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12.19.08 Issue #354 Forward This Newsletter To A Colleague

Angie Stone RDH, BS
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There Isn’t An “I” In Team

There is a saying that there isn’t an “I” in “team.” This typically is said to members of a sports organization, when players are not working together and the game is not going according to plan. This saying, however, can be applied to almost every work environment, including the dental office.
One of the areas in a dental office where lack of team work is perceived is the hygiene department. Business staff and dental assistants often report a feeling that many hygienists do not buy into the team concept. Complaints of hygienists not helping out in the sterilization of instruments, not emptying the trash, not helping to keep the clinical area clean, not offering to help in the business office, etc., are heard frequently.
This misunderstanding usually stems from the team not realizing that hygienists are different than other team members. The difference is that they are the only employees, other than dentists, who directly generate production.

When the hygienist does not have a patient in the chair she/he is not producing revenue for the practice. When not producing, some hygienists will read magazines, make personal phone calls or chit chat with other team members. Because many hygienists have a guaranteed salary, they are paid for down time. Instead, it would be more productive if the hygienist was directed by the Business Coordinator to review the unscheduled recall list, highlight those patients who would most likely respond to a call and make notes as to what to say to get them into the chair, such as, “Jane, our hygienist Mary has noticed that you have not scheduled your professional cleaning appointment. She asked me to remind you that she needs to check the pockets on teeth numbers 3 and 4 to see if there has been healing. Mary is available Tuesday at 9:00 a.m. Shall I schedule you?”

Making outbound calls to patients is an administrative task and not to be assigned to the hygienist unless staffing is at a minimum and the hygienist has been taught the protocol for making outbound calls to patients, including how to record responses in the chart or computer system. It is also not recommended to have a hygienist scrubbing instruments, emptying the trash, filing charts, etc., unless there is a shortage of staff assigned to these areas.

If the other team members are otherwise busy and the hygienist is not willing to help, discontentment among the team follows. Team members may feel as if the hygienist is not a vested team member. This in turn leads to the hygienist being seen as a prima donna. Hygienists are part of the team and should be willing to be directed to help where necessary. On the other hand, more than 0.5 openings a day on the hygienist schedule is an indication of broken systems in the practice, such as an ineffective recall system, lack of periodontal assessment or too many hygiene days. An analysis of the hygiene department to assess systems is in order.


When there aren’t standard operating procedures, well-defined job descriptions and areas of accountability, team members begin to develop their own ideas of what each person should or should not be contributing. In any well-run establishment there is a plan. Take a football team, for example—the quarterback has a definite job, as do the wide receivers, the running backs, etc. If they are going to be successful as a team they all need to focus on their individual job descriptions. Though the major job responsibilities in a dental office are basically understood (the Business Coordinator runs the front desk, the Assistant assists the dentist, the Hygienist cleans the teeth) issues tend to stem from smaller, not-so-defined tasks. Who is supposed to scrub the instruments? Who is responsible for emptying the trash? What is supposed to be done when there is down time? If these tasks are just left to whoever has time or whoever gets to it first, there is going to be discontentment, especially when some members take responsibility and others don’t.

The dentist ultimately is the person who is responsible for determining who has the primary responsibility for doing which tasks. With written job descriptions, it is easier for the dentist to address a lack of responsibility being taken for required tasks. While sharing duties, chipping in and all team members doing the same amount of work is a wonderful concept, it won’t begin to happen without the implementation of protocols and job descriptions.

Need help with implementing new systems in your hygiene department to ensure stellar performance? Email

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