prevent cross contamination from patients to professionals and vice versa or among staff, as well as the concern to possible spread of the infection to their relatives, it is advisable to quickly analyze the etiopathogenesis of the disease. 

The coronaviruses belong to a family of encapsulated RNA viruses that cause different affections, from a common cold to serious diseases as the severe acute respiratory syndrome (SARS-CoV).

We are currently suffering the impact of a new strain, the SARS-CoV-2, the seventh coronavirus known. It affects humans (Fig. 1. Colored microphotography of a severe infected apoptotic cell with the virus SARS-CoV-2, isolated from a sample of a patient. Captured and colored imaged with the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland). National Institute of Allergy and Infectious Diseases, NIH.)

Its protein, Spike (S), like the protein S of the SARS-CoV, joints to the human protein ECA-2, as well as to other similar animal proteins (Fig. 2). However, the place where the protein S of the new virus and the human ECA-2 joints, is different and less efficient from the place where the SARS-CoV, previously studied joints. This fact seems to indicate that the virus was not intentionally created, but it is a result of a natural mutation.

The protein ECA-2, can be found in many different tissues of the human body, particularly in the oral mucous membrane which is considered to be the main entrance of the SARS-CoV2 to our bodies. It is also believed that the virus can also get in through the connective membrane of the eyes, as we have found professionals infected that had worn masks but not protective glasses

 

Because the SARS-CoV-2 infects the respiratory tract, the way to detect it in nasal andoropharynx samples, sputum, bronchia-alveolar fluid and in biopsies of patients with more severe symptoms. 

There is a study that analyzed different samples, from 205 patients in 3 hospitals in China, and there were cases where the virus was found in blood and in feces (1% and 29% of the cases respectively). This may suggest that the disease can be systemic (not limited to the respiratory tract) and it can be infected also oral, fecal route.  

Besides, the problem that the disease arises is (2):

·       The incubation period, the time between the exposure to the virus and the appearance of the first symptoms, seems to be around 5 days, but it can vary from 2 to 14 days.  This is the reason of the quarantine, there are 14 days after the contact with the person infected. As we know more of the disease, how it progresses and more precise analysis, we can fiz this parameter better.

·        Latency time, the interval between exposure to the virus and the development of the consequent disease and the patient can infect others. The analysis of the positive patients and the ones with minor symptoms may suggest that the latency time is lower than the incubation period, which means that an infected person can infect others even before he shows any symptoms.

·       Persistence on surfaces. It has been proven that the SARS-CoV-2 remains stable in the air up to three hours. The virus can keep up alive (it can infect), during 72 hours in plastics, 48 hours in stainless steel, 8 hours in paperboard and 4 in copper. All the above information means that the virus can be transmitted through sprays. The way to decontaminate the objects is to use proven and efficient agents against another coronavirus or even against the SARS-CoV-2.  What is important is to use the correct ratio of one of the following chemical components: 62-71% ethanol, 0,5% hydrogen peroxide or 0,1% sodium hypochlorite (bleach). We must previously wash the surfaces to eliminate detritus and the chosen disinfectant should react the recommended time (3). The gloves have to be discarded immediately. 

Then the SARS-CoV-2 can be transmitted from person to person through respiratory drops that are expelled when a person infected, with or without symptoms, coughs or sneezes or is treated at the dental office without the correct precautionary measures and the professional breaths those drops. There is also a risk of cross contamination, when one touches a surface or a contaminated object with the virus and then he touches his mouth, nose or eyes.


2. Social consequences of the SARS-CoV-2 infection

As a result of the characteristics of the virus, the infection has gone global quickly. It affects mostly seniors, people with previous infections or immune compromised and others. But there are also people infected who apparently are healthy, people of all ages where it was not likely to be infected with fatal results.

Epidemiologists do not agree on the percentage of the population who will be infected at the end, but they work with figures between 70 to 80%, if there is no effective vaccine asap. In order to reduce the exposure of the population, especially the most susceptive ones, the death rate and to avoid the collapse of the sanitary system, many countries are focusing their efforts to:

·       Reduce the social contact by the population confinement 

·       Provide enough barrier protectors in cases where people are exposed to contamination, they can avoid infection.

