12.2.11 Issue #508 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Hygienists: It's Time to Face Economic Reality
By Sally McKenzie, CEO

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In 95% of the practices McKenzie Management works with, hygiene alone is losing $35,000 – $150,000 annually, and that number has likely gone up over the past 24 months. This says nothing of the thousands of dollars in additional dentistry that also disappears, all because key team members simply don't fully understand the economic impact on the practice when patients aren't in the chair.

To maximize the effectiveness of your hygiene department, follow the “Rule of 33.” This means that the hygiene department is expected to produce 33% of the total office production, not including doctor's exams. Each hygienist provides 33% of her/his production in periodontal procedures such as periodontal maintenance, and the hygienist’s compensation should be no more than 33% of his/her production. If the hygienist receives a guaranteed salary, the expectation must be that s/he produces three times his/her wages. If the hygienist is paid $40 an hour and the cost of the prophy, not including the doctor’s exam, is $80, the hygienist is making 50 cents on the dollar, well above the 33% benchmark. To determine where you stand on the Rule of 33, retrieve the production analysis reports from the practice's management software.

Next, every hygienist needs to think like the VP of Production. Not only do you need to view yourself as a dedicated healthcare provider, you also need to recognize your extremely critical role in production. And like it or not, it is production that affects the economic success of the practice and individual team members.

Too many hygienists never feel the need to learn business skills. And some even resent the fact that they are, at times, expected to look at their departments from a business perspective. For many, it is not until their incomes or job security is affected that they recognize the importance of becoming an active participant in the business side of the practice.

While employees may never be as personally invested in the business as the owner, the prospect of taking a cut in benefits, a wage freeze, or a reduction in hours should cause a team player to pay better attention to the business side of the practice and how they can directly make a difference. Read on.

 Hygienists: It is essential that you have a clear understanding of what you produce per day, per week, per month, or per year for your practice. Monitoring your daily production is as easy as downloading the Daily Hygiene Monitor Form from the McKenzie Management website, or creating your own daily log with the following information:

  1. The date.
  2. The names of the patients scheduled. Patients that cancel or don’t show get a “CA” (for cancel) or “NS” (for no-show) next to their name.
  3. Number of hours you are paid for that day.
  4. Open time (time that was never booked by the scheduling coordinator). All time increments should be based on 10-minute units. So, a 60-minute appointment accounts for 6 units.
  5. All procedures performed on each patient that day.
  6. Procedures charged out of hygiene.
  7. The total fee for each patient that day.
  8. The amount you produced that day.

Once you have created your log, check off what you did on each patient and total it for that day. To determine production per hour, add up your total production for that day and divide it by the hours you were paid, not the hours you saw patients. If you're paid for an eight-hour day but only saw seven patients, you will take the total daily amount, let's say it is $1,000, and divide it by eight.

Therefore, your hourly production for that day is $125 an hour. The office lost money in two ways during that open hour. First, it lost money because of open production time. Second, you continued to earn a salary during that hour.

Recession or no recession, your role in the business of dentistry is critical. And as this soft economy continues to linger, there is no better time than now to not only face the economic realities, but take specific actions to address them.

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, Ph.D.
Leadership Coach
McKenzie Management
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Check Your Boundaries
By Nancy Haller, Ph.D.

As a dental leader, maintaining professional boundaries is crucial for your success. I’m not talking about abiding by a code of ethics - that’s a given. I’m referring to the more ambiguous lines of authority that get crossed, the “fuzzy” boundaries that can derail your team and your practice. In essence, it’s the way you communicate - verbally and nonverbally - with your employees.

The definition of a boundary is the ability to know where you end and where another person begins. When we talk about needing space, setting limits, determining acceptable behavior, or creating a sense of autonomy, we are really talking about boundaries. Boundaries protect us. They help promote healthy relationships. They minimize conflict. Boundaries in the workplace are designed to create a healthy and productive environment.

Boundaries allow for appropriate connections between you and your employees. Being “friendly” is not the same as being “friends.” Yet our lifestyles have become so casual that people have lapsed in their ability to maintain constructive professional boundaries. Remember - mixing business with your personal life can cause serious problems.

There is a general misconception that having good boundaries will distance you from others. Certainly there needs to be some flexibility with your boundaries, so consider a continuum of professional behavior. At the left end of the scale is under-involvement, which looks like a lack of engagement, disinterest, and even neglect. Contrast that with the right end of the continuum that is represented by over-involvement, which includes socializing outside work, “friending” your employees on Facebook, and the like.

Aside from obvious ethical principles, there is no clear-cut rule about boundaries because there are many variables. Your leadership style, your employees' personalities, your practice culture, all factor into how you interact with one another. But one general principle does apply - your team needs a leader first and a friend second. Here are some common areas in your work life to review to ensure that you are maintaining constructive boundaries, for your sake and the sake of your team.

