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5.16.08 Issue #323 Forward This Newsletter To A Colleague
Case Study
Morning Huddle

Is “Cross-Training” the Answer or the Problem?
by Sally McKenzie CEO
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I have to admit that I really like the idea that many dentists have of “cross-training.” Everyone on the team covers for everyone else. It’s a nice, warm and friendly notion that team members just automatically step in and help whenever the need arises. But when I try to gather more details on how this works in their practices, what the protocols are and what training took place to prepare the staff to just “step in” when necessary, the answers are typically long on generalities and short on specifics. One of my favorites is, “Well they just do what needs to be done.” Oh, really?

Unfortunately, doctors’ perceptions are rather idealistic, to put it mildly. What many of these dentists don’t consider is that the dedicated assistant, Mary, who’s been with the practice for two years, doesn’t necessarily know how to just “step in” and help. Sorry—I know that might come as a shock. It’s not that she isn’t willing. But when she’s expected to just “step in,” she’s being thrown into a situation for which she probably has zero to minimal training. Because she has been in the practice for two years doesn’t mean that she knows how to collect from patients, that she understands the specifics of scheduling or that she’s prepared to handle patient phone calls effectively.

Perhaps the business manager spent 10 minutes on the fly showing her how to take care of a few things—a quick and dirty lesson, and definitely not what you can consider training. It’s a common approach that often causes more problems than it solves.

Consider this: If Mary, the assistant, as well as everyone else on staff, is simply expected to collect from patients, who is responsible when revenues are down? If a patient complains that she was treated rudely on the phone, who’s accountable? If the schedule has the doctor racing from room to room and the hygienist sitting around thumbing through magazines for half the day, whose job is it to correct this? The fact is that when everyone has their hand in everything, no one is accountable for anything.

Instead of answers to problems, you hear the chorus of excuses. I thought she was taking care of that. Oh, I didn’t realize that. When did we start doing this? Uh oh, how did that happen? Not because your team is incompetent or unwilling, but because there are no real expectations, there is no delineation of duties and there are no real measurements of performance. No one is taking responsibility or has genuine pride in the outcomes of any one system because they are not allowed to do so.

You cannot ignore solid management practices, or human nature for that matter. If staff are simply expected to “fill in” wherever they are needed, no one has the opportunity to take ownership or to shine, because the focus is merely on getting the job done, not getting the job done well.

Long before you can expect everyone to do virtually anything someone has to actually be responsible for something. In other words, a system of accountability is the foundation for a highly functioning team in which cross-training can eventually occur.

The process of establishing system accountability begins with creating results-oriented job descriptions for each member of your team. The job description includes the job title, a summary of the position and a list of the responsibilities and duties of the position.

It also includes individual performance goals that complement practice goals, such as increasing collection ratio, improving accounts receivables, improving treatment acceptance and maximizing the hygiene schedule.

In addition, provide job expectations in writing and list standards for measuring results. For example, if you expect the front desk staff to schedule to meet specific production goals, they not only have to know what those goals are, they also must have a strategy and the necessary training to achieve them. In other words, they need the tools to accomplish what you expect them to accomplish. Once those are provided, you can hold them accountable for that system.

Should team members be able to step in and help when necessary? Absolutely, as long as one person is designated as the individual responsible for the system, specific system protocols are established and staff are given more than a 10-minute tutorial—in other words, real training to ensure that the integrity of the system is maintained.

Next week make “cross-training” work in your practice.

Interested in speaking to Sally about your practice concerns? Email her at
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Nancy Caudill
Senior Consultant
McKenzie Management
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Remember When You Used To?

Dr. Lou Howard—Case Study #114

“I need more patients!” Dr. Howard’s statement is becoming more common with the downturn in the economy. The schedule starts to look lean and hygiene is riddled with cancellations. The symptoms are bringing to light that Dr. Howard needs to know exactly how many new patients are coming in daily, weekly and monthly, as well as where these new patients are coming from. He also needs to know if they are continuing with treatment and if his marketing dollars are giving him the return he should be getting.

To help him solve the problem, the following computer reports were examined:

Number of New Patients
Depending on the software you are using, various reports can be generated to determine your new patient count. The accuracy of the report is based on how the software extrapolates the information for the report. There are two types of “new patients.” There are new “emergency” patients and new “hygiene” patients. Emergency patients do not contribute to the growth of the practice unless they are converted to comprehensive exam patients.

Some software programs allow you to print a New Patient Report. This report is based on the “first visit date” but does not distinguish between emergency and hygiene or comprehensive new patients. Other software programs generate this report based on the date when an ADA code is posted to the patient’s ledger.

How to resolve this: All new patients going into your hygiene program should receive a Comprehensive Exam (D0150). This code is posted to the patient’s ledger, so a running total of this code is tabulated within the software. A report can be generated to determine how many of these codes were posted during any time period. This report may be called a “Production Summary Report,” “Procedures by Provider Report,” or “Production by ADA Code.” If you are unsure how to generate this report, contact your software support team. By the way, this report is one of the most important reports that can be generated to determine the performance of your practice, based on the procedures that are completed.

Where Are New Patients Coming From?
If your Scheduling Coordinator is not entering referral information into the New Patient’s information screen, your Referral Report will not be accurate. In Dr. Howard’s office, the referral source was entered if the new patient answered the question on the intake form; otherwise, no effort was made to gather the information. This information is essential to determining how future marketing and advertising dollars are to be spent.

Examples of referral sources:

  • signage (drove by and stopped)
  • yellow pages
  • direct Mail
  • insurance participation
  • employees
  • referral by patients of record, relatives or friends

The most valuable referral source is “existing patients.” These are patients that are happy with you and your team, and enjoy coming to see you. It is also the most cost-effective source of marketing and can be developed by improving your “internal marketing” strategies.

