AUDIO - DUwHF #1294 - Karen Daw
Having launched 1,275 (and counting) Dentistry Uncensored with Howard Farran podcasts, Farran Media is proud to open its recording studio to the public. Reaching a new audience and potential patients has never been easier as you partner with a sound engineer and professional equipment to create, host and launch your very own podcast and video content. Farran Media offers hourly studio rental, remote recording, podcast launch packages with custom logos and intros and so much more. We’ll guide you throughout the entire process to ensure your podcast is a success–click here to learn more or give us a call at 480-445-9699.
Howard: It is just a huge honor for me today to be podcaster interviewing karen Daw MBA CECM the MBA Masters in Business Administration the CECM certified environmental compliance manager even if you think you've heard it all before you've never heard it in the way Karen Daw the OSHA lady delivers OSHA training. With a fresh fun and efficient approach Karen keeps things moving always grounded in real-world examples of what can go wrong sometimes in a matter of seconds if we let our guard down Karen Daw is an award-winning national speaker, author of numerous articles and CE courses on safety industry and a consultant to practices across the country she and her BA from the Ohio State University and her MBA with concentrations in health care administration and business management. After graduation Karen was recruited to from the emergency department to her roles as assistant director of sterilization monitoring and Health and Safety Director for the OSU College dentistry Karen draws on her rich background to educate audiences large and small on how not to do safety and best practices to avoid penalties negative reviews and the six o'clock news and man this is this has really hit home for me because when I got a school in 87 and please don't tell me you weren't born in 87 I just assumed you weren't you know you would talk when I went to the CDC whenever I was in LA and I'd swing by the CDC and and Dr. Dylan Berger give me the names of the dentists there and all those they had about 15,000 scientists and they all had a hunch that there were these breakout diseases that might be traced back to this restaurant or this dental office or this that but it was more kind of like a detective and footwork game and you know all that kind of stuff but man today it's a totally different game I mean you can have some good old boy dentists and Tulsa is just a good old boy but doesn't know his autoclave stopped working and the next thing you know he's on the six o'clock news or shutting him down I mean it's just getting and CDC people will tell you that they can sit there and say no Howard did not get that disease at that restaurant or that office or in fact he did so it's really changed hasn't it?
Karen: It has and you know really you can google infection control breaches related to dentistry primarily in related to sterilization now and there are no shortage of articles that you can pull up and that's what's scary is that given the number of educators out there the fact that this is part of dental school and dental hygiene dentistry school curriculums that we still continue to make the news with these types of stories so it's really scary.
Howard: So dentaltown has 50 forms and if you go to any science place like NASA or any of these places we talked about they all do the message board forum just so you can everything's at searchable it's indexed and at least 50 forms one of those regulations and I saw your posts on that this morning was as awesome but I want to ask an expert like you under regulations we have documentation HIPAA infection control injury prevention in the workplace and OSHA or any of those redundant or is that a good way to do this?
Karen: Injury prevention in the workplace and OSHA is because you know here's the thing a lot of people they make blood-borne pathogens and OSHA synonymous with each other what they forget is if you look at the top ten things that dental offices were dental most were cited for in the past few years blow more pathogens and infection controls only a sliver of that pie overall OSHA is concerned with providing employees with a safe workplace so I would say that injury prevention would kind of work under that umbrella of OSHA.
Howard: Yeah that's all that's what I was thinking and your post was a very interesting where you said I'm here let me whatever says I'm that HIPPA and OSHA should be two separate compliance programs OSHA infection control is very different than HIPAA cybersecurity I'll talk about that is that and what is your cup of tea you do HIPAA and OSHA or do you think HIPAA knows just two totally separate animals?
Karen: I think there are two totally separate animals there are fabulous speakers out there who can speak to both of those I am definitely not one of them I chose to focus just on OSHA standards because the code of federal regulations governing healthcare is this thick and I chose to focus on that manual it's all eight point font there's no pretty pictures it is strictly text and I had to port through that manual front and back to look at what are some of the things that OSHA might visit dental office for and everybody like I said I thinks it's all blood-borne pathogens and as long as I do my annual blood-borne pathogens training that we're in compliance and that's not necessarily the case so I think if you were to break those two apart and work with experts in each of those fields you're gonna be better off the other reason I recommend separating those two is because many times we saddle one individual in the office with compliance and this person might already be a practice manager or a dental assistant or dental hygienist and they're doing it all and when I see that I see it break down in systems already I already know what I'm getting into when I when I do a discovery call with a practice that has reached out to me and they said I'm doing this this this this and this I'm doing all of this and it's not a team effort then I worry I already know what I'm getting into before I even visit the office.
Howard: So you know the neat thing we're doing here is most humans all live alone I mean you know they they they drive to work alone they spend a lot of time alone so they really when you're an individual dentist and I said you don't really know what's going on with the other 200,000 dentists in America or the two million dentists around the world so she's driving to work right now and she's not you would it what is your end of the world look like why are people calling you what are you doing what what why is what's what's going on in OSHA and section control and and you know Socrates said that humans only had two emotions it was greed and fear but I think biology said it better that you're either a predator or you're being preyed on so when you're a predator you want resources greed good but when someone's preying on you that's frightening and scary you don't want to get arrested and fines and all that so OSHA infection control greed fear predator-prey what should they worry about?
Karen: So I'm gonna flip that around just a little bit the likelihood of a dental office being missing by OSHA in most states it's it's actually rather small it is a complaint driven process what we need to think about right now is that we now live in an environment where we if we don't get the results or the responses that we want if we're not being heard we're gonna find somebody who's gonna listen to us look at Yelp reviews look at Google reviews people can easily go online and complain about anybody we now have resources with regards to if I am in a healthcare facility I'm not happy with one aspect or another of the care that I received or if I just feel like I got bad bad customer service from the front desk team member well by golly I'm gonna contact OSHA and i'm gonna contact the Dental Board and I'm gonna report you to somebody I had an office that believes they were reported to OSHA over a billing dispute am i full poor front desk team members they never get yelled at by patients right over billing matters never ever ever so somebody was upset about it and on the way out they said well I'll show you and next thing you know she was visiting their practice so I always want to try to get people to think not necessarily and what you know the fact that they could be inspected but at the end of the day it's about doing the right thing if you're doing the right thing you got nothing to worry about.
