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11.18.05 Issue #193  
Tolerate or Terminate?

Sally McKenzie, CEO
The McKenzie Company

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It’s 7:35 a.m. and your team is assembled for the morning huddle. Well … that would be most of your team. Christine is late again. She’ll come dashing in breathless at any minute. Perhaps the excuse will be traffic, maybe her alarm didn’t go off again, or her mom called and she just couldn’t get her off the phone, her coffee pot caught on fire, she had an allergic reaction to her hairspray. Whatever today’s excuse is, it will no doubt be creative. In fact, if Christine would put as much effort into getting her herself to work on time as she does coming up with some novel reason why she can’t she might become a halfway decent employee.

Or perhaps in your office it’s the mercurial diva Deanna who gives you “the look” anytime she’s asked to stop what she’s doing and take care of something more pressing. Then there are the sighs of annoyance that hiss through the halls when a patient asks for a special appointment time, and the air of superiority that fills the room like a noxious odor when Deanna, who thinks this job is beneath her, is expected to fill a sudden opening in the schedule.

Circumstances such as those and countless others face dentists everyday as many struggle with their competing roles as CEO, human resources director, vice president of production, conflict mediator, and so on. Dental practices are small offices that depend on quality work from a cohesive team. There simply isn’t room for the pouting diva or the perpetually disorganized.

Certainly standing toe-to-toe with a troublemaker is not something many doctors signed on to do when they decided on a career in dentistry, and terminating an employee is viewed as an occupational hazard most will go to great lengths to avoid. Consequently, rather than face the unpleasantness, Dentists will bolt to the operatory and drown out the groans of disgruntlement with the whir of the hand piece.  Yet personnel problems that typically start with seemingly minor annoyances, insignificant little bends in the rules, trivial personality snits can explode into all out wars that can rock your office to the foundation and force you to send employees packing or yourself into solitary confinement.

I recommend you fire up a few common sense human resources strategies, and address employee issues long before they require someone to stand before the firing squad. 

  1. Provide clear job descriptions to employees, so they know exactly what is expected of them.
  2. Train new employees. Someone needs to help a new worker understand how things are done in this practice. Even if she/he has dental practice experience, no two offices are alike.
  3. Give the employee some form of personnel policy manual. This document spells out the office code of conduct, dress code, policies regarding tardiness, overtime, sick leave, office policies and procedures. All employees deserve to know the rules of the game and what they need to do to continue playing.
  4. Give direction and constructive feedback often. Too many practices wait until the 90-day review, or longer, before they give a new hire any feedback. Engage in some “fire prevention” early on and give feedback frequently from day one.
  5. Be specific. Don’t candy-coat the feedback and don’t beat around the bush. Tell employees what isn’t being done that needs to be done. 

Know when to cut your losses. There are situations in which an employee is not going to work. Next week, terminating an employee and preserving the team.

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Listen Your Way to Higher Case Acceptance

Dr. Nancy Haller
Executive Coach
McKenzie Management

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How do you react when patients object to treatment recommendations?

It’s tempting to assume they need convincing, then ‘talk up’ the hi-tech ‘proof’. Or try to motivate them with warnings about how bad things will get if they don’t follow through with their dental plan. But until you really listen, you won’t understand their objections, or how to gain compliance.

Listening enables you to find out about your patients’ reality…what’s important to them, what motivates them, what issues prevent them from moving forward. Once you understand that, you are in a better position to educate, clarify, and gain trust with your patients. In turn, they are more likely to choose to have more dentistry done with you. Even as a psychologist with 25 years of practice, I am still amazed by the power of listening to change and influence decisions. Yet listening is the hardest thing for a human to do.

  1. Listening is more than just being quiet. To listen means putting aside your own endless internal monologue. Suspending your own opinions and constant critiques. Unlike ‘hearing’, ‘listening’ requires full attention to imagine the person’s point of view. Help yourself to be more focused by reducing environmental distractions. Turn off your cell phone. Eliminate interruptions as much as possible. Talk in a quiet area or room. And as you schedule patients, build in time so you won’t feel rushed and impatient to listen.
  1. Refrain from interrupting. Let the other person finish speaking before asserting your own view. Even if you think you know the issue, curb your tendency to interrupt. If this is a problem for you, pay attention to when interruptions occur most often. Notice whether there is a pattern and identify what you will do to improve your patience.
  1. Look interested. You can say a lot without words. Show attentiveness. Maintain eye contact without staring. Relax your face and jaw, drop your shoulders. Let the patient know you follow their thinking with an occasional nod. Smile when appropriate. Sit (rather than stand) at the same height as the patient. Lean forward slightly.
  1. Listen for main thoughts. Effective listening goes beyond the words and facts the speaker communicates, especially if there are emotions involved. Create rapport by using reflective statements such as, ‘I can tell you’re worried’ or ‘This feels overwhelming to you’.
  1. Encourage the patient to keep talking. Before you respond to objections, make sure your understanding is accurate. Ask open-ended, clarifying questions. Paraphrase or summarize the main points then ask for verification. 

