5.7.10 Issue #426 Forward This Newsletter To A Colleague

Your Employee Made a Mistake? Don't Penalize, Party
by Sally McKenzie CEO
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If you read this newsletter regularly, you might have noticed that I dedicate a fair amount of space to telling you how you should be addressing shortfalls in your practice systems. This week, I’m taking a little different approach. I want you to plan a party. Now, this isn’t just any party. This is a “screw-up party.” I have to give author Bill Bartman credit for the term and I love the concept. The idea is that you embrace the mistakes, you acknowledge the weaknesses, and you celebrate the fact that you have “screwed up.”

I can virtually guarantee that you and everyone on your team has made at least one major mistake in the past 6 to 12 months. Mr. Bartman refers to an employee who made a $10 MILLION contract error. The company managed to whittle it down to $1 million, which most of us would still consider a huge blunder. But the point Bartman makes is that if he were to have crushed the employee, who is otherwise very good, he would have shut down the flow of creative problem solving and new ideas, not just from that employee but from others as well. The “chilling effect” as we know it - where speech or conduct is suppressed by fear of penalization.

Frequently we find employees who are too paralyzed to take action. They are afraid of making mistakes. They are afraid of being reprimanded. They are afraid of disappointing or angering the doctor. They have to secure approval on everything from the way they answer the phones to the way they punctuate a sentence. Consequently, the practice is virtually immobilized because no one has permission to think, to improve systems, or, as the case may be, occasionally screw up. Dentists, being notorious perfectionists (a quality that patients dearly appreciate), are keenly focused on doing everything right. Understandably, you are mortified when you or members of your team make mistakes, even though you fully understand that to err is human. Like everyone else, some days you and your team are simply more “human” than others.

It is through mistakes that you and your practice have grown, and perhaps throwing a party once a year to celebrate the blunders rather than stuffing them in the closet, hoping they go away and never embarrass you again, is something to consider. It’s easy to celebrate how great you and your team are and the successes you enjoy. But what about the tough challenges, the hurdles, and the many things that just went wrong that you and your team had to face? The fact is that while the experiences were likely not enjoyable, yours is a better team today because of them. Giving you and your employees permission to be human and make mistakes, at least occasionally, may actually help to avoid bigger blunders in the future.

Case in point, I recently had a conversation with a doctor whose Collections Coordinator accidentally charged a patient $1,120 for a $120 procedure. The patient called the office furious. The matter would have been resolved at the end of the day, but at the time the patient was checking out, things were chaotic at the front desk. The doctor, unfortunately, got an ear full from the patient. During these stressful economic times, it’s easy to get upset and fly off the handle with employees when things go wrong.  After taking it from the patient he promptly ripped into the employee, which he later deeply regretted. In this case, both the doctor and the employee made significant errors, one was an accidental mistake the other was poor judgment. Nonetheless, it was an opportunity for both to grow personally and professionally from the experience. 

Fortunately in the scenario above, the doctor did offer a sincere apology to the employee. They also looked at the patient check-in/check-out system to determine how bottlenecks could be addressed and pressure eased during hectic times. None of us enjoys making mistakes. Nonetheless, they are a fact of life and work. A “screw-up” party gives everyone a chance to acknowledge blunders, talk about them openly, offer creative solutions to help prevent them in the future, and most importantly, move on.

Next week: Is This Your Practice’s Biggest Blunder?

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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Carol Tekavec, RDH
Hygiene Consultant
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Hygiene Scheduling - Never Enough Time?

Hygienists may complain about lack of time to complete necessary hygiene services.  Dentists may complain that the hygienist has enough time, but just doesn’t get the appropriate tasks completed.  So… what is “enough time?”

Dental offices commonly allow 40-60 minutes for a typical prophy and recall. (While there are other names given to this appointment, such as “recare,” we will call it by the name many of us know and use: “recall.”) But are 40-60 minutes enough time? What procedures are expected to be performed during the appointment?  Does the hygienist provide all services by herself?  Is there time allowed for set-up and clean-up? Does the hygienist take blood pressures?  Radiographs?  Provide fluoride treatments? Oral hygiene instructions?  Intraoral photos?  Identification of possible future restorative needs to support appropriate patient care and office production?  

