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1.27.06 Issue #203  
Adding Hygiene Chair Time?

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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So, you have decided to add a hygienist to your practice or you are thinking about adding a day of hygiene to your already existing hygiene department, or even worse you have an existing hygiene department that has a lot of open time.

Let’s talk about what a dental office may want to evaluate when looking at adding a hygienist for the first time or when thinking about adding more hygiene time. It involves more than hiring the hygienist to fill the time and do the prophylaxis. Listed below are just a few of the things that you may want to have evaluated before adding a hygienist or more days:

  • How much hygiene chair time do you need? .
  • Are salaries in line with production?
  • Do you have an Interceptive periodontal therapy program in place? Is it productive?
  • Is your practice growing?
  • Do you have a written x-ray and periodontal recall protocol?
  • Does your Hygienist provide ancillary services?

While you may not have ever thought about how the hygiene department could be tracked statistically, we are going to look at the hygiene department as a business within a business.

For example, how much hygiene availability do you really need? Unfortunately, most dental offices determine their availability simply by looking at the schedule and seeing holes or no openings.

Are your hygiene salaries in line with production or what are you going to pay the hygienist you are about to hire? What will determine raises? You can’t have more going out of the checkbook in salaries than you are putting into the checkbook with collections.
What will the protocol be for your interceptive periodontal therapy program? How will the patient be routed through the office when they have been diagnosed with periodontal disease? Who is responsible to go over financial arrangements? Do you have an interceptive periodontal therapy program in place and if so, how successful is it? Many hygiene departments simply provide prophylaxis, exam, and bitewings with an occasional root planing.

Do you have a written x-ray protocol? Are bitewings taken every six-month, once a year or every eighteen to twenty-four months? Is your hygiene department meeting or exceeding this protocol?
I think you get the picture now, there is much more to a hygiene department than making a recall appointment.

As far as recall, how does your current recall system work or how is your recall system going to work? What is the protocol when it comes to making the next appointment for the patient? What is the office policy when it comes to no-shows and cancellations? How are you going to fill open time? Who is responsible for working the recall system? Hygienists who rely on “down time” from treating patients to work on the system rarely devote the amount of time actually needed to make the system successful. The recall system is the most neglected system in dentistry. The time required to successfully operate this system can only be obtained by delegating the task to a person who is not involved in duties, which routinely contain interruption as most front desk positions do. The recall retention system directly affects the largest patient referral source in the dental practice, word of mouth referrals from existing patients. It costs five times as much to get one new patient as it does just keeping the ones you currently have. Therefore, the practice’s investment in a retention system that will keep patients returning should not be minimal.

Having hygiene open time is a hardship on everyone. In many practices it means that the hygienist is still getting a salary and nothing is being produced. If nothing is produced, then no monies are collected but expenses are still occurring.

Our goals with the Advanced Hygiene Performance Enrichment program are to help prevent any open time, no shows, or cancellations from occurring in the first place. To have the hygiene department meet or exceed the industry standards which are:

  • 33% of practice production coming from the hygiene department.
  • Hygienist’s salaries should not exceed 33% of their production.
  • 33% of total hygiene production should come form ancillary services and an interceptive periodontal program.

So, if you are thinking about making changes or adding a hygiene department you may want to do this self evaluation above and consider having an outside professional come in to your practice in order to help prevent future chaos or breakdown with your hygiene department.

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