20 Jun Practice Evaluation Survey Posted at 23:46h in by Dr. Noble 0 Likes Welcome to the Practice Evaluation Survey. There are no right or wrong answers. The purpose of this battery test is to generate valuable insights to help make your practice better. The data will be analyzed using SPSS statistics. The evaluation takes about 15 minutes to complete. This 15-minute survey could add 15% more new revenue to your practice month after month. Let's discover the hidden treasures together. Good luck! Instructions: This is a 'YES', 'NO', or 'N/A' evaluation survey It is designed for quick response ~2-3 sec./question The system will not allow more than one answer You will not be able to change your responses Click the "next" button to advance to the next question 1. What are the major needs (at this time) for your practice? Choose only one major need. Use the comment field below to list more of your needs (if applicable.) More Patients Develop Practice Growth Plan Clinical Efficiency Training Total Practice Evaluation Improve Collections Marketing The Practice Electronic Dental Records System Grow Hygiene Department (for dentistry) Improve Financial Systems Compensation Plan Information Technology Systems Not Sure None Comment 2. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).a) Public Relations 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 3. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable). b) Practice Website and Software 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 4. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).c) Phone Management 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 5. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).d) New Patient Marketing / Intake 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 6. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).e) Patient Education 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 7. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).f) Initial Diagnosis / Education 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 8. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).g) Treatment Plan Presentation 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 9. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).h) Cash Plan Management System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 10. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).i) Patient Tracking System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 11. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).j) Recall System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 12. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).k) Missed Appointments System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 13. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).l) Financing (Billing) & Collections 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 14. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).m) Insurance System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 15. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).o) Referral System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 16. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).p) Patient Reactivation System 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 17. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).q) Staff Hiring / Training Systems 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 18. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).r) Staff Meetings 5 = Very Effective 1 = Ineffective n/a = Not Applicable None 19. a) Are you satisfied with your income level? A = Yes B = No n/a = Not Applicable None 20. b) On 1-10 scale (10 being high), is your stress level below 5? A = Yes B = No n/a = Not Applicable None 21. c) Have you had leadership training? A = Yes B = No n/a = Not Applicable None 22. d) Do you have a written practice philosophy? A = Yes B = No n/a = Not Applicable None 23. e) Do you create a strategic plan each year? A = Yes B = No n/a = Not Applicable None 24. f) Do you have a personal business coach? A = Yes B = No n/a = Not Applicable None 25. g) Do you have business marketing training? A = Yes B = No n/a = Not Applicable None 26. a) Does your practice have an organizational chart? A = Yes B = No n/a = Not Applicable None 27. b) Does each staff member have a list of job responsibilities that everyone knows about? A = Yes B = No n/a = Not Applicable None 28. c) Is it easily apparent who is responsible for certain duties and responsibilities? A = Yes B = No n/a = Not Applicable None 29. d) Is your practice prepared to cover for a staff member who leaves unexpectedly? A = Yes B = No n/a = Not Applicable None 30. e) Does staff know who their supervisor is and who is responsible for evaluating them? A = Yes B = No n/a = Not Applicable None 31. a) Does your practice have departmental leaders? A = Yes B = No n/a = Not Applicable None 32. b) Do members of the leadership team have authority as well as responsibility? A = Yes B = No n/a = Not Applicable None 33. c) Do they make, communicate and stand by their decisions? A = Yes B = No n/a = Not Applicable None 34. d) Are staff members’ complaints and concerns always addressed to the correct person? A = Yes B = No n/a = Not Applicable None 35. e) Are leaders supported by the practice top management? A = Yes B = No n/a = Not Applicable None 36. a) Is there a clear decision-making process in the practice (e.g., certain decisions are made by consensus, others are made only by doctors, and still others are reserved for “the boss/owner”)? A = Yes B = No n/a = Not Applicable None 37. b) If a process does exist for making decisions, is it followed each time? A = Yes B = No n/a = Not Applicable None 38. c) Does staff know how decisions are made? A = Yes B = No n/a = Not Applicable None 