What about entering information into the computer? Does the hygienist enter updates to the medical history, probings and other perio considerations, findings of the dentist’s exam, and progress notes? Does she also go over future treatment plans, print out an estimate of fees for those plans, set up future appointments and generate a “walk-out” statement of fees for today’s services? It can readily be seen that a “typical prophy and recall” may encompass much more than the just the actual clinical service. Let’s look at a possible break down of time required.

  • 5 minutes: Seat patient and update medical history
  • 3 minutes: Take and record blood pressure
  • 10 minutes: Take 4 BWS, expose and develop or generate digitally
  • 15-25 minutes: Take FM series (every office needs a “radiographic protocol” which should be set up by the dentist for all staff to follow)
  • 10 minutes: Alternately - take panograph (depending on office “radiographic protocol”)
  • 1 minute: Do extra/oral head/neck cancer screening
  • 1 minute: Do intra/oral cancer screening
  • 5 minutes: General oral screening. This may include evaluating current restorations, visible decay, broken teeth, tissue issues, painful teeth, calculus, evidence of plaque, and problems mentioned by the patient
  • 5 minutes: Take intra/oral photos of restorative concerns to have ready for the dentist
  • 10-20 minutes: Perio probing, including data collection and documentation of 6 measurements for each tooth and recording of bleeding, mobility, furcations and recession.   
  • 20-30 minutes: Prophy procedure-scaling and selective polish (patients who require more extensive scaling or other treatments should be identified).
  • 1 minute: Oral hygiene instructions
  • 5-10 minutes: Dentist’s exam - have photos and radiographs ready to view, concerns from oral screening ready to discuss
  • 5 minutes: Fluoride application - varnish or tray
  • 3 minutes: Enter progress notes
  • 2 minutes: Enter next appointment
  • 3 minutes: Assist patient in filling out recall reminder
  • 5-15 minutes: Explain, enter, and print out  a treatment plan for necessary treatment identified during appointment
  • 3 minutes: Enter and print a “walk-out” form with fees for the day
  • 5-7 minutes: Return to treatment room - clean, take instruments to sterilization, set-up for next patient

Total time for the least time consuming options = 102 minutes! Even if you take off the FM series or panograph and/or the fluoride application, you still have around 80 minutes.

Does this mean that in order to perform all duties expected, the hygienist needs at least an hour and twenty minutes? The answer is “yes” if all of the services listed are performed by the hygienist alone. The answer is “no” if some of the services are excluded, an assistant is available to help, technology is employed to save time, or others perform a portion of the tasks. The hygiene department is an important production generator for the office. If necessary dentistry is not identified at a patient’s recall appointment, when will it be identified? If an office is committed to pursuing an appropriate periodontal evaluation, assessment of needed restorative work, and explaining and implementing a treatment program for patients, when will this be accomplished if not at recall?

One answer to the time problem might be to find a method of delegating to other staff members parts of the “prophy/recall” not required to be performed by a licensed hygienist.  While all staff members are busy, there are some segments of the aforementioned list that might be appropriately performed by others, or with the assistance of others, without causing a disruption in daily activities. The use of technology can also help. In addition, some services might be performed once annually instead of at each appointment.

Some ideas:

  • Business staff can be in charge of entering the patient’s next appointment, generating a “walk-out” form after the hygienist has entered the patient’s treatment and fees for the day, further explaining needed treatment, generating a printed treatment plan for the patient, and overseeing the completion of the recall card reminder after the hygienist has filled out individual concerns. Time savings: 8-20 minutes.
  • An assistant can be made available for recording probing depths, either on a paper or computerized format. Alternately, technology can play a role. A voice activated computer system or automated periodontal probe can reduce time while still allowing for complete data collection. Time savings: 5-15 minutes.
  • If the hygienist is running late, necessary radiographs might be taken by an assistant in another treatment room prior to the hygienist seating the patient. Time savings: 5-20 minutes.
  • Some services might be done once annually, such as taking and recording blood pressure, instead of at each prophy/recall. This would not be appropriate if the patient has given information indicating new concerns, has a current blood pressure problem, or has had a change in general health. Time savings: 3 minutes.

