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Original article

The prospects of improving dental health care management – a case study by the "Vukadinovic" dental practice, the Republic of Serbia

Aleksandra Vukadinović1
  • University of Belgrade, The School of Dental Medicine, Belgrade, Serbia

ABSTRACT

Introduction: Dental medicine is a part of health care which is responsible for providing dental health care for the population of an area using all available means - by preserving, improving and establishing the specific functions and the appearance of the oral cavity and its individual parts, by studying and preventing common diseases of the mouth, as well as by treating diseases, disorders and mouth and dental injuries. The system of dental health care in the Republic of Serbia requires changes in the field of legislation and the organizational process, as well as financial investments for the purpose of improving the organizational process and achieving a greater number of professional staff that would provide dental services. The McKinsey 7S Model is a good tool for checking the managing abilities and the capacity of a certain organization to respond to the modern demands of its users.

Aim: The aim of the paper was to investigate the prospects of improving the current dental health care management system.

Methods: The method involves a case study on applying the McKinsey 7S diagnostic model to a private dental practice.

Results: The results of the research served as the basis for proposing potential improvements to dental health care management.


INTRODUCTION

Management is a scientific discipline which deals with planning, organizing, running and controlling certain businesses, enterprises or systems for the purpose of achieving common goals more efficiently and more effectively [1]. Efficiency refers to the appropriate use of available resources and the "job-needs-to-be-done-inthe-right-way" rule, whereas effectiveness is focused on the activities that result in achieving the desired outcomes. Health care management strives to satisfy the needs of all participants in a health care system, both patients and health professionals. It deals with the process of planning, organizing, running and controlling the work of health care programs by organizing resources (i.e. staff, money, funds, capacities, knowledge, equipment, regulations, laws, time), by monitoring the implementation of health-related programs, by making decisions at all levels of a health care system and by achieving goals related to the improvement of the health status of the population [2],[3],[4].

Dental medicine is a part of health care which is responsible for providing dental health care for the population of an area using all available means - by preserving, improving and establishing the specific functions and the appearance of the oral cavity and its individual parts, by studying and preventing common diseases of the mouth, as well as by treating diseases, disorders and mouth and dental injuries. The following elements are essential to managing the provision of dental health care: resources (i.e. staff, associates, space, and equipment), control and the finances of the system.

In the Republic of Serbia, dental health care and the entire health care system are managed by three most important institutions:

  1. The Ministry of Health of the Republic of Serbia, which creates the health policy, determines the standards for health services and manages the quality of health care;
  2. The Institute of Public Health of Serbia "Dr Milan Jovanovic - Batut", which provides data on the health status of the population and the way health institutions work, proposes measures for improving public health, analyzes the collected data on public health indicators, creates a proposal for the annual work plan of health institutions, and organizes and improves the information system; and
  3. The National Health Insurance Fund of the Republic of Serbia, the national organization through which citizens exercise their right of health insurance thus financing their own health care [5].

Dental health care is provided through public healthcare institutions (i.e. community health centers, institutes, the School of Dental Medicine University of Belgrade, the Clinics of Dentistry at the Faculties of Medicine in Niš, Novi Sad, Kragujevac and Priština) and private practice (general or specialist dental practice as well as dental laboratories, according to Article 38. of the Law on Health Care). The primary level of protection, which includes prevention, early detection, and treatment of oral and dental diseases, plays a fundamental role in dental health care. If the level of primary dental health care is unable to provide appropriate specialist care, the patient will be referred to a higher level of protection. The tertiary level of dental health care is the most complex form of providing dental health care, which includes the provision of care using cutting-edge diagnostics and treatments in tertiary care institutions.

The dental care service is the most represented type of service for oral care and treatment, and it consists of the department of pediatric and preventive dentistry, the department of jaw orthopedics, the department of oral diseases, the department of triage, tooth extraction and oral surgery, the department of prosthetic dentistry and a dental laboratory. Public health institutions that provide dental care are publicly funded according to the Healthcare Facilities Network Plan adopted by the Government of the Republic of Serbia.

