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  Sally McKenzie's
 Weekly Management e-Motivator
  1.16.04 Issue #97

Hygiene Schedule - Finding the Perfect Balance

Sally Mckenzie, CMC
McKenzie Management

   As long as there have been dental practice schedules, doctors and staffs have been trying to discover the perfect scheduling balance. It’s the age old practice riddle. How do you craft a schedule that ensures enough hygiene days are allotted so that new and existing patients do not have to wait weeks or, worse yet, months for a hygiene appointment and the hygienist is spending her day peering into patients’ mouths and not filling idle time perusing product catalogs? You follow a proven and tested formula

for determining how many hygiene days the practice needs each week.

Here’s how it works:

  1. Count the number of active patients – those seen in the past year for oral health evaluations.
  2. Multiply that figure by two, since most patients come in twice a year for oral hygiene appointments. (To be more accurate, multiply the # of patients on specific recall intervals, i.e., 3 months x the # of appointments needed in the next 12 months, i.e., 4 appointments.
  3. Add the number of new patients receiving a comprehensive diagnosis per year. For example: your practice has 1,000 active patients + 300 new patients = 1,300 x 2 = 2,600 possible hygiene appointments.
  4. Now take that number and compare it to the hygienist’s potential patient load.
    If the hygienist works four days a week, sees 10 patients per day, and works 48 weeks a year there are 1,920 hygiene appointments available.
  5. Subtract that total from 2,600. You are losing nearly 700 appointments per year – 680 to be exact – or 14 patients per week. In this scenario, the hygiene department should be increased 1.5 days per week.

If your practice schedules patients when they are due rather than pre-scheduling appointments, examine how far ahead patients are booked for appointments. If there are no openings in the hygiene schedule for a solid three-week period and some patients are being bumped into the fourth week, begin increasing the hygiene department’s availability in half-day increments. If you find there is more hygiene time than necessary develop a patient retention strategy and focus greater attention on filling those extra days.

While you’re at it, take a close look at recall. Many practices send out low-budget postcards, which do plenty to cheapen the importance of dentistry and virtually nothing to instill value in the patient’s mind of the importance of regular dental care. Meanwhile the practice considers that little card to be the recall system. Patients respond to the cheap postcards the same way you do – a quick glance, toss it aside, maybe you’ll do something with it, maybe you won’t. That’s not a recall system. The hygienist, no matter how wonderful her personality and patient rapport cannot single-handedly guarantee that her production will be 33% of practice revenue. Systems must be in place, the correct number of hygiene days must be determined, and a steady stream of patients must be flowing into the practice. Ensuring it all comes together is the trained patient coordinator. She is accountable for the recall system, and her time is spent on the phone talking directly to patients, making sure they will be in the chair at the designated hour, filling any holes, and keeping the schedule from crashing and the production from burning.

If you have any questions or comments, please email Sally McKenzie at

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Building On The Theory

How An Ailing Business Foundation Can Cause
“Digital Chaos”

Mark Dilatush
VP Professional Relations
McKenzie Management

Technology Tool Box

Last week, [see article], I discussed the first four technology responsibilities of the financial coordinator. This week, we continue breaking down the technology responsibilities of that job description. Please understand that these coordinator data responsibilities are “general” in nature. Each dental office is different. You should consider the following data responsibilities are “bare minimum”.

1. Follow up with outstanding patient and insurance balances
Assuming everything else is in order, this one should NOT be a problem. DO NOT wait until the end of the month to run your overdue insurance claim and accounts receivable reports. Run them once a week! It makes no sense to pile up receivables. Always put contact notes into your computer system. Not only for your own use but the scheduling coordinator and the rest of the dental team will want to know what’s going on with each patient’s account. For instance, if a patient calls to make an appointment, the inquiry will most likely get routed to the scheduling coordinator. If the scheduling coordinator views the contact notes and sees that a balance is being disputed because of a pending divorce situation, the scheduling coordinator is responsible for communicating this to the account holder BEFORE allowing another appointment to be scheduled. The scheduling coordinator is then required to enter pertinent notes from that conversation into the patients record for the financial coordinator to use.

2. Database maintenance
The financial coordinator is ultimately responsible for the accuracy and completeness of the following database files.

