Exceptional Dental Practice Management

Tell What You Know

   

What does your staff know about what you do in your practice?  It is important that everyone understands the procedures that are offered in your practice.  Most staff members only know about what they do in their little corner of the practice, but often are clueless about what happens elsewhere.  Hygienists may know all about prevention and perio treatment, but can they answer the patient who questions them about the implant the dentist just told them they need?  Can the front desk assistant answer any question that patients ask on the phone?  Can your assistant tell the patient who was just referred to the periodontist what they can expect?  If not, this is the next thing you need to attend to. 
    I suggest you set up a "Tell Me What You Know" staff meeting.  Start by listing each treatment category such as: Preventive, Restorative, Oral Surgery, Perio, Endo, Implant.  List each as a column and under each topic ask the staff to call out services that you either provide in your practice or refer out and list them.  Then go one by one and ask why each treatment would be recommended, what it entails and why and when you would refer the patient to a specialist. Be sure to talk about symptoms, triage questions to ask and post-op expectations.
    When we did this it was very gratifying to see our very young dental assistant explaining the steps to restoring an implant to our rdh's with 20 years experience and to see them explaining scaling and root planing to her and our front desk assistant.  Everyone enjoyed and participated in the meeting and we left the info on the white board for months as well as printing out handouts for the staff.  Now we hear more consistency when staff members are explaining treatment to patients and that is a key to confidence for both staff and patients.
    I have also asked the specialists we refer patients to or their staff members to come to our practice for a lunch and learn session.  This really helps enhance communication between our practices and helps everyone realize that when we all work together to serve our patients we are all much bigger than our individual practices. 

What's Your Problem?

   

What's your problem?  C'mon, you know you have one, we all do.  It doesn't matter who you are, what your job title is, you have a problem.  And you know what it is.  It probably drives you crazy sometimes.  You may think you're stuck with it. You may make excuses for it:  my father was that way, I have so much stress, I'm overworked, underpaid, unaapreciated, misunderstood, born under the wrong sign, you name it, but it will be nothing new.  We've heard it all before.  The problems and the excuses aren't new.  You're just one more person with a problem.
    Some people embrace their problem and think it makes them who they are.  Love me or leave me, I y'am who I y'am.  As long as the problem isn't too offensive, that may work for them, as long as they have the gift of charm.  The gift of charm makes them disarming and allows others to just glide past the problem area because the person is just so darn great to be around.  There may be moments of frustration with this person, but soon enough the charming part comes out to save the day.  These people are few and far between and we like them so much, we'll forgive them anything.
    And then there's the rest of us.  The ones with the problems that interfere with success at work or with our relationships.  We get annoyed at the grouchy patient, the lazy co-worker, or the wishy-washy boss and his pushy wife.  (Author note:  I am in no way referring to my wonderful boss or his sweet, not at all pushy wife.  Just want to make that clear).  Maybe you have a quick temper, maybe you push too much even though that little voice in your head is screaming at you to   KNOCK IT OFF!  Your problem might be more subtle, you may walk past that scrap of paper on the floor 10 times without picking it up.  You didn't know that your boss put it there to see if you'd pick it up or walk past.  Yeesh!, you'd have picked it up if you knew that.  Or...you might be a boss who puts a scrap of paper on the floor to see if anyone would pick it up.  Aha!  Just liked you suspected, no one picked it up.  So now you know you have a staff that won't bend over to pick up a scrap of paper.  Now you can begin extrapolating and come up with a whole menu of malignant character traits that would cause someone to behave that way and start assigning those discredits to your staff.  Where will that get you? 
    Ok, so you get my point, we all do things that get in our way at work and in the rest of our lives.  We see ourselves doing those things over and over again.  We wish we weren't that way, sometimes we're our own worst enemy, aren't we? 
    What can we do to change it?  Becoming aware of our problem is the first step.  The next step is watching ourselves in action.  We can feel that problem behavior coming.  We know the things that push the button that activates it.  So we have a few breaths before it is set into motion to say, "Not this time."  Everything inside of you may fight to set it free, but you really are stronger than that urge to react.  Nike may have their slogan, but I want you to memorize mine, "Just don't do it."  That's right.  It sounds easy, but it's not, because you'll be battling with yourself.  But, your reasoning brain can be stronger than your reactive brain.  It all depends on which side you keep your acting brain on.  Acting with reason rather than reaction will get the better outcome.  Do it enough and you will start to react with reason.  Soon that will become your pattern and it will come naturally.  When you begin to act naturally rather than react irrationally, your problem will become one of those things you used to do.  So, what's your problem?

