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  Sally McKenzie's
 Weekly Management e-Motivator
  2.13.04 Issue #101

California Dental Association Endorses McKenzie Management
It is a tremendous honor to receive this recognition from the CDA. To be among those companies singled out for their ability to provide the very best programs and services to California Dental Association members is a distinct privilege. McKenzie Management is one of the first practice management companies to be endorsed by any state dental association. Our sincere thanks to you for your friendship and continued support that have helped us to achieve such high levels of distinction.
Sally McKenzie, President and CEO

Clinical Efficiency – It’s Right Before Your Eyes

Sally Mckenzie, CMC
McKenzie Management

       Dentists are suffering from a serious case of busyness. Sounds like the ideal small business dilemma – save one major drawback; busy doesn’t translate to better production. In fact, often dental teams will feel they are constantly on the run only to find production at a crawl.

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 you

seldom if ever notice the details. Dentist and assistant fall into a pattern of performing procedures the same way repeatedly, giving minimal thought to efficiency. What’s more newer dentists 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 trying to find a small opening to insert the suction 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, patients are backed up, days are long, and tempers are short.

Surprisingly, significantly improving chairside efficiency often 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 she 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 major 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. 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 must delegate every procedure, patient interaction, and staff matter legally allowable in their state if they want to achieve maximum efficiency. For example, most states allow dental assistants to remove a temporary crown, clean the tooth and try on the permanent crown. However, often the dentist is performing these procedures, which is clinically inefficient.

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.

If you have any questions or comments, please email Sally McKenzie at

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Tech Tips For Today!

Designed to improve management techniques through your technology platform

Mark Dilatush
VP Professional Relations
McKenzie Management

    Last week, [see article], I finished discussing the minimum technology requirements of the scheduling coordinator job description.

This week, we start a whole NEW chapter in e-Motivator history. The column has a brand new title! Management Technology…Tips For Today will be a series of weekly practice management/technology tips and to-do’s designed to improve your practice management technique through the use of

your existing technology platform. Readers of the e-Motivator have asked for these tips in small “bite sized” chunks so they can print and implement each and every week.

Calculating Patient Flow
The business administrator or scheduling coordinator in your office should run these calculations once per month. You might as well start this week right! The whole team should know the results.

Step #1
Confirm with everyone who posts procedures to a patient ledger that ADA code 00150 is only used for new comprehensive examinations. If this is not the case, take the steps necessary to make sure ONLY ADA code 00150 is used on brand new comprehensive patient examinations in the future.

Step #2
Each month, run a Production by Provider, Practice Analysis or Production by ADA Code (different names depending on your software system) report for the past 12 months (exactly). For instance - 2/13/03 through 2/13/04. The report will tell you exactly how many 00150’s were performed in your practice in the past 12 months. Jot down this number on a piece of paper.

Step #3
Each month, on the same day you run the production report, run an overdue recall/continuing care report for the same exact date range (the last whole calendar year – same as above). If your practice management system tracks the number of recall notices received (some systems call this motivated recall), make sure the “notice due” range is a wide one. What we’re looking for here is EVERY human being who was due back into the practice during the past 12 months. When your computer system is done finding all the patients, just print the report to the screen. Some practice management software will tally all the patients on the report and tell you how many there are on the last page. Some, you have to count. Simply count the number of patients on one page and then multiply that number by how many pages.

Jot that result on a piece of paper right next to the number of new patients.

Example: (300 new patients vs. 350 existing patients overdue for recall)
You’ve just calculated your first patient flow ratio!

Healthy Patient Flow Ratio (established practice – 6+ years)
2:1 ratio
Example (300 new patients vs. 150 existing patient overdue for recall)

Healthy Patient Flow Ratio (newer practice – Years 1 through 6)
Typically a brand new practice will have an incredible ratio. Years 1 through 3, look for a healthy ratio to be at or above 4:1. Years 4 through 6, a healthy ratio will slowly work its way down to a nice 2:1 ratio. Use these as benchmarks only! Compare these each month to the month prior. You might even start a real simple spreadsheet month by month.

I hope you find the new format of this article series useful and something you can implement immediately.

I welcome any and all readers to email me with specific questions, problems, requests and challenges. Who knows? Maybe your inquiry will lead to a new Tips For Today article! Don’t worry, your inquiry will remain anonymous.

