8.26.11 Issue #494 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter
 

The Dentist/CEO's #1 Concern
by Sally McKenzie CEO

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Years ago, large company CEOs were seemingly insulated when things went south. Poor decisions were made, company profits would plunge, but there were always the underlings to blame. The CEOs had the Teflon shield around them. Remember “new Coke?” A blunder here a disaster there, yet the CEOs would remain. While that is no longer the case in corporate America, it’s never been the luxury for dentists. As leaders of their practices, when things went wrong, the proverbial buck stopped with them. True, they weren’t likely to get fired - but they’ve always had to take responsibility.

mailto:info@mckenziemgmt.com What has changed, however, is that dentists today must acquire far more CEO-type skills than ever before. As CEOs of the practice, they need to clearly understand profit and loss, marketing, human resources, hiring and firing. Long gone are the days where Betty the office manager takes care of the books and the staffing issues.

Running a dental practice requires careful attention to 22 business systems - none of which are thoroughly taught in dental school. When doctors inquire about the McKenzie Management training program for the dentist/CEO, invariably it’s because the doctor has one primary concern: The practice is losing money. Yet no one is paying attention to those systems that directly impact revenues - starting with production. Few dental teams understand how to establish production goals or even how to determine the number of hygiene days necessary. I recommend this approach:

Start by identifying a realistic financial goal for your practice. For example, let’s say your goal is $700,000 in clinical production. This calculates to $14,583 per week (minus four weeks’ vacation). Working 40 hours per week requires you to produce about $364 per hour. If you want to work fewer hours, per hour production will need to increase.

Use the formula below to determine the rate of hourly production.

  1. The assistant logs the amount of time it takes to perform specific procedures. If a procedure takes the doctor three appointments, s/he should record the time needed for all three appointments.
  2. Record the total fee for the procedure.
  3. Determine the procedure value per hourly goal. Take the cost of the procedure, for example $900 for a crown; divide it by the total time to perform the procedure, 120 minutes. That will give you your production per minute value - $7.50. Multiply that by 60 minutes - $450.
  4. Compare that amount to the doctor’s hourly production goal. It must equal or exceed the identified goal.
  5. Start scheduling to meet that goal every hour of every day.

If you choose to block the schedule for specific procedures, do so based on actual procedures performed over the past six months - and not on what you would like your ideal day to be.

The other area that is critical to production, obviously, is hygiene. You want to ensure that you have an adequate supply of hygiene days so that new and existing patients do not have to wait weeks, or worse yet months, for hygiene appointments. Additionally, patient demand should be such that the hygiene department accounts for 33% of your total practice production and your hygienist is producing 3x her/his daily wage. Follow this formula to guarantee that your supply meets demand:

  1. Count the number of active patients seen in the past year for oral health evaluations.
  2. Multiply that figure by two, since most patients come in twice a year for oral hygiene appointments.
  3. Add the number of new patients receiving a comprehensive diagnosis per year. For example: your practice has 1,000 active patients + 300 new patients = 1,300 x 2 = 2,600 possible hygiene appointments.
  4. Take that number and compare it to the hygienist’s potential patient load.
  5. If the hygienist works four days a week, sees 10 patients per day, and works 48 weeks a year there are 1,920 hygiene appointments available.
  6. Subtract that total from 2,600. You are losing 680 appointments per year or 14 patients per week. In this scenario, the hygiene department should be increased 1.5 days per week.

If your practice schedules patients when they are due, examine how far ahead patients are booked for appointments. If there are no openings in the hygiene schedule for a three-week period and some patients are being bumped into the fourth week, begin increasing the hygiene department’s availability in half-day increments. If there are several open appointments, develop a patient retention strategy.

