12.31.10 Issue #460 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Create a Winning Culture in the New Year
by Sally McKenzie CEO
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What will 2011 bring your practice? Most dentists hope for steady patient flow, strong treatment acceptance, and minimal staffing problems. While your skills as CEO affect each of these areas, the manner in which you manage your team has the greatest impact on your overall practice success. A key aspect of that management is the culture you create as leader.

Generally, culture refers to the practice’s beliefs, values, and behaviors. It has a powerful impact on attracting and keeping quality team members, and a domino effect on attracting and keeping quality patients. Ultimately, it has a profound influence on the practice’s overall ability to achieve goals and objectives. The workplace culture can be one in which team building is encouraged or discouraged. As the leader/CEO of your practice, you can choose to create an environment in which you manage your employees through fear and control, where conflict and backbiting are part of the daily routine. Or you can guide them through empowerment, trust, and team-wide problem solving.

In working with dental offices around the country, we see a variety of practice cultures. Some are effective, others are debilitating. For example:

Every Day Brings a Five Alarm Fire
In this dental practice, the leader is continually sounding the fire alarm because s/he enjoys putting out fires. The team is in a perpetual panic because it seems the leader is continually creating and/or finding problems. The doctor has a powerful need to “solve” these problems; thus, s/he cannot delegate effectively. Consequently, most practice systems are struggling if not crippled. The leader says s/he desires organization and effectiveness, but instead creates a culture of perpetual crisis. Team members are powerless and cannot take action to avoid the crises because the leader/CEO/dentist insists on calling the shots, all the shots, and is largely responsible for creating the problems.

Here Comes the Feudal Lord
Also known as the Fiefdom practice. In this practice, the leader of the Fiefdom is similar to a fire alarm practice in that they are highly controlling and dominant. However, they take it up a notch. They enjoy competition and pitting employees against each other in a game to win the leader’s favor. Fiefdom leaders despise the idea of delegation, but will often have someone on staff who is their “trusted advisor.” This person is the leader’s “eyes and ears.” The Fiefdom leader typically places unrealistic expectations on the staff and has a laundry list of rules that everyone is expected to follow. Staff and patient turnover are high in these offices.

Creating Community
Community leaders see their role as building quality dental practices rooted firmly in community, both internally and externally. They create an environment and a culture for success by establishing clear, challenging, realistic goals and specific expectations for members of their team. They set employees up to succeed by investing in training to maximize employee potential. They are eager to share information and explain the “why” behind the “what.” In other words, they don’t just tell employees what to do; they clarify why their responsibilities are important to the overall success of the practice. They encourage an open exchange of ideas, and listening is a key part of their management strategy.

Additionally, the most effective practice cultures keep conflict among the team in check. Certainly, disagreements arise, but they are dealt with according to a clear set of conflict management strategies, including the 10 below:

  1. Establish clear standards for professional office behavior.
  2. Do not tolerate destructive personal attacks among team members.
  3. Establish clear office policies and follow them.
  4. Set aside time to address matters that are causing conflict. Talk to people, not about them.
  5. Identify the conflict triggers and address them.
  6. Do not react emotionally and judge, criticize, or attack.
  7. Do not make excuses for not confronting conflict. She’s too nice. He’s too argumentative. They’ve been doing it that way forever. They’ll never change.
  8. Focus on addressing the issue rather than proving who is right or wrong.
  9. Admit when you are wrong.
  10. Choose to be a problem solver. Walk calmly toward the issue and work toward addressing it before it grows out of control.

Consciously working to shape the culture of your practice will not only profoundly impact the team that you work with day in and day out, it will impact patient relations more than you could ever imagine.

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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Guiding Patients to Perio Treatment
By Carol Tekavec RDH

We know that many patients are not receiving the perio treatment that they need. Either they don’t understand or accept their oral condition, or they may simply want “just what insurance pays for.” We also know that many patients are receiving the perio treatment they need, at the expense of the practice. When patients don’t understand or accept their disease, hygienists can find themselves providing perio treatment at “prophy prices.” We don’t want our patients to receive less than optimum care, so the practice provides the care for less than optimum fees.