At your next staff meeting, brainstorm what might be done to streamline the hygiene schedule in your own office. The dentist and the hygiene department are production centers, and it benefits everyone in the office if revenue is being consistently generated at these centers. No revenue is generated if hygienists are using time to perform duties that do not have to be performed by licensed personnel. Despite this, not all offices will agree on what should or could be delegated, and state laws may mandate who performs certain procedures. As always, the appropriate treatment of patients is the most vital concern. It is important to patients, all team members, and the financial health of the practice to see that patients have their needs identified, scheduled and treated. Taking a close look at hygiene scheduling can be a significant part of making sure that this happens.

Carol Tekavec CDA RDH is a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

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

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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It's a Laughing Matter

Laughter is the best medicine. Yes it’s a cliché, but we know that humor is a great tool to help us cope with life. Studies show that laughter produces biochemical changes in the body that affect the immune, endocrine, respiratory, cardiovascular, and musculoskeletal systems. Laughter releases natural painkillers that combat arthritis and other inflammatory conditions.

The notion that laughter possesses healing powers was popularized by former magazine editor Norman Cousins. In his book Anatomy of an Illness, he recounted how, armed with humor, he was able to overcome the debilitating symptoms of a crippling spinal disease. Minutes of a good belly laugh, he says, produced several hours of pain-free sleep.

Perio Disease

Laughter can have huge benefits for your team because laughter is a social phenomenon. People are more likely to respond with laughter when they are with others than when they are alone. Most laughter is not so much about humor as it is about relationships. Those curious “ha-ha-ha’s” connect us. Research by Robert Provine at the University of Maryland found that most laughter does not follow jokes. In actuality people laughed after a variety of statements that were not jokes.

The Yale School of Management did a study about how one's mood can affect the work environment. It was found that "emotions spread like viruses” with cheerfulness and warmth at the top of the list. The study also stated that "in any work setting, the sound of laughter signals the group's emotional temperature, offering one sure sign that people's hearts as well as their minds are engaged."

If laughter can have that kind of effect on health, imagine what it might do to dental team performance. We know that stress can interfere with how employees function on the job – interrupted focus, depleted motivation, and reduced problem-solving abilities to name a few. But laughter helps us to maintain healthy perspective. Humor and laughter facilitate positive social interactions. It is the one form of communication to which everyone can relate. You don’t have to speak the same language to laugh together. Laughter also helps break the ice in groups. At its best, laughter builds bridges between people.

Many of the issues that you and your team face at work are outside your control – late cancellations or no-shows, difficult patients, increasing business costs. As long as you have a sense of humor, however, you can do something to minimize the hold that upsetting situations can have over you. When you feel as if you’re losing control, allow a little humor time. If you can find what’s funny in a situation, your distress might not seem as strong. We all know the relief we feel when someone in a group makes a funny comment during a tense situation. Humor can dispel anger and aggression in ourselves and others. Victor Borge said it best - “Laughter is the shortest distance between two people.”

Humor is an important, but often overlooked, tool for team building. This doesn’t necessarily mean telling jokes, unless that is one of your talents. It means beginning to share your humorous perspective and giving others permission to do the same. A good sense of humor is something everyone can work on. It doesn’t just happen. Here are some ideas to help add more laughter to your team.

  • Use humor to prepare folks or a fun and engaging team meeting. Ask your employees for the funniest movie they’ve ever seen. Consider having employees bring a clip to show at every staff meeting.
  • Share examples of things that make you laugh or that you find humorous, and encourage your employees to do the same.
  • In groups of two or three, select a difficult or annoying situation, such as being stuck in traffic, waiting in line or come up with your own “most frustrating office stressor.” Ask each pair or triad to construct a funny story out of this situation and exchange with the team.
  • Develop comedic vision. Look for the humor in every situation. Learn to laugh at the incongruities of life. Learn to laugh at yourself and model a light-hearted style to your staff and look for the funny side. You will experience a special joy of accomplishment that only a lively, generous sense of humor can bring. Tell a funny story and you may get one back.
  • Celebrate what works. Rather than agonizing over what’s broken or not working any more, celebrate what is working. If you have a bad day or a family difficulty, try a positive approach. Humor can increase your capacity for solving problems and help you acknowledge your victories in life.
  • Surround yourself with humor and make it a daily ritual. Clip cartoons, collect funny sayings, gather humorous video and audio tapes. Share these with your team. Display cartoons throughout the office.

Laughter is one of the finest, most economical ways to build your team. Infuse humor into your office and inspire your team. You may be amazed how it helps to connect the employees in your practice. Remember, he who laughs, lasts.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

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

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