Mary Lynn Wheaton

The dental hygiene component of a general practice can and should be a profit center for the practice. Yet in too many practices it is viewed as a break even, or even worse, a loss leader. The following miss-steps contribute to the perception that a hygiene department is unprofitable:

		Lack of hygienists fully utilizing their skills

		No soft tissue management program grounded in the philosophy of the practice

		Patient commitment and compliance issues

		Lack of verbal skills utilized by the dental team

		Little statistical measurement or knowledge of what are the acceptable range norms for the hygiene department

Hygienists can and should provide all procedures that are allowed by the state dental practice act. This diversifies their delivery models which supports the development of an “Ideal Day." The Ideal schedule allows the hygiene team to reach a production goal, provide appropriate care for all patients, and will prevent monotony (and burnout) in their careers. A step “0” is to check your Dental Practice Act and brainstorm with your hygienists on how to fully utilize all of their skills to create the most efficient and profitable continuing care department.

Make sure there is a hygiene philosophy of care that ties into your practice philosophy, vision and strategies. A soft tissue management program can be a comprehensive approach that partners with your patients to provide the utmost in quality care. If a practice has over 90% of its patients seen for routine prophys with hygienists trying to manage periodontal disease in this manner, but your practice vision states you are committed to state of the art care, then there is a disconnect between what you say you want  and what is actually being done. 

A complete and effective new patient evaluation will lead to a diagnosis and treatment plan that allows for soft tissue management of periodontal case types. You and your clinical team can brainstorm the treatment protocol for each case type and designate fees for the procedures provided (always with a profit margin included). Additionally procedures performed by hygienists can include: taking blood pressure, doing oral cancer screening, caries risk assessment, applying chemotherapeutic agents, taking impressions, giving anesthesia, screening patients for TMD, utilizing lasers, (and the list goes on). With appropriate fees tagged to these procedures, your hygiene schedule will be filled with diverse and profitable procedures.  Additional product sales can contribute also.

But how do you keep the "puppies in the basket?"

The commitment of each unique patient for initial care and the on-going compliance to their re-care visits can make or break hygiene departments. Sometimes keeping the hygiene schedule full can feel like trying to keep your puppies all in one basket (or even worse…“herding cats”)! The national average for no shows and cancellations resulting in unfilled appointment time in hygiene is over 20 percent. Simply reducing this is a major step toward a more profitable hygiene department. There is no silver bullet solution to this epidemic; it’s a combination of upgrading systems and the commitment by all team members to focus on new and better verbal skills that are the essential elements to battle this very frustrating statistic. Every department in the practice has responsibilities toward increasing patient compliance.

Examples are: hygienists performing focused, effective debriefs at the end of appointments to build value for the next appointment and scheduling that next appointment in their operatories;  assistants reminding patients of their next hygiene visit at the completion of a restorative appointment; dentists assuring they are influencing patients to the importance of following your hygienists recommend re-care intervals;  scheduling coordinators assuring that the courtesy call (or email or text) is having the desired outcome of having patients keep their appointments;  and there are many more! To take your team’s skills a la, Emeril, “up a notch," starts with skilled questioning, actively listening and determining the motivators and concerns of patients. Utilizing these “M & C’s” to formulate statements that the patient hears as a benefit to them go a long way in building awareness and then commitment by patients.

Once they're in the chair…the gift that keeps on giving!

Of course, the true key to a profitable hygiene department is what goes on during chair time. And the best opportunity comes during the all important periodic examination – the choreographed dance between the dentist and hygienist that result in value and commitment. Over 60 percent of the restorative care in a general practice can be generated from the diagnosis of care needed on patients of record. The hygienist’s skill in recognition of not only periodontal needs but additionally the restorative needs and conveying this information and influencing the patients’ decision is paramount. Working with your hygiene team to determine the information to be gathered, the choreography of the conversation triangle between the patient, doctor and hygienist will pay off major dividends in the increase case acceptance in patients of record.

