Assume the Best, Find Out the Rest
September 1st, 2010
My personal rule is that no matter how rough a patient looks, no matter how jacked-up their teeth are, I assume the best. This holds true for my clients too. No matter how low their perio percentage or how many ‘perio prophies’ they’re performing, I assume the best.
The fact is, we all do the best we can with the resources we have.
So if a patient hasn’t been to the dentist in 10 yrs, I don’t automatically assume they are intentionally neglecting their health or they just don’t care. I have no idea what’s been going on in their lives over those years. Many times, the stories you hear will break your heart. Or maybe they’ve had a demanding job that keeps them on the road 5 days a week. Regardless, I like them to know they’ve entered a ‘no guilt zone’. I can’t take credit for this term. You know my clever friend Dr. Chris Bowman, right? He’s the one who came up with this term and it works like a charm.
Once the patient knows you’re not there to judge or scold them, they are instantly at ease. And when they’re relaxed, they’re more likely to be receptive to your recommendations.
Here’s an exercise to do at your next team meeting:
Start with a neutral example such as this…
Heather got an F on her report card
Assumptions Truth
She’s lazy She needs a pre-requisite course
She didn’t study Her note taking skills need improving
Now we’ll use a dental example…
John has decay between all his teeth
Assumptions Truth
He doesn’t care He has a hard time flossing and no one has taught
him an alternative
He drinks soda all day He has low salivary pH and is taking Zoloft
Your task is to:
1- List on the left side all the assumptions you make about each other, your
doctor, your team andyour patients on a daily basis.
2-List on the right side what the truth could be. You’ll be amazed how this will re-frame how we communicate our patients and how receptive they are to your recommendations.
Stay Inspired,
Rachel
Testing our Podcast
August 19th, 2010
Testing out our new project…The Hygiene Profits Podcast for Dentists.
Doctors…are you on the same page?
August 12th, 2010
I’ve known for a long time that in a group practice, it’s critical for all the dentists to have generally the same treatment philosophy and to express this philosophy to the team.
Knowing this and making it a reality are two different things.
I’ve heard story after story from hygienists revealing how they struggle with juggling two (or more) distinctly different treatment philosophies within the same practice and trying to reconcile that when they are preparing their patients for the doctor’s diagnosis. With Dr. A, they see a leaky filling and know that the doc will want to watch it. With Dr. B, they know she’ll want to restore the tooth and possible recommend a crown because of how much tooth structure is involved.
In the hygienist’s defense, it’s tough straddling that line.
And then you have the issue of Father-Son, Brother-Sister, Husband-Wife dynamics. A hygienist in one of my recent Co-Diagnosis program said that she’s in a practice where the son has joined his father. Dr. Father watches things and is very conservative. Dr. Son is a bit more proactive but is afraid to tell his patients what he really believes because they’ll think he’s trying to ’sell’ them something.
I heard about another situation with a Husband-Wife team that was far more complex. How do you tell one dentist that you feel his/her spouse is doing inferior work? Talk about sitting on a land-mine. Whoever has the nerve to bring that up will either be a hero or hitting the pavement!
Now, I know it’s easier said than done and MUCH easier for me to write this than to actually have ‘the talk’ but…Docs, I’m speaking to you. Please, please, please do yourselves, your partners and associates, your team, your practice and your patients a favor and have these conversations. I have facilitated these conversations many times and the involved parties are always glad they did it.
In fact, many times the team perceives the doctors to have very different philosophies when in fact; there are only subtle differences that can be easily reconciled.
Here are your action steps:
1-Ask your team. And allow them to be honest and safe. “Do you feel there are differences between the doctors’ treatment philosophy?” and “What do you see as the major difference?”
2-Set aside an hour on your calendar, sit down with all doctors and a few cases and really get down to the nitty gritty. Again, let it be a safe environment for learning. No right or wrong, just come to a consensus on how you diagnose and what treatment you recommend. Be very specific. When do you recommend a crown versus a filling, etc.
