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7.14.06 Issue #227

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Turn Patient Satisfaction into Patient Loyalty

Sally McKenzie, CEO
The McKenzie Company

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Patient satisfaction vs. patient loyalty, what’s the difference? Simple, it’s the difference between the practice that has plateaued and the practice that is truly profiting. In recent years, management experts have spent a lot of time trying to better understand the disconnect between customer satisfaction and customer loyalty. What they are finding is that while satisfaction is often high, loyalty is not.

Patients may be satisfied with your ability to see them on time. They may be satisfied with the cleanliness of the office. They may be satisfied with the care they received during their routine appointment. But satisfaction is one thing and loyalty is something quite different. Loyalty is driven by a patient’s emotional connection and experiences with the doctor, the team, and the office as a whole.

It’s the loyal patients who are sustaining your practice. They are open to your treatment recommendations. They see the doctor and the team as their partners. They pay on time. They happily refer new patients. They understand the occasional bad day in which you may be running behind. They are forgiving of a minor error on their statement. They don’t look for a new dentist because of a slight infraction. They recognize that occasionally fees will increase. In short, they trust you and your team and they value the care that you deliver.
So how do you recruit more long-term loyal partners? Take a close look at systems and service. While surveys indicate 70% of customers/patients cite service as the number one reason they defect, too often employees view managing patient service as a distraction from what they consider to be more important tasks, such as ensuring the schedule is full, collecting from the insurance companies, confirming appointments, etc. Ironically the success of each of these goes hand-in-hand with providing excellent service.
First, find out what your patients think. Survey patients to assess if seemingly minor concerns raised by a few patients are a bigger problem than you may have realized. Invest in a statistically valid survey instrument that is designed to ask questions that will elicit the most valuable and revealing information.
Next, engage in “action listening,” which is different from active listening. With action listening, the dental team commits to bring concerns and issues voiced by patients to the staff meetings for discussion and action. For example, if patients are commenting that practice hours are inconvenient, the team develops a plan to address the issue, such as adjusting the practice hours for 60 days, marketing the change, and monitoring patient reaction and subsequent patient retention. The team can then assess if the change should be made permanent.

Look at practice systems and evaluate if they are best serving the patients, thereby best serving the practice. If the schedule is booked out weeks for the doctor and months for hygiene, if the business employee is too busy to acknowledge patients when they walk in the door, if patients are routinely declining treatment, if collections are low, and holes in the schedule are frequent, these are all system indicators that patient loyalty is seriously lacking. Which most likely means patient service is seriously lacking.

Pay attention to the obvious:

  1. Welcome each “guest.” Treat each patient as the most important person in your office. From the moment he/she walks in the door, until they leave the parking lot.
  1. Have the answers. Patients expect you to have immediate answers to basic questions. Track the common questions that patients ask. Take steps to ensure that every member of the team is prepared to answer them.
  1. No Pretending. Under no circumstances should a patient be ignored when they come to the counter. Acknowledge their presence immediately regardless of what you are doing at the time. It takes five seconds to look over at the patient and let them know you will be right with them. If you pretend they are not there, you tell the patient that they are an annoyance and unworthy of your time.

Remember, building patient loyalty means building a strong emotional connection with the patient – not just running on time and providing great dentistry. It means that every member of the team makes it clear that they care about that specific patient, are willing to listen to them and show genuine interest and concern for them.

Interested in speaking to Sally about your practice concerns?  Email her at

Interested in having Sally speak to your dental society or study club? Click Here.

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Resolve Office Conflict...
Get your staff to work with you, not against you.

Dr. Nancy Haller
Executive Coach
McKenzie Management

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Conflict. What words, thoughts, images immediately come to mind? Stress. Danger. Anger. Fear. Out of control. These are some of the most common descriptors.

However, if you perceive conflict as only these things, you’re missing golden opportunities to increase production in your practice. Conflict is a natural part of life. And managing conflict is a necessary skill that directly impacts turnover and retention. The better you manage conflicts in your office, the bigger your bottom line…and peace-of-mind!

