1.11.13 Issue #566 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Budget Busters Choking Profits?
By Sally McKenzie, CEO

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A recent news story reported that the long-lost cousin of a loner living in Nevada would be the heir to millions in gold coins. Overnight the woman went from substitute teacher to multimillionaire - not a bad deal. Most of us don’t win the lottery or find ourselves on the receiving end of a long-lost relative’s riches. Rather, it’s hard work and perseverance that must pave the road to financial success.

In the dental practice, that long road also involves 22 systems and dozens of variables that directly affect the financial wellbeing of the business and your subsequent path to riches. If your wealth seems to be the stuff of mailto:info@mckenziemgmt.comdistant dreams, perhaps it’s time to take a close look at a few financial realities, starting with practiceoverhead. Examine the areas listed below and compare your practice overhead numbers to the target percentages listed next to each item.

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

You know what your overhead targets are, so how do you actually hit them? First, consider the areas that are most likely to be well above the benchmarks. Payroll is usually number one. If your payroll costs are pummeling 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

Consider your employee rolls. When determining the need for more business staff, keep in mind that administrative tasks, specifically patient check-in and check-out, 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 is 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’s systems need to be evaluated and the time and motion efficiency put towards working the systems.

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.

Next, assess your procedures for giving staff raises. 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, you don’t give raises.

The third major contributing factor to inflated overhead is low hygiene production. Typically, this is the result of a malfunctioning recall system. 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 be scheduled to produce three times her/his wages.

Incorporate an interceptive periodontal program into the practice. This can be initiated seamlessly with the patient check-in process. The business assistant greets patients and hands them a questionnaire and brochure with a checklist educating them on the importance of addressing the signs and symptoms of gum disease. The patients check any symptoms they have experienced, which opens the door for discussion in the treatment room.

Pay attention to other areas of overhead as well. Dental supplies should run about 5% of monthly collections. If yours are higher, make sure you are budgeting these expenses and working with your dental supply company and dealer representatives 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 or your fees will not withstand the market to off-set the lab charges.

The miscellaneous category often includes several smaller items that add up to big bucks. Certainly, many items in this category are necessary. Nonetheless, pay attention to what’s labeled as miscellaneous and ask questions.

To learn more about your office’s overhead numbers and what you can do to improve them, visit www.mckenziemgmt.com for a FREE Overhead Assessment and report.

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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Be a Trust Builder
By Nancy Haller, Ph.D.

Teamwork is a hot topic in dental offices. It’s likely that when you advertise for a new staff member, you include “teamwork” as a job requirement. During the pre-hire interviews, you probably ask prospective employees if they are “team players” and it seems that everyone says: “Yes, I am!” So why is it that when they actually join your team, they tend to pursue their own self-interest? They resist or challenge the ideas of others most of the time. They fail to communicate important details to co-workers. They isolate themselves from teammates.

Dental leaders say “teaming” is the one thing they need more of. But before you can be a team builder, you must first understand that trust is at the core of good teamwork. Trust is the foundation. The reason that trust is so important is because a lack of it increases project completion times, drags out decision making, and delivers poor communication. Low trust takes away from the bottom line. So your job is to be a trust builder. In fact, the primary goal of a leader is to enable their team to trust.

Unfortunately, many dental leaders confuse trust with the namby-pamby virtue of being “nice” and overlook the fact that the most effective teams experience disagreements and tension from time to time. What enables trust is not “niceness” but respect. Trust is less about employees liking each other and more about them respecting one another so they get the job done and the practice is successful. Building trust doesn’t happen automatically. It requires attention and it takes a development path. Here are 10 basics to help you to be a “trust builder.”

1. Insist that employees know what you are trying to achieve. Share your vision with them and put it into simple, easily remembered words and phrases. Repeatedly remind people, and periodically ask them to recite the mission. The purpose is that it becomes second nature, a mantra, to everyone on your payroll.

2. Create ground rules. These are basic policies about conduct as well as clear job descriptions. Be sure team members know exactly what is expected of them.

3. Understand that running a productive and profitable dental practice is a complex group effort. You can only succeed if everyone takes responsibility for his/her chunk. Hold people accountable to the rules.

4. Ensure everyone participates. It’s easy for groups to be dominated by the most extraverted personalities. Don’t let that happen. Introduce the element of equal “air time” by going around the room to hear from each employee.

5. Accept that everyone on the team is fallible, and that when mistakes happen the team will work together to fix it.

6. Provide employees with the information and resources they need to get their jobs done. Coach them to be flexible. Change is constant and the need for adaptation is crucial.

7. Find ways to prioritize the work so that even if you can’t accomplish everything you set out to do, the team stills has a viable, successful outcome.

