It might be surprising to know that telehealth has been occurring for about 100 years now; there’s evidence of radios being used in the 1920s to provide clinical advice to people in remote locations. The way telehealth is conducted or provided has changed greatly over the years as the technology which supports it has changed and developed.

What is telehealth

Telehealth is providing health services remotely with the use of technology. There are many forms of technology which assist this such as phone calls, teleconference calls and sharing of images and videos.

There are many reasons why telehealth is used, however, they primarily boil down to the patient and practitioner not able to physically be in the same place. This may be because of geographical remoteness. Age or disability can prevent patients from travelling to their practitioner. And now social distancing requirements to reduce the spread of COVID-19 is making face to face appointments difficult and potentially unsafe. Therefore, telehealth is very beneficial, however it isn’t without risk. And these risks need to be considered and managed before this service is offered.

Is it right for you?

All business owners want to stay ahead of their competitors and provide the best service possible to their clients. However, this can mean at times business owners leap into something new too quickly without proper consideration and assessment.

Telehealth isn’t ideal for all health practitioners. Before you start offering telehealth services, do some research that will help you assess if it’s right for your business, your patients and the services you provide. Consider the pros and cons; think about how it’ll benefit your business but also consider the risks and challenges it’ll create.

You should consider developing an implementation plan to assist you in working through a range of factors to consider, such as:

• Which services will suit telehealth, which won’t?
• Who’ll assist with providing and supporting the technology required?
• How will this new process be communicated with patients?
• How will patients be assisted if they have difficulty with the technology, or simply
  don’t want to use it?
• Will the process be phased in gradually?
• How will it be evaluated?

Invest to do it well

The old saying ‘if something’s worth doing it’s worth doing well’ really does apply to implementing telehealth practices. When technology works well, it’s fantastic, when it doesn’t, it can cause a huge amount of frustration and time wasting. It’s therefore important that health practices don’t rush into implementing telehealth practices. It’s worth taking the time to ensure the tools and technology used are suitable for that individual practice. It’s also recommended that time is spent training all staff to be sure they understand how to use the new technology and what’s required of them with this change. Investing both time and money at the beginning will benefit the practice, practitioners and patients in the long term.

Some things stay the same

Much of what you already do, and what you’re required to do, as a health practitioner won’t change when using telehealth.

• Communication – communication is always incredibly important for all health practitioners. However, it needs additional focus when consulting via telehealth. Practitioners may find they need to spend longer having conversations and should consider what questions they’ll ask the patient to be sure information has been understood.

• Record keeping – you need to keep detailed and accurate records of all consultations and communications with patients, and this includes when using telehealth. It’s not just about actual consultations, even details about phone conversations with patients need to be recorded. If a consultation takes place via telehealth, make a note of this in the clinical record including the type of technology needed.

• Informed consent – you need to ensure patients give their informed consent prior to treatment. Providing signed informed consent is a bit harder when consultations take place remotely, yet this can still be done in some cases. However verbal consent is sufficient. But remember, informed consent can only be given when the patient has been informed about the treatment, so sending a form to be signed to a patient before there has been any discussion or consultation isn’t appropriate. Also, verbal informed consent must be noted in the clinical record.

• Privacy – you have a professional obligation to maintain the privacy and confidentiality of your patients. Therefore, when conducting a telehealth consultation, be sure it’s done in a private setting where no one in the background can hear or see what’s happening. Many forms of online communication, such as teleconferences, have a recording function. Consultations shouldn’t be recorded simply because they can. They should only be recorded if there’s a clear and specific reason for it and if the patient has given their consent.

• Duty of care – health practitioners have a duty of care to all patients they treat. If a patient is being treated using telehealth and has never met the practitioner prior to this, this doesn’t change anything in terms of the practitioner’s duty of care to that patient.

• Clinical decision making – Incorrect diagnosis is one of the greatest risks with telehealth, yet telehealth is no excuse for mistakes being made. If you don’t have the information needed to make a diagnosis or provide/recommend treatment, you must to find a way to get this additional information. Practitioners may want to consider if their assessment processes alter when using telehealth. Practitioners should also be sure they don’t allow the patient, or the treatment circumstances, convince them to provide treatment or advice that goes against their better judgement.

• Practice within scope – when consulting using telehealth, the need to keep within your recognised scope of practice, and refer when the situation is outside of this, is no different.

• Funding schemes – some funding schemes, such as private health insurers and Medicare, provide cover for telehealth, for some forms of treatment. As the treating practitioner, it’s your responsibility to be sure you’re meeting the requirements of the various funding providers and don’t claim for items which aren’t permitted.

• Regulatory requirements – in addition to the above, any other requirements set by regulatory bodies need to be adhered to. This includes keeping on top of government advice and restrictions relating to COVID-19

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The Coronavirus pandemic has challenged us all personally and professionally, as we live through never before seen challenges. Many professionals and businesses alike are struggling with the ever-changing landscape as they navigate business continuity in a way which is safe for them, their staff and their customers and also complies with changing government restrictions and requirements.

