11.2.12 Issue #556 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Signs of a “Sick” Practice - Part 2
By Sally McKenzie, CEO

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Last week, I shared with you the story of my friend whose experience with her long-time dentist is prompting her to seek a new doctor. The reason: She doesn’t think he wants to do dentistry. Let me recap her situation. She is frustrated because the office is open only three days a week. The office manager insists on six-month scheduling for patients. Yet it is clear that the practice has a serious problem with cancellations and no-shows. The manager is inflexible, and frankly, rude to patients that must reschedule or cancel at the last minute.

Happy Labor Day The doctor, who is in his 60s, is extremely conservative in his treatment planning. His three-day-a-week schedule is riddled with openings. Yet, my friend had to practically beg him to address the cosmetic issues she had lived with for years and was finally prepared to invest in. He recommended six anterior crowns for the patient and floated the possibility of whitening as well as adult ortho. My friend was excited about the potential. But clearly, this would be a significant investment, and she wanted more information. The assistant promised her that the office would call to schedule a treatment consultation visit in which the doctor would thoroughly explain his recommendations.

The patient waited for FIVE weeks, yet heard nothing from the practice. Finally, she picked up the phone and called them. The manager explained that the doctor still had her file on his desk, but would recommend she come in to get a current set of X-rays. The office manager told her that the office could see her within the next day or two for the X-rays. No treatment plan. No consultation with the doctor about his recommendations, just X-rays. My friend was stunned, to say the least.

After five weeks, she may well have begun treatment - but there her record sat, on the doctor’s desk. Obviously, she was interested in pursuing the recommended plan. But now she is sincerely concerned that this practice simply does not value her or her business. She’s looking at a sizeable investment, one that the car dealer down the road would be thrilled to have and would likely treat her far better than she’s been treated by this practice. So I wasn’t surprised when she asked me a very pointed question, “Sally, do dental practices make so much money that they really don’t need patients like me to invest $12,000-$14,000 in dental care?”

We get calls daily from practices just like this. The doctors and staff are totally baffled as to why they are not producing more. This is the perfect example of how a “sick practice” cannot diagnose its own problems, let alone address them.

As I noted last week, this practice suffers from numerous issues. This doctor is likely uncomfortable with treatment presentation. We know that he is extremely conservative in his diagnoses and treatment recommendations. My friend may perceive that he doesn’t “want” to do the dentistry, and he may well lack the confidence in his skills. Therefore, he sabotages the treatment plan, or in this case, does everything he can to simply avoid it. Compound that with inconvenient hours and an office manager who insists on doing things “her way” - which is a clear indication that she has likely never received professional training. She has probably taught herself everything she thinks she needs to know, and thus created her own little fiefdom.  

Customer service does not exist in this practice. There are clearly no systems in which the office is following up with patients regarding treatment plans. There is no established treatment plan presentation system. In this case, the doctor informally chatted with the patient about possibilities. In turn, the patient was ready to make a sizable investment in treatment. All she wanted was more information. Yet she found it virtually impossible to get the details she needed to proceed. Is it any wonder, this patient perceives that either the doctor doesn’t want to do the dentistry or the practice doesn’t need patients like her.

My advice to her: Find a new dentist. My advice to practices that simply cannot understand why they are struggling: Seek outside help to identify the weaknesses in the operations that are keeping the practice from achieving its full potential.

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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Is Turnover Killing Your Practice?
By Nancy Haller, Ph.D.

According to a recent article in Fortune, the U.S. national average for turnover usually runs between 2-3% per month, whereas the top 100 companies have a turnover rate of only 2-3% in an entire year. Obviously, a certain degree of turnover is unavoidable, but the last thing you want to do is lose your best performers. Turnover sucks the life out of your practice and equates with knowledge loss. Consider the impact when the person leaving is in a key role or hard-to-fill job in your office. It may take six months to find their replacement and a year or more before they are up to speed. To add insult to injury, what if they go to a direct competitor in your community?

Understandably, turnover is not preventable. Employees relocate to different cities, go back to school, and decide to be full-time mothers or fathers. But with some focused attention, reducing turnover is a solid and achievable goal. Here are four important factors that increase retention.

Leadership Matters
Employees don’t leave companies, they leave bosses. Your leadership is the #1 factor in reducing turnover. What is the quality of your interactions with the people on your payroll? Are you creating the right work atmosphere? Fine-tune your people-skills with Leadership Training so that you maintain a culture where employees are engaged and want the practice to succeed. When your staff is happy, they won’t want to leave.

Confront Your Hiring Process
Research shows that most employers make a decision on an applicant during the first 4 minutes and 20 seconds of the interview. This susceptibility to first impression is natural, but hiring an employee based on “gut feeling” is a reckless business move. There is more you can do to make an informed decision about the people you bring into your office.

Review job descriptions. Good hires need to have a clear understanding of the job you want them to do. Not only what to do but how you want them to do it. Standardize your interview. Eliminate subjectivity as much as possible by structuring questions that are focused on the real needs of the job and your office environment. Expand your selection tools beyond the resume. With the increasing importance on interpersonal effectiveness for job success, employers who add pre-employment testing have a strategic advantage.

