4.20.07 - Issue # 267 Forward This Newsletter To A Colleague
Fear of Change
Monitoring Your Numbers
Hygiene Patients

Creating a Welcome Change
by Sally McKenzie CEO
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To change is difficult. Not to change is fatal. Ed Allen

In a small practice a simple change can make the difference between keeping a patient and losing them, between scheduling someone for treatment and letting them drift away. But change, as we know, is difficult. People fear change because they are uncertain how it will affect them. Employees often resist change because they are concerned that they will lose power or control or they feel their job security will be threatened.

Supervisors, who are often uncertain how to implement change, will simply thrust change upon the staff, giving them little or no input, training, or advance preparation. One day the employee is going along just fine, fulfilling their duties as they believe they should be and the next day they have to completely change how they do something.

For example, Dr. Jordon decided he wanted his employee, Nichole, to begin  following-up with patients to remind them of their appointments 48-hours in advance. In addition, he wanted Nichole to contact patients with unscheduled treatment in their records. Nichole was instantly resistant to the idea and told Dr. Jordon that patients would feel they were being “hounded” by the practice.

In reality, most patients appreciate reminders and welcome a call from a practice that is genuinely concerned about their wellbeing. After all, patients are dealing with dozens of demands, responsibilities, and stresses. They are so overextended between employment issues, children’s activities, volunteer responsibilities, economic concerns, and so on that when it comes to a commitment that the patient may not feel is absolutely necessary, such as a dental appointment, it’s likely to be relegated to the “I’ll get to it eventually” category. Therefore, a follow-up phone call from the practice reinforces the importance of keeping or scheduling the appointment.

But…back to Nichole. What is probably going on in Dr. Jordon’s practice has little to do with her concern about how patients will feel. Rather, this is about Nichole’s fear of change. She is very comfortable with her current duties. What’s more, she has absolutely no idea how to encourage patients to keep or schedule their appointments.

Dr. Jordon is right to want to have the practice follow-up with patients, but if Nichole is going to be responsible for carrying out this duty, she needs the tools to do so effectively. In this case, scripts.  

Scripts ensure that when it comes to day-to-day patient communication everyone is saying the same thing. For example, when Nichole calls patients to remind them of their appointments, she has a general template of what she’s going to cover with the patient. In addition, she’ll personalize the call by noting a particular area of concern. She’ll reinforce the need for the treatment, based on the patient information in the chart. This personal attention impresses upon the patient both the importance of the appointment and the fact that Dr. Jordon’s practice is truly attentive. Finally, she can use this follow-up call as an opportunity to remind patients about any pre-medication needs and offer to call the necessary prescriptions into their pharmacies.

In addition to helping Nichole succeed in carrying out her new duties, scripts can benefit virtually every member of the team. When it comes to collections, a script enables even those most reticent to effectively request payment from patients. They enable the entire team to effectively communicate with past due patients, to reach out to those with unscheduled treatment, and to expertly handle those who have failed appointments. Scripts enable the clinical team to boost treatment acceptance because they understand how and when to effectively educate patients on recommended procedures.

The bottom line: Everyone knows what to say, how to say it, and when to say it because they are prepared. They aren’t in a situation in which they have to think on their feet. Rather the communication is natural and comfortable because they have practiced thoroughly and are confident in virtually every patient communication scenario. 

While asking employees to change how they handle certain procedures or daily interactions with patients is likely to be greeted with resistance, providing them the tools to succeed will go a long way in making the change process exciting and positive rather than frightening and negative.

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.

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Belle DuCharme CDPMA
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Monitoring Your Practice Success

You are back to your office after attending McKenzie’s Advanced Business Training and you are all fired up to succeed.  You now know the business of dentistry and how to focus on success.  How do you stay on top of your game?  What signs do you watch for to measure success and know when to take immediate action when something is not right?  Foremost, don’t get complacent.  It is critical that you and your staff maintain communication about the practice on a daily, weekly, and monthly basis.  The morning huddle and the monthly Business Planning Meeting are just as important during a growth period as they are during a slump.  Morale of the staff is an ongoing nurturing process with thoughtful praise and perks for jobs well done.  As the practice succeeds and becomes more profitable, remember that the team is paid for their contribution to the success of the practice.

Often I hear of offices dropping their morning huddle and monthly business meeting because they are too busy and don’t feel the need.  This is a sign of trouble ahead that manifests in sloppy, incomplete work, lower new patient numbers, system failures, and staff turnover. 

For those of you that enjoy the sport of football, you know what happens when the intended receiver drops the ball, lost points, field position and team morale.  If you take your eye off the dental business monitors of your practice the same thing happens.  The critical monitors are as follows:

  1. Number of new patients per day/month/year. Is the practice growing?
  2. Overhead percentage goal is 55%.  Every % that is over 55% is less profit.
  3. Average daily production of doctors and hygienists.
  4. Average daily collections.  Over the counter collections at 45% and overall at 98% of monthly production.
  5. Overhead percentages in line with accepted industry standards-as taught in the course.
  6. Staff salaries 19-22% of gross production.
  7. Patient retention of patients in recall should be no less than 50% of the new patients per month.
  8. 90 day past due AR is 10% or less.

