Ever feel like you’re working with the team better suited for the offices of Dr. Jekyll & Mr. Hyde? All is well; things are going along just great. The staff are effective. They’re cohesive. They’re efficient. They get along well. They are happy. You are productive. Work is good. Then, seemingly without warning, you’ve found yourself trolling the bottomless pit of discontent. What happened to all that harmony and satisfaction? 

These people aren’t happy with anything from the temperature in the breakroom to the décor of the bathroom. They are cold and distant. And if they didn’t have to be here working with you they wouldn’t. Work is not good. And you’re wondering how can everything be going along reasonably well only to shift seemingly over night. Was it something you did? Chances are it has nothing to do with what you did but more with what was expected and never delivered. Let me explain.

Certainly, there’s plenty of literature about the importance and value of establishing expectations for employees and measuring their ability to meet those, but have you considered the expectations your team has of you, your practice, and, that ever thorny issue of compensation?

Let’s rewind to those really good days in which the team is functioning particularly well together. There are challenges and the staff is able to work as a unit effectively to overcome them. To the team members, they are busting their tails to make sure you and the office remain on track. Yes, siree, each pressure-packed day has “pay increase,” “raise,” “reward for a job well done,” written all over it. Individual employees start dropping hints that it’s been an awfully long time since their last pay raise. Maybe a bonus is in order this month. Right or wrong, real or imagined, members of the team have expectations.

The doctor has questions. “Why do they think they can expect more money when all they’re doing is their jobs?” To the doctor, the employees are merely stepping up to the plate, as they should to face day-to-day challenges that arise in a busy dental practice. To the staff, they are superstars worthy of a cut of the action. Clearly, expectations have not been managed.

And the funny thing about expectations is that when the “big ones” aren’t met, people become less satisfied with other aspects as well. In other words, they start looking for things that aren’t right. “Doctor won’t give me a pay increase for all my hard work. Meanwhile, he/she’s making a boatload of cash. She/he also keeps the place freezing cold, never allows us to drink the good coffee, and buys the cheapest hand towels possible for the bathrooms!” You could call it the coattails effect of disgruntlement.

Meanwhile, the doctor is wondering how he/she can make this whole money thing just disappear and get things back to “normal.” Typically, dentists don’t know how to rationally discuss the issue of compensation. They don’t know how to determine the impact of a little increase here or what a “special reward” there will have on the practice. Consequently, when feeling the pressure to pay, they either dismiss the request out of fear and ignorance, or cave to the request out of fear and ignorance, or bargain for some costly alternative out of fear and ignorance. So how do you manage this seemingly continual state of dollar discontent? By sharing knowledge and information to manage employee expectations and following the four rules of staff compensation. 

Rule #1 – Establish a standardized compensation policy.
Rule #2 – Never increase salaries until you have conducted a Salary Review.
Rule #3 – Develop a plan as a team to make more before you spend more.
Rule #4 – Make staff, not you, responsible for their success, their income, and their advancement.

Next week, implementing the four rules of staff compensation.

Interested in speaking to Sally about your practice concerns?  Email her at sallymck@mckenziemgmt.com.

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

Dr. James Hauser’s Story:
Disgusted, Dr. Hauser’s venting went something like this:

“I seem to be busy seeing patients all day, but when I look at the production at the end of the day, it is pitiful!  How can I be working so hard and not be making any money?”

I would bet money that ALL dentists have asked that very same question more than once during their careers.  While it’s common that many questions are asked throughout the course of a career, it is few who make the effort to seek the answer.  Maybe one of the reasons dentists’ questions are never answered is because they are fearful that there is no real solution and the problem is just “part of the beast” of being a dentist.  Maybe another reason is because they are afraid of the answers they may get and in order to solve it, action must be taken!  Change?  Oh how we despise to change our ways, even when we are going down the wrong path.

Back to Dr. Hauser’s excellent observation of his concern.  It is obvious that something is broken in his systems and needs to be fixed because “where there is smoke there is fire” and he definitely has something smoldering in his practice.  Let’s see what kind of fire extinguisher we’ll recommend to put out his fire before it burns down the office!

Office Facts:

• 15 year old practice working 4 days a week
• 1 hygienist working 4 days a week
• 15 New Patients per month
• Production has peaked at about $80,000/month for the past year

In-office Observations:

• Fees haven’t been increased in over 3 years
• Hygiene retention is around 40%
• No job descriptions for staff
• No daily scheduling goals for doctor or hygienist

Each of these observations is an article in itself, that has been addressed in the past. So, let’s address the last observation – that of “No Goals”.  Lack of daily production goals affects the schedule and how productive it is.  This relates to how hard you work – did you know that?  This is what happens where there are no goals:

• The Schedule Coordinator is a ”hole filler” – not a coordinator.  You both think that she is doing a good job, only when all the holes are filled.
• The patients run the schedule instead of the coordinator running the schedule.  The question, “When would you like to come in?” is a dead giveaway.
• Openings don’t get filled intentionally – only because another patient calls and wants to be seen.
• One day you have to work like a gerbil on a wheel and the next day you are like a snail on Valium!
• One day you produce $3,000 and one day you produce $1,000.