39. d) Are decisions communicated by the practice’s leadership to all staff? A = Yes B = No n/a = Not Applicable None 40. e) If a staff member has an idea about an improvement or change to the practice, is there a clear process for gathering suggestions and submitting them to management? A = Yes B = No n/a = Not Applicable None 41. f) Does the practice make decisions quickly? A = Yes B = No n/a = Not Applicable None 42. g) Is the practice flexible and cooperative? A = Yes B = No n/a = Not Applicable None 43. h) Do you have methods for communications among all levels of the practice? A = Yes B = No n/a = Not Applicable None 44. i) Do all providers and employees understand the patient’s needs and place priority on those needs? A = Yes B = No n/a = Not Applicable None 45. j) Does the practice culture encourage and reward continuous improvement? A = Yes B = No n/a = Not Applicable None 46. Please indicate which of these services your practice now outsource to other organizations. Use the comment field to list more (if applicable.) a) Digital / Electronic Paper Conversion b) Dental Billing System c) Collections (through collection agency) d) Functions performed by Advisors (such as legal, accounting, business coaching, etc.) e) System Software Support & IT Technology f) Recall & Mailings g) Video Recording h) Sterilization Monitoring Services i) Marketing j) Public Relations k) Janitorial Services l) Dental / Medical Laboratory m) Staff hiring & initial assessment n) HR Management None Comment 47. If applicable, do you currently have an online interface with any of the outsourced services listed below? List more in the comment section below. a) Administration Services b) Marketing Services (such as TV, Newspapers, Social Networks, etc) c) Information Technology Services d) Financial Services e) Dental Laboratory f) Applicant Testing None Comment 48. a) Do you have recruitment and hiring process for your practice? A = Yes B = No n/a = Not Applicable None 49. b) Is your staff provided with copies of the employee manual? A = Yes B = No n/a = Not Applicable None 50. c) Do you conduct a performance evaluation for your staff on a periodic basis? A = Yes B = No n/a = Not Applicable None 51. d) Do you have salary administration guidelines and schedules for your practice? A = Yes B = No n/a = Not Applicable None 52. f) Do you have an active employee incentive plan (bonus system)? A = Yes B = No n/a = Not Applicable None 53. g) Does your HR department properly document disputes (if any) that occur between staff members? A = Yes B = No n/a = Not Applicable None 54. h) Do you have a corrective action system? A = Yes B = No n/a = Not Applicable None 55. i) Does your human resources department have standardized Termination / Separation Forms? A = Yes B = No n/a = Not Applicable None 56. a) Do you have a dedicated staff that handles your regulatory and compliance issues (OSHA, HIPPA, DEA, etc.) A = Yes B = No n/a = Not Applicable None 57. b) Do you have the required CE credit for staff and doctors properly recorded? A = Yes B = No n/a = Not Applicable None 58. c) Do you have a CE calendar for all doctors and staff? A = Yes B = No n/a = Not Applicable None 59. a) Do you have an online backup of all practice computer data? A = Yes B = No n/a = Not Applicable None 60. b) Are your backups verified daily? A = Yes B = No n/a = Not Applicable None 61. a) Do you have written job descriptions? A = Yes B = No n/a = Not Applicable None 62. b) Training program for each employee? A = Yes B = No n/a = Not Applicable None 63. c) Written system for every procedure A = Yes B = No n/a = Not Applicable None 64. d) Written scripts to train new employees? A = Yes B = No n/a = Not Applicable None 65. e) Scripts for every routine patient question? A = Yes B = No n/a = Not Applicable None 66. f) Written customer service protocols? A = Yes B = No n/a = Not Applicable None 67. g) Customer service training program? A = Yes B = No n/a = Not Applicable None 68. h) Do you have a self-managed team? A = Yes B = No n/a = Not Applicable None 69. i) Would you consider each member of your team to be a 7 or above on a scale of 10? A = Yes B = No n/a = Not Applicable None 70. j) Is there any individual team member with whom you truly dislike working? A = Yes B = No n/a = Not Applicable None 71. k) Does staff function like a team with each person having a stake in the success of the practice? A = Yes B = No n/a = Not Applicable None 72. a) Do you have a KPI (Key Performance Indicators) System? A = Yes B = No n/a = Not Applicable None 73. b) Do you have a Personalized New Patient Experience? A = Yes B = No n/a = Not Applicable None 74. c) Do you have a Non-Surgical Perio Evaluation and Treatment System? A = Yes B = No n/a = Not Applicable None 75. d) Do you have a TMJ Evaluation System? A = Yes B = No n/a = Not Applicable None 76. e) Do you have a Reconstruction Checklist? A = Yes B = No n/a = Not Applicable None 77. f) Do you have an Ortho Evaluation System? A = Yes B = No n/a = Not Applicable None 78. g) Do you have an Implant Evaluation System? A = Yes B = No n/a = Not Applicable None 79. h) Do you have a Cosmetic Analysis and Planning System? A = Yes B = No n/a = Not Applicable None 80. i) Do you have a Smile Analysis Form? A = Yes B = No n/a = Not Applicable None 81. j) Do you have a Staff Bonus System? A = Yes B = No n/a = Not Applicable None 82. k) Do you have a Team Results System? A = Yes B = No n/a = Not Applicable None 83. l) Do you have an Office Maintenance System? A = Yes B = No n/a = Not Applicable None 84. m) Do you have a Medical Emergency Plan of Action? A = Yes B = No n/a = Not Applicable None 85. n) Do you have an Employee Hiring System? A = Yes B = No n/a = Not Applicable None 86. o) Do you have an Employee Firing System? A = Yes B = No n/a = Not Applicable None 87. p) Do you have an