3-Once you decide what you believe, bring your team together again and teach them your common treatment philosophy.
4-Live it! Keep each other accountable and allow your team to keep you accountable to your philosophy.
Have fun!
Stay Inspired,
Rachel
Turn 10 into $100k
July 21st, 2010
What I consistently find when analyzing hygiene departments is that one huge area of opportunity is undiagnosed and untreated perio in existing patients. Most practices are pretty good at getting new patients into some level of perio care but then there are no systems for keeping them in maintenance or identifying when they need to go back through active therapy.
When doing the analysis, I make very conservative projections for growth because I want them to be attainable. One of those projections is the amount of revenue that could be generated if just 10% of your existing patients were enrolled in even site-specific perio care. I have a formula to determine this and I’ll share that with you. But first, let’s do the ‘gap analyses’.
One exercise I do with clients and audiences is to ask the hygienists, “What percentage of the adult patients you see for prophies on a daily basis have 4mm bleeding pockets?”. What I usually hear is somewhere between 40 and 60%. I’ve asked this of hundreds of dental professionals and I always get the same answer. This is a huge indicator that something is not working with their perio program (assuming one exists).
So I challenge you to do the same. Ask the question. Then compare that number to your perio percentage. If 40% of patients have some active disease and your perio percentage is 12%-there’s your opportunity. If you’re already at 40-50% perio…Bravo!! Keep up the good work.
So I promised to show you how to create an additional $100k with just 10% of your patients.
Here you go:
2 hygiene practice with 1600 patients in recare
SRP fee = $200
Perio Maint fee = $90
10% = 160 patients X 2 quads site-specific SRP X $200/quad = $64,000
160 patients X 4 perio maint (every 3 mths) X $90/perio maint = $57,600
And there you have $121,600 in additional hygiene revenue by diagnosing disease that needs attention and delivering high-quality care. And we haven’t even accounted for your use of advanced diagnostic tests, local antibiotics, home care products or other adjuncts.
And I bet more than 10% need treatment so just double that and you’ve created one quarter of a million dollars!
I’d be happy to help you uncover your hygiene department’s profit potential. Email Gretchen@InspiredHygiene.com and she’ll get you started today!
Stay Inspired,
Rachel
How to Finally Get Things Done
June 9th, 2010
No one likes marking things off a ‘To-Do’ list better than me! That’s how I see what I’ve accomplished and create my work plan for the coming days, weeks and months.
The same is true for a dental practice. Here’s what I see happening a lot. You have a great team meeting with lots of new ideas and solutions. Everyone leaves excited and fired up, ready to take on the tasks. And then a week later, you’re right back where you started. No action has been taken on any of your ideas. It’s no one’s ‘fault’, it’s just what happens when there’s no accountability or time frame around the task.
Here’s how you avoid that…
Never end a team meeting without an Action and Accountability List!
1-Purchase a poster-size 3M Post It flip chart to use during all your meetings.
2-At the end of your meeting, create a list that looks like this:
What
Create a Doc-Hyg exam checklist
Order new ultrasonic tips
Who
Rachel
Diane
By When
May 5
May 7
3-Be very specific with the task and give yourself a reasonable deadline. Post this huge sticky note in your team lounge so you can see if every day and review it during your morning huddle.
4-Get a verbal ‘ok’ from the person accountable that they will follow through on the task.
5-Agree as a team that you all have permission to gentle ‘nudge’ each other if you haven’t followed through on your commitment.
6-Doctor and Office Manager, your team needs you to hold them accountable. If a task hasn’t been completed by the agreed upon date, ask what support that person needs to get it done.
7-Celebrate your success as you see the results of your ACTION!
What have you done for them lately?
June 7th, 2010
They come in like clock-work, rarely missing an appointment and just being great patients. And yet it’s easy to take them for granted. You count on your base of solid patients to keep your practice running and busy. So what have you done for them lately?
