Plug These Cash-Draining Holes in Your Practice
It’s not a happy day when you realize that there’s not enough money for you to pay yourself…again. Or maybe you can take a partial payment, but there’s nothing left for retirement. Or you are putting off continuing education as long as possible because you’re not sure you can afford it. Why? Practice expenses are dictating your every move. Yet, you still have the “helper” at the front desk. She’s a nice person who greets the patients warmly but is equally good at merely warming the chair most of the time. Hygiene continues to lose money, and on top of it all some of the employees are asking about annual raises.
When money is tight, there are 3 areas - staff, hygiene, and salaries - that are often the ones draining practice resources. It is critical that you carefully assess each for inefficiencies, starting with staff. When things get a little rushed, a little harried, and a little busy, too many dental teams think that's an indication that another employee is needed. Wrong. Determining the need for more staff must be based on actual numbers, not on a little stress.
For front desk staff, look at check-in and check-out. Typically, these administrative tasks take approximately 10 minutes per patient. If your practice is seeing 15-22 patients per day, which would total 150-220 minutes of patient contact, one person should be able to effectively manage the front desk duties. If that person is spending more than 240 minutes handling patients, or half the day, the practice should consider hiring an additional employee.
As for assistants, if the procedures are streamlined, one assistant can efficiently maintain two treatment rooms for a general dentist using two operatories and seeing 13 or fewer patients a day. This would include setting-up the room, seating the patient, assisting the dentist, dismissing the patient, and cleaning-up.
Another common contributor to inflated overhead is low hygiene production. Before you take out your financial frustrations on your hygienist, look closely at the recall system. Typically, weaknesses in hygiene production can be traced to inefficiencies in this system. An effective recall system ensures that patients are in the chair. And if they are in the chair, the hygienist should be expected to produce 33% of total practice production. Moreover, the hygienist's salary should be no more than 33% of her/his production (excluding doctor's fees). If the hygienist receives a guaranteed salary, the expectation must be that s/he produces three times her/his wages. Again, the key to achieving that is the hygiene schedule.
Hygiene schedules frequently appear to be overbooked. But practices commonly dismiss holes and no-shows that creep in. If patients aren’t in the chair, the hygienist can’t meet production goals, plain and simple. The practice should designate a Patient Coordinator. This is the point person who is responsible for keeping a steady flow of patients streaming into the hygiene treatment rooms through a solid recall system. This job has an enormous impact on production/overhead. Just be careful that the person doesn’t get dumped on with all the “menial” tasks that no one else wants to do. Their primary focus must be keeping the schedule full, using all of today’s modern communication tools including text messaging, email, in some cases social media and of course the phone to reach patients in order to maintain a solid schedule.
In addition, take a good look at perio. This is a critical factor in improving hygiene production. There are several ways to incorporate an interceptive periodontal program into the practice. I recommend the business assistant greets the patient upon arrival and mentions the program. She hands the patient a questionnaire and a brochure educating them on the importance of addressing the signs and symptoms of gum disease, such as Periodontal Disease - What you Need to Know.The patient checks any symptoms s/he has experienced, which opens the door for discussion in the treatment room.
Finally, address the issue of staff raises. Guidelines must be clearly established for when raises are discussed and under what conditions they are given. Make certain your employees know what is expected of them. Job descriptions are a must for everyone. Use performance measurements to determine raises. And remember the Cardinal Rule of Raises - if the practice is losing money, employees do not get more. Check out my Employee Salary Review form HERE. This form will help you mathematically determine how much of a raise you can afford and still keep your salary overhead in line with the industry.
Be consistent. Monitor the systems. Controlling overhead requires constant vigilance or before you know it, high overhead will pull you under…again.
For more information on this topic and for additional Dental Practice Management info, visit my blog: The Lighter Side.
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Scheduling New Patients
In my last article, I gave you some things to think about when it comes to scheduling new patients and talked about whether or not you should be scheduling them with the hygienist first. I will remind you that the first comment made was, if it is against the law in your state to have the new patient scheduled in hygiene before the doctor has completed a comprehensive exam, then it should not be done that way. Now let's look at some ways of scheduling the new patient that will leave a positive impression and make them not only want to return themselves - but to also refer their family and friends to your office.
Some doctors are not comfortable probing, where most hygienists seem to be very comfortable with probing. This may be why some doctors like to have new patients scheduled with the hygienist first. This is fine, but keep in mind an initial probing takes more time than a probing done at a periodontal maintenance appointment, and a team member needs to be available so the probings can be done out loud, allowing the patient to hear the numbers and co-diagnose their periodontal disease along with the hygienist (unless your office has a voice operated probing system or something similar).
There is also a lot of educating that needs to be done at this first appointment - if you are going to schedule the new patient in hygiene first, make sure you allow enough time. This may be determined based on how long it takes your hygiene department to do each procedure that they are expected to do during the appointment. The best way to determine this is to time how long it takes the hygienist to complete the procedures a few times, and add the average amount of time on to the new patient appointment.
If the patient is being scheduled in hygiene first because the front desk is informing the team that the patient is insisting on a cleaning, then that patient had better get a cleaning at that appointment. Yes, even if they have periodontal disease and need to return for root planing. Otherwise, you have already lost the patient's trust. The patient will need to be rescheduled for his/her root planing after being educated about periodontal disease, and after the fees have been reviewed.
In order to keep the office running on time, the doctor may want to schedule time into his/her schedule to do the comprehensive exam. This can be before the hygiene appointment or after the hygienist is done, even if the hygienist is moving the patient to another chair. This will allow time for the patient to ask more questions and build a rapport with the doctor. The doctor's time may be only 20 to 30 minutes, since the probings and any necessary x-rays will already be taken either by the hygienist or assistant.