Articles

Creating a profitable hygiene department

	Many dentists have a written document that outlines their practice’s vision and philosophy. Ideally, the doctor shares this with the dental team and with patients as it is not only a statement of what you aspire to attain, but it is a useful tool for clear communication. It has been said that the difference between a vision and a hallucination is how many people see it! If your team and patients have not seen your practice philosophy, it may be a hallucination.

	In our challenging economic climate where patients question the recommendations we make for their care, the dental team plays a critical role in representing the practice’s vision. Often dental hygienists are on the front line, advocating treatment plans to patients. Patients must be educated to understand that it is in their best interest to heed the hygienist’s recommendations. The Dental Hygiene Philosophy of Care is another tool to help with this. It is tied intimately to the practice’s vision, and takes it a step further by explaining how dental hygiene care plays an integral role in the patient’s health.


	The Dental Hygiene Philosophy of Care can be a guiding tool to help your team consistently make decisions that are  compatible with the clinical direction of the practice’s doctor and the hygienists. The document can be used during the hiring process, at the very beginning of the relationship between a doctor and a potential new hygienist. For example, in reviewing the practice philosophy along with the dental hygiene philosophy, a dentist and hygienist can discover incompatibilities between their philosophies. Compatibilities ensure a match made in heaven!

	Multiple hygienists in a practice can benefit from developing a Dental Hygiene Philosophy of Care. The process allows hygienists to share their views and come to a common ground on what they aspire to attain for patients as well as expressing their desires toward career fulfillment. Think of a practice where all clinicians are on the same page, using the same methods, providing the same information to patients and having a continuity of services. This provides a seamless delivery to patients and decreases everyone’s stress, including the doctor, administrative staff, and assisting colleagues.

	Think of this philosophy statement as the broadcast of the hygienists’ vision and values. What do they want to broadcast? Here are three areas for each hygienist in your practice to consider:

	Facts: What does the hygienist stand for? What contribution does she want to make to the patients and to the practice?  What does she aspire to create?  What words does she connect to in the practice vision?

	Emotions: What feelings does the hygienist want to have when thinking about her career? What does she want others to feel about her personally and professionally?

	Images: What images come to mind when she thinks about her future? What phrases or mottoes describe the practice? What images come to mind in thinking of the relationships she has with her patients and co-workers?

	If there are multiple hygienists in the practice, encourage them to use these and follow-up questions to interview each other. Have someone take notes to capture the words and phrases that seem most important to the team. If there is only one hygienist in the practice, encourage that hygienist to have this conversation with you. Talk about getting to know one another.


	Your practice’s hygiene vision might end up sounding like this example: “We believe that patients deserve to attain the highest level of health possible. Our dental hygienists partner with the doctor and patients to provide trusting relationships where patients understand their care. Our hygienists are dedicated to assessing the health status of each patient and providing customized treatment recommendations based on these assessments. Patients value this approach by committing to their care and ultimately are rewarded with a lifetime of smiles!”

	These words are now part of your armamentarium. When patients question you or your hygienists about why they need 3-month continuing maintenance care and raise some of the myriad of other objections you hear daily, you and your team are “armed and dangerous.” The vision is a catalyst toward conversations that unite people. Uniting people with an understanding of common goals is important in achieving success any time, but in these economic times it is foundational.


	Part of Pride Institute’s vision is to provide the dental community the best information and counsel to enable them to enhance their lives as well as the lives of the patients they serve. This DPR supplement along with our new Building Blox,  “More Than a Cleaning: Building a Dynamic Continuing Care System,” are examples of our commitment to provide practice management tools to the dental hygienist. And it starts with that vision!

 Many dentists have a written document that outlines their practice’s vision and philosophy. Ideally, the doctor shares this with the dental team and with patients as it is not only a statement of what you aspire to attain, but it is a useful tool for clear communication. It has been said that the difference between a vision and a hallucination is how many people see it! If your team and patients have not seen your practice philosophy, it may be a hallucination.

Developing a hygiene philosophy of care

	The old adage, “You never get a second chance to make a good first impression” is so appropriate when thinking about the opportunity to convert a first-time caller into a loyal patient. The first minute of the call can make or break the relationship.

