6.3.11 Issue #482 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

High Debt and Mega Overhead Clobbering Your Practice? Do This.
by Sally McKenzie CEO

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It is said that the longest journey begins with a single step. For dentists in debt, getting it under control is only the first step on the road to solvency. Next is the critical part of the journey: ensuring that once they achieve financial freedom, they keep it. That requires ongoing, painstaking system scrutiny.

As I discuss in the McKenzie Management Educational DVD Achieving Peak Performance, there are 22 systems and dozens of variables that affect your practice, all of which require ongoing assessment and monitoring. Effectively managing those systems goes hand-in-glove with controlling overhead. But it won’t happen overnight. You’ll need a strong commitment, a solid plan, and possibly outside assistance to achieve your practice profit objectives.

mailto:info@mckenziemgmt.comTake a good look at expenses and set goals. Establish the following budget targets:

  • Dental supplies - 5%
  • Office supplies - 2%
  • Rent - 5%           
  • Laboratory - 10%
  • Payroll - 20%
  • Payroll taxes and benefits - 3%
  • Miscellaneous - 10%

Now how do you achieve those targets? Read on.

If your payroll costs are crushing your profits, here’s what may be happening:

  • You have too many employees
  • Raises are based on longevity rather than productivity/performance
  • Hygiene production is low

When determining the need for more front desk staff, look at check-in and check-out. These administrative tasks take approximately 10 minutes per patient. If your practice is seeing 15-22 patients per day, which would total 150-220 minutes of patient contact, one person should be able to effectively manage the front desk duties. If that person is spending more than 240 minutes handling patients - or half the day - the practice should consider hiring an additional employee and have their business systems analyzed for time and motion efficiency.

As for assistants, if the procedures are streamlined, one assistant can efficiently maintain two treatment rooms for a general dentist using two operatories and seeing 13 or fewer patients a day. This would include setting-up the room, seating the patient, assisting the dentist, dismissing the patient, and cleaning-up.

Tie raises to performance, and raise - or perhaps establish - performance standards. Set guidelines for raises when you hire an employee and explain to current staff when raises can be discussed and under what conditions they are given. Job descriptions are a must for everyone. Use performance measurements to determine raises. And if the practice is losing money, employees do not get a raise, plain and simple.

Another major contributing factor to inflated overhead is low hygiene production. Typically, this is the result of a malfunctioning recall system and lack of accountability. The hygienist’s salary should be no more than 33% of her/his production (excluding doctor’s fees). If the hygienist receives a guaranteed salary, the expectation must be that s/he produce three times her/his wages. The key to achieving that is the hygiene schedule. Hygiene schedules frequently appear to be overbooked, but practices pay scant attention to those holes that creep into the workday. Bottom-line: If patients aren’t in the chair, the hygienist can’t meet production goals.

Incorporate an interceptive periodontal program into the practice. I recommend you start at the front. The business assistant greets the patient upon arrival and gives the patient a questionnaire and a brochure with a checklist educating them on the importance of addressing the signs and symptoms of gum disease. The patient checks any symptoms they have experienced, which opens the door for discussion in the treatment room.  Carol Tekavec RDH, Hygiene Director for McKenzie Management, has an excellent 1-Day in-office training program. Go Here for more information.

Supplies should run about 5-7% of monthly collections. If yours are higher, make sure you are budgeting these expenses and work with your dental supply company and dealer representatives. They are very willing to help you control costs. 

The standard for laboratory expense is 10% of gross production, assuming that 30-40% of your production involves crowns, bridges, partials, etc. If your laboratory expense is below that, it typically means that the amount of crown and bridgework you’re diagnosing, selling, and completing falls short of the standard. You may need to examine diagnostic approaches and treatment presentation skills. If your laboratory expenses are over the 10% benchmark, the business employees are probably not collecting from patients.

