10.13.06 - Issue # 240 Forward This Newsletter To A Colleague
Establishing Guidelines
Starting Up Successful
Hygiene Scheduling

Tired of Playing 20 Questions?
Give ’em the Answers
by Sally McKenzie CEO
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“But doctor, you said that I could take those two weeks off before Thanksgiving. It’s not my fault you promised Jackie she could take that time also.” “The office doesn’t open until 8 a.m., why do I have to be here earlier for a meeting?”  “Are we paid overtime for this?” “Why can’t I wear flip-flops? They’re comfortable, and the patients don’t notice my feet.”

Questions come up every day in the dental practice, and too often the dentists position themselves as the go-to person for the answers to virtually every practice policy matter – the all knowing, Divine Maker and Enforcer of the Rules, if you will. They reason that most of the issues come down to plain, ‘ol common sense. Or perhaps they actually developed some loose policies along the way but don’t necessarily follow them or share them with the staff. They deal with the circumstances as they arise, and therein lies the biggest practice policy pitfall – inconsistency. Without established policies or documented procedures for even the most fundamental management issues, the doctor sets him/herself up for a multitude of unnecessary personnel headaches

Oftentimes, when consistency is lacking, the staff perceive the doctor to be perpetually waffling. One person asks him/her what the policy is on this and he/she says one thing, the next time there’s a different answer. Or “special circumstances” will warrant an exception but nowhere is it spelled out what those “special circumstances” might be – employees are left to guess on how the doctor will respond.

Situations become extremely stressful and frustrating for both doctors and team members when there are few, if any, clearly established guidelines for handling day-to-day concerns such as time off, dress code, vacation policy, sick time, work hours, etc.

Moreover, most employees walk into a job wanting to be successful, seeking to understand the expectations so that they can effectively meet or exceed them. But without clear policies and established expectations, the employees can feel they are at the mercy of the doctor’s whims. Consequently, the practice becomes fertile ground for conflict. If the doctor appears to be making up the rules as he/she goes along, or if the doctor seems to repeatedly make exceptions for some employees and not others, morale plummets. Backbiting, bickering, and a culture of distrust and ineffectiveness permeates the office. This is not an environment in which many employees can succeed and few will stick around for long. 

Staff need clear guidelines. They need to understand what policies and procedures are to be followed in the office. They need to understand plainly what the rules of the game are and how they are to go about following those rules. They need an employee handbook.

The purpose of the handbook is to clearly explain what the expectations are in the dental practice. Rather than serving as a laundry list of rigid rules and requirements, it sets up guidelines that reflect good business practice and builds strong employer/employee relationships. It can be used to articulate the doctor’s philosophy for the practice and general goals for the team as a whole. It’s an effective means of conveying a positive message of teamwork and encouragement.

But most importantly, the handbook enables employees to know what is expected. Thus, they don’t feel as if the ground is always shifting beneath them. They aren’t strategizing and mentally calculating when would be the best time to ask for the doctor’s ruling on this or that issue because the answers are already part of well-established practice policies. It’s not the doctor telling the employee that she cannot wear flip-flops to work because she’s already familiar with the standards for professional attire in the office. It is part of the practice policies that are established in the employee handbook.

But writing a handbook seems so overwhelming, where do you start?

Next week, handbook basics.

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

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Belle DuCharme, CDPMA
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Is Success in Dentistry Like a Poker Game?

“You’ve got to know when to hold em, know when to fold em, know when to walk away and know when to run.”  Kenny Rogers

In order to take your practice to a higher level of success, you must first be definite in your vision of success, not what you think it should be, but what you want it to be.  The question I ask of all that attend, The Practice Start-up Program at McKenzie Management is, “Why are you here?”  The number one answer is: “I want to build a successful practice where I enjoy coming to work every day and I want to retire and be able to survive on my investments.”  Like building a good poker hand, it takes the necessary components to put the play in action. We all have some kind of idea of what it means to be successful.  You need to write it down and then get a plan of action.

