Tips: McKenzie Case Study

Nancy Caudill
Senior Consultant
McKenzie Management
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Say What You Mean and Mean What You Say!

Dr. Steve Smith – Case Study #61

Dr. Smith’s primary concern is high overhead caused by relocating his office and they are not producing enough dentistry.

Dr. Smith’s practice facts:

20 year old practice – 2 years in new location
His patients are scheduled less than 1 week in advance
25 new patients per month
2 hygienists working 8 days a week
Signed up for Delta PPO a few months ago in hopes of getting more new patients

Yes, it was unfortunate that Dr. Smith was forced to relocate after the expiration of his long-term lease. The building was being sold. His lease payment at the previous location was much less than the new lease agreement that he has agreed upon in his new location. It is also written to inflate each year for a few years. I suppose the assumption is that his practice will continue to grow each year.

“Nancy, I feel like I am trapped. I am not making enough money to pay the bills. I would sell this practice in a moment and work for the person that buys it, but I also like being my own boss.”

My Observations:

The Schedule – It was obvious that Dr. Smith was not getting enough restorative production on the schedule, as he was only scheduled out a few days.
Team Meetings – They held morning huddles and monthly meetings. The feedback I received from the team was that he was non-participatory and seemed as though he didn’t really care about making changes.
Lack of daily production goals – Every day was like riding a roller coaster. Some days they produced $1,200 and worked like honey bees. Other days they produced $5,000 with only a few patients.
New Patients – The practice averaged 25 new patients per month. Keep in mind that “new patients” are those patients that are seen for a comprehensive exam and are also seen in hygiene and go into the recall system. This is more than sufficient for a 1-doctor practice, under “most” conditions.
Business Systems - Because the Practice Coordinator had worked in another McKenzie office, many of the McKenzie systems were in place. The A/R was healthy, as was the outstanding insurance claims, collections over the counter, etc.
Business Staff – 2 experienced team members at the front desk. One employee had been with the doctor for over 9 years and was familiar with the patients. She also was very confident in presenting treatment to the patients. She has recently changed her position in the office from Dr. Smith’s primary assistant to managing the business area.
Recall System – This area needed some work because there were no specific job descriptions at the front desk. As usual, this system was not in place as it should have been.

Overall, the practice ran very smoothly. The doctor was seldom behind schedule, the team was experienced and knowledgeable and the office was beautiful. The patients could watch TV or their favorite movie. However, all these “high-tech” luxuries were keeping the team from talking with the patients about dentistry,

After spending two days observing the team’s performance, as well as listening to the doctor’s dialogue with the patients, it was evident to me what the problem was. Dr. Smith lacked confidence!

McKenzie Recommendations:

Recall System – Assign a “Hygiene Coordinator” to manage the recall system. Currently, neither business team member is held responsible for this position. Job Descriptions are imperative in a dental office.
Morning Meetings – These short daily meetings must be organized and cover specific issues of the day, such as outstanding treatment. In Dr. Smith’s office, many patients had incomplete restorative treatment. However, when the hygienist would mention these to the patient, Dr. Smith would “overrule” her. This should all be clarified at the morning meeting to avoid the hygienist from losing her credibility.
Doctor’s Presentation to the Patients – this is the area that is “killing” the practice. As I listened to Dr. Smith present his diagnosis with the patient, these are the words that I heard:

                        “I think”
                        “Little stick”
                        “Adequate”
                        “ML Resin”

A patient does not want to here “adequate”. They want to hear “best option”. Dr. Smith should not “think” – he should “know”. The tooth either has decay or it doesn’t. Patients have no idea what an “ML Resin” is….they do understand a “2-surface tooth-colored filling needed because of the cavity”.

I also observed Dr. Smith changing his diagnosis once the patient had been anesthetized. The patient was prepared for a crown and he elects to restore the tooth with an MODBL composite. I have to question the doctor’s “wishy-washy” approach to dentistry. My concern is the patient’s loss of confidence when these changes are made.

Conclusions:
Dr. Smith shared his concern for the time needed to properly diagnose the necessary treatment. I recommended a change in the way new patients are scheduled to allow “dedicated” time with the patient for proper diagnosis. For those patients that have more extensive treatment needed, reschedule the patient to present the diagnosis so changes are not required in the near future.

Review the outstanding treatment during the morning huddle, using the computer so the photos and x-rays can be reviewed. Do not conduct the morning meeting in the sterilization area where there is no computer. Confirm the treatment as being accurate so the hygienists can present it to the patients and Dr. Smith can re-confirm and support her. Allow Sandy, the 9-year veteran, to “sell” the treatment to the patients. Dr. Smith and the hygienists do not like to “sell” and Sandy is excellent at presenting treatment and getting it scheduled.

I asked Dr. Smith not to be the “nice guy” and downgrade his treatment recommendations. When he recommends a crown instead of an MODBL and this is what is “sold” to the patient because it is the best option for them, stay with it.

Please understand that I am not saying that treatment recommendations don’t change…sure they do. What is important is that your team understands your reasons for change, as well as the patient. EVERYONE must be on the same page in order for the office to work in unison. Say what you really mean and don’t downplay it. Do what you say unless there are clinical reasons to change your diagnosis.

At my revisit with Dr. Smith 6 months later, he has learned to remove his indecisive words from his clinical presentation and has become more consistent with “staying the course” of treatment. As a result, his production has increased over $10,000 a month. Sandy has been instrumental in presenting and selling treatment in the consultation room instead of simply passing the patient to the Schedule Coordinator at the front desk.

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email info@mckenziemgmt.com

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