The miscellaneous category often includes many little items that add up to big bucks. No question, several of the items in this category are necessary. Nonetheless, pay attention to what all those little percentage points are adding up to, and ask questions. Be consistent. Monitor the systems. Avoid the temptation to get comfortable when you begin to experience the success of your efforts. And don’t be afraid to seek help.

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

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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You Have New Patients! Now How Do You Keep Them?
By Carol Tekavec, RDH

New patients are vital to any successful practice. Dentists know that traffic through the door spells dollars in the bank account. The monetary value of a new patient to a practice is difficult to quantify exactly, however many believe that the average new patient will likely need between $1000-$1500 worth of treatment. (In some areas of the country the amount may be much more.) Outside marketing, internal marketing, satisfied patient referrals, web pages, Facebook, Twitter, and even the good old phone book can be important sources for new people in your practice. And now, congratulations! Your strategies have worked and an expectant new patient sits in your chair, looking to you to take care of his dental needs.

 Unfortunately, while that new person is arriving in the front door, a former patient is leaving out the back. What happened between the time you first met that patient-of-record and their decision to leave the practice? Let’s look at a few possible causes.

Chaotic Scheduling
When new patients come to the office, the entire staff plays a role in treating them correctly and making sure they have a reason to keep coming back. Haphazard scheduling is one way to ruin a new patient relationship, before it ever gets a chance to get going. New patients deserve to have the undivided attention of the dentist for a designated period of time, before they have radiographs or prophys.

Needed x-rays can be ordered by the dentist after a brief visual exam, and a full exam can take place once they are exposed. Ideally any “cleaning” the patient requires should take place at a separate visit, after the patient’s periodontal condition has been evaluated. It is difficult to keep patients coming back if they find out that the pumice prophy they had been receiving at their previous office is not what your office considers to be appropriate periodontal care - especially if they don’t understand why. It can be worse if new patients are always scheduled through the hygiene department. Patients who come to the hygienist first may be shocked to discover they have periodontal disease and can be distrustful and resistant to treatment. They may believe that the office is just “saying that to get money.” Couple that with a common resistance to having x-rays, and you have a patient that is already half out the door before the dentist even says hello.

If a separate hygiene appointment is not possible, at least schedule the patient with the dentist first. The patient has a chance, however brief, to meet and develop an initial relationship with the doctor, and then on to the hygienist after the dentist’s exam. If periodontal disease is discovered, the hygienist can reinforce what the dentist has explained to the patient, and perhaps begin with one quadrant of root planing.

Doctor overbooking is another scheduling concern that can damage patient retention. If the dentist is overscheduled, s/he will be forced to leave a patient in the chair while s/he attends to another. While this is typically not a problem if it involves a brief “recall” exam, it is an issue if the dentist is getting up and down frequently to try to diagnose or treat multiple patients at the same time. Patients wonder where the dentist is going and why s/he is gone so long during their supposed designated appointment time. It is inconsiderate and a detriment to the practice to leave patients sitting in the chair when they are expecting their treatment to be completed. Leaving patients for long periods makes them think you are just too busy for them.

Ignoring A Patient’s Primary Concern
There is a reason a patient has come to your office, and once you discover what that is, that reason needs to become your primary focus when dealing with that patient. A dentist can simply ask, “What brings you to our office?”  Whatever the patient says is likely his/her primary concern, and therefore should be the first thing the dentist addresses when eventually working up a treatment plan for that person. For example, if the patient says, “I don’t like the looks of my front teeth,” any treatment for #8 and #9 must be first on the priority list. Even if the patient has three abscesses and two posterior teeth decayed to the gumline, and #8 and #9 simply have uneven incisals that can be corrected with a little enamelplasty, the front teeth need to come first.    Ignoring a patient’s primary concerns make a patient think you do not really care about them. Be sure that when working up the case, the patient’s priorities are put first. Patients whose primary needs are ignored leave the practice.