·       Determine and isolate the infected population, people who are asymptomatic or who have not yet developed the disease, by performing rapid tests.

 

 Because of all that has been said, this disease is making a significant impact in our lifestyle, and we will have to adapt ourselves and change many of our social customs.

We were surprised to see the Chinese population wearing masks on the street, now, what would be a surprise is not to wear it in the western world. We will have to eliminate proximity, hugs and kisses, shake hands, etc. At least until the disease can be eradicated, if it is, but by then we will be used to the changes.

This situation generates uncertainty in the population, that on top, is secluded, and with no possibility to work, and as a result, les income or financial problems to maintain their own business.

 

3.   Economic consequences of the virus SARS-CoV-2 pandemic

The economic consequences of the pandemic might be severe. Some of them can be the following:

·       Lack of trust of the markets with the with the consequent withdrawal of funds and decrease of the stock, loss of value of the listed companies and increase of the unemployment.

·       Increase of the uncertainty in the families and significantly reduction of the spending and investment (Marslow Pyramid).

·       Need to increase the public spending to finance the population with soft credits, basic rent, etc. Increase of the tax pressure and “sharing of suffering” among the population.

·       Increase of the payment times, etc. 

As an example, here we have some of the International Monetary Fund forecasts, on the Spanish Economy published on April 14 th (4):

-       Spain and Italy will be the 2 developed countries that will suffer the most the economic crisis, the biggest in the last 90 years (Fig. 3).

-       The GDP in Espain will drop in 8%, this will happen in the first two quarters of the year. In the previous crisis it dropped 7% between 2008 and 2013.

Since the forecast of the GDP, 3 months ago, was that Spain would grow 1,6%, that means a drop of 9,6%

-       In only 2 weeks there has been a loss of 6,5% of all business in Spain.

-       These previsions consider that the pandemic will slowly disappear in the second half of 2020, and the containment efforts will gradually be relaxed, but there are many experts that don’t agree with that, they say the recovery will start at least in a year time.

-       The IMF estimates that the “average unemployment rate” will be 20,8%.

-       They also predict that the recovery in Spain will not be in “V”, it will be very slow, probably going through a “W” phase, it means there will be a sharp decline of the economic activity with a little recovery to fall again because there will be new waves of infection. Once those peaks get stable, there is going to be a gradual recovery 

-       They also estimate that the average unemployment rate in 2021, will be of 17,5% which is less than 50% of the jobs destroyed in 2020.

If all the above happens, Spain will last years to recover the wealth level it had in February 2020, and the resultant impact not only economical but also social. 

The Bank of Spain, has issued a report on April 20th (5) which is aligned with the  one the IMF filed, and even, the scenery of the one the Bank of Spain issued, is probably more pessimistic, with a very bad prognosis, it says that the GDP in 2021 will reach to a  -13,6% and the unemployment rate to 21,7% (Not counting the workers affected by the temporary file of employment regulation)

All these forecasts show a very gloomy picture that we must consider in detail to plan, it means we have to “limit the uncertainty” and be prepared to bear the impact and to be able to overcome it.  

 

Trying to summarize what is coming to work in dentistry, we can say: 

-       Very virulent infection in the first wave, that is going to affect to a 1% of the Spanish population, with high risk of successive waves until an effective vaccine comes. This will generate fear in the population that, in the first place, due to confinement, and then to the risk of contagion, will change their habits and reduce the demand for goods and services. 

-       The slowdown in the economy will generate an impoverishment of the country, increased by a greater fiscal pressure, again reducing the demand for goods and services by the population.

-       Unemployment will increase as a result of the closure of many big companies, SMEs and the self-employed, because they will not be able to carry out their activities, withstand higher taxation and the drop in demand; The situation of dental offices is especially difficult because, when they are considered by the Government as ‘essential’, although they do not make any money and they must maintain their activity, pay taxes, etc.

