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
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
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.
The Perio Paradox
May 24th, 2010
If you’ve been reading my articles for awhile, it’s probably no surprise to you to hear about the “Perio Paradox”, a term coined by one of my mentors, Dr. Chris Bowman. Depending on what study you read, it’s estimated that 35-75% of Americans have some form of periodontal disease. And when I ask my coaching clients and Mastermind members what percentage of their patients have 4-5mm bleeding pockets, they routinely say 40-50%. Yet for many of them, perio therapy and maintenance makes up only 5-10% of their clinical hygiene services. It’s an absurd but true statement. This is the “Perio Paradox”.
So how do we close that gap? Well, first we must realize that it’s not the dentist or the hygienist’s intention not to treat perio disease. In fact, many times they are treating the disease BUT calling it a “difficult prophy”. Everyone loses in this situation. The patient loses because they are not made aware of the disease and it’s far reaching effects. The hygienist loses because he or she is working extremely hard on what should be a simple prophy. The practice loses because it’s not being compensated for the work. And the doctor loses because undiagnosed perio disease is the most common reason for dental lawsuits.
So what do you do? My readers have heard me say it a thousand times…we must be doing complete perio charting with bleeding points, recession, mobility and furcation AT LEAST once a year. How else are we going to know if the patient is healthy or has disease?
At Inspired Hygiene, we give our clients tools to use this data to educate and enroll the patient into therapy with ease. Like printing the perio chart and sharing it with the patient- knee to knee.
And we help our clients work through obstacles that might have held them back in the past from developing and implementing a truly progressive periodontal diagnosis and treatment program.
Some of the most common obstacles are:
- No clear consistent system for perio diagnosis and treatment
- Hygienists are not calibrated (not all on the same page)
- Poor tools/instruments
- No room in the schedule for perio care
- Beliefs about patients’ ability to pay
- Difficulty using technology
- Too much scaling and not enough exam time in the hygiene appointment
- Fear of presenting to long-term patients
Sound familiar? If not, congratulations! If so, you’re not alone AND there are several ways we can help. To start, we’d like to invite you to attend a Free Tele-class “Stop Losing Thousands of Dollars in Undiagnosed and Untreated Perio”. Go to www.InspiredHygiene.com/perio for details and to register for the class. All dental team members are welcome. On the call, we’ll preview our High Performance Perio 6 Week Perio Webinar Training. Consider it an investment in the health of your practice and your patients.
Do the Hustle!
May 20th, 2010
Remember the dance “The Hustle” from the 1970s? Everyone knew the song and the dance steps. But if you’ve ever tried to learn a line dance or other dance routine you know that you don’t just JUMP in and get in step right away. It takes time to learn each step and the sequence of the dance.
I recently attended a Hip Hop dance exercise class for fun. The “routine” was made up of about seven or eight different dance moves each with their own name. The teacher was brilliant in her approach.
She knew that to get us all on the same page, she would have to teach each move one at a time. Then she would put move #1 and #2 together and we do that over and over. Then we’d add move #3 and do that a few times as a sequence. By the end of the hour, we were doing an intricate dance routine.
The same is true for us as hygienists. Each hygiene visit is like “dancing” with a different partner, over and over throughout the day. We’ll do the same dance but we might throw in a few different moves depending on our partner’s attitude and experience.
As a hygienist, when we add a new service or technology, it’s important to take it a step at a time. It’s like trying to perform a new dance in front of an audience without any practice. Sometimes we get frustrated and we shut down saying “I can’t learn that dance”.
Instead, wouldn’t it make sense to learn the new system one step at a time? Let’s say you’re going to take your oral cancer exams to a new level. Here are the steps you would take:
- Learn about the technique and technology
- Learn oral cancer stats and why it’s so important to test
- Talk to patients about oral cancer
- Consistently do intra-oral screening on every patient
- Add extra-oral cancer exam
- Add technology such as Velscope or Vizilite
- Review your success and stay the course
You might start by putting #1 and #2 together. Then you could add #3 and #4 for a week. Then add the extra-oral exam and then the technology.
Building confidence with a new service or technology requires study and practice. At first, it feels a little awkward, then it feels better and before you know it, you’re an expert. Take the time to learn all the steps and put them together one by one. Then you’re ready to “dance”. Have fun!
Obstacle #5: Challenging Old Beliefs
May 17th, 2010
Overcoming our old beliefs and assumptions is where real breakthroughs happen. I remember about 10 years ago, I was working with a very progressive female dentist. She had been a hygienist for years before becoming a dentist and had built a very successful practice. This step in my career would turn out to be one of the most important for a lot of reasons but the primary reason is because she challenged what I thought I knew about dentistry and hygiene. Needless to say I learned a ton from her and I will be forever grateful.
One day, she came to me and said “Rachel, it’s time for you to start using your ultrasonics more. You’re running behind schedule too often and I rarely see you pull out your Cavitron unless you’re doing scaling and root planing.” I was holding on to old beliefs from hygiene school that hand-scaling was best (the reality is that we only had 2 ultrasonic units for about 30 students). I can’t imagine that I’d still be working pain free if it weren’t for my years using ultrasonics on all of my patients. And I “now know” that it’s better for my patients too. She worked with me to be sure I was confident in using this instrument more fully and she held me accountable by making sure there was a used cavitron tip on my tray every time she came into to do an exam. 
I’m the first to admit that when I’m faced with a challenge to the way “I’ve always done things” I have a specific physical reaction. I feel resistance in my body; I know exactly how it feels. Over the years I’ve learned to welcome this feeling as a trigger that I’m about to learn something, I’m about to have a big breakthrough. That day was just the beginning of being challenged to step out of my comfort zone in order to grow.
This feeling is one I’m sure my clients experience when we have our coaching and workshop sessions. And we each have different ways of assimilating new information and changing our beliefs around it.
The next step is taking action. Its one thing to say “Yes, I believe that periodontal disease is a chronic, bacterial infection that has systemic effects for my patients” and quite another to be doing a complete diagnostic perio exam, presenting needed treatment, enrolling the patient and completing the therapy.
One of my favorite motivational writers and speakers, Jim Cathcart publishes a free e-zine that I encourage you to explore at www.cathcart.com.
In one of his issues, Jim says the following about our beliefs:
- Know what you believe. Spend time determining just what it is that you believe is so.
- Explore what you believe. Study and challenge your beliefs so that you can assure that it will stand up to scrutiny.
- Live what you believe. Make sure that your day to day behavior is a reflection of what you believe. As someone once said, “if it is not affecting your actions, it is doubtful you believe it.”
Jim’s words really hit home for me and they play in my head while I’m teaching, coaching, treating patients. It’s not always the easiest thing to live our beliefs, but it’s the surest way to success.