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

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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Carol Tekavec, CDA RDH
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Making Recommendations - Supporting Sources
Carol Tekavec RDH

Dentists and hygienists are called upon every day to make recommendations for patient care based on the best information and professional judgment they possess. Diagnosis and treatment planning are the dentist’s responsibility; however, hygienists shoulder a significant role in carrying out certain aspects of treatment as well as educating patients about their care. In the case of periodontal disease, we have many sources and opinions on which to base our recommendations. One extremely valuable resource is the American Academy of Periodontology. The AAP publishes reports and guidelines developed by experts and reviewed and approved by the AAP Board of Trustees which can be accessed by professionals on the AAP website or purchased in print form from their catalog. A July 2011 report addresses Comprehensive Periodontal Therapy; what it entails and what treatment might be expected to accomplish.  

Under “Treatment Procedures” the report includes (but is not limited to) the following:

  • Patient education, training in oral hygiene, and control of risk factors such as smoking should be performed.
  • Removal of supra and subgingival bacterial plaque/biofilm and calculus by comprehensive, meticulous periodontal scaling and root planing, sometimes incorporating these into surgical treatment, should be accomplished.
  • Chemotherapeutic agents may be used to reduce, eliminate, or change the quality of microbial pathogens, or to alter the host response through local or systemic delivery.

Under “Evaluation of Therapy” the report mentions:

  • The patient’s response to therapy should be evaluated (probing, bleeding points, elimination of swelling) and treatment objectives should have been met.
  • An appropriate periodontal maintenance program, specific to the individual, has been recommended.

Under “Periodontal Maintenance Therapy” the report lists:

  • Evaluation of tissues should be accomplished.
  • Assessment of oral hygiene status should be done.
  • Mechanical tooth cleaning to disrupt/remove plaque, biofilms, stains and calculus should be provided. Local delivery or systemic chemotherapeutic agents may be used as an adjunctive treatment for recurrent or refractory disease.
  • Appropriate intervals for maintenance should be established.

Incorporating information contained in the AAP Comprehensive Periodontal Therapy report into our own treatment planning can help us provide the best possible care for our patients. In addition, we can use this report as a supporting source when talking with our patients - providing credibility and trustworthiness for our treatment advice and encouraging patient acceptance.

While scholarly reports are important, articles written in laymen’s terms can also be helpful. One such article, titled: “Chronic Illness is Related to Mouth Germs! What You Need To Know” explains the relationship between tooth and gum infection, inflammation and a person’s general health. It also supports treatment acceptance in that root planing and scaling are discussed and recommended.

Here is an example of using the AAP report and the web article with a patient:

After a full mouth periodontal probing, Annie the hygienist notes that Mr. Patient has several areas of 4 and 5 mm loss of attachment, and numerous sites of redness, bleeding, and gingival swelling. Her assessment, along with the diagnosis of the dentist, confirms that Mr. Patient has chronic generalized moderate periodontitis, and they recommend periodontal scaling and root planing.  Mr. Patient knows very little about periodontal disease, so it falls to Annie to educate him concerning his condition, as well as to obtain his acceptance of treatment. She provides written formation for him, such as a print-out of the web article mentioned above, and explains:

“Mr. Patient, based on our examination, we have determined that you have periodontal disease. This condition is an inflammation and infection of the gums and bone that support your teeth.The American Academy of Periodontoloy is the most respected source of current information concerning periodontal disease, and their recommendations include removing bacteria, plaque, and hard deposits from around each tooth in a very comprehensive way. That is why we are recommending scaling and root planing of all of your teeth to accomplish just that. The AAP considers scaling tooth root surfaces to be a critical element in establishing periodontal health. Left untreated, the toxins produced by the bacteria living around your teeth can overwhelm the mouth’s defenses, resulting in loosening of teeth and the possible spread of infection to other parts of the body. The print-out I have given you talks about this in detail. The good news is that with our treatment and your own home care, this condition can be controlled. Working together we can help you keep your mouth and teeth healthy and strong for life.” 

In addition to providing patients with sources and handouts, it is good to be prepared with quick and simple explanations for common questions. For example:

No dentist has ever told me that I had gum disease.  Why is this happening now?

“Even if a dentist has never previously told you that you need gum and bone care, new conditions require new treatment. It is not uncommon for even “regular” patients to develop mouth infections from time to time and need more than just a “cleaning” such as they have had in the past. Just as a person may develop high blood pressure, having never had it before, so may a person develop gum and bone disease. Our bodies change and face challenges all the time.” (Excerpted from Chronic Illness is Related to Mouth Germs article)

I accept that I need periodontal treatment and subsequent periodontal maintenance.  How often will my insurance pay?

