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5.12.06 Issue #218

The High Price of Assumptions

Sally McKenzie, CEO
The McKenzie Company

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We tend to assume many things. When we settle into our seat on the airplane, we assume that the pilot and crew are trained and prepared to transport us to our destination. And if we have to go through Chicago, we can assume there will probably be a delay. When we bring our car to the mechanic, we trust that they are prepared to repair the model we drive. When we order lunch from our favorite restaurant, we assume that the waiters are trained to fill the order correctly. We can usually make any number of safe assumptions.

Then there are those assumptions that aren’t so safe. Dentists often make assumptions about the people they work with day after day. Take Dr. Anthony’s office for example. It is clear that the doctors in this large practice have made numerous assumptions. First, they assume that the new girl at the collections desk will receive adequate training from the other staff members before she’s left alone to do the job. Wrong. Missy didn’t know what to do with the patient who had two different insurance plans. When no other staff members were around to help her sort through the matter, she became so flustered with the transaction, she forgot all about the co-pay and overcharged the patient $90. Oops.

The doctors also assume that the Insurance Coordinator is helpful when working with patients. Wrong again. Shannon immediately goes on the defensive at the mere hint that a mistake might have been made with a claim. And if she’s asked by a patient to do anything she considers to be beyond the scope of her specific duties, forget it. Then there’s the assumption that Darcy, the Scheduling Coordinator, is able to use the computer system to effectively schedule appointments. Wrong, once again. She spent an entire morning scheduling patients in the wrong year. Yes, those assumptions are costing this practice a lot – reputation, patients, and money.

Most of us have learned that valuable lesson about what happens when we ass-u-me. Yet, when it comes to staff training, many doctors assume they can skate by, investing as little time and money as possible. Unfortunately, the employee is then the “beneficiary” of as little information as possible. We find many doctors who rely on “layered education.” One layer of employees trains the next. Carol, who was trained by Betty, taught Darcy. Darcy trained Shannon. Carol was fired; Betty left, so Shannon tried to teach Joe and Jill. Joe passed on what he thought he knew to Missy. Somewhere in between all those layers of wrong or partially correct information, the employee might pick up a kernel or two of useful knowledge.

In other cases, it’s training by osmosis, and it starts off typically like this. “Ellen, you’ll be taking over the collections responsibilities. You know what that means, right? You’re responsible for making sure the patients pay. I’m sure you’ll do just great.” Once again, the doctor is making some very costly assumptions. Ellen, meanwhile, is making a few of her own. “No big deal. All I have to do is ask patients if they would like to be billed for today’s procedure.” Is it any wonder that the single, biggest contributor to practice inefficiency and mismanagement is a poorly trained team? Ironically, it is the dentist who suffers most, both financially and emotionally.

Just a few hours of professional training – rather than the “when time allows training” from busy fellow employees many practices rely on – would solve numerous system problems and failures. But doctors are often reluctant to make the investment they assume are attached to professional training programs. In reality, the return on investment to the practice is increased revenues, better patient retention and customer service. The marketplace today also provides multiple affordable training options for dental teams, including online training that can be done without ever leaving the office. 

Next week, avoid the costly assumptions, look to affordable training instead.

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So, Your Office Was Referred a New Patient From Another General Dentist

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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I recently had an office ask me the question, “What do we do when the office around the corner is closing their doors and are referring patients to our office? Then the patients are calling our office expecting to be able to appoint for their regular recall appointment as if they never changed practices? All of their x-rays are up to date, and they are not overdue for a prophylaxis.”

This is a great time to establish office protocol. Not only for the patients coming from the neighborhood office, but also for any patients that call. These are new patients to your office and need to be treated as new patients no matter where they come from. These people need to be “WOWED!” just like all of your patients every time they walk in the door or telephone your office. They have the right to know what treatment provides optimal care for them, and that your office is committed to providing quality of care for both the teeth and gums.

First, take all of their information by interviewing them with the new patient interview form that your office uses when new patients call. When the patient informs your office personnel that they only need to schedule for a cleaning, seize the moment in educating your new patient about your office protocol. Always remember that office protocol needs to be taught from the first point of contact in the office until the day that patient moves out of the area. Of course, this is done in a very polite non-confrontational manner. Here is just one approach that may be used, “Mr. Jones, I realize that Doctor Black’s office has taken very good care of you, and we would like that same opportunity. Therefore, it is best if we schedule you with the doctor first, so you can get to know Doctor Good and the excellent care that we take pride in providing. I will schedule you with Doctor Good for an exam, and then have you scheduled with the hygienist. ”

Take note, the person making the appointments does not say that they are going to schedule them for a professional cleaning appointment. It is best to say, “…and then have you scheduled with the hygienist.” The reasoning is because this patient may need more than a professional cleaning.

Let’s assume the patient still demands a professional cleaning, and refuses to see Doctor Good. Do you still appoint the patient with the doctor and lose a potentially good patient? It is suggested that the patient be scheduled with doctor first, but if you have no other choice then appoint the patient with the hygienist, but remember you will not tell the patient you are appointing them for a professional cleaning. Be sure to give the hygienist enough time to win that patient over and build patient rapport.

