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Practice Evaluation/Analysis Survey

15-Minute Practice Evaluation Survey

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:

  1. This is a 'YES', 'NO', or 'N/A' evaluation survey
  2. It is designed for quick response ~2-3 sec./question
  3. The system will not allow more than one answer
  4. You will not be able to change your responses
  5. 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.)

2. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

a) Public Relations
3. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

b) Practice Website and Software
4. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

c) Phone Management
5. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

d) New Patient Marketing / Intake
6. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

e) Patient Education
7. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

f) Initial Diagnosis / Education
8. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

g) Treatment Plan Presentation
9. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

h) Cash Plan Management System
10. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

i) Patient Tracking System
11. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

j) Recall System
12. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

k) Missed Appointments System
13. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

l) Financing (Billing) & Collections
14. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

m) Insurance System
15. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

o) Referral System
16. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

p) Patient Reactivation System
17. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

q) Staff Hiring / Training Systems
18. Please rate the current status of the following: (1 = Ineffective, 5 = Very Effective, n/a = Not Applicable).

r) Staff Meetings
19. a) Are you satisfied with your income level?
20. b) On 1-10 scale (10 being high), is your stress level below 5?
21. c) Have you had leadership training?
22. d) Do you have a written practice philosophy?
23. e) Do you create a strategic plan each year?
24. f) Do you have a personal business coach?
25. g) Do you have business marketing training?
26. a) Does your practice have an organizational chart?
27. b) Does each staff member have a list of job responsibilities that everyone knows about?
28. c) Is it easily apparent who is responsible for certain duties and responsibilities?
29. d) Is your practice prepared to cover for a staff member who leaves unexpectedly?
30. e) Does staff know who their supervisor is and who is responsible for evaluating them?
31. a) Does your practice have departmental leaders?
32. b) Do members of the leadership team have authority as well as responsibility?
33. c) Do they make, communicate and stand by their decisions?
34. d) Are staff members’ complaints and concerns always addressed to the correct person?
35. e) Are leaders supported by the practice top management?
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”)?
37. b) If a process does exist for making decisions, is it followed each time?
38. c) Does staff know how decisions are made?
39. d) Are decisions communicated by the practice’s leadership to all staff?
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?
41. f) Does the practice make decisions quickly?
42. g) Is the practice flexible and cooperative?
43. h) Do you have methods for communications among all levels of the practice?
44. i) Do all providers and employees understand the patient’s needs and place priority on those needs?
45. j) Does the practice culture encourage and reward continuous improvement?
46. Please indicate which of these services your practice now outsource to other organizations. Use the comment field to list more (if applicable.)

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.

48. a) Do you have recruitment and hiring process for your practice?
49. b) Is your staff provided with copies of the employee manual?
50. c) Do you conduct a performance evaluation for your staff on a periodic basis?
51. d) Do you have salary administration guidelines and schedules for your practice?
52. f) Do you have an active employee incentive plan (bonus system)?
53. g) Does your HR department properly document disputes (if any) that occur between staff members?
54. h) Do you have a corrective action system?
55. i) Does your human resources department have standardized Termination / Separation Forms?
56. a) Do you have a dedicated staff that handles your regulatory and compliance issues (OSHA, HIPPA, DEA, etc.)
57. b) Do you have the required CE credit for staff and doctors properly recorded?
58. c) Do you have a CE calendar for all doctors and staff?
59. a) Do you have an online backup of all practice computer data?
60. b) Are your backups verified daily?
61. a) Do you have written job descriptions?
62. b) Training program for each employee?
63. c) Written system for every procedure
64. d) Written scripts to train new employees?
65. e) Scripts for every routine patient question?
66. f) Written customer service protocols?
67. g) Customer service training program?
68. h) Do you have a self-managed team?
69. i) Would you consider each member of your team to be a 7 or above on a scale of 10?
70. j) Is there any individual team member with whom you truly dislike working?
71. k) Does staff function like a team with each person having a stake in the success of the practice?
72. a) Do you have a KPI (Key Performance Indicators) System?
73. b) Do you have a Personalized New Patient Experience?
74. c) Do you have a Non-Surgical Perio Evaluation and Treatment System?
75. d) Do you have a TMJ Evaluation System?
76. e) Do you have a Reconstruction Checklist?
77. f) Do you have an Ortho Evaluation System?
78. g) Do you have an Implant Evaluation System?
79. h) Do you have a Cosmetic Analysis and Planning System?
80. i) Do you have a Smile Analysis Form?
81. j) Do you have a Staff Bonus System?
82. k) Do you have a Team Results System?
83. l) Do you have an Office Maintenance System?
84. m) Do you have a Medical Emergency Plan of Action?
85. n) Do you have an Employee Hiring System?
86. o) Do you have an Employee Firing System?
87. p) Do you have an Inter-office Communication System?
88. q) Do you have a GAP Analysis System?
89. r) Do you have a Photo & X-ray Assessment Form?
90. s) Do you have a Marketing system?
91. t) Do you have a ROI (Return on Investment) Analysis System?
92. u) Do you have a Doctor Compliance System?
93. v) Do you have a Marketing Action Plan?
94. a) Does your orientation process include communication of the “unwritten rules”?
95. b) Are experienced staff members asked for their ideas and opinions on how things may be improved?
96. c) Are staff members comfortably communicating both successes and failures?
97. d) Do all team meetings have agendas, notes, follow-ups?
98. e) Is there an organized way in which feedback is obtained from staff members?
99. a) Does your practice have a specific written vision statement, mission statement, and culture points?
100. b) Do staff members know what the mission is, their role in achieving it?
101. c) Is your practice organized around the practice vision, purpose and mission?
102. a) Does your practice have policies and procedures (P&P) that describe “how things are done”?
103. b) Are policies and procedures up-to-date?
104. c) Is there a process in place to ensure that policies and procedures are regularly updated?
105. d) Does your team have a written copy of your policy & procedures?
106. e) Is someone in charge of drafting, updating and approving policies and procedures?
107. f) Do policies and procedures (P&P) meet the test of 4 Es: evidence-based, effective, efficient and entirely clear?
108. g) Do you have a uniform dress code/grooming protocol for the staff and doctors in your practice?
109. a) Have you moved from a paper to digital records?
110. b) Do you have a written, clearly defined workflow that every staff understands?
111. c) Has your practice established a commitment to re-evaluate and optimize workflows?
112. a) Do you know your staff and what is important to them?
113. b) Is the practice set up to promote good relationships between staff members?
114. c) Is there a sense of loyalty among staff and an assumption of good will?
115. d) Do staff members enjoy time together outside of work?
116. e) Have you had a team function after work within the last 6 months?
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).

118. s) Are employees given a total benefits statement annually?
119. t) Do you know what percent of practice overhead is employee benefits?
120. a) Has your annual practice revenue grown at least 7% for the past 3 years?
121. b) Are you collecting 98% of your production on an annual basis?
122. c) Are 90% of your active patients currently scheduled for their next hygiene or restorative appointment?
123. d) Is hygiene responsible for at least 30% of your practice production?
124. e) Is your overhead 60% or below?
125. a) Do you have dedicated sales staff or marketing coordinator for your practice?
126. b) Do you have a practice website?
127. c) Have you published a book or an eBook?
128. d) Are you using your website to generate new patients?
129. e) I am actively seeking referrals from existing patients and it is successful


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.



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