Howard: and what's the worst thing that they worry about what's when Lady Luck is not on your side and everything goes bad is it is it an infection outbreak is it...?
Karen: Absolutely you're gonna potentially cause harm and on top of that if we're looking at OSHA and we're thinking about what possibly could happen well the Dental Board gets involved you're looking at possible license suspension if OSHA is involved and they find a willful neglect scenario and I've only seen this used in two dental offices that I'm aware of anyways from researching the OSHA website to dental offices receiving the willful neglect fine currently that willful neglect fine I don't think a lot of people realize this our it's one hundred and thirty three thousand dollars per occurrence and on a daily basis your practice can rack up thirteen thousand three hundred dollars in fines for every day that a particular hazard hasn't been abated and I think that is a worst-case scenario definitely gets people thinking.
Howard: So it's big fine so when you're out there in the field what is the low-hanging fruit what are what are my homies not doing right where they dropped the ball?
Karen: I'm going to say training training upon hire and annual training and this is what I see a lot of and for some and don't get me wrong for some offices being able to do online training and watching a 30-minute video and checking off that boxes is a good fit for their culture I have been blessed that the people who reach out to me realize sometimes you don't know what you don't know and there's more to it than just a thirty minute video so they realize that they want their training to be comprehensive they want their team to get the same information they want to make sure they're doing the right things so annual training and training upon hire definitely another one is this one is trending actually and that is water safety water quality being used in the office and I know people who are listening right now are gonna say oh but if I test my water for bacterial counts that's really just for patient safety and it's only recommendation by the CDC how is that mandatory well we're being exposed to that those aerosols that are being generated every time we irrigate or use a handpiece therefore you want to make sure your team members aren't being exposed to bacteria in the water lines too like Legionella or M obsesses I would say that's a number one thing I think a lot of offices are not doing right now.
Howard: When I say I don't like about the online training and when I say that I I have online training courses on dentaltown so I'm shooting myself in the foot is I to me it's I need to get this implemented is if someone comes in the only people get referrals there if I give you money and you come in y'all gets done they get educated we get whatever we have to do at the end of they we're all done that that's what you want as opposed to hoping that they went home and watched a video or you know took a test or something like that I just want it done.
Karen: Yeah yeah realistic nobody ever wakes up that morning go whoo today's the day we're doing OSHA training I'm so excited like it's Christmas morning and I think because traditionally we haven't we haven't made the topic exciting I think especially when you look at the millennial generation they are more interested in experience or learning we know from studies that hands-on training you're gonna learn and get more value out of that versus online training and again there are offices where online training is a good fit for them but I think for the most part I'm seeing that people want they admit that they don't know what they don't know they want you to tell them what they don't know and they want systems in place that's going to make it easier to maintain in the long run.
Howard: Yeah and boys should really be serious because when you look at all the OSHA nightmares you look at all the OSHA everything I mean men are just crazy I mean all over social media you'll see somebody having a ladder out of the back of the truck who climbs up to a window and stands on the air conditioner to place and just look at it like what is wrong with people but so what are the biggest injury to worker issues I mean if our hygienists or dental assistant says you know I just personally don't want to get injured what's going on to get at someone working in the dental office injured?
Karen: Well let me go back to how you said you could find all these pictures of men to be honest when I put my PowerPoint together and I use those slides I cannot find any with women in it not to say that they don't exist but it's very difficult to find and be a gender equal with regards to that, so I think that's hilarious and if you are watching this majority those visions for but as far as workplace injuries the preventing workplace injuries I think it all begins with education and knowledge and having a culture honestly we dental office where we saddle the dental assistant with responsibility and being the safety officer and on top of that she's supporting sometimes two Doc's if they're short if somebody calls in he or she's supporting two doctors they're also the steri ferry for the practice so they're cleaning instruments.
Howard: The steri ferry
Howard: I have never heard of this steri ferry
Karen: Every office should have a I think a full time steri ferry someone who just takes care of instruments it all day long for everyone else but sometimes they played they put on these multiple hats and then we go oh and by the way here is an entire here's four or five manuals that I've been collecting for the last 20 years you figure out what to do with it pam our previous safety officer won the lottery yesterday took off you're responsible now just do what you need to do and we haven't set them up for success there has to be a team dynamic we have to have proper support from the leadership I think this is in any business I think you'd agree promised support from the leadership that sets forth the expectations you have that person who's been empowered and given the proper resources to tackle this responsibility and then you have to have the buy-in from the team, the team us to understand the why behind why they do what they do now just some finger wagging and going you need to wear a utility gloves but helping them to understand why it's important that they wear those utility gloves when they're cleaning instruments.
Howard: So where did you get the name that the OSHA lady Karen Daw is the OSHA lady delivering OSHA and infection control training?
Karen: Yeah so my last name is three letters long d a w but you would be surprised how many people want an e or an S or an es or spell at DOLL because they misheard it and people weren't finding me but without fail whenever I called an office to remind them that hey I'm coming in on Thursday to do the training and the consultation at noon invariably somebody's always saying hey it's the OSHA lady on the phone or if I walk in there's a big sign that says the OSHA lady's coming in des and as a brand it made sense it told everybody what I did they didn't have to know my name but they could find me and actually got that federally trademarked too so now if you were to look me up you'd find the OSHA lady synonymous with Karen Daw you don't need to know my name as long as you know what I do for you.
Howard: So one of the problems we have is that this show is international and the I've done podcasts on location in Paris and Cambodia Malaysia and Tokyo so to our international people are on the world they don't live in America can you explain to them what is OSHA stand for and what it is and what is the difference between OSHA and infection control?