Interested in having Mark speak to your dental society or study club?
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Getting The Cold Shoulder


Giving Dentists And Their Staff Different Perspectives On Day To Day Issues

The Concepts of Leadership and Management

A Continuing Discussion

To reiterate last week’s discussion [See Febuary 6th issue] ... there is a great deal of talk these days about leadership. It is a big concept that is thrown around in national and international politics and corporate America.

Today, the concept of leadership from politics and economics has been rationalized down to the level of the small business. This process has led to ambiguity, distortion, and confusion over how it should or should not apply. These detriments not only confuse the office staff who pines for a great leader on horseback, but also is distorted by the business owners who perceive themselves to be more responsible than they really are or need to be.

This week's column is a continuing discussion of the difference between leadership and management. For the sake of clarity, I believe that all business owners must be managers first and leaders second. The reason for this definition is that the goal of the office practice is simply to carry out the product and services as promised, effectively and efficiently. The typical office practice is not challenged with the responsibility of guiding millions of people and billions of dollars. Ours is a very simple challenge: make money and enjoy the day.

Systems and People

Today, we take television and the role it plays in our lives for granted because it is so interwoven into the fabric of our lifestyle. However, there was a time, immediately after the invention of television, that a question was asked, "So what do we do with it, how do we use it, what is it good for? " Several formats were discussed and, believe it or not, the idea of selling advertising in between the programming was not one of the first ideas, but rather one of the last and met with enormous doubt and opposition.

The meaning of this documentary anecdote is that everything in our lives at one time was an isolated event. Over time, that technological event integrated into a system that produced a product or service that would pay for itself. A dental practice consists of literally thousands of technological breakthroughs that have been integrated into a business system.

The challenge in every office is to manage, control, facilitate, and advance the human relationship regarding all of the systems that are in place in the average dental practice today. Running any business today requires two levels of authority. One level must focus on the systems in place and maintain them with great certainty that the systems operate as designed. The judgment involved in this responsibility amounts to recognizing when office systems and business systems deviate from the prescribed format, and then taking corrective action.

It is the manager's responsibility to understand the nature of every system in the office. Such responsibility assures that decisions which must be made, can be made effectively and decisively. Good decision-making is essential if the overall integration of all the systems is to continue to operate efficiently. Managers keep the engine running smooth.

In businesses, every system consists of materials and people. These systems, in and of themselves, will not generate profitability. These systems must be implemented in order that the exchange of service for profitability takes place. It is the people who operate the systems that make it all work. People are the most important component. Good people can make up for faulty systems, but the reverse will never be true in a service industry like dentistry.

The leader of the team of any business is responsible for the selection and elimination of personnel. The leader is personally responsible for choosing the people who will run the systems. Accurate and effective hiring and firing is perhaps the surest way of creating a great team and guaranteeing a good working environment that will lead to excellent production. It is the leader’s capacity to know people and to assess their strengths and weaknesses, which assures the success of the businesses and the team. Therefore, the good leader must know themselves before any attempt to organize their systems can be successful.

Trust and Control

There are those who fantasize that they have power and influence; however, deep down inside, they know of their own insecurities, despite their best efforts to hide them. Within any work environment, that involves the interaction of people, recognition of real power and real responsibility is the first part of building a business. To be successful working with other people, you must recognize who has the power, who does not, who wants it, and what is your job description.

The second part of building a business concerns the ability to maintain and control the relationships which must interact as deemed appropriate by the structure of the business. Within any business operation, it is the manager who is responsible for controlling the personnel. The topic of control is quite complex and beyond the scope of this column; however, there is a frequent mistake regarding control made by thousands of practices.

In the name of power and influence, thousand of leaders desiring to position someone in control choose their manager based upon the presumption that “years in service” reflect upon the ability to manage people. This is simply not true. Years in service only reflect one's personal history and need to earn an income. One's ability to control and influence people has absolutely nothing to do with years of service.

The manager's job is to control the implementation of the systems that have been put in place by the leader of the business. Managers are responsible for controlling the movement in and out of the business arena and this would include products, services, and personnel. Years of service do not make a manager. Managing people is about letting go of control when appropriate and increasing control when necessary. This is about personality and temperament rather than years of service. Managers who can run things have the personality for it.

If the manager is responsible for control and maintaining the direction of the business, then the leader is responsible for providing an environment of trust so that everyone will move together. When there is trust in the leadership, everyone on the team will perform their jobs in a coordinated effort to move in a direction for the common and individual good.

People will move in a common or individual good if you give them what they need. Such a presumption of direction will materialize under the right circumstances. Leaders who are confident and convey direction and purpose to their method will discover that their people have little difficulty trusting them. For those leaders who fail to display these essential qualities, they will be perceived as not warranting the team’s trust. As a result, the manager will find it hard to control, and the staff will find it difficult to maintain a good working spirit.

