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  Sally McKenzie's
 Weekly Management e-Motivator
  7.09.04 Issue #122

Employees – a Potential ‘Fire’ Hazard

Sally Mckenzie, CEO
McKenzie Management

       It is the rare individual that doesn’t struggle with this professional challenge. Perhaps the situation involves Julie who is a relatively new hire. She was so enthusiastic in the interview. Everyone thought she would fit in perfectly, but this dream employee has decided she’s the Diva of the Dental Practice. If the task at hand doesn’t fit neatly into what she perceives to be her job, it’s not getting done. Or maybe in your office it’s Wanda who has practically built the Great Wall of China between herself and any system change. She’s a long-term employee who came with the practice. She has a lot of patient history, so you

had long hoped she would just retire. But you know you can’t sit on this any longer. Regardless of the scenario, the decision to terminate an employee can be one of the most challenging – if not the most difficult – a dentist will ever face.

Understandably, at 3 a.m. when you’re agonizing over the decision at hand instead of getting a good night’s sleep, the path of least resistance looks like the yellow brick road. But small offices depend on the quality work of a dependable team, and deadwood can’t just float along in your operation.

Ideally you will avoid ever having to fire an employee by following a few simple, yet positively critical steps to avoiding major personnel headaches.

#1 Every single one of your employees must have a clear job description in writing that defines the job they are responsible for, the skills they must have, the specific duties and responsibilities that rest on their shoulders.

#2 Train them! Too often new hires are thrown into a busy practice situation, shown the computer, given the instrument tray, or whatever, and offered an encouraging, “Go get ‘em.” Ha! How exactly are they supposed to do that? Save your sleep, preserve your practice, marshal your team – train the staff.

#3 Provide all employees access to a policy manual that clearly spells out the code of conduct, dress code, policies regarding sick leave, tardiness, overtime and overall office procedures. Every employee, new or existing, should have easy access to the office policy manual. This does not need to be a long and cumbersome tome, but it does need to spell out the rules of the game.

#4 Provide regular, consistent, ongoing feedback. We’ve talked about this recently in the e-Motivator. Constructive feedback should be given daily to help employees continuously fine tune and improve performance. If you avoid telling staff what you don’t like, you are reinforcing poor performance. What’s worse, you undermine their ability to succeed.

#5 Formally review performance regularly. Performance reviews are one of the most effective tools in creating a total climate of success in your practice. They provide an objective and neutral means of leveling the playing field for the entire staff. Employees rated against objective measures place more trust and confidence in the review process. They also see the direct relationship between their performance, the success of the practice, and ultimately their potential for individual achievement. Provide job expectations in writing, and rate the employees on those expectations.

Too often doctors and team members complain to one another about a fellow staff member, but are afraid to raise concerns with the employee. The consequence of this behavior is that the doctor eventually traps him or herself into having to fire the employee. Take every reasonable step to prepare the employee for success. If you’ve done all you can within professional reason and the problems persist …

Next week, dealing with the inevitable – firing an employee.

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

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The Consultation

From the Patient’s Perspective

         You are a master clinician yet patients routinely refuse or are slow to accept recommended treatment. Indeed, at times it seems that convincing a patient they need the treatment is more grueling and challenging than dental school ever was. In other cases, a patient appears to be fully ready to forge ahead only to

“change their mind” before the first scheduled appointment.

Because doctors receive very little, if any, training in case presentation, the process can cause considerable unease. In some cases, the dentist is as nervous as the patient. They know that presenting a case can make or break the relationship. Yet they often forget that like expert dentistry, it requires ongoing training, education, and practice.

Improve your presentations/consultations by evaluating four key factors:

  1. Surroundings
  2. Attitude of the dentist
  3. Language of the presentation
  4. Patient’s ego which will accept or deny the case

Take a good look at the ceiling in your operatory and you’ll better understand how patients view your case presentation. Too many dentists present their cases in the operatory. From the patient’s standpoint, this is the worst place to try to discuss a recommended treatment plan. The patient is naturally guarded here because they are at the mercy of the dentist. In this space the doctor is in a position of power that the patient is hesitant to question. Consequently, patient buy-in is considerably more difficult to achieve in the operatory. Changing the setting alone to an office or consultation room will improve case acceptance immediately because you’ve leveled the playing field for the patient.

