Hygiene Leadership in the Dental Group Setting

Author: Heidi Arndt RDH, BSDH– – CEO – Enhanced Hygiene

According to a recent report from the American Dental Association (ADA), dental group practice growth has risen 25% in the past two years, and this growth is expected to continue in the years to come.

From a clinical care standpoint, dental group practice is very similar to the solo-practitioner setting. However, due to the number of providers and staff with in a dental group practice, they have to manage differently. Consider this: A dental group of 20 offices could employ upward of 25 doctors and 40 dental hygienists or more on a day-to-day basis. The sheer numbers requires a different manner in which to support and manage the providers and the teams in the offices. Especially when it comes to the dental hygiene team.

Creating a Dental Hygiene Leadership structure in the group setting is necessary to develop and grow the hygiene team into the future. Today, dental groups often hire a Dental Hygiene Coordinator, or a Director of Hygiene to manage, grow and motivate the dental hygiene team. This role is crucial to the success of the group.

In most dental groups, the role of the Director of Dental Hygiene is responsible for managing the overall dental hygiene side of the business; and the development of the dental hygiene team. Their job description will look like this:

The Director of Dental Hygiene at ABC Dental Group will partner with the Chief Clinical Officer (a dentist) in the management of the dental hygiene team and business. This will include clinical training and coaching of the dental hygiene team.

Job Summary:

To lead dental hygiene team in achieving the highest levels of quality patient care and productivity through orientation, mentoring, coaching and leadership development activities designed to meet the mission, vision and goals of the group.

Essential Responsibilities:

- Support the financial goals of the group

- Develop, implement and support a dental hygiene curriculum for professional development.

- Develop, implement and monitor dental hygiene protocols and systems, training initiatives, mentoring/coaching plans, productivity, service mix goals and a social operating system for dental group.

- Provide ongoing coaching, feedback for performance of dental hygiene team, and dental hygiene mentors.

- Support dental hygiene recruitment and hiring.

- Continuous improve revenue, service mix, scheduling efficiency and patient retention.

- Establish and maintain a dental hygiene orientation and mentoring program for dental group.

- Develop social operating plan with dental hygiene team in order to drive initiative and results.

- Meet regularly and collaborate with operation and clinical leaders to coordinate development and implementation of dental hygiene initiatives.

- Meet regularly & collaborate with dental hygiene mentors/coaches.

- Act as subject matter expert for dental hygiene.

 

Knowledge and Skills:

- Understanding of Business Acumen

- Proven success in project management

- Experience delivering training to providers using sound principles and research to support information.

- Demonstrated success achieving results through defined goals.

- Possess outstanding communication skills; verbal and written.

- Ability to influence change through interpersonal skills.

- Passion to drive results and deliver on commitments.

- Ability to understand, develop and execute organizational development/dental hygiene development strategy to fulfill business objectives.

- Demonstrated proficiency as a strategic thinker, possess self-confidence and organizational awareness, and ability to impact and influence.

- Ability to work independently toward achievement of agreed upon goals and tasks.

- Ability to confront difficult issues.

- Ability to lead team projects from start to finish.

 

Attributes:

- Strong communication skills with patient, doctors and team members.

- Ability to work independently.

- Act with honesty and integrity.

- Ability to hold self and others accountable to performance and results

- Respect strength and weaknesses of each team member.

- Ability to delver on expected results.

 

Finding the right candidate for this position is more than just promoting your top performing dental hygienists. You should select someone who has proven success chair side, but who also has a strong understanding of the operational side of the business. And no doubt, strong leadership and communication skills should occupy this role.

There are no rules or timing for hiring your first Director of Hygiene. However, managing teams over locations greater than 6 can become challenging. The earlier you bring in this position, the

better. Remember, you don’t have to start with a full time position. This role could easily work clinical and management until you have the full time demand within your group.

One of the largest struggles groups encounter when hiring their Director of Dental Hygiene is taking a person from clinical to a full time management role. This transition can be very difficult due to the change of expectations and the management of their time and focus. As with your clinical staff, it is important that you provide training and mentoring to this individual.