Internal marketing isn’t just about asking for referrals. It’s also about really loving your patients and showing them how much you appreciate them.If you wonder why their friends aren’t coming to see you too, I’ll ask you one question: Have you given them a reason to? Have you given your patients an experience that they can’t help but talk to their friends about?
I know you’re great at what you do! So what could you do to really make them feel special. Maybe you give flowers to the ladies or bake chocolate chip cookies in the office. That’s great! Keep it up!
I recently read a wonderful book called “Referral of a Lifetime” by Tim Timpleton. I highly recommend it and you better believe I’m using his strategies to take care of my clients. In the book, Tim outlines a specific plan for staying in touch with those you love to do business with so they are always reminded of whom to recommend when a friend asks “Who’s your dentist?”.
Here a few tips to get you started:
1-Set your intention- if your intention in this process is to genuinely show your patients how much you care, that will come through loud and clear. If you come at it just to get more patients and make more money, that will come across too. And it won’t feel ‘right’. Set your intention to be sincere and the referrals will follow. That’s just how it works. You must set a loving intention and not be tied to the outcome. Try it, I promise it works.
2-Have a plan- make a list of your best 100-200 patients and begin to focus on giving them a simple greeting card, box of cookies or flowers each month. Set a budget for the gifts, cards and postage. This will help you select the gifts and the number of patients you wish to focus on.
Set up a system (there’s a guide for this in Tim’s book) and stick to it. Plan ahead 12 months for the gifts you’re going to send and put someone on your team in charge. Make them your ‘Ambassador of Appreciation’ so they are accountable for making sure the gifts are sent and the system implemented. Hygienists are great at this because they often have close relationships with patients.
3-Work your plan-Every morning during your huddle, make a note of those patients who are on your ‘100 Best Patients’ list or anyone you want to add to your list. Even if you have a small budget to start with, each hygienist can do something special for one patient and it will make an impact. You might start by choosing one patient on your schedule and give them a gift of a complementary whitening touch-up kit, Sonicare head, homecare kit or fluoride treatment, for example. And let the patient know this is ‘Just Because’.
4-Track it-Just like you track your other marketing efforts, run a report every month and see who has referred new patients. Send them a thank you gift immediately.Create a spreadsheet to track which gives you’ve sent to whom and the resulting referrals. It might take 6-8 months but you WILL see a strong return on your investment. And remember, you’re not just investing money, you’re investing in relationships.
Productivity…It’s Not About Money
June 3rd, 2010
Productivity, profitability, production, sometimes it seems that dentistry is all about the numbers. Let’s face it, you’re in business to deliver outstanding care to your patients AND make a living, right? I tell the teams I work with all the time, the numbers are a tangible way to track how well we are taking care of our patients. We have to track the numbers so we know where we are doing well, where we can improve and how to set goals for growth.
But you know what I’ve learned recently? Productivity isn’t about money. When we do what’s right for our patients, when we are laser focused on delivering the best care possible, the money will follow. So, we’ve determined that productivity is about :
- Relationship
- Efficiency
- Focus
Relationship- There’s a difference between relationship and rapport. Rapport is when we know and like someone. Relationship can be defined as an agreed upon course of action between two individuals. When you and your patient agree to move forward with treatment, you’ve cemented your relationship. From that point forward you build on that patient-doctor relationship by caring about the patient, being sincerely interested in their life and being committed to delivering the very best care for them. You can also draw on that relationship by asking your patients to hold fast to their commitments to you and your team: being on time for their appointments, trusting your recommendations and referring their friends and family. When this type of relationship occurs, it supports your productivity.
Efficiency- Be prepared! Having everything you need for that patient BEFORE they walk in the door will keep you efficient. Documenting treatment and personal notes in the chart will help you continue to build that relationship. Creating and then implementing clear treatment protocols will help you and your team make quick, consistent treatment decisions. Delegating certain tasks to your highly skilled assistant makes you more efficient.
