5.2.14 Issue #634 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Build Teams, Not Walls
By Sally McKenzie, CEO

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Effective teams are driven by a common purpose, common goals and objectives, and are fueled by mutual respect and trust. They must be nurtured over time, rewarded for a job well done, and redirected when they veer off course. But where do you start? As they say, every journey begins with a single step, which in this case is careful examination. A group of people doesn’t become a team until together they identify opportunities for improvement and commit to action. Over time, employees work through various building blocks that are essential in constructing a high-performance team, including:

• Improving communication skills and establishing dialogue.
• Providing a non-threatening forum for the team to evaluate strengths and weaknesses.
• Defining clear responsibilities for the members.
• Assessing individual roles in the group and understanding how each contributes to the overall practice objectives.
• Developing specific team processes such as decision-making and conflict management.
• Improving problem-solving strategies.

But it’s not just up to the employees. Becoming a highly functioning team takes time and above all commitment from everyone, especially the doctor. Dentists often lament the poor quality of their teams. They wring their hands over employees who don’t work well together or don’t fulfill their responsibilities according to the doctor’s standards. And far too many doctors convince themselves that if they hire staff with previous “experience,” they will simply know how the hiring doctor wants his or her practice run.

Effectively running your practice requires far more involvement and instruction than you’ve likely ever considered. And your success is contingent upon more than great dentistry. That’s the easy part. Achieving true excellence demands good management as well as a healthy dose of inspiration, motivation, and leadership.

First, let’s consider management and leadership. Effective management means that you have clearly defined systems and procedures in your practice, from how the phones are answered to how new patients are handled to how compensation is established and so on. In other words, each individual knows what s/he is accountable for and how his/her success is measured.

While management is the roadmap directing everyone left, right, or straight ahead; leadership influences whether the ride will be smooth or rocky. The manner in which you lead is directly related to whether and how quickly you will reach your destination, i.e. achieve your goals. It’s no surprise that micromanagers and command and control dictators continuously struggle to retain staff and achieve desired results. They like to give orders. Team members would prefer engagement and instructive feedback. The most effective leaders are those who are capable of giving clear direction and guidance, are willing to explain changes as well as the why behind the request, and encourage cooperation and open discussion, not fear and dissension.

When it comes to motivation, many doctors mistakenly believe that the regular paycheck and an occasional bonus should be plenty of motivation and inspiration. In actuality, if you’re giving bonuses, studies show that their impact is short-lived. Inspiration and motivation come from a work environment in which employees feel that their contributions are valued. They are empowered to make decisions that are in the best interest of the business, and they are trained to ensure that those decisions are wise and well-reasoned. Where practices get into trouble is in empowering employees without properly training them. Empowerment without training is a recipe for failure.

For example, if business employee “Emily” is empowered to “do whatever needs to be done to take care of the patient,” and the patient wants to pay $50 a month on their $3,000 bill, without appropriate training, Emily may give the patient what they ask for. But if she is trained to have informative conversations with patients about convenient payment options that also make financial sense for the practice, she can feel good about helping patients to receive the care they need and also appreciate the importance of her role in enabling the team to achieve key treatment acceptance goals.

In most cases, it requires an entire team to achieve success, and office-wide rewards can reap significant benefits as they reinforce the value of total team effort. They also help to shake things up and break up the monotony. Schedule “reward days” throughout the year and use these for spa days, a trip to the ballpark for the season opener, or a limo-driven shopping trip to the boutique strip.  

Invest time and attention to build your high-performance team and reap the rewards in productivity and profitability.

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 McKenzie Management Seminars speak to your dental society or study club? Click here.
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Carol Tekavec, RDH
Hygiene Consultant
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If Insurance Doesnít Cover It, I Donít Want It!
By Carol Tekavec RDH

The more things change, the more they stay the same. A cliché that many facts support - particularly in the arena of dental insurance benefits. While massive changes are occurring in the insurance coverage business market, changes in dental benefits appear to be slow to advance. While it is true that most states are accommodating Medicaid expansion, which includes more dental coverage for adults, right now there are not enough Medicaid provider dentists to cover existing pedo patients, let alone more adults. If Medicaid benefit payments increase, this will likely change. But it will probably be several years before we know what the increases entail or if improvement in payments actually happen at all.

In addition, private dental plans may “someday” provide better benefits. For now, employer driven benefit plans remain fairly consistent. Maximums are stuck at around $1200 annually, and restrictive rules as to coverage for specific treatment continue to effectively limit what many patients receive. While some patients can afford whatever treatment they require regardless of insurance, many cannot. So we are left with a problem that has persisted for years; that of patients refusing treatment not covered by their insurance.

As a hygienist, this is a continual issue. Patients who we identify as needing periodontal scaling may refuse. They may not fully understand what we are recommending and why. They may not want to spend the time necessary for treatment, or they may not think that insurance will cover it. The good news is that most plans DO cover perio scaling. Plans typically will cover the 1-3 teeth or 4 or more teeth per quadrant options once every three to five years. The criteria for coverage is not complicated, but must be documented for payment to be allowed. A pocket of at least 4mm on at least one surface of each tooth designated for treatment is required. Documentation of bleeding, furcations, recession and mobility may also be requested. A diagnosis is important as well. Many carriers accept the older version of diagnoses such as Case Type II Moderate Periodontal Disease, while others are looking for the newer version as described by the American Academy of Periodontology, such as Chronic Periodontitis, Generalized.

