What, they didn’t show up?

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

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

#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

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!

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

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.

Obstacle #4: There’s no Training

Training goes hand in hand with accountability. When you agree to a certain job, you must have the skills to complete the task at hand. If you don’t, you must find the resources for it. The sink-or-swim philosophy of training is never productive. It leads to staff turn over and can interfere with effective communication and bonding between team members.

Here are a few tips to ensure proper training for your team:

1-When purchasing new equipment or software, purchase the training package. The money you spend will be money saved in time spent ‘figuring out’ all the nuances of the technology. The faster your team can learn to use the new digital x-rays system you purchased, the sooner they can be productive with it and the less likely they will develop frustration and want to go back to the old way of doing things.

2-Develop an operations manual for your practice. This is not a task for you, doctor. This is a task for your seasoned, trusted team members to begin to create systems around everything they do from answering the phone to assisting in a crown prep. And when I say systems, I mean step-by-step-by-step.

3-Give a new team member every chance to succeed. Plan on AT LEAST 3-4 weeks of training before expecting them to be up to speed on all your processes and procedures. Prepare each member of your team to allow the new team member to ‘shadow’ them for a few days. If you hire an assistant, allow her to spend time with the admin team and the hygiene team. Make sure new team members read the operations manual and view any CDs or DVDs you have in your training library.

4-Find out who’s good at a certain task and make them the ‘trainer’ for that task. If you have one hygienist who is fantastic at utilizing the digital camera, have him train the team and new staff that come on board. You’ll create a team of experts and everyone feels appreciated for their talents and accountable to contribute to team training.

Obstacle #3: There Is No Accountability

Out of all the obstacles, this one might just be the most ‘in our face’ on a day to day basis.  When there’s no accountability, things fall through the cracks. These can be little things like running out of cotton rolls or they can be big things, like a patient showing up for their crown delivery appointment and the crown’s nowhere to be found.

We’ve all been there, right? It’s embarrassing, frustrating and it can makes us look bad in the eyes of our patients.

Being accountable is knowing who is in charge of a certain job or task and then that person carrying it through to completion. When you agree to be accountable, the buck stops with YOU.  Now, you don’t have to complete every part of the task personally but you are responsible for making sure it is complete and accurate. To create more accountability in your practice, here a few things to implement:

1-Create an action list during every team meeting.  Assign each task to a team member and agree to a date on which it will be done. This is the What, Who, By When. I recommend using a piece of 3M Post-It flip chart paper and put it on the wall of your meeting space. This way,  you can check things off when they’re done and go back to items that haven’t been completed to find out why.

2-Utilize trackers!! Tracking your progress is imperative. In fact, many consultants have seen that tracking alone increases productivity by 10% or more, without implementing any other changes. When you’ve implemented something new, whether it’s a new marketing strategy or perio program, using a tracker will allow you to see what’s working and where you need to make adjustments. If your hygiene team is presenting the perio treatment but it’s not showing up on the tracker as completed, then you know you need to look at how you’re admin team is presenting financial arrangements or if the schedule is allowing those patients to be cared for quickly.

3-Assign ongoing tasks. Being very clear about expectations is one secret to success as a leader. Create clear, consistent accountability by assigning one person to be in charge of OSHA, another in charge of the supply budget and inventory and another in charge of patient confirmation, for instance. Try to choose folks that are good at that skill. The person in charge of the supply closet should be an ‘organizer’ at heart.

In a couple weeks, I’ll share a bit about training. I bet you know what I’m going to say… 🙂

Obstacle #2: There Are No Systems

A few weeks ago, I stepped into the office of one of my clients and I was pleasantly surprised. Based on their analysis, I expected to find a hygiene team that was not performing a complete perio exam on every patient and was not aware of each patient’s condition. Very quickly, I realized this was not the case.

This team was doing a fabulous job with calling out the perio numbers and recording each number on the chart along with bleeding points, recession and furcation. They had a threshold for the number of bleeding points before they recommended some form of periodontal therapy. But that’s where they hit their biggest obstacle. There was no system.

Although it seems intuitive to some of us, it is critical to have a clear system for:

  • Distinguishing health vs. disease
  • When to place patients into gingivitis and/or perio disease treatment
  • How to present this treatment
  • Clear fees and coding for perio therapy
  • When and how to follow up on therapy
  • What adjunctive products/services to use
  • How to keep those patients in periodontal maintenance

This is especially true when there are multiple doctors and hygienists in the practice. Everyone must be on the same page and using the same system. What happens when we’re confused is we do nothing, we shut down. This is true for patients as well. When patients are confident and clear on both the problem and the solution, they say yes!

The great news is that when we put a system in place for taking periodontal patients into active therapy and maintenance, this team sky rocketed! They already had a strong foundation in place. They didn’t have to start from scratch.

Here are a few signs that this is one of your obstacles:

  • Low perio percentage despite thorough periodontal exams
  • Acceptance of perio treatment is low
  • Not starting treatment until the disease has progressed to a moderate/advanced stage
  • Most of your perio patients are being referred immediately to the periodontist

If this sounds familiar, sit down with your team and talk about it. Decide what help you need. We offer support from our High Performance Perio webinar series all the way up to private in-office coaching programs. Starting with a high quality CE program and gaining more knowledge is a great place to start.

To quickly determine where you are with your perio percentage, download our free Perio Percentage Calculator tool by clicking here.

Hidden Obstacles

Have you ever experienced this? You’re trying to implement a new product, procedure or service and for some reason, it just won’t stick. It works fine for a little while but then you go back to your same old ways. Chances are there are some hidden obstacles that you haven’t yet identified. There are lots of things that stand in our way of success but I’m going to reveal the most common obstacles that I see, in both my own clinical practice and with my clients.

The 5 Most Common Barriers Are:

#1 Your Schedule Is Out of Balance

#2 There Are No Systems

#3 There Is No Accountability

#4 No Training Is Taking Place

#5 You’re Holding Onto Old Information and Beliefs

Obstacle #1 Your Schedule Is Out of Balance

I recently gave a tele-class to our High Performance Hygiene Mastermind (link) members on this very topic. Whether your schedule is wide open or jam packed, each situation presents its own set of challenges.

If your schedule is wide open then every hour of open time cuts into your production per hour. Even if you’re doing everything you can with the patients you have, it may be difficult to reach your hourly production goal. Over a long period of time, this chips away at team morale and motivation. And too much of your admin team’s time may be spent moving patients around to make the schedule look full or trying to recover from a day that’s fallen apart.

If this is your challenge, find the true reason for the open time. Here are a few items to analyze:

  • How many patients do we have that are NOT in recare? This is your reactivation pool.
  • Begin an aggressive reactivation program
  • Begin an internal marketing campaign
  • Work with a marketing specialist to analyze the success of your current external marketing systems and track where your high quality new patients are coming from
  • What percentage of the open time is unscheduled vs. cancellations or no-shows? Is your confirmation process working?
  • Determine if the number of hygiene hours match the demand for patient care

If your schedule is jam packed, you have a challenge of abundance. A good problem to have but it too can be very frustrating. When you have more patients than you can handle, appointment times tend to get shortened which results in less treatment enrolled and fewer adjunct services. Also, when there are no appointments reserved for perio therapy, often it just doesn’t happen. We realize that if it’s going to be 2-3 months before we can get a patient back for perio treatment, maybe we should just scale really well today and check them next time. And so a cycle of “perio prophies” begins but that’s an article in and of itself. Again, with this situation you may be very busy but you may not have the time to deliver the very best treatment and hygiene may not be reaching their production goals.

If you find yourself in this situation here are some solutions:

  • Add more hygiene hours
  • If you’re already at maximum capacity, look for creative ways to utilize your current facility
  • It may be time to consider assisted hygiene with a highly skilled dental assistant
  • You may want to utilize Power Hygiene days
  • Take a good look at the quality of each patient and their commitment to your practice. Perhaps you decide not to pre-appoint those patients that have a habit of cancelling at the last minute or not showing up-be sure you’re tracking this on each patient

Take time to sketch ou your ideal hygiene day including the procedures and production you’d like to see. It’s exciting to see what’s possible when you get your schedule into balance.

If you’d like to listen to the recording of last month’s Mastermind mind call on this topic, you can get more details about the Mastermind and register for your free 2-month trial membership at www.hygienemastermind.com. There are several resources on hygiene supply and demand and scheduling that are at your finger tips when you’re a Mastermind member. I hope you’ll join us.