05.15.09 Issue #375 Forward This Newsletter To A Colleague
Keeping Good Employee’s
Internal Marketing
Treatment Presentation

One or Two Employees Don't Make a TEAM
by Sally McKenzie CEO
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I recently had a conversation with a dentist on that ever - popular topic: employees. This doctor went on and on about how fortunate he was to have had the “best” office manager any practice could hope for, but now he was frantically looking for someone to replace her because she’d turned in her two-weeks’ notice. He was crushed.

I asked him what set this person apart from the others. “She just takes care of everything,” he told me. I was intrigued. “Everything?” I asked. The good doctor went on to explain that he could delegate virtually anything to this person and it would get done. She could take care of insurance, collections, billing, payroll, recall, staff communications, case presentation, treatment planning. Why, she even oversaw the office parties. If it was someone’s birthday, she baked the cake.  What a gal! He was about to start a practice newsletter and this employee was going to be responsible for writing, designing, and distributing it. She might as well leap tall buildings and wear a red cape.

I was seeing red flags. “Are all of those duties in her job description?” I asked. “Oh no,” he puffed. “I don’t like job descriptions; they just limit everyone’s responsibilities.” Yes the alarm bells were blaring loud and clear. “You mentioned ‘staff communication,’ what does that involve?” I asked. “I have problems with my other staff. My assistants don’t do things the way I want. The hygienist is too chatty. You know, the usual stuff. I just tell the office manager to handle it and she does.”

This was, indeed, a full-scale alert. No job descriptions, no accountability, no leadership. Clearly, there are significant problems here. The doctor had used the office manager as a gatekeeper to insulate himself from the other employees and from serious matters that required his direction and involvement. Whatever issue he didn’t want to deal with, he just handed off to her, from clinical particulars to patient relations to business operations. Not only was she the office manager, she was the de facto leader, responsible for virtually every major system in the practice except the actual dentistry. With pressure like that, it’s no wonder she quit.

Why didn’t she speak up? It’s not uncommon for the good employees to remain silent. They don’t want to bother the doctor. They just keep taking the pressure, being the good stewards that they are until they crack. And in reality, the fact is there is probably little she could have done. In situations like this, the doctor simply will not or cannot see where he/she is wrong. This particular dentist believes that his office manager is responsible for “managing” every aspect of the office as the doctor sees it. And as far as the doctor was concerned, it worked, why change it.

It usually takes a seriously troubling event – such as a major financial shortfall,  the departure of a critical employee, etc. – for the doctor to even take notice. From there it takes an outsider, such as a practice management consultant, to sit down with the doctor and discuss his/her frustrations, why he/she cannot trust other staff, determine where the system shortfalls are occurring, assess training weaknesses, and get to the bottom of why the doctor cannot or will not lead his/her team.

This case is particularly unfortunate because it appears the doctor had a very dedicated and highly competent employee, which is common. Practices will have one or two rock-solid staff and a host of mediocre chair warmers. Instead of creating systems of accountability, instituting training programs, developing job descriptions, etc. doctors will simply pile the critical duties on those that they know they can count on. Ultimately, everyone loses.

The good employees eventually break or burnout. The weak employees are never given the opportunity to grow and flourish. And the doctor is losing a fortune because, whether they care to acknowledge it or not, things are falling through the cracks, simply because there are not enough capable hands on deck to ensure they don’t.  Yet with some outside assistance, most practices can create entire teams of high performers.

Next week, the recession is no guarantee that your good employees will stay. Take steps to keep them.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club? Click here.

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Belle DuCharme CDPMA
Instructor/Consultant
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Don't Push The Panic Button

Examining ways to influence patients to keep regular appointments in hygiene (recall) and to buy services and products that will maintain and improve dental conditions can be more challenging during an economic recession.  Some areas of the country are experiencing loss in production that is comparatively more than other areas due to demographics specific to the area such as plant layoffs or large areas of housing foreclosures. Helping patients to “check panic now” is important to insuring that they do not have more challenging dental work in the future due to neglect.