Before hiring your Director of Hygiene, take the time to define what a typical day as the “Director of Hygiene” looks like, and what you expect from them day-to-day, week-to-week, etc. Having clear expectation is crucial to their success, and their ability to navigate their way into this new role.

The Director of Hygiene will provide abundant benefits to the practice, including a return on the investment of their role. With the right candidate, clear expectations and support; your dental hygiene director can grow your hygiene business rapidly while keeping your team motivated and happy.

 

Hygiene Productivity Goals Made Simple

Author: Heidi Arndt RDH, BSDH– – CEO – Enhanced Hygiene

Have you set your hygiene goals for 2014? Did you set up your goals to ensure you are profitable? Have you communicated your goals to the hygiene team?

When you developed your financial plan for 2014, how did you project hygiene revenue for the year? Most dental practices will set a random revenue number on what they feel is in line with industry standards. However, the “industry standards” published by consultants and in articles are usually based on inconsistent data. For example: The industry standards do not take into consideration if there are different fee schedules, or if the numbers are based on the gross revenue vs. adjusted revenue. Also consider, some offices do not credit the hygiene team with the same procedures as the others. As you can see, the data can be inconsistent and may not relate to how you are looking at revenue in your group.

Your hygiene production goals need to be based on the needs of your specific group, and your group alone. Keep in mind, you can use industry information as a comparison; but it is important to understand the variables that exist behind those figures.

Here is the simplest way to figure out your Hygiene Production Goals.  In fact, I would encourage you to develop your annual plan based on these figures, so you can ensure you are targeting the right goals each day, week and month.

What is the breakeven point for hygiene?  Your breakeven point is what you need your hygiene team to produce each month to cover your hygiene overhead, and provide a 30% profit margin.  As a note, your hygiene team should produce 3-3.5 times their salary and benefits.  With that being said, the easiest ways to figure out your break-even amount is to take your hygiene compensation, plus the all benefits paid to your hygiene team; and then multiply that total by 3.5. If you are unsure of the amount of benefits paid, you can estimate it is around 20% of your total hygiene

compensation.  (20% is based on the current benefit trends found in most dental groups across the country.)

Here is an example:

You pay your dental hygienist $40/hour.  In September, she will work 8 hours/day for 20 days; making her total compensation $6400/for the month.  If you add in benefits at 20%; your total hygiene compensation and benefit expense will be $7680.

Now, take your total hygiene expense $7680 and multiply it by 3.5.  This will provide you the total revenue needed to provide a break even, yet profitable margin for your practice.  In this example, this hygienist must produce a minimum of $26,880, or $168.00/hour. 

Please note, the $26,880 needs to be the money you can collect.  This is especially important for the groups that accept multiple PPO plans.

Look at historical data.  Once you have your breakeven or baseline production goal identified, you should look at your production trends from the past year.  If your hygiene team is producing above your break-even point, then you will rely on your historical data. 

I like to look at the previous calendar year when looking at historical data.  As you know, there are certain months that trend lower than others; and this data is extremely helpful in setting realistic goals.

Set your goals with a little stretch.  In fact, I would encourage you to plan for a minimum 3% organic growth each year.  This growth should not include the fee schedule increase.  But it may include an increase in hours, and of course production per hour.

Taking time to set accurate and meaningful production goals for your hygiene team will help you confidently hold your team accountable for what you know the business needs.  Remember, hygiene is intended to bring you a healthy profit margin to your practice.

Communicate Your Annual Plan and Your Goals

Your dental hygiene team must know what the annual plan looks like and how it is figured. The practice manager and doctor should sit with each dental hygienist and review their individual annual plan for the year. During the meeting, you should discuss how the daily goal is figured and

how they trended to this goal the previous year. If the dental hygienist has trended below the break-even mark; provide him/her with some tools or suggestions on how they can improve their performance and obtain their goal for 2014. Creating clarity around the annual plan and goals will help your dental hygiene team understand their role in the practice success. This also gives them something to reach for. After all, we all want to be winners and to be successful!