Playing the “Hero” Role
Motivated by good intentions, you decide to loan money to a staff member. (This was recently a case on The People’s Court. The dentist provided the funding for her Front Desk employee to have cosmetic surgery…and you can guess the outcome.) Sure, it’s called an “advance on pay” - but when you do this be very careful. You are crossing the invisible line drawn between earned wages and a gift.

Bending Practice Policies
Suzie Q is a single mother. She frequently leaves work 15-20 minutes earlier than the other employees due to childcare issues. Because she is a hard worker, you allow this special “favor” to Suzie, but you’ve violated the boundary of your own 8-hour workday policy. The other employees see Suzie as your “favorite” and this has the potential to cause problems in morale and disloyalty. Worse, if her co-workers perceive this as unfair treatment, they can ostracize Suzie.

Poor Teamwork
When you don’t trust that your employee can fulfill their responsibility, or you believe that you can do it better/faster (you probably can), you step in and do the task yourself. You may fool yourself into thinking you were “just trying to help” or s/he was so busy and it needed to get done, or you didn’t want to keep the patient waiting. But you have violated a boundary. You’ve taken over by doing someone else’s work.

Too Much Self-Disclosure
There's nothing wrong with sharing something personal about yourself with your employees. In fact I encourage appropriate sharing. It makes you human and builds relationships within the team. But when you go into too much detail or reveal intimate information, it confuses your staff in terms of the roles and expectations you have of them. Information about your private activities, personal habits, religion, sex life or politics could be either intentionally used against you, or unintentionally affect someone's opinion of you or your practice.

Lack of Clear Job Responsibilities
Without defined accountability, employees can legitimately blame one another for poor performance. “It’s not my job” may very well be the truth unless you establish boundaries for who does what. It’s equally important to identify when and how you want things done.

Not Respecting Physical Boundaries
You lean over Mary's shoulder to look at the computer monitor as she posts payments into your accounting program. For some people this is an invasion of personal space. Ditto when you open an employee's desk drawer or search through their belongings. In these instances you've stepped over a boundary and the impact can be one of disrespect or even betrayal.

There’s an old proverb that says: Good fences make good neighbors. Mind your “fences” and carefully balance the tricky tight rope of workplace boundaries.

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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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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The Hygiene Periodic Exam
By Jean Gallienne, RDH BS

I think many doctors, hygienists, and front office staff would agree that the periodic exam in hygiene is a challenge. Oftentimes, when the hygienist is done with her portion of the hygiene appointment, the patient is left waiting while the hygienist goes over to the doctor to let him/her know that she is done and needs the periodic exam that was mentioned at the morning business meeting. Of course, the doctor is right in the middle of performing a root canal or crown and veneer prep, and it is the most inopportune time to break away from his/her own patient.

If space permits, the hygienist moves the patient to sit in a room waiting on the doctor. Meanwhile, the patient was expecting to be done with the appointment within the actual time scheduled. At times, the hygiene patient is left waiting for 10-30 minutes. This is not the best way to have patients refer their family and friends to your practice.

Even worse is when there is not another room the patient can be moved to, and not only does the patient waiting for an exam have to stay late, but now there is a good chance that every patient after that one will have to be seen late. Again, this is not a good way to help build your practice or keep the current patients that are consistently not being seen on time for their appointments.

Many offices review who needs an exam in the morning business meeting, but once the day starts it just does not jive into the schedule. One suggestion to help the periodic exam process is for the hygienist to get all of the x-rays, probings, and possible decay at the beginning of the appointment. This may happen in many practices, but what does not happen in many practices is the doctor coming in to do the exam at his/her convenience.

The periodic exam does not have to be at the end of the hygiene appointment, and it is actually better if it's not done at the end of the appointment (check your state law). The earlier the exam is done, the more time the hygienist has to go over what treatment was recommended, answer any questions the patient may have, and reinforce the treatment plan to the patient.

As we all know, the hygienist is the person in the practice that patients tend to see more often, and the hygienist has a powerful influence on patients because of this. Patients will quite often look for advice on whether to move forward with the treatment the doctor has recommended. If the hygienist has reviewed with the patient what may be needed prior to the dentist coming in, then anything the doctor recommends will be accepted quicker. However, the hygienist should be sure to tell the dentist about any prior conversations with the patient about possible treatment. This will also help to speed up the dentist's exam.

While the doctor is making closing statements, the hygienist can go ahead and write up the treatment plan and give it to the front office to have it put into the computer before the patient is hovering over them. This allows the patient to walk out of hygiene, up to the front desk or consult room, have the treatment plan and financials gone over, and an appointment made to get the treatment done. If the patient is not ready to go ahead with treatment, notes should be made in the patient's record.

Having the exam done earlier in the hygiene operatory will allow for more flexibility if additional x-rays are required, or if the patient may benefit by seeing the recommended treatment on an intra oral camera. The periodic exam in hygiene is very important, because of the amount of treatment that is diagnosed from the hygiene department. Being less rushed and doing it at the doctor's convenience and earlier in the appointment may also lead to more treatment acceptance.

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1-Day Hygiene Training Program.

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