 


Possible effect of the SARS-CoV-2 pandemic in the dental offices

As the reader knows very well, with the current level of uncertainty about the disease, its evolution and consequences, it is not easy to establish possible scenarios and how to combat them. However, with the best of spirits to prevent this negative impact that it may have for the dental office, we must infer the possible effects of this crisis:

-       Financial weakening of the dental office because of the lack of income during confinement and lower income vs. the pre-COVID19 situation due to lower demand for treatments. As a consequence of this, will my dental office need?

-       Modification in the reception and flow of patients in the clinic. We have to guarantee the possible crossing of patients with each other and with the staff to the minimum. This requires continuous training to ALL staff to “integrate” this new way of working and will condition a net reduction in the number of patients per day. What will be the impact of this on my business income?

-       Substantial change of the protocols of asepsis, disinfection and treatment of patients. This will increase costs and reduce revenue, since fewer patients can be treated per day and the costs of the materials increase.  If these higher costs of material (PPE, etc.,) and treatment time, can cannot be passed on to the patient’s cost of treatment, that will have a significant impact on the margin. Should I also consider financing for my dental office for this?  how long?

 

How to avoid or minimize the impact of these, and other possible effects of the SARS-CoV-2 pandemic in the dental office?

 

 1. Financial aspects

The financial situation of the dental office, its resistance capacity will depend very much on the type of clinic and the economic situation it is in. For example, it will not be the same if the clinic is consolidated and paid, from the one that it is recently created with high financial obligations.

 

In any case, it is recommended to do the following exercise:

Analyze the fixed and variable costs of the year 2019. The fixed costs will allow us to determine our financial “lung” based on post-COVID19 projections of patients to treat and make decisions about the need for their modification (reduction of personnel and the size of the clinic, specialization, etc.) or finance. 

Analyze the type of potential patients that will allow me to make an income forecast. If the clinic is the type that has maintained its patient portfolio with a focus on loyalty, its situation will be less dependent compared to the ones that have focused on recruiting new patients, with a lower focus on% loyalty.

In any case, it will be necessary to carry out an exhaustive analysis to know who the active patients are, to appoint them and to re-start the treatment as soon as possible after the lack of confinement; Call patients even if they are not in an active treatment, but are loyal clients who should be checked. 

It is also very convenient to think about what the strategies must be to reach new potential clients (on-line events, direct marketing and others).

Clearly establish the “Key Performance Indicators” (KPI`s). This will allow me to more accurately estimate revenue and measure deviations vs. set targets. Here we will have to consider the recommendations of social distance so that the crossing of patients and professionals is the least possible (appointment procedure, number of patients in the waiting room, chair time/ type of treatment, and we have to take into account the revised treatment protocols, asepsis and disinfection of the cabinet, among others).

- Optimize material purchases. The margin has been declining over time as a result of price adjustments to compete in an increasingly difficult environment. In the post-COVID19 era, patients in general will have fewer resources and will not be able to assume a price increase as a consequence of the increase in treatment costs, because we will use much more material and an increase in treatment time. All of that as a result of the implementation of all measures to prevent infection with the SARS-CoV-2 virus. Thus, the only possibility of guaranteeing the use of all the necessary materials for an efficient prevention without raising the prices of the treatments, will be by buying better.

The Distributor is not in his best moments either and its margins are also very tight, so they will not be able to improve the conditions unless the purchase volume increases. This “equation” has only one viable solution: partnering with other clinics or a Group Purchasing Organizations (GPO). This may seem so simple, but really it is not. In North America this has been a model of success for years, but in Spain, it has not worked. The main reason is that purchases must be very large; This implies that you cannot buy all kinds of materials, use different protocols, etc. For the model to work, there must be a professional director that, advised by a technical direction, takes decisions that ALL the members can follow, the professional then, must renounce to his individuality-independence. The dentist-owner must choose between maintaining his independence and disappear or losing it and survive. 


