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  01.06.05 Issue #148

Will You Commit 24 Hours To Your Practice in 2005?

Sally Mckenzie, CEO
McKenzie Management

Over the last 12 months an entire year slipped by. For some the close of 2004 saw productivity and team cohesiveness stronger than ever. For others it was yet another year of more of the same. Inadequate systems that managed to shuffle through '04 will limp into '05. Productivity will continue to teeter between the "sorely lacking" and the "barely good enough" levels - not because the doctor isn't working his/her hardest or individual team members aren't committed to the cause. Rather it's typically because the primary focus is on dealing with whatever problem has to be managed right now and not on addressing what caused that problem and what can be done to prevent it in the future.

Ironically, a mere 24 hours over the next year could transform a practice locked in a seemingly perpetual state of crisis management or lackluster success into one of superior efficiency and productivity. Monthly business meetings that are given just two hours of dedicated, uninterrupted doctor and staff time could be most cost-effective, production efficient step you'll take to achieve your practice's full potential in the coming year. The key: designate every member of the team a contributor. Here's how:

  1. Block off two hours each month over the next 12 months. These are the 24-hours that you commit to continuously improving your practice during the next year.
  2. Develop an agenda with input from the entire team.
  3. Include all areas that impact the profitability/success of the practice. For example: numbers of new patients, recall patients, collections, treatment acceptance, production, accounts receivables, unscheduled time units for doctor and hygiene, uncollected insurance revenues over 60 days, overhead, etc.
  4. Distribute the agenda at least two days in advance of the meeting.
  5. Assign each member of the team to report on the area for which they are responsible. For example, the scheduling coordinator reports on the monthly production as compared to the goal, the number of unscheduled time units for the doctor, and the doctor's daily average production.
  6. Encourage team members to come prepared to discuss topics on the agenda. For example, if the doctor has a higher number of unscheduled time units than desired the team can discuss contacting patients with unscheduled treatment, encouraging hygiene patients with unscheduled treatment to move forward on recommended care, identifying patients with unused insurance benefits, etc.
  7. Seek input from everyone by asking questions such as, "What is your reaction to that?" "As the patient, how would you react?" "What are the advantages of this approach? What are the potential disadvantages?"
  8. Delegate responsibilities and establish deadlines for completing tasks identified during the staff meetings. For example, if hygiene cancellations are high and the group has developed a plan to reduce the cancellations the person responsible, probably the hygiene coordinator, needs to know she is accountable for implementing the changes and should be prepared to report on the effects of those changes at the next monthly meeting.
  9. Share ideas during staff meetings for improving the work environment, the patient experience, and the efficiency of the practice.
  10. Designate the amount of time you will spend discussing each issue and avoid getting bogged down on unrelated topics.
  11. Discuss only what is on the agenda.
  12. Hold staff meetings off-site in a conference room with a conference table. Many local libraries, community colleges, and other public facilities have public meeting rooms available for use.
  13. Eliminate outside interruptions.
  14. Seek consensus from the staff as to the best time to hold staff meetings; meetings scheduled outside normal work hours should be paid.
  15. Hold meetings at least once per month, more frequently if you are implementing several changes.

Meetings are meant to be designated times in which you can focus all of your energy and team resources on addressing key management issues and problems that arise as a part of operating a small business. Run correctly, they are the most effective means to identify and solve problems, establish policies, share information, motivate each other, define areas of responsibility, and exchange ideas. Use them to your practice's full advantage.

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

Interested in having Sally speak to your dental society or study club?
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The $263,200 Practice

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

Why would I talk about a $263,200 practice when any solo general practice needs to produce at least double that to be profitable? It's the practice within the practice I want to discuss. If you consider your hygiene department to be an integral component of the office and a profit center, then having a business plan that maximizes the talents of your hygienist is important. What are some of those talents that need to be encouraged?

  1. The hygienist can evaluate the dental health status of the patient during the hygiene examination. I do not mean that they diagnose treatment. Only the doctor can do that. But the hygienist can assist with the co-discovery of problems with the patient and inform the dentist of the findings. Then the doctor can make the treatment recommendations.
  2. The hygienist has the ability to evaluate the emotional well being of the patient. They have the time to discuss the patient's concerns and treatment options. Usually, the patient will be more open to ask questions of the hygienist than the doctor.
  3. The hygienist can accurately assess periodontal status after therapy. In most dental offices the hygienist has already removed the calculus, stain, and plaque before the doctor sees the patient at their periodontal maintenance or periodic recall visit.
  4. The hygienist can accurately record periodontal pockets and gingival defects. Once that information is available to the doctor the diagnosis can quickly be ascertained and the appropriate therapy instituted.
  5. The hygienist can discuss ancillary services with the patient such as bleaching, esthetic restorations, orthodontic options, etc. This can lead to optional services available to the patient at the practice.