Office Discord
You may not think that your patients notice, but if there is tension or problems among the staff at the office, your patients will sense it. Likewise, if staff members are rude to one another or show in other ways that they are not getting along, it makes patients uncomfortable. In a professional office all staff members treat one another with courtesy, regardless of how they are feeling. Personal issues must be left at home and interoffice disputes must be handled away from patient hearing. Patients are uncomfortable having treatment where staff members appear to not get along. If they don’t feel comfortable, you can be sure they will be inclined to find a place where they do.

These are just three possible causes for patients leaving a practice. There are certainly many more, and future articles will explore them. Keep in mind that getting new patients to the office is an important aspect of any successful practice. Keeping the patients you have is equally important.

Carol Tekavec 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 hygiene efficiency and profitability for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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Nancy Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Tough Times Require Tough Leadership
By Nancy Haller, Ph.D., Leadership Coach McKenzie Management

Events are out of our control. Tornados. Tsunamis. Earthquakes. Nuclear meltdowns. The economy. We are vulnerable. It makes us anxious about the future.

In today’s increasingly complex world, even rock-solid workers are likely to have times when their lives are affected by crisis. At some point, you probably will be faced with an employee's family, financial, legal or health crisis. The skill and humanness exhibited by you, the leader, will be important in the final outcome. Balancing your interest in employees without getting too deeply into their lives requires good judgment and tact. It’s important to care about employees. People who are cared for in turn show caring to others. They work more efficiently and are more congenial. Effective leaders have empathy - the ability to understand and respond to others, to see the world from someone else’s perspective, to step into their shoes.

Perio DiseasePerhaps you believe that work and personal life should be separate. You may have been told to keep a healthy distance from employees. Be careful - because the work environment has changed. Work is more than a job and a paycheck. It is a place where people spend 30, 40, 50, 60 or more hours together a week. Good leaders know more about their employees than just the work they do. And employees expect some compassion from bosses and co-workers. They need personal validation. Being impersonal signals disinterest and a lack of caring, and is as risky as being overly involved.

In his book, Primal Leadership, Daniel Goleman describes empathy as the key to retaining talent. Although a positive relationship with a boss is not enough to produce worker productivity, it can significantly contribute to it. And the absence of sensitivity can lead an employee out the door. At the same time, you need to strike the right note in your interpersonal relations with your staff. It is important to be approachable and friendly, yet fair and firm.

It may be that you are worried about saying the “wrong thing,” such as:

  • You shouldn’t take it so hard
  • You’re overreacting
  • It could be a lot worse
  • You’ll get over it
  • Just pull yourself together

Those statements minimize a person’s pain and convey a lack of interest on your part. The impact is negative and potentially damaging to your relationship.

So how should you handle the situation?

1. Be Understanding
An emotional problem is really no different than a physical problem. Although we live in the 21st century, it often amazes me how little we have advanced from the Salem witch-hunts when it comes to our acceptance of psychological distress. Think about how you would respond if your employee had a broken ankle, or a surgical procedure.

2. Ask Employees How They Are Doing
Be concerned without becoming a therapist. Don’t get into the counselor role. Avoid giving advice or probing for details. Most people work through problems and issues very well on their own. Simply expressing concern is greatly appreciated and often enough.

3. Pay Attention
Show empathy by listening. Be patient. Refrain from interrupting. Nod appropriately. Maintain good eye contact and display interest in your facial expression and posture.

4. Be Objective
Redirect if necessary. The office is a place of business. Keep personal disclosures to a minimum. If your employee becomes too self-revealing or rambles, manage the time by gently redirecting the conversation to a close. You might say, “Sounds like you have a lot on your mind. You’re an important member of our dental team and I worry about you. I hope you feel better soon. (Pause) I’ll let you get back to your patients now.”

5. Meet With The Employee
If performance is being affected, meet informally with the employee. Show genuine concern and not “gossip” style interest. Offer help in finding professional resources when necessary.

Be curious about how your team is feeling. Morning huddles are excellent times to get a quick pulse on the mood and mindset of your team. Of course, keep quiet about personal problems employees bring to you. It’s important to respect confidentiality. Some subjects are not matters of public discussion in the workplace.

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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