– a Potential ‘Fire’ Hazard
It is the rare individual that
doesn’t struggle with this professional challenge. Perhaps
the situation involves Julie who is a relatively new hire. She was
so enthusiastic in the interview. Everyone thought
she would fit in perfectly, but this dream employee has decided
she’s the Diva of the Dental Practice. If the task at hand
doesn’t fit neatly into what she perceives to be her job,
it’s not getting done. Or maybe in your office it’s
Wanda who has practically built the Great Wall of China between
herself and any system change. She’s a long-term employee
who came with the practice. She has a lot of patient history, so
long hoped she would just retire. But you know you can’t sit
on this any longer. Regardless of the scenario, the decision to
terminate an employee can be one of the most challenging –
if not the most difficult – a dentist will ever face.
Understandably, at 3 a.m. when you’re agonizing over the decision
at hand instead of getting a good night’s sleep, the path
of least resistance looks like the yellow brick road. But
small offices depend on the quality work of a dependable team, and
deadwood can’t just float along in your operation.
Ideally you will avoid ever having to fire an employee by following
a few simple, yet positively critical steps to avoiding major personnel
Every single one of your employees must have a clear job
description in writing that defines the job they are responsible
for, the skills they must have, the specific duties and responsibilities
that rest on their shoulders.
#2 Train them! Too often new hires are thrown into
a busy practice situation, shown the computer, given the instrument
tray, or whatever, and offered an encouraging, “Go get ‘em.”
Ha! How exactly are they supposed to do that? Save your sleep, preserve
your practice, marshal your team – train the staff.
#3 Provide all employees access to a policy manual that clearly
spells out the code of conduct, dress code, policies regarding sick
leave, tardiness, overtime and overall office procedures. Every
employee, new or existing, should have easy access to the office
policy manual. This does not need to be a long and cumbersome
tome, but it does need to spell out the rules of the game.
Provide regular, consistent, ongoing feedback. We’ve talked
about this recently in the e-Motivator. Constructive feedback
should be given daily to help employees continuously fine tune and
improve performance. If you avoid telling staff what you don’t
like, you are reinforcing poor performance. What’s worse,
you undermine their ability to succeed.
#5 Formally review performance regularly. Performance
reviews are one of the most effective tools in creating a total
climate of success in your practice. They provide an objective and
neutral means of leveling the playing field for the entire staff.
Employees rated against objective measures place
more trust and confidence in the review process. They also see the
direct relationship between their performance, the success of the
practice, and ultimately their potential for individual achievement.
Provide job expectations in writing, and rate the employees on those
Too often doctors and team members complain to one another about
a fellow staff member, but are afraid to raise concerns with the
employee. The consequence of this behavior is that the doctor eventually
traps him or herself into having to fire the employee. Take every
reasonable step to prepare the employee for success.
If you’ve done all you can within professional reason and
the problems persist …
Next week, dealing with the inevitable – firing an
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
the Patient’s Perspective
are a master clinician yet patients routinely refuse or are slow
to accept recommended treatment. Indeed, at times
it seems that convincing a patient they need the treatment is more
grueling and challenging than dental school ever was. In other cases,
a patient appears to be fully ready to forge ahead only to
their mind” before the first scheduled appointment.
doctors receive very little, if any, training in case presentation,
the process can cause considerable unease. In some cases, the dentist
is as nervous as the patient. They know that presenting a case can
make or break the relationship. Yet they often forget that like
expert dentistry, it requires ongoing training, education, and practice.
your presentations/consultations by evaluating four key
of the dentist
Language of the presentation
Patient’s ego which will accept or deny the case
a good look at the ceiling in your operatory and you’ll better
understand how patients view your case presentation. Too many dentists
present their cases in the operatory. From the patient’s standpoint,
this is the worst place to try to discuss a recommended treatment
plan. The patient is naturally guarded here because
they are at the mercy of the dentist. In this space the doctor is
in a position of power that the patient is hesitant to question.
Consequently, patient buy-in is considerably more difficult to achieve
in the operatory. Changing the setting alone to an office or consultation
room will improve case acceptance immediately because you’ve
leveled the playing field for the patient.
ideal setting is a consultation room that is warm
and comfortable. The patient and doctor sit at a table and review
the presentation together. The patient has a pen and paper to take
notes and jot questions, and they are fully engaged in the process.
They are not having something done to them, they are actively participating.
a consultation room is not available the dentist’s private
office is commonly used. Take care to keep the office orderly.
When a patient walks into a cluttered, messy office it sends the
message that doctor is disorganized and has a poor attention to
detail. There should be a clear place where you can show the patient
what is needed whether you use X-rays or models in your presentation.
to the patient. Many doctors hear their patients but they do not
listen. The doctor is usually so focused on getting out all the
facts that he/she doesn’t listen to the patient’s
questions or concerns. Welcome, encourage, and prepare
for questions. Questions are your best indicator that the patient
is both engaged and considering your recommendations.
a patient asks a question and you do not have the answer, write
the question down and tell the patient that you will find
the answer and get back to him/her. Understandably, this
is challenging for dentists who, as doctors, often feel they should
have all the answers. However, patients respect the dentist who
is honest about not having all the answers all the time. Say to
the patient, “That question has never come up. I will
find out for you and get back to you.” This reinforces
the patient’s role in the process, and you
have made them feel pretty smart because they have asked a question
the doctor will research.
Remember to call the patient with the answer. This is the reason
you wrote down the question.
careful not to speak above or below the patient’s level of
understanding. Present the case in terms the patient can understand.