Keep Your Eye On What Is Good

When times get tough, people tend to notice the tough parts and forget about the good things that remain with us no matter what. Sometimes it's hard to see through the fog of despair that is sent up by the media, but we must try if we are going to triumph. If you're determined to be miserable and give up, do me a favor and watch this video. You can try to go back to being dismal when you're done, but I don't think you'll be able to suppress a smile.

This is what you must do to keep your practice driving forward through the fog. Look at all the positive things around you. First of all, open your mind to new ways of practicing while times are changing. Be flexible. Be willing to work with patients and do the less expensive, less optimal procedure that will keep them going for now. If you do, chances are good that when things improve, they'll come back to you for the treatment they couldn't afford before. Don't look at your staff as extra weight to be tossed overboard when the load gets heavy. Look at them as the wind beneath your wings. Ask them what they're willing to do to keep the practice healthy. Will they work hours that suit your patients schedules? Will they take on tasks that they usually don't deal with? Will they find fresh new ways to serve your patients and market your practice? Avoid talking about the recession with your staff and patients constantly. Express hope and confidence that things will get better, rather than despair. The more we reinforce worry and anxiety, the more it spreads and the longer it lasts. Resist knee jerk reactions and stay true to your patients, your team, your practice and yourself. We are standing on the cusp of a momentous day in the history of our country. When Barak Obama is sworn in tomorrow we will witness the result of minds opening all across our country. How can we doubt that anything is possible?

How Am I Doing?

   

It's more important to know the answer to that question, now more than ever.  As an employee, you deserve and need to know where you stand.  As a manager or owner, you must give your staff the feedback that will help them stay motivated or let them know where improvement is needed.  As the dental care team, you have to have your finger on the pulse of the practice, and the patients drive the beat.
    If you're a staff member, when is the last time you received a performance review, or feedback of any kind from your supervisor?  Do you really know how you're doing, or are you just assuming everything's ok?  Are you avoiding this discussion because you know their are things you might not want to hear about?  Yank your head out of the sand and ask for a chance to sit down and find out what you should keep doing and what you should change or improve.  Then, take that information and use it.  Don't argue, don't defend yourself, just be grateful for the fact that your manager cared enough to be honest.  Now that you know, take action.
    If you're a manager or owner, are you giving your staff honest and regular feedback?  Why do I say honest?  Because sometimes the truth is uncomfortable to deliver, so some people just skim over problems.  Sometimes we worry that people will quit if we're honest with them and we don't want the hassle and expense of replacing them.  People don't like hearing that we're not satisfied with their performance and they can get upset or defensive.  That can make us dread the difficult conversations just because they can be exhausting.  Sometimes we don't have the guts to say the hard things.  Whatever the reason, now is the time to say the difficult words and be honest with our staff members.  We need to be the best we can be in order to plow through these times when their are more obstacles to treatment acceptance than usual.  We need people who will be creative and flexible to keep our practices healthy.  They need to know that they have to be part of the process, and that they can't just be along for the ride.
    The whole team needs to know how our patients are feeling about what we are doing in our practices.  The only way to know is to ask.  How do they feel about their treatment, the staff, the atmosphere in the office?  What are their concerns and desires?  Prepare a written survey and just come right out and ask.  You know which patients will feel comfortable with a face to face discussion and which will feel more free to be honest in a written survey.  We can't afford to shy away from the answers that are hard to hear.  We need to accept criticism and use it as a means for growth and improvement. 
    It's important to be aware of the economy and to make some adaptations that will make it easier for patients to afford treatment.  It's just as important not to become paralyzed by fear of the economy.  Don't focus on it constantly or bring it up with your patients and staff every day.  The more we talk about it, the more we become afraid to spend money at all, and the deeper the recession grows.  Try not to let it go viral in your practice.  Next I'll talk about ways to keep your practice hours intact and your staff employed.