Inter-office Communication System? A = Yes B = No n/a = Not Applicable None 88. q) Do you have a GAP Analysis System? A = Yes B = No n/a = Not Applicable None 89. r) Do you have a Photo & X-ray Assessment Form? A = Yes B = No n/a = Not Applicable None 90. s) Do you have a Marketing system? A = Yes B = No n/a = Not Applicable None 91. t) Do you have a ROI (Return on Investment) Analysis System? A = Yes B = No n/a = Not Applicable None 92. u) Do you have a Doctor Compliance System? A = Yes B = No n/a = Not Applicable None 93. v) Do you have a Marketing Action Plan? A = Yes B = No n/a = Not Applicable None 94. a) Does your orientation process include communication of the “unwritten rules”? A = Yes B = No n/a = Not Applicable None 95. b) Are experienced staff members asked for their ideas and opinions on how things may be improved? A = Yes B = No n/a = Not Applicable None 96. c) Are staff members comfortably communicating both successes and failures? A = Yes B = No n/a = Not Applicable None 97. d) Do all team meetings have agendas, notes, follow-ups? A = Yes B = No n/a = Not Applicable None 98. e) Is there an organized way in which feedback is obtained from staff members? A = Yes B = No n/a = Not Applicable None 99. a) Does your practice have a specific written vision statement, mission statement, and culture points? A = Yes B = No n/a = Not Applicable None 100. b) Do staff members know what the mission is, their role in achieving it? A = Yes B = No n/a = Not Applicable None 101. c) Is your practice organized around the practice vision, purpose and mission? A = Yes B = No n/a = Not Applicable None 102. a) Does your practice have policies and procedures (P&P) that describe “how things are done”? A = Yes B = No n/a = Not Applicable None 103. b) Are policies and procedures up-to-date? A = Yes B = No n/a = Not Applicable None 104. c) Is there a process in place to ensure that policies and procedures are regularly updated? A = Yes B = No n/a = Not Applicable None 105. d) Does your team have a written copy of your policy & procedures? A = Yes B = No n/a = Not Applicable None 106. e) Is someone in charge of drafting, updating and approving policies and procedures? A = Yes B = No n/a = Not Applicable None 107. f) Do policies and procedures (P&P) meet the test of 4 Es: evidence-based, effective, efficient and entirely clear? A = Yes B = No n/a = Not Applicable None 108. g) Do you have a uniform dress code/grooming protocol for the staff and doctors in your practice? A = Yes B = No n/a = Not Applicable None 109. a) Have you moved from a paper to digital records? A = Yes B = No n/a = Not Applicable None 110. b) Do you have a written, clearly defined workflow that every staff understands? A = Yes B = No n/a = Not Applicable None 111. c) Has your practice established a commitment to re-evaluate and optimize workflows? A = Yes B = No n/a = Not Applicable None 112. a) Do you know your staff and what is important to them? A = Yes B = No n/a = Not Applicable None 113. b) Is the practice set up to promote good relationships between staff members? A = Yes B = No n/a = Not Applicable None 114. c) Is there a sense of loyalty among staff and an assumption of good will? A = Yes B = No n/a = Not Applicable None 115. d) Do staff members enjoy time together outside of work? A = Yes B = No n/a = Not Applicable None 116. e) Have you had a team function after work within the last 6 months? A = Yes B = No n/a = Not Applicable None 117. Do you provide any of these benefits to your employees? Please choose one option. Select option 't' if you have three or more of the listed benefits for your employees. Use the comment field below to list more benefits (if applicable). b) Life Insurance Benefit c) Dental Insurance Treatment d) Cell Phones e) Disability (Short/Long Term) f) Laundry g) Books and Journals h) Continuing Education i) Society Dues j) Sick Pay k) Vacation Pay l) Holiday Pay m) Bonus Incentives n) Child Care o) Awards & Gifts p) Flextime Hours q) Overtime Options r) Uniforms s) Health Insurance t) I Provide 3 or More of the Benefits Listed Above u) I don't Provide Any of the Benefits v) N/A None Comment 118. s) Are employees given a total benefits statement annually? A = Yes B = No n/a = Not Applicable None 119. t) Do you know what percent of practice overhead is employee benefits? A = Yes B = No n/a = Not Applicable None 120. a) Has your annual practice revenue grown at least 7% for the past 3 years? A = Yes B = No n/a = Not Applicable None 121. b) Are you collecting 98% of your production on an annual basis? A = Yes B = No n/a = Not Applicable None 122. c) Are 90% of your active patients currently scheduled for their next hygiene or restorative appointment? A = Yes B = No n/a = Not Applicable None 123. d) Is hygiene responsible for at least 30% of your practice production? A = Yes B = No n/a = Not Applicable None 124. e) Is your overhead 60% or below? A = Yes B = No n/a = Not Applicable None 125. a) Do you have dedicated sales staff or marketing coordinator for your practice? A = Yes B = No n/a = Not Applicable None 126. b) Do you have a practice website? A = Yes B = No n/a = Not Applicable None 127. c) Have you published a book or an eBook? A = Yes B = No n/a = Not Applicable None 128. d) Are you using your website to generate new patients? A = Yes B = No n/a = Not Applicable None 129. e) I am actively seeking referrals from existing patients and it is successful A) Yes B) No C) N/A None Please fill in the comment box below. Whew! Congratulations! This evaluation seems to have taken forever! Now, enter your name and email address. The result will be delivered to your email. Based on the result of your survey, you may be automatically redirected to a certain relevant section of our website for a followup. Again, thanks a lot for your time. Email Name Practice Phone Time's up