One thing the doctor may want to consider is having the assistant get the x-rays that are needed first, then the doctor and assistant can sit down and chart the existing conditions. This will slow the doctor down and really enable him/her to evaluate each filling that exists not only on the x-ray, but also in the mouth. At this time, the doctor can inform the patient of the restorative needs and what the priorities are. The treatment plan will be noted in the patient's record and the front office can now start looking at the financials. The doctor will inform the patient that the hygienist will be doing probings to determine the health of their gums and all of the treatment will be gone over with them.
When the patient is moved into the hygiene room, the hygienist will not only do the probings, but will be able to talk to the patient about the treatment that is needed and why. If the doctor wants, this would be the time for the hygienist to use the intra-oral camera to take pictures. The doctor will have to come in and officially diagnose the periodontal disease.
If the hygienist sees the patient first, s/he will get the probings and then the doctor and assistant will chart the existing and make the treatment plan. However, doing it in this order prevents the hygienist from having extra time to go over any additional questions the patient may have about treatment with a clinician once they leave the doctor. Working as a team at a nice steady pace instead of trying to do more in an appointment than time allows can really WOW the patient!
Another option is to have all new patients in the doctor's schedule first. Make sure to allow enough focused time to do a thorough comprehensive exam, and build rapport with the patient. This appointment, at the least, may include probings, any necessary x-rays, documenting existing, restorative and periodontal needs.
If the patient insists on a cleaning appointment, this may be scheduled back to back with the doctor's appointment. If possible, allow time to go over any periodontal treatment that may need to be done, so if the patient wants to start on their periodontal therapy program immediately, they may have that option.
The main thing to focus on is providing the patient with more than what they expect at this initial appointment. This will make them want to go out into the community and share with family, friends, and co-workers what great treatment they received at your office, and how awesome the work atmosphere is.
Interested in improving your hygiene department? Email email@example.com and ask us about our 1-Day Hygiene Training Program.
Beware of the Triangulation Zone
Your hygienist talks to you privately about another employee, also a hygienist. She tells you her co-worker isn't cleaning up at the end of the day and is intentionally slow with charting to avoid helping out. Wanting to fix this quickly, you agree to talk to the other hygienist.
Watch out - you have just entered the triangulation zone!
While people often suggest that venting is good for the soul, it is actually not very productive. Venting to someone about a third person is simply an avoidance technique that creates a relationship triangle, or triangulation.
Triangulation is a term that is most commonly used to express a situation in which one person refuses to talk directly with another person but gripes to a third person, thereby forcing the third person (in this case, you) to be part of the triangle. No positive outcome will occur. A lot of emotional energy is wasted. Relationship back-biting worsens and practice productivity is sabotaged.
In my conversations with dentists, I hear about this all the time. Why? Dental offices are largely comprised of people who are oriented toward taking care of others. Their compassionate nature is a plus, until it results in conflict avoidance. Wanting everyone to get along and/or being afraid of hurting someone, these “feeling-based” people side-step issues. They often hope that the negativity will just go away on its own.
Be careful that you don’t dismiss this situation as “high school antics” that will blow over. When one of your employees complains to you about someone else’s performance, it’s serious because the team is lacking in trust. Without trust, employees are afraid to communicate directly with each other about disagreements. They engage in this kind of political behavior that wastes everyone’s time. Without a climate of trust, teams are limited in what they can accomplish - and this impacts your bottom line!
First and foremost, when an employee complains to you about another staff member, do not be too quick to take sides. In all likelihood you only have one perspective, one side of the story. By staying objective you refrain from jumping into action and making a bad situation worse.
It’s alright, even helpful, to acknowledge the emotional impact. For example, to the employee in the above example, you might say, “I know it’s stressful when we have such a busy day and you don’t feel like you have help.” Validating the feelings behind the complaint is good. It lets the employee know that you understand - that you care about her.
The next thing you need to say is: “Have you spoken to that person yet?” In all likelihood the answer will be “no” followed by a string of explanations (i.e. excuses). Be careful because these could seem reasonable and justified. Here is where the buck stops - with you! Communicate your expectations so the employee understands what they are to do.
For the hygienist who complains about her co-worker, spend a couple of minutes talking about the details of her frustration. The remaining time is devoted to goal setting. She needs to address this directly with her peer and the two of them - NOT YOU - must iron out a clean-up plan. Your job as the practice leader is to coach this hygienist to find her own solution. You can make suggestions but it's up to her to fix it. Establish a time frame for this to be completed, perhaps one week. In a follow-up meeting, discuss her progress. If nothing's been done, explore the obstacles and set another goal.
Here are a few questions that could be helpful in coaching your staff when they complain.
In this way you guide an employee through a thought process about her own responsibility. You could role play it with her too. Suggest that she try out what she has “practiced” with you then come back and let you know how things are going. In this way, you are not in the middle but a coach on the sidelines.
As the Dental Leader, one of your most important jobs is to develop your employees. Even the best teams have conflict and it will be uncomfortable from time to time. The tendency is to want to “fix things” and make the problem go away. However, by showing patience and strength to tolerate the discomfort you enable your team to move to higher levels of productivity and profitability. Normalize conflict and help them to learn constructive ways of resolving their differences.
An empowered team is built on trust and mutual respect. Team building retreats are an excellent way to establish that foundation. Obviously that takes an investment of time, but it will pay big dividends…and keep you out of the triangle trap.
To enhance your leadership skills or host a team building event, contact Dr. Haller at firstname.lastname@example.org.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at email@example.com
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