2. Exhaustive protocolization of all the procedures of the clinic

It is a critical moment and we cannot make mistakes, because they can be fatal for all, our health,  the staff’s, the  patients and for our dental office, if there is any incidence of contagion and this is known.

For this reason, we must exquisitely protocolize the relationship with the patient (communication, appointment coordination, flow of patients in the clinic), and their treatment:

 

Model of relationship with patients.

The relation with patients will change in the post-COVID era19 and probably, the previous model will never be recovered. According to the new model, we must try:

- To guarantee that the dental office is a safe place: create prevention protocols, staff with confirmation of their health status and perfectly trained.

- Digitize all patient relationship tools to facilitate tasks without contact or unnecessary use of storage space and infection possibilities. For example, whenever possible, patients should be provided with the use of tele-tools to ask for appointments, to sign consents and others. 

However, there is a new informed consent that is essential for patients and professionals to sign to exonerate the dental office from all responsibility in case of infection. An example is shown for the treatment in an emergency of the alarm state. The format should be adapted as soon as the state finishes and the visit to the clinic is normalized. (This informed consent has been created by dental colleagues as ICOEC).


- Avoid the physical contact, keeping the security distance, no kisses nor shaking hands. 
                                        

- Make triage when the patient asks for an appointment to classify him and establish priorities (urgency, active treatment, new treatments, checkups or vulnerable patients who must be treated independently using extreme security measures)

- Patient flow: appointment scheduling must be done very carefully; ask patients to wait to enter until they are notified, protect vulnerable patients in specially protected spaces

- Regulate the number of patients in the waiting room with structured and staggered entrances and exits;

- Create a hygienic point to be used by patients upon arrival (hand washing, disinfection, temperature taking).

- Follow up by with the treated patients by phone after 14 days to see if they have symptoms. If yes, it is necessary to review the situation of the dental office, the patients who attended the same day as the confirmed patient with symptoms. 

- Manage patient’s fears, communicate with them before the appointment, in the appointment and right after, all the efforts that are being made to avoid infection. This must be done periodically through calls, sms, whatsapp, and others.  The professional should also be involved in this action during the treatment.

- We have already discussed the “economic vulnerability” of most of our patients. Therefore, we have to consider financing conditions for patients with financial difficulties.

Action Plan
ConsDent_PlEstrat_May01-20.pdf (3.27MB)
Action Plan
ConsDent_PlEstrat_May01-20.pdf (3.27MB)

 Related to the Patients Relaton protocols, and the ones of asepsis and disinfection, it is recommended to review the Action Plan for the Dental Office during the COVID-19 impact (see it annexed in spanish).

 

Define very clearly the needs and protocols for asepsis and disinfection that all the professionals in the dental office will use.

Biocide Agents approved by the Health Ministry of Spain
MinSanEsp_Biocidas_COVID-19_Abril27-20.pdf (213.24KB)
Biocide Agents approved by the Health Ministry of Spain
MinSanEsp_Biocidas_COVID-19_Abril27-20.pdf (213.24KB)

In the absence of regulations, much is being discussed about the necessary measures needed to guarantee the safety of the patients and the professionals. There is much confusion and many dentists are making heavy investments in equipment, buying ultraviolet equipment, ozone, that are far from essential.

Virucidal agents approved in Spain
MinSanEsp_Virucidas Autorizados_COVID-19_May05-20.pdf (798.86KB)
Virucidal agents approved in Spain
MinSanEsp_Virucidas Autorizados_COVID-19_May05-20.pdf (798.86KB)

However, based on the recommendations of the National Council of Dentists,  Associations and  specialists in Preventive and Community Dentistry, for example Dr. Gema Maeso, we can conclude that the following precautions / materials, constitute a safe list to prevent the risks of contagion in the dental office, if they are used in a protocolized and appropriate way:

-       Guarantee that the air sucked in the cabinet and in the equipment, goes directly outside and it is not directed to the compressor room, where it is concentrated and re-circulates.