All business systems must be as efficient as possible because more diligence will be necessary to keep up the stats.  Without the critical meetings with team members, no one knows how the practice is doing and what things can be done to improve.  The days are full of purposeless chaos.  For instance, a day without the morning huddle doesn’t catch an undelivered bridge case; a patient that needed to pre-med and wasn’t reminded; 3 patients needing a full mouth series; and emergency patients put into the schedule at the worst possible time.  Mapping your day with the guide of the morning huddle planning form would have eliminated these unexpected events.  Without the monthly business meeting there can be no place to discuss production and collection goals, ways to attract and keep new patients, ideas to improve systems in the practice, and most of all for staff to connect and improve communication.

A dental practice cannot succeed with under trained or under directed team members.  Mentoring and coaching are part of the training program within the dental team purpose.  When a new hire is brought into the existing team it is very important that this person be given the time and attention to get them performing at 100% in the shortest period of time.  Written job descriptions with areas of accountability and stated performance measurements are mandatory. This information is provided during the Advanced Business Course.  Giving the team member purpose over just a job is important in building long term team players.  No two dental practices are alike in operations or philosophy and even the most experienced person will have to relearn some job skills to get to an acceptable level of performance in the new practice.  “Dr. So and So used to do it this way” must be dropped and new skills adopted.  In general, it takes three months of supervised training to get a new hire up to speed.  Don’t assume that they know their job because they say they do.  Monitor the performance during the 90-day training period and have a senior team member check the accuracy of the work with the intention of coaching - not criticizing.  Front office accuracy in new patients, collections, production and retention can be checked by the daily and monthly reports run by the computer.  Instructions on reading these important reports are also incorporated into the curriculum no matter what system you are using.

Becoming complacent, and “dropping the ball” when hiring and training, can cost you far more than you anticipated.  If you have the proper systems in place, this transition can be smooth and pleasant.  Give your team a “touchdown” for success and send them in for the Advanced Business Training at McKenzie Management.

For more information on McKenzie's Advanced Training Programs for Dentists, Office Managers and Front Office, email training@mckenziemgmt.com, call 1-877-777-6151
or visit our web-site at www.mckenziemgmt.com.

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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The Patient That Continually Refuses Treatment

In the past, we have discussed how to develop your hygiene department into the profit-making department that you want. One of the industry standards is to have periodontal treatment and ancillary products at 33% or above total hygiene production. This is extremely doable with a continuous effort from the hygiene department and truly benefits the periodontal patient as much as the practice. Those patients that have gone to the periodontist and have refused surgical treatment, but are willing to have non-surgical therapy, will benefit from the more aggressive non-surgical treatment. However, they should be reminded that the surgical treatment recommended by the periodontist is still to their advantage.

We have just looked at one reality of working as a hygienist in a general dentist office. Not every patient is going to have the same priorities as ourselves or as other patients we see.

What do we do with the patient that will only do treatment based on what the insurance will pay? What about the existing patient that refused to have periodontal maintenance appointments? What about the patient that refuses the 3month recall they so desperately need? These are just a few of the realities that happen when practicing chair side. Yes, in the perfect world of hygiene, every patient would floss, stay on schedule, make every appointment, do all restorative treatment, have surgery when diagnosed, and not care at all about how much insurance pays.

Those patients that refuse to do only what the insurance will cover need to be educated about their insurance benefit provided by their employer. What does this mean to the dental hygienist? It means she should be made aware of insurance benefits, limitations, and insurances that have unusual benefit limitations. Not because the hygienist will be going over financials, but because she does need to help the Financial Coordinator when it comes to educating the patient about insurance. This may be as simple as explaining to the patient the different limitations that different insurances have. Thus, making the patient aware that insurance companies are not there to keep the dentist from doing unnecessary work, but that their benefits are based on what their employer was willing to pay for their dental insurance. The pamphlet, My Insurance Covers This Right?, is another great way to help with educating not only the hygienist about insurance but also the patient. 

Then there will be those patients that refuse to have periodontal maintenance appointments. These patients need to be educated about the difference between a periodontal maintenance appointment and a prophylaxis. This education needs to be not only verbal but also in the treatment that is actually done. Yes, we know that a periodontal maintenance appointment requires more work by the hygienist but does the patient perceive that there is something else or more being done compared to a prophylaxis?  The hygiene department should be doing additional therapy specific to the patient’s individual needs at every appointment. Also, if the patient refuses to have a periodontal maintenance appointment, then office policy will need to be developed. Do you continue to see that patient? Does the hygienist only treat the patient with a prophylaxis? Why should the dental hygienist do the work of a periodontal maintenance appointment if the patient is not willing to pay for it? When I go to the grocery store, they do not sell me a steak at hamburger price just because I don’t want to pay for it.

This brings us to the patient that refuses to come in every 3 months because of insurance limitations or they just don’t want to pay for more than two professional hygiene appointments a year. Again this is a matter of educating the patient about the importance of coming in every 3 months. It is not just to get their teeth cleaned. It is to prevent them from developing periodontal disease. Possibly the patient needs to reevaluated and may need root planing. A bloody cleaning with 4 mm or more pocketing is not a healthy cleaning.

If the patient has already had root planing, and is on a 3 month periodontal maintenance appointment, it is in order to help slow down a disease process that cannot be cured.

Is the hygienist aware that some insurance companies pay for four periodontal maintenance appointments, but will only pay for two prophylaxis? Of course this varies from insurance company to insurance company.

It is recommended that the patients receive the treatment that is needed. However, the patient retention in the office may increase if you do everything you can to utilize their insurance 100%.

Educating ourselves as hygienists, not only about the disease process, but also about insurance limitations may help with treatment acceptance. It will also help us educate our patients and support us in patient compliance. The doctor should develop office policy and the entire team should work on verbiages to be used for these particular patients.

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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