You don’t have to be powerless through this uncertainty, and the key to continue to thrive as we move into the new normal is robust communication with your customers. Clear, concise and relevant  communication with your customers is vital in the coming weeks and months to ensure continued engagement.

As Guild Insurance works across multiple industries, our experience of working with thousands of professionals and their customers puts us in the unique position to understand what customers need from you. We have compiled some information to assist you in developing email communication with your customers.

Please note that this information is generic and should be used as a guide. All businesses are unique and how they’re responding to COVID-19 is also unique. Therefore, you need to create your communication to suit your individual circumstances.

Start your email with an introduction to the situation

E.g. We face challenging times ahead as we navigate through a continually changing
environment caused by the impact of the Coronavirus pandemic. Here at (business
name),we are focused on staying healthy and continue to review our health and safety
processes, so we can keep our doors open to our customers when they need us. A key part of this is to ensure we change our operational practices to maintain compliance
with evolving government recommendations and restrictions and reduce the risks to our
staff and visiting customers. We’re therefore contacting you keep you informed of what
we are doing here at (business name).

Now inform your clients of what you’re doing to avoid the spread of infection in your business

E.g. At (business name), the health of our clients and staff is our number one priority.
Therefore, on top of our usual cleaning and hygiene processes, we’re implemented the
following steps.

• All clients will be asked to wash their hands when they enter the premises
• Hand sanitiser is readily available, and we insist all staff and visitors use it regularly
• We’re asking all clients to wait outside the building, where there is space to maintain
  the recommended distance, rather than in our waiting room which doesn’t allow for
  social distancing. We’ll call you when you should come in for your appointment.
• We are regularly cleaning and sanitising all high touch areas such as doorknobs and counters.
• We will no longer accept cash and will only accept card payments.

Let your clients know if anything about the service you usually provide has changed

• Is there a service no longer available, have modifications been made, is there something new you’re now doing?
• Are you offering services remotely?
• Have opening and closing hours changed?
• Will your usual cancellation policy alter to encourage people to not attend if unwell
• Will you be offering any financial assistance or support to customers who may be experiencing financial hardship?
• Will you offer refunds if people have paid upfront and are no longer able to participate/attend?

E.g. Our usual cancellation policy requires 24 hours’ notice or a late cancellation/no show fee of $40 is charged. However, we are currently waiving this notification period until further notice. This fee will not be charged provided you call us to let us know you can’t attend. Therefore, if you feel that on the day of your appointment you have flu like
symptoms and shouldn’t attend our practice, please give us a call and don’t come in.

Finish with a reminder asking people to not attend your business if they have any concerns about displaying COVID-19 symptoms

E.g. We understand everyone wants to get on with life and do the things they are used
to doing. However, for the time being it may not be possible, and we must do what we can to flatten the curve. At (business name) we’re committed to doing our part to minimise the spread of COVID-19. Therefore, if you are experiencing any flu like symptoms, please consider others and stay home, do not visit our practice. We’re keen to see you again soon, however only when you’re feeling well

As we all do our best to minimise the spread of COVID-19, one of the tragic outcomes is that many businesses need to close their doors for a period of time. This is never a decision made lightly as the ramifications are enormous. There are many factors to consider when doing this, such as how staff will be looked after during this time, if services can be provided online and how to communicate the closure with clients.

Another important consideration should be the protection of the property from which you operate your business. Sadly, vacant buildings can lead to an increase in thefts and burglaries as a lot of crime is opportunistic. Thieves will know that many businesses have closed only temporarily and therefore the buildings may not be empty, there may still be items worth stealing inside.

The following are some tips to consider if you are temporarily closing the physical premises of your business:

• While you want to inform your clients about the change to the business, placing a sign on the front of the building may not be the most ideal way, especially if this will be easily visible for those walking past. If you do want to place information on the building about a
  closure, don’t indicate this is potentially long term or indefinite, simply provide details for clients to contact you.

• Redirect mail to a home or post-office box and place a ‘no junk mail’ sign on the building’s letterbox. A messy overflowing letterbox is a sure sign no one has been frequenting the premises.

• Use a timer to have the lights turn on and off at certain periods of the day, creating a look of someone being in.

• Electronic Security Alarms should be kept operational where fitted.

• Consider which appliances can be turned off as many appliances continue to use power even when they aren’t being used. Items to consider turning off include hot water tanks, televisions, microwaves and computers. However, be sure to think about what you’re turning off before you quickly switch off all power; for example, fridges and freezers, unless empty, should be kept on.

• It’s important to conduct regular external inspections of your property to check the condition, ensuring that it’s safe and there are no signs of attempted entry or vandalism. Where possible, visit your property fortnightly, however, be sure you’re complying with government COVID-19 restrictions when doing this. Maintain the external appearance by removing any rubbish and mail and keep lawns and gardens trimmed.

