10.18.13 Issue #606 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Profitability, Production, and Patients in 2 Hours or Less
By Sally McKenzie, CEO

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Dentists continually express their frustration over challenges they experience motivating their teams. Yet they do little to create a culture in which employees feel engaged, valued, and part of the decision-making process. Doctors commonly set themselves up as the wise sage of the practice, the guru, and the go-to-person for any and all matters. The unfortunate and often unintended byproduct is a virtual strangulation of creative problem solving. Employees commonly lament, Why should we give input? If it’s not the doctor’s idea, she will make an excuse for why our suggestions won’t work. Or, We’d like to recommend changes, but the doctor never gives us the opportunity; he shuts us down if we try to offer suggestions. The employees you want on your team have no interest in merely being cogs in your wheel.

Quality employees want to deliver quality work and be part of a collaborative process. But real collaboration requires a commitment of time and energy to identify and address issues and explore opportunities that will enable the team to become more effective in their roles, and enable the practice to become more profitable and successful. Racing from procedure to procedure day after day doesn’t lend itself to building strong collaborative teams. Rather, it requires time away to meet and discuss challenges and opportunities that the practice faces. In other words, it comes down to well-planned and well-organized staff meetings.

It is in monthly staff meetings that the team has the opportunity to identify and solve problems, examine areas of responsibility/systems, establish policies, present information, motivate and educate one another, exchange ideas - all of which are vitally important to growing a thriving practice and creating a culture of engagement, inspiration, and problem solving.  

Allow about two hours a month for your staff meetings and make sure the agenda is delivered in advance; otherwise employees will not be prepared to discuss matters that require their input and are likely to perceive that you don’t really want it. The agenda should include standard items that the practice is continuously monitoring - all areas affecting the profitability/success of the practice. For example: numbers of new patients, recall patients, collections, treatment acceptance, production, accounts receivables, unscheduled time units for doctor and hygiene, overhead, etc.

One person is responsible for compiling and distributing the agenda to doctor and staff in advance of the meeting. However, this person is not in charge of developing the entire agenda. That task is the responsibility of the full team. Post the agenda in the break-room or other area where staff will see it regularly and can add items as they come up during the month. Issues that present themselves regularly in the daily huddle but require more involved discussion and analysis should be put on the monthly meeting agenda. In addition, consider items such as improving the work environment, examining the patient experience in detail, practice/patient communication, etc.

List the most critical issues highest on the agenda to ensure there is adequate time to talk about them. Determine how much time you will spend discussing each matter, avoid getting bogged down on unrelated topics, and insist that team members come prepared to discuss the items listed. Assign a facilitator/leader (other than the doctor) to “guide” the group in the discussion. Talk about only what is on the agenda.

First, cover the critical systems. For example, the scheduling coordinator would report on key numbers within the scheduling system:
1. New patients scheduled for the month
2. New patients actually seen
3. Number of emergency patients
4. The number and dollar amount of unscheduled time units for the month
5. The number of patients with unscheduled treatment

From there the group can discuss if the practice is on track with its scheduling goals. Are there specific system barriers that are preventing the scheduling coordinator, and consequently the practice, from achieving those goals? Use the collective problem solving skills of the team to develop strategies to address those barriers and help identify solutions to problems that may be occurring in the scheduling system. Seek input from everyone, and don’t be afraid of conflicting views.

Meetings are intended to be designated times in which you can focus all of your energy and team resources on addressing key practice issues. Run correctly, they are the most effective means to identify and solve problems, establish policies, share information, motivate each other, define areas of responsibility, and exchange ideas.

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
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Nancy Haller, Ph.D.
Leadership Coach
McKenzie Management
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Take Timeout: Another Lesson from Team Oracle
By Nancy Haller, Ph.D.

Yes, I'm still enamored with the America's Cup Race. In my last article I wrote about the resiliency of Jimmy Spithall and Team Oracle. The post regatta analyses have been equally remarkable and so very, very relevant to you and your dental team. As you will recall, the Oracle team was down 8-1, with Team New Zealand only one win away from taking it all. In the final race, even with a three-second deficit at the start - which previously predicted another loss - Oracle won by 44 seconds. Just what did they do to pull that off? They took time out to learn.

During the first week of America's Cup racing, the Oracle team called a timeout to reassess its racing strategy. In particular, the racing team had to rethink its upwind race leg where Oracle was being conservative and the New Zealand team was taking risks. Each night they made much-needed adjustments to the strategy and tactics. The victory wasn’t due to one thing but to a series of small improvements adding up to big increases on the upwind leg.

How often do you call a "time out" to assess what’s going on, to train your team? Or do you get caught up in challenging situations and just keep forging ahead blindly, continuing to do what isn’t working? Like the Oracle team, you have a lot of technology at your disposal. The question is, are you making the time for your team to learn, to improve?

Your employees are an investment. From small businesses to large corporations, people are the most valuable resource of any organization. In Fortune 500 companies, employees are now referred to as ‘human capital’ and they are typically the greatest untapped resource of any business! Stop worrying about how much it costs to train employees and start realizing how much untrained employees could cost you!

A culture of continuous improvement is one in which individuals are growing, learning and contributing to the overall goal. Schedule a special staff meeting to talk about the ‘big picture’ - what you want for your practice. Set the standard for continual learning by sharing your own strengths as well as your needs for improvement. It’s likely that your staff already know what you’re good at and what you need to do better. By verbalizing it you model courage and inspire growth.

