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  Sally McKenzie's
 Weekly Management e-Motivator
  9.03.04 Issue #130

Everyone’s Job
No One’s Responsibility

Sally Mckenzie, CEO
McKenzie Management

       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 that

everyone is to step in and “help out” whenever and wherever they are needed.

Unfortunately, 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?

Instead 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 so.

It’s 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.

Next week, pull back the “covers” on everyone and start building a team that is proud of what they do and accountable for the outcomes.

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

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Is A Hygiene Assistant Right For Your Practice?

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

        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.

The Vision
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 an assistant.

The Physical Plant
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 on scheduling

The Schedule
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.

The 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 with care.

It 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.

Assistant’s Role
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.

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

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


“DENTAL RECEPTIONIST WANTED” Experience preferred, will train interested dental assistant.

Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development

         Advertisements, 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.

Years 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

there 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.”

My 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.

A 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?

For more information, call THE CENTER FOR DENTAL CAREER DEVELOPMENT 1-877-777-6151.

Belle M. DuCharme, RDA, CDPMA

Exceptional Front Office Employees?
The Center for Dental Career Development can provide your team with “customized” expert training to improve the performance of your practice ...Go Here Now...


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C.E. Magic! Releases First
of Its Kind, Interactive DVD Learning Kit
for Dentistry

By Leslie Fang, M.D., PhD and Robert C. Fazio
C.E. 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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** To take advantage of this amazing tuition offer ... doctor and staff must stay at the Aladdin Resort & Casino.
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