It’s NOT about Money
Pay may be a factor for turnover in some cases, but only if your compensation structure is far below community standards. When employees use money as a reason for leaving, it’s more likely an excuse. What they aren’t telling you is that the work environment is so toxic that the wages aren’t a good trade-off for the misery they have to endure.

Focus on improving the level of trust in your practice. High trust is correlated with high retention and boils down to communication, communication, communication. Trust is more than honesty. It’s also about appreciation for others and the willingness to sacrifice personal gain for that of the team. Take the time to extract your employees from the mayhem of everyday work with an event like a team retreat. Explore team synergy, and as a result you will increase retention rates.

Create a Better Future
Employees who see a pathway to a better future will generally stick around to experience it. Training and development are crucial to help people know there is a brighter future. Make a plan to cross-train your office staff. When employees feel they are being developed they know they are important to the practice. It also makes the work more interesting.

Express more appreciation and praise to your staff. Let them know when they are doing things right, even if the best you can offer is to acknowledge their efforts to learn. Stop micromanaging. Set your standards at “excellent” and let go of “perfect.” When employees see you collaborating instead of controlling it goes a long way toward building loyalty and longevity.

Spend your time, money and energy on programs and processes that have a positive impact on employee happiness. You will reap the benefits. Dental practices that focus on these four factors will have more employee satisfaction, and that equates to lower turnover and higher retention rates. 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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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Supporting the Doctor’s Treatment Plans
By Jean Gallienne, RDH BS

We have discussed the new patient many times in past articles, and different scenarios when it comes to scheduling the patient with the hygienist or doctor first. Many times, old beliefs encourage that the patient be scheduled with the hygienist first, because the patient calls requesting a cleaning. However, there are many advantages to having the patient scheduled with the doctor first. Here are just a few:

1. The patient is not rushed through the appointment or the financial arrangements.

2. The high risk of not having everything diagnosed because the time allotted in hygiene is not enough time for the doctor to do a thorough comprehensive exam becomes minimal.

3. The doctor is enabled to establish rapport with the patient.

4. When the patient does have a hygiene appointment, the hygienist should be reinforcing the recommended treatment with the patient and continually educating the patient about why it needs to be done.

5. If root planing is recommended and the patient states they “just want a cleaning today,” then the hygienist may be prepared to educate the patient about why they need more than “just a cleaning.”  

Even if the hygienist does the probings and gets any needed x-rays first, the doctor should come in and chart the existing and diagnose the restorative portion of the exam. This will give the hygienist production for the time she spends probing and getting the x-rays, which may actually be more production than doing “just a cleaning.”

During the time the hygienist spends doing the probings and co-diagnosing with the patient their periodontal health, the hygienist may also mention things that jump out or look suspicious, and what the treatment may be. For instance, if the hygienist sees that a tooth is missing s/he may say, “Mrs. Jones how long have you been missing this tooth in the upper right? Do you miss it when you are chewing? There are many things the doctor may be able to do to replace that tooth, but s/he will have to determine what is needed. If you have enough bone s/he may recommend you have an implant placed there, especially since the teeth next to it have never had any fillings in them.”

Having been in many practices, I have seen that the new patient exam is done many different ways and for many different reasons. It is up to the staff to educate patients on the way your office does things. There may be times when it is required that the scheduling coordinator educate the patient on the way your practice does their scheduling and why. They may tell the patient, “Mrs. Jones, at this practice we like to schedule the patient with the doctor first, as he will do an oral cancer exam and verify what type of hygiene appointment you need in order to provide you the best quality of care. We can schedule your hygiene appointment after your exam on that same day if you like.” Most patients are going to want quality of care, and they are still getting the hygiene appointment that same day.

Regardless of whether the patient is scheduled with the doctor or the hygienist, it is part of the hygienist’s responsibility to help educate the patient about the treatment the doctor has diagnosed, and why the doctor recommends it. In order to help the hygienist do this, it is recommended that when the doctor is diagnosing the restorative needs of the patient that s/he not only charts the existing, but also makes note of why the treatment is needed. For example, if the patient has a large MOD filling with mesial decay and the tooth needs to have a crown, then this should be included on the original treatment plan. This way the hygienist will not only be able to confidently educate the patient about their needs, but will also become more educated about the way the doctor diagnoses needed treatment and why.

It is advised that this be done with any treatment that is recommended. This way, anybody can read the patient’s chart and know exactly what and why something was diagnosed. If your office is chartless, then it needs to be decided where this information will be noted. Are you going to scan every treatment plan in, no matter how big or small it is? Will you put it in the notes area for that tooth? Will it be noted in the clinical notes? Will it be put in all of the above? The main thing is that everyone needs to know where to find the information, and that the information is in the chart somewhere.

No matter if the patient is new or an existing patient, any time the patient is diagnosed by the doctor as needing a specific treatment, the hygienist should be educating the patient about their needs - even if this involves giving the patient viable web pages to look at themselves. The more educated patients are about their needs, the more likely they will get the recommended treatment done and build a trusting, long lasting relationship with the practice. 

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151

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