Practice Profitability and the “New Normal”
"The pessimist sees difficulty in every opportunity. The optimist sees opportunity in every difficulty." - Winston Churchill
Certainly, the challenging economy is presenting its share of difficulties and opportunities for dental teams. As our nation gradually crawls through this recession, we hear repeated references to the “new normal.” The pundits refer to a “new normal” in terms of unemployment percentages, homeowners vs. renters, saving vs. spending.
So what’s the “new normal” in the dental practice? Likely, it is unwavering attention to the business details. In my 30+ years of working with dentists, I have never before witnessed a time in which it has been more critical to evaluate practice management systems and immediately address weaknesses. The inefficiencies that dentists could ignore three years ago are now crippling some practices and doing serious damage to many more.
There are 22 systems that directly impact your success and profitability, and each should be carefully evaluated and scrutinized for effectiveness, starting with the following six:
1. Patient Retention
One of the most common misconceptions dentists have is that patient records in the computer or in the files constitute active patients. In actuality, only those patients that have been in the practice for a hygiene recall appointment in the past 12 months can be counted as active patients. The recall system, or lack thereof, is a huge factor in patient attrition - but more on that later. I recommend running a computer report and comparing the number of patients that are scheduled for recall appointments in the next year and the number of records in the computer system or the files. Most likely, you will find that there are far more patients in the records than there are appointments in the schedule.
2. Don’t Skimp on Treatment Recommendations
Continue to diagnose patient needs according to your practice philosophy. You should be aware that the patient may not be comfortable pursuing a larger treatment plan beyond what is immediately necessary - at least not yet. Continue to educate patients. Emphasizing the importance of oral health and its impact on overall health has never been more important. Communicate with patients regularly through periodic email newsletters that reinforce the value and necessity of preventive oral health care.
3. The Most Important and Most Ignored System - Recall
In addition, communication between doctor and hygienist and with the patient must reinforce the need for ongoing care. It is not uncommon for the dental team to refer to the hygiene appointment as a routine checkup, thereby trivializing the importance of what you deliver and confirming the patient’s misperceptions that these six month visits aren’t all that important.
Practices need to be proactive in bringing patients back into the office. Call those patients with unscheduled treatment plans, those that have missed appointments, recall patients. They need to know that you care about them and you are concerned about their oral health and wellbeing.
Next week - three more systems that impact your “new normal.”
It’s been two months since 33 miners were buried half a mile underground in San José, Chile. At Day 40, they rejoiced the birth of one miner’s first child. At Day 50, they celebrated the country’s bicentennial. They are surviving in harrowing, sweltering conditions. Truly an environment and situation of extreme stress. Yet their remarkable story is inspiring. It exemplifies the principles of effective teamwork.
Faced with life-and-death risks and challenges, these men are showing us that the essence of well being is to work as a group. Even when the world thought they were dead, they created a structured society. They established discipline and order out of chaos. Ranging in age from 19 to 63, they are managing their diversity with patience and encouragement. They developed a chain of command and divided their shelter into different functional areas. Natural leadership behaviors emerged with the most senior of the shift workers taking charge. He assigned roles to the others. Communication channels were put into place. They are engaged in useful daily tasks such as rationing food, daily exercise and predictable sleep cycles. These activities have enabled them to stay busy, and more importantly, to have hope. Essentially they are contributing to something greater than themselves. Together they are demonstrating that the whole is greater than the sum of its parts.
The miners have a clear purpose - survival. Does your team know what their purpose is? Lack of clarity about purpose is a common cause of team failure. Your employees should be able to give the same answer to the question: What are we here to accomplish? When the team’s purpose is clear to everyone, there is motivation, ongoing effort and willingness to endure setbacks and overcome tough obstacles.
The miners have an empowering structure. As the leader of your team, you are responsible for the roles, responsibilities and competencies of your staff. The process by which the team carries out their work needs to be reviewed periodically to see if they are working well. Teams that feel a sense of ownership about the procedures and processes they use are more motivated to follow them thoroughly.
In addition to clarity about roles is the importance of organizational support. If you want your team to work collectively, they need to be rewarded for team performance. Often dental practices compensate employees for individual work which encourages people to focus their efforts and time into solo tasks. However, when the group is rewarded for their joint efforts they tend to hold each other accountable. This minimizes blame and raises the standard for work behavior.