Karen: So OSHA is the Occupational Safety and Health Administration and overall it's the overarching umbrella of safety so when we think about infection control and blood-borne pathogens and in hazard chemical hazard usage they all fall under the symbol of safety anything can be safety related if I see an extension cord along a walkway well that's a safety hazard there so anything that can create a hazardous situation in the workplace different countries have different entities some have specific entities I couldn't tell you their names and then some actually don't have a regulating regulatory agency that oversees us but OSHA is just primarily concerned with employees safety and this is where I think a lot of people get confused a lot of business owners get confused they think well OSHA doesn't apply to me I am the employer and then I have to say well how are you classified for tax purposes because if you're paid as an employee of your corporation you are an employee if your what you're getting paid checks you're an employee and therefore OSHA standards govern you as well and besides I have doctors that well wear short sleeves but insist that their dental assistants a hygienists wear the Long's buttoned up jacket and I'm looking at them going that's what kind of example are you setting you're telling people to do as I say and not as I do so I was like for the business owners regardless to practice what they preach to mimic or set example for what they want their employees to do as well.
Howard: and it was hard to change because I got out of school in 87 and that's when everybody just kind of started wearing but all when I when I started practicing in 87 the old guys didn't want to wear gloves.
Karen: Oh yeah
Howard: and then the first thing that hit me really really hard is I got out 87 89 the HIV started slowly coming out and the first thing we're in Phoenix Arizona where it's 120 you know for half the year and we all wore shorts and short-sleeved shirts and they told us we had to wear long pants I actually lost a hygienist over it because I said well we're gonna do this and she goes well I'm not I'm not wearing pants and 119 degrees I can get a job across the street and it was tough I mean because we went from this really laid-back fun coming to work in shorts and flip-flops and t-shirts to now being all you know professional but it's funny how times change. So OSHA's more about worker safety and so OSHA cares more about the employees than the customers would you say?
Karen: Yes and the business owners that are listening in right now need to consider are those subs and temps that they utilize some questions they should be asking is who's gonna maintain their hep-b records it's gonna be you or the temp agency cuz you got to keep that on file for 30 years if it's your responsibility length of employment plus 30 years who's going to provide the blood-borne pathogens training for that individual is it going to be you well if it's you you've gotta invite them in an hour before the start of their shift to do the OSHA training or is it going to be the temp agency and then who was responsible in the event of an exposure so all employees even if they're a separate temp you've got to treat them as if they're regular employee unless there's an agreement or an understanding a place with a temp agency you're utilizing.
Howard: That is interesting, so when you go into an office and how is it a combined it's a combined program of OSHA and infection control is it an afternoon is it a day how much does it cost how do they find, walk us through that?
Karen: So it really depends on the need the office I offer anybody who's interested fifteen minute complimentary discovery session because there is no one-size-fits-all I have to figure out what are your major concerns what is it that you're hoping to accomplish where you are and where you need to be in what we need to do to bridge that gap so during that call we can assess a lot of that and then we can either determine whether or not I need to come in to do an assessment where we look at your systems in place what do we need to create what can we enhance or we might do virtual consulting I have offices where I just work strictly with a safety office or I might do a webinar based training for that office but then the consultant and I are meeting routinely to figure out what is it that they need to get their office in a compliance so it can be virtual consulting and training or in-office consulting and training and then I also speak and I'll be posting my speaking calendar I update that on my website so they can see hey there's a seminar coming up with Karen I want to go and check this out.
Howard: and your website is Karendaw, Karendaw?
Karen: Yeah well you can find me at the OSHAlady.com as well it'll link you directly to my website.
Howard: Okay let me check that the OSHAlady
Karen: dot-com and I'll just take you straight to Karen daw.com it'll redirect you.
Howard: Yeah I must have cookies on you because it took me right to Karendaw I couldn't go to the OSHA lady.
Karen: Exactly it just redirects it directly straight there.
Howard: So what are my homies gonna find if they go to Karendaw.com what are they gonna find on your website?
Karen: They're gonna find some information about what the services that I offer so they can make a good decision about whether or not it's a good fit for them I realized early on in my career that if I provided OSHA training the same way that I received it when I was at Ohio State that people were gonna tune out that they weren't going to pay attention and you put me in front of a roomful of dental students that already didn't want to be there I knew I had to do something differently so I kind of approached it with a sense of humor I use real world examples I hear stories over my career one of my recent offices that I visited the dental assistant had one of the treatment rooms quarantined and I thought well why is there a yellow caution tape blocking people from entering the that operatory no kidding Howard the staff had been complaining for months that they were animals in the Attic they don't know if it were rats they didn't know if they were bats they weren't quite sure what it was the doctor rather than hiring an exterminator sealed off every known entrance that these critters could have entered and exited from and eventually as you can imagine the scurrying in the NS ceiling stopped well nobody bothered to go in there and clean up afterwards and what happened was one day the dental assistant went by the room and heard a plopping sound on the plastic that was covering their chair it was maggots falling from the ceiling vent into the treatment room
Howard: That is crazy.
Karen: and actually is an OSHA violation having a vermin infestation I'm not saying one field mouse or one ant or one cockroach but having an infestation that has an OSHA violation people don't think about that.