This situation is wrong. 

How can we guide our patients to accept perio care, particularly if we have been treating them as prophys for many years? What about the difference in fees? A system of disease identification and effective patient communication can help us achieve routine scheduling of appropriate treatment for our patients.

Disease Identification, Communication, and Scheduling Appointments
Dental practices can develop a method of disease identification that makes communicating with patients easier and the scheduling of appointments more predictable. For an approach, we can look to the way physicians identify and treat individuals with hypertension. The identification of the disease process in that system is simple. Blood pressure readings over a certain threshold trigger treatment. This may mean medication, lifestyle changes, and re-appointment in the near future to assess your condition. Similarly, in dentistry, bleeding and pocket depths can serve as the “readings” that trigger treatment.

While most hygienists record bleeding and pocket depths during a typical prophy appointment, these readings often do not translate into patient acceptance of disease and/or scheduling of patients for future perio treatment. Making the process easier for patients to understand, having everyone in the practice agree on treatment thresholds, and scheduling appointments  based on these thresholds can work.

Here are some examples of how an office might deal with disease identified at a regular “prophy/recall” appointment:

1. Patients with more than 10 bleeding points, but no pocket depths over 3 mm, as recorded at today’s prophy appointment, are considered to have gingivitis.  These patients receive their prophy today, along with home care instructions to help them reduce the bleeding points, and are appointed for one month in the future for a second prophy and re-evalutation. The hygienist can explain that gingivitis is often an alert for possible gum and bone disease, just as a high blood pressure reading can be an alert for possible cardiovascular disease. If the hygienist is asked, “Will my insurance cover this?” she can answer, “Insurance plans commonly cover two standard ‘cleanings’ a year. Sue at the front desk can let you know what your plan will do.” The business assistant can then inform the patient of possible insurance benefits for the second prophy when setting the appointment for next month. 

2. Patients with bleeding and pocket depths of 4mm or deeper in 1-3 teeth in a quadrant as recorded at today’s prophy appointment, are considered to have Class II Localized Periodontitis. These patients receive their prophy today, and are appointed as soon as possible for scaling and root planing for the teeth that need treatment. (This might be one appointment or two depending on how many teeth are to be treated.) The hygienist can explain that pocket depths over 4mm signal that periodontal disease, with its’ resulting bone loss, is beginning.

Using the blood pressure example, she can say, “If your physician found that you had high blood pressure, he would not want you to ignore what that might mean for your general health in the future. We know that bleeding and unhealthy pocket depths can signal bone loss and future consequences for your teeth and appearance, as well as general health problems and bad breath. We can help you control and prevent your problems from getting worse by reducing the bacterial load from around your teeth, which in turn will allow your home care efforts to be successful.” 

If the patient asks, “Did I just get this disease?” or “Why didn’t you tell me about this before?” the hygienist can answer, “You have had bleeding and pocketing before, but I had hoped that your own home care and regular professional cleanings might have worked to prevent it from getting worse. Unfortunately, that hasn’t happened, and we need to get control of things now. We can’t just let you get worse and worse while we stand by and watch.” 

The hygienist can give the patient information about perio disease as well as detailed home care instructions, and then the patient is taken to the business assistant to schedule the necessary future appointments.  If the patient asks, “Will my insurance cover this?” he can be told, “Scaling and root planing are often covered by insurance.  We will do all we can to help you receive the benefits you and your employer are paying for.”

3.  Patients with bleeding and pocket depths of 4mm or deeper in 4 or more teeth in a quadrant as recorded at today’s prophy appointment, are considered to have Class II Generalized Periodontitis. These patients receive their prophy today, and are appointed as soon as possible for four quadrants of scaling and root planning (typically two appointments). The hygienist and business assistant’s conversation can proceed as in example #2 above, as well as the hygienist providing detailed home care instructions.

Your office may have a different bleeding or pocket depth threshold for patients, but this method of guiding them to perio treatment may work for you. Your patients deserve the best care, and your office deserves proper remuneration.