Sympathetic nervous system arousal puts you into a knee-jerk reactive state. At those times, you might come to blows with your chronically late hygienist. Or fume silently, feeling like a prisoner in your own office. When the ‘fight-or-flight’ reaction kicks in, you respond from a visceral, feeling position rather than in a cerebral mode. As a result, you act from the pure emotion of the moment. That might be helpful if the building’s on fire, but dentistry success is built on rational, objective decision making.

The key is to keep normal disagreements from becoming harmful conflict. The more deliberate you are in your choices, the better your ability to accurately assess what is happening, and what is most appropriate.

Examine your beliefs about conflict. Disagreements can result in positive change, just as the source of a pearl is an irritation. Commit to developing your skills in managing conflict constructively.

If you are a conflict-avoider, stop tip-toeing around. Address the sources of friction in your office in a timely manner. Contain normal disagreements before they rage into harmful conflict. Disagreements can be painful and difficult. It’s not supposed to be easy or feel good. Get a coach to help you learn and grow.

Remember that conflict situations offer a wide range of choices. Choices about how you choose to frame and interpret your employees’ actions. And choices about how you will respond. Choose to act from a rational approach, one that is based on objectivity.

Conflict management is about understanding and accepting different views. Disagreements can be resolved without damaging relationships. The first step is to reduce criticism in order to discover needed changes. 

Criticism is based on judgments. It is often accusatory and focuses on the problem.

Discovery is based on inquiry. It is goal-oriented. It focuses on a mutually beneficial outcome. When you open a dialogue with your staff, you collaborate with them to find a solution.

Here are some ‘Discovery’ questions you might consider using to address disagreements and ward off harmful conflicts.

  • I really want to understand the situation from your point of view. Can you tell me what’s going on?
  • I think I see the specifics of this situation. Can you describe a time when it has been different? What made that situation different?
  • If you could wave a magic wand to fix the situation, what would happen? What would change? Would you do things differently?
  • Do you feel like you’ve been heard/understood? Are there pieces I’m missing?
  • What positive can come from this situation?
  • What can I do that would help the most?

To improve your skills in managing conflict, focus on one or two actions that seem most promising.  Be patient with yourself. New skills seem awkward at first. With practice, you will begin to feel more confident about managing conflict. Most importantly, recognize the progress you make. ‘Celebrate’ incremental steps toward turning conflicts into opportunities for constructive outcomes!

To keep your office from becoming a battleground, contact Dr. Haller at

Interested in having Nancy speak to your dental society or study club? Click Here.

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What is a Dental Hygienist?

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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What is a dental hygienist? Depending on who you ask you will get different answers. Many staff members and doctors consider the hygienist to be a prima donna. While many patients and the general public either consider the hygienist to be a cleaning lady or confuse the occupation with a dental assistant. Meanwhile the hygienist looks in the mirror and sees a college educated (in most states) professional. Some doctors view the hygiene department as a loss to the practice, a black hole, and rightfully so because their hygiene department is not a profit center.

Depending on the hygienist, any or all of these may be true. However, while going through hygiene school most of us were taught dental materials, computers, front office positions, how to take impressions, probe and evaluate periodontal health, root plane, take and read x-rays, take out the trash, work as an assistant, teach patient education, pharmacology, anatomy and physiology, head and neck, psychology, communication, oh…. and clean teeth. These are just a few of the skills taught and developed during hygiene school. Unfortunately, for whatever reason, many hygienists and doctors have decided to only utilize a portion of these skills. Let me rephrase that, we learned the skills but may not know how to implement them into private practice in order to be the health care provider that a hygienist is trained to be.
This is the time to decide on being a team player or the prima donna. When time permits between patients, there is always something that can be done to help another team member. Learn to utilize the operating software your office uses, take the trash out, do anesthesia for the doctor in order to help their schedule go smoother, (in states where it is legal), file charts, answer the phone, relieve an assistant, seat the doctors patient. Do whatever the office and state law permits that will help with the care of the patient and help reduce the stress of the office.
Being a hygienist is much more than cleaning teeth. Developing into a hygienist is like being a detective. Every skill we were taught must be utilized in order to provide complete oral care to our patients. Now is also the time to decide if you want to be a prophylaxis-based hygienist, a cleaning lady, or a diagnosis based hygienist.  A prophylaxis-based hygienist will do a lot of routine prophylaxis, x-rays, and exams. Where a diagnosis based hygienist will evaluate the patient’s medical and dental history then ask the patient what changes or problems there have been since their last visit. They will also ask the patient, “What changes would you like to make to your smile?”  The next step is to perform the necessary diagnostic tests which may include all of the following: blood pressure measurements, radiographs, intra-oral photographs, periodontal probings, gingival bleeding index, plaque index, caries detection, restoration evaluation, cosmetic evaluation, joint sounds, and cancer screening. Once the patient evaluation is performed, if the doctor is to examine the patient, now is the time. The doctor should be notified at this time if he/she was not already informed at the morning meeting.

