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07.22.05 Issue #176
Is your Time on the Run or your Practice on a Roll?

Sally McKenzie, CEO
The McKenzie Company

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When you considered a career in dentistry, you probably didn't imagine that your life would eventually be driven by units. Units of time that is - 10-15 minute slots, 30-minute sections, two-hour blocks, etc. You probably thought about the people you would serve, the highly skilled, perfected techniques you would use to create magnificent restorations and gorgeous smiles, the expert care you and your team would provide. And when that first patient walked in the door it was cause for Champagne celebrations and hopes for several more as the early days were focused on simply filling the hours in the week.

My how things have changed. Today many dentists are suffocating under the crush of voluminous patient records. Just about any "thriving" practice has patients booked out for weeks and even months. Cancellation lists paper the walls. Doctors and teams spend their hours trying to outrun the schedule, head off the latest calamity, and reserve enough energy to make it home at the end of the day. Yet, in spite of the seemingly non-stop work, production revenues are disappointing, if not down right embarrassing.

The problem: your schedule has become practice enemy number one. When work and life are spiraling out of control, this is what we typically find:

  • The doctor is booked more than three weeks out, and patients have to wait several weeks for even the most routine procedures.
  • There is little if any consistency in the time booked for procedures - 30, 60, 90, minutes.
  • The objective is simply to keep the day full - just stick patients anywhere.
  • The hygiene schedule is loaded up for months.
  • Lunch "hour" is a food fantasy. The team typically catches 10 minutes to inhale fries and a burger or chug a power shake.
  • Patient retention is flimsy at best.
  • New patients can't be seen for a month.
  • Worst of all, revenues are flat.

Too often those who manage the schedule are given one, single sentence of training and instruction: "Keep the doctor busy." Beyond that, they are on their own, and the clinical team is left to race the hallways, be in two places - sometimes three - at once, skip lunch, and remain calm at all times. When quitting time finally rolls around, everyone is ready to collapse in a heap.

It's time to shift the focus from busy to productive - big difference and it goes to the heart of controlling your day while increasing your profits.

Start by using your schedule to meet production objectives rather than survival training exercises. First, establish a goal . Let's say yours is to break $700,000 in clinical production. This calculates to $14,583 per week not including four weeks for vacation. Working forty hours per week means you'll need to produce about $364 per hour. If you want to work fewer hours, obviously per hour production will need to be higher.

A crown charged out at $900, which takes two appointments for a total of two hours, exceeds the per hour production goal by $86. This excess can be applied to any shortfall caused by smaller ticket procedures. Use the steps below to determine the rate of hourly production in your practice.

  1. The assistant logs the amount of time it takes to perform specific procedures. If the procedure takes the doctor three appointments, she should record the time needed for all three appointments.
  2. Next record the total fee for the procedure.
  3. Determine the procedure value per hourly goal. To do this, take the cost of the procedure, for example $900; divide it by the total time to perform the procedure, 120 minutes. That will give you your production per minute value - $7.50. Multiply that by 60 minutes - $450.
  4. Compare that amount to the doctor's hourly production goal. It must equal or exceed the identified goal.

Now you can identify tasks that can be delegated and opportunities for training that will maximize the assistant's functions. You also should be able to see more clearly how set up and tasks can be made more efficient.

Next week, creating daily order from hourly chaos .

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Appreciative Leadership.
What's right with the world, and YOUR PRACTICE?

Dr. Nancy Haller
Executive Coach
McKenzie Management

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Last week's bombings in London reminded me of the unsettling times in which we live. I was stopped in my tracks when I heard the news, stunned again by another senseless tragedy. In the days that followed, I have had to encourage myself to avoid getting swept up in the mentality of what's wrong with the world.

Your office may not be a war zone but I'm sure that many of you feel like you're going to battle each day. You just want to do your dentistry but you're forced to handle employee issues - tension between two hygienists, tardiness by your front office staff on your busiest day, inefficiency by your dental assistant.

There are innumerous ways that employees can annoy and disappoint you. In fact, you can find problems everywhere if you look for them. If you aren't careful, it can all seem insurmountable . And the more you think - and talk - about what a drudge it all is, the more it becomes a reality.

But what if you stopped to consider the possibilities ? How would you like your practice to be? Think back to a time when it was that way, even for just one special day. What might happen if you started talking about that vision?

Appreciate Leadership (A.L.) is an emerging area of organizational development designed to build efficient and productive workforces. It is a social constructionist model. The theory states that employees and their leaders create reality through their interpretations and conversations about the world . By talking about stories of strength and potential, solutions are crafted.

1. Invite your employees to recall a day when they felt that things were going well . It's essential that you ask the right question. As an example, if you want to improve patient service and satisfaction, you could take a traditional approach - 'What can we do to minimize complaints?' However, the better question is, 'When have patients been pleased with us, and what can we learn from those moments of success?'

