Implement the Program

You must consider several key steps as you proceed from planning and preparation to program operations and services delivery. These seven steps are intended to help your organization establish efficient processes but also to refine them over time. Depending on your program’s size and scope, as well as on your community’s specific needs, you might spend more time on certain steps than others as you implement your program.

  1. Establish clear policies and procedures
  2. Onboard staff and promote engagement
  3. Recruit potential clients
  4. Develop efficient scheduling and follow-up protocols
  5. Minimize missed appointments
  6. Purchase equipment and supplies
  7. Prepare for program evaluation

Establish Clear Policies and Procedures

  • Develop a policies and procedures manual that describes your program’s day-to-day activities. The manual should serve as a framework for all of the program’s operations and should be distributed to new and existing staff. See the sample oral health program policies and procedures manual from the National Maternal and Child Oral Health Resource Center.
  • Develop a staff handbook that outlines employment practices, office operations, benefits, and other information important to employees. Templates are available, and the sample staff handbook from the National Maternal and Child Oral Health Resource Center provides more information on important content.
  • Hold contractors and volunteers to the same standards as staff, and include the staff handbook in signed contracts and volunteer agreements to ensure compliance and understanding. Be certain that your organization also follows the policies and procedures agreed with contractors.

Onboard Staff and Promote Engagement

  • Identify the types of providers you need based on your program model (e.g., dentists, dental hygienists, transportation managers for mobile-portable programs). Develop and refine an optimal staffing mix that uses different staff types efficiently.
  • Determine whether your organization will use volunteers. Cater to your volunteers’ needs, and offer a scope of services that affords them satisfaction. To keep them engaged, hold volunteer appreciation events, and bring volunteers into the program’s decision-making processes. See the Program Spotlight: Ensuring Sustainability for more information on engagement.
  • Adopt effective recruitment and retention strategies (PDF), as described by the National Network for Oral Health Access. Advertise open positions through dental schools, job fairs, and national, state, and local associations. Provide supervision and support to ensure that staff members feel connected to the program’s mission.
  • Schedule initial training courses for staff and volunteers as well as opportunities for continuing education. Be sure to train staff on the health information technology that your organization chooses to implement (e.g., electronic health records). Continuing education opportunities can also help improve recruitment and retention.
  • Create a job description for each position that clearly outlines minimum requirements, roles, and responsibilities. Distribute these descriptions to all staff members to promote accountability. For an example job description, see the National Maternal and Child Oral Health Resource Center’s Clinical Operations for Safety Net Dental Clinics.
  • Host an orientation to introduce new staff and volunteers to the facility, and provide information on the organization’s background, structure, and functions. During this orientation, distribute the staffing and policies and procedures manuals.

Recruit Potential Clients

  • Develop a recruitment plan that includes your target number of clients, outreach strategies to contact potential clients, and list of potential partners that can help with this effort.
  • Discuss potential outreach strategies, and determine how your organization will contact potential clients using one or more of these strategies. The University of Kansas’s Community Tool Box Chapter 7, Section 3 describes methods for outreach and the advantages and disadvantages of each.
  • Decide which community partners can most help your organization recruit clients. Strategies for partnering to increase client recruitment could include direct referral from partner organizations, partners marketing your organization to specific sectors in the community where they have influence, or partners going into the community to conduct outreach where potential clients reside (e.g., public housing communities).
  • Consider expanding the inclusion and exclusion criteria for people who can receive services from your program. Allowing a wider range of people to receive services can be particularly helpful in cases where you’re not meeting your goals for the number of clients you’d like to serve.

Develop Efficient Scheduling and Follow-Up Protocols

  • Determine whether your program will serve clients by appointment, on a walk-in basis, or both. Establish how far in advance you’ll make appointments. (No more than three weeks is recommended.)
  • Schedule appointments based on a detailed treatment plan that the dentist creates for each client. This approach allows for better estimation of timing for appointments. For more information on treatment planning, see the National Maternal and Child Oral Health Resource Center’s Clinical Operations for Safety Net Dental Clinics.
  • Remind clients about upcoming appointments or necessary follow-up via email, phone, or U.S. mail. Confirm with all clients the day before their appointment.
  • Ask clients whether they’re available on short notice for appointments, and maintain a list of these clients to fill last-minute gaps in the appointment schedule.
  • Follow up with clients after a treatment or operation, and describe normal responses for the procedure (e.g., swelling), steps the client should take to ensure proper healing (e.g., medication), and body responses that warrant immediate attention (e.g., fever).
  • Create a protocol for handling emergency visits (e.g., toothaches, broken fillings) based on your program’s available services and capacity. For additional guidance on handling emergency visits, see the National Maternal and Child Oral Health Resource Center’s Clinical Operations for Safety Net Dental Clinics.

Minimize Missed Appointments

  • Develop a written policy for missed appointments (see a sample (PDF) from the National Maternal and Child Oral Health Resource Center), distribute it to all clients during the first visit, and collect their signature for the policy as a signed contract.
  • Develop a script for front desk staff to use when clients question the missed appointments policy. See page 11 of the DentaQuest Institute’s Best Practices Manual (PDF) for example language to include in the script.
  • Schedule appointments no more than three weeks in advance, which decreases the likelihood of no-shows and cancellations. In addition, send a written reminder and follow up with a phone call to schedule necessary additional appointments rather than scheduling these appointments at the end of a current appointment.
  • Consider scheduling two clients for one time slot if both clients have a history of missed appointments. Be sure that at least one of the clients is scheduled for a simple procedure in the event that both clients arrive for the appointment.
  • Provide clear directions or support to help clients access the location of their appointment because inadequate transportation is often a significant cause of missed appointments among older adults. The brochure Choices for Mobility Independence: Transportation Options for Older Adults (PDF) can help you explore transportation assistance options.

Purchase Equipment and Supplies

  • Determine the types of equipment and supplies you’ll need for your program as well as their cost (see the Finance the Program section for more information on estimating cost). Consider different products’ shelf life, the usual amount of time the product remains functional and safe before needing replacement, and use rate.
  • Track your inventory to ensure supplies are replenished and haven’t passed their expiration dates. In addition, pay attention to supplies that require certain temperatures (e.g., anesthetics).
  • Plan for maintenance of facilities, vehicles, and other equipment, as described in the National Maternal and Child Oral Health Resource Center’s Safety Net Dental Clinic Manual. Consistent preventive maintenance can reduce operating costs and increase shelf life.
  • Consider purchasing bulk amounts of supplies with other programs, clinics, or organizations for reduced prices.
  • Speak with manufacturers or suppliers at state or regional meetings to secure discounts or donations as a charity or nonprofit organization. Also, consider asking private dentists to donate their used equipment when purchasing upgrades (i.e., as tax write-offs for the private dentists).

Prepare for Program Evaluation

  • Identify the data measures (e.g., number of clients served, number of procedures performed) to be tracked regularly, which helps ensure that evaluation and quality improvement efforts later can proceed as planned with a sufficient amount of data for robust, reliable evaluation. See the Evaluate the Program section for more information.
  • Plan ahead for collection and storage of health records and other client documentation (e.g., informed consent, referrals). The National Maternal and Child Oral Health Resource Center’s Clinical Operations for Safety Net Dental Clinics provide more information on storing health records. In addition, adopting health information technology can lead to more efficient workflows and can improve service delivery (see the Key Concept Health Information Technology for more information).
  • Ensure that staff members understand Health Insurance Portability and Accountability Act (HIPAA) rules as well as Institutional Review Board (IRB) requirements for conducting research on human subjects. The ASTDD provides information on the IRB Review and HIPAA requirements (PDF) for oral health programs.

Program Spotlight: Access Dental Care

This case study provides additional information on how to implement a program based on the experiences of Access Dental Care, a mobile-portable program in North Carolina that provides onsite oral health services in long-term care facilities to older adults and people with intellectual and developmental disabilities. When Access Dental Care started, it adopted many ideas from existing portable programs and collaborated with these programs to improve its own operations. The program, for example, learned about a chair that another program had custom designed with a manufacturer to reduce the risk of back pain among its dentists and hygienists and was able to purchase this same chair for its dental staff. In addition to working with similar programs for implementation, Access Dental Care hired a mix of dentists, dental hygienists, and dental assistants based on the type of services provided, particularly seeking staff who could communicate effectively given the program’s desire to educate other health professionals in the long-term care facilities. For equipment and supplies, the program worked with the dental equipment manufacturers to customize products that would incorporate versatility, size, and disposability, all major factors. Although disposable supplies are more expensive, Access Dental Care decided to use them to maximize client service time at each site. Through products customization and adoption of promising practices from other programs, Access Dental Care was able to implement the program effectively and maximize efficiency.

Key Resources

The resources listed below provide additional guidance and support for implementing your program.

  1. National Maternal and Child Oral Health Resource Center’s Clinical Operations for Safety Net Dental Clinics – This resource contains six modules with comprehensive, experience-based information on how dental clinic staff can develop and streamline implementation to improve quality of care and operational efficiency.
  2. DentaQuest Institute’s Best Practices Manual for Safety Net Dental Programs (PDF) – This manual outlines and provides guidance on key steps that safety net dental directors and staff should take as they operate their programs. This includes scheduling, staffing, and billing and collections advice, among others.
  3. National Maternal and Child Oral Health Resource Center’s Safety Net Dental Clinic Manual, Chapter Four: Clinical Operations – This fourth chapter of this manual provides detailed guidance on successfully operating a safety net dental clinic after determining the design and launching the program. The manual covers staffing, inventory management, and safety issues, among other topic areas.
  4. Rural Health Information Hub’s Oral Health Toolkit, Module Three: Implementation of Programs – The third module of this toolkit focuses on how rural oral health programs can effectively implement their programs after selecting a program model. Topics in this module relate to finding the appropriate staff, partners, and resources, and also address specific challenges to expect during implementation.
  5. National Network for Oral Health Access’ User Guide for Implementation of Interprofessional Oral Health Core Clinical Competencies (PDF) – This resource highlights key areas for program implementation and provides guidance on planning, as well as four system areas: training, health information technology, clinical care, and evaluation.
  6. National Network for Oral Health Access’ Operations Manual for Health Center Oral Health Programs – This six chapter manual provides tools and resources for oral health programs located within larger health systems. Chapters essential to implementation are Chapter 3: Financials and Chapter 5: Workforce and Staffing.