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5.9.08 Issue #322 Forward This Newsletter To A Colleague
Telephone Communication
Hygiene Instruments
Dentist Coach--Team Trust

Is Your “Best” Costing You Big?
by Sally McKenzie CEO
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Remember the parable about the six blind men and the elephant? They each touched a different part of the elephant and walked away with very different impressions of what the elephant really was. Each of them was correct about what he had experienced but all of them were wrong in their understanding of the whole.

Telephone communication can be much like the experience of the six blind men. For the dental employee, the phone is often viewed as a constant interruption to more important job duties. Few realize the powerful impact of this “annoyance” on the total success of the practice. Dentists commonly view the phone simply as a perfunctory duty. It rings, someone answers it and schedules an appointment, and that’s it. Then there’s the patient. Their take on the phone—the only door to your practice—is considerably different. Just ask Elizabeth.

Elizabeth is new to the area, so she’s calling a few practices to inquire as to when she and her family can get in for their appointments. Elizabeth is an intelligent consumer. She has little patience for businesses that are not accommodating and friendly, and that do not put the consumer first. Let me assure you, Elizabeth is not the exception. Her attitudes are today’s norms.

When the dental employee finally answers the phone on the fifth ring, the greeting is an unenthusiastic, “Dr. Bolton’s office.” The employee doesn’t identify herself, nor does she ask how she can help the patient. Unimpressed, Elizabeth tries to keep an open mind. “Yes, I’d like to schedule an appointment for me and my two children.” Silence. The employee hesitates before she says in a discouraging tone, “Well, that’s going to be challenges because the doctor…oh, could you hold for just a minute, please?” Click. Elizabeth ignores the urge to end the call now. Instead, she waits and listens to the annoying music.

The unidentified staff member returns to the line. “I’m sorry. Now what is it that you need again?” Elizabeth grits her teeth. “An appointment for me and my two children.” “Oh yeah, that’s’ right. Now, hmmm, gosh, I don’t know when we’re going to get you in. I hope no one is having any problems because it’s going to be at least three months. But I could get one of you in on August 4 at 2 p.m. I could get someone else in on Thursday, August 21 at 11 a.m., and, let’s see, oh. Here’s an opening on August 26.” Elizabeth is shaking her head and rolling her eyes. “Can’t you get all three of us in on the same day?” “Oh sure. We could do that in December if you would like; I have plenty of openings then.” “But December is seven months away!” “I know. It’s a busy place.”

The staff member believes that she is doing the best she can. Elizabeth feels this office doesn’t care about serving new patients. The doctor, meanwhile, is oblivious to the entire exchange. As far as she can tell, the staff member handles the telephone just fine. But then again, like one of the six blind men, Dr. Bolton doesn’t have the full picture. Many dentists are blissfully unaware of how their practices are presented daily to the buying public.

This practice had one chance to win three new patients and the opportunity was lost.
It is for this reason that McKenzie Management recently began offering a 28-point telephone assessment in which a professionally trained and certified “mystery shopper” calls a practice and assesses the effectiveness of a team’s telephone skills on multiple occasions. Dentists receive a written report as well as a recording of the conversations.

The Telephone Mystery Shopper monitors several areas aspects of service, including phone etiquette, hold times and scheduling procedures, for starters. In addition, the assessment gives dentists a much clearer sense of the tone and attitude that the practice employees convey to current and prospective patients over the telephone. Moreover, this service helps practices determine the number of potential new patients they may be losing.

Oftentimes, very capable dental employees unwittingly drive new patients away because they have never been trained on how to effectively use the telephone—a practice’s most vital link to patients. In many cases, simply educating staff on effective telephone communication can significantly improve their approach. Moreover, it can prevent the loss of hundreds of patients and tens of thousands of dollars every year.

Schedule your mystery patient telephone call—Go here

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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Angie Stone RDH, BS
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Are Your Instruments Working for You or Are You Working for Them?

 When it comes to considering options for increasing revenue in the hygiene department, the first options that come to mind are daily openings in the hygiene schedule and the lack of periodontal procedures being performed. Addressing these issues can help increase hygiene revenue, true, but there are other, less obvious ways to achieve an increase.

