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  11.25.04 Issue #142

Building Your Practice Palace? Make Sure It's Not a Prison

Sally Mckenzie, CEO
McKenzie Management

Your home may be your castle, but your office needs to be the ultimate blend of form and function. As dentists rush to lock in low interest rates and begin building what they envision will be their practice palace, too many quickly discover that with just a few costly mistakes in planning they've transformed that palace into a prison.

My friend, dentist/architect Dr. Michael Unthank of Unthank Design Group (, urges practitioners to work with professionals in developing functional spaces from practice needs, wants, and goals, which are spelled out in

what architects refer to as a Design Program. These functional spaces are considered zones, and effective zones take into consideration numerous elements, from equipment and ergonomic considerations to privacy to lighting to technology. Follow a few of Dr. Unthank's primary recommendations to design the most effective zones in your solo general practice:

  • Private areas should never be on public display.
  • Create a reception area that enables the receptionist to turn 90 degrees to welcome the patient and turn 90 degrees away from the patient to conduct other business. This ensures that private conversations or transactions conducted in this work zone do not become public information to those sitting in the waiting room.
  • The area should enable patients to pay fees out of the view of others.
  • Ensure that patients and staff never are left to negotiate fees within view or earshot of others in the office.
  • Collection calls should be assigned to a separate work zone so that the staff member can make the calls in space completely removed from the appointment/reception desk or the financial arrangement area.
  • Position treatment areas so that they are not visible from the public areas, including the reception zone.
  • Designate office and break room space further away from public areas of the practice.
  • Single practitioners should plan for five treatment rooms – two treatment rooms, two hygiene rooms, one overflow room.
  • Equip all treatment rooms identically so that every room is the doctor’s favorite.
  • Equip all treatment rooms with computers and two computer screens – one behind the patient and the other in front of the patient for education, treatment co-diagnosis, and possibly entertainment during procedures.
  • Hardwire the practice to allow for technology growth and expansion in the future.
  • Involve the community in celebrating the new location by placing an architect’s rendering of the new building on the lot.
  • Involve patients in the excitement by including a rendering in the reception area and explaining to them the state-of-the-art dental care the practice will soon provide them.
  • Before you build take a seminar on office planning and design.

The physical facility is a testament to the care provided. If the dentist proclaims that he/she is committed to delivering the highest quality dentistry but the physical environment says bottom dollar cheap, this sends confusing messages to patients. And patients assess practices on numerous factors, not the least of which is the physical image that the practice projects. If the space is worn, tattered, cluttered, and generally poorly organized, patients believe that is how doctor and team operate. The office doesn’t need to be the Biltmore Estates of dentistry, and it should not create a huge debt burden for the practice, but is should make a statement about the dentist and his/her commitment to providing quality care for patients.

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

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Make Your Office a Place of Appreciation
From The Patient's Perspective

Thanksgiving is one holiday that most everyone in the United States takes time to celebrate. It is an annual reminder for each of us to pause and give thanks for the many gifts that we enjoy throughout the year –families, friends, staffs, patients, health, happiness, and prosperity.

Certainly every dentist is tremendously thankful for his/her patients. Obviously without the patients there is no practice. But equally important to the success of the office is the team that supports the dentist day-in and day-out. Many dentists have difficulty expressing genuine gratitude and appreciation to their team members. Some even consider the paycheck as the only necessary acknowledgement for a job well done.

Yet it is widely established that the most effective staff motivator isn’t a salary increase, bonus, or expensive gift; rather, it is the sincere expression of gratitude for their efforts. Study after study demonstrates that employees do their best work when they feel appreciated and valued. What’s more, thanks for a job well done consistently ranks near the top of the list of what employees want from their jobs. Saying “thank you” is the most effective, inexpensive, and underutilized incentive in the dental practice today.

As Thanksgiving and the season of giving approach, make it a point to give your employees something they will treasure – your sincere appreciation. There are many ways to make an employee feel that they are a valued and contributing member of your team, and Thanksgiving, before the holiday rush begins, provides an excellent opportunity to do so. We offer a few suggestions:

  • Consider holding your holiday party in November, rather than December. It is less likely to conflict with other parties and employees are less hassled with the holiday rush.
  • If you plan to give bonuses do so before the holiday season when the extra funds will come in handy.
  • Take some time to think about each employee’s contribution to the success of the practice and share that with them in the form of a written note of appreciation. The note can be simple and straightforward but must be sincere. During the staff holiday gathering read each note aloud to the team and hand it to the staff member with a sincere “Thank you.”
  • If you are giving holiday gifts, establish a budget. The gifts need not be expensive, but they should reflect that employee’s individual likes or interests. Identical gifts purchased en masse may be convenient, but they are often viewed as meaningless tokens of obligation rather than genuine expressions of appreciation.

Most importantly, make it a point to give thanks to your staff throughout the year. For example:

  • Thank the team for reaching established monthly or quarterly goals by treating them to the movies and snacks.
  • Create an “above and beyond the call of duty” award.
  • Provide rewards based on employee interests, such as tickets to the theatre for the Broadway fan or tickets to the hockey game for your sports buff.
  • Pay dues to auxiliary professional organizations for the employee.
  • Schedule planning meetings off site at the zoo or a museum and allow time for the team to enjoy the excursion.
  • Bring in a balloon bouquet to recognize your star employee.
  • Give a rose for each year of employment on the employee’s anniversary.
  • Write a note recognizing them for a work-related achievement and attach it to their paycheck.
  • Send a handwritten letter to the employee’s home regarding their accomplishments and value to the practice.
  • Give extra paid vacation time between Christmas and New Year’s.
  • Send the employee for a “day of beauty” at the full-service salon.
  • Make it a point to recognize at least one employee every day for something they did that you considered exceptional and share that accomplishment with the entire team during the daily huddle.
  • Encourage all staff to catch each other going above and beyond, and share those “acts of excellence” with the entire team.