2. Hold a staff meeting and swap stories . Be detailed. Pay attention to the excitement that is generated as you and your employees tell and hear each others' stories. Get everyone involved in a conversation about what they were good at and the outcome of those positive efforts.

3. Note the common themes in the stories. Explore the ingredients that made those 'high moments'. This is not the same as picking the 'best' story. The purpose of this step in the A.L. process is to identify the factors that are consistently present in those moments of success. It is important that you involve all your staff in finding those elements.

4. Build on the momentum of the energy created in Step Three. With your staff, articulate the dream. What will it be like when those 'high points' are present every day? Together, craft a collective vision of the future. This is a good time to write your practice mission statement. Have it printed. Post it throughout the office.

5. Create the future. What are the circumstances that will allow you and your team to repeat those elements of success every day? Encourage creative brainstorming with someone taking notes. Be specific about the action steps that each person will take to achieve the desired result.

What we focus on becomes our reality. If you want a different workplace, stop talking about problems and start visioning possibilities. Make your focus achievement and joy, not problems and distress. The outcome is energy and success. Pay attention to what your employees are doing right. Pay attention to what's working. Pay attention to what's right in your world.

If you would like assistance in creating deeply satisfying practice results, contact Dr. Haller at

"I Can Make This Happen"
A Key To Treatment Plan Acceptance

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

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I recently presented a treatment plan totaling $10,500.00 to a forty-year-old female patient. Dr. Goodfellow had come highly recommended to her and she was here to have a full comprehensive exam and consultation. Upon hearing her options delivered in easy to understand language, she turned to me and said, "I have to do this, let's get started."

She was prepared to pay and was motivated by a desire to take action. The personal referral paved the way to trust Dr. Goodfellow and she felt his treatment would solve her dental problems. Sometimes a patient is reluctant to proceed with necessary dental treatment because they don't believe that they are the kind of person who would benefit from investing time and money in dental health. If a friend has given a positive testimonial, this often allows the patient to believe and say, "I too have the ability to achieve excellent dental health." How often have you heard, "My Mom has dentures, I guess I will too someday." Or "I have soft teeth like my Dad, so I expect to have bad teeth."

If you can deliver patients from these beliefs you can open the door for them to realize that they can be effective in turning their own health around. To do this, the dental team must be vigilant in its care and education of patients. Patients who are ready to take action and change the course of their health have certain characteristics:

  • They have come to have a clear understanding of the serious nature of their dental condition
  • They fully understand the steps necessary to get them the results they are seeking
  • They trust in the doctor and the team
  • They believe that they are capable of accepting the treatment and in getting good results

As a team we have to voice our confidence in the patients' decision to move forward. Keeping the patient involved in the process by telling them what is happening and what they can anticipate keeps the trust building.

To keep the patient on a positive track to success, the dental team must avoid behaviors that would cause a patient to "give up" and avoid treatment. Never blame a patient for the disastrous state of their mouth. Watch your body language. Rolling your eyes or shaking your head only makes the patient want to avoid you. Avoiding eye contact and not listening devalue the patient and may cause the patient to avoid the office altogether. Taking the stance that you are morally superior to the patient because you would never have allowed your mouth to get to such a condition should always be avoided. Putting pressure on the patient to make a decision and using "scare tactics" such as saying, "Your teeth are going to fall out of your mouth if you don't do what I say", is a negative and does not build trust.

Achieving consistent treatment plan acceptance is a challenge because there are so many factors involved in patient's decision-making process. One thing is for certain, if the patient does not trust the doctor and team, then you will never hear "Let's get started!"

Don't miss our NEW WEB-SITE where you will find on-line training, and our course curriculums

Want to improve your treatment plan acceptance?
Contact The Center for Dental Career Development at 1-877-777-6151, or email .

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This issue is sponsored
in part by:
McKenzie Management's Seminar Schedule
2005 Location Sponsor Information Topic Speaker
July 21-24 San Diego, CA IA of Comprehensive Aesthe 702-341-7978 Peak Performer Sally McKenzie
July 28 La Jolla, CA Southern CA Ortho. Symposium 619-656-4646 Top Issues Sally McKenzie
August 13 Topeka, KS Delta Dental Plan of Kansas 800-733-5823 Breakdown Sally McKenzie
Sept. 9-11 San Francisco, CA California Dental Association 916-443-0505 Successes Sally McKenzie
Sept. 22 El Paso, TX El Paso Dental Society 877-777-6151 Breakdown Sally McKenzie
Sept. 23-24 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Oct. 14 Riverside, CA Riverside Implant Study Group 951-279-7847 TBA Sally McKenzie
Nov. 18-19 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Dec. 1 Cincinnati, OH Cincinnati Dental Society 513-984-3443 Breakdown Sally McKenzie

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