Here Comes the Toothbus

Re: "Tooth and Consequences" by Bill Santamour & "Easing the Bite on the ED" by Geri Aston in September H&HN

Excellent job of accurately describing how dental care (or the lack of) negatively impacts individuals and hospitals! Paying attention to the level of dental care available in a community, and partnering with dentists and physicians to tackle the issues can go a long way toward improving the physical and mental health of an individual, as well as improving the bottom line in a hospital (by keeping dental patients from ending up in the emergency department).

Rural western North Carolina was very fortunate to have insightful leaders tackle this problem 17 years ago with Mission Hospital in Asheville. In rural counties where little or no dental care is available for lower-income or Medicaid-insured children, our program takes dental services to the children, at school, in the form of "The ToothBus." The ToothBus is a "dental office on wheels" so to speak, a 40-foot-long RV with two dental chairs where children get full dental care.

Ninety-seven percent of the ToothBus patients are [receiving] Medicaid (N.C. was one of the states that did NOT expand Medicaid). The remainder are uninsured and may be eligible for a sliding-fee scale discount.

Children who are young or have special needs often cannot be treated in a dental office. Our program provides full-mouth restoration under general anesthesia in the operating room.

The main focus of the five dentists and staff for both programs is to treat and educate children and their families on how to effectively prevent dental pain and disease. We are optimistic that ongoing collaboration with primary care providers and other health care professionals will increase awareness of this issue, and help children to get treatment and education at an earlier age.

Shawn Henderson, MBA
Practice Manager ll
Mission Children's Hospital
Asheville, N.C.

Hate That Wait

Re: "Patients Waiting: Wasteful to Some, Valuable to Others" by Marty Stempniak in H&HN Daily, Oct. 7

Are you serious? Everyone I know hates wait times in ambulatory clinics. Ask any mother, who's juggling many things, how "satisfying" she finds wait times. (That may help explain why pharmacies saw upward of 9 million appointments in 2012 — access, reasonable or no wait, and care by an APN).

E. Mary Johnson

Waiting Time = Wasted Time

Re: "Patients Waiting"

First, we need to be clear with language. If your "appointment" time includes watching a film, filling out a form, or some other activity, then you are technically not waiting, because your treatment/visit has begun.

Waiting to most people means wasted time when you showed up at a time given to you and you could be doing other things somewhere else at the same time (and watching TV, reading a book, meditating, or visiting is NOT productive time.). ... Just saying.

Charles Owen, M.D.

The Bully Culture

Re: "Standing Up to the Bullies" by Matthew Weinstock in H&HN Daily, Nov. 7

Having contributed to the research that supported the Joint Commission "Sentinel Event Alert," Issue 40, and the subsequent accreditation requirement that hospitals need to have and support a disruptive behavior policy, the situation in the NFL highlights the importance of cultural integrity, leadership enforcement, and behavioral accountability and its influence on misbehavior tolerance and lack of action. I've been addressing these issues for the past 10 years and it still amazes me that this type of behavior still occurs. It highlights the point that policy and education can only go so far. Organizations need to recognize the negative impact of bullying, intimidation and other types of disruptive behaviors on staff morale, work relationships, process and outcome efficiency, and the potential for compromises in patient safety and quality of patient care. Through my research, consultation, and expert witness experiences, I feel that organizations need to do a better job not only of addressing disruptive behaviors, but improving the underlying troubles in organizational culture and leadership support that allow these types of problems to recur.

Alan H. Rosenstein, M.D.