Thank You: Two simple words that make a world of difference to your loved ones, your patients, and your team. We at McKenzie Management thank you for all your support, your referrals, and most of all your friendship. We are honored to be able to help your practices grow and flourish.

Share your comments, questions, and “patient perspectives” at

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Can You Change?

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

One of the most difficult transitions for the team after an in-office consult is determining that a prescheduled appointment model in hygiene has not been working effectively for that office. Many dental offices do preschedule their six month recall visits because it is a very easy system to implement. However, there are many factors to evaluate its effectiveness for your office. While I am not saying that every office

should eleminate prescheduling but first evaluate its effectiveness, this article will focus on possible advantages to eliminate prescheduling. However, changing this system requires a change in the mindset of the patients and the staff.

What are the disadvantages of scheduling six months ahead? Prescheduling gives a false sense that the hygiene appointment book is full, when in actuality there are appointments that will not be honored or patients will cancel at the last minute making it impossible to fill the time. In our busy world the patient has difficulty knowing their schedule in six weeks much less than in six months. If everyone already has an appointment where is the list of patients to call that need an appointment?

When the appointment book is full where do you insert new patients in the hygiene schedule or the scaling and root planning that was recently diagnosed? Do you place these patients on a call list hoping for the right opening to occur to get them in the schedule? Can you guarantee that they will be seen within three weeks? Will your hygienist be able to complete the necessary conservative periodontal procedures in a timely manner?

What happens if your hygienist needs to take a regularly scheduled day off? Where do you put the patients that need to have their appointments rescheduled? When you schedule six months in advance how do you get a day off for continuing education, the flu, or a funeral?

There are some offices that have educated their patients that if they don't keep their appointments it will be months before they can be rescheduled. Does this benefit the patient's oral health? Does this send the message that the six recall appointment or the three month periodontal maintenance visit is not that important if another eight weeks goes by before the patient can be seen? Do you think the patient that does value their maintenance or recall visit, who unfortunately had to change their appointment, may consider leaving the practice because they could not get an appointment in a reasonable interval?

It was much more difficult before good dental software to track the patients in the practice. Now, most of the difficulty in communicating with your patients is eliminated with letter merge and accurate reports of the patient's maintenance status. The difficulty is establishing the correct protocol to maximize patient return and retention.

Any major system change takes careful planning, communication and commitment. The staff needs written guidelines on eliminating prescheduling. Staff meetings on implementation are paramount to a successful transition. Do you stop all prescheduling or phase it into the practice? Do you modify the protocol by prescheduling intervals of three months or less? It is important to test the new protocol that is established and modify as warranted. Everyone on the staff has to be involved in order to convey a consistent message to the patient. The benefit to the change in procedure needs to be communicated to the patient. The patient must understand the value of their maintenance visit. Give them a reason to return in a timely interval other than to have their teeth professionally cleaned.

Utilize the computer generated reports to contact the patients due or overdue on a regular and consistent basis. Establish when the patient should be notified that they are due to return for their hygiene visit and when the patient needs to be called if they have not contacted the office to schedule their appointment. How often and at what interval should you communicate with the overdue patient before you place them on the inactive list?

Before you make any changes, have every protocol is in place to give you a smooth transition and allow you to succeed. If you can eliminate prescheduling hygiene, the benefits to your office, staff, and patients will give you the ability to be more flexible with scheduling, appoint highly productive conservative periodontal therapy and new patients quickly, and increase the patient's perception that their maintenance visit has value.

If you have any questions, please 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.


I just can't say enough wonderful things about McKenzie Management and their help in making my practice a "business," not just a "place of dentistry." I learned so much from McKenzie Management that I can't begin to tell you how it's impacted my life. If I hadn't contacted McKenzie Management, I would still be in the same unorganized, "flying-by-the-seat-of-my-pants" routine that I had been in since I started my practice. I now know with the business principles that McKenzie Management has taught me and of course my willingness to learn and perfect new techniques, that my dream of having a million dollar practice is very attainable and will be here sooner than I had originally thought.





How To Reward
Your Dental Team

by Sally McKenzie, CMC

Learn when and how to reward your staff. Understand why saying "thanks" can mean more than dangling a financial carrot. This book is full of checklists and questionnaires to help you determine what rewards are best suited for each of your team members.

You will understand when to use non-financial versus financial rewards, when to use group versus individual rewards, plus how important it is to set performance goals so you know when to give a reward. You will learn the difference between rewarding employees for outstanding performance versus paying them a bonus for simply doing their job.

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Sally's Mail Bag

Dear Sally,
Hi Sally, My staff keeps saying they need another assistant to help keep everything running smoothly. Everyone works hard and occasionally we get behind where a second assistant would help. However this is not all the time and I'm not all that into paying another salary and benefits. Any thoughts??? Townie Doctor Posting

Dear Doctor,

I would tell your staff that you would very much like to consider this possibility, however, it would help you to assess the situation if they could provide for you in writing those times or circumstances when another assistant is needed and how many times this has occurred in the past six months, when this is not occurring what do they perceive this new assistant's job description would be? In the meantime, tell them that you will assess what the current payroll expenditure to income is as a % of your collected revenues. Industry says no more than 19-22% and then you'll have to look at what you would have to pay a new person plus taxes and benefits and how much that would raise the payroll overhead costs and how much more the practice would have to produce and collect in order to keep payroll within the industry standard. My guess is that this will keep them busy for a while.

Hope this helps,


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