If the periodontal condition is stable and it is determined the patient does not need any periodontal treatment, then the hygienist may proceed with the professional cleaning. Depending on office policy, the cleaning may be done at the first appointment with the root planing at future appointments, or the root planing may be started immediately if the patient has been informed of all financials and treatment recommended.
One more decision must be made to be all that you can be when it comes to being the professionals, we as hygienist, perceive ourselves to be. That is to take pride in ownership of the practice that you work for. No, that does not mean as a hygienist that you are the owner of the practice. However, that you work as if you are the owner of that practice and want not only to provide quality of care but to be profitable at the same time. You want to receive a paycheck, get raises, buy new state of the art technology, and go home knowing that you have done everything for your patients that you are legally and professionally trained to do, and being paid well for your services. Help stop dentists from viewing the hygiene department as a black hole, a non-profitable department. Look at the hygiene department as a business within a business. For example, the shoe department at Nordstrom’s is a department within a business and the hygiene department is not any different. Not even Nordstrom’s would consider keeping the shoe department if it didn’t prompt sales to the dress department or was profitable overall. What do you need to make your hygiene department profitable? Do you have an effective interceptive periodontal therapy program in place? Do you help promote the doctor’s treatment plans? Are you referring patients to your practice? Is the practice growing? These are all concerns of the doctors and should be your concerns too as a professional. Do you have an x-ray protocol in place? Is your hygiene department meeting or exceeding this protocol? Do you have goals? Has the number of hygiene days increased in the last year? I think you get the picture now that there is much more to a hygienist and a hygiene department than cleaning teeth.

These thoughts of what a hygienist and a hygiene department are or are not are not necessarily the fault of the hygienist. Often times they are seemingly booked into eternity and single handedly trying to manage patient recall. A number of factors can undermine your hygiene department. Improving hygiene is a multi-step process and the first place to start is tracking what is happening right now. Take the time to evaluate yourself as a hygienist and track your hygiene department, and decide for yourself what you really want for our profession.

Interested in knowing more about how to improve your hygiene department?  Email

Interested in having Jean speak to your dental society or study club Click Here.

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McKenzie Management's Seminar Schedule
  July 20 Del Mar, CA - Ortho Symposium * Sally McKenzie  
  July 26 San Diego, CA - San Diego Womens Dental Society Nancy Haller  
  Aug. 2-6 Denver, CO - Academy of General Dentistry * Sally McKenzie  
  Sept. 15-17 San Francisco, CA - California Dental Association * Sally McKenzie  
  Sept. 29-30 Oviedo, Spain - Clinica Sicilia Sally McKenzie  
  Oct. 7-8 Krakow, Poland - UNO Dental Sally McKenzie  
  Nov. 2-3 Santa Barbara - The Art of Endodontics Sally McKenzie  
  Nov. 8 San Diego, CA - San Diego Womens Dental Society Sally McKenzie  
  Nov. 17 Concord, NH - New Hampshire Dental Society Sally McKenzie  
  Dec. 7-8 Santa Barbara, CA - The Art of Endodontics Sally McKenzie  
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