	Let’s face it, when you pick up the phone and talk to a potential new patient, the practice wants a certain outcome and so does the caller. The team wants to schedule callers for a new-patient appointment and callers want to feel they have found a safe place that will satisfy their dental and emotional needs.

	Because the practice and the patient both want positive results, this should be simple. Unfortunately that is not always the case.

	So what can you do to make this first-impression call a resounding success? By creating a vision and strategy for these patient touches, along with focused training and practice, the dental team can gain competence and confidence in these vital skills.

	We suggest following a template. Emphasize “We Care Questions” to gather the information needed while building a strong foundational relationship and providing your new patient with a different experience that exceeds expectations. This is what can set you apart from your competition and help you develop a great patient partnership from the get go.

	The phone rings and you answer, “Good morning, Dr. Shine’s office, this is Sylvia, how may I help you?”

	Here’s a great beginning. Patient asks, “Does your dentist do implants?” Your immediate opening script should be, “To answer your question and make a proper appointment for you, may I ask you a few questions? First, may I ask your name?” Obviously the caller will say yes, but isn’t that a better way to begin than the typical, “Yes he does, what insurance do you have?”

	When a patient calls in with specific questions like, “Where are you located?” or “Do you see emergencies?” it’s not unusual to fall into the trap of answering the direct question without even stopping to ask the caller’s name.

	That’s an easy mistake to make if you are trying to be helpful and informative, but the ultimate goal of the call must be centered on creating the relationship. Better still, answer the implant question with more than a yes. Instead say, “The good news is you made the right decision to call, because our dentist does wonderful work with implants. Our patients love their results and you will, too.”

	Once you have introduced yourself and the patient has done the same, ask, “Whom may we thank for referring you to us?” This is always a great way to acknowledge commonalities between you and the patient, as well as set the precedent with the new patient that your patients of record are ambassadors of the practice. This also allows you to track the return on investment on any of your marketing opportunities.
	Do acknowledge and offer thanks for any compliments given and again take the opportunity to reiterate that the prospect is making the right choice in choosing your practice because this kind of compliment is typical for your doctor and team. 

	An open-ended question of, “What concerns do you have that prompted you to call?” is now in order. This will let you evaluate the caller’s immediate needs. Take notes on your computer or a telephone information slip so you can share this information with your teammates when this patient does come in for the first appointment.

	At this point, you are in control of the call and the remaining information that you need should be easy to gather.

	We find that asking, “May I ask how you will be taking care of the fee for this appointment?” is an appropriate way to find out if the caller has dental benefits. Be prepared to discuss how you handle insurance, including what you do for your patients who have insurance and for those who do not.

	Of course, not all calls start with the prospect wanting to make an appointment. Many inquiries will be about procedures, costs, promotions, etc., so you must be prepared for these different scenarios. Remember to always be positive. Describe what the practice does do, not what you don’t do. Your verbal skills and active listening, showing empathy, speaking clearly and slowly, with sincere interest (not making it sound like you’ve said this 100 times that day) and focus will make an impression on these prospects.

	Close the prospect into an available time by giving the caller a choice of two appointment times that might work. And close by asking, “So that we can make your visit as comfortable as possible, is there anything else you would like us to know about you?” and “What questions might I answer for you?”

	As in, “Jerry Maguire,” when Renee Zellweger says to Tom Cruise, “You had me at hello,” you want your prospects to say the same thing at the end of this call.

Mary Lynn Wheaton, RDH, MA, has 25 years of experience in all aspects of dental practice management and serves as consultant team leader at Pride Institute. She specializes in practice development, team building, group interaction and customer service and is known for providing interactive in-office training and dynamic workshops. Mary Lynn can be reached via e-mail at 

 The old adage, “You never get a second chance to make a good first impression” is so appropriate when thinking about the opportunity to convert a first-time caller into a loyal patient. The first minute of the call can make or break the relationship.  A shared goal

The ultimate first recall

	With so much technology out there, which practice systems get first dibs? I recommend approaching your technology integration efforts as a puzzle, with each system acting as a piece that needs to fit into an overall strategy so that, when the puzzle is complete-and individual products selected-it reflects the right picture for your practice.