-       Universality: treat all patients equally. It is recommended to take the temperature to the patient before his treatment. If the patient has symptoms (high temperature, dry cough, shortness of breath, etc.), we will put on a mask and we will not treat him until he is fully recovered.

-       Before we begin with the exploration and treatment of each patient, we have to ask them to rinse his mouth, because it has been proven that the use of certain mouthwashes reduces the viral load, in case of infection. 1% hydrogen peroxide, 0.2% povidone, or 0.12% cetyl-pyridinium should be used for 1 minute. Chlorhexidine is not indicated as SARS-CoV-2 is not sensitive.

-       Use Coronavirus screening tests in the dental office. There is a lot of confusion on this matter and therefore it is advisable to go to the appropriate sources to make the decision on this.

(https://www.consejodentistas.es/pdf/coronavirus/TEST_PREGUNTAS_RESPUESTAS.pdf). This is a very clear and proven document on all aspects of the Coronavirus screening tests. 

- Use of barriers to treat patients: the following procedures and materials are, used routinely and carefully, enough barriers to prevent infection with the SARS-CoV-2 virus. It is not necessary nor convenient to exceed these elements, increasing the work of the professionals, increasing unnecessary costs and increasing the risk and time of cleaning and disinfecting the “uniform”.

o   Cleaning and personal care: A good hand cleaning at the beginning, end of the day and between patients, with a nail brush with a viricidal solution, guarantees good protection against contagion and cross contamination. It is not recommended to use nail polish because it has irregularities that can retain germs. Nails should be well cut. It is recommended not to wear rings, bracelets, watches. 

It is recommended to remove makeup or other cosmetic products that may be a source of prolonged exposure if they become contaminated.

o   Uniform: wear uniforms with classic lines and long sleeves. with minimal seams, pockets, folds, or any design that can increase the retention of dirt or germs. 

When examining patients, the gown must be fluid resistant. For procedures where aerosols can be generated, the gown must be waterproof with long sleeves (if not waterproof, a plastic apron must be added).

o Cups: It is advisable to wear a hat. In any case, long hair should be collected in a ponytail or low bun, covering it with a cup.

o   Latex or nitrile gloves: It is recommended to change them every 15-30 minutes because they lose their barrier effect, or sooner if the consultation with the patient lasts less

o   Mask: FFP2 is recommended when exploring (if you use surgical, it must be changed whenever it is wet or deteriorated). 

For procedures where aerosols can be generated, precautions should be increased, its recommended the use of a FFP3 mask or, if not available, an FFP2. 

They must necessarily be changed with each patient and should never be kept in the pocket or moved from their position of use. If they get wet, they lose their effectiveness.

o   Glasses: as indicated, the eyes are a possible route of contagion, so its use should be mandatory. Avoid using contact lenses. If glasses are required, they should be taped from the eyeglass bridge to the forehead

o   Rubber dam: the greatest risk of infection of an intensivist is when he intubates a patient because an extremely contagious aerosol is formed. Therefore, in the dental office, the rubber dam should be used whenever possible. It will not only protect the professional from infection, but also will  protect the patient. 

o   Ventilate the room between patients as long as possible. Also, the waiting room and all the dependencies of the clinic. If there are difficulties in ventilating the cabinets between patients, a disinfecting spray should be used to ensure disinfection of the environment.

-  Sterilization process. Of course, extreme precautions must be taken when sterilizing all dirty material:

o   Appropriate personal protective equipment (PPE) must be used: clothing, cups, glasses, plastic apron and special thick gloves over latex gloves (Fig. 4). 

o   The Instruments should be immersed in disinfectant immediately after use. Make sure that the disinfectant used is the indicated one, and that it is used according to the recommended concentrations, time and temperature

o   The cleaning must be thorough, and the material must always be submerged to avoid contaminating aerosols

o   Drying should also be careful as humidity can invalidate the sterilization process

o   We must use an autoclave type B to sterilize, taking care not to stack the material to guarantee the desired sterilization. It is recommended to perform the Helix test daily and the spore test weekly.

o   The Cabinet surfaces must be protected with surface protectors and disposable material

o   The dental chair must be thoroughly cleaned after removing its protections with a suitable surface disinfectant. An alternative may be a sodium hypochlorite solution with 1,000 ppm of active chlorine (1:50 dilution of a freshly prepared 40-50 g / l bleach).