Insurance plan
Insurance company
Insurance coverage tables
Individual account contact notes
Posting payments (transactions)
Reconciling Daysheet
Creating nightly deposit

3. Database reporting

Report collection percentage (total – compare month to month)
Report over 90 day percentage of total receivables (compare month to month)
Report over the counter collections percentage (compare month to month)
Report outstanding claims totals and the current status of all over 45 days old
Report 3rd party financing usage month over month (compare month to month)
Print list of all insurance plans (review and eliminate duplicates)
Print list of all insurance companies (review and eliminate duplicates)

Your particular financial coordinator may wear more or different “hats” in your dental office. The last two weeks, we covered the bare minimum requirements of that position.

Next week, I will begin to expand upon the scheduling coordinator position.

Call me or email me if you have any questions.

If you have any questions or comments, please email Mark Dilatush at

Interested in having Mark speak to your dental society or study club?
Click here

Getting The Cold Shoulder


Giving Dentists And Their Staff Different Perspectives On Day To Day Issues

Let’s get to work !!!

There is a great deal of talk these days about leadership. It is a big concept that is thrown

around in national and international politics and corporate America. I think it is important to recognize that the concept of leadership and its relationship to national and international economics makes perfect sense. In light of the reality that this is a competitive world, innovations as well as charisma are essential ingredients for surviving more than just the day.

Today, the concept of leadership from politics and economics has been rationalized down to the level of the small business. This process has led to ambiguity, distortion, and confusion over how it should or should not apply. These detriments not only confuse the office staff who pines for a great leader on horseback, but also is distorted by the business owners who perceive themselves to be more responsible than they really are or need to be.

It is more reasonable to clearly understand the distinction between leadership and management and become accustomed to the accompanying expectations. These expectations are more pleasant than the never-ending distortions, exaggerated expectations, and unrealistic office dynamics, which the self-help and office-help literature fantasizes about.

This week's column is a discussion of the difference between leadership and management. For the sake of clarity, I believe that all business owners must be managers first and leaders second. The reason for this definition is that the goal of the office practice is simply to carry out the product and services as promised, effectively and efficiently. The typical office practice is not challenged with the responsibility of guiding millions of people and billions of dollars. Ours is a very simple challenge: make money and enjoy the day.


The basic necessities of your typical office practice require a very short time line. The typical office is challenged with fulfilling its obligations to provide a service to clients. That service is usually performed within a 1 to 2 hour window and the accumulation of these units of service provides the productivity, which after expenses leaves us with a profit. This is a short-term arrangement and therefore is very manageable for the average private practice business owner.

The emphasis on long-term planning can be overstated, and when it is overstated, it provides for the opportunity to experience unnecessary disappointment and frustration. I am not implying that long-term goals are not part of the growth of every business, but rather that excessive emphasis on a long-term perspective distorts the true meaning of the day.

Good management allows us to keep our perspective short-term, and with this perspective, concepts of efficiency and goal achievement are far more attainable. When things become attainable, the brain processes this experience as noble and rewarding. Too much emphasis on long-term perspectives leaves the brain with an information and experience void, which is unsettling and disorienting.


The basic necessities of your typical office practice require an excellent grasp of how things are to be done and when they should take place. This experience leads to a sense of good organization. It is this perfect sense of organization together with the accomplishment of our purpose that provides the clarity, as well as one's personal definition, for every working day.

Understanding how to do your job and what is expected of you is part of your personal management responsibility. The business management responsibility of the owner comes in knowing how all of these pieces should come together. When this knowledge is known, everything integrates and the process of business feels seamless and performs like a smooth running piece of machinery.

When management clearly and effectively makes sure that all of the human components of the business know how to do their jobs and when their responsibilities are expected to appear, the flow of product and service to the customer will be experienced by the staff and client as smooth and almost natural.

It is this state of naturalness that defines why some office practices are perceived as better than others are. It is the competency and the lack of bumps in the road that garner a client's confidence and their loyalty. Good management knows how to do the job.

The concept of leadership and the element of process takes responsibility for answering questions such as what are we doing here and why are we doing it. If you will take a moment to examine seriously this point, you will see that, while there is great intellectual merit to imposing such questions, they are useless in the day-to-day performance of your typical office practice when your team is well trained and productivity is maximized.

The how’s and when’s are very clear to the staff and the business owner, or at least they should be very clear to everyone when they arrive at the office on Monday morning. There is no need to ask why. Asking why is a leadership question and when asked too often, it only serves to take the emphasis away from the sense of immediate accomplishment.