Focus- Defined as a clear vision, focus is what drives your team and keeps you productive. If you’re focused on building relationships instead of just diagnosing treatment, your case acceptance will go up. If you are focused on educating patients using your intra-oral or digital camera rather than just talking them to death, you’ll be more productive. Setting time aside for team meetings will help you stay focused by dealing with all the petty distractions rather than letting them build up and take you off course.
Action Steps for Productivity
- Find what you have in common with your patients- make a connection
- Determine what specific tasks you can delegate to your team
- Be sure your team is trained to perform those tasks at a high level
- Delegate with confidence
- Focus on what you want to achieve TODAY
- Clear up any “office clutter” with regular team meetings
Define your focus and goals at those meetings
What, they didn’t show up?
May 31st, 2010
Have you had trouble with last minute cancellations and no-shows? We’ve all been in that boat. You look at your schedule at the beginning of the week and it looks great. Every hygiene appointment is full and it’s been that way for weeks.
Then, the confirmation calls are made the day before and POOF, the whole thing falls apart. Now your stuck with just a couple hours before closing and the next day looks like Swiss cheese. There’s nothing you can do. Doesn’t make for a very relaxing evening does it?
The answer to your trouble is hidden in the last paragraph- the ‘day before’ call. For so many practices, this is the only communication between the day the hygiene appointment is made 6 months ago and the day of the visit. That’s the problem!
If you are experiencing more than 10% open time in hygiene, it’s time to refresh your confirmation protocol.
Here are a few ideas to use to give patients the reminders they need:
- Send out a postcard 2-3 weeks before the appointment
- Call 1 week before to remind the patient of their confirmed appointment
- Leave a message that compels them to call you back
- On that postcard-change the language to say “Call Jane when you receive this card to confirm your appointment”
- Make a ‘courtesy call’ the day before if necessary
Use an on-line recare system like Smile Reminder to help automate the confirmation process
What You Don’t Know Might Hurt You
May 28th, 2010
Well, I’m back home and enjoying every minute of it. While I love Southern California, there’s nothing like the smell of Honeysuckle, Jasmine and Magnolia to make you appreciate living in the South.
I’m looking forward to a great weekend with family and friends as we celebrate Memorial Day with a party at our neighborhood pool and Matt and I go out for a birthday celebration dinner. That’s right…I turned the Big 40 today!
Last year on my birthday I sent you a photo of me with no front teeth so to top that, here I am at my high school graduation in 1988. Yes, I know. I had a lot of hair back then. But who didn’t? Oh, and that’s Diane, Inspired Hygiene’s Business Manager on the left and our other great friend, DesiRae on the right. We’re all still best friends 20+ years later!
While I was in California I attended the CDA meeting. I was so impressed with the level of speakers at this meeting and how well it was organized. I will be back! One of the speakers I saw was Dr. Brian Novy. If you follow me on Facebook you saw my post about his program on CAMBRA and MI Dentistry. He made a very dry subject fun and entertaining. I learned a ton!
Rather than try to feebly recount all the amazing points he made and how this information is turning our old caries theories upside down, I’d like to refer you to a few articles. If you haven’t started thinking about how to update your caries management protocol in the last couple years, now is the time. You must be informed on how to manage patients risk as well as treat their disease and prevent further occurrence. And what you don’t know may hurt you… and your patients.
The first article is a snapshot of Dr. Novy’s presentation, “Dental Caries: a pH-mediated disease”. The second article is by Carri Cady of Oral Biotech and is titled “Sued over caries?!”. I want to point out the section in Carri’s article where she quotes Dr. Ed Zinman. Dr. Zinman is a periodontist and an attorney who handles medical and dental malpractice cases-from the plaintiff’s side. Here is a link to his article “Ethics versus Legal Informed Consent – A Distinction with Little Difference”. In short, he states that lack of knowledge of new standards of care is no excuse for not implementing them. I’m not trying to be dramatic. I’m just saying…
Have a great weekend!
Stay Inspired!
