Clinical Efficiency Doesn't Compromise Care
For “Dr. Dial,” the last few years haven’t been great, but they haven’t been bad either. His days are full, but his coffers are not. Dr. Dial is putting in the time but doesn’t see the financial return, and he can’t quite understand why.
The problem is that “busy enough” doesn’t translate into “productive enough.” In fact, the irony is that in many practices even when overall production is weak, the dental teams will feel they are overextended. They are stressed and struggling to keep on track, only to find that the results don’t reflect the level of effort the team seems to be putting in day after day. Understandably, this creates tension, a fair amount of frustration, and finger pointing.
Is it treatment acceptance? Is it scheduling? Is it hygiene? Certainly many factors can and do contribute to weak or uneven production. But one factor dentists often overlook is clinical efficiency. It’s like wallpaper. You walk by it every day but seldom if ever notice the details. Dentist and assistant repeatedly fall into a pattern of performing procedures the same way, giving minimal thought to efficiency. Or they might consider making some changes but believe they’ve adapted well to the “less than perfect” way of doing things. In other words, they know there are other and possibly better ways to operate, but they’ve “always done it this way.”
Then there are the newer dentists who emerge from dental school with little or no training in how to effectively use a dental assistant. Consequently, clinical inefficiencies develop almost immediately. Those inefficiencies grow into work habits that become second nature - so much a part of the routine that they are almost never considered for improvement. The dentist may think nothing of stopping a procedure to adjust the light, or the fact that they have to ask the assistant for specific instruments, or that the assistant is repeatedly stopping the handpiece and craning to better see the procedure. Yet each of these minor annoyances or seemingly insignificant details adds up in time, money, and lower production. If the clinical efficiency is lacking, the procedure takes longer and fewer patients can be scheduled. Consequently, production suffers.
Oftentimes, significantly improving chairside efficiency requires one simple change. Typically, the dental assistant who isn't adjusting the light source as necessary or isn't anticipating the suction needs, air and water needs, or medicament needs is likely not sitting in the chair properly. The assistant must be one head higher than the dentist and there should be a hydraulic lift on the chair so s/he can see into the mouth and properly anticipate the dentist's needs.
Dentists are legendary perfectionists. It's both a great strength as well as a weakness, particularly when it comes to maximizing clinical efficiency. A dentist may change burs five times during one procedure. Every change increases the time necessary to complete the procedure.
Additionally, it is not uncommon for dentists that struggle with productivity to get up from their chair numerous times during patient procedures, or have their assistants leave the treatment room to retrieve items that should have been set up in the first place. Each of these interruptions equates to clinical inefficiencies, as do slow treatment room turnaround, underutilization of chair-side assistants, and inefficient procedural protocols. The consequence is lower production and greater stress on the doctor, staff, patients, and the practice as a whole.
Then there is the matter of delegation. If you feel you are run ragged day after day, take a good look at the tasks you are performing that should be the responsibility of other team members. Dentists should consider delegating every procedure, patient interaction, and staff issue legally allowable in their state.
Improving clinical efficiency never involves compromising care. Rather, the focus is on improving the delivery of that care as well as fully maximizing each hour of doctor and staff time.
For more information on this topic and for additional Dental Practice Management info, visit my blog: The Lighter Side.
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Silence is Golden
Undoubtedly you’ve heard this proverbial saying. It’s often used in situations where saying nothing is thought to be preferable to speaking. Emily Dickinson said, “Saying nothing sometimes says the most.” Claude Debussy, the famous French composer, said, “Music is the silence between the notes.”
Unfortunately, pausing in silence and listening is a skill that has been ignored in the modern era of quick fixes and instant gratification. Plus, people dislike silence because it feels awkward. Consider the ways we describe it - eerie silence, deafening silence and hushed silence, to name a few. But silence is a powerful influence tactic, as in: “His silence spoke volumes."
The ability to listen effectively is a vital skill for leadership. Few do it well. Most of us engage in listening only as a way of waiting until it's our turn to speak. But taking a deep breath and keeping your mouth shut is one of the most powerful ways to get others to be accountable and get things moving in the right direction.
If you can't resist thinking about what you want to say when listening, focus instead on what people say and how they say it. You'll find they give themselves away to you constantly and enable you to understand their beliefs and objections. If you want to hear what a person is really saying, listen to the silence between their words and listen with your eyes.
Think about the times patients have refused treatment recommendations. Typically the tendency is to respond by launching into arguments designed to make your advice clearer. STOP. Unless you know why the patient is refusing, you won't be able to influence effectively. When you silence yourself and listen first, you may learn that preconceived notions about why you are being refused are wrong.