 Many of us are cutting back on non-essentials such as gourmet coffee, dinner out, cable television and designer purses and that makes sense.  Cutting back on health care and dental care does not make sense if the reason is to save money. Consumerism did not teach us how to prioritize our discretionary spending habits and consequently there is “priority confusion” over what we buy. That is why patient education is more important now than ever to get this point across.

If you are a PPO provider, now is not the time to discontinue participation in any plans and most likely it is time to consider adding more plans to your list.  Some companies are still resisting layoffs but they are cutting benefits to offset lost profits.  If cuts are made to dental benefits affecting your current patient base it would be advantageous to add more plans now. You can run a demographic report from your computer to find out what percentage of your practice is represented by any particular employer.  If that employer is doing layoffs or cutting back on dental benefits you can send a letter to that group of patients offering them a recession reduction on their next visit to help them get through these times. Historically, more patients will buy services because they have benefits than patients who do not have benefits. If you recognize the impact this has on your practice, you will know why it is important to not sit idly by in a panic mode.

Fear can immobilize the practice into not promoting services and products assuming no one can pay or wants to pay. Continuing to promote services by demonstrating the benefits to the patients and the long-term investment dental care provides to achieve optimum health should not be shelved because of the mindset of “they aren’t going to buy because of the recession.” 

I spoke recently at a seminar in the Midwest. Before going on stage, the sponsor said to me, “You are going to address the recession aren’t you?”  In my recent travels, I have noted that the recession has been portrayed by the media as being the same for everyone, when in fact; it is widely different from one part of the country to the other.  So I asked specifically how the recession was affecting the sponsor’s immediate community and the feedback from the dentists in the region.  He replied that their community had growth, good job prospects and was in very good shape.  His practice was growing and he recently added some new technology that he was very excited about. Even though the dental community was not experiencing unusual problems, fear of what may happen with the recession was affecting many dentists in the area. The sponsor’s point was to give them encouragement to not panic.  The talk was focused on making sure that the business systems in the practices were effective and how to measure each system to identify if a breakdown was happening.  Making everyone on the team accountable, in measurable ways, to the success of the practice was paramount in getting everyone involved with the practice success.  If the practice was to succeed in tough times it was to be internally strong to resist outside forces. 

Whether a recession has touched your practice in a large or a small way, it is vitally important to have solid practice management operating systems and protocols in place to keep your practice on solid ground.  McKenzie Management can offer you peace of mind with proven consulting and training services designed to show measurable improvement in a short period of time.  Call now, 877-777-6151 and get your finger off the panic button.

If you would like to learn more about McKenzie Management’s Advanced Training Programs, email:  training@mckenziemgmt.com.

Interested in having Belle speak to your dental society or study club? Click here

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In 30 days, you could be depositing more money. What are you waiting for?


Nancy Caudill
Senior Consultant
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"Something is better than nothing!"

Dr. James Bradford – Case Study #321

“I am not busy……not busy…….not busy!”  Sound familiar?  Unfortunately, we are hearing this expression much more than usual.  Dr. Bradford had the good fortune of enjoying a profitable practice, but now, the number of openings are occurring with greater frequency, and the situation is forcing him to start paying closer attention to his practice production and collections.  “My production is down 10% from last month.”

Dr. Bradford’s practice was established 18 years ago and focused on general dentistry with much of his production in fixed prosthodontics.  The practice averaged 23 new patients and 9 new emergency patients a month.

Low case acceptance
When patients are comfortable with their personal financial condition, it is much easier for them to accept “ideal” dental treatment.  They are not as concerned about insurance maximums and “patient portions.” Utilizing outside financial institutions such as Care Credit for elective services is acceptable and inviting. 

Dr. Bradford prided himself on his high case acceptance of fixed prosthetics, including his in-house fabricated restorations.  Not so, as it seems now.  Reviewing the monthly case acceptance rate for these procedures, it became obvious that his historical approach to treatment presentation and recommendations would need to be altered.

Case presentation
Ideal dentistry to Dr. Bradford was not always what the patient “wanted” or thought they “needed.” Often times it is a perception by the patient and many times it is strictly a matter of affordability.  After reviewing his lower case acceptance over the past two months, it was obvious that his patients were shifting to their wants and needs and not his.  In order to improve case acceptance he was going to need to recommend other options that were more “palatable.”