The organizational process and the rights and obligations of dental care service providers and holders in the Republic of Serbia are governed and regulated by laws and regulations in the field of health care, health insurance and other segments of health care. Article 1. of the Law on Health Care [6] regulates the system of health care in the Republic of Serbia, the way this system is organized, the social concern for population health, the general interest in health care, the supervision of the implementation of this law and other issues of importance for the organization and implementation of health care. The Law on Health Care [7] defines the conditions, rights and obligations in the field of mandatory and voluntary health insurance of the Republic of Serbia. The Regulation of Healthcare Facilities Network Plan [8] determines the Healthcare Facilities Network Plan for public ownership – the structure, capacity and spatial arrangement of healthcare institutions, as well as their organizational structure at all levels of health care.

Despite the development of technology and knowledge and a growing number of specialist dentists, the oral health of the population of the Republic of Serbia is at an unenviable level. Almost every sixth citizen (16.1%) stated they had had unmet needs for dental care. The most frequently cited reasons for unmet needs for dental care included financial obstacles to the availability of dental health care (66.6%) and the fear of treatment (15.1%) [9]. Free dental care in the public sector is provided only for underage patients, pregnant women, emergency cases and students up to 26 years of age, which resulted in a decline in the use of dental services among adults. The most common reasons for avoiding and neglecting the need of dental services are high prices and the fear of dentists. The need for improving the organizational process and providing dental health care to all categories of the population of the Republic of Serbia urges us to consider expanding the provision of services at the expense of the National Health Insurance Fund and emphasizes the need for allocating greater funds from the National Health Insurance Fund to dental health care. It is also important to adapt the price list of dental services to low-income individuals and to ensure quality staff for providing dental services and improving the quality of services in order to achieve standards and preserve the oral health of the population of the Republic of Serbia. In this sense, the system of dental health care in the territory of the Republic of Serbia demands changes in the field of legislation, organizational process and financial investment in dental health care for improving the work process and obtaining a larger number of professional staff for providing dental services.

Introducing changes in management primarily requires the choice of approach [10],[11]. McKinsey 7S Model is a good tool for checking the managing abilities and the capacity of a certain organization to respond to the modern demands of its users. This model is one of the most efficient approaches to managing changes in organizations [12]. It was developed in 1980 by Robert Waterman and it was published by a consulting firm becoming the basic tool for global management. This model was first mentioned in the book "The Art of Japanese Management" and is used for analyzing companies and organizations. This planning model looks like an atom, and it contains seven factors, all starting with the letter S. The factors are divided into soft and hard ones. Hard factors include strategy, structure and systems, whereas soft factors include skills, style, shared values and staff [13],[14].

Figure 1. The analysis of an organization: McKinsey 7S Model (adapted according to https://gmbusiness.biz/analiza-organizacije-mckinsey-7s-model/#prettyPhoto/0/).

Figure 1. The analysis of an organization: McKinsey 7S Model (adapted according to https://gmbusiness.biz/analiza-organizacije-mckinsey-7s-model/#prettyPhoto/0/).

Strategy is an action plan implemented by an organization to achieve specific corporate goals. It is the direction in which the organization achieves its goals through the distribution of its resources [2],[14]. Structure is the hierarchy of the organization. It shows how different departments or employees relate to each other, who reports to whom, how tasks are assigned [2],[14],[15]. Systems refer to the processes which support a company’s daily operations. These systems include the information system, the financial system, management, and human resource (HR) system. The system of control is divided into three groups – preventive, current and corrective control [2],[14]. Style refers to the way the organization is run. It involves the culture of the organization, the way managers and executives behave – what they do, how they manage working hours, how they value results, how open they are for creativity, if they recognize quality and success [14],[16]. Skills are the characteristic abilities of the organization and its employees necessary for the implementation of the organization’s strategy [14]. Staff refers to employees in the organization, their abilities, potentials, experience. Staff have a direct influence on how an organization provides its services and performs its activities, so the organization needs to hire capable people, train them and assign them the right positions through training, selection, motivation, recognition, awards, etc. [14]. Shared values are considered the first essential step in defining the role of an organization within the community in which it functions. Values are what an organization stands for and what its universal purpose is. They can also be described as conscience and identity of an organization, and they include factors such as work attitude, competitive spirit, and cooperation among coworkers. Cooperation is an important technique for achieving organizational goals as it offers the best chance of reaching mutually satisfactory solutions based on interests and ideas coming from everyone involved. Cooperation both maintains and strengthens work relationships [14]. The effectiveness of dental institutions, public or private, is reflected through the prism of the 7S Model; in other words, for an institution to be effective, a balanced relationship of all seven elements of this model is necessary.