The Dental Assistant As Patient Care Coordinator

The following is an article that I had published in the now closed Contemporary Dental Assisting magazine.  I've had a few e-mails lately asking about the PCC position.  I thought I'd run it here in case any of you are looking at this position for your practice.  I will be speaking on this subject at the Florida National Dental Convention in Orlando in June.

The Dental Assistant As Patient Care Coordinator

Clinical dental assisting has been around a long time and is gradually evolving into a profession that is dynamic and multifaceted. When I started assisting in 1976, there was little for the assistant to do except set up and clean rooms, take radiographs, and provide suction. Dentists that I worked with did not generally ask my opinion, expect me to understand the procedures I was assisting with, or think that there was an opportunity for growth within the profession. As a matter of fact, I don't know if I or they considered dental assisting a profession.

Fast-forward to today and dental assistants know and understand a wide variety of procedures and materials, and must be able to discuss those procedures with patients and help them understand how the proposed treatment can benefit them. We are human behavior specialists who need to be able to read the dentist's mood on any given day and respond accordingly. We have to understand that patients act in certain, sometimes unusual, ways when they are stressed and fearful, as they often are in the dental office. We must be able to reassure the patient and help turn their fear into confidence in our skills and care for their well-being. Behind the scenes we keep the equipment maintained, the supplies stocked, and the office immaculate. What else could there be?

A new and exciting step for an experienced, well-trained, enthusiastic dental assistant is to become a patient care coordinator (PCC). This position offers the practice the ability to extend even greater services to their patients. The PCC escorts the new patient into the practice and is their advocate thereafter. The position can be infinitely satisfying for a person who can get genuine gratification from having a positive impact on the patient. The PCC lets patients know that they are viewed as unique individuals and will be cared for as such. The PCC is also available to patients whenever they have questions or concerns about the proposed treatment or even about financial considerations. Finally, the PCC dedicates his or her time and resources to working with patients to help alleviate any fears, concerns, or misconceptions they have about their treatment. The PCC is the icing on the cake and let's face it—what's a cake without the icing?

The PCC is also a great adjunct to the dentist. He or she is able to step in and take over with sensitivity at a certain point in the dental process, allowing the dentist to go on practicing dentistry.

Which scenario sounds better? A dentist is stretched for time. He or she has to check up on hygiene, inject the patient in room one, and finish the composite in room two. Now the dentist has to explain a complicated, lengthy treatment plan as quickly as possible. Enter the PCC whose time is dedicated to helping the patient understand the treatment that is recommended and why it is needed. The PCC can do what the dentist might wish he or she had the time to do.

Progressive dentists are identifying people they know and trust to handle this important aspect of patient care.

PCC and Patient Interaction
What a PCC does exactly will probably vary according to the practice. The following is an example of how things work in our office. When the new patient arrives in the office he or she is immediately greeted by name by the receptionist, who then brings the patient's file to me. After reviewing the file, I greet the patient in the reception area and invite him or her into my office for a preclinical visit. In my opinion, this is one of the most important steps. It gives me a chance to get to know the patient and the patient to get to know and trust me and the practice team.

I begin by asking open-ended questions about the patient. I also tell him or her about myself, the dentist, the staff, and the practice. I ask about any good and bad experiences the patient has had in dentistry and what we can do to help. We spend anywhere from 15 to 20 minutes on this part of the visit.

A few times it became apparent during this step that our practice was not the right choice for a particular patient. Using the right questions and giving the pertinent information about the way we care for our patients, I can help the patient come to the understanding that he or she might want to continue searching to find a practice that fits his or her particular needs. For example, our practice is prevention oriented with an emphasis on restorative dentistry. If during the preclinical phase of the initial visit it becomes clear that the patient is really only interested in being seen on an emergency basis and has no interest in being active in our recall system, then we are probably not the right practice. When I see this, I will explain to the patient that we do expect our patients to come in for regular prophies and exams. We will usually agree that it would be better for the patient to find dental care that better suits his or her individual desires. This saves the patient, the dentist, and the staff a lot of frustration.