One way that is constantly overlooked is that of instruments. Many hygienists are using less-than-ideal instruments. It may be because they have had the instruments since they were in hygiene school or that they were already in the operatory when they began to work in the office and are used to them. Hygienists can do what they need to do with them and are resistant to trying something new because they are comfortable with the old ones much like they are comfortable in a pair of old slippers. They don’t realize the blades are not sharp anymore or that the blade is dangerously thin from years of sharpening—until they see what a new instrument blade looks like. Worn out instruments cost practices money and they have no place in hygiene treatment protocol.

Consider the benefits of high quality, sharp instruments:

  • increased productivity
  • increased efficiency
  • improved ease of deposit removal
  • increased patient comfort
  • decreased time in the chair for patient
  • decreased operator hand and wrist injury
  • decreased incidence of sharps events

Instruments can directly and indirectly affect productivity in various ways. The most direct and measurable way is related to sharpening. It takes time to keep scalers and curettes sharp and ready to face clinical challenges. During the average hygiene day, eight patients are seen and the hygienist has the luxury of having a total of eight instrument set ups. A typical prophy kit contains three to four instruments that require sharpening. That gives the hygienist approximately thirty-two instruments to keep sharp. If the hygienist works four days a week, the instruments need to be sharpened at least once a week to keep their edge, due to constant use and repeated sterilization.

Sharpening thirty-two instruments once a week takes approximately one hour. This is one hour each week, per hygienist. The hygienist is being paid during these hours and is not bringing in any revenue. Multiply the average charge of a hygiene visit by the number of hours spent sharpening per year. Then, add the amount paid to the hygienist for all the hours spent sharpening. The amount might be staggering!

This lost revenue can be recovered due to recent advances in metallurgy and material coatings. These advances translate into scaling instruments that remain sharp over a prolonged period of time. One such technology, XP technology, is being utilized by American Eagle Instruments, Inc. XP technology produces a razor-sharp edge that starts sharp and stays sharp longer than any other stainless or carbon steel curette available on the market. The Perio Power Pack from American Eagle is the technology offered through McKenzie Management, and it can change the way hygienists view their instruments. After examining the numbers, it is obvious instruments designed to stay sharp longer are much more cost-effective than those of traditional design.

Not only can hygiene productivity be increased with the use of adequate instruments, patient and operator comfort can also be improved. A dull instrument requires the hygienist to use extra pressure during instrumentation and perform more strokes to achieve deposit removal, which produces hand and wrist fatigue. An instrument that is always razor sharp involves applying only a slight amount of lateral pressure to lightly scale away deposits with minimal working strokes. Hygienists should alternate using instruments with different handle sizes to reduce the prolonged pressure exerted on specific muscles throughout the appointment time. Instruments should not be gripped tightly unless the hygienist is removing hard deposits. Exploring, probing and light scaling require a light stroke. This method provides superior tactile sensitivity during assessment type strokes and allows the muscles in the fingers, hand and wrist to rest between the working strokes required for hard deposit removal. Due to the risk of repetitive stress injuries, clinicians should be drawn to instruments utilizing technology that requires fewer strokes to get the job done.

Dull instruments with misshapen blades can cause patient discomfort in various ways. First and foremost, the use of dull instruments can increase trauma to gingival tissues, which has a direct correlation to patient discomfort. Dull instruments require repeated scaling strokes, which can result in increased tooth sensitivity due to the removal of cementum. As cementum is removed, dentin is uncovered and the dentinal tubules become exposed to stimuli, resulting in sensitivity to instrumentation, cold items in the mouth and, potentially, sugary foods (to name a few). Sharp instruments that require fewer working strokes to remove hard deposits preserve cementum and therefore reduce sensitivity. The use of effective instruments reduces time a patient spends in the chair, which is viewed as a positive for patients as well as dental teams.