Howard: Yes I'll tell you my Jesus oh I had that problem at my home I and it turned out to be that if you have your trees in Arizona close enough to jump from the tree to roof you get these roof rats and then the roof rats go down and live in your walls and I'm sitting here with four boys they're coming to me saying dad what is that noise and it sounded like you know sound like wild animals in the wall and oh my god it took this day a week to get them all catch them all and all I got but I got to tell you another thing this is embarrassing I probably shouldn't say it but I'm so where I heard the desert it's really really hot and I had I was doing a root canal and the patient the swelling afterwards was like crazy and and I am and my oral surgeon and everybody thought man it must have been some weird super bug or something and then about six months later it happened again and luckily they're my friends are saying Howard you know something's wrong because these are two crazy infections and you know these are once-in-a-lifetime infections and they had two of them he has wounds last time you had your water tested and this is like I don't know this is like 1994 I remember it was it was after April Fool's Day of 1994 I know that for a fact and I said what water what your water lines have your I said I didn't I know I have water but I don't I'm never - oh my god I had a guy come out and test the water lines he goes it's a heat sink the waters 140 degrees he says it's just liquid mold moss it's just insane and so we immediately switched to each operatory having its own bottled water and I don't know but I knew a lot of people that Denison told me this I said well yeah I live in Ohio we got good water and it's clean and I drink out of a hose and is drinking out of a hose in your backyard the same as irrigating a root canal?
Karen: and that kinda reminds me of you know said early things have changed over time I was trying to say my orthodontist was a smoker and the reason why I know that is because when he didn't wear gloves I could taste the nicotine on his fingers and then Karen would come home from her braces braces adjustment pinging off the walls from the nicotine and my parents couldn't figure out why but now we can't imagine working on patients without gloves I think that water quality issue it's not nascent I mean we're aware that bacteria can thrive in water but I think that the concept of testing our water even if we're using sterile water or distilled water and there's some manufacturers that will tell you don't use distilled water in their dental units because you know distilled water is not in a state of stasis and it's gonna leach the minerals from your unit so you need to follow the manufacturers recommendations for what type of water to use I prefer the bottled water system but there are offices that are saying I used to distilled water in my bottles and therefore I don't need to treat it or I'm in Ohio and I'm in a county where we have really good water well bacteria thrives everywhere and bacterias gonna find a way into your water lines and you think about how narrow those dental unit water tubes are and that just a slow flow rate well it's yet ideal breeding ground for bacteria and so if your listeners take away one thing one thing from this call is to please go back and test your water lines for bacterial count don't use it a meter somebody comes in and sticks it in your water in a cup of water and says oh your your water's fine they're only testing for dissolved solids in your water lines that's a TDS meter it comes with any zero water pitcher you can get from Amazon what we're looking for is heterotrophic bacteria and there's a couple ways you can test for that you can test for that in office using a paddle system or you can use a mail in testing mail in testing as your gold standard they use an R2A auger system that is the one that's going to hold up in a court of love but if you want an e-zpass test system and that's less expensive than mailing system at least initially doing in in-office water testing you'll get results in three days you'll know if you have an issue.
Howard: Okay are those resources on your website karendaw.com?
Karen: They will be I will add it just for you with a link that says Howard.
Howard: Yeah or or that post you made this morning you could follow it up and say I just talked to Howard about this post and but should people in the hot desert of Phoenix and Palm Springs and test their water lines more often than the cold areas of Maine and New Hampshire?
Karen: Not necessarily and what the CDC and many manufactures will tell you is it depends if you test and you fail you gotta do something shocked your water lines test shock test shock until eventually the water readings are good OSAP the organization for safety assesses prevention issued a white paper on this their recommendation is quarterly testing of all your water lines there are manufacturers that make tablets that is very popular that i used in water bottles their recommendation is monthly testing initially until your water lines pass then quarterly after that and there are manufacturers that make straws that sit in your water bottle they'll tell you to test once a year so you really gotta go by the manufacturer but initially you got a test you have a test to see if you have an issue then treat your water lines and continue to test and treat until your water lines are good and then follow the manufacturer's recommendations for frequency of testing out of that.
Howard: Wow so I I want to switch gears completely to HR and I also want to switch gears to DSOs because I know dentistry organization every tribe when they don't like someone the first thing they start to do is dehumanize them and do all their tribal stuff they've always done and right when I got a school the bad guy was capitation dental insurance and then the bad guy was the PPO now the bad guys a DSO dental service organization let me tell you something those guys if they do something wrong everybody's talking about it but it seems like every time I see a major OSHA violation it's just some good old boy country all alone by himself dentists in the marketplace you lecture to everyone everywhere do you think DSOs take this more serious than individual because they live in an aquarium?
Karen: I wouldn't say that they take it more seriously I just think that they have their resources to dedicate individuals to oversee the program whereas when you have a mom-and-pop dental office and it might be one dentist one assistant in a front office staff in some places they really don't have the resources dedicate someone to oversee this entire program I've seen I have actually heard some horror stories related to large corporation dentistry and then I've seen some mom-and-pop dental offices that are doing phenomenally there it's all about for me as a consultants all about coachability are they coachable can I go in there and work with them and nine times out of ten they've asked me to come in because they want to make sure they're doing the right thing the other part of the time it's because they hired a new dental assistant you heard me speak somewhere and they want they said well she said he'd be a good trainer but they're not willing to implement anything so I wouldn't say I don't want to vilify anybody, anybody who's open to receiving help I think you already taking the first step if you're willing to acknowledge okay I don't know I don't really know for sure if I'm compliant and I really want someone to come in and assess and maybe do a mock inspection and let me know hey validate all the things were doing right but then also help me identify all those areas where I could be doing things better.
Howard: So what happened like if you just google dentist OSHA violation I mean I mean the first one that pops up I mean just the very first one says court orders dentists to pay eighty five thousand dollars to employee fired four OSHA violations what the hell do you do to have to write someone a check for 85 grand?
Karen: So going back to when you were talking about HR here you had an individual who brought their concerns to the managers attention and to the attention of the the dental employer as well regarding I think that one was for sharps disposal primarily and post-exposure protocol due to a needle stick and nobody was doing anything differently and they were being very dismissive going back to what I said originally about you know listening we live in a society where people want to be heard and if this is something that your team members are bringing to your attention and you're being complacent or dismissive about it well now you've opened up your practice to liability the possibility that you might be sued so what happened with OSHA what happened in this case was this individual is dismissed from the office and we have whistleblower protection and this person technically should have been protected from retaliation from the employer as a result of them complained about what was going on in the practice the practice dismissed her so they had to pay provider with back pay in addition to an award as well.
