Tips: No Goals = No Growth

No Goals = No Growth
By Sally McKenzie, CEO
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If you don't have goals you won't have growth. I find time and again with dental teams - if there are no goals, objectives, or measurement systems in place, profits and productivity stagnate or decline. The situation continues until the doctor is facing a financial crisis that could have been avoided.

mailto:info@mckenziemgmt.com In the dental practice there are certain benchmarks, i.e. goals, which effective practices achieve: Collections should be 98% of the dentistry produced. Case acceptance should be at 85%; hygiene should produce 33% of practice production; 85% of emergency patients should be converted to comprehensive exam; and the schedule should have fewer than .5 hygiene openings per day. Although I have seen practices of all types and in virtually every area of the country achieve those benchmarks, it doesn't just happen on its own. Protocols are in place, measurements are established, and in many cases the doctor recognized that s/he could not singlehandedly fix the shortfalls and sought additional help.

With multiple systems in the dental practice all affecting your profitability, determining where to start can be daunting. In some cases, it's easier to look at it in terms of four broad categories: Service, Staff, Profit, and Growth.

Service
Establish specific goals related to improving and delivering superior service. The quality of your service has a direct and powerful impact on collections, case acceptance, hygiene production, emergency patient conversion as well as no-shows and cancellations. Create an internal team to examine the total patient experience for both new and existing patients and carefully consider what could be improved. Track common patient questions and concerns. Seek feedback from your patients and act on their recommendations. In today's fluctuating economy, many patients are looking for an excuse to cancel or not show up for their appointment. Make sure that your superior customer service keeps the patients coming.

Staff
Establish specific goals related to attracting and retaining excellent staff. If you are experiencing a high degree of staff turnover, it's likely to be one or more of the following systems that needs to be addressed: Hiring and employee selection/testing, staff training for new and existing employees, ineffective or non-existent job descriptions, and/or lack of employee accountability. Issues with the staff permeate the practice and lead to a climate of conflict and daily drama that is both emotionally draining and directly affects practice revenues as well as patient retention.

Profit
Establish goals to monitor and improve profitability. If specific practice management systems are in place, you should be able to expect to increase profits each year. Start by taking a close look at your practice management system reports. These are readily available on your computer in your practice management software system.

One of the most critical reports requiring ongoing careful review is the Unscheduled Treatment Report. This specifies who has unscheduled treatment in the records. In actuality, this report is documentation of revenues waiting to be tapped. In addition, take a close look at the Production by Provider Report each month. This shows the number of each type of procedure performed over a specified period of time. Your business assistant should run this year-to-date report every month for each doctor and hygienist, so they can determine how their production compares with the same time periods last year as well as with production goals that have been established for this year.

Growth
Establish goals focused on improving patient retention. Patient retention and expanded services are essential to practice growth. The higher percentage of patients you retain in your practice, the greater the value of your practice and the likelihood that new patients will increase. Retaining patients is the key to growth - but if you don't know why patients leave, you can't address the problem(s). In almost every case, patients who leave your practice do so because of system breakdowns that you are most likely not even aware are occurring.

Consider new treatment services. Practices that are struggling are likely doing what they've always done, i.e. crowns, fillings, and prophys year-after-year. Dentists who are doing interceptive perio, endodontics, veneers, bleaching, and implants not only expand their patient base and improve their production, but they also renew their professional enthusiasm for dentistry.

For more information on this topic, visit my blog: The Lighter Side.

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
Interested in having Sally McKenzie Seminars 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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Are You Looking Out for Your Brain?
Nancy Haller, Ph.D.

Your brain is a precious resource. Since you're reading this, you were blessed with a good one. Your brain enables you to see. It allows you to learn. Your brain takes in information from your senses, it analyzes that data, and then gives you a plan of what to do, from simple tasks like walking to complex tasks like dentistry. The brain is truly amazing! Through the growing field of neuroscience, we now know more about how it functions. In essence, the brain runs the show and controls just about everything you do.