Note that the objective here is to increase case acceptance, not necessarily to increase dollars accepted.  Understand that Dr. Bradford’s production is down and the number of openings on his schedule is up so it becomes important to get patients in the chair.  An unfilled chair is not adding anything to the doctor’s production numbers!

Dr. Bradford’s approach to case presentations was to share with patients everything they need. The hygienist or assistant would present the entire treatment plan and then the patient was dismissed to the Financial Coordinator to make an appointment.  The dialogue went something like this:  “Joe, it appears that you will need a few ceramic crowns and composite restorations, and let’s replace that missing tooth on the lower right side with either an implant or a bridge.  OK? Great. I look forward to seeing you next time.”

Carol, the hygienist would enter all this into the computer, print out the treatment plan and begin to review it with him.  His treatment plan total is $6,775 but Joe’s primary focus for visiting Dr. Bradford for the first time was to get his teeth cleaned!

Carol escorts Joe to Jane, the Financial Coordinator and says, “Jane, Joe is all finished for today. Good bye Joe, and thanks for coming in.”

Now, Jane is left with the overwhelming task of scheduling an appointment for Joe after she discusses with him his financial options to cover the $6,775 and proceeds with the question, “Which option works best for you?”  Is it surprising that Joe’s response is, “Wow. I didn’t realize that I had so much work to be done.  I have to go home and think about this.”

Not only has Joe not accepted any restorative treatment, but his periodontal concerns have not been addressed ANDhe has also been lost to the myriad of unscheduled hygiene patients because he has no plans of returning.  After all, he just wanted his teeth cleaned!

A Different Approach
Let’s play this out differently without taking into consideration the fact that Carol, the hygienist, has “pre-heated” Joe about potential concerns and revealed these areas to Joe with the intra-oral camera.

Dr. Bradford presents to Joe after his diagnosis, “Joe, as you can tell, you do have some areas of concern.  I understand that you are a businessman that travels for a living.  I sure would hate for you to be on the road and one of those large, broken down silver fillings crack, wouldn’t you?  With your permission, I would like to start by replacing those two old fillings here (and he shows Joe the image) with two beautiful porcelain crowns.  We can complete them right here in the office in one visit so you don’t have to make a trip back.  I know how valuable your time is.  Then we will discuss the other areas when you return.  How does that sound?”

When Joe is escorted to the Financial Coordinator, the hygienist says to Jane, “Jane, Joe did great today.  We really enjoyed having him here as a new patient.  He and Dr. Bradford have determined that they would like to address those two broken down old fillings on the upper left side by restoring them with two porcelain crowns that we will make right here for him.  Dr. Bradford will need about 2.5 hours.  At that visit, we will discuss his other concerns.”

Success!  Jane offers to Joe the financial options for the total treatment of $1,800 and he accepts and schedules.  The treatment plan was much more palatable and not as overwhelming.

What if there is no acceptance?
After Jane’s financial options are presented, Joe is still not comfortable with the fees.  Jane’s approach would be to break it down to an even smaller treatment plan that is more appealing and acceptable to Joe.  Remember that it is not what Dr. Bradford wants but what Joe wants.  Therefore, she presents 1 restoration instead of 2.  If this also fails to get a “yes”, this is the most important question Jane will ask:

“Joe, our goal here is to help you accept and receive the dental care that you want and deserve.  Are you going to be home or at work later this afternoon?  Please allow me to discuss your concerns with Dr. Bradford and see what other options we may offer you to resolve your concerns for these two old fillings.  How does that sound?”

Something is better than nothing. Dr. Bradford does not want to lose a new patient because of options that were presented that the patient was not willing to accept.  He also didn’t want to lose Joe as a hygiene patient.  Even though Joe didn’t accept his restorative options, Dr. Bradford still wants to maintain him as a hygiene patient so he can retain the relationship and keep him in the practice.

After three months of following Dr. Bradford’s “new” treatment acceptance protocol, his rate has climbed from 41% to 67% by offering alternatives that his patients are willing to accept.

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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