Attachment 1. Shared values

Attachment 1. Shared values

Attachment 1. Shared values

Attachment 1. Shared values

The general aim of this paper was to consider the prospects of improving dental health care management in Serbia, which primarily meant analyzing the current managing system with the use of the diagnostic model McKinsey 7S, on an example from private practice.

METODOLOGY AND RESEARCH INSTRUMENTS

The research is based on a qualitative analysis of the management system of the "Vukadinovic" dental practice, 26 Pazinska Street, Voždovac municipality, Belgrade, with the use of McKinsey 7S Model. The practice was founded in 2014 as a micro-level company with around 14 permanent or occasional employees. There are 25 to 30 patients on a daily level. Data from the questionnaire were obtained by interviewing the manager and the present members of the professional team.

The interview was conducted on September 9th, 2022, using a survey questionnaire (McKinsey 7S Model Checklist) (Attachment 1). This research instrument contains 31 questions that cover the elements of the Model. Strategy was covered with five questions related to the business strategy itself, the set goals of the dental practice, its relations with competitors, demands of its patients and its attitude to the environment. When it comes to Structure, there were seven questions related to the organization of the work process, hierarchy, making decisions and the line of communication. Three questions on Systems were referred to the management system and control system on the internal and external level of the dental practice. The four questions on Shared values referred to the values on which the dental practice was built and its team. Style was covered by four questions related to the management style of the dental practice and additional three questions referred to the positions and specializations of the employees. Finally, there were five questions related to the most significant skills represented in the team and possible deficiencies in that field, as well as the way in which skills were monitored in the dental practice and what distinguished this practice from others.

RESULTS

According to McKinsey 7S Model applied in "Vukadinovic" dental practice, the basic strategy of the practice is to remain successful in business and strengthen its position among the leading private dental practices in the Republic of Serbia. The practice achieves this by constantly following the development of new technologies and introducing them in the workplace, by continuous professional development of employees, by investing in and providing the most modern dental equipment and supplies, by adjusting the availability of its services and by insisting on kind and professional attitude to patients (Table 1).

Table 1. The soft elements of the McKinsey 7S diagnostic model at the "Vukadinovic" dental practice

Table 1. The soft elements of the McKinsey 7S diagnostic model at the "Vukadinovic" dental practice

The practice has the traditional vertical organizational structure, with the owner of the practice at the top of hierarchy, followed by the head of the professional team and other employees divided into medical, administrative and support team. The managerial part of the team consists of the owner and the head of the professional team, whereas the professional team consists of the medical part of the team which includes specialists from certain branches of dentistry. The financial part of the team consists of an administrative worker who is in charge of the finances within the practice and an external agency for financial operations. An external dental laboratory is responsible for the production of metal-ceramic, metal-free and ceramic crowns, bridges and prostheses, implants, etc.

The system of control at "Vukadinovic" dental practice exists on internal and external level. The head of the professional team is in charge of internal control and controls, on a daily or weekly basis, the continuity and quality of services provided to patients, communication with patients and the overall professional work. The external control is performed by an appropriate department of the Ministry of Health following established legal acts. Medical and financial records are stored and kept electronically in a separate information system.

The practice management style implies the concept of a functional team. The office has an autocratic management style where the owner and the head of the professional team make decisions on the organization and the way of providing services to patients. On the other hand, a democratic style is present when professional decisions are made, and the entire team of specialist employees takes part in it. This means that every employee can express their views on the organizational process and possibly make suggestions in terms of improving work and introducing change to its.

The "Vukadinovic" dental practice stands out for its skills such as expertise of its employees and the quality of services provided. Emphasis is put on quality selection of the medical team and its professional competence, experience, and skills. The practice is committed to the continuous refreshment of knowledge and professional development of employees, by providing the employees with opportunities to follow educational seminars and lectures so that they are up to date with new knowledge in the field of dentistry. This practice stands out for its "single-day treatment" which allows patients to have a complete dental, prosthetic and surgical treatment in just one day using analgosedation.