Howard: Yeah do you think a lot of OSHA complain you you said it's a complaint process.
Karen: In most states yes.
Howard: What percent of those complaints you think are from disgruntled employees?
Karen: I would say a lot of them whether they're current or past employees and I think the reason why they became disgruntled in many cases again they did not feel they had any other recourse that's that that's what I hear from a lot of people is you know I'll have people contacting me after I visit their office and they'll say well doctors not gonna implement anything and I just feel like I have no know nothing else to do other than quit the job and so I wrote an article in RDH magazine about this called talker walk what to do about subpar infection control in your office and I said a first first thing to do was communicate with them let them know where you stand let them know that this is unacceptable let them know why it's unacceptable because sometimes gentle employers don't know what's going on behind the scenes approach at first communicate with them and then if you have if absolutely you are jeopardized know that you can leave find another office and some instances that's not possible then know that you can contact and reach out to the local Dental Board and OSHA as well.
Howard: Yeah cuz I couldn't actually when I got was in college like when I got a college I couldn't quit my job because there was only one Chippendales in the whole Phoenix area other work. So I want to go back to that water lines because I'm Mandi the hardest dental you know water lines water quality you talk about the OSAP white paper and recommendations what do you do you think there's anything it says provide guidance for manufacturers of dental units that are water treatments so I see on dentaltown people talking about you can buy like a big machine that sterilize your water for the whole office I mean other people will have that well I just gonna use bottle of sterile bottled water in each operatory which one do you prefer?
Karen: Combination to the two I like to see that water filtration system I think that those those are great units out there I do still on occasion because they're not 100 percent they'll tell you the 99 point something percent on occasion I will see offices primarily through lack of proper maintenance where they will have failed water lines we're talk about water lines we're talking about your handpiece your water your ultrasonic scaler lines that may fail even with those water filtration severe but on occasion does happen so that in combination with a straw or a tablet or liquid in the bottle I think isn't giving an overall comprehensive program that's going to make sure that the water that you're using the water you're being exposed to a safe and again monitoring testing testing testing.
Howard: Yeah and I always say something about HR where we really listen as closely is this is really profound advice but it might take you a lot of years to remind us. You know you always hire dental assistants because they have five ten years experience you can make the best anterior single to temporary but they have no organizational skills and I look at your sundries bills and is like four percent this 8% next month 6% I'm like dude your supply bill variance is a hundred percent well she's at a great artist she has no organizational skills I see that the front to where you hired this girl because she had five years experience and dental office knew all the codes but then I go talk to her is okay well that office you are indent ryx for five years I'm just curious does dentrix have five reports 50 500 how many reports are dendrix and she has no idea okay so you sat on a program for five years and you have no idea anything about it you know you just you train house so then I started saying okay looking back 32 years the best front office people I ever got were from Chase Bank or from bookkeepers you know the best employees ever got were bookkeepers because they're organized and I can hire if someone if I go to hire a bookkeeper in Arizona they're gonna ask for like twelve to fifteen bucks an hour I go I go hire a dental assistant they want $20 an hour well that $20 an hour dental assistant you couldn't teach her accounting if you put a gun to your head and her head and there's an your supply bills over but I can take a bookkeeper and teach her the art of Dentistry real quick and she's trainable I can teach her that you can't teach organizational skills to some people they're not wired that way and on this OSHA thing I mean OSHA to me I hate say this I'm I hate to say to the OSHA Lady but you know you the first thing you start thinking about your dental assistant having organizational skills is that your supply cost are four to four and a half percent every single month you know money is answer what's the question and then when you say that the the waterline should be tested every quarter 80% of the dental assistants in America couldn't even create a system to remind themselves to do something four times a year artist they're artists.
Karen: and many times they're the ones who are saddled with that responsibility of overseeing infection control compliance OSHA compliance so I think what every business owner needs to think about every listing in this call is do we have the right person for that job do we many times it's just by default it's the newest person or it's you know sometimes it's the person received the lowest salary in the office that's getting these huge responsibilities and I think we really need to kind of evaluate is this a good fit for this person if my job my license my reputation is on the line, do I have the right person that's gonna keep my name off the six o'clock news in charge of this.
Howard: Do you know who's the lowest paid person in my office?
Karen: Who is?
Howard: The smartest person we pay the dumbest people twice as much because we know they have to work twice as hard that's a joke twice as much they are interviewing someone they think they need a quarterback or running back and they need a dental assistant and what they need is is in this particular case and you know if you have four dental assistants someone's got to be organized so you can have three that can crush an anterior single to temporary okay I got you that and maybe maybe your organizational girl would be your last go-to choice on the cosmetic anterior temporary temporary on a highly level pretty girl but someone in every department needs to be led by the most organized person and and a lot of times in your interviewing receptionists like oh I'm gonna hire her because she's got ten years dental experience and and that office used the same Dentrix that we use and I'm like oh that's great why why did she leave the last office Oh after the bankruptcy he killed himself and it's like oh yeah you know good good good great great I really like where this is going. So someone needs to be organized for cost for OSHA for infection control and then once again just for our international audiences if they're confused about what is the difference between OSHA and infection control versus HIPAA and why are they not the same?
Karen: So OSHA again overarching responsibilities employee safety infection control can be employed safety as well as patient safety so the things that we do to keep our patients safe the fact that we disinfect and sterilize instruments so that would be more your infection control and prevention and then HIPAA is a whole separate base so that's a different agency that's responsible that's charged with protection of patient information cybersecurity so has nothing to do with employee safety so to separate gamuts but I think the reason why people love those two together is because the compliance umbrella they just put them both under that they make it sound like it's someone in the same as two separate entities there are infection controls more closely aligned with those than it would be for HIPAA because under the OSHA blood-borne pathogens standard there's a lot of infection control and prevention standards underneath nineteen ten ten thirty which is the actual OSHA standards for blood-borne pathogens on the side of infection control stuff in there so things overlap.
