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Table 4 Conceptual memo

From: How to do a grounded theory study: a worked example of a study of dental practices

Believing + Embracing + Developing = Adapting?

In these dental practices the adaptation to preventive protocols was all about believing in this new approach to manage dental caries and in themselves as professionals. New concepts were embraced and slowly incorporated into practice. Embracing new concepts/paradigms/systems and abandoning old ones was quite evident during this process (old concepts = dentistry restorative model; new concepts = non-surgical approach). This evolving process involved feelings such as anxiety, doubt, determination, confidence, and reassurance. The modification of practices was possible when dentists-in-charge felt that perhaps there was something else that would be worth doing; something that might be a little different from what was done so far. The responsibility to offer the best available treatment might have triggered this reasoning. However, there are other factors that play an important role during this process such as dentist's personal features, preconceived notions, dental practice environment, and how dentists combine patients' needs and expectations while making treatment decisions. Finding the balance between preventive non-surgical treatment (curing of disease) and restorative treatment (making up for lost tissues) is an every moment challenge in a profitable dental practice. Regaining profit, reassessing team work and surgery logistics, and mastering the scheduling art to maximize financial and clinical outcomes were important practical issues tackled in some of these practices during this process.

These participants talked about learning and adapting new concepts to their practices and finally never going back the way it was before. This process brought positive changes to participants' daily activities. Empowerment of practice staff made them start to enjoy more their daily work (they were recognized by patients as someone who was truly interested in delivering the best treatment for them). Team members realized that there were many benefits to patients and to staff members in implementing this program, such as, professional development, offering the best care for each patient and job satisfaction.