For example, one of your patients needs several crown replacements but refuses to schedule the first appointment. This is not due to cost but out of fear that he doesn't think he can sit for the required time to shape the teeth, take impressions and place temporaries all in one visit. If you presume that his objection is monetary, you miss the opportunity to negotiate a plan that is mutually viable. Listening first enables you to understand his objection or to counter his unjustified fear. Rather than bombarding the patient with every detail of what you think is problematic, leave plenty of space for him to fill in with a comment or question. That's what gets the patient invested and committed to treatment.
More than anything, your patients and your employees want to be heard and understood. Silence is a powerful tool that gives people a feeling of calm and confidence. It can inspire thoughtful action. And it can hold people accountable. Here's an employee example.
Jane, your finance coordinator, comes into your office to complain about Mary the scheduling coordinator. She tells you that Mary talks too much with patients and she (Jane) can’t concentrate on her work. To emphasize her frustration she also says that Judy, another front desk employee, “feels the same way.”
Like so many people, you are more likely to take the path of least resistance and opt for the quick fix. You might say to Jane, “OK, I’ll talk with Mary.” STOP. If you want to take your practice to the next level, you need to restrain your action-oriented style. Here’s what you should you do.
Listen for a short minute (that means less than 60 seconds) and then stop the noise. In a soft tone with a neutral face expression (and in a genuinely curious mindset), ask Jane to tell you three things she has done to make the situation better. And then be silent. Do not say another word. In these types of conversations, few people can stand a prolonged silence. By not jumping in with “I’ll talk with Mary” you empower Jane to be more accountable. Your silence will allow her to solve her own problems, and that makes her a better problem solver and a better employee down the road.
The ability to influence others continues to be the single most important factor for effective leadership. Your practice success is directly related to your ability to win trust and gain respect through communication with employees and patients. By using the tool of silence, you increase your power to influence. With consistent practice you will become more skilled, feel more comfortable, and be more successful in leading your team and your patients.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at firstname.lastname@example.org
Interested in having Dr. Haller speak to your dental society or study club? Click here.
The Value of a Hygiene Appointment
Offices come to us quite often with the complaint that they are having a lot of no-shows and last minute cancellations in the hygiene schedule, and they are unable to fill them. I wish I could tell you the answer to miraculously fixing this problem, but there is no simple answer. What we are able to do is reduce the amount of last minute cancellations and no-shows by changing the dental team's words and actions within and outside the dental practice.
Words and actions can send the message to patients that the hygiene appointment is not that important or valuable. For instance, I have received in the mail and witnessed many practices sending out marketing postcards that offer a $49 special for a cleaning, any necessary x-rays and a new patient exam with the doctor. I have to ask a question of anyone that may have done this: what kind of patients are you attracting? Do you really think they will pay full price for any other services, or even continue with their recommended recall if they have to pay more than $49? What are we saying a hygiene appointment is worth if we are willing to give it up for almost nothing?
Yes, this will put people in the chair initially for the existing and the new practice, but user beware - those patients may not return, as they will move on to the next dental practice willing to sell their product for less than the value it really should have placed on it.
Other examples of how dental offices are saying it is acceptable for you to be overdue is when the office has to cancel the patient’s appointment and they do not reschedule them within the next week, or the patient calls for their hygiene appointment and they do not get scheduled immediately because of all the 6 month pre-booking. However, all the front office has to do to rectify this is to inform the patient by saying something like: “Sam, I am not able to get you in immediately, but we have changes in our schedule on a regular basis and if I should have a change in the schedule, would it be all right if I call you immediately and see if we can get you in earlier than you are scheduled now? It is very important that we keep you on schedule for your hygiene appointments.”
Notice I did not mention that the changes are because of cancellations or no-shows. These changes may be because the hygienist added time to her schedule. This is also the perfect person to put on your ASAP list. The more people you are able to get onto this list, the more people you have to call when there is a last minute cancellation or no-show.
Then there is the office that has too many things for the hygienist to do. Post set complete appointments, make the next hygiene appointment, do treatment plans, get necessary x-rays, perform oral cancer screening exams, do periodontal probings, check blood pressure, look for possible decay, take intra oral camera pictures, have the doctor do the periodic exam…leaving hardly any time for the actual scaling.
Yes, the hygienist may get the scaling done as fast as she can, but how comfortable is the patient? What quality of dentistry is being implemented? Is there any patient rapport being established? Many patients have made their way to my chair and stayed for years to come because the hygienist before me was not able to do a good scaling due to time limitations.
It is not a “cleaning” or “just a cleaning appointment.” The hygienist is doing far more during the scheduled time than just a cleaning. It is a hygiene appointment, and it is priceless when used correctly to help build a practice, keep the doctors schedule full, and keep patients from leaving out the back door.
Interested in improving your hygiene department? Email email@example.com and ask us about our 1-Day Hygiene Training Program.
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