	Under each category you’ll find several bullet points to serve as a preliminary checklist for emerging technologies to enhance your practice. Discussing these systems with your team members will alert them to new possibilities and provide an evaluation process to determine what pieces come first in putting your puzzle together.

	More than 90% of dental practices use scheduling software. Thank heavens appointment coordinators have thrown out the “book” and are no longer using duplicate systems. Today, there are color-coded appointment blocks, procedure codes and times, the ability to search for appointment times, automated recall systems, etc. For the most part, teams also are using the software for insurance information and processing to great success. Beyond that, what are the new innovations you should look at to enhance these important systems?

		Ability to schedule and/or see appointments online via your website

		Confirmation of appointments via automated phone message, text or e-mail

		Ability to check families’ financial accounts and insurance updates

		Generation of reports using software to provide analysis of practice statistics

	Many practices are in the chasm between digital and paper charts. Oftentimes, information from charting and treatment plans goes into the digital record while other valuable information can’t seem to find a place anywhere but in paper charts. This is often the result of lack of training and knowledge of the customization potential of the software.

	First, find the right software. Then, spend the time in training to fully use and customize it to your needs.

	Beyond practice management software there is, of course, a vast arena of clinical and diagnostic technology evident to anyone who reads journals or attends dental meetings. Knowing this, here are key categories to consider and discuss in your updating/upgrading quest.

		Magnification (for dentists and dental hygienists)

		CAD/CAM for fabrication of fixed prosthetics

		Caries detection enhancement and caries risk assessment

		Joint vibration analysis and occlusal analysis aids

	The area changing most rapidly in our lives and in our dental practices is how we communicate with eachother. Seemingly gone are the days of “let your fingers do the walking” and snail mail flyers. Now, it is absolutely necessary for patients to be able to find and communicate with us online.

	You must first establish your own brand identity and your target market so your efforts are not “spray and pray.” Rather, seek a rich new flow of patients who are already connected with you, even prior to a new patient experience.

	Once they are in your practice, how do you continue to effectively communicate with a combination of high tech and high touch? You’ve taken those digital radiographs and have great pictures to show them, but are you able to communicate that information in an environment that is conducive to the delivery?

		Website supported by Search Engine Optimization: SEO is a science unto itself and is constantly changing, requiring professional assistance on a regular basis

		Social media links such as Facebook and Twitter

		Ability to connect with patients via e-blasts, e-newsletters, virtual birthday cards and holiday cards

		Operatories equipped with two computer screens: One for clinical data and the other for patient education

		Use of iPads or computer check-in stations for patient registration

	Every one of these bullet points represents a technology that requires an investment of time, energy and money. Each should be broken down into component parts of a systems analysis that includes:

 - How to obtain it (including cost analysis, physical facility needs, etc.).

 - What training and verbal skills are needed.

 - Who on the team will need to be involved.

 - How and when to evaluate and determine efficacy.

	These major systems represent puzzle pieces that are, of course, composed of many smaller pieces. After thorough analysis, they will enable you to start to put your practice technology puzzle together. Just as a jigsaw puzzle brings friends and family together, this activity brings a team together, ensuring that everyone is contributing to the overall picture of your practice.  

Mary Lynn Wheaton, RDH, MA, has 25 years of experience in all aspects of dental practice management and serves as consultant team leader at Pride Institute. She specializes in practice development, team building, group interaction and customer service and is known for providing interactive in-office training and dynamic workshops. To ask Mary Lynn about technology in your practice or to request a complimentary Technology Integration Checklist, go to 

 or call Pride Institute at 800-925-2600.

 With so much technology out there, which practice systems get first dibs? I recommend approaching your technology integration efforts as a puzzle, with each system acting as a piece that needs to fit into an overall strategy so that, when the puzzle is complete-and individual products selected-it reflects the right picture for your practice.  The systems to evaluate are: