2.23.07 - Issue # 259 Forward This Newsletter To A Colleague
Inheriting A Team
Patient Communication
Hygiene Instrumentation

What’s Your Inheritance Look Like?
by Sally McKenzie CEO
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It’s a package deal. You just bought a practice from a retiring dentist. You get the patients, the equipment, the records, the parking spaces, the computer system, and …the staff. Inheriting a team can be both a blessing and a curse. If you’re lucky, they will be a good group of people who will be key to your success, thanks to their established relationships with patients, knowledge of practice systems, and openness to change. If you’re not so lucky, they will present a host of challenges, barriers, and frustrations, particularly if you don’t establish your expectations from day one. Consider the case of Dr. Watts.

Ellen has been the business manager in the practice for about eight years. For the first seven, Ellen worked for Dr. Sullivan. He retired about a year ago, when the practice was sold to Dr. Watts. Ellen was very comfortable working for Dr. Sullivan. As long as she took care of specific tasks, this salaried employee could come and go as she pleased – out promptly at noon for her one-hour lunch and heading for the door at 5 p.m., regardless of how many patients remained in the office.  If Dr. Sullivan didn’t approve, he simply looked the other way.

In trots Dr. Watts and she fully expects Ellen to be at the desk to handle patients even if it means leaving a few minutes behind schedule for lunch and getting out a little later in the evening. After all, checking patients in and out is Ellen’s job. When Dr. Watts mentions that she would like Ellen to be at the desk to take care of patients, Ellen will improve for a while but slips back into her old habits.

The bottom line is that Ellen wants control of what she sees as her schedule. She had control when she worked for Dr. Sullivan and she’s not interested in relinquishing it to Dr. Watts. Her behavior is much like a child testing a parent, Ellen will continue to push to see just what she can get away with in terms of leaving before her job is done.

Although Dr. Watts has told Ellen she’d prefer she didn’t leave until the patients are checked out, it’s not in writing. There are no job descriptions, and there are no performance reviews or disciplinary procedures. She has not set forth clear expectations for her new team. Ellen may be a solid employee, but she doesn’t understand why Dr. Sullivan didn’t have a problem with her leaving “on time” but Dr. Watts does. She doesn’t see the importance of her role and how it affects the productivity of the team as a whole.

Taking over a practice requires change management. It requires the dentists to share her/his vision, goals, and expectations for the practice and the team immediately – not a year or two after she/he’s set up shop. Helping employees to adapt to the change in leadership and helping the doctor determine if this team is the right fit for her/his practice starts with clear direction and written expectations from the doctor as well as regular performance reviews. Otherwise, the dentist may well find that she/he is working for the team rather than the team working for the dentist. 

Take these steps and spell out your desires clearly from day one:

  1. Make a conscious effort to establish open and clear communication with your new staff. Give them plenty of direction and feedback.
  2. Clearly explain employee responsibilities. 
  3. Establish expectations for employees and, if necessary, provide training to enable them to meet those expectations.
  4. Hold regular meetings with staff and follow a specific written agenda.
  5. During meetings, require each employee to report on the system they are accountable for, such as scheduling, accounts receivable, recall, hygiene, etc.
  6. Encourage a problem solving environment in the meetings, so that employees feel comfortable asking for direction, guidance, and assistance if they are having difficulty reaching a goal.
  7. Identify issues that could be problems with patients or among the team.
  8. Develop strategies and delegate responsibility to specific staff to address those critical issues.

Focus on staff communication up front and you will significantly reduce the pain of change and establish yourself as the leader of your practice and your team.

Next week, avoid the number one pitfall when inheriting a new team.

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

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

Forward this article to a friend.

Carol Tekavec
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What is the Difference?
“Cleaning”, Root Planing, Perio Maintenance?

Do your patients understand why they have been scheduled for a root planing procedure?  Do they complain about coming in for “cleanings” several times a year?  Do they understand what a “cleaning” actually is and how it differs from periodontal maintenance?  Most patients don’t!  Patients rely on dentists and staff to help them understand their treatment, but it can be difficult to choose the right words.  What follows are excerpts from my patient education brochure, “What is the Difference Between a “Regular” Cleaning, A Root Planing, and Periodontal Maintenance”, available from McKenzie Management.  The statements in the brochure can help staff focus on common issues before talking to patients; while giving the brochure as a “take-home” handout supports staff explanations later. What is needed is something that actually answers the kinds of questions patients really ask; not a brochure that is “institutionalized” and therefore, frequently tossed away without a thorough reading. Here are some typical questions and answers taken from the brochure:

What is a “regular cleaning”?
A “regular cleaning” is known as a prophylaxis in dental terms.  The American Dental Association describes a prophylaxis as “removal of plaque, calculus and stains from the tooth structures”.  It is recommended for persons who do not have any bone loss, periodontal disease, or infections around their teeth.  There should also be no bleeding, mobility of teeth, receded areas where the gums have pulled away from the teeth, or gaps where spaces around the roots of the teeth are exposed.  In other words, the mouth should be healthy with no gum or bone problems.

How often do I need to have my teeth cleaned?
The old system of everyone having their teeth “cleaned” twice a year has fallen out of favor.  Most dentist and hygienists are now setting up a patient’s cleaning schedule based on individual needs.  This may be as often as four times a year.

What is periodontal disease?
Periodontal disease is very common, but does not always have distinct symptoms.  It is an inflammation and infection of the supporting structures of the teeth, which includes the gums, bone, ligaments, and root surfaces-- that can eventually result in the loss of teeth. You may notice that your gums bleed easily, you have a bad taste in your mouth, your gums appear red or swollen, your teeth appear longer or seem to have shifted…or you may not notice anything at all.

What is a root planing procedure?
Patients with periodontal disease may require root planing to remove diseased deposits from the roots of the teeth.  Other treatment, including surgery, may be required.  Root planing removes bacteria and its toxins, tartar, and diseased deposits from the surfaces of tooth roots.  Scaling (using dental instruments or an ultrasonic “machine” scaler to scrape away deposits) is required for the full length of the root surface, down to where the root, gum, and bone meet.

What is periodontal maintenance?
After the disease process is under control, a “regular cleaning” is not appropriate anymore.  Instead you will require special ongoing gum and bone care procedures, also known as periodontal maintenance, to keep your mouth healthy.  Periodontal maintenance is different in scope from a “regular cleaning”, even though a hygienist may perform both services.  Periodontal maintenance can include a medical and dental history update, radiographic review, dentist exam, gum and bone exam and periodontal probing, a review of home care, and scaling and root planing, polishing and irrigation of the gums as needed.  The dentist’s exams and X-rays are not included and are billed separately.  Typically an interval of three months between appointments may be needed.

Will my insurance pay for these procedures?
Most plans will pay for root planing for patients with a defined amount of bone loss on a “once every two years” basis.  The majority of plans also will pay for two “regular cleanings” a year or two periodontal maintenance procedures per year.  Insurance can help you pay for treatment that you need, however, it was never designed to pay for everything.  Most plans pay a minimum, regardless of what you may need as an individual.  It is a mistake to let benefits be your sole consideration when you are making dental decisions.

Being prepared to answer patient questions and having easy-to-understand patient education materials available can make dealing with periodontal issues a little easier.  Patients look to their dentists and staff to help them with their concerns. The “What is the Difference” brochure can help.

To order this brochure visit the McKenzie web-site….here.

Carol Tekavec CDA RDH is the author of the Dental Insurance Coding Handbook, designer of an inexpensive dental chart, an informed consent booklet, and several patient education brochures. While still functioning as a clinical hygienist, she is a featured speaker at most national dental meetings.  Contact her at 800-548-2164 or visit www.steppingstonestosuccess.com.

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Are Your Hygiene Instruments Performing at
The Level You Need?

One of the many things we observe when evaluating hygiene departments are the instruments being provided for the hygienist to utilize. Having the right instruments for the procedure at hand is extremely important. This is why we find it important to look into the operatories of the hygienists in order to evaluate the tools she utilizes to provide quality of care. Some of the things we evaluate are:

What type of probe is the hygienist using? What type of probe is the doctor using?

The entire office should be using the same type of probe in order to allow for calibration throughout the office, whether they have decided to use a computer probe or a traditional probe. There are many different traditional probes to choose from such as the Williams 1, 12 (Marquis), South Dakota 12, or the Michigan 0 probe. All of these probes have different incriminations on the probe. The shape or the angulations of the tip, or the weight may be different, possibly causing one operator to measure the same pocket differently based on the probe itself. Continuity of probes throughout the entire office is important in the treatment of periodontal disease. American Eagle even has Hi-Lite Probes that are yellow or yellow and green allowing for greater visibility of depth do to distinct precise markings.

Are there enough probes to get through a scheduled day of hygiene?

It is recommended that there be at least one probe for every cassette of instruments for the adult patients who are going to be probed.

 Are the probes in good condition?

If the probes are bent, the probings will be different from those in good condition. Also, the markings on the probes should be easily readable and not faded. Some probes require different care. In order to extend the life of your Hi-Lite probes, sterilization temperatures should not exceed 300 degrees Fahrenheit or 149 degrees Celsius. The Hi-Lite probe should not be put in the ultrasonic and should have minimal exposure time with any solution. The hygienist may want to wipe the probe with an alcohol wipe and place into her cassette in order to sterilize.

Does the hygienist have an ample supply of hand scalers?

Just like the dentist, a hygienist needs to have the tools required to provide quality of care. She will have her cassettes for prophylaxis and for periodontal maintenance appointments, and she may have some single instruments packaged that she utilizes for extremely hard to reach areas such as furcation areas and deeper than usual concave areas on the root.

Are her instruments sharp? What does she use to sharpen her instruments? Are the tips in good condition or does she need new instruments?

Sharpening instruments has always been a chore, but is very important when it comes to quality of care, reducing operator fatigue, and patient comfort. We all know that implementing a sharp instrument on a tooth requires far less pressure and working strokes than a dull instrument. Using an instrument that does not have a good tip or is not sharp is like using a bur that is worn out. It just does not do the job adequately. It will require more effort and time to do the job at hand.

Does she have separate cassettes of root planing instruments?

Separate root planing cassettes are recommended, as these instruments need to be a little thicker than the instruments used during a prophylaxis. The last thing we want is to have a tip break off in the patient’s periodontal pocket. XP technology is a great way to go when looking for root planing instruments. We have found XP technology to have a sharper factory edge and maintain that sharpness longer than the traditional stainless steel instruments. The blade is also thinner on XP scalers and curettes than standard scalers and curettes. This allows the hygienist the access she wants from a thinner blade for sub-gingival scaling while knowing the integrity of the blade is present.

Quality sharp instruments will help with quality of care for your patients. When it comes to a hygiene department there is more to it than scheduling, recall, production, communication skills, and periodontal disease. Using the hest possihle well-maintained instruments during the clinical procedure can make the experience better for the hygienist and also the patient.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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

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