Dental Assistants - Seize Your Golden Opportunity
Take a moment and think of a situation in which you were under a great deal of stress, you needed help, you were in a bind and weren’t sure where to turn or how to deal. You sought help from a friend, trusted advisor, or professional, and the difficult situation was resolved. If those helping you did so with kindness and compassion, you probably look back on the experience with appreciation and gratefulness. If it was unpleasant, you likely have negative feelings about those involved. Perhaps you are resentful. Those charged with helping you instead made you feel badly about yourself, and you’ve likely shared the negative experience with several others. You may not even remember if they resolved your issue, but you do remember how they made you feel.
That is precisely the situation emergency patients are in when they come into the practice. They are in a difficult position. Most likely they are in pain. They are under stress. And they are probably feeling somewhat desperate. They need help, but they also need kindness and compassion.
For assistants looking for opportunities to increase their value to the practice, taking extra care with emergency patients can have a huge payoff. The goal is to convert 85% of emergency patients to comprehensive exam, but that doesn’t happen without a carefully crafted and well-executed plan that ensures this person who walks in under stress and in pain leaves feeling good about the doctor, the assistant, and their decision to choose your office.Pay attention to emergency patient biases that can creep into the practice culture. Oftentimes, there is a stigma attached to the emergency. Although it may be unintentional, this patient is frequently viewed as an annoyance, an interruption to the day rather than an opportunity. And that message comes through loud and clear to the patient.
If you don’t already have one, create an emergency patient experience protocol. Obviously, this goes beyond triaging the patient to address the immediate oral health problem. This protocol also addresses how the patient is to be managed throughout the visit. Certainly, the priority is to get the person out of pain, but it is also a huge opportunity to provide a truly excellent patient experience that the patient will not only remember fondly, but will happily share with others. In addition, it’s the opportunity to educate the patient on what your practice can do for them so that they don’t find themselves in a similar situation in the future.
The objective is to ensure that the emergency patient feels that the employees are understanding and helpful - not punitive - even when staff are under pressure. Consider each person’s role in putting the patient at ease as well as gathering information that will be essential in understanding those issues that are future barriers to necessary treatment.
Assistants: Pay attention to cues the patient is giving. Does the patient appear anxious or fearful? Is the person concerned about the cost of the treatment or the pain or the time the procedure is going to require? Is the patient apologizing because it’s been such a long time since their last appointment? Has this person had a negative dental experience in the past? Does the patient appear angry or frustrated?
The assistant should be able to identify the most likely obstacles the dental team will encounter when encouraging this patient to pursue comprehensive care. Knowing the barriers enables you to break them down. Track the most common reasons why emergency patients delay dental care. From there, develop a patient communication strategy through the use of scripts and educational materials to overcome those barriers.
Additionally, make it a priority to follow-up. The assistant should contact the emergency patient as well as any other patients that have undergone more extensive treatments. This is a critical communication strategy that yields extremely positive responses from patients. Ideally, the doctor already does this, but for those dentists that either do not want to personally follow-up with patients or don’t have time, the dental assistants play a vital role in building longstanding and mutually beneficial relationships between the practice and the patients.
Understanding patient concerns and showing sincere kindness and compassion enables dental teams to convert far more emergency patients to comprehensive exams. Embrace the opportunity that emergency patients bring and watch them become your greatest and most loyal fans.
For more information on this topic, visit my blog: The Lighter Side
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Silos, Part 2: Balancing Boundaries
In last month’s article, I wrote an article about Silos - subgroups of people within an organization that have their own specific function. The most common in dentistry are Front Office and Back Office, also known as Administrative and Clinical. Each department performs specific tasks that are uniquely different from one another. Although these divisions are natural, from a practice point of view they absolutely need to collaborate for effective patient care. As the dental leader, your challenge is to simultaneously balance the ‘us’ vs. ‘them’ mentality that accompanies practice silos.
This past week, I had the opportunity to talk with a dental leader whose team was battling the silo-war. A new practice management system was established that necessitated a closer collaboration between Hygiene and Front Desk staff. At first glance it seemed like a rather small task for the ‘front’ to notify the ‘back’ when the next patient arrived. But the change escalated the ‘prima-donna’ hygiene perception and the boundary-battle was on.
The ‘Front’ was too busy already with all they had to do checking patients in and out, handling insurance and collection issues, answering the phone, etc. And why couldn’t ‘Hygiene’ keep themselves on track? Why did they need so much ‘hand-holding’ and ‘baby-sitting’? And from the Hygiene Department...what was so difficult about a simple notification? After all they were treating the patients, setting up and breaking down their room with each appointment, sterilizing instruments, scheduling follow-up appointments, etc.
Most commonly, Doctors get frustrated. They throw their hands up and issue a commanding order of “you just need to get along and work together.” Indeed, that is the goal. But just how do they do that when they’re in an emotional war with one another? In this instance, a dictate to “get along” only increases resistance to change.