The leader is therefore responsible for the working spirit of the team and the ability of the manager to control the day-to-day operations. The leader exercises this influence through the ability to generate a sense of trust. Perhaps this is the greatest responsibility of the leader. The manager cannot create trust. In order to create trust, the owner of the business must be believable. Leaders, who do not like people, cannot be expected to generate trust, since they do not understand what makes people move to the left and to the right. Before the leader can know others, the leader must know themselves.

Regards, Coach

Want your issues answered? Ask the


Wish Your Chairside Assistant Were More Efficient?

Optimizing Team Performance!

How long have you been practicing inefficiently? Are all those compromises you've been making worth the price of lost production and the physical wear and tear on your body? Wish you could choreograph your chariside team for optimal performance? If so, then this DVD "Optimizing Team Performance" was designed for you! This training resource was produced by Risa Simon, a certified management consultant, published author and one of dentistry's top clinical management speakers. Don't waste time watching videotapes when you can dial up topics of interest from the DVD's scene selection menu. Scenes include: Posture & Positioning, Magnification & Illumination, Assistant Access & Visibility, Ergonomic Work Zones, Chairside Efficiency Techniques, including Instrument & HP Transfers for efficient 4 handed & 6 handed dentistry - a must for every office!

e-Newsletter special: $59


McKenzie Management, Inc. has been named the WINNER in the DentalTown Magazine and 2003 Townie Choice Awards™ for Practice Management Consultants.

“It is an overwhelming honor to be singled out by literally thousands of dental practices across the country as the number one dental practice management firm,” said Sally McKenzie, President, McKenzie Management. “We know that dentists take great care in selecting only the very best products and services, and to be among this elite group is truly a testament to the commitment the McKenzie Management team has demonstrated over the past 23 years to provide consistently superior consulting products and services,” added Ms. McKenzie.

The McKenzie Management Team looks forward to continuing to provide the very best consulting services so that dental practices in turn can perform at their very best.


McKenzie Management, Inc.
737 Pearl Street
Suite 201
La Jolla, CA 92037

Sally's Mail Bag

Dear Sally,
We want to establish a bonus system based on collections and factoring in overhead. Can you give me some ideas of a good bonus structure?
Dr. Goodfellow

Dear Dr. Goodfellow,
There is no formula that is completely fair to you or employees but, if you are going to have one, my suggestion would be to know for the past 12 months what your overhead costs have been and you expect those costs to be 55% of x ( collections). So, if your average overhead for the past 12 months averaged $35,750/month, that expense is 55% of $65,000. It might behoove you to add a 10% surcharge on top of the $65,000/collections for unexpected emergencies. Payroll (gross) should be no more than 21% of the collections which is $13,650/month. If collections go above the $65,000, say $70,000 you would allocate 21% of the $5000 overage or $1050 as bonus. Now...the question becomes, do you divide it equally? Do they equally put out the same effort? Usually not. I would also recommend that you NOT give them 100% of the $1050 but give them (example) 75% of the $1050 and $262 goes into a "savings" account for those months when collections dip below $65,000 and you still have to meet payroll. That's when the whole "bonus" structure becomes unfair. The employees get rewarded if collections rise but nothing is taken away if the collections take a dip. It's win/win for them and potential win/lose for you. Hope this is helpful.
Best regards,

IN 2004?
Dr. Allan Monack,
Hygiene Clinical Consultant for
McKenzie Management,
develop a profitable
Hygiene Department

To find out more about the
Hygiene Clinical
Enrichment Program
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For a FREE
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e-mail us at:
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Missed Past Issues of Our e-Motivator Newsletter?

This issue is sponsored
in part by:
The Center for Dental Career Development
San Diego Workshop Series
Fall/Winter Schedule
 Date Seminar Instructor(s)  
 Mar. 5
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Sally McKenzie, CMC.  
 Apr. 7
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Sally McKenzie, CMC.  
 May. 7
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Sally McKenzie, CMC.  

The Center for Dental Career Development has been approved under the Academy of General Dentistry Program Approval for Continuing Education (PACE) program. Starting 10/19/03 through 10/18/07 members of the Academy of General Dentistry can receive AGD credits for all seminars and workshops sponsored by the Center for Dental Career Development.

Please visit to view a list of upcoming seminars and workshops.

To Register 877-900-5775 or

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