DISCUSSION

McKinsey 7S case study applied to the "Vukadinovic"dental practice helped identify the strengths and weaknesses of this private practice. Its strong points include strengthening the strategy for maintaining success at work by investing in the best and most up-to-date materials and medical devices in dentistry, IT equipment, and professional training of employees, and by insisting on professional and kind relationship among employees and between employees and patients as well. When it comes to internal indicators, what stands out is the medical part of the team and their expertise and skills that greatly contribute to the successful work of the practice. Decision-making is centralized when it comes to organization and providing services to patients, whereas it is decentralized in case of professional decisions. The weaknesses of this private practice are manifested in the lack of dental nurses when compared to the number of dental specialists as well as the lack of administrative staff for the purpose of organizing shift work. For example, Chmielewska et al. [17], who applied the McKinsey 7S Model to the organizational performance of public hospitals, concluded that more attention should be paid to the soft elements of the model (i.e. shared values, staff, skills and style) as they have been shown to play a more significant role in managing a hospital. Hard elements (strategy, structure and systems) are certainly important aspects of organization, but only to a limited extent do they determine the performance of management, i.e. organizational activities and decisions that lead to the achievement of set goals. Like in the given example, the weak point of "Vukadinovic" dental practice is related to a soft element – the lack of dental nurses and administrative staff for giving information to patients via phone, e-mail, or face-to-face, scheduling examinations and treatments, charging for the provided services, etc. Due to this lack, administrative duties are taken over by a dental nurse whose primary job is to assist specialists and take care of patients, so there is a delay in work and effectiveness of the business, as well as the limitation of shift work.

It should be noted that the Regulation on the National Program of Preventive Dental Health Care was published in 2009 [18], which is a clear indication that it is necessary to refresh the National Program of Preventive Dental Health Care based on the contemporary concept of the organization of dental health care, which would improve both public and private practice according to the programs of European countries and those countries whose programs have already achieved expected results.

According to the abovementioned Regulation, at the time there were 69.7% of three-year-old children with all healthy teeth and 8.3% had circular caries (early childhood caries), whereas the number of six-year-old children who had all healthy teeth was smaller by a third (20.6%) and the percent was even smaller in the population of adolescents – 14% of 12-year-olds and 11.3% of 15-year-olds. In contrast, the results of numerous epidemiological studies in the population of children aged 12 indicated that the caries epidemic had almost been stopped in the counties of Western Europe and the USA [18]. Methods for achieving such results include the implementation of regular promotional check-ups and health education programs at school, the improvement of oral hygiene, a healthy diet, continuous application of fluoride and adoption of a healthy lifestyle. Besides, in developed countries health care resources are more focused on preventive health care strategy as it is more accessible and more effective compared to the high cost of traditional curative measures used for the treatment of dental diseases.

By applying the McKinsey 7S Model to "Vukadinovic" dental practice, and according to the results obtained, it has been concluded that positive results concerning oral and dental health in children can be achieved through free preventive examinations and increasing awareness of the importance of prevention. Such results can also be achieved by giving free samples for preserving oral and dental hygiene and by adequate education on the importance of a healthy lifestyle and diet adapted to children of certain age.

Using the data of the National Health Insurance Fund of the Republic of Serbia, the possibility of collective voluntary insurance of dental services has been realized and it includes treating and repairing teeth, removing tartar build-up, treating periodontal pockets, extracting and filling teeth, and other services that belong to the category of basic dental services and that are listed in the Special conditions within dental insurance [19]. A good example is given by the Republic of Srpska Health Insurance Fund, which has signed contracts with a certain number of private dental practices according to which private clinics can provide dental services to the Fund’s policy holders and invoice the Fund for those services. It is done in accordance with the regulations of the Republic of Srpska in the field of health care insurance and by using STOMIS (Dental information system) program which supports the IT reporting obligations of the practice defined by the contract. STOMIS includes the data on the practice, its doctors, laboratories that provide dental prosthetic services, and data on patients, as well as the updated price list that is also available on the website of the Republic Fund [20]. The Republic of Serbia has not achieved this type of cooperation between the National Health Insurance Fund and private dental practices. The first step towards this type of cooperation would be the introduction of a standby plan for private dental practices based on the transparent Standby plan list which can be found on the website of the National Fund of Health Insurance of the Republic of Montenegro [21]. Unlike this good practice example, dental health care of the Republic of Serbia does not have a defined Standby plan, although it is very likely that a few private practices could do standby arrangements in larger towns of the Republic of Serbia.

