SGA Dental Partners  ·  Confidential  ·  March 2026
P R I S M
Patient Risk Identification, Safety & Mitigation Program
Strategic Realignment: From Patient Experience to Risk Mitigation & Executive Escalation Management
Confidential  ·  For Internal Use Only
01 — Program Overview

PRISM — What It Is & Why It Matters

Centralizing high-risk patient escalation management across the full SGA portfolio
250+
Offices Supported
L4+
Escalations Only
1
Strategic Leader
Mission: PRISM centralizes and elevates the management of high-risk patient escalations, board and legal complaints, release of liability / refund negotiations $2,500+, and consent compliance across all 250+ SGA offices.
Program Pillars
Escalations & Clinical Dissatisfaction
High-risk patient concerns with legal or financial exposure
Release of Liabilities
Liability agreements, dispute resolution, refund coordination
Board & Legal Complaints
Dental board inquiries, legal escalations, standardized responses
Consent Compliance
Maintaining accurate, compliant informed consent practices
02 — Team Evolution & Strategic Shift

From Broad Support to Focused Risk Mitigation

How the program structure transformed from the Gen4 model to SGA / PRISM
BEFORE — Gen4 Model
👥
2 Team Members
Director + Coordinator
🏢
~100 Offices Supported
Limited geographic footprint
📋
Broad Scope
Operational + strategic patient experience
📊
Level 1–3 Escalations
All complaints, including routine service recovery
AFTER — SGA / PRISM Model
👤
1 Strategic Leader
Director of Patient Risk, Compliance & Resolution
🏢
250+ Offices Supported
Full SGA portfolio coverage
🎯
Narrow: High-Risk Only
Legal protection + risk mitigation focus
🚨
Level 4+ Escalations Only
Legal, reputation, or financial risk present
SHIFT: Operational Support  →  Risk Mitigation + Executive Escalation Management
03 — Scope Realignment

What Changes — Clear Ownership of Responsibilities

Functions transitioning out vs. responsibilities PRISM continues to own
✖ Transitioning Out (Moving to Ops, Marketing, or Office Level)
↗
Responding to 1–2 Star Google Reviews
→ Office Manager
↗
Financial Disputes / Chargebacks
→ Finance
↗
NPS Management & Reporting
→ Marketing
↗
Secret Shopping Programs
→ Operations
↗
Front Office Training
→ Operations
↗
Level 1–3 Patient Escalations (routine)
→ OM / Ops Director
↗
Patient Dismissals
→ Office Manager (compliant process owned at office level)
✔ Continuing to Own (PRISM) (Legal, Financial Risk & Brand Protection)
✓
Release of Liability (ROL)
Refunds, legal docs, Finance + Ops partner
✓
Board Complaints & Legal
Dental board, legal escalations, standardized responses
✓
High-Level Escalations (L4+)
Legal, reputation, or financial risk present
✓
Consent Compliance
Accuracy, compliance, consistency across all offices
04 — Updated Escalation Model

PRISM Engagement Triggers at Level 3+

Tiered escalation model with clear ownership at each level
Level 1–2
Office / Ops Managed
  • ▸ Routine complaints
  • ▸ Service recovery
  • ▸ Scheduling issues
  • ▸ Billing questions
  • ▸ Minor dissatisfaction
Level 3
Ops Leadership
  • ▸ Elevated dissatisfaction
  • ▸ Provider-specific concerns
  • ▸ Escalated refund requests
  • ▸ Repeat complaints
Level 4+ — PRISM
Director of Patient Risk,
Compliance & Resolution
  • ▸ Legal risk present
  • ▸ Board complaints
  • ▸ High financial exposure
  • ▸ Reputation risk elevated
  • ▸ Consent compliance issues
PRISM engages ONLY when:  Legal risk is present  •  Reputation risk is elevated  •  Financial exposure is significant

Director of Patient Risk, Compliance & Resolution

Scope: All 250+ SGA offices — case management, documentation, resolution tracking, and board reporting on risk trends and mitigation outcomes.