It is important to understand that you are not just giving the patient the impression that you care about him or her, you must truly care or the impression won't last long.

Once we have completed the preclinical interview, I accompany the patient to the operatory. I then proceed to chart existing conditions. This provides a great opportunity to educate the patient about his or her present oral health. By explaining what I am seeing and how it can affect him or her and explaining the treatment options available, the patient is better able to understand the dentist's diagnosis and treatment recommendations.

Once I have finished charting existing conditions and have made notes about what I see, I will talk to the dentist for a few minutes and relate the patient's goals for his or her oral health, fears and anxieties if any, and past dental experiences, good and bad. I also will be sure to let the dentist know what conditions I have mentioned to the patient while charting. The dentist then goes in, spends some time getting to know the patient, and proceeds with the exam.

This is where the importance of a well-trained PCC is evident. While carrying out the exam, the dentist will be bringing up areas of concern that have already been introduced by the PCC. This reinforces the patient's confidence in the practice and the diagnosis. The patient has already had time to absorb some of the information and has started the process of accepting that treatment is needed. Now the patient is more receptive to the dentist's recommendations because time has been spent carefully and thoroughly explaining the conditions and options.

Next, I will take the necessary radiographs, study models, and diagnostic photos as prescribed by the dentist. If the treatment plan is limited, I can go over fees with the patient at that time. If the treatment plan is lengthier, the patient will be recalled for a consultation.

After I complete the comprehensive exam, the dentist and I review the findings together and organize a treatment plan. I will then prepare a review of the findings and print out x-rays and information sheets pertinent to the treatment being proposed. I also will be ready to suggest a few payment options. By the time the patient returns for the consultation, I am prepared to discuss and explain the needed treatment. I have time to answer questions patiently and continue to educate the patient about his or her oral health.

There are many creative options that I can suggest to help the patient find a way to afford the necessary treatment. Once the patient decides to begin treatment, I help schedule a series of appointments, help track everything, and remain available at any time.

Making a Difference
There is great satisfaction in being a PCC. You have a major impact on the patients you serve, the dentist, and the practice. You are not only a caregiver, you become an educator. Most patients tell me that they have never had such a thorough exam. I get to know the patients and understand them. Then I can share what I learn with the rest of the team. I am using all the skill and knowledge I have developed over years of assisting in a new and interesting way that benefits our practice and patients. I still assist clinically, too, so I truly believe I have the best of both worlds. There is definitely a place for a PCC in any practice that wants to provide excellent service and satisfaction to their patients. It requires an educated, experienced, caring, and dedicated person who is confident in his or her abilities and wants to take a new professional direction. You can have a new opportunity to make a difference.

The One Thing

   

What is the one thing you can stop doing that will make your life better, just because you have ceased and desisted?  I bet it flew right into your head when you read that sentence because we are all so aware of the things we do that make us miserable.  So few of us, including myself, actually own it. 
    Ok, I'll own my miserable thing.  I ruminate.  I rarely just get over anything.  I think I do, I say I will, but I really don't.  I take it home and examine it from every angle.  I fertilize it until it achieves magnificent growth.  I cultivate it, encourage it, reshape, rename and reinforce it.  I chew it up, spit it out, poke it around and put it in my pocket just in case I need it later.  Wouldn't want to be caught without a lingering hurt or unfair, inconsiderate, flippant insult would I? 
    Even as my heart says, "Leave it alone, get over it", my head says, "No way, I can spend days, no, even weeks on this."  Even when my head says, "You know this will hurt you more than it will hurt them", my ego pushes back with "Don't be such a sap, you know you have to run with this."  And on and on it can go. 
    Heart, head, ego, it doesn't matter which, I know it doesn't help to ruminate.  It only keeps life in the past and pain ever present.  It's no fun, so it's the one thing I'm determined to stop doing.  It's not smart and it's not a wise use of my time.
    It's important to be aware of these things.  Years go by and life is wasted while we keep doing the one thing that gets in the way.  Only you know what it is and what it gets in the way of.  For me, ruminating blocks out positive considerations.  How can I appreciate how good I have it if I'm dissecting every slight, hurt or insult that comes my way?  What use is there is trying to assign intent to what others do?  There is no way for me to know what they might not even understand themselves.
    What will I replace the one thing with?  Hopefully wisdom.  Hopefully acceptance.  Patience.  Tolerance.  The benefit of the doubt.  The understanding that I just don't know and never will understand what everything means.  The ability to live in peace with that.  That's not such a bad trade off.