Howard: So a lot of people think another genre is just quote documentation is that even a genre thing or is that?
Karen: OSHA does require certain documents our annual training records are if you look at...
Howard: Is that OSHA or HIPAA or documentation just a separate thing on its own?
Karen: They don't have their own documentation requirements so maybe it might be its own standalone, headings under documentation.
Howard: So is there any new products and new technologies new is there anything new product wise that's I've got you excited about?
Karen: New products...
Howard: Technologies, procedures something new in the...
Karen: It would be related to safety and I think the big things that I'm noticing right now the in-office testing kits that's available now whereas they didn't have that before and the more that we hear about that's the better I think not necessarily new but something that I've been stressing because I see a lack of it everywhere I go proper eyewear when you're using your caring lights because we know the intensity of that blue light has increased over time and yet people will continue to close their eyes or look away when they're engaged in a bonding or curing procedure so using that blue light in the proper eyewear that I don't know about new technology I think there's a whole gamut of new disinfectants out on the market with shorter contact times that are safer for our equipment they're not cracking or corroding or rusting their equipment I see a lot of comments and your forms related to different types of disinfectant products so I think that's really new I get excited about everything every time I learn about something I get excited about it because that would be more solution.
Howard: That would you say do more officers get you for OSHA or infection control?
Karen: I kind of love the two together I tell me you get one you get the other that's my deal with them.
Howard: So let's go through two of those things so I wanna go I'm gonna go back to your plan, on average, what do you think it costs for you to come down and would you spend half a day in the offices at a full day what is your average if I go to McDonald's it's a Big Mac, fries and coke what is your Big Mac fries and a coke?
Karen: My Big Mac fry and a coke would be OSHA infection control with the one-on-one with the consultant and mock inspection.
Howard: So one on one would be the most thing you do?
Karen: Actually the training in office training they so it's almost like a cat like a it's a happy meal right so it's the training so everybody gets the same message then I get the one-on-one so I can support their safety officer and then I do the mock inspection so they didn't know exactly what's going on that's kind of where the rubber hits the road the doctor sometimes are are not are not aware they're they're well-intentioned their team members are well-intentioned they think they know that they're doing the right thing but until we actually do an assessment where I'm actually watching I'll sit there some some ups I've stood there for two hours I just watch patients flow in and out of treatment rooms and instruments flow in and out sterilization and I make a report and I present it to the doctor and I go okay here are your pain points and again here all the things you're doing great but here your pain points I've got a great resource that's absolutely free for anybody who wants it and it's created by the CDC the CDC has a dental summary checklist that they can download and it's free and say here's related to infection control here's a little office here are the policies and procedures you need to have in place and then here is observational checklist and you can actually download it there's a it's called the CDC dental check they can download that and do an in-office internal infection control audit today if they wanted to and that's a free resource available to anybody and I think few people realize you know that there is.
Howard: So when you do that lecture that's for the full office how long would they have to block out patients at a half-day all day?
Karen: So some of my repeat offices we will go over it in about 90 minutes to two hours but if it's brand-new I would at a minimum like to have three to four hours with the team.
Howard: So the first time half-day and then on the Safety Officer is that usually gonna be they had dental assistant hygienist who's usually the safety officer?
Karen: Primarily it's a dental assistant I don't know necessarily it's a lead dental assistant but somebody's been saddled with that 9/10 of the times it's it's a dental assistant that I'm working with and their that really in some ways that makes sense because they are hands-on they're in the back they're in the clinical area they know what needs to be done back there but then in other respects when I ask them how much time are you given to devote to making sure that your systems are updated that you've got the checklist completed your weekly monthly quarterly annual check is completed and they'll say I'll have to take a lunch here and there but I have no dedicated time to do this so for the for the employers listening today if this is important to you and we always make time for the things that are important to us I asked you earlier how do you squeeze in the show and manage your form and practice dentistry I think if you love something in your past about something and you it's important to you you're going to make the time I need offices to support their team and give them the time to dedicate to safety.
Howard: and I'll answer the question which yes me I always get asked that you know how do you do it you know you do all these things how do you do it it's like well it's easy because I don't do any employee training employee training is is a never-ending problem when you have a staff turnover once you've collected a bunch of people that have been with you 20 to 30 years like Karen have you been with me 20 to 30 years and every day I came by and to see what you were doing you'd finally shoot me I mean none of my none of my staff watch they don't want micromanage and then a lot of people tell me they say well you know it doesn't cost anything to fire someone and get a new person and and oh yeah and that new person you got that new dental assistant and she was your dental assistant for a whole year and she never figured out that your autoclave quit working and then but the Centers for Disease Control figured it out and you're on 60 minutes and you're on the evening news and all the dentists in Oklahoma are like oh my god that's like the nicest guy in the world and and then you tell me that and there's no problem with employee turnover and you don't need staff training and you don't need all these things like that and the reason I it's so easy for me is like everything that you do well I've got someone that's been worrying about that for 20 years and quite frankly I don't even know what she does or how she does it or any of that stuff but so you just fix employee turnover you don't want to marry a toxic person get rid of the toxicity in your life I see so many dentist who found five drinking buddies in college you all think dentistry sucks and the world's coming to an end and by Bitcoin and all I said and it just sucks them down and then and that's why you start doing you go get your FAGD your MAGD because you'll find out that it's the same AGD people trying to get their FAGD at every day I'm continuing education deal and those people love dentistry and they're all excited and they're all going so once you're surrounded by about five dentist friends who love dentistry they'll drag you up and it's the same thing with staff if you can't keep any of your staff for one or two years then I would just go work for Heartland I mean just throw in the towel if you can't if you can't it's people time and money and if you can't get an A or B people then all the time and money in the world you're still gonna have inferior results so this this training is everything. So back to the the mocks okay so the lectures half-day when you're onboarding someone new 90 minutes on follow-ups safety officers usually a dental assistant mock inspection we talk about what technologies for procedures practices are excited about so I know my homies you when you lecture you say hey is there any questions no one has a question okay don't take a potty break we'll start back in ten minutes and everybody runs up with their private personal question and everybody has the same personal question but it comes to the fact that a lot of dentists are shy introverts they're afraid to raise their hand and ask so what do you think there are that the scary thoughts are there thinking about OSHA and why they're hesitating on pulling the plug on having you come in their office and get them up to speed what is what what is the fear factor why they won't pull the cord make a decision?