Rachel
I Just Can’t Do It All – Part 1
May 27th, 2010
#1 Assuming Perio is Taken Care Of
Having a sharp hygiene team is a beautiful thing. But assuming everything is being taken care of is a big mistake. Be sure you know that a complete perio exam is taking place at every hygiene visit AND the data is being recorded. This is a huge area of liability for you and it’s your hygienists responsibility to collect and analyze this information. One way to find out where you stand is to do an audit of your charts. Randomly pull 20 charts of adults seen in the last 6-12 months. How many have a complete perio exam recorded in the last year? Chances are very good that if the percentage is low, so is the amount of perio treatment.
#2 Starting Perio Treatment Too Late
My interpretation of the AAP’s Perio Classification system is that Beginning (slight) periodontal disease is 4mm pockets with bleeding and slight bone loss and 1-2mm CAL. This is a huge distinction for many dental teams. Often, these are the “difficult prophies” or the patients that have 3 month prophy intervals. I see it time and time again- teams waiting until pockets are 5-6mm deep before beginning treatment while valuable the patient loses valuable bone that could have been saved.
#3 Too Little Time for Hygiene Visits
I’ve mentioned this before and I’ll say it again. Every time I have ever coached a team to increase their hygiene time, their production has increased as a result. Now that wasn’t they only thing they did. They put in place systems to deliver a higher level of service and enroll more treatment. Critical steps that drive production are left out of the hygiene exam when time is short. When you choose to allow 60 minutes for adult recare and perio maintenance, it’s important to outline exactly what will take place during that time. If you are going from 40min hygiene visits to 60min, what are you going to add?
To Be Continued…
Wait- Here are a few action steps to help you get started NOW:
- Do a chart audit-look for current perio charts
- Communicate to your hygiene team that you’d like them to do a complete perio exam on every adult patient
- Give your hygiene team the time they need to complete a comprehensive hygiene exam
- Be proactive and get the information you need to really believe that starting perio therapy early is the right thing to do
Think back to the last time you attended a really great CE course. You came back with some great ideas and wanted to get started right away. Then you pull out your notes and realize there are 10 or more new products, services or ideas you want to put into place NOW. I know the feeling. I’ve been there myself. And I know that the next thing you feel is overwhelm. Where do you start? How am I going to fit all this into my 50 or 60 minute appointment time? Are my patients going to think I’m just trying to sell them the next best toothbrush?
Then you get that feeling that stops you in your tracks…I just can’t do it all! The good news is, you don’t have to! Here are a few tips to help you systematically incorporate all that you’ve learned, over time.
Sit down with your notes and make a list of all the new products, techniques, services you want to begin offering to your patients in the next 12 months. Then rank them with #1 being something that you must do NOW. This would be something critical like doing an oral cancer screening on every patient. Somewhere lower on your list might be completing a Caries Risk Assessment on every patient. Maybe your already doing a complete perio exam, oral cancer screening and Caries Risk is high on your list of To-Dos. This is going to vary for everyone
Then create a timeline for when it will be implemented. Maybe you start doing visual & tactile oral cancer screenings on Monday. Then you request a lunch and learn on the Velscope or ViziLite on Wednesday knowing that it will be next month before you make your decision on which testing system to use. Get that system implemented and running well and then focus on the next item. Maybe the Caries Risk and Treatment System will be 6 months out. That’s ok, just have it in your long-range plan.
Every team is going to have different priorities but there are some standards of care that must be addressed quickly. These are musts in EVERY hygiene exam:
- Oral Cancer Screening
- Complete Periodontal Exam with charting
- Medical Review
These are important but may be on the 3-6 month To Do list:
- Cosmetic evaluation with shade guide
- Caries Risk Assessment Form and Treatment System
- Implement a new Homecare System
We all want to do everything tomorrow but the reality is that if we don’t prioritize, we’ll get overwhelmed and not implement any of it. Now take a breath and make your list.
Next month, I’ll share how to stay on time and avoid overwhelming patients with new products/services.