“How does something as simple as setting a daily production goal cure the above maladies?” you ask.  Because there is a system that must be followed when scheduling to a goal.  The Schedule Coordinator actually applies a specific thought process to “filling the holes”.  There is now a “method to her madness.” And not just random luck.

Take this short multiple choice test:

• Would you rather have a day that produces:
• $750
• $3,000
• Would you rather see:
• 15 patients/day
• 8 patients per day
• How many crown/bridge deliveries a day do you prefer:
• 2
• 5

Without daily goals, let’s look at what a typical day might be like in your office without goals:

Delivery - Delivery - Composites - Composites - Emergency - LUNCH - Composites - Composites,Try-in-Extraction.  This equates to 9 patients with a total production of $1,200.

Now let’s look at a day with an established schedule goal of $2,750:

Crown Prep - Composites - Composites - Delivery - LUNCH - Crown Prep - Composites - Composites - Delivery.  This equates to 8 patients with a total production of $3,000.

“Way too simple”, you say.  OK, this is an exaggerated example but the point is this:  When there is a goal to schedule to, the Schedule Coordinator has to think about what type of patient she is scheduling with other patients.  It is like working a puzzle so the pieces all fit.

Conclusions:

After visiting with Dr. Hauser 6 months later, to observe their progress, this is what he shared with me:

• Less daily stress for the doctor and the staff
• Less patients seen per day
• More production per day
• Reducing waiting time for patients
• Less fluxuation in production and collection figures

Contact McKenzie Management today and see how you can turn your “hole filler” into a real Schedule Coordinator by giving her the tools that she needs to make your days more productive and less busy.  Go get that fire extinguisher before your practice slowly smolders away to ashes!

If you would like more information on how McKenzie’s Practice Enrichment Programs can help you….. email info@mckenziemgmt.com.

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If I were to be hired in your practice today, would I know what happened with your patients the last time they were in? We were all taught in college to make sure to utilize good documentation when it comes to our patient’s records. What exactly is good documentation? What do we really need?
 
Unfortunately, we may not know exactly what we should be documenting until we end up in court. Hopefully, we have done our job of having good documentation in order to avoid actual litigation.  However, most dental malpractice suits today involve the misdiagnosis and failure to properly treat periodontal conditions. Dental hygienists may be held liable if breakdown is not detected or if “supervised neglect” occurs.

There is a multitude of ways to document treatment records. The most important issue is standardization and continuity between providers in the office. Also, patient records must be thorough, containing precise information relating to existing oral conditions, treatment recommended, treatment administered, self-care recommendations and follow up care.
 
One method of record keeping that encompasses the above factors is the SOAP system. SOAP (Subjective, Objective, Assessment, Plan) is designed to center only on the problems and concerns of the patient and eliminates unnecessary information making records specific and explicit. The abbreviations are used to indicate conditions and treatment; every clinician in a practice should utilize the same system with the same abbreviations. This provides for a way to easily interpret the notes.

SOAP notes are common-sense approaches to record keeping. After S (subjective) and O (Objective) findings are noted, the patient’s condition is A (assessed) and a treatment P (Plan) is formulated. It is a logical sequence of events and can be utilized at every Interceptive Periodontal Therapy appointment.

The SOAP system is a valuable asset to the dental hygiene department. It standardizes treatment documentation. Therefore, different clinicians can easily interpret the notes and can readily convey treatment outcomes between one another. The SOAP system only records information pertinent to the needs of the patient. It follows a logical chain of thought from documentation to treatment. Thus, helping to make sure no important facts are inadvertently forgotten and keeping records complete.

Another method that may be used along with the SOAP method is to create a self-inking stamp and use it in addition to the SOAP method. The stamp may have on it the following routine procedures done by the hygienist.

• Px. = prophys
• PerioMaint. = Periodontal maintenance
• Hemo. = Hemorrhaging gen = generalized
• plq = plaque   gen = generalized    Lt. = light   Mod. = Moderate     
• rad = radiographs ________
• This is where the hygienist will write what x-rays were taken
• WNL = within normal limits
• OHI = oral hygiene instructions  TB = toothbrush  RT = rubber tip
• OH = oral hygiene
• Calc. = calculus   gen = generalized     subg = subgingival
                                  supg = supragingival
• anes. = Anesthesia       Init. = Operators initials________

The stamp allows the hygienist to circle the correct abbreviation that applies to the individual patient. This will help save time when it comes to record keeping.

 Any additional notes will be made using the SOAP method. These abbreviations are just a few of the standard treatments performed by the hygienist that you may want to include on the stamp that the hygienist would use. Additional examples of abbreviations are included in McKenzie Management’s book, “Enhance Your Hygiene Department.”

Each practice should have a staff member assigned to the development of a record keeping protocol. The most important issue is standardization and continuity between providers in the office. Also, patient records must be thorough, precise information relating to existing oral conditions, treatment recommended, treatment administered, self-care recommendations and follow up care.

For more informarion on how to turn your hygiene department around email info@mckenziemgmt.com.

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