Exceptional Dental Practice Management

The Pinkie Finger of Dentistry

I doubt there's a dental practice in the country that hasn't been affected in some way by the economy in the past year. That has everybody thinking about how to get through this difficult time and keep their practice healthy until things get better.  Some will try to increase marketing, some will change their hours, and others are looking at lowering overhead. 

From what I hear, a few dentists are considering, or have already begun, downsizing their staff.  In my opinion, this should be a last ditch option rather than a knee jerk reaction.  I think that dentists see reducing staff as the easiest way to reduce overhead.  If that was the only impact that action had, I'd agree, but it's not.  When you reduce staff, you may be reducing opportunity for the practice to grow and thrive. 

Let's look at the hygiene department.  I think hygiene is often the pinkie finger of dentistry.  If you asked someone which finger is the least useful on their hand, they'd probably say it's the pinkie.  It's small and you've got three other fingers to oppose the thumb, so what good is it?  Ask any dental assistant and she'll tell you she'd be lost without that pinkie.  Now that I've pointed it out, I'll bet there are some dentists nodding in agreement.  Hire a pinkie-less assistant?  Not if they want to practice 4-handed dentistry.  So, it's all in how you look at it.  Some dentists and consultants consider the hygiene department to be a loss leader.  Show them a hygiene department with holes in the schedule and a highly paid hygienist with time on her hands, and they are probably going to zero in on her as a way to cut overhead.

What's wrong with that?

Well, again, it's all in how you look at it.  Maybe this is the perfect time to re-vamp your hygiene department.  If you're a hygienist in a struggling practice, this is the perfect opportunity to step up and help give the practice a boost.  Cutting hygiene time takes away opportunities for the dentist to exam patients and for the hygienist to educate them.  So, let's start with patient education.  Sometimes hygienists get so focused on the prophy or on building a personal relationship with their patient, that they don't spend enough time educating their patient.  I suggest incorporating co-discovery into your prophy.  This means that as you are scaling, you are noticing conditions of the teeth and mentioning them to the patient.  This opens the door for education when the patient then asks what significance an incomplete fracture has and what can be done to prevent further problems.  When the hygienist adds education to her treatment time with the patient it enhances treatment acceptance and deepens her connection with the team.  Communicating her observations and discussions to the dentist creates a greater sense of partnership.  Finally, you add importance to the next exam by letting the patient know about any areas of concern that you will check when she comes back, or, by congratulating them on their great oral health and letting them know that they have achieved that by their excellent home care and dedication to keeping regular recall appointments.

I'm adding some PDF files for you to look at and use if you wish.  The protocols list the elements that I like to see in a hygiene exam, the observations detail the reasons for each part of the exam.  The hygiene report is a paper that the hygienist will fill out as she goes through her exam, she will then place it in a designated area for the dentist to pick up and review before he comes into the room.  At the end of the exam she will review it with the patient and give it to the patient to take home.

Download Microsoft Word - HYGIENE APPOINTMENT PROTOCOL

Download Microsoft Word - EXAM OBSERVATIONS

Download Microsoft Word - HYGIENE REPORT

People Are Strange?

    Is it just me or are people stranger than they used to be?  I have never had more bizarre experiences hiring people than I have in the last few years.  I hear that since the economy is so bad, we should have a great pool of people to choose from when hiring.  Where are they? 

    From what I've seen, most people are expecting us to impress them, rather than trying to knock our socks off.  Hiring is a nightmare anymore.  Everyone knows what an employer is looking for, and they can wow you at the interview.  Ok, so knowing that, we are going to call references, have multiple interviews, ask open-ended questions, and do everything we can think of to weed out any insincere candidates.  They can still get through, though.

    I recently interviewed someone in her 40's who never took her coat off, kept her sunglasses on top of her head through the interview, and texted on her cell phone every second we left her alone.  She made it easy to decide not to hire her, but somehow, she thinks we made a big mistake.  She has emailed me every week to ask when I'm going to hire her.  Glad to miss that bullet.

    The way people answer their phone speaks volumes. Some barely grunt, others sound like they hate whoever has the nerve to bother them.  Then there's the waiting music that makes you so happy that you called and dodged yet another bullet. 

    People don't appreciate opportunity anymore, they don't even recognize it when they are getting one.  I've seen young women with no training come in, throw out attitude, text, disappear into the breakroom, leave messes behind and show up late and leave early.  If you dare to voice displeasure, you're the unreasonable one in their eyes. 

    When someone who really stands out comes along, I feel irrationally lucky.  I just found a person who really wants to be part of a great team, who realizes she's getting a wonderful opportunity, and who is not strange, thank goodness.  I've had all the strange I can stand for a while and our team needs stability.  Whenever we lose a staff member I feel a sense of dread because I know how difficult it will be to find someone of the caliber we want. It's pretty easy, be real.  Don't play games, don't manipulate, you will be found out and it won't last.  The best thing anyone can do when starting a new job is work hard, have a good attitude, and appreciate the opportunities you get.  That's so rare these days that you will be worth gold.  Not so strange, is it?

What Do You Have To Offer?

Selling dentistry?  Selling yourself?  The professional hates the sound of that, but the business person inside the professional knows that it's necessary.  And guess what?  It doesn't have to be so bad.  You don't have to put out a lot of cheesy ads, buy TV time, or offer coupons to let people know what you have to offer.  You have to begin by knowing what people want, what will make them brag about you, and then developing a vision and sharing it with your staff. 

We often figure that the sign says it all; a dentist offers dentistry, what else do we have to say?  We can even add a tooth to the sign or business card just in case there's any confusion.  When you want to buy a puppy, you go and check out the litter and they're all adorable.  They all look pretty much the same with some variation in color, but the one you choose is the one that sells himself to you in some way.  You're not going to choose the one that stays over in the corner and doesn't pay much attention to you, as if he thinks, "I'm a puppy, I'm cute, what more do you want?  If you want me, I'm here."  No, the one you choose is going to work for it.  He's going to wiggle all over, shower you with kisses and to seal the deal, he'll roll over and stare lovingly into your eyes.  How can you resist, he wants you as much as you want him.

Now, I'm not comparing dentists to puppies, but the theory's the same, patients want to be courted.  They want to feel like they matter, that they're worth pleasing.  So, first you have to decide what you are offering.  Are you going to provide fillings and extractions (that gets people excited), or are you offering a partnership in a lifetime of oral health that will allow patients to live their lives comfortably and more healthily overall?  Basically, you're offering a lifestyle. 

When your patients think dentist, what comes  to their mind first?  Is it the aroma of Eugenol hitting them in the face as soon as they enter?  Is it a disinterested receptionist blankly telling them to take a seat?  Do they then wait in limbo until an equally bland staff member shoves open the door and mumbles their name, then marches them back to an operatory?  Do they then spend time in second limbo until the dentist finally rushes into the room, hurriedly greets them and proceeds to inject and run, leaving them wishing it was all over?  Are they basically a thing in the chair during the procedure only to be treated to the same dull receptionist waiting for them to pay at the end?  It happens, and lots of people think that's just the way it is when you go to the dentist.  Why do patients tolerate it in their dental practice and why do practices accept it for themselves?  Because we don't think about what should be offered or expected.  We just go with what we've gotten used to.  Time to think again.

Here's a better scenario:  your patient walks in and is greeted warmly by your receptionist who remembers that the patient has been on vacation to see her grandchildren in Florida since her last visit.  She asks about the visit and comments on how wonderful the patient looks.  Surely, it's a result of the warmer weather and the joy in seeing the kids.  She offers her a beverage and then let's her know that the hygienist will be with her in five minutes.  In the meanwhile the patient has a variety of current, popular magazines to choose from.  If she uses the restroom it will be clean and well stocked with disposable, pre-pasted toothbrushes, good smelling soap and hand lotion and some mouthrinse.  The receptionist will have made sure that everything is in order on a routine check.  The plants in the reception area will be healthy and the patient will feel like a welcome guest.  When the hygienist is ready she will go to the patient and greet her and escort her to the room, walking next to her rather than away from her and expecting her to follow.  Once in the room, a neck pillow will be waiting because the hygienist noted that preference on the patient's chart.  They will then have a conversation about the patient's health since the last visit and the hygienist will proceed with an interactive exam and prophy.  By explaining what she is seeing and what it means for the patient, the hygienist is educating the patient and giving her the ability to make good, informed decisions about her oral health.  When the dentist enters for his exam, he's been briefed by the hygienist and he and the patient can have a good discussion about the patient's treatment choices.  This patient never feels like a thing, but like a valued, unique individual. 