Explain to everyone why they matter. Employees need to know that their contributions make a difference. Their ideas, questions and thoughts are all important contributions that can potentially generate new and more productive ways of doing things.

Provide encouragement. Praise staff members when they show progress in the mastery of a specific skill. This is especially important when they have worked hard to learn and improve.

Allow room for experimentation and mistakes. People learn through a process of trial and error. Let your team know that excellence is the ultimate goal and that achieving it may involve experimentation and imperfection. Case in point, the performance of Team Oracle - it took many races and defeats before they identified how to win.

Continuous development requires advancement in knowledge and skills. Schedule ongoing training sessions. Identify the individual skills required for continuous improvement and provide opportunities for employees to strengthen those skills. Training sessions may take place daily, weekly or periodically, depending on the particular skill. Be prepared to answer questions. As people learn new information, make yourself available for guidance and feedback.

‘Winning’ is about inspiring your team to give their best effort. It’s tough work unifying individuals into a cohesive group. It takes time, coordination, and consistency. It takes planning and preparation. Add to the equation personalities and conflicting goals or ideals, and it becomes even more problematic to find a team of people that work well together - let alone on the fly at a moment’s notice. Oracle chose to be the master of their circumstances and not a victim. Ask them if it’s worth it. Ask them if it’s rewarding. You know the answer.

Dr. Nancy Haller is available to coach you and your staff to higher levels of performance. She can be reached at nhaller@mckenziemgmt.com.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at nhaller@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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Why Arenít We Doing More Perio?
By Carol Tekavec RDH

Mr. Patient comes in today for his recall/prophy appointment. His insurance covers this type of treatment every six months and he has been a patient of the office for over four years. He has accepted restorative treatment in the form of two full coverage crowns and a few composite resins over this time. Ms. Hygienist has been taking care of him through the years and has recorded probing depths at a minimum of once annually. He routinely has scores of 4mm around many biscuspids and 5mm on molars. Her recommendation has been increased flossing and she has shown Mr. Patient his scores and reviewed flossing at each appointment. He is not showing improvement. In the past, when Dr. Dentist performed his exam he has mentioned the probing depths, but is more focused on necessary restorative issues. Restorative treatment is being addressed, but perio treatment for this patient is not going forward. What is happening and what might be done better?

What appears to be going on is a situation common in many offices. That is, the hygienist is scoring perio but not explaining what is happening or pressing the need for treatment. The dentist is rightfully addressing the patient’s restorative needs, but in doing so appears to be relegating perio to a back-burner. And the patient is complacent, believing that by coming in for the “cleanings” every six months that his insurance will cover, he is doing all he needs to be doing to ensure good oral health. All of this contributes to necessary perio treatment being neglected. We can do better.

When patients of record who have been receiving prophys have perio identified, it can be a balancing act to explain the situation and go forward. If the hygienist announces today that the patient has periodontal disease, the patient will wonder why he is just hearing about this now. He may be resistant to pursuing additional treatment. If the dentist appears to be putting restorative ahead of perio, it further complicates matters. Here are some ideas:

1. Many dentists trust their hygienists to identify perio issues and bring them to their attention. What may be lacking is a stronger focus on integrating necessary perio treatment with necessary restorative care. The hygienist can vocalize her findings to the dentist during his exam, and even provide her opinion on recommended treatment.  When the dentist confirms what has been discovered and verifies the need for treatment, the patient has confidence in what is being proposed. It is easier for him to say yes.

2. It takes finesse to explain why a patient who has been coming in regularly needs perio treatment now. The hygienist might say, “As you can see, the past two periodontal charts I made for you have shown us that you have several areas around your teeth that appear to be declining in health. Your cleanings and home care have not taken care of the problem. I recommend that we address these problems with scaling and root planing right away. Simply taking the readings and doing nothing to attempt to stop the problem is not sensible. Most adults face this problem at some time in their lives. It is as common as developing high blood pressure when previously normal blood pressure was seen. The good news is we see positive results when we remove the deep source of gum and bone destruction, which is bacteria at the base of the pockets around your teeth, with root surface scaling. You can make the results more lasting with a renewed focus on daily removal of plaque from around and between the teeth.”

3. Scheduling restorative treatment in conjunction with perio is also helpful.  For example - if the dentist has identified #3 as needing a crown, the patient can be anesthetized on the maxillary and mandibular right, scaling and root planing can be accomplished, and then the crown prep performed. The patient makes one appointment for both services.

4. Talking about insurance coverage is also important. The treatment coordinator can explain that most dental insurance covers scaling and root planing for pockets scoring 4mm or higher. There are codes available for one to three teeth per quadrant, and four teeth or more per quadrant. After root planing has been accomplished, most insurance contracts will also pay toward two to three periodontal maintenance appointments per year (more frequent maintenance appointments will be the patient’s responsibility and this should be explained to the patient prior to treatment). Knowing their insurance will help pay also encourages patients to say yes.

5. Root planing sounds scary, so emphasize that local anesthesia can be used. With this in mind, be sure to schedule enough time to accomplish this. Scaling and root planing appointments must not be rushed. At least 90 minutes per half of the mouth is a good rule of thumb.

Many patients in our practices need periodontal care. They rely upon us to identify and treat this common condition. We should be doing more perio! The dentist, hygienist, and treatment coordinator can streamline their messages to support one another in identification, confirmation, and insurance coordination, to help patients say yes. It’s a winning situation for everyone.

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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