• Clear out your gutters. A build-up of leaves and other debris creates a fire hazard as well as a risk of an overflow of water entering the roof space during a storm.

• If you have a good relationship with your neighbours, let them know about your closure and be sure they have your contact details. That way if anything goes wrong or they notice anything suspicious, they can let you know.

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Dentists need to acknowledge that adverse outcomes are an unfortunate, yet very real, aspect of dentistry. Whilst dentists may do all they can to avoid these outcomes, they won’t ever be completely eliminated from dentistry, or any other area of healthcare.  Therefore it’s vital that all dentists have considered how they’ll manage an adverse outcome should the situation arise.

What to do following an adverse outcome

One of the first steps a dentist must take when there’s been an adverse outcome is to discuss this with the patient. It’s acknowledged this is a very challenging thing to do, however it isn’t optional.  The Dental Board of Australia’s Code of Conduct states that ‘When adverse events occur, practitioners have a responsibility to be open and honest in communication with a patient’.  It’s well recognised that patients appreciate a healthcare professional being upfront and honest with them in informing them of what has occurred and what this means for the patient.

Many practitioners are hesitant to say sorry when informing a patient of an adverse outcome. There is often a concern that this may mean they’ve admitted guilt and are then more likely to be held accountable.  However, Australian legislation makes it clear that an apology is not an admission of liability.  It’s best to avoid statements such as “I’m sorry I’ve done this to you” as this may be seen as an admission.  An apology needs to be carefully worded and can be as simple as “I’m sorry this has occurred”.

When having this conversation with patients, it’s important to give them opportunities to ask questions. It needs to be a balanced two way conversation, not just information given by the dentist.  This will ensure the patient has a greater understanding of what’s occurred and what the implications are for them.  It also assists the patient in feeling part of the treatment process and decision making moving forward.

It’s common to hear patients state that they want to know what the practitioner and practice is going to do to avoid a similar situation occurring again to either themselves or other patients. This means you need to explain to the patient what you’ll do to understand why the adverse outcome occurred and what measures you’ll put in place to reduce the likelihood of it happening again.

Why are these conversations difficult?

It isn’t uncommon for a practitioner to find it difficult to have this open and honest conversation with a patient following an adverse outcome. This isn’t surprising given many people find it challenging to initiate hard conversations.

In many cases the patient will know there has been a poor outcome as it will be obvious to them. In these cases there is no avoiding the conversation as the patient will probably confront the dentist.  However there will be occasions where the patient isn’t aware, such as when a file has fractured during RCT.  There may sometimes be a temptation for a dentist to not inform patients of these cases, possibly thinking they don’t need to know.  However, this is not an acceptable way to practice.  Patients have a right to be informed about their health outcomes and dentists have an obligation to keep them informed.

There are a number of reasons why a dentist may find these conversations challenging, such as:

• Dentists may be concerned that informing patients of what went wrong and why may increase the likelihood of a formal complaint and demand for compensation.
• The outcome may be a surprise to the dentist, leaving the dentist thinking “I never thought this would happen to me”. If the dentist is struggling to understand what went wrong and why, explaining it to the patient is going to be difficult.
• A dentist may be concerned they’re admitting to professional incompetence.
• A dentist may be worried the conversation will lead to professional or financial repercussions for the dentist or practice.

Benefits of a well handled adverse outcome

There are obvious benefits for both dentists and patients when a poor outcome is well managed.

When a patient has lodged a formal complaint about a health experience, it’s quite common for them to state that they’ve done so as a means for obtaining information and or an apology regarding what occurred and why. It seems that when a situation is not well explained to the patient, they may feel the need to take the matter further, such as a formal complaint, to get the information they need.  It also seems that a patient may lodge a complaint when they feel their concerns have been dismissed and they haven’t received an appropriate acknowledgement or apology.

This is evidence of two things:

• Patients don’t necessarily complain for financial or malicious means. It’s easy to assume that patients complain because they want to receive financial compensation or because they want there to be repercussions for the practitioner who has harmed them. Whilst these may be influential factors in some cases, they aren’t in all situations. There are situations where a patient complains simply to receive further information.
• An open and honest conversation may prevent some complaints from occurring.       If the patient feels the dentist has been up front with what’s occurred, has provided a commitment to rectify the situation and has provided information about how the situation will be prevented in future, many patients may not feel a need to formally complain. They may also be more likely to continue treatment with that dentist as the relationship and trust still exists.

In summary…

Dentists need to remember that they have an obligation as a registered health professional to provide their patients with honest information following an adverse outcome. However, being obliged to do this shouldn’t be the only reason it’s done.

It’s well recognised that patients expect and appreciate this honest conversation. And having this conversation can go a long way towards the patient deciding whether or not to lodge a formal complaint and whether to continue being treated by that dentist.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them. This article contains information of a general nature only, and is not intended to constitute the provision of advice.