8. Maintain a positive, constructive attitude. If things are going poorly, help identify what’s going wrong and propose solutions.

9. Be vulnerable. Actively seek opportunity to connect with your employees on an individual level by being the first to share appropriate, personal details. Put yourself out there and watch the magic as people willingly open up with their own personal information and experiences.

10. Affirm employees and value their contributions. Look for people's strengths and catch them doing things right.

Note that teams are not static. Employees come and go, and each time the trust must be rebuilt. Regular team maintenance is required to sustain trust. No matter how strong the team is, the members are human beings and come from all types of cultures and environments. This not only creates conflict but more importantly, it reduces the level of trust within the team. Personal problems and home situations are the greatest challenge. Include maintenance as part of your leadership routine and plan for it. No matter how many hats or functions are juggled, the maintenance must be conducted just like changing the oil of a car engine.

If you believe you have built a solid team, ask each employee how much trust they have in each individual team member. Consider a 1-5 scale with 5 being high. The responses will enable you to know the strength of the team, and what is required of you to build it stronger.

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
Hygiene Consultant
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Patients Notice Everything!
Carol Tekavec RDH

Dentists want to attract new patients and keep their existing patients. We spend time, energy and money looking into marketing, keeping our websites interesting, and tracking new patient traffic. These efforts are important and should never be neglected.  But we can’t stop there. We need to realize that when our patients come into our offices they are typically on “high alert.” They are paying attention to everything, from the cleanliness and décor of the reception area, to whether or not the rest rooms have enough toilet paper. We need to focus on what they see and perceive from their points of view. It is important that we never drive away a good patient by neglecting some of the basics. A few suggestions:

Clean Reception Area
The reception area must be clean and inviting with spotless carpet, clean chairs and tables, and an assortment of reading materials. Educational brochures, books, and magazines can be placed in this area, but don’t neglect to put out the latest People Magazine or Sports Illustrated. Children’s magazines or activity books are also appreciated. What about offering coloring books and crayons? We want our patients to be at ease and entertained while they await their appointments. The reception area sets the stage.

Wait Times
No one likes to be kept waiting. In fact it is one of the most common complaints patients have about their medical and dental appointments. Dentists try hard to keep the schedule moving, and as a hygienist I am ever cognizant of the time. Usually we are able to keep to our appointment times. But what do we do when a procedure takes longer than expected and our next patient has arrived? It appears that most people will accept a slight delay if they do not feel that they are being ignored. To me this means that if a patient is going to be kept waiting longer than ten minutes, someone needs to inform the patient and give them the opportunity to reschedule. Seriously. The patient coordinator at the front desk can do this, or the assistant or hygienist can go out to the reception area and let the patient know. Patients will rarely decide to reschedule. After all, they are already there and usually want to proceed as planned. However, being given the option shows that the office values their time. We want our patients to respect their appointment times, and to do this we need to show that we respect their schedule as well.

Hand Washing and Gloves
A recent poll showed many patients are worried that dental staff are not washing their hands or changing gloves frequently enough. Patients notice when a gloved hygienist touches a drawer handle and then goes right back into their mouths. Patients see when their dentist comes from another treatment room wearing gloves, and then sits down and starts treating them. They wonder if the gloves have been used on another patient, or if the dentist touched other items before coming into the treatment room. We need to be very aware of hand cleanliness and the appearance of sanitary practices. The dentist should wash his hands in front of the patient and then put on clean gloves prior to beginning treatment. The hygienist should remove gloves to open any drawer or touch other items, and then wash and put on clean gloves before resuming care. While all of us know these rules, we must take great care to observe them and let the patients see us observing them. Most patients will be reluctant to mention a hand washing concern, but if they are worried, they may decide not to come back to our office. We must not let this happen.

Treatment Room Cleanliness
All areas that might be touched during treatment should be covered with disposables, and items on counters should be kept to a minimum. Other non-covered areas should be meticulously clean. Sit in the patient chair and look around the room. Is the patient light free of any spatter? Is the room light free of dust, dirt and bugs? In Colorado we have a long “miller moth” season where moths are everywhere. Nothing could do more to discourage a patient than looking up into the room light cover and seeing a left-over dead moth!

Restroom Cleanliness
The restroom that patients use must be pristine. Assign someone the task of checking on the restroom several times during the day. The sink, counter tops, mirror and floor must be absolutely clean. The toilet paper roll and paper towel dispenser should be full and ready. The trashcan should not be overflowing. If the restroom is not clean, patients wonder if the treatment rooms are clean. We don’t want them to wonder.

None of these suggestions are hard to accomplish. They also don’t cost any money! Ensuring that your existing patients have confidence that you care about their time and are providing them with a clean, safe environment will encourage them to refer their friends. Patients notice everything.

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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