The patient is now walking in the front door and they are greeted. “Mr. Jones, welcome to our practice. Jean, our hygienist, will be examining your gum tissues today during your professional hygiene appointment. If you will fill out this questionnaire along with your new patient information, this will help both of you to evaluate the health of your gums.” It is recommended that the patient is mailed the health history, HIPAA, and any brochures or questionnaires you want filled out prior to their initial visit. 

Questionnaires and brochures addressing the signs and symptoms of gum disease such as the American Dental Association’s, Gum Disease Are you at Risk?, could be introduced at this time. The patient would simply make a mental note or check any symptoms they have experienced. This will lead to conversation in the treatment area regarding their periodontal condition. Using a co-discovery technique enables the examiner to create value for the patient.

Following the periodontal exam, the patient will have an indication as to whether they have signs of gum disease. Doctor Good will also come in and do a cursory exam and meet the patient during the hygiene appointment. Communication between the hygienist and the doctor regarding the patient’s condition and concerns should occur either before the doctor enters the treatment room or done in front of the patient as the doctor begins the examination. This communication can be verbal or non-verbal but the dentist should not examine the patient without being aware of existing conditions and potential treatment areas that were discussed with the patient by the hygienist. If the doctor does not agree with the recommendations, then the doctor needs to explain the alternative treatment and why it varies from the hygienist’s. If the alternative treatment is presented in a tactful and positive manner, the patient will not be concerned with the treatment chosen for them. The doctor always has the final say in what therapy is necessary.

The patient is more likely to accept treatment needed if they have been thoroughly educated about their needs. With the use of good verbal skills and non-verbal skills such as the intra-oral camera, and brochures, your office will be successful in educating your new patients.

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Too Many Chiefs and Not Enough Arrows
A McKenzie Management Case Study

Nancy Caudill
McKenzie Management
Senior Consultant

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This case study is an illustration of a dental practice that may be similar to yours. The names have been change to protect the guilty!

Drs. Sarah and Bob Scott’s Story:
The phone call went something like this:
“My wife is graduating from dental school in a couple of months and we want to work together in my practice!”

My first thought was, “how sweet and romantic”.  My second thought was, “How great that he is busy enough to support 2 dentists” – WRONG!

Office Facts:

  • Dr. Bob Scott has a small office with 3 operatories.  He uses 2 and the hygienist uses 1.
  • His schedule is booked a little over a week in advance.
  • There are about 15 New Patients per month coming into the practice.

In-office Observations:
After my arrival at Dr. Scott’s office and reviewing the computer-generated reports, I questioned Dr. Scott during our lunch together.  “Dr. Scott, are you going to give your wife X of your patients and one of your chairs?”  His immediate response was, “Of course not.  Why would you ask that?”  Let me ask if you have thought about the following:

  • Where is she going to get her patients?
  • Where is she going to work in the office?
  • Does she need a paycheck?”

It was obvious that those issues never crossed his mind or hers.  He was going to add her name to the front door and “they would come”!

Immediate Recommendation:
The soon-to-be Dr. Sarah Scott should seek an associateship in another practice to allow her the opportunity to gain experience and have an income to help offset her dental school debt. 

In the meantime, Dr. Bob Scott can continue to grow his practice until he finds himself booked out 4-6 weeks on a regular basis and his New Patient base has increased to at least 30 patients per month.  At this point, he and Sarah can start planning to relocate to a larger space that would accommodate two dentists and the supporting hygienists and staff and live “happily ever after”.

Whether you are considering adding your spouse, your classmate and friend, your son or daughter or just an associate/partner, evaluate your needs and review these areas:

  1. Are your patients scheduled out more than 4-6 weeks and have been for several months?

The first indication of the need for another dentist in your practice is your schedule.  It is poor customer service to not be able to accommodate your existing active patients within 2-3 weeks for an appointment.  New Patients should be seen within 1 week.

  1. Do you have a marketing plan that includes the addition of another dentist?

You may have more than enough new patients now but do you have enough to allow you to continue to grow your own patient base as well as that of the additional dentist?  Let’s face it, you may be the greatest dentist in the area but you will lose at least 10% of your patient base each month simply through attrition.

  1. Do you have the operatories necessary without giving up yours or reducing your hygiene days?

You do not want to interrupt your own production or your hygienist’s in order to provide chair time for the new dentists, unless you are willing to take a reduction in your salary!

  1. Do you have reliable business systems in place to manage the growth and to avoid chaos?

Review your existing business systems to confirm that they are all in good working order, such as Patient Retention, Accounts Receivable, Scheduling, Overhead, Billing, Insurance, etc.  More dentists and more patients equal increased workload.  Without effective systems in place it will mean increased breakdown. 

  1. Do you have adequate staff or will you need to employ more?

You need specific Job Descriptions for your existing staff in order to handle the growth so the right hand knows exactly what the left hand is doing.  More patients do not always lend itself to more staff.  With proper job descriptions for your business staff, additional personnel may not be necessary.  You may be overstaffed now!

Congratulations on the mere fact that you are even considering inviting another dentist to join you!  You are obviously doing many things right.  Stay the course and plan wisely for your future growth. 

If you would like more information on how McKenzie’s Practice Enrichment Programs can help you, email

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