So, we know that perio scaling is covered, but what about periodontal maintenance? Most plans will cover maintenance only twice per year, whereas most patients need the service three to four times annually. Here is where acceptance problems may crop up.  A patient may tell us that he wants only the two covered maintenance visits a year. The insurance carrier may confuse the issue by telling the patient that if his dental office codes the other two maintenance visits as prophys, insurance will cover them. We know that alternating D4910 Periodontal Maintenance and D1110 Adult Prophy makes no sense. One is for a periodontally compromised person; the other is for a healthy adult with no pockets. 

Education can help our patients understand why more frequent appointments are needed, even if their insurance will not provide a benefit. And we owe them every effort to explain. But more importantly, we need to demonstrate the differences between a standard prophy and periodontal maintenance so patients don’t think they are receiving the same service at just a higher fee. If patients can’t perceive any difference, why should they come more often, plus pay out-of-pocket? We need to be sure that we are observing the standards for periodontal maintenance and that our patients know it.

This means that every D4910 includes full mouth perio charting and recording, including bleeding, furcations, mobility and recession. Printing out a copy of this charting for the patient to take home is also helpful. If sulcular irrigation is needed, this should be done as part of the appointment and the patient should know what the irrigant is and why we are using it. Isolated areas of root planing may also be required and we should tell the patient why we are performing this. Most patients expect a polish at the end of the appointment, and if appropriate, this can be accomplished as well. A slightly longer appointment time is helpful. Rushing periodontal maintenance is not conducive to patient confidence. If the patient needs prescription mouth rinse, consider having this available for sale in the office. It saves the patient from making a stop at the pharmacy and is often appreciated. Keep in mind that at least twice annually the dentist should also perform an evaluation. This evaluation is not considered to be a part of perio maintenance and should be coded separately. 

There are patients with insurance who need perio treatment but refuse no matter what we say or do. Should we keep treating these patients with prophys? Should we send them elsewhere? This situation is a matter of office philosophy and everyone in the practice should know what the philosophy entails. For many, keeping the patient in the practice and performing “prophys” with education, probings, photos, and radiographs may ultimately result in the patient accepting perio treatment. If the patient’s insurance covers periodontal scaling, be sure s/he knows this. The front desk staff can talk to the patient about what the benefit might be before s/he leaves. Even after a period of years, some patients will eventually go ahead. We can’t give up.

Doing “just what insurance pays for” can often be a barrier for proper patient care.  We owe our patients as much information as we can provide to help them get what they deserve, and often what insurance pays for as well.

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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Nancy Haller, Ph.D.
Leadership Coach
McKenzie Management
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Shift from Busy to Significant
By Nancy Haller, Ph.D.

The morning alarm goes off. You dread the idea of going to the office, constantly running from thing to thing but never getting it all done…overwhelmed with everything you have to do. You know you can’t go on feeling stressed all the time because it is affecting your health.

You’re not alone. When you ask people what they’ve been up to, the most common answer today is, “Busy”. In our fast-paced, complicated society, people are desperately trying to juggle demanding careers  and personal lifestyles with no time to catch their breath. Worse yet, neuroscientists have found that when we feel pressed for time and caught up in overwhelm, the prefrontal cortex shrinks, reducing our thinking capacity to that of a chimpanzee. Recent studies also conclude that we are not really working any harder today compared with 40 years ago. Why then do we feel wrung out, joyless, and stretched too thin to smell the roses?

The challenge we face is fragmentation. We switch between checking emails and text messages on our ‘smart’ phones to interacting with co-workers and patients, to writing clinical notes, to making dinner to folding the laundry to putting the kids to bed. If you are going to reclaim your sanity, you must admit that the overwhelm you feel is at least partly self-inflicted.

For some folks there is a sense that busyness is productivity, even a badge of honor. You feel important when you’re always booked, rushed, scrambling to accomplish one more task. You are deluding yourself because a) multitasking does not exist and b) when you ‘multi-task’ you are actually less efficient, even though you feel as if you’re getting more done. Studies in neuroscience now prove that the human brain is capable of focusing on only one thing at a time. And the distractions from too many things going on at once hamper our ability to distinguish between relevant and irrelevant information. Everything seems important and urgent.

The solution is to shift your perspective from busyness to significance. Busy doesn’t make you important. Doing the important things you need to do makes you important. And busy keeps you from being authentic with the people in your life. Over the next week, you will have 168 hours. How much of your time will you allocate toward the significant side? Here are some things to consider.

1. Organize your thoughts and write down what’s on your mind. Stop the brain drain that comes from worry.

2. Prioritize. Thinking that if you spend enough time you will “get everything done” is an illusion. You will never be “done” until you are six feet under. Decide what’s important and do that first. Otherwise you may never get to what really matters.

3. Delegate. You think that putting postage on outgoing mail ensures that bills will be sent that day. Or writing the progress report that your dental assistant missed is easier than asking her to do it. Nonsense! Large gains are made by assigning duties to your team. Invest time in clarifying job responsibilities. Give feedback when they do not meet agreed-upon expectations. If you have a task that could be done by an employee, use the next occasion to start training him/her to do it instead of doing it yourself.

4. Manage your energy, the essential ingredient of high performance. Nobody is at their best when exhausted. Get enough restorative sleep. Know your prime hours and use that time for your greatest priorities. Eat nutritional meals and snacks. Strategically use routines that keep you positive and energized. You will be more productive if, several times a day, you step away from mentally challenging tasks for three to five minutes. Get some fresh air, for example, or just look out the window.

5. Practice single-tasking. Silence your phone, turn off your email and try to perform just one task at a time. Start with 15-minute intervals and increase gradually. Redirect yourself if you get distracted. It takes repeated effort but when you give your full attention to the project at hand you will be more accurate and more efficient.

Significance is time meaningfully spent for long-term impact. You can always make more money, but you can never get more time. Spend yours wisely.

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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