Dr. Howard’s Referral Report was proof that the information was not accurate because the Procedural Report showed he was averaging 16 new hygiene patients per month but the Referral Report was only reporting 7. Of those referral sources that were reported, the majority of the patients were coming from the yellow pages and not existing patients.

Are Your Patients Staying?
Now that you know how many new hygiene patients you are seeing per month, multiply this by 12 months to get a yearly average. If you have already been tracking the number of New Patients correctly, run the procedural report for the past 12 months for a more accurate count.

Next, run the Past Due Recall Report. This is also a very important report, as it tells how many patients are lost through your hygiene department if action is not taken to retain these patients.

Dr. Howard discovered:

Number of New Patients (average) for this year = 192
Number of Past Due Patients for the past year = 223
Number of patients lost in a year = 31

The practice isn’t growing; patients aren’t staying and are not referring their friends and family. Why? Dr. Howard had stopped doing the things that had built his practice in the beginning.

Implement customer service points to recapture the patient base:

  • handwrite personal notes to all your new patients
  • call patients after long or difficult procedures to see how they are feeling
  • handwrite “thank you” notes to patients that refer other patients
  • recognize patients’ birthdays with cards or gifts
  • give tokens of appreciation to all your patients during holidays or special events
  • follow up on the status of a patient referred to a specialist
  • make time to develop a relationship with new patients and to reconnect with recall patients

Dr. Howard built his practice with his caring nature. He connected with his patients in a special way that made him unique. His patients loved him and referred their family and friends. As Dr. Howard became complacent about these personal touches, his patients fell by the wayside. They stopped referring their friends and eventually stopped going to his office because he was no longer the same dentist.

Re-evaluate your practice. Are the majority of your referrals coming from your existing patients? If not, improve your internal customer service techniques to make yourself unique again. You will have happy patients and you will be happy as you “reconnect” with them.

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email

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Belle DuCharme CDPMA
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What Is a Morning Huddle?

“The brain is a wonderful organ; it starts working the moment you get up in the morning and does not stop until you get into the office.” —Robert Frost

Sometimes called the daily meeting, the morning huddle is an opportunity for the dental team to examine the schedule of the day and make a plan for action. But because time is limited and every member of the team has something important to do to prepare for patients, the huddle is often overlooked or considered time-consuming. Studies of hundreds of offices by McKenzie Management’s consultants have determined that the daily meeting is crucial to the success of the practice by improving communication between team members and organizing the day for the benefit of practice profitability and customer service to the patient.

The morning huddle need not last more than 10 to 15 minutes and is scheduled prior to the arrival of the first patient. Everyone on the team is required to attend these meetings. Discussion of today’s schedule is the main focus, but reviewing yesterday’s schedule and looking at the schedule for the next two days to anticipate any problems are recommended. Other topics to cover could include: discussing where the clinical team would feel comfortable seeing an emergency patient, identifying patients that need to take care of financial concerns before they are seated, verifying treatment plans with treatment scheduled, finding unused insurance benefits and scheduling unscheduled patient family members.

The daily schedule and/or routing slips should be distributed to everyone at the meeting. If there are any personal issues with any patients coming in, such as a birthday or a new baby, it is important that everyone give those patients special attention. (However, please use discretion when discussing patient issues to comply with HIPAA privacy requirements.) Hygienists should review their charts for the day and comment on unscheduled treatment, where they would need help with taking x-rays and periodontal charting. Clinical assistants would review their charts to verify the schedule with the treatment plan and see that lab cases are being delivered on time and necessary supplies are ready for the day.

Guide to developing a Daily Meeting Agenda:

  1. Distribute today’s schedule and/or routing slip to all team members.
  2. Review today’s patients and procedures.
  3. Address the following issues:
    • Clinical Assistant: where to place emergency patients, proposed treatment for each patient, review lab cases due up to two days ahead and converted emergency patients from yesterday’s schedule
    • Hygienist: patients due for FMX & BWX, who will help with perio-charting and screening, family members past due for recall and new patient exams today
    • Financial Coordinator: past due accounts, unused insurance benefits, production, collection goals and patients who will be paying prior to seating today
    • Scheduling Coordinator: unscheduled time units, open-ended appointments and unscheduled treatment, and the number of new patient examinations
    • Yesterday’s Schedule: What was good? What needs to improve?
    • Schedule Two Days Out: Does it meet goal? What needs to be changed?
  4. The Dentist closes the meeting with a personal view of the day and a positive message.

Some of the benefits you will receive by committing to this organized daily regimen include:

  • better organization by planning the day instead of just letting it happen
  • knowing patient needs in advance and seeing that the supplies and lab cases are there
  • increased productivity by having the entire team aware of patients who have not scheduled and using the information to motivate patients to accept treatment
  • improved profitability by identifying unscheduled treatment and unscheduled patients
  • improved team morale by deciding who needs help throughout the day and assigning a person to assist
  • effective handling of emergencies because the clinical team is involved in selecting the best time
  • keeping the team informed of daily production goals and reinforcing that it is a team effort to meet them.

Committing a brief 10 to 15 minutes of your day to the “morning huddle” can benefit your team and patients, and can eliminate most of those surprises that bring chaos into a seemingly well-scheduled day.

Want to create more successful business systems for your practice? Call McKenzie Management today and sign up for our Front Office or Office Manager Training Program.

For more information about McKenzie Management’s Advanced Training courses, email, call 1-877-777-6151 or visit our website at

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