Listening to patients lets them know you care. It builds trust and strengthens your relationship. Set a goal to listen twice as much as you talk. Then keep track of the amount of treatment recommended and compare it to the amount of treatment accepted. I guarantee that you will listen your way to higher case acceptance.

Dr. Haller can be reached at  Dr. Haller provides Executive Coaching for McKenzie Management and conducts one-on-one leadership training.

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Establishing Periodontal Protocol

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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In my last article I discussed establishing a game plan and an orderly sequence of treatment and appointments in relation to establishing or enhancing an interceptive periodontal therapy program. Protocol, ideally, would include those procedures that predictably determine the results most often expected. The goal of your periodontal therapy program is to reach optimum results for the patient in a minimal amount of time.

The amount of time required for the first therapy visit after the diagnosis is determined based on the diagnosis. Every assessed and diagnosed periodontal type would have its own protocol to follow. One must consider what the appointments will consist of at each visit.

An example of a first appointment treatment plan for case type III, might consist of: updating the medical history, having the patient pre-rinse with an antimicrobial oral rinse, performing one or two quadrants of scaling and root planing with or without anesthesia, irrigation, and possible local delivery of a chemotherapy agent as per manufacturer’s recommendations. This appointment time may be 90-120 minutes for two quadrants of scaling and root planing or 60 minutes for one quadrant of scaling and root planing.

Each subsequent visit to treat the remaining quadrants of scaling and root planing should be identical to the first visit until all treatment is completed, unless the patient’s needs are different for each quadrant. This would be determined at the time of diagnosis and treatment planning.

The last visit prior to placing the patient on periodontal maintenance is an evaluation appointment with a prophylaxis. Thereafter, the patient will continue their care with a periodontal maintenance appointment  (4910) every three months. This may vary depending upon patient compliance, as well as the clinical knowledge and judgment of the licensed clinician. When new or recurring periodontal disease appears, an additional diagnosis and treatment may need to be implemented. This is just one example of an interceptive periodontal therapy program protocol. The practice’s hygiene department should also consider establishing protocol for prophylaxis and periodontal maintenance appointments too.
Now that you have established a new office protocol for your interceptive periodontal therapy program, decisions regarding how to educate your patients about your new commitment can start immediately. Informing the patients of new procedures incorporated in the office usually starts at the front desk when the patient is appointed.  For example, the front desk may explain to the patient about the new commitment the office has made to screen all patients for periodontal disease. For example, “Ms. Jones, we have recently been to a seminar and are very excited about our new commitment to screen all of our patients for periodontal disease. We are sure you will benefit from our Periodontal Therapy Program protocol that we will be incorporating into our office.”
The Business Coordinator can mention the periodontal therapy program when she greets the patient. This could take place as she is asking the patient to fill out initial information, for example: “Ms. Jones, welcome to our practice. Jean, our dental hygienist will be examining your gum tissues today during your professional cleaning. If you will fill out this questionnaire along with your new patient information, this will help both of you to more accurately evaluate the health of your gum tissues.” Questionnaires and brochures addressing the signs and symptoms of gum disease such as the ADA’s Gum Disease Are You at Risk? could be introduced at this time. The patients would simply check any symptoms they have experienced and read through the brochure they were given. This will lead to a conversation in the treatment area regarding their periodontal condition.

The patient will have an indication as to whether they have signs of gum disease. Here is a sample presentation to use with a new patient. “Ms. Jones, as the screening process that we just completed, has indicated you have several areas of infection or periodontal disease. Before we can start your restorative dentistry, we want to get your gum tissues in good health. To accomplish this in a conservative manner, we would use a non-surgical approach. It’s the most effective way to get your gums healthy and keep them that way. Working together, we can establish a home care regimen that is most effective for you and your life style. The periodontal therapy will take approximately four visits, at a week to ten days between appointments. If you do not have any further questions, it’s best if we get started as soon as possible.”

This sample dialogue along with many others can be found in our new book,
 “Enhance Your Hygiene Department, How to Take Your Hygiene Department to the Next Level,” and during McKenzie Management’s “Advanced Hygiene Performance Program” that we provide at our location or yours. The dialogues are designed to give the presenter a foundation on which to build their conversation with the patient. McKenzie Management can help you with designing an interceptive periodontal therapy protocol for your hygiene department or to help enhance the performance of an already existing program.

For more information, or 1-877-777-6151

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