When it's time to leave, the receptionist inquires about her treatment experience, professionally collects payment and makes a future appointment.  The patient leaves to meet a friend for lunch and tells her about the wonderful treatment she received at the dental office.  Coincidentally, her friend just came from a dental appointment, too.  As a matter of fact, she's the patient we discussed in the first scenario.  She listens in amazement and mentally compares her experience with the one her friend is raving about.  She asks her friend who her dentist is because that sounds like an experience she'd enjoy a lot better than what she's gotten used to.  Her friend pulls the dentist's business card out of the nice little zippered take home kit she received and another word of mouth referral is gained.  When people like what you have to offer, they tell other people about it.  But, then again, when they don't like what you have to offer, they tell other people about it.  So, have you thought about what  you have to offer?

The ADAA Creed - Enthusiasm

"To be enthusiastic– for therein lies the easiest way to accomplishment."

                                                ~Juliette Southard~

Your success in life can only be as great as your enthusiasm.  You can spot someone who is enthusiastic about what they're doing by the light and life in their eyes.  Their whole face and demeanor gives it away.  There's no hiding enthusiasm, and there's no substitute for it either.  I'm not talking about false or forced enthusiasm.  You can spot a fake a mile away.  False enthusiasm is irritating, and just as bad as a lack of enthusiasm.  Actually, false enthusiasm actually is a lack of enthusiasm wrapped in plastic.  Someone tried to cover it up, but the lack is transparent.

Think about the employees or co-workers you've worked with in the past.  When I think of enthusiastic people, a few spring instantly to mind and make me smile.  Just being around them made you feel more energized because enthusiasm is contagious, if you have the frame of mind for it.  It's a "I pull you, you push me" kind of thing.  Enthusiasm is interactive, welcoming and compelling.  Now, when I think of people who I've worked with who've lacked enthusiasm I feel a heaviness as I picture them.  They are the people the word drag was invented to describe.  They make everything a struggle and spend more time throwing boulders into the path of progress, than they do actually trying to achieve goals.  They are the "It's good enough"  "That's as good as I get" people  They don't see potential as an ever-expanding journey, rather they see it as a stopping point. 

Enthusiastic employees raise the bar for everyone.  Unengaged employees hang on the bar to try to pull it down into their comfort zone.  Enthusiastic employees grow your practice.  Unengaged employees slow your practice.  Worse yet, unengaged employees want to discourage enthusiastic team members.  They know that they make them look bad and think it's easier to stop all that enthusiasm than it is to develop some within themself. 

What does an enthusiastic dental assistant look like?  She is well-groomed, her clothes are neat and clean, she has an open, smiling face and a pleasant attitude.  She looks like she loves her job and enjoys the people she works with.  What does she sound like?  She sounds upbeat, interested and involved.  She knows what she's talking about and when she doesn't, she asks someone who does.  She educates her patients, she is respectful to others and she has dignity.  She cares.  How does she act?  She is always looking for ways to help  others and to do things better.  She acts like she's happy to work in the practice and to take care of her patients. 

When you hire, look for the fire of enthusiasm.  Believe me, I know how easy it is to be fooled in an interview, so be sure to be very clear about how you will expect the employee to conduct herself on the job.  If you don't get what you want, be ready to address it and offer advise.  If it doesn't change, be ready to make a change.   Your employees help you accomplish your goals, enthusiasm drives accomplishment.  Got enthusiasm?