11.18.11 Issue #506 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Does Burnout Have You Checked Out?
By Sally McKenzie, CEO

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Burnout is an interesting experience. We see it typically in offices in which the doctor has been practicing for 15-20 years. There can be several contributing factors, but in many cases, the doctors are tired. They have been waging an uphill battle for far too long, typically moving from one crisis situation to the next - staff turnover, low treatment acceptance, lack of new patients. In the past, they could muddle through. They were busy enough that even if things weren’t perfect, the practice was doing pretty well - until a few years ago, when circumstances quickly went from good enough to barely getting by.

Problems in practice systems pile on. Overwhelmed and under-enthused, the doctors try burying their heads in the dentistry. The only catch: the demand for treatment is down. Serious system troubles mean that typical practice feeders such as new patient promotions, hygiene visits, and treatment acceptance are in severe trouble. While these situations often require professional practice management intervention, there are steps doctors can take to refocus the team and reenergize the practice.

First take responsibility. Lack of leadership from the doctor breeds apathy among the team. Practices that are not cared for go into autopilot. Those that remain on autopilot struggle, and in some cases even fail.

Next, take a close look at key treatment generators. If you are engaging in new patient promotions, make sure that your business team is trained to represent the doctor and the office effectively on the phone. If they are not, you are wasting a fortune on marketing that is being derailed at the frontline. Truth be told, most front office staff view the telephone as a source of frustration and interruption. Oftentimes that irritation comes through loud and clear to the caller. Consequently, it’s costing dental practices a fortune in lost patients and lost production.

Consider the following patient facts:

  • 7 out of 10 patients decide not to use a practice after their first call because the telephone was not answered promptly or they received an unwelcoming greeting from the person answering.
  • It takes 3-6 seconds to impress a patient.
  • It costs 5 times more to obtain a new patient than to keep an existing one.

 Do you know how your team members come across on the telephone? If not, find out. McKenzie Management can have a professional mystery patient call your office for the purpose of evaluating phone etiquette, hold times, customer service, etc. You receive a report and recording that enables you to hear exactly what transpires on the phone between your patients and your staff.

Next, examine hygiene production. The hygienist should be producing three times her/his salary. If that’s not happening, it’s most likely that patients are cancelling or not showing for their appointments. It is critical that all hygiene appointments be confirmed via phone, text message, and/or email - whichever communication method is preferred and most effective with the individual patient.

Ensure that the patients understand the true value of the “routine” hygiene visits. Enhance patient perception of the hygiene appointment by explaining the impact of oral health on systemic health, periodontal health, and oral cancer. This increases the patient’s perceived value of routine care. If a periodontal co-examination is performed and the hygienist talks about the results and educates the patient - even healthy patients - they will have far greater appreciation and understanding when you must recommend that they be seen in four months rather than six.

In addition, rather than sending patients away with nothing more than a yellow credit card receipt, include a hygiene appointment summary. This might provide a list of all of the procedures performed such as periodontal exam, oral cancer exam, a brief review of the hygiene evaluation, home care instructions, a reminder as to specific areas the patient should pay special attention to between now and their next visit, the doctor’s recommendation for follow-up treatment, and a list of free products given to the patient along with their estimated value.

Finally, evaluate doctor and team attitudes toward treatment acceptance. Do you or members of your team undermine practice production by assuming that patients will not consider ideal treatment options? Do you suggest that treatment isn’t urgent, so the patient perceives they can put it off indefinitely? Do staff imply to patients that fees for dentistry are too high? Are you truly comfortable presenting treatment plans, or would this be better delegated to a trained treatment coordinator?

If practice problems and burnout have you feeling overwhelmed and under-enthused, seek help. In the meantime, start examining your production feeders and begin reclaiming your practice.

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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Nancy Haller, P.h. D.
Leadership Coach
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Leadership Illusions
By Nancy Haller, Ph.D., Leadership Coach McKenzie Management

It’s likely that you’ve seen the optical illusions exercises. The most famous is the Rubin vase which depicts both a vase and two profiles of a human face. Depending on your focus, you will see the picture as two difference images. For some people it is difficult or even impossible to see both meaningful images at the same time.

Perception and awareness are truly amazing phenomena. And people never cease to be marveled by optical illusions and cognitive deception exercises. The activity provides information about how the human mind perceives and structures the world. While optical illusions can be fun and certainly interesting, they also can serve as a metaphor for leadership.

To make sense of the world, we organize incoming information in a meaningful way. But optical illusions remind us that things are not always the way they seem, even when we think we have ‘evidence’ to the contrary. That’s because the brain takes lots of short-cuts. Most of the time, these shortcuts work pretty well. The world actually does fit our perception. However, there are many times when we misperceive reality and think and act irrationally.

In terms of your effectiveness as a leader, consider the following three common distortions and whether you are inclined to misperceive reality due to:

1. A Lack of Time
The world is going at warp speed and we struggle to keep up with technology, but we all have the same 24 hours per day. How you chose to spend those hours is the issue. Are you allocating the right amount of time to the right priorities for the right reason? Irrationality also can arise when you don’t take enough time to think things through but simply respond with a knee-jerk reaction. Make time for reflection. Even just five minutes of uninterrupted thinking and planning can save you hours in the long run.