Carol Tekavec CDA RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com

Carol is also 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

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Imprive your hygiene performance one day... in your office

Nancy Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Resolutions for 2011 - Know What You're Up Against
By Nancy Haller, Ph.D., Leadership Coach McKenzie Management

It’s that time of the year when we reflect on the past 12 months and make resolutions for the next 365 days. We feel inspired to exercise, to slim down. We make proclamations to be more loving to family and to show more kindness to strangers. We vow to be better listeners. The reality is that few of us will sustain the motivation to work on our goals. According to surveys, 80-92% of New Year’s resolutions fail. Why is it that people can't keep to their resolve?

Consider how resolutions are made. Generally people don’t think about making resolutions until the last minute. They tend to react on New Year’s Eve, frequently after some cocktails. A lot of wishin’ and hopin’ but rarely much serious planning. Many people trying to lose weight, for example, think it’s enough to stick a picture of a model on the fridge or fantasize about being slimmer. If you are going to make any appreciable progress on your goals in 2011, it’s important to know what the obstacles will be.

Changing behavior is hard work. In fact, it can be a painstaking, labor-intensive undertaking. Human nature is to resist change. We are wired to seek homeostasis, our system’s need to regulate its internal environment and to maintain a stable, constant condition. Change for the better or change for the worse - no difference. What you’re up against is the “keep-things-the-way-they-are” syndrome, even if they’re not very good. Remember that it’s normal to feel uncomfortable in the midst of change, but do it anyway.

Change takes time. Remember, you didn’t develop habits overnight. Many of the most successful techniques involve making a plan and helping yourself stick to it. Other helpful strategies include making only one resolution at a time and viewing occasional lapses as just temporary setbacks. What you’re up against is our “immediate-gratification” world. We expect things to happen fast. Remember that overnight success generally takes about 10 years!

The motivation to change has to come from within. One of the most important things to know before making a change is your readiness. Identify why the change is important to you and the positive impact it will have on you in the long run. By identifying the “what’s-in-it-for-me” benefits, you’re more likely to find real value in the process of change. What you’re up against is that no amount of bribing or being reasoned with by others will be enough to successfully steer you towards an improved business or personal life. The buck stops with you, so stop doing it for someone else. If it’s not really important to you, you won’t do it.

Preparation is key. Resolutions are easy to make, easy to break. If you want to stick with them, you have to develop a plan, preferably by breaking down your goal into small, manageable steps. Focus on the outcome and the specific actions that you will take to get your there. Determine how and when you will measure your progress. What you’re up against is making goal setting a priority and setting aside the time to do the planning.

Persistence pays off. A long-term study by the University of Washington found that only 40% of people who stick to their #1 resolution did it on the first try. The rest had to try multiple times; 17% finally reached their goal after more than six attempts. What you’re up against is the tendency to believe you don’t have willpower, when in reality it takes discipline and resiliency.

Your thinking is key. The power of thoughts cannot be underestimated. Consider a study done with Olympic skiers who were trained to visualize themselves in a downhill race. Monitored with biofeedback, they emitted electrical impulses in the same muscles while sitting in a recliner chair as they would if they were speeding through the gates of a real competition. Your mind has incredible power. Tap into it by seeing yourself accomplishing your goal and feeling the pride of achievement. What you’re up against is self-limiting emotions and thoughts.

Get support. Yes, you are the only one who can make the change - but support from others is important. Self-sufficiency is a great quality but when it comes to making behavioral change you need encouragement. Have an accountability partner, a coach, someone who will help you face the challenges with courage and confidence. What you’re up against is a tendency to go it alone. Don’t.

Celebrate success along the way. Congratulate yourself for small achievements. You are making changes that will culminate into a different way of being. But change is hard work and takes time, so be realistic. Progress comes in small increments moving from minor modifications to noticeable differences. What you’re up against is discounting small but significant successes then losing motivation to keep at it. Take notice and pat yourself on the back.

My wish is that you establish one or two (no more) meaningful goals and practice them with intentionality and diligence. May you have patience with yourself and pride in your efforts. And may all your days be merry and bright, at the holidays and throughout 2011.

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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