Following the example of more developed countries, investments in dentistry should be directed at prevention programs and the implementation of regular check-ups for schoolchildren, promotional programs, health education programs, improvement of hygiene, improvement of the quality of life so as to prevent the development of diseases and the neglect of oral and dental diseases. Although the dental health care system of the Republic of Serbia is limited in the domain of providing services that are the responsibility of the National Health Insurance Fund (because the provision of services refers to the services provided in public sector institutions and only to certain categories of population), the Rule book on special conditions for insuring dental services enables basic dental procedures at the expense of the Fund in private practices as well. In this sense, "Vukadinovic" dental practice, with its 7S Model, should consider this possibility.

The proposal of measures for improving dental health care management is based on the prospects of expanding the provision of dental services covered by the National Health Insurance Fund so that in addition to pregnant women, children up to 18 years of age, students and seriously ill individuals other categories of the population could also use the services covered by their health insurance. Further proposal of measures is based on a prospective cooperation between health insurance and private practice, where private practices would be able to provide dental services defined by the contract in the same way as public sector institutions which provide dental health care. It would be necessary to consider the type of insurance for the abovementioned categories who these services would be provided for, which would result in shorter waiting lists for a dentist or dental specialist and fewer cases of neglect of oral and dental diseases in patients who are not able to pay for dental services at the defined high rates. In order to modernize dental health care, it is necessary to improve the National program of preventive dental health care through participation of all interested parties who participate and contribute to the evaluation of the preservation of the oral health of the population, to allocate significant funds from the national budget to dental health care, as well as to expand the scope of service provision covered by the National Health Insurance Fund to include all categories of the population of the Republic of Serbia, to establish cooperation between The National Health Insurance Fund and private dental practices (e.g. voluntary health insurance) and to introduce a standby plan that would include doctors in all places of the Republic of Serbia.

CONCLUSION

The effectiveness of dental institutions, both public and private, is reflected through the prism of 7S Model – for an institution to be effective, there should be a balance between all seven elements of the model. By analyzing each element of the model in the private practice from this paper, we would get a precise picture of the elements that need to be improved, as well as those that need to be maintained as they bring good business results. The proposal of measures for improving dental health care management at the "Vukadinovic" dental practice refers to a soft factor and the examination of the possibility of providing dental services to pregnant women, children up to 18 years of age, students and seriously ill individuals at the cost of health insurance.

  • Conflict of interest:
    None declared.

Informations

Volume 3 No 4

December 2023

Pages 421-435
  • Keywords:
    management, dental health care, model Mc Kinsey 7S
  • Received:
    02 November 2022
  • Revised:
    15 November 2022
  • Accepted:
    19 November 2022
  • Online first:
    25 December 2022
  • DOI:
  • Cite this article:
    Vukadinović A. The prospects of improving dental health care management: A case study by the "Vukadinovic" dental practice, the Republic of Serbia. Serbian Journal of the Medical Chamber. 2022;3(4):421-35. doi: 10.5937/smclk3-40962
Corresponding author

Aleksandra Vukadinović
University of Belgrade, The School of Dental Medicine
Faculty of Medicine, University of Belgrade, Serbia
4 Rankeova Street, 11000 Belgrade, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


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2. Petrović D. Menadžment i organizacija. Beograd: Fakultet organizacionih nauka; 2012.

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17. Chmielewska, M., Stokwiszewski, J., Markowska, J. et al. Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework. BMC Health Serv Res 22, 7 (2022). https://doi.org/10.1186/s12913-021-07402-3 [HTTP]

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19. Posebni uslovi za osiguranje stomatoloških usluga. 2011. Dostupno na: https://rfzo.rs/download/dobrovoljno/Posebni_uslovi_stomatologija.pdf. poslednji pristup: septembar 2022. [HTTP]

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