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11.28.08 Issue #351 Forward This Newsletter To A Colleague
Leadership Strengths
Customer Service
Consultant Case Study

Are You An Effective Leader?
by Sally McKenzie CEO
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The recent presidential election focused considerable attention on leadership and the direction in which our country is headed. In recent years, many have asserted that we are facing a leadership crisis. How our new president and the lawmakers in Washington address our economic issues, the wars, health care, the middle class squeeze and other critical concerns remains to be seen. Regardless of your personal political leanings, these are major issues that have a profound and powerful impact not only on our country but on the world at large.

Thankfully you’re not dealing with matters that affect the global economy or world peace! Still, the leadership of your practice is no less relevant to your own economic well-being, as are the potential conflicts and concerns that you and your team must face daily, and the manner in which you lead has a profound and powerful impact on your personal success.

Do you have what it takes to effectively lead your team through the difficult (as well as prosperous) times ahead? As you look through the list below, challenge yourself to answer the questions honestly. We all have leadership strengths and weaknesses. The struggle, of course, is to maximize the strengths and shore up the weaknesses.

Communicate—Do you communicate clearly and continually with your team? You simply must express to your staff your practice goals and objectives. It is said that some two-thirds of employees do not know their employers’ goals or business philosophies. Open the lines of communication with your team. Encourage ongoing discussion, feedback and problem-solving from everyone.

Vision—Do you have a vision? Do your employees know what it is? Vision is the ability to see your practice not where it is today but where you want it to be when you're done. If so, share your vision and your passion for achieving it. If you see the practice you want in your mind’s eye and you share that vision with your team, you can develop the systems and strategies to make it your reality.

Ask Questions—Do you ask the hard questions regularly? Resist the urge to be satisfied with the simple answers. Look below the surface. Ask yourself every day what can be improved. What system is not delivering the results it should? Why? What needs to be changed, adjusted and improved? Remember that being the leader doesn’t require you to have all the answers, but it does require you to routinely question the way you and your staff do things. While you’re at it, regularly ask yourself questions related to your leadership. For example: Am I communicating a vision for my practice to my staff? Am I doing what I need to do to achieve my priorities? Do I give my team the tools and training they need to achieve their priorities and help me achieve mine? Do I give employees timely and direct feedback they can act on? Can I handle the pressure that comes with leading a team and running a practice? Do I need help?

Accountability—Have you established clear, written expectations for every team member? It is common for practice leaders to face significant challenges in establishing accountability among the team. Oftentimes, job duties and expectations are not clearly defined. Team members don’t take responsibility for their actions. The practice doesn’t have systems in place to solve problems and individuals waste valuable time backbiting, gossiping and wallowing in frustration. Accountability is key. It builds trust and confidence among the entire staff.

Courage—Do you take action when problems arise? Talk about issues and problems that stand in your way. Don’t look the other way. Address the issues that don’t make you popular: problem employees, showing up on time, following the dress code and office procedures, and treating each other and every patient with dignity, respect and patience.

Leaders demonstrate many positive qualities and chief among those is the ability to recognize their weaknesses and surround themselves with employees whose strengths balance the boss’s shortcomings.

Next week, surround yourself with a team of leaders.

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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Belle DuCharme CDPMA
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Is The Customer (Patient) Always Right?

There is an old saying that the customer is always right. This saying, along with the golden rule of doing unto others as you would have them do unto you, has been a core value of customer service for many decades. During the course Telephone Skill Training which is offered at McKenzie Management, trainees are asked to identify difficult situations in scheduling patients so that a scripted response can be developed to help them remain in control. The usual suspects take the form of patients that cancel without sufficient notice or who don’t show up at all. Sometimes cancellations and no-shows happen for good reason; if the patient, however, is a repeat offender and continues to expect the practice to tolerate this lack of commitment to keeping scheduled appointments, this is not right. The problem needs to be communicated to the patient.