“Many insurance plans pay for periodontal maintenance twice a year, although most patients require appointments more frequently. Insurance plans limit the number of exams, cleanings, and periodontal maintenance appointments that they will cover because these are the types of treatments that many people need to have often. Insurance can help cover expenses, but it will probably not pay for everything you need. It is a mistake to let benefits be your sole consideration when you make decisions about your dental condition. People who have lost their teeth often say that they would pay any amount of money to get them back. The good news is that your insurance can reduce your expense. It helps!”

Helping patients make appropriate decisions concerning dental treatment is important for their health as well as the health of the practice. Resource material can provide valuable support.

Carol Tekavec RDH is the director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office”.  Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

Carol is also a speaker on hygiene efficiency and profitability for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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Imprive your hygiene performance one day... in your office


Nancy Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Do You Have Sight or Vision?
Nancy Haller, Ph.D., Leadership Coach McKenzie Management

Once upon a time there was a shoe salesman who went to Africa to scout the market. Seeing everyone bare-footed, he became discouraged and wired his manufacturer: “There’s no business here. They don’t wear shoes.” The company brought him home. Meanwhile, a competitor who was in the same region sent a message back to his organization. Excitedly he said: “This is an unbelievable opportunity. They all need shoes and no one else is selling here!”

 This story illustrates the difference between sight and vision. Sight is the ability to see things as they are. Vision is the ability to see things as they could be. The way you frame your world will make all the difference in your professional and personal life. The first salesman viewed the situation through the narrow lens of his current reality, while the second person saw future opportunities.

How often do you stay on the track of “what is” rather than to challenge your initial reactions and ask “what might be?” When you only focus on the problems of your life - revenues are down, holes in the schedule, employee conflicts - you are near-sighted. You allow your vision to be obstructed by what you see now or what you believe based on past experiences.

Although the human brain is able to take a lot of helpful short-cuts, our minds often misperceive reality through the distortions of our own thinking. Once you recognize that reality is an invention that you’ve constructed, then there's no reason not to believe that you can create what you once considered impossible. 

Your belief system can be like the first salesman and impede you. Or you can think like the second man and open your world up to vast opportunities. The choice is yours. Success truly begins in your mind. As the motivational speaker Zig Ziglar said: “You must see the reaching before you reach the reaching.” 

Leadership is about thinking in new ways, about envisioning possibilities that do not yet exist. Sight without vision is dangerous because it has no hope. The question of vision is a very simple one - what do you want in your life?

Be aware of the things that are influencing you. For example, what books do you read? What words do you speak? What thoughts do you think? With whom do you spend the most time? If you’re constantly mixing with people who talk about how lousy life is, these people form the basis of your reality. Be careful about what you allow into your head because these things shape your views and eventually your vision.

Although it can be difficult for some, everyone has the capacity for vision. The problem is that most people use their vision the wrong way. They imagine what they don’t want! Here’s a quick example:

While you silently count to 10, do not think of a zebra, that horse-like animal with black and white stripes.

If you were successful in this little exercise it’s probably because you directed your mind to other possibilities. Perhaps you pictured a giraffe or an elephant. You had vision that enabled you to go beyond the obstacle of “zebra.” If you only focus on the “zebras” of your thinking, you’ll remain near-sighted.

Your beliefs inherently are the foundation of everything that happens to you in life. Rid yourself of quick judgments, fixed perspectives, and old opinions. Make room for discovery and innovation. The ability to open your thinking to different views, to connect with other people, and to shake outmoded paradigms is within you!

Challenge how modest your ambitions or aspirations are. If you are constrained by conventionality, begin by taking small risks. Go to the leadership weight room and dare to stretch the limits of your thinking. Model more explicitly the kind of practice you want. These are the basic factors that will move you from “sight” to “vision.”

Imagine what might be.
Determine what should be.
Be a part of creating what will be.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

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

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