Reward it!

If your hygiene team continually exceeds your break even point, why not reward them. One way of doing this is to design a commission style pay, but you may also consider a share at the profit above their daily breakeven. Placing an incentive around your revenue goal, will help your dental hygiene team “buy in” and take a personal interest in making the goal each day and month.

Make 2014 a profitable year for your hygiene team by setting yourself up for success from the start. Set your goal, communicate it and reward it!

 

Trends in Hygiene Education

Author: Heidi Arndt RDH, BSDH– – CEO – Enhanced Hygiene

The past 10 years have brought many changes to dental hygiene supply & demand with the growth of dental hygiene schools all over the country. With that, the compensation of dental hygiene has also seen some big changes.

I went to dental hygiene school in Minnesota in the late 90’s. At the time of my graduation there were only 7 schools in Minnesota, and only 1 of which that was offering a 4-year degree. Now there are over 10 dental hygiene schools in the state and some are graduating 2 classes/year of graduates. Needless to say, Minnesota (urban) is saturated with dental hygienist, as are many other cities and states across the country.

The saturation of dental hygienists has also caused some changes in the compensation landscape for dental hygiene. And, in my opinion the changes are not so bad. As long as you are committed to practicing to the top of our license and training, which we should be doing anyway…right?

According the recent RDH magazines survey, the per hour pay is still the most popular form of compensation for dental hygienists, however this form of pay has seen a slight decrease in the areas where there is a heavy supply of dental hygienists.

The dental hygienists that were reporting pay increases in 2011-2012 were part of a commission type structure of pay, which is the pay structure that is picking up popularity in dental practice and groups throughout the country.

However, The question remains, how should you compensate your hygienist?  There are several schools of thought ranging from hourly rates, to base plus commission, or full commission.  There are benefits and challenges inherent in each method.  Your selections of compensation plans should be based on find the most balanced method for your practice, keeping in mind profitability, competitive rates, and personal incentive needs for the dental hygiene team.  And, no matter the method,  

the focus of patient care is the highest priority!

COMMISSION: I have seen a lot of success with the commission style compensation. For the hygienists, the practice and the patient care that is delivered.

Commission pay is best calculated from the Adjusted Gross Revenue or the Collections number. Using this, I have seen commission percentage ranges from 24-38%. And the percentage, depends heavily on your mix of business (insurance, write offs, etc.) Commission paid from the UCR of gross revenue can is an easy calculation for the hygiene team, but depending on your collections and mix of business; it can cause fluctuations on your profit margin.

There is no doubt the commission structure provides an ‘incentive” for the hygiene team. Yet, it is often met with a lot of resistance from the hygiene team. Why? Because of the unknown, the change, and the fear of how it will affect their personal finances. And, this is completely understandable.  

Before, implementing a commission style pay the dental group needs to set a strong foundation of protocols, systems and support for the dental hygiene team. These measures will help ensure success for the hygiene team. Not only that, the management needs to be prepared for all of the questions and concerns the hygiene team will have.

And by all means, NEVER implement a commission style pay as a punishment or as a result of frustrations with your hygiene team performance.

Instead, reward your high performing team with a piece of the pie. Allow them to take a piece of the production they bring to the practice!

**Also, be sure to check on your states labor laws about commission style pay for your hygiene team. There is some language that you need to be aware of before implementing this type of plan.

BASE PAY + Commission: The base pay, plus commission plan is a good

compromise to the straight commission plan. The base pay is provided to the hygienists as a per hour or a per day compensation. This rate should be set well below the standard pay rate for hygiene, so an incentive can be easily built in. Production above this amount will be paid as a percentage of the adjusted revenue (collections) they produce. 

This plan takes some modeling in order to find the right base and commission based on your geography and mix of services.

BASE PAY + Incentive: The other plan that has some popularity is the base pay plus incentive. It is much like the base pay, plus commission but it is set up slightly different. The dental hygienists will be paid their standard hourly rate up to a set daily production goal. Once the hygienist exceeds their daily goal, they receive either another $1-2 per hour, or they get a % of the over-age.