So, like any number of old sayings, this one about customers isn’t always true. There are gray areas of patient management that must be addressed. What do you say to the patients when they are wrong?

  • First, never let patients feel that they were wrong to have chosen your practice for dental care.
  • Second, the patients may not be right, but you still have to work with them for resolution.

How to script the response to patients that cancel at the last minute or don’t show up at all should be based on the doctor’s philosophy and the practice scheduling system. When presenting the treatment plan and subsequent scheduling, patients must be told the amount of time that is scheduled, what will happen during the appointment, any post-op instructions and the expected recovery time. Financial options must be presented and the patients must communicate how they intend to pay for services. If a patient makes an appointment and you have not discussed how he/she is going to pay, it often leads to a cancelled appointment. It is very important to explain to patients that appointment times are reserved just for them and that the doctor and the team are looking forward to providing their services. Patients must acknowledge understanding of your system of confirmation, whether it happens two days or 24 hours prior to their appointments, and realize that every attempt must be made to keep them.

If you receive a patient complaint about a procedure, service or product, it is important to engage in active listening skills to get the patient’s point of view and to provide positive feedback in order to keep a situation from escalating to an argument. Dissatisfaction that arises from a problem, such as discomfort after an endodontic procedure, unhappiness about the shade of a crown, or a miscommunication of the amount of payment due, has to be viewed as being valid until you get all of the facts.

Telephone Skill Training teaches you to remain calm and in control and to remember that an objection is not a rejection. Responding to issues without alienating the patient takes practice and good listening skills.

Here is a sample script to use when handling a patient that is going down the wrong path:

(P) Hello, this is Mrs. Smith. I was just there in the office today. I am a new patient and I have been thinking that I would like the teeth filled, not capped, and I want to make monthly payments to the doctor because I do not have any credit cards—nor do I want them. I pay my bills on time and I want to do it this way because this is what I did at my last dentist office.

(O) Mrs. Smith, thank you for considering our office for your dental needs. We know that we can provide you with excellent service. I have your treatment plan in front of me and can see the doctor’s notes. We provided you with a written treatment plan detailing the options. Dr. Brown has noted that the two teeth on the lower right side— #30 and #31—have large, old, defective fillings in place. Dr. Brown will not know the full extent of the condition of the teeth until he removes the old fillings and can view what is underneath. Often, the removal of old, defective fillings reveals additional decay that does not show in the x-ray. After removal of this decay, a crown and possibly a build-up is the best coverage for what is left of the tooth. Dr. Brown always tries to be conservative in his estimate and if the teeth can be safely filled that is what he will do.

(O) To answer your other question, Mrs. Smith, thank you for assuring us that you pay your statements on time. But because we are a small business and cannot give interest-free loans, we have provided to our patients the services of CareCredit; you can make affordable monthly payments to them. They have an excellent reputation for customer service and can offer a payment plan to suit your needs. All I need is a little information from you to get started with them.

(O) Have I answered all of your questions, Mrs. Smith?

Don’t “wing it” with trial and error when communicating with patients. Learn new skills today by calling us or visiting our website for information about our Telephone Skill Training and Advanced Business Training.

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

Interested in having Belle speak to your dental society or study club? Click here.

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Nancy Caudill
Senior Consultant
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Avoid These Dental Traps In Managing Your Practice

Dr. Sam Causey—Case Study #211

“My office runs me—I don’t run it!” was Dr. Causey’s cry for help when he called McKenzie Management.

Upon further investigation it was determined that Dr. Causey was caught in five very common traps and did not know how to spring himself from them. This is what he heard:

  1. From the front desk team: “We need another hygienist!”
  2. From the hygienist: “I need to work more days!”
  3. From the front desk team: “We need more help!”
  4. From the entire team: “We want more money!”
  5. From the doctor to himself: “I want a larger facility!”