 

3.     Marketing and Advertising - Where are my patients? 

As previously indicated, the clinics that have “treasured” their patients over the years, building loyalty, will be the ones that will suffer the least during the critical period that we will live immediately after confinement, and when the economy begins to activate. However, we must try to get new patients as soon as possible. In order to do this, we have to be selective and “recruit” candidates to make them new patients among selected groups (clinics focused on famous patients, with high purchasing power, that also have  other activities such as health insurance, for example), or focus in a selected area where we can generate all possible impacts in order to earn their trust, showing the professionalism of the staff.  We also need to show our excellence in results, and our guarantee and safety of the treatments along with our humane and closeness (if this were the 'position' that the clinic wants to communicate).

This is a complex and expensive task and it is advisable to have a marketing professional to deal with it, thus guaranteeing the desired result. Again, optimal results can be achieved, increasing the effectiveness of our actions and adjusting costs. All activities have to be developed in an integrated manner and with scaled economy in a purchase group. 

We can use all types of marketing tools: 

Digital Marketing

o  An attractive, clear, and intuitive website of the clinic should be available to facilitate navigation. This may be the main “showcase” of the clinic. There, we should show   all the services and treatments offered a highly professional and attractive way, highlighting the safety aspects that are in these times, very important to calm the social alarm of our patients. The objective of transforming visitors into patients should be sought, facilitating the request for more information, generation of appointments via the web or by phone.

o   If the objective is to attract potential patients from a specific geographical area, we will have to position the site very well in searching engines such as Google, this way, whenever a person looks for a nearby dental office or dentist, our clinic (local SEO) appears. 

o   Having a presence in “Google Local Business” is an excellent marketing strategy because the clinic will appear in the first search positions of the patient in the area, with the possibility of accessing a map with the route to be taken to get there. 

o   We must actively work to have the satisfied patients generate positive reviews of the clinic. In addition to including them on our website, they can be included in our “Google my business” file, thereby improving our positioning at a local level and our reputation with potential new patients.

o   Google “local guide” can be vital in generating the dental clinic's online reputation, the candidate patients can read opinions of these “influencers”. These local guides will value our treatments, positively or negatively, and can generate a public opinion. They are people hired by Google who are dedicated to writing comments. The platform takes points away from them if they think they have not followed the “publication rules”. This is how they try to guarantee that the opinions received are sincere and fair.

o   Create a “blog” where patients who know us can come and participate but also non patients who have doubts or want to know more about the treatments we perform, or they want to learn more of our treatments and protocols. If we work in the blog routinely, we can build a strong relationship with current and potential patients. In addition, it can be a good place to obtain information on the needs and suggestions from our patients to improve our procedures and services offered. 

Any “Community manager” can confirm that by properly creating and managing a blog, our brand can be promoted on social media and attract new patients to the clinic. 

o   Google also has a tool called “Google AdWords” that if it is well configured, makes ads for the local public and can attract patients to the clinic. These adds allow reaching the public of the selected area. 

o   Create a good social media strategy. Have a Facebook page, being active in Instagram, uploading videos in YouTube regularly. If we support this activity with ad promotion, and good local segmentation, we can reach potential customers. Being regularly on social media can be a tremendous and powerful marketing tool

o   Create an advertising campaign on social media. Facebook is the social network with the largest number of users in Spain, so, it is a very interesting advertising tool.  We can filter to target audience based on interests and location

o   WhatsApp has an intelligent messaging services tool to create an official profile of the clinic and provide information of interest to patients, such as contact information, description of services and treatments. It also has tools to facilitate the management of the patient service. It can be very useful to retain and attract patients to the dental clinic.