Although it is a fairly small organ, your brain consumes about 25% of the oxygen you breathe. About 25% of the blood pumped from your heart flows to your brain. Approximately 40% of the nutrients your body uses are consumed by your brain. It is estimated that 80% of your blood glucose goes to feed the brain. In short, your brain soaks up a lot of energy. In the bestseller book, The Power of Full Engagement, author Tony Schwartz (and co-author Jim Loehr) report that the key to peak performance is managing energy, not time. Energy management means alternating intense focus with regular periods of renewal. In short, to perform at your best, you better be refueling regularly.

However, if you are like most people these days, you’re probably operating from the ‘survival zone’ - too much to do and not enough time to do it. With the rising demand of digital technology and the expectation of 24/7 responsiveness, we are increasingly burning our brain and depleting our capacity. When you spend more than you make you will go bankrupt. So too with our brains. The indicators are anxiety, reactivity and defensiveness…and poor performance.

Recently, Tony Schwartz asked 160 senior executives at a large bank to complete an energy survey. Here's what he found:

77% said they had trouble focusing on one thing at a time, and felt easily distracted during the day.
80% said they take too little time to think strategically and creatively, and spend too much of their time reacting to immediate demands rather than focusing on activities with long-term value and higher leverage.
54% said they often feel impatient, frustrated or irritable at work, especially when demand gets high.

Given these percentages, it's not surprising that the following figures also were reported:

82% reported they regularly get fewer than 7-8 hours of sleep and often wake up feeling tired.
70% don't take regular breaks during the day to renew and refuel.
70% eat lunch at their desks, if they eat lunch at all.
65% don't consistently work out.
68% said they don't have enough time with their families and loved ones, and when they're with them, they're not always really with them.
71% take too little time for the activities they most deeply enjoy.

After reading these statistics, it's obvious why our economy is in such poor shape. Having this lifestyle yields short-sighted and ill-developed decisions! Before you dismiss these figures - you're not a banker - let me tell you that the same survey has been given to tens of thousands of leaders across multiple industries and the results are consistently similar. What this points to is a lack of knowledge about how the brain impacts one's energy level.

How well you take care of your brain impacts your ability to think clearly, to make sound decisions, and to live a rewardingly successful life. Protect your most important asset. Take care of your brain. Maximize your brain power by doing the following:

1. Get at least 7 hours of sleep every night. Sleep impacts our capacity to focus attention, store information and remember it. We also have the best access to creative insights for problem-solving when we are fully rested.

2. Take brain breaks. The brain is an energy-intensive organ that is capable of deep thinking, but only for brief periods of time before it needs a break. When you take regular breaks to refuel, you top off the glucose levels in your blood stream. In turn you can make better decisions and solve complex problems more efficiently.

3. Exercise. If you want to look after your brain, you need to keep the body in shape. Regular workouts contribute to increasing your mental health as well as your physical health.

4. Spend time with the people you love. Social connections are key to our wellbeing. Turn off the smart phone and get away from the computer when you are home. Be present and live in the moment, at least some of the time.

5. Self-manage your emotions and be optimistic. The brain refuels when we are happy.

Everything you do, including the thoughts you generate in your mind, impacts your brain health. Take care of your brain and get into the ‘performance zone’. Alternate intense focus with regular periods of renewal. Encourage your employees to do the same.

Dr. Haller helps Doctors to build brain-power and practice success. 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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Imprive your hygiene performance one day... in your office

Carol Tekavec, RDH
Hygiene Consultant
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What Does a Hygienist Do? Part II
Carol Tekavec RDH

In my last article, we talked about the role of the hygienist in identifying and promoting necessary restorative treatment. Now we will focus on the identification, education, and performance of periodontal therapy, for both new and recall patients.

