Improving Dental Practice Culture to Better Accommodate Dental Hygienists

We all know it: dental practice culture has changed for dental hygienists. Right before the COVID-19 pandemic slapped us sideways, I decided to make a job change and work closer to home. I accepted a promising part-time position in a public health setting and was excited about working with patients who had more pressing and challenging oral healthcare needs.

Instead, I found myself in a setting where data collection trumped patient care. Once COVID-19 hit, I would sit in my operatory day in and day out, collecting a paycheck without seeing patients and feeling very much alone and confused. I suspect many dental hygiene clinicians felt the same way and it was an eerie time for healthcare and all of humanity. Part-time clinical positions in dental practices were not very numerous before COVID-19 but surprisingly, dental hygiene positions, part and full-time, are now more plentiful. Dental hygienists can pick and choose like they used to and find a workplace culture that works best for them.

What does workplace culture entail?

Workplace culture is how a company communicates, how it treats its employees, and what it values. Dental hygienists know that when we have the freedom to choose (or at least modify) our work style, we can do our best work. Clinical excellence is an objective for many practicing hygienists, and we take pride in good clinical outcomes. It’s not that we’re necessarily competing against each other. Instead, we’re mostly competing with ourselves and working hard to provide technical excellence, satisfactory patient relationships and best hygiene outcomes.

In chatting with other dental hygiene clinicians in a variety of practice settings, those who are thriving report certain dental hygiene practice culture characteristics that make clinical excellence and a peaceful work environment possible.

Let’s explore some of the culture characteristics that give dental hygienists a boost:

1. Being given adequate time to focus on each patient is essential. I have never stayed in a clinical position where I was not able to focus on patient care in a relaxed manner. This means that I do not "fit in" another patient to increase productivity, but I pride myself in being efficient and staying on schedule. I do my best to make sure my schedule flows smoothly throughout the day and so does my front office administrator. If I don’t have time to greet the patient, review the health history, and perform preventative services to the best of my ability, I walk away from this type of dental practice. I spoke with a hygienist recently who works in a pedo-corporate owned dental practice who loves her job but finds herself feeling very anxious about 30-minute blocks. The time blocks would work for her but there are 5 hygiene clinicians who are expected to complete 6 columns of patients to increase profitability. She is also expected to schedule the next appointment, so I encouraged her to communicate her concerns to the practice administrator.
2. "First, do no harm," and other ethical principles must be applied. If dental hygienists are working with sickle scalers to scale sub-gingivally (ouch!) or a power-driven scaler with worn tips or inserts that don't allow them to remove calculus, they'll probably speak up, buy their own instruments, or leave! Dental hygienists are educated to perform technical and interpersonal soft skills with the right instruments and equipment to help them perform their duties to the best of their ability. An RDH told me that a dental assistant in her practice was rubber cup polishing with bleach added to prophy paste to assist in removing extrinsic stains. Lack of education about polishing agents is no excuse and hygienists know it! Years ago, I observed a dental hygienist with a master’s degree in Dental Hygiene hand scale with bad technique and the wrong instruments. It was most unusual. What is common, however, is for hygienists to accept a permanent employee position without taking an inventory of the dental hygiene operatory. A long and healthy job placement includes taking into consideration ergonomics, air filtration and overall aerosol reduction, chair and equipment placement, and modern equipment and instruments appropriate for dental hygiene instrumentation.
3. Collaboration with other members of the dental care team is important. In talking to a good friend in California who loves her 2 part-time dental hygiene positions, I asked her to comment about her workplace culture. She's been an employee in these 2 practices for 18 years and here are the reasons why she's stayed so long. She loves her “bosses.” They don’t micromanage her and it’s a good fit for her because she’s very independent by nature. She’s encouraged to run her hygiene department as she sees fit. What works for her doesn’t necessarily work for all hygienists. Some hygienists prefer being managed and in a practice that employs several hygienists, some management direction and consistency are important goals to achieve. Sometimes, new dental hygiene graduates prefer some management and direction. She also said that she loves the patients in both practices. One practice has mostly blue-collar patients while the other practice attracts more affluent patients who require more time and energy. She states she must stay on top of their dental needs and in general, they are more needy. Renumeration in this practice is higher, too.Both of her employers thank her for her work, and they trust her. She has autonomy and support, and they are both always asking her opinion on patient care. “When thanked, I give 10 times more,” she told me. She is trusted to order her own instruments and she is conscious about cost. Rarely is she told “no, you can’t order that.”
4. Team members need to trust each other. Front office administrators and dental assistants must be in tune with the hygienist’s workflow to make the day run smoothly and keep everybody happy. Dental hygienists often need assistance and administrative roles should be kept to a minimum, so they have adequate time with patients. Dentists need to be respectful of a hygienist’s time too and that includes not putting the hygienist behind schedule when performing exams.
5. Cohesiveness is part of team fitness, and it applies to the hygiene department along with the rest of the dental practice. When goals are reasonable and hygienists aren’t being singled out as being solely responsible for dental practice profitability, they will be happy and thrive. Most dental hygienists I meet are receptive to change and can implement change and adapt.

With the right workplace culture, a dental hygienist will take the initiative and individually contribute to the team’s success. A positive workplace culture raises morale, increases profitability and efficiency, and enhances retention of the dental hygienist. Reducing stress is an added bonus. Dental hygiene positions are plentiful and dental practices are now competing for dental hygienists. Strongly consider a change or shift to improve dental practice culture to accommodate dental hygienists if you wish to attract and retain the best. Self-directed dental hygienists are not a dime a dozen.