The ideal setting is a consultation room that is warm and comfortable. The patient and doctor sit at a table and review the presentation together. The patient has a pen and paper to take notes and jot questions, and they are fully engaged in the process. They are not having something done to them, they are actively participating.

If a consultation room is not available the dentist’s private office is commonly used. Take care to keep the office orderly. When a patient walks into a cluttered, messy office it sends the message that doctor is disorganized and has a poor attention to detail. There should be a clear place where you can show the patient what is needed whether you use X-rays or models in your presentation.

Listen to the patient. Many doctors hear their patients but they do not listen. The doctor is usually so focused on getting out all the facts that he/she doesn’t listen to the patient’s questions or concerns. Welcome, encourage, and prepare for questions. Questions are your best indicator that the patient is both engaged and considering your recommendations.

If a patient asks a question and you do not have the answer, write the question down and tell the patient that you will find the answer and get back to him/her. Understandably, this is challenging for dentists who, as doctors, often feel they should have all the answers. However, patients respect the dentist who is honest about not having all the answers all the time. Say to the patient, “That question has never come up. I will find out for you and get back to you.” This reinforces the patient’s role in the process, and you have made them feel pretty smart because they have asked a question the doctor will research.
Remember to call the patient with the answer. This is the reason you wrote down the question.

Be careful not to speak above or below the patient’s level of understanding. Present the case in terms the patient can understand. Avoid clinical references or prematurely using materials that may graphically demonstrate the procedure before the patient is emotionally committed, causing them to reconsider the treatment. Clearly list the benefits and tie in emotional motivators at every opportunity. Encourage the patient to ask questions. Use testimonials from other patients who have had similar treatment and urge the patient to talk to the other successful patients. Nothing has more impact than the endorsement of another successful patient. Train and involve the entire team in reinforcing the treatment plan with the patient.

The objective is to excite and make the patient feel good about the possibilities, so he/she wants the work and feels that he/she deserves the work that you can provide.


Tracking Your Hygiene Department

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

         In past articles, I have discussed how your hygiene department can be profitable. The following tools will help you to monitor your success while you are implementing new ideas and helps to keep you informed if everything is on track. It is essential that you continually perform these tracking monitors to insure you are on target for your hygiene goals. If you determine that the numbers are not within the parameters you established, you can correct these areas early enough to avoid loss of

productivity. These are only areas in the hygiene department monitors. Mckenzie Management’s Practice Enrichment Program™ evaluates over 20 systems of the practice and teaches you how to monitor all aspects of your practice. I recommend that if your numbers are deficient in your practice you consider a complete practice analysis by Mckenzie Management.

There always is confusion on who an active patient is in the practice. It is important in order to calculate how much hygiene time you need in the practice. It also helps you monitor the growth of your practice. Mckenzie Management defines active patients are those patients that have not missed more than two recall or maintenance intervals. If the patient is on six month recall and they have not returned for their professional cleaning within eighteen months, they are considered inactive and should be purged from the active patient list after review of the “effort” that has been applied to retain them in that period of time. Hopefully, all the protocols to get the patient to present for hygiene maintenance have been exhausted by then. You should be able to retrieve this information from a computer report or you need to physically count all the charts and purge the ones that do not fit into the definition. Calculate this monthly.