When a leader asks “why” out loud, they direct everyone toward feelings and sensations of uncertainty and unlimited possibilities and definitions. Coping with unlimited definitions and possibilities is really beyond the scope of the typical office practice day-to-day responsibility. I believe that most of your clients would discourage such intellectual bantering in return for smooth and effective treatment and courtesy.

We will continue to discuss the concepts of management and leadership next week.

I would like to request your stories of Dentists and Staff members who have experienced the difference between management and leadership. Send them to No incriminating information will be published.

Regards, Coach

Want your issues answered? Ask the

Increase Production by 25%?
Set job descriptions for staff with performance measurements?
Reduce the accounts receivable by 15%?
Get a full one hour for lunch?
Bring on an associate dentist in the first quarter?
Increase perio treatment in the
hygiene department by 28%?
Equip another operatory first quarter?
Increase fees 3% the first of March and October?
Teach dental assistants how to make temporary crowns?
Have 2 hour monthly meetings with system measurements?


Wish Your Chairside Assistant Were More Efficient?

Optimizing Team Performance!

How long have you been practicing inefficiently? Are all those compromises you've been making worth the price of lost production and the physical wear and tear on your body? Wish you could choreograph your chariside team for optimal performance? If so, then this DVD "Optimizing Team Performance" was designed for you! This training resource was produced by Risa Simon, a certified management consultant, published author and one of dentistry's top clinical management speakers. Don't waist time watching videotapes when you can dial up topics of interest from the DVD's scene selection menu. Scenes include: Posture & Positioning, Magnification & Illumination, Assistant Access & Visibility, Ergonomic Work Zones, Chairside Efficiency Techniques, including Instrument & HP Transfers for efficient 4 handed & 6 handed dentistry - a must for every office!

e-Newsletter special: $59


McKenzie Management, Inc. has been named the WINNER in the DentalTown Magazine and 2003 Townie Choice Awards™ for Practice Management Consultants.

“It is an overwhelming honor to be singled out by literally thousands of dental practices across the country as the number one dental practice management firm,” said Sally McKenzie, President, McKenzie Management. “We know that dentists take great care in selecting only the very best products and services, and to be among this elite group is truly a testament to the commitment the McKenzie Management team has demonstrated over the past 23 years to provide consistently superior consulting products and services,” added Ms. McKenzie.

The McKenzie Management Team looks forward to continuing to provide the very best consulting services so that dental practices in turn can perform at their very best.


McKenzie Management, Inc.
737 Pearl Street
Suite 201
La Jolla, CA 92037

Sally's Mail Bag

Dear Sally,
Thanks for your tidbits of information you send us weekly.
My question is: what is the average production expected from an operatory per hour if I'm using 3 ops?? And do you have suggested time blocks per procedure??
Thanks, and a very happy holiday to you and yours.

Dear Ken,
There isn't any industry average production from an operatory. Your average will depend on your overhead expense and how much money you want for personal living expense. That number is then taken times your average existing collection ratio ( collection ÷ production) and that is what the practice has to produce divided by the # of days you will work in the next 12 months, 33% of that total divided # of hygiene operatories and the remaining 67% divided by the # of doctor operatories. Let me know if you have any more questions.
Happy New Year,

IN 2004?
Dr. Allan Monack,
Hygiene Clinical Consultant for
McKenzie Management,
develop a profitable
Hygiene Department

To find out more about the
Hygiene Clinical
Enrichment Program
[go here]
or contact us at:
or call:

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators
For a FREE
Educational Video
e-mail us at:
The Center for Dental Career Development
Advanced Business Education for Dental Professionals
737 Pearl Street, Suite 201
La Jolla, CA 92037

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Missed Past Issues of Our e-Motivator Newsletter?

This issue is sponsored
in part by:
The Center for Dental Career Development
San Diego Workshop Series
Fall/Winter Schedule
 Date Seminar Instructor(s)  
 Jan. 30
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Sally McKenzie, CMC.  
Feb. 6
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Sally McKenzie, CMC.  
Mar. 5
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Sally McKenzie, CMC.  

The Center for Dental Career Development has been approved under the Academy of General Dentistry Program Approval for Continuing Education (PACE) program. Starting 10/19/03 through 10/18/07 members of the Academy of General Dentistry can receive AGD credits for all seminars and workshops sponsored by the Center for Dental Career Development.

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