He Likes Everyone

    Isn't it amazing how one person's attitude can influence everyone around him?  Since either a good or bad attitude has the same ability to influence, we should all try to make sure we bring a good one with us wherever we go.  Yesterday was our first day back to work since we began our Christmas vacation on the 23rd.  As expected, it was a little (very) hectic.  The "I've been waiting to call you when you got back, I can't wait another day" phone calls started at 8 and continued through the day.
    I saw one name pop up on the schedule and thought, "Oh no, not today."  Some people just seem to be more difficult than others.  This patient was scheduled at a very busy time and I was not in the room when Dr. Morgan went in to check on her.  I was relieved when I heard the words, "You're healing fine, it will just take a little longer."  I figured he'd be letting her go any minute.  A few minutes later I heard her apologize for being such a problem.  Then I heard him say, in the most sincere tone, "You're never a problem, I never think of you that way."  And he meant it, he actually sounded confused by her statement.  As I walked by the room I saw him standing with her looking at pictures she was showing him and you could see how happy it made her that he was taking the time to do that.  Now, he was taking the time when we were about 20 minutes behind schedule.  He was not thinking about being behind, he was thinking about the person he was with at that moment.  As he left, he told her he was sorry she had received bad news.  It so happened that her sister had died on Christmas Eve.  The pictures she was showing him were of she and her sister throughout the years.  When she pulled those pictures out to show me, I looked at them and her with kinder eyes than I would have if I'd not seen the care that my boss had shown minutes earlier. 
    Seeing how he treated her made me feel differently toward her.  He modeled compassion, but he also demonstrated something else.  It really is possible to look past a person's veneer.  Some people wear their most annoying behaviors as an overcoat.  It's what's underneath all of it that we have to try to get to.  I saw him look through the things that usually caused me to think of  her as difficult, almost as if he refused to be distracted by something so petty, and get to the real person that lies within all of us.  He knows it's there and he's willing to invest in each person to get to it.  That's why he likes everyone and I suspect it's one of the main reasons that he's so happy all the time.  Not a bad thing for all of us to aim for.  You never know who might be watching and learning something.

Show Me

    Patients are becoming discerning "consumers" when it comes to dentistry.  Especially when it comes to anything that involves aesthetics or cosmetics.  People want whiter, straighter, more perfect looking teeth more than ever.  Or they want very natural looking teeth.  They want to know what they are going to look like when it's done.  Most important, they want to see what you can, and have done.
    What can you show them?  This is not usually an area that most dentists have a lot of experience with, but it can drive case acceptance.  People have to be able to see something in order to want it, and patients will only agree to treatment they want.  The first step in helping patients want treatment is to explain the benefits they will receive in terms of health, better quality of life and appearance.  Beauty being in the eye of the beholder, the next step is in showing them what you can and have done.  One helpful tool is a lab wax up of their study models.  Using an actual study model in comparison to a wax up will enable the patient to not only see what's wrong, but also to envision the improvement that restorative dentistry can provide.  Many photo software programs allow you to enhance and manipulate the patient's photo to give them a better idea of how they will look after restoration.
     Perhaps the most influential aide though, is a gallery of the results of the dentistry that you have provided for others.  They want to see proof of what you can do.  Time and time again, I've seen patients say, "I want to improve my smile, but have you ever done this before?"  Why just say yes, when you can show them instead.  Take the time to document the dentistry that you're proud of.  It can be as important as the degree that hangs on your wall to your patients.  Get some quality training for yourself, or for any staff members that will be taking photos.  Consider using a professional to develop some marketing media from your photos.  Check out this website for some ideas.  Even if you're just starting out, invest the time in documenting your dentistry, even if you just buy an inexpensive photo album to start with.  Don't be caught empty handed when patients say "Show me."  It may be the last step along the path to treatment acceptance.