2. Ignoring Complexity
You have a lot of decisions to make every day. Most of the time, you’re right. However, when your decisions are wrong it’s likely that you didn’t consider all the relevant factors involved. This is particularly true when it comes to employee issues. Human behavior is complex. Don’t assume you know what your staff is thinking or feeling. Engage the members of staff in frequent conversations and avoid jumping to conclusions when your emotions try to hijack you.

3. A Desire to Stay Comfortable
Many times we make decisions to make ourselves happy and comfortable. Often there are elements of fear and anxiety involved as we want to avoid mistakes. Rather than trying something new, we stay stuck in doing things because “that’s the way it’s always been done.” If you want to take your practice to new levels of success, it’s likely that you need to change some things about your systems, your leadership, and your team dynamics. Remember, there is no perfection. There will be setbacks. Things will take longer than you expected. But if you stay the course, you can achieve your goal.

If you find yourself focused on the negative, if you generalize situations and people or set exceedingly high standards with overly critical self-evaluations, it’s likely that you’re experiencing the effects of cognitive illusions…or even distortions. These can turn into habitual beliefs and thought patterns that keep you trapped and prevent you from realizing your dreams. It’s time to incorporate rational reasoning into your thinking. Call me. I’m here to help.

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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Carol Tekavec RDH
Director of Hygiene
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A Penny Wise and a Dollar Foolish?
Carol Tekavec RDH

There is an ongoing argument in the dental world concerning time frames for hygiene appointments. At the heart of the argument lies the bottom line…office production. On one side are those who promote the shortest possible appointment slots for so-called prophys, and on the other side are those who advocate longer times to allow for “other services.” Let’s look at the main features of both.

Short Appointments
Short appointments (30-40 minutes) make it possible to see many patients during a day’s time. Short appointments create income for the practice. 10-15 patients a day in the hygiene schedule can generate fees for prophys, x-rays, and fluoride treatments. It is the hygienist’s job to work quickly and efficiently, and longer appointments foster a lazy approach to the task at hand. Patients are fine with fast appointments because they are busy and appreciate not being tied up at the dental office for long periods. Screening patients for perio and possible restorative issues should not take longer than a few minutes for a competent hygienist. With digital x-rays, a full mouth series can take as little as five minutes. Since production is one of the most important aspects of keeping an office in business, and the hygienist is usually the most expensive employee at the practice; it is the hygienist’s responsibility to pull her weight and work quickly.

Longer Appointments
Longer appointments (60 minutes) make it possible for the hygienist to perform more procedures in an atmosphere of personal concern and care. Eight patients a day generates fees for prophys, x-rays and fluoride treatments, plus it allows for more complete screening for perio and restorative patient needs. It is still the hygienist’s job to work quickly and efficiently, but a slightly longer appointment time fosters patient trust and provides a framework for the hygienist to connect with the patient concerning possible future patient care. Since the hygienist is not rushed, she has time to explain what she has found and set the stage for the doctor’s diagnosis and recommendations.

Even though digital x-rays shorten the time necessary to expose and view radiographs, patients are not mannequins. Sensors can be uncomfortable for some patients, and the hygienist needs time to find a way to take the needed views that provide the least discomfort. Patients appreciate not being rushed and like the chance to ask questions.  While an immediate measure of the hygiene department’s effectiveness can be the actual production generated “today,” the future production generated from treatment diagnosed, accepted, and scheduled can be many times more significant. The “recall” appointment is essential for long term practice viability. If future treatment is not scheduled from the recall appointment, when will it be “discovered” and scheduled? It is the hygienist’s responsibility to aid the dentist in screening for future treatment, and to do it in such a way as to facilitate his ability to gain the patient’s trust. It is another way hygienist’s “pull their weight.”

From these two descriptions, it is easy to see what side of the argument I lean toward. As a working hygienist myself, I consider one of the most important duties I perform to be setting the stage and fostering the framework the dentist needs to help patients receive the treatment that they need. I also believe that having time to explain treatment needs, whether it be scaling and root planing and subsequent periodontal maintenance, or possible Class III cracks in a molar likely necessitating a crown; having both the dentist and hygienist make a recommendation enhances the chance that a patient will agree. Hygienists do not diagnose - but they can observe and inform. Conditions that appear to need treatment can be identified, and then confirmed or “denied” by the dentist with notes in the record to keep an eye out at the next recall. Even when the recommendation is to “watch” the situation and re-evaluate at the next recall, it gives the patient another reason to come back in six months.

Speaking strictly in dollars and cents, hygienists who have the time to address a patient’s individual concerns add revenue to the practice. For example, if the hygienist recommends and the dentist confirms that a patient needs prophys three times a year rather than only twice, she has time to explain, and the patient will be more likely to accept.  Just 50 patients who go from twice a year prophys (at $80) to three times a year intervals adds $4000 to the practice’s bottom line!

If only 25 patients are identified who need scaling and root planing, and then go on to accept four periodontal maintenance appointments per year (at $125); instead of 2 prophys at $80 = $160 x 25 = $4000 generated annually, these 25 patients will generate $125 x 4 = $500 x 25 = $12,500.  An increase of $8500!

Similarly, if the hygienist identifies and the dentist confirms necessary crown restorations on only 50 patients a year (at $1,100 each), $55,000 can be added to annual revenue.

There is great potential for the hygiene department to increase office revenue, without that potential being totally tied just to daily production. It makes sense not to be a “penny wise and a dollar foolish.” The hygienist’s contribution can extend far beyond what she produces directly at the chair.

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.

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