No One’s Responsibility
This is one of my all time
favorite lines: “Everyone on my team covers for
everyone else.” I’ve heard it so many
times from doctors that I’ve wondered if they didn’t
all read from the same script. I know your intentions are well placed.
You tell yourself that you don’t want there to be a situation
in which a system shuts down simply because a specific employee
is out or has up and quit. You hang your hat on this concept called
cross training. The problem is no real training has ever actually
taken place. In most cases there’s just a general expectation
is to step in and “help out” whenever and wherever they
in reality this approach serves more as a handy excuse to avoid
any number of sound business policies. For example, practices that
engage in the “everyone does everything” strategy typically
avoid job descriptions. The dentist will claim.
“Well I don’t want to box my people in. I want employees
to have the freedom to step in and help in virtually any area of
the practice.” That certainly sounds like a noble reason;
unfortunately you are unwittingly justifying gross inefficiency.
Consider this, business employees, assistants, hygienists - are
all scheduling patients, answering phones, dismissing and collecting
from patients, and conducting consultations. But when collections
are down whom do you talk to about taking steps to shore up the
numbers? How do you schedule to meet financial goals when any open
slot is open season for any procedure? Can anyone remember whose
turn it is to work the cancellation list when the hygienist
is reading her professional journal or filing patient records because
she/he has unfilled appointments?
you hear the chorus of excuses. “I thought she was taking
care of that. Oh, I didn’t know we were supposed to do that.
When did we start doing this? Uh oh, how did that happen?”
The “everyone is responsible for everything”
approach accomplishes one thing every time: a total lack of accountability.
Not because your team is incompetent or unwilling, but because there
are no real expectations, there are no real measurements of performance.
No one is taking ownership, responsibility, or genuine pride in
the outcomes of any one system because they are not allowed to do
hard to let go of this practice management myth, until you consider
the practice management reality: There is simply no way goals can
be established, let alone met, if individual team members are not
expected to take ownership of practice systems.
week, pull back the “covers” on everyone and start building
a team that is proud of what they do and accountable for the outcomes.
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
A Hygiene Assistant Right For Your Practice?
Dr. Allan Monack
Hygiene Clinical Director
Have you thought about
adding a hygiene assistant to aid your hygienist? Having a clear
vision of an assistant/hygiene model is important for its long-term
success. Developing an outline of the delineation of duties
and responsibilities of the hygiene assistant and the hygienist,
ahead of time, will help the entire team to understand the process.
It is important that the primary goal is to improve the quality
of care for your patients. Secondarily, assisted hygiene
will increase the production of your hygiene department. The result
will be a better hygiene visit experience for your patients who
will have a greater awareness of their dental health. There will
be a higher treatment acceptance rate and it will
be easier to complete the proper therapy. Finally, there will be
more quality time to educate the patient on other services that
are available as well as any incomplete treatment plan, less stress
on the hygienist, and more patients treated per hygienist than without
Unfortunately, this assistant/hygiene model doesn’t work if
there is only one treatment room available for each hygienist. It
doesn’t make sense to have the hygienist not producing while
the assistant is performing her duties. Additional treatment
rooms are in order for this system to be efficient. There
are two possible scenarios that can be implemented. The first is
to have two rooms for each assistant/hygienist team. This would
allow you to schedule 25% more patients than with one hygienist
without an assistant. The second scenario is for one assistant to
support two hygienists using three treatment rooms. This team could
then treat 15% more patients per hygienist than without an assistant.
In this case the assistant will have less time to perform tasks
that can be accomplished in the first example. However, there is
an exception to the rule which is illustrated in the next section
The one assistant-two hygienist-three room model works best if there
is an ongoing conservative periodontal therapy program
in place. When there are longer appointments the assistant can be
helping the hygienist with the maintenance patients while the other
hygienist is performing quadrant or half mouth scaling and root
planning therapy. Ideally each hygienist’s schedule should
have two periodontal therapy patients per day. The scheduling coordinator
should stagger the periodontal therapy so the two
hygienists are not performing this treatment at the same time. If
there are enough ninety minute plus appointments, then the number
of patients seen can approach the one assistant/one hygienist model.
first model allows for the maximum utilization of the assistant.
The proper appointment control is critical for successful patient
care. The scheduling coordinator must have an understanding of the
dynamics of the relationship between the hygienist, the assistant,
and the patient. The duties of the hygienist and assistant must
be well defined and open communication between the two should exist
in order that the treatment needed is performed efficiently and
is important that the patient receive an adequate appointment time.
In most instances the patient will have more quality time
with the assistant or hygienist to meet their needs. Since, the
next patient is seated and being seen by the hygienist, the staff
is not as stressed waiting for the doctor to examine the patient.