So, What Will You Be In 2009?

    Resolutions, Schmesolutions!  Nobody keeps them for long and then you just feel guilty for a few minutes.  You probably even realized that's how it would be when you made them.  I  prefer to look at a new year as a fresh start.  I think about my favorite memories of the previous year and try to figure out what made them happen.  That's what I'll try to do more of.  Those are the things that make me feel good when I think about them. 
    Then there are the things that make me cringe.  As I write this my husband is watching ESPN and the announcer is talking about pro golfer John Daily, and the bad reputation he has developed.  The commentator puts it down to bad life habits.  Things he keeps doing over and over that just damage his reputation and will basically ruin his career.  He may even be kicked out of pro golfing because he adds nothing to the sport but embarrassment.  Will anything make him change? The reporter thinks not.  He has potential, but he makes himself an underachiever with his disinterest in changing his bad behavior.  I think that something inside of him just won't let him take an honest look at himself, because he knows if he does, he'll have to change and that's hard work.

    So, what is inside you that you're afraid to look at?  What have you avoided admitting you notice about your staff?  Are you going to go another year wishing things were different, or are you going to begin the hard work of change?  First you have to be real with yourself about yourself and that's not easy.  I'll start.  The worst thing about me is the fact that when I'm unhappy or annoyed, it shows.  I used to put this down to being real.  As in, "I'm not able to be a phony, so when I'm mad, it shows.  I have no control over it."  Well, I'll tell you, that's just a bunch of garbage.  First of all, for some reason, I seem to be the person who sets the tone for the mood in the office.  That means the onus is on me to set a good tone so we have a good mood.  I've been reading The Power Of Now by Echhart Tolle.  I now realize that if I just concentrate on what I'm doing at the moment and how I want that moment and the moments to come to be, I can choose how I will be.  It's actually living out E + R = O.  Recently, we were having a very busy, hectic day.  Someone had added someone to the schedule when I wanted a certain procedure to be uninterrupted for various, well thought out reasons.  I was not happy about it and expected things to get tense.  Which they did.  Funny how life has a way of living up or down to our expectations.  I began to realize that I was beginning to fume.  Worse yet, I found myself planning out a bad reaction.  Huh, what was I thinking?  I asked myself just that.  I reminded myself of E + R = O.  I told myself to concentrate on what I was doing in the moment.  And then, I pushed all that good thinking aside and acted like a jerk.  I said some things that stung to people who I really like.  Then I had to go back and try to make it better.  The negative effects of my moment of indulgence lasted for days.  In the end, everyone was long past it and I couldn't let myself off the hook.  Maybe that's a good thing, because I've looked at it, dissected it, I know I will never ignore the good mindspeak again.  It would have protected me and everyone else from that part of me that is stupid.

    So, be honest, what part of you is stupid like that?  If it's little and hurts no one but you, you can just accept about yourself.  Same with your staff.  Everyone has something we don't love about them, but if it's inconsequential, be tolerant.  If it's something that really detracts, talk about it.  I've seen staff members make life miserable for everyone, just because everyone else was too nice to say anything.  To her.  There's was plenty of complaining going on, just not to the one person who could do anything about it.

    What will make 2009 better than 2008?  How will you and your team  make it happen?  Don't base everything on the economy, base it on the way you want to spend every day.  I don't want to sound all preachy, or Oprah-ish, or like I've just read a book and now I think everyone should think a certain way-ish,  you get what I mean, right?   I do think there is an advantage in living in the present.  Dragging stuff from the past just obliterates what's happening now because you can't see anything but the past.  You can't think about more than one thing at a time.  Planning for the future is fine, but living there won't get you where you want to go.  You have to do what's important right now.  Thinking about where you want to go gives you the direction for what you need to do in the moment.  It will get you there.  But, what about right now?