The first and most important step in resolving this ‘turf’ conflict is for the dental leader to buffer the two groups by allowing them to be different. Unfortunately this is frequently overlooked because it seems paradoxical. However, the research findings are strong - the remedy in breaking down silos begins with appreciating the importance of and the need for boundaries.
The definition of a boundary is the ability to know where you end and where another person begins. It is basic to our core identity. When we talk about needing space, setting limits, determining acceptable behavior, or creating a sense of autonomy, we are really talking about boundaries. Boundaries protect us. They help promote healthy relationships. They minimize conflict. Boundaries in the workplace are designed to create a productive environment.
Therefore the strategy is to reduce the threat that each group feels when asked to collaborate by giving them a sense of safety and security. Then and only then will they be able to have a constructive dialogue about working together more effectively. The plan is to have the Hygiene and the Front Desk departments describe their daily experiences to each other. As the dental leader, your role is to facilitate that exchange by encouraging active listening as these two groups learn more about one another.
Keep in mind that this is not a time for debating or defending. Should that occur, it is very important that you redirect that person(s) to listen. The goal is to allow each group to gain a clear sense of their differences and the problems they experience in doing their work. After hearing each other, ask them to summarize or paraphrase what was said. No editorializing, just summarizing.
It is equally important to recognize that this is not a quick fix. It takes time to get groups to work together cohesively. You may need to monitor several more meetings like this.
During the exchange, it is important for you to continually remind employees of the practice mission and vision. In fact, this is a key starting point to the meeting as it establishes the Direction for everyone. The next step is Alignment but you can't have that until you insure that they understand and accept the Direction, then feel safe to join with others. When Direction and Alignment occur, your next job is to inspire Commitment. That is the formula for leadership: Direction - Alignment - Commitment (DAC).
It may engage your team if you were to start the meeting with a few key questions, such as: Why do we come to work? What is our goal? Who do we serve? What is our purpose? (to name a few). Ultimately, it is about patient care. And, if during the meeting you should find yourself or the group 'stuck', bring it back to the mission or purpose. Again, everyone needs to buy into the mission. Until that happens you cannot align folks to row together.
There’s an old proverb that says, Good fences make good neighbors. Mind your ‘fences’ AND manage them well.
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
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Continuity of Care
Bill comes into your office as a new patient, and is seen by the hygienist initially. The hygienist reviews the health history, performs an oral cancer exam, takes any x-rays the doctor has prescribed, charts existing, and probes. She discusses with the patient what she thinks may need to be done in his mouth before the doctor comes in to perform the comprehensive exam and determine restorative needs. She also has the patient co-diagnose the periodontal disease, and explains periodontal etiology to Bill. He is fortunate and does not need to have root planing, as his mouth is healthy. So, the hygienist goes ahead and cleans his teeth.
Bill has never had such a great experience at the dentist. He tells one of his friends about it and refers his friend to the practice. But when Bill’s friend comes into the practice he is seen in the dentist schedule instead of hygiene, and the dentist is only given a half-hour. The dentist does what he can in that time, probing quickly and doing a full mouth debridement. He informs the patient of restorative needs and goes on with the next scheduled appointment after telling the patient he needs to return for a prophy.
Bill’s friend did not have even close to the same experience as Bill did. The cleaning he received hurt and everything seemed very rushed. This make Bill’s friend think that Bill may not be a trustworthy source when it comes to future referrals. Even worse, Bill’s friend is not going to return to this practice, as he did not have a good experience. He is also going to inform Bill of his experience so he knows not to refer to the practice again. Actually, Bill is now considering not going back.
Now 6 months have lapsed and Bill has decided to go back to the practice once more to see if he has the same experience. This time Bill is scheduled with a different hygienist and she does not spend the time with him that the other hygienist did. This is because the new hygienist only requested 40 minutes to do her prophylaxis. She is rushed and not nearly as gentle. She also does not take the time to build patient rapport. Bill is in and out of her chair in no time at all.
Bill decides to not return to the practice again. There is no continuity of care - not only between doctor and hygienist, but even between hygienists. The person doing the initial appointment, whether it is the doctor or hygienist, has nothing to do with the care the patient receives.
The time allowed for the appointment is what made the difference to the patient and his perceptions of the office. Shorter appointments, allowing more people to go in and out of the practice in a day, do not necessarily lead to greater production. Patients that are rushed in and out of the office often do not accept future treatment or end up being lifetime patients in the practice.
That 40-minute exam and cleaning, rather than being $400 for the full mouth series of x-rays, comprehensive exam and full mouth debridement, may have been treatment planned for four quadrants of root planing, and three-month periodontal maintenances. At $200 a quadrant, that would be the potential of $800 generated in production that day, and putting the patient on a needed three-month periodontal maintenance equals more production, better quality of care for the patient, and less stress for the patient and provider.
This leads to quite a few good outcomes. The patient is impressed and comfortable while receiving the care, which may lead to better quality of care and even more referrals. There is less stress in the office because the schedule is not being over-booked with too much treatment in one appointment. This in turn will lead to enjoyment of doing dentistry for many years to come, not to mention a higher amount of patient retention.
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