This is probably the most time consuming statistic to determine accurately. It is very important to have the correct amount of time available for your active patients and new patients so you do not get too backlogged or have too much open time with no patient list available to help fill the hygiene appointment book. Generate a recall report of patients due with and without appointments from today to one year from today. Determine how many are on 2, 3, 4, 6, 9, 12 etc. month appointments. This number should approximate your active patient number. Multiply the interval by appointments needed per year. (ie: # of 3 month intervals X 4, # of 6 month intervals X 2, # of 9 month intervals X 1.33, etc. ) This will give you the total yearly hygiene appointments needed for your active patients (A). Determine the total number of comprehensive exams performed in the last 12 months (B). Determine the number of quadrant scaling and root plane performed in the past 12 months and divide by 2 (C). Add A+B+C=D. (D) is the number of appointments needed. Divide the total # of appointments needed (D) by the total # of weeks the hygiene department will work. This equals (E). Divide (E) by the average # of hygiene appointments daily per hygienist. This is the number of hygiene days per week the office needs to meet the needs of your practice. Calculate this quarterly.

Divide the amount of non prophy related services performed by your hygienists by the hygiene department total production. Examinations should not be included as that is the Doctor’s production. This should be at least 30% of the total hygiene production. Calculate monthly.

Divide the total hygiene production by the total office production. This should be 33% of the total office production. Calculate monthly.

Ideally, you want to have no more than 0.5 appointments open per hygiene day unfilled. Less than 1.0 is good More than 1.0 is unacceptable. Total all the unfilled appointments per week and divide by the # of hygiene days that week. If the number is consistently greater than 1.0 you need to find out why and correct the problem. Calculate weekly.

In conclusion the office needs to stay on top of the hygiene production. It is the key to a successful growing practice. When the statistics are not correct, discover why and implement the necessary procedures so the office can continue to be productive and efficient.

If you have any questions concerning your hygiene program submit them to me at allan@ and I will answer them in future articles.

Interested in having Dr. Allan Monack speak to your dental society or study club? Click here

McKenzie Management’s Hygiene Clinical Practice Enrichment Program is designed to improve Hygiene Clinical Skills and develop and implement a step-by-step Interceptive Periodontal Therapy Program that will immediately bring greater productivity, with enhanced patient care. For more information...GO HERE


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Sally's Mail Bag

Hi Sally,

We have a quick question for you concerning bonus structures. We have FINALLY reached our BAM (basic monthly amount to cover overhead) and are beginning to calculate bonuses. My question concerns collections. We base the bonus on collection. However, we are not sure (for bonus purposes) how to handle the discounts. For example, if someone pays cash we give them a 10% discount. The total collection goes into the system but the total collection for the month is offset by the discount. Should the credit adjustments be included in the collections figure when we are figuring bonuses? We offer a variety of discounts including a senior discount, community organization discounts, etc.

Business Manager

Dear Pam, can’t pay what you don’t deposit in the checking account. Therefore any collection amount figured in a bonus must be “adjusted”.

You should also consider items such as: how long a person has worked there, what about taking vacations and what if a front desk person doesn’t collect the money? The chairside and hygienist have no control over their bonus. There are many other measurements of a practice that should be considered to determine if a practice is successful other than collections. What happens on those months when you are below BAM? Do employees get their paychecks cut? Or what happens when you need to hire another employee? Or you have a break-in and all your computers are stolen? Make sure you have thought out ALL ramifications before implementing because once you do and you try to take away... you will have a very bad situation on your hands.

Good luck,

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

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This issue is sponsored
in part by:
The Center for Dental Career Development
San Diego Workshop Series
Summer Schedule
 Date Seminar Instructor(s)  
 August 6
 9:00 - 4:00
10 Vital Skills to Master Management of Your Dental Practice Belle DuCharme, RDA, CDPMA  
 August 27
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Belle DuCharme, RDA, CDPMA  

The Center for Dental Career Development has been approved under the Academy of General Dentistry, Program Approval for Continuing Education (PACE). 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

Southern Oregon Dental Society Presents
Ms. Sally McKenzie
“The Hidden Signals of Practice Erosion”

Friday July 16, 2004 from 8:30 am – 4:30 pm at the Smullin Center 2825 E. Barnett Road, Medford Oregon 97504

Reservations may be made in advance by calling SODS at 541-773-6215

Be sure to plan on enjoying Rogue Valley’s many fine attractions. Choose from: Shakespeare, Britt Festivals, Rafting, Golf, An Italian Cooking Course and much more!

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