Above all, effective team work requires a foundation of positive relationships. Ultimately, team problems stem from interpersonal strife and tension. Trust and espirit de corps are damaged. Competitive interests soar and cooperation wanes. Employees become preoccupied with who is or isn’t doing their share, leading to finger pointing, conflict and even turnover.
Just as with the 33 miners, personal ties are fundamental in keeping the group focused on the goals they need to achieve. As the dental leader, you need to bring your employees together to show them a possible future. A good intervention is an off-site meeting or team retreat to build camaraderie and reinforce team identity. Remind them of the need to remain united and act together. While they may not be in a life-and-death rescue situation, your team does have complex challenges to solve. Help them to do so collectively, for their “survival” and your own.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at email@example.com
Interested in having Dr. Haller speak to your dental society or study club? Click here.
Frustrated With Open Time?
Dr. Little has a lot of open time, both in the hygiene department and his own chair. He is very frustrated and is considering dropping hygiene time, using his own retirement to pay the practice bills, reducing benefits and salaries - all because of the decrease in money coming into the practice. The most frustrating thing of all… his hygienist and staff are not stepping up to the plate to help get the practice rolling again.
When there is open time in hygiene, it means that the doctor’s chair will experience the same open time in a few weeks. Many times, it is the recall patients that keep the doctor busy - so working the recall system is essential! Yes, we at McKenzie Management would like to have a person hired to do nothing but work the recall system. However, if there is not enough money to pay all the bills and the current staff find themselves doing busy work, then there is no reason to hire somebody new. They do, however, need to make recall a number one priority!
Filling the hygiene chairs is the number one focus of everybody on the payroll when there is open time. When the hygiene chairs are full, the doctor’s chair will also be full. You may be thinking: “We have the patients scheduled but they cancel last minute or don’t show up at all.” You have to ask yourself, “Why is this happening? What can we do to help prevent this from happening?”
The hygienist and doctor need to find a reason why the patient must return in 3 months for their hygiene appointment. If nothing else, they need to keep their teeth and oral cavity healthy because of the affect over the entire body (diabetes and heart disease for example).
As a patient, I may be thinking that anybody can clean his or her teeth at home. It doesn’t matter if I miss a hygiene appointment or two. Nothing hurts me. Educate your patients of the “need” to return.
Hygienists use their education to take care of patient’s dental health. The patient is depending on you to do so, and thinking that it is solely the doctor’s job is not fair. All licensed professionals are responsible for the patients care. It takes a dental team to care for patients the way they need to be taken care of - and patients depend on their healthcare professionals. When I visit my physician, I depend on that health care professional to read and diagnose my symptoms accurately and tell me what needs to be done - not just do what they can in the time allotted and hope that it’s good enough. I wouldn’t want to have health care professionals taking care of me that are just there to collect a paycheck and go home… would you?
Doctors and hygienists diagnose and treat periodontal disease, and then inform the patient of what needs to be done and the options that they have when it comes to treatment. This is an ongoing process the entire time the patient is in your practice, and should be evaluated every time the patient is in the hygienist chair.
It may be difficult for some dental professionals to tell the patient bad news or that they will have to pay more money than anticipated. But failing to tell a patient what the optimal care is and what their options include is not providing any service or quality of care to the patient. Don’t just inform them - say it with confidence! When dismissing the patient, remind them of why they need to return. This also is noted in the chart or computer so the entire staff is aware of the patients needs when they are talking to them.
Go over the office protocol and recall system with all new patients. Remind them to give as much notice as possible if they need to change an appointment. Mention to them that if they are not good at keeping their appointments, they may want to hold off on scheduling and receive a reminder, and to call the minute they get the reminder because appointment times go fast.
Without patients in the chair, there is not going to be money in the bank to meet the expenses of the practice. Just because there are checks in the checkbook doesn’t mean there is money in the bank. Think of the practice as your own when it comes to keeping the doctor and hygiene schedules productive. Always remember it is not only the doctor that pays you and the costs to keep the practice alive, but the patients that are actually coming into the practice for their appointments and keeping the chair warm.
Interested in improving your hygiene department? Email firstname.lastname@example.org and ask us about our 1-Day Hygiene Training Program.
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