Karen: I think I'm especially with our newer dentists that are graduating with a large amount of debt it's the least thing last thing on their minds is safety and this compliance aspect so I think we tend to push it off and defer defer defer it or have this mentality that oh it could never happen to me and and I and I want to tell that the shy ones especially that are afraid to ask the questions if you're thinking that question I guarantee you there are other people that have that same question too and I think that we have to accept that when when we need help and not be afraid to ask for that help I think a lot of people have this mentality that especially I mean even some of the support team members in dental office they feel like they need to know everything where their boss is gonna look down on them and that's not the case you're not gonna know everything I don't you know I know how to change a tire but I couldn't swap out an engine in my car I go an expert for that if you need help with something go to the people who are experts in their field they're gonna people who are they're not gonna like my style I'm just tube I have been told this in comments she is too bubbly for something that's supposed to be a serious topic I'm not gonna be a good fit for you find the right mechanic to help you tune up your practice then if that's the case find the right consultant find the right experts to help you so I think that sometimes they're afraid to ask and for those who think that it can never happen to you I have a great story you might have heard of Jen Maroney she is based out of PA she went to her doctor to get her root canal and the doctor passed the needle to his dental assistant uncapped across her face she was not wearing I wear nor was she aware she should have asked for I where the needle slipped and went into her eye she did not go to an eyewash station she was not told to go to an eyewash station which is the first step of any confirmed blood-borne pathogen exposure she was given a tissue to dab at her eye which was starting to tear up this Noelle kelps fabulous writer wrote a whole article about this that went viral the next day Jen woke up she said it felt like her brain was on fire well that's because he had injected streptococcus bacteria directly into our eye and after several surgeries she lost her eye and people nobody thinks they're gonna go to their dentist and lose an eye and that's the story that I share with people when they go it could never happen to me well it happened to Jen losing and eye by going to the dentist anything can certainly happen and that's what you've got to prepare for I advise everybody as I sing walk around your office as if you were an OSHA inspector look at all the potential unsafe conditions in your practice make a list and then get to your next morning huddle let's chat about some of these things you are your own best inspector you're your own best adviser your own best consultants.
Howard: Wow that is just a crazy story but luckily he didn't get fined any money or anything right?
Karen: Yeah I think they settled Jen I had a privilege of meeting her at one of the OSHA conferences and she said she couldn't discuss the terms of settlement but she said basic that covered her medical fees that's it that's that's pretty much it that's what I gathered from that conversation .
Howard: Oh my god she should have retired into the Bahamas, what's the name of her attorney?
Karen: Yeah I have no clue but she has a fabulous Facebook page called Jen's vision and she's an advocate right now for patient eyewear so for those of you who are listening if you don't currently provide patient eyewear please don't make it optional don't let your patients say oh but I want to wear my own eye glasses during this appointment let them know it's an office policy or let them know it's for their safety or heck just say it's per OSHA, nobody's gonna kind of question it even though she has nothing to a patient safety let them know that there are policies in place and that we're the side where don't make it optional.
Howard: Well tell her you mentioned her in the podcast and she wants to come on the show and talk about it because that would just be an amazing show. I mean talking about the rock bottom of everything that can go wrong and like say I confess I confess that I in I opened in 87 91 is the year 91 I had two crazy postoperative root canal swelling so it and and then embarrassingly I found out that I in fact had the San Diego Zoo living in my water lines and I felt horrible about it I mean I just felt sick and I even told the people what had happened and what I'm doing about it and and and again I think we might have been a victim in Arizona because you have no idea how hot it is like I remember calling them some dental materials company one time and I don't think they were realizing back in 87 that when you make that vinyl polysiloxane ship it to me in a UPS truck well in the inside of the UPS truck in the summer in Kansas might be hundred and ten it's a hundred and forty in Arizona I mean I was getting buying polysiloxane and it was rummy and it's like and they're like and then over the years people started figuring out that you know that you know the different different scenarios. So my gosh I am so is back to the safety officer is there any qualities in that safety officer that you said this work this type of person works better than the others I mean HR is everything HR HR HR if you get an A or B on people you can get a D on everything else and be a happy millionaire is there anything you've seen in that Safety Officer that you say that's that's the one I'd be looking for?
Karen: I think we're seeing kind of more of a focus on EQ versus IQ and making sure that you have the right fit so in a Safety Officer someone who's coachable someone who's willing to take on the responsibility because you know most of the time they're not they don't volunteer to be the safety officer they're all told that they're the safety officer and here they are going well when am I supposed to find the time to do this so if you have someone is codes will in attack and I think that people who do it you know eventually they understand the importance of what they do but they're just not given the proper support they're basically thrown a couple manuals that they purchased online or thrown at them and they go here you ago you're now in charge and they don't know that there are resources available to them that there are courses they can take that can help support them in this role so someone who's willing someone who's coachable someone who gets the reason why we do what we do is going to be the ideal candidate for that Safety Officer position.