My inspiration for this article comes from the book Poker for Dummies, by Harroch and Krieger.  “Bookstores are filled with self-help books. Seminars galore promise to teach you how to be a winner in business, in love, and in your personal life. Some of the same principles can make you a winner at the poker table.”  And the same can make you a success in the dental office.  Sometimes I have to get my clients to “think outside the box” to get the ideas flowing.  The ten keys for a successful poker game can also be the keys for success of a dental practice.  Here they are as follows:

  1. Be Aware of Your Strengths and Weaknesses
    Find your passion in dentistry and build on it and create your own niche.  Get out and let people know whom you are and what you want to create for the community.  If you are introverted and have difficulty presenting treatment then take some courses in public speaking or join Toastmaster’s International. Just as in poker, you play your best game in your own comfort zone.
  1. Act Responsibly.
    Be accountable for the results you achieve or don’t achieve.  It is not the responsibility of anyone but you the dentist, the CEO. Luck is a factor in the game at first, but in the long run it is skill and determination.
  1. Think.
    You need to think about the business of dentistry. Keep up on the latest technology and how you may improve your “game.”
  1. Have a Plan.
    Do you have a written business plan?  Have you set short term and long-term goals? Have you thought about retirement and creating it now?  What kind of practice do you want?  Multiple treatment rooms, associates, or a smaller set-up in a solo practice.
  1. Set Deadlines.
    You need to set timelines on what you wish to achieve.  If you are having difficulty getting the goals met, it may be time to get help from other dental professionals such as McKenzie Management.  Many doctors plod along for years just breaking even and never fully realize the success that could have been theirs.
  1. Be Realistic.
    Don’t set yourself up for failure by setting a goal that is not tangible.  Don’t indulge in idle fantasy or spend a lot of time comparing yourself to your peers or the practice down the street.  Get the information based on the reality of your location and the kind of dentistry that you want to do and start-practicing goal centered dentistry.
  1. Expect Difficulties.
    “I never promised you a rose garden.”  You will experience ups and downs and how you cope with them or your “attitude” in the matter will determine whether you have a positive or negative outcome.  I know a dentist that has more stress on a good productive day than a day full of exams.  Why? Because he has a mind set that a busy day “has to be hard”.  Coaching would be good at this point in his career.
  1. Build on Small Accomplishments.
    Celebrate your accomplishments as they happen.  Give yourself and your staff the rewards that they deserve.  Keeping people motivated and feeling good about their work is important to creating the dream practice.
  1. Persist.
    Don’t get derailed from your purpose and goals that you have in your plan.  You must sustain.  Each time you reach one of your goals, savor the moment and then reach for the next.  Try visualizing yourself in the practice of your dreams.  What does it look like?  Start picturing yourself there.
  1. Have Fun.
    Of course you have to be serious about delivering dentistry in a controlled environment but nobody said you couldn’t enjoy it.  Get to know the fun side of your staff and your patients.  Small talk is good for morale and the patients will get to know you as a real person.

“Look inward, look outward, set goals and deal with inevitable setbacks, show up, have fun and succeed.

Join us at McKenzie Management for the Practice Start-up Program.  If you are just starting a new practice or are moving to an existing one, at the beginning is the time to get it right.

For more information on McKenzie's Practice Start Up Program, email training@mckenziemgmt.com,
call 1-877-777-6151 or visit our web-site at http://www.mckenziemgmt.com/.

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Nancy Caudill
Senior Consultant
McKenzie Management
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“Is Your Hygienist Reading People… People Magazine?”

Dr. Sam Snyder - Case Study #245

Dr. Snyder called our office so frustrated.  “My hygienist is driving me to drink!  She reads People Magazine more than she works!”

Dr. Snyder’s Office Facts:

  • 5 year old practice
  • 1 doctor – 1 hygienist – 1 business coordinator – 2 assistants
  • 15 new patients a month
  • $50,000 gross production per month
  • 98% collection rate

Dr. Snyder shared with me at dinner the first evening about his practice frustrations:

  • No practice growth in terms of # of new patients
  • No significant increase in practice production or collections
  • Not as busy as he would like to be
  • “Hygienist costs me more than she is worth”

I assured him that his practice was not unique.  His concerns are common in the dental community and he was not alone.  The good news is:  “These symptoms are curable.”