The assistant’s duties can consist of seating and dismissing
the patient, being present during the doctor’s examination,
recording periodontal findings, taking necessary radiographs and
other diagnostic tests, instructing the patient on oral hygiene
and discussing treatment options that have been
recommended by the doctor. The assistant can also explain any post-treatment
instructions, assist in writing the clinical notes, getting the
patient to value their next return visit, and hand off the patient
to the financial coordinator. This will allow hygienists the maximum
time to perform the specialized skills they are trained for.
If you incorporate a well thought out plan to add an assistant to
the hygiene department and have your staff trained properly, understand
the vision, and receive the cooperation of your staff, you will
benefit from better patient care, less stress and
an increased productivity from your hygiene department.
you have any questions concerning your hygiene program submit them
to me at firstname.lastname@example.org
and I will answer them in future articles.
in having Dr. Allan Monack speak to your dental society or study
DOES YOUR OVERHEAD
RECEPTIONIST WANTED” Experience preferred, will train interested
Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development
like the one above, appear in the local newspaper often, to my dismay.
As the instructor of advanced business training at THE
CENTER FOR DENTAL CAREER DEVELOPMENT, it is disheartening to
see that the most critical position in the dental office is thought
of as something that can be taught between seeing patients.
ago, after I had completed college and had graduated from an accredited
dental assisting school, I was hired as a full time dental assistant
for a busy general practice. I had been
a year, when the “receptionist” took ill and could no
longer work. My employer, Dr. Q., came to me and said, “Belle,
I am promoting you to receptionist because the
patients know you. This job is not difficult. Answer the phone and
fill in the appointment book every day. If you do something wrong
I will tell you.” I did not have any training in filing claims,
making appointments, posting, balancing the day sheets etc. Dr.
Q. would show me briefly and then go back to patients. When I had
a question, it had to wait till later and he became increasingly
irritated when my questions encroached upon his lunch time or time
to leave at the end of the day. Insurance claims that were denied
were put in the drawer for later along with questions about delinquent
accounts and questions from patients about treatment estimates that
I could not answer. Then there were the questions: “Why didn’t
my insurance cover this charge?” “ Why do you charge
more than my insurance company says is fair?” Or remarks such,
as “I need to make payments because I don’t have the
money to pay you.” “I have to cancel my appointment
today, something came up.” “I won’t pay for this
because I never gave Dr. Q permission to do fillings on Johnny.”
frustration mounted over each encounter and I “winged it”
daily. All I wanted was to be an assistant again, but someone had
been hired to replace me. One horrible day, Dr. Q. called me into
the operatory and announced: “Please move all of the
patients up one hour, I need to leave early.” Mrs.
R. was on the schedule at 4:00. She was very difficult and always
complained about everything and then didn’t want to pay. She
agreed to come in at 3:00. At 3:30 Dr. Q. called me back and said
there was a problem with the current patient and to tell Mrs. R.
it would be another hour. Mrs. R’s response was loud and carried
throughout the office. “This is terrible, why did you call
me to come in early if you can’t see me? You are the worst
secretary and I am going to tell Dr. Q about you.” That’s
when my temperament came through as I replied, “If you don’t
like it, you can leave.” Dr. Q reprimanded me. The following
week, I was told, in a nice way, to turn in my key. This experience
taught me an important lesson.
It was training I needed not firing.
receptionist, one who greets, and checks patients in and out, is
only a small part of the position of any front office position in
a dental practice.. At THE
CENTER FOR DENTAL CAREER DEVELOPMENT, it is my mission to promote
professional business training for dental office
personnel. Our Dental Front Office training course covers job responsibilities
from Scheduling Coordinators to Business Administrators detailing
all the systems that govern the successful and profitable
dental practice such as scripting and role-playing to prevent
cancellations and no shows, ways to diplomatically handle the most
difficult and non-compliant patient, scheduling for production and
less stress, job descriptions to clarify each employee’s areas
of accountability and need for more training, and understanding
overhead and the need to keep accounts payables in line with accounts
receivables. Wouldn’t you say it is time to give your “receptionist”
the title of Dental Business Administrator?
more information, call THE CENTER FOR DENTAL CAREER DEVELOPMENT
M. DuCharme, RDA, CDPMA
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Magic! Releases First
of Its Kind, Interactive DVD Learning Kit
Leslie Fang, M.D., PhD and Robert C. Fazio
Magic! An Interactive Learning Kit entitled, “Antibiotics
in the Dental Office.” The Kit includes a comprehensive
interactive DVD, which can be accessed on a computer with
a DVD player or any DVD player hooked to a television to
watch movies. The Kit also contains a comprehensive written
summary with hundreds of printed information slides. Two
additional audiotape programs are included on the subjects
of prophylaxis in the dental office and intraosseous anesthesia.
Each component of The Kit has a corresponding post-test,
which can be sent to C.E. Magic! for grading. A dentist
who successfully completes all the components of The Kit,
and passes the tests, will earn a total of 10 CE credit
hours recognized by the Academy of General Dentistry.
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