05 — L3+ Intake Criteria & Decision Matrix

Standardized Thresholds for PRISM Engagement

Clear, documented triggers that define when PRISM takes ownership of a case
Risk Category Threshold / Trigger Level PRISM Action
Legal Risk Threat of lawsuit, attorney contact, demand letter L4 Immediate legal liaison, documentation lockdown
Board Complaint Dental board inquiry or formal complaint filed L4 Standardized response protocol, legal coordination
Financial Exposure Disputed amount > $2,500 or involves insurance fraud allegation L4+ Financial review, ROL coordination, Ops + Finance alignment
Reputation Risk Negative media inquiry, viral social post, or pattern of 1-star reviews at single location L3+ Rapid response, review investigation, PR coordination
Clinical Dissatisfaction Treatment outcome dispute with potential malpractice implication L4 Clinical review, risk assessment, legal coordination
06 — Governance Structure

Reporting, Documentation & Accountability Framework

Clear reporting lines, standardized documentation, and cross-functional accountability
Reporting Line
CEO / Board of Directors
↓
CCO / COO
↓
Director of Patient Risk,
Compliance & Resolution
Cross-Functional Partners
Legal Counsel
Finance / Billing
Regional Ops Directors
Marketing
Case Management & Documentation

Centralized Case Tracking

All L4+ escalations logged in a single system with unique case IDs, status tracking, and full audit trail.

Standardized Intake Form

Consistent documentation of complaint type, risk category, financial exposure, parties involved, and timeline.

Resolution Documentation

Outcomes recorded with actions taken, costs incurred, ROLs issued, and follow-up requirements.

Reporting Cadence
Weekly
Active case review with Ops leadership
Monthly
Trend analysis, KPI dashboard to CCO
Quarterly
Board report: risk trends, cost avoidance, patterns
Annual
Program effectiveness review & policy updates
07 — The Prevention Loop

Turning Escalation Patterns into Operational Improvements

A continuous feedback cycle that converts case data into systemic change
1
Identify
Escalation data logged and categorized in PRISM case system
2
Analyze
Quarterly pattern analysis by office, provider, complaint type, region
3
Report
Findings shared with Ops leadership and Clinical Leaders
4
Act
Ops implements targeted training, process changes, or staffing adjustments
5
Monitor
PRISM tracks whether interventions reduce repeat escalations
💡
Key Insight
The strongest risk programs don't just react — they feed patterns back into training and operations. If PRISM identifies the same complaint type across 15 offices, that becomes an Ops initiative, not just a series of individual resolutions.
08 — Transition Matrix

Responsibility Assignment for Transitioned & Retained Functions

RACI framework across PRISM, Ops, Office, Marketing, and Legal/Finance
R = Responsible
A = Accountable
C = Consulted
I = Informed
X = Primary Owner
Function PRISM Director Ops Leadership Office Manager Marketing Legal / Finance Owner
✔ PRISM Owned
Board & Legal Complaints XI—C— PRISM
Release of Liability R / ACI—R PRISM
Consent Compliance R / AIR—C PRISM
↗ Transitioned to Ops / Office / Marketing
L3 Escalations —XC—— Ops
Patient Dismissals —CX—C Office
1–2 Star Reviews IARR— Ops / Mktg
Financial Disputes CAR—R Finance
NPS / Secret Shopping —ARC— Ops
Front Office Training —AR—— Ops
L1–2 Escalations —AR—— Office
09 — Tiered Response SLAs

Accountability Standards for PRISM Case Resolution

Defined timelines ensure consistent, defensible case handling across all risk tiers
Level 4+ — Elevated Risk
Acknowledgment
Within 24 hours of intake
Initial Assessment
Within 48 hours
Resolution Plan
Within 72 hours
Target Resolution
Within 5 business days
Status Updates
Every 48 hrs to Ops leadership
Level 5 — Critical / Legal
Acknowledgment
Same business day
Initial Assessment
Within 24 hours
Resolution Plan
Within 24 hours
Legal Coordination
Within 24 hrs if attorney involved
Target Resolution
Within 7 business days
Status Updates
Daily to SVP / COO
Board Complaint — Regulatory
Acknowledgment
Same business day
Legal Notification
Within 4 hours
Response Drafted
Within 48 hours
Board Submission
Per regulatory deadline
Status Updates
Daily to SVP + Legal
PRISM Success Metrics
SLA Compliance Rate
% of cases meeting response and resolution timelines
> 90%
Cost Avoidance
Estimated liability reduced through early intervention
Track Quarterly
Repeat Escalation Rate
% of offices with multiple L3+ escalations in 90 days
< 10%
Resolution Satisfaction
Post-resolution survey score from involved parties
> 4.0 / 5.0