My first day in the office illustrated what I had suspected – no hygiene system in place.  Examples of this malady are:

  • Appointment confirmations made 1 day in advance
  • “Cutsy” computer-generated reminder cards mailed
  • No pre-blocked appointments for new patients and SRPs
  • No hygiene daily production goals set for scheduling

As you read through this list, I am sure that you don’t see any real issues here – appears to be “business as usual”.  Dr. Snyder thought the same thing and wondered what this had to do with his issues at hand…low production and a lazy hygienist!

First, I don’t believe in lazy hygienists…hygienists work the schedule they are presented with every morning, just as the doctor is.  If they have 5 patients on their schedule, that is how many they see.  If they have 10, they see 10, does this make sense?  Let’s review the symptoms above and see what the solutions are.

Appointment confirmations not being made…
Mrs. Jones has a hygiene appointment with Dr. Snyder on Monday morning.  Jane, his front desk person called and left a message on Mrs. Jones’ home answer machine on Friday to remind her of her appointment.  Johnny, Mrs. Jones’ teenage son, was expecting a message from his girlfriend so when he came home from school he checked the messages and, sure enough, there was the message from Jane reminding his mother of her appointment.  Guess what?  Johnny forgot to tell his mom.  Monday morning Mrs. Jones is guilty of “missing in action” at Dr. Snyder’s office.

“Cutsy” postcards…
Jane loves Garfield and has his picture on everything, including the hygiene reminder notices.  This says a lot about the value of professional cleanings in Dr. Snyder’s office, doesn’t it?  And because the cards are computer-generated, they are flimsy so they get lost inside the Penny Saver and tossed in the recycle bin without being discovered!

No pre-blocked appointments for New Patients or SRPs…
This becomes a non-issue when the hygiene schedule is not slammed with patients that aren’t coming!  There are enough openings in the schedule to accommodate the new patients and periodontal appointments within the next week.  Remember – new patients must be seen within 7 days or they will look elsewhere.  Periodontal therapy should be initiated and completed within 21 days according to the AAP.

No scheduling goals for hygiene…
What is the motivation for Jane to keep this hygienist busy?  She thought the hygienist should be calling “her” patients because Dr. Snyder told his hygienist to “stay busy”.  Jane will schedule a hygiene appointment if a patient calls but…no one is calling!  She even called everyone on her yellow legal pad but they were all busy.  The hygienist offered to help make phone calls but Jane told her that she had already called them all!

Now, I am not criticizing Jane.  She is following the guidelines that were given to her by the previous business person and Dr. Snyder has no idea what the system is that isn’t working!


  • Re-confirm hygiene appointments that were scheduled 6 months in advance 2 days prior to their appointment.  This would have given Jane an opportunity to follow up one more day if she had not heard from Mrs. Jones.
  • A professionally printed “announcement” with a personal note written by the hygienist in a self-addressed envelope that also includes information about Dr. Snyder’s new “cavity-detecting” laser actually survives being captured by the Penny Saver and gets opened. 
  • If hygiene appointments are being scheduled 6 months in advance, appointments must be reserved for new patients and SRPs because when the time arrives 6 months from now, there will be no openings available to see these patients except all those patients that are going to cancel their appointments the morning of their appointment or just be MIA.
  • Establish the daily hygiene scheduling goal to 3 times her daily salary.  Be sure to factor in any PPO adjustments if scheduling UCR fees instead of PPO fees.
  • Give the business coordinator the training tools to teach her how to keep the hygienist busy and scheduled to goal each day.  This is her responsibility – not the hygienist’s.

I have a saying…”if the hygienist doesn’t have her fingers in a patient’s mouth, she is not making money!”  You don’t want to pay your hygienist $45 an hour to send out recall cards!

Dr. Snyder will reap the rewards of increased production and grow his practice when his hygienist is productive.  The hygienist is happy because she doesn’t want to read People, she wants to treat patients.  Jane wants to achieve her goals, now that she has one, for a sense of accomplishment each day.  Everyone wins!

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

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McKenzie Management
A Division of The McKenzie Company, Inc.
3252 Holiday Court, Suite 110
La Jolla, CA 92037
Email info@mckenziemgmt.com
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