What are we really discussing? The hygienist's ability to communicate. By utilizing their knowledge of dentistry, your hygienist can help your patients obtain optimum health and get them to identify with their needs. What has this got to do with the $263,200 practice? Having the ability to help the patient accept necessary services performed by your hygiene department will increase your productivity, improve patient health, and increase the hygienist's value to the practice.

Adding periodontal scaling and root planing procedures into your hygiene department protocol can dramatically increase production. One patient per day for each hygienist will increase production between 20-25%. Including other ancillary services available in the hygiene department will contribute another 5-10%. After instituting an enhanced hygiene program into a practice I have obtained increases from $850 in daily production to as high as $1400 in daily production. If the average hygienist works 4 days a week and 47 weeks a year considering vacation, holidays, sick leave and office closures than the total days available are 188 days. Multiply 188 by $1400 equal $263,200 of yearly production. Obviously, not every office will achieve these results. This is working smarter not harder. The average number of patients seen in an eight-hour day is nine. This includes adult and child recall appointments, periodontal maintenance visits, and scaling and root planing procedures.

In a future article I will show a typical daily hygiene schedule based on this enhanced treatment model. You can plug in your numbers and see where your hygiene department stands. If I can help you set up an enhanced hygiene program in your practice email me at

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

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No Time For A Toothache!

From the Patient’s Perspective

9:00 A.M.
My mouth is starting to hurt. I don't have time for a toothache. I have a meeting in two hours and I need to get this report done. I probably just brushed too hard this morning.

10:00 A.M.
This tooth is really starting to hurt me. I better see if anyone in the office has any pain killers. I don't have time to see the Dentist.

Well, I got through the meeting with this tooth pain. The pain killers really helped. I should call the Dentist. He is probably out to lunch. I'll call after lunch. I might have to drink my lunch because I don't think I can eat anything.

2:00 P.M.
I can't believe that I just got a rush on this report. I won't be able to see the doctor this afternoon. I will just have to take some more of those pain killers.

4:00 P.M.
The painkillers aren't working as well as they should be. I wonder how many you have to take to keep the pain away. I can't remember how many I took, but I do remember that I have a dinner appointment. The pain killers will have to work through drinks and dinner.

9:00 P.M.
"What do you mean the Doctor isn't in? I need to see him right away. I am in severe pain. What do you mean his office is closed? Can you tell me where he can be contacted? He must see me now. I will be waiting in pain for his call. Am I drunk? I had a little to drink because I thought it would kill the pain. Please have him get in touch with me as soon as possible. I have a big meeting tomorrow morning for breakfast and I don't want to go to my meeting in pain like I did all day today."

Does this scene seem familiar? Do your patients honestly think that you will be on their schedule? Do your patients know what to do and what not to do if they have an emergency? Patients should be informed of your emergency policy and what they should do or not do concerning medicines, pain killers and muscle relaxants. Patients should be aware of the effects of alcohol when mixed with a variety of drugs. Most patients will try to stop the pain themselves. Some people think that the pain will go away. Some people don't want to take the time and will suffer. Most will eventually call for relief.

It is important for the Doctor to put the patient at ease. A doctor in New Jersey added a half hour on to his lunch for emergencies. If there was no emergency, he would catch up on paperwork, lab work telephone calls or reading materials. All his patients knew that if they needed him, he was available around lunchtime. It was a system that worked for the Dentist and the patients. The Doctor saw most of his emergencies during the day or he got a lot of work done. The patients did not usually lose work time and knew the doctor was available.

Another option is to identify at each morning meeting where in the schedule is the best place to put an emergency patient. Good customer service can reflect providing diversified times rather than the same time every day as well. A well organized team and an informed patient keeps an office running smoothly and everyone wins!


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Sally's Mail Bag

Dear Sally,

One of my dental assistants uses the phone in the lab which is real close to the treatment room and she makes 1 to 3 lengthy personal calls a day. I can hear her saying things like, "I can't believe she did that.." "Why doesn't she dump him?" And on and on. It sounds like a segment from "Desperate Housewives." If I can hear her I know the patients can too.

No More Dr. Niceguy

Dear Know More,

Being nice has nothing to do with it. This is business. First, confront her. Tell her that you are paying her a salary to do her job and making personal phone calls is not working. Tell her that you don't view it any differently than if she went out to the desk and "borrowed" three postage stamps to mail her bills. Then I would ask her point blank if there's any reason she cannot stop making these calls in the middle of the work day? And finally, ask yourself why she has the time to make these calls. Maybe you don't need two dental assistants after all... I would also write up an Employee Warning Notice and put it in her file.

Hope this helps,


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McKenzie Management Upcoming Events
Date Location Sponsor Speaker
Feb. 18-19, 2005 Griffin, GA Endo Magic Root Camp Sally McKenzie
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Mar. 3, 2005 Rochester, NY Monroe County Dental Society Sally McKenzie

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