Furthermore, the sharpening of contaminated instruments chairside increases the risk of operator injury. There are reports of clinicians being poked or cut by non-sterile instruments when sharpening during appointments. Instrument pokes result in loss of revenue due to clinician down time and potential medical bills. There is also an inconvenience on the part of the patient if they need to be tested for possible communicable diseases. In order to eliminate such injuries, scalers and curettes should not be sharpened chairside. Necessary sharpening procedures should be accomplished only after sterilization. The need for chairside sharpening can be reduced by utilizing instruments with new technology such as American Eagle’s XP technology, which virtually eliminates the need for sharpening. This issue can also be addressed by having several sharp instruments on the instrument tray set up.

Clinical dental hygiene is hard work, both mentally and physically. The thoughts of the hygienist should be free to focus on the patient in the chair, not on whether instruments are sharp, or the blades strong enough to not break during scaling, or the pain in their hand from scaling with dull instruments.

Time is money. Valuable time should be spent with patients providing education and high quality oral care, not sharpening instruments. In this day and age, we have the technology available to virtually eliminate any time spent sharpening.

Find out more about the Perio Power Instrument Pack—Go Here

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

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Nipping Employee Snipping in the Bud

Email from Dr. Gale:

Just when I thought things were going smoothly I got a phone call tonight regarding one person saying something about another person and on and on and on. What can I say to the entire team to nip this in the bud?

This situation is serious because it signals that the team lacks trust. Without trust, employees are afraid to communicate directly with each other about disagreements. They are unwilling to be vulnerable about their mistakes, fears and behaviors. They engage in this kind of political behavior that wastes everyone’s time. Without a climate of trust, teams are limited in what they can accomplish, and this impacts your bottom line!

The situation that Dr. Gale describes is referred to as “triangular communication.” I explained this in my last article.In essence, one employee complains about another employee to a third employee or, in this case, to the doctor. Everyone does it from time to time. We lack the courage to speak directly to the person and we want to avoid conflict.

Employees should try to resolve their own problems before coming to you. It may be that the McKenzie Team Retreat is the solution. That said, there are ways that you, the Dental Leader, can help your staff learn to constructively handle disagreements and differences.

First and foremost, when an employee complains to you about another staff member, do not be too quick to take sides. In all likelihood you only have one perspective, one side of the story. By staying objective you refrain from jumping into action and making a bad situation worse.

Depending on your team make-up, their dynamics as a group and the longevity of the conflict(s), use this situation to teach (a) the person who called you and (b) the rest of the team—BUT ONLY IF this is appropriate. Be careful because if this is primarily an issue with the individual who complains, you do NOT want to expand the problem into the entire team. By bringing it up with the whole team you could escalate the situation. If you step in and attempt to fix things, the problem could increase if the other employee feels that her co-worker has tattled on her and thus gets more incensed.

Teams have difficulty addressing conflict because comfort levels with conflict differ radically. Some people argue passionately. Some shout and even scream. Others are silent, hesitant to air even the mildest of dissenting opinions for fear of offending anyone. As the Dental Leader, one of your most important jobs is to develop your employees. Normalize conflict and help them to learn constructive ways of resolving their differences. A very helpful tool is the Team Dynamics book series on the McKenzie Management website.

Start by asking questions. Here are a few:

  • What have you said or done so far?
  • Why do you think she is angry with you? or Why are you so angry with her?
  • How is this affecting patients/customer service?
  • What could you do about this to make it better?

In this way, you guide an employee through a thought process about his/her own responsibility. You could role play it with him/her too. Suggest that he/she try out what he/she has “practiced” with you and then come back and let you know how things are going. In this way, you are not in the middle but rather acting like a coach on the sidelines.

Nipping employee snipping in the bud is all about creating healthy teamwork. Don’t let it go on and on, lest you find yourself in a real office battleground. Even the best teams have conflict and the office might be uncomfortable from time to time. The tendency is to want to fix things and make problems go away. However, by showing patience and strength to tolerate the discomfort, you enable your team to move to higher levels of productivity and profitability.

If back-biting and snipping are present in your office, contact Dr. Haller.

Dr. Haller is available for team building and dental leadership coaching. She can be reached at
Interested in having Dr. Haller speak to your dental society or study club? Click here.

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