In order to make sound decisions about these 5 declarations, information is necessary. An analysis of practice systems revealed the following details:

Practice Information

  • Hygiene patients are pre-booked in advance
  • 3 days of hygiene per week
  • 2 full-time front desk business team members
  • Last salary increase for the entire team was 18 months ago
  • Facility has 4 operatories; the hygienist uses 1 treatment room and Dr. Causey uses 3 each day

Periodontal Screening and Recording. The periodontal screening procedure involves concepts that are different from traditional periodontal examinations.

  • The mouth is divided into sextants.
  • For each sextant, only the highest screening score is recorded.
  • The probe that is utilized during PSR is different than a traditional probe. It has a rounded tip. The color-coded band extends from 3.5 to 5.5 on the shank of the probe. (PSR probes can be ordered from several manufacturers.)
  • Pocket depths are not measured. Only relationship of the gingival margin to the colored band is assessed.
  • The codes determine the need or lack of need for a comprehensive periodontal exam.

Practice Statistics

  • Doctor sees 20–25 patients per day
  • Hygienist sees 6–8 patients per day
  • Average daily doctor production is $5,500
  • Average daily hygiene production is $850 (not including doctor’s exams)

After analysis, Dr. Causey learned how to address each trap with the following “Practice Standards”:

Need another hygienist? Because all the hygiene patients were pre-scheduled without the use of pre-blocking, there appeared to be no openings for new patients, periodontal scaling and root planings, or past-due hygiene patients.

By reviewing the previous days’ hygiene schedule, it was obvious that the hygienist was averaging two cancellations or “no-shows” per day.

When the recall report was generated for the next 12 months, and the number of appointments needed based on their recall intervals (along with new patient, past-due and periodontal appointments) was reviewed, it was determined that the practice did not need another hygienist, nor did the practice need additional hygiene days. It actually proved the contrary. The practice was doing 12 new comprehensive exams per month and the past-due recall showed a loss of 23 patients per month. This is a net loss of 11 patients per month. Dr. Causey’s practice was in decline.

More help in the business office? It appeared that the business staff was overworked and overwhelmed with the influx of 30 patients per day. What was lacking in order for them to work effectively and efficiently was job descriptions. They were duplicating each other’s tasks, repeating to one another information taken from phone calls and actually spent more time taking personal phone calls, texting their friends and checking e-mail than they did working for the practice. Job descriptions that divided tasks resulted in directing the incoming phone calls to the person in charge. Two business team members can check in and check out 44 patients per day effectively; Dr. Causey was averaging 30 a day. These team members actually had too much time on their hands!

More Money? Dr. Causey did not conduct performance reviews, let alone salary reviews. He perceived these two tasks as being one in the same. This is NOT correct. A performance review is held periodically (minimum of once a year) to discuss with an employee the performance of job duties based on the job description. A salary review is conducted to inform the employee of a salary increase based on the performance AND the gross wages to collections percentage of the practice. As noted above, Dr. Causey was running at 25% of the total. Standard in the industry for a general practice is 19–22 % (not including benefits). He couldn’t afford to give salary increases based on the practice statistics.

New Facility? Standard in the industry is that no more than 5% of the practice’s monthly collections should go towards the expenses associated with the facility, such as rent, utilities, etc. With an average monthly collection of $74,775, as long as Dr. Causey stayed within a monthly facility expense of around $3,750 a month, he would be within the standard. However, his current lease payment was $5,100 including utilities, so he was already at a 6.8% overhead. He couldn’t afford a larger facility!

With a thorough analysis and implementation of systems, Dr. Causey and his dental team were educated about healthy practice statistics and learned to share information about the practice that affected them as a whole. Their previous perception was that Dr. Causey pocketed every cent and was profiting daily.

These “traps” would never have caught Dr. Causey if the team had been informed monthly of the practice performance and expense overhead relative to operating the practice in the black.

Contact McKenzie Management today to keep yourself from getting caught in the traps.

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

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