Avoid clinical references or prematurely using
materials that may graphically demonstrate the procedure before
the patient is emotionally committed, causing them to reconsider
the treatment. Clearly list the benefits and tie in emotional
motivators at every opportunity. Encourage the patient
to ask questions. Use testimonials from other patients who have
had similar treatment and urge the patient to talk to the other
successful patients. Nothing has more impact than the endorsement
of another successful patient. Train and involve the entire team
in reinforcing the treatment plan with the patient.
objective is to excite and make the patient feel good about the
possibilities, so he/she wants the work and feels that he/she deserves
the work that you can provide.
DOES YOUR OVERHEAD
Your Hygiene Department
Dr. Allan Monack
Hygiene Clinical Director
past articles, I have discussed how your hygiene department can
be profitable. The following tools will help you to monitor your
success while you are implementing new ideas and helps to keep you
informed if everything is on track. It is essential that you continually
perform these tracking monitors to insure you are
on target for your hygiene goals. If you determine that the numbers
are not within the parameters you established, you can correct these
areas early enough to avoid loss of
These are only areas in the hygiene department monitors. Mckenzie
Enrichment Program™ evaluates over 20 systems of the practice
and teaches you how to monitor all aspects of your practice. I recommend
that if your numbers are deficient in your practice you consider
a complete practice analysis by Mckenzie Management.
There always is confusion on who an active patient is in the practice.
It is important in order to calculate how much hygiene time you
need in the practice. It also helps you monitor the growth of your
practice. Mckenzie Management defines active patients
are those patients that have not missed more than two recall or
maintenance intervals. If the patient is on six month recall and
they have not returned for their professional cleaning within eighteen
months, they are considered inactive and should be purged from the
active patient list after review of the “effort” that
has been applied to retain them in that period of time. Hopefully,
all the protocols to get the patient to present for hygiene maintenance
have been exhausted by then. You should be able to retrieve this
information from a computer report or you need to physically count
all the charts and purge the ones that do not fit into the definition.
Calculate this monthly.
This is probably the most time consuming statistic to determine
accurately. It is very important to have the correct amount of time
available for your active patients and new patients so you do not
get too backlogged or have too much open time with
no patient list available to help fill the hygiene appointment book.
Generate a recall report of patients due with and without appointments
from today to one year from today. Determine how many are on 2,
3, 4, 6, 9, 12 etc. month appointments. This number should approximate
your active patient number. Multiply the interval
by appointments needed per year. (ie: # of 3 month intervals X 4,
# of 6 month intervals X 2, # of 9 month intervals X 1.33, etc.
) This will give you the total yearly hygiene appointments needed
for your active patients (A). Determine the total number of comprehensive
exams performed in the last 12 months (B). Determine the number
of quadrant scaling and root plane performed in the past 12 months
and divide by 2 (C). Add A+B+C=D. (D) is the number of appointments
needed. Divide the total # of appointments needed (D) by the total
# of weeks the hygiene department will work. This equals (E). Divide
(E) by the average # of hygiene appointments daily per hygienist.
This is the number of hygiene days per week the office needs to
meet the needs of your practice. Calculate this quarterly.
Divide the amount of non prophy related services performed by your
hygienists by the hygiene department total production. Examinations
should not be included as that is the Doctor’s production.
This should be at least 30% of the total hygiene production. Calculate
Divide the total hygiene production by the total office production.
This should be 33% of the total office production. Calculate monthly.
Ideally, you want to have no more than 0.5 appointments open per
hygiene day unfilled. Less than 1.0 is good More than 1.0 is unacceptable.
Total all the unfilled appointments per week and divide by the #
of hygiene days that week. If the number is consistently greater
than 1.0 you need to find out why and correct the problem. Calculate
conclusion the office needs to stay on top of the hygiene production.
It is the key to a successful growing practice. When the statistics
are not correct, discover why and implement the necessary procedures
so the office can continue to be productive and efficient.
you have any questions concerning your hygiene program submit them
to me at allan@
mckenziemgmt.com and I will answer them in future articles.
in having Dr. Allan Monack speak to your dental society or study
YOU LIKE TO IMPROVE YOUR HYGIENE DEPARTMENT?
Clinical Practice Enrichment Program is
designed to improve Hygiene Clinical Skills and develop
and implement a step-by-step Interceptive Periodontal Therapy
Program that will immediately bring greater productivity,
with enhanced patient care. For more information...GO
PAST ISSUES OF OUR E-MOTIVATOR NEWSLETTER?
to find out about
To Hire The Best Employee
Dentist's Guide to Effective Interviewing
Successful Job Descriptions
New Sample Ads for Advertising
New Ready to Use Application
Over 100 Interviewing Questions
Both Sample and Ready to Use Tests
A Guide to Checking References
have a quick question for you concerning bonus structures. We have
FINALLY reached our BAM (basic monthly amount to cover overhead)
and are beginning to calculate bonuses. My question concerns collections.
We base the bonus on collection. However, we are not sure (for bonus
purposes) how to handle the discounts. For example, if someone pays
cash we give them a 10% discount. The total collection goes into
the system but the total collection for the month is offset by the
discount. Should the credit adjustments be included in the collections
figure when we are figuring bonuses? We offer a variety of discounts
including a senior discount, community organization discounts, etc.
Remember...you can’t pay what you don’t deposit in the
checking account. Therefore any collection amount figured in a bonus
must be “adjusted”.
should also consider items such as: how long a person has worked
there, what about taking vacations and what if a front desk person
doesn’t collect the money? The chairside and hygienist have
no control over their bonus. There are many other measurements of
a practice that should be considered to determine if a practice
is successful other than collections. What happens on those months
when you are below BAM? Do employees get their paychecks cut? Or
what happens when you need to hire another employee? Or you have
a break-in and all your computers are stolen? Make sure you have
thought out ALL ramifications before implementing because once you
do and you try to take away... you will have a very bad situation
on your hands.
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