As hygienists we have all been faced with the new patient who presents with obvious periodontal needs. If the patient has been appointed with the dentist prior to seeing the hygienist, s/he may have already heard about these problems by the time s/he is in the hygiene chair. Some education has already occurred and the stage has been set for treatment - either a debridement or scaling and root planing. Even when the patient has accepted her/his condition, the situation is still fraught with potential stumbling blocks. Does the patient trust the diagnosis when s/he has not really had much of an opportunity for a relationship with the dentist and practice? Does the patient understand the time commitment that will be required for appropriate therapy to be performed? Does the patient understand that treatment today will not take care of the entire situation? Have fees been presented and is the patient “on board” with the additional cost of perio care? What brought the patient to the office in the first place - and if it was not perio symptoms, when will the patient’s primary concern be addressed? These are only a few common issues.

When a patient of record arrives for a “standard adult prophy” and “recall” exam and periodontal disease is identified, there can be even more problems. The patient is used to having a “cleaning” and may be resistant to accepting more in-depth care. S/he may be unhappy that “after coming in all these years, now I have periodontal disease!”

How might we handle these situations?

The New Patient
Ideally a patient should first meet the dentist in a non-threatening area (such as a clean private office), have a conversation where the primary concern is identified, and receive an order for radiographs, perio charting, or any other procedures. If this is not practical, the dentist can speak with the patient in a treatment room and then order any diagnostics. Keep in mind that a certain number of radiographs are not appropriate just because it is the office “routine” to take them. There needs to be a reason to take them, a reason provided to the patient, and a proper notation in the patient chart (For more information on radiographs go to ADA.org). The dentist’s exam follows, with the diagnosis including identification of periodontal disease. A Phase 1 treatment plan featuring scaling and root planing can be presented, along with possible fees, and then (time permitting) one quad of scaling and root planing, or a debridement, or whatever is appropriate, can be performed. If the patient has a restorative problem as his/her primary concern, even if it is not as pressing as the perio condition, this might need to be considered first. Nothing is more disillusioning for new patients than to have their main concern pushed aside in favor of what the dentist wants to address.

If the hygienist meets the patient first, the dentist should come to the hygiene room for a preliminary exam and the ordering of radiographs, but then may delegate to her the responsibility of identifying and explaining periodontal conditions and treatment as necessary. This should not be rushed, or the patient may become distrustful. Ample time must be provided to show the patient's photographs, perio charting, and provide other educational materials. The dentist and hygienist need to be on the same page about how the appointment needs to proceed.

The “Recall” Patient
When a patient of record develops periodontal disease, explanations are even more critical. A patient may ask how this might have happened when s/he has been coming for “cleanings” for years. One way to approach this is to use a comparison with a discovery of high blood pressure. A person may have had a healthy blood pressure all their life during regular exams, only to receive a less than healthy reading at their last check-up. A patient will likely understand that health is not static, but can change over time. Therefore, dental health is changeable as well. Just because someone has not had periodontal disease in the past does not mean that it will never happen. The hygienist might say:

“Periodontal disease is common, but does not always have distinct symptoms. It is an infection and inflammation of the gums, bone, ligaments, and root surfaces of the teeth. It is our job to be on the look-out for the condition, which is why we always examine your gums every time you come in. Here are the probing depths from the last two times you were here, and here are the probing depths today. Remember when I explained that 1-3mm with no bleeding is healthy? Today we see that you have several areas with 4mm and bleeding and several areas with 5mm and bleeding. We know that it is not appropriate to let these areas go. That is why we will need to do scaling and root planing of these inflamed sections, and then put you on a more frequent schedule of maintenance to keep the disease process under control.”

The next question is often: “Will my insurance pay for this?” A good response is: “Many plans cover this treatment, but may have limits on frequency. Most plans realize that periodontal treatment is a common need, so they are careful to restrict how often they will cover it. Let’s talk with Amy, our treatment coordinator, and see what your plan says. Even if your plan limits payments, it is important that we let you know what you really need. It is our job to try and keep you healthy - it is the insurance plan’s job to watch their bottom line.”

When perio scaling, root planing and subsequent periodontal maintenance is performed, the patient must be able to perceive a definite difference between these therapies and a standard “cleaning.” It goes without saying that the treatments are significantly different. Be sure your patients can see and understand these differences. Identification, education, and performance of periodontal therapy are important aspects of what hygienists do.

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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