Howard: Okay so under OSHA someone just posted as anyone worked with the company that they thought did a great job we are in illinois' does anybody recommend anyone so I was wondering what who are your best clients who brings you in and says this was great how do they know if you're the right fit for their practice and how would you answer that guy in Illinois if you're the right set to take a look at the web sites you can get the feel for someone's personality and their expertise just by looking at what they have on their website and find the one that's going to be a right fit for you find somebody who's gonna be able to elevate your team who's gonna be able to help you identify the problems and then help you enhance their systems not somebody's gonna come in and help you check out the box unless that's all you're looking for I do check out the box training I don't like it because I know that OSHA is just much bigger than that but to make sure that the right fit for your organization get a good feel for their personality take advantage of those free complimentary calls I offer a fifteen minute complimentary call I'm not gonna answer your OSHA specific questions but I'm going to give you a good sense of what I bring to the table and how I can help your practice and I think every office should take advantage of that and call around if you talk to me and I rattled off some corny joke and you think oh this person is just not serious enough for me well then you want to find an office with a consultant that does have more of a serious nature that can go in to just nuts and bolts and cross that off your list for you.
Howard: I was blown away when three of the best oral surgeons in Texas their damn autoclave exploded and the assistants suing him for a ton of money in fact what do they say in the lawsuit she said ah how much is it oh she the dental assistant alleges negligence and autoclave blasts and seeks monetary relief between 1 million and ten million dollars 1 million in 10 million is someone drinking it shouldn't be your attorney why would you say 1 million at 10 million you should say 10 million but anyway so did I before last week I didn't even know an autoclave ever did blow up I never heard that before that I didn't know that was a thing.
Karen: and I think that's the importance of getting a really good person has a solid background in OSHA I knew how important it was for me to make sure that I became an authorized OSHA trainer so I attended all the courses to the Department of Labor to be able to use that title and I train the trainer so I go and I train other OSHA trainers and that's because when you think about that sterilizer breaking it's exploding well they weren't implementing proper or what we call a lot oh but it's lockout tagout if you have an equipment that can be charged or can be plugged in and is electrified and it's not it's not working properly that equipment should have been unplugged it should have been placed in storage with the sign that says malfunction equipment securely attached to it so it should not have been able to be sit on a counter plugged in accidentally by who knows you know who knows who happens to be walking by that create that scenario that scenario is completely preventable in my opinion.
Howard: and then the other thing is you know what I see with humans they always know the right answer as you see them talk about imply it's maybe their family or some other business or whatever but then in this situation they're not applying it correctly but like for instance if you work on many of your things it voids the warranty well guess who fixed the autoclave yeah was the thought was that the distributor was the manufacturer now as an oral surgeon because that's not who you want to fix the autoclave oh hell yeah you want a surgeon fixing that thing not the man you yeah so in almost everything you work on you're not trained to work on you're trained to be a dentist and all the other things you work on it says right there if you do this you just voided your warranty so bring it back to us and we'll fix it and if you go on from here there's no work. So I can't believe we went over an hour and I just last but not least I'm last question needle stick protocol, so you just handed your assistant to the syringe and just stuck in her finger what do you do?
Karen: That so first exposure protocol every office should have when it's part of your exposure control plan if you bought one of those read paid a couple hundred bucks for one of those ready-made manuals I'm really not a big fan of those but in it there was something a section called the exposure control plan and within the exposure control plan it you're supposed to detail it actually gives you a template and guidelines already but you need a detail where you're supposed to do at the very first step is to wash the affected site and in Jen's case where the needle in her eye you're gonna take somebody to an eyewash station I have heard countless stories over the years of patients getting acid etch in their eye or hygienists getting calculus in their eyes so the first step is going to be to watch the site and then there's going to be an instant forum you're going to complete copy the instant form I copy the blood-borne pathogens standard and a copy of your hep-b records need to go with you when you go get evaluated somebody's going to talk to the patient convince the patient to go get tested and then somebody's gonna let the front office staff know hey you need to clear clearance appointments for the rest of the afternoon because she's gonna go get evaluated at the urgent care up the street this is already an angst-ridden event the simpler we can make it by creating an operating procedure around it the better off the practice is going to be.
Howard: Wouldn't it be just faster to fire her and hire a new assistant?
Karen: For an exposure incident?
Howared: That was a joke.
Karen: Yeah that would be interesting, I wonder how I'm sure we're playing without one.
Howard: So if someone wants to bring Karen Daw MBA CECM for certified environment compliance manager or environmental?
Howard: Environmental they go to Karendaw.com I'm trying to think of something anomic for daw there's got to be some documentation and workers they go to karendaw.com on average what would it cost for you to go in there and do this for a day and get about to speed?
Karen: It really depends it really depends are they flying me in so we'll talk about that during that assessment call if they decide to bring me in or if they're gonna do virtual training.
Howard: and what percent bring you in versus virtual?
Karen: Right now the majority of it is in office so I do have offices that fly me out to their practices or they'll have a miniature seminar and by other practices to be there and while I'm there I'll do there I'll do an assessment for their particular facility so I would say right now I am probably 75 25 but it's the virtual part of it is really exploding so if cost is a concern and you don't really need to fly me out and you're looking at some coaching or consulting we can certainly plan a series of consulting calls around what your what your needs are of your practice.
Howard: Well it's so weird to think you'd bring in an infection control lecture to your staff I mean they're their staff, staff is an infection Staphylococcus isn't that where they got the name staff from staff infection?
Karen: Yeah yeah
Howard: Last question I just want to get one feeling and or more of your customers larger group practices DSOs than the individual?
Karen: No they tend to be individual.
Howard: Individual, because the DSOs they never know when to brag you know they get beat up all day long and they have departments that fear this stuff and again every time I see someone hung out to dry it's always a good old boy by himself, so people take this stuff seriously cuz now you know I just read in case today a patient needs a liver transplant and indeed they think they got the the hepatitis virus from this exact dental office and when and if you're gonna go to court and bring in some viral DNA guy that sits there and says no she got this one from your place and so it's a whole new world out there you don't want patients lose an eye if that girl wants to come on the show on time I losing an eye, maybe that'll scare them but Karen Daw of Karen Daw Consulting Karendaw.com Karen thank you so much for coming on the show today and letting all my homies listen to the OSHA Lady for an hour.
Karen: It is a pleasure, it's all mine thank you all so much for listening.