Offline Marketing

The tools of conventional marketing can also help to attract new patients to the clinic and retain them. This type of approach is complementary to the digital marketing plan, and besides the classic actions such as mail boxing around the clinic area, ads in local media, posters, we can do actions such as:

o   “Mouth to mouth” this is one of the best methods to recruit new patients.  If we manage to impact our patients with an excellent, professional, close, safe, honest and transparent attention, they will be the best ambassadors for potential future patients. One example, it is known that over 80% of new patients come from recommendations from satisfied patients. This “word of mouth” is the one that we have to try to translate into a “recommendation” in social media.

o   Promotions to make current patients loyal by providing new patients, establishing a system to reward those who bring new patients to the clinic. An example may be to make discounts to families, couples or friends.

o   Presentations and conferences. We should do presentations on safety in dental treatment, procedures, and others in our neighborhood social centers, women's associations, local entities, schools, etc. 

 

The National Council of Dentistry in Spain, says that because of the Coronavirus and as a consequence of its economic and health impact, more than 50% of dentists will go bankrupt.

 In a recent survey to more than 4,200 dentists by the Spanish Oral Public Health Council and Society (Employment situation of dentists compared to COVID-19 in Spain. April 17, 2020), indicates that:

-        10% of the dentists surveyed have been in contact with the COVID-19 virus

-       2% have passed the disease 

-       25% of clinics have temporarily ceased their activity due to the pandemic. 

-       80% have not been able to acquire the necessary protection material due to lack of supply

-       60% of dentists say they are concerned about the risk of being affected for the disease due to the lack of protective material.

 

As the days go by, we are having access to the much-desired protection material and we are approaching a progressive lack of confinement that will allow us to restart the activity of the clinics, although with high uncertainty, difficulty and effort.

However, if professionals can objectively analyze their options and work on the relaunch of their clinics, success will be guaranteed and both they and their businesses will have grown and become stronger.

 

(As previously indicated, a more exhaustive analysis and a more detailed development of the measures, proposals and protocols can be found by visiting the website www.asd-consulting.net).

 

 

Bibliography

1.     Benjamin Neuman. ‘The conversation: Virologist Explains What The Coronavirus Does to Your Body That Makes It So Deadly’. Science Alert – Health, Abril 6, 2020: https://www.sciencealert.com/why-is-this-coronavirus-so-much-more-dangerous-a-coronavirus-expert-explains.

2.     World Health Organization. ‘Q&A on Coronaviruses (Covid-19)’. April 8, 2020: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses.

3.     ECRI. ‘Disinfectant Concentrations and Contact Times for EPA’s List of Products Effective against Novel Coronavirus SARS-CoV-2, the Cause of COVID-19’. Rev. April 1, 2020: https://www.ecri.org/components/HDJournal/Pages/Disinfectant-Concentrations-for-EPA-list-N-COVID-19.aspx?tab=2.

4.     FMI (International Monetary Fund), Abril-14 2020: ‘Perspectivas de la Economía Mundial”.

5.     Banco de España, Abril 20 2020: ‘Escenarios macroeconómicos de referencia para la Economía Española tras el COVID-19’.

 

The analysis and forecast in this article are based on my own knowledge and experience, and when considering the future with a high degree of uncertainty, other professionals may have divergent opinions. Therefore, I invite those who may disagree with my approach, to enrich this analysis based on their own training, experience and criteria, and enlightening the professionals who read it to facilitate a rapid and profound change in their model that guarantees their post-survival. -COVID19.

Please send your comments to: agustin@asd-consulting.net.


About the author: Agustín Sánchez has a PhD in Biochemistry and Executive MBA. He has developed his professional activity in the Commercial and Marketing Management in different companies in the pharmaceutical sector such as Bristol-Myers-Squibb, Serono Laboratories, Cilag-Janssen (Johnson & Johnson) and Wyeth-Lederle, and in the dental sector such as Dentsply Sirona. Currently he carries out his activity as an independent Consultant in both sectors.