Although this plan sounds nice, it is cumbersome to calculate and understand for the entire team.

What’s the RATIO?: As a general rule of thumb, dental groups will allocate about one-third of hygiene production for compensation.  This includes gross salary, tax match and all benefits.   This should be what you what your outcome to look like when modeling your compensation plan.

 

WHAT YOU SHOULD EXPECT: I have heard dentist say that all the good hygienists are already taken!  While that’s not true, it can seem that way when it comes to creating a strong working relationship with your hygienist.  Dental groups should expect high performance from highly compensated hygienists, and the truly great hygienists know this.The mark of a true dental hygiene professional is possessing a proactive nature, being held accountable, and demonstrating an eagerness to contribute.  This goes both ways… doctors should educate themselves to the expanding role of the hygienist and learn ways to open the lines of communications.  Building an appropriate compensation package is a foundational step in creating an outstanding, long-term relationship with your hygiene team.

The BOTTOM LINE: There are several hygiene compensation plans out there today, and the all have their perks and a downside. The plan you select for your hygienists needs to be one that you are confident in, and happy with the outcome of patient care and financial outcome for them and your group.

After helping over 13 dental groups implement commission style plans, I can tell you this…keep it simple for everyone- simple for the hygiene team to understand, and simple for your accounting staff and managers to calculate.

Be clear and transparent about the plan, and help them understand the benefit to the patient, to them and to the business.

 

 

 

 

 

You Can Do It Too!

Author: Heidi Arndt RDH, BSDH– – CEO – Enhanced Hygiene

Hygienists are not supposed to love numbers, if the are anything like me, they went to hygiene school to avoid taking a bunch of math classes. However today, numbers have become a highlight of my day. I especially love numbers when we look at the performance of our clients! The effort and results they make each day is what powers the Enhanced Hygiene team to keep going. No, it is not just about the number but what those number represent. Better patient care = Revenue = Growth = Opportunity for all!

Today, I want to share an example of an office who put in the effort and the commitment to grow. Let me mention, this change was difficult for this team as they have been working together for over 20 years and changing the status quo was not something they were really excited about, until they saw how some simple changes would impact their patients, their practice and themselves!

Here you go…

Last summer I received a phone call from a dentist (chose to stay anonymous) in Georgia who wanted to know if there was anything we could do to help improve the revenue from his hygiene team. He took over his dad’s practice about 3 years ago, and was tired of working his tail off to pay for all the overhead in his office. (Yes, he saw the hygienists as overhead!) His dad had taught him that hygiene was a loss leader, but he was intrigued by some of the success stories we had shared in the past and wondered if this was possible for his office.

The first thing we do at Enhanced Hygiene is pull some hygiene reports in order to identify the opportunities that exist in hygiene. Upon pulling these reports we saw a great opportunity sitting right within the practice (organic growth, at it’s best!), and we knew with some training and implementation support we could make some major progress within this practice.

The doctor saw the opportunities to grow and without question brought us in to turn around his team! Before we got started on-site, we completed staff surveys, we reviewed current systems and installed a performance dashboard. Once on site, we spent 1- full day training the entire office on the dental hygiene standard of care, communication standards, smart scheduling practices and expectations. Then for 2 days following the training we worked side by side with the team to execute on what we had just trained them on. Once we completed the onsite training, we followed up with virtual support and consistent monitoring of the digital dashboard.

Even with some ups and downs, this team rallied together and achieved some remarkable results!

Here is what this team has achieved in 9 months, and each month it keeps getting better and better!

Screenshot 2016-06-23 at 8.45.47 PM.png

In just 9 months, their return on investment by working with us is a 12x! Now, that is impressive!

As you can see from the numbers, there is still room to grow and the team is poised to meet their goals.  

This team is much like every team we work with. If you are struggling to meet grow your hygiene team, please contact us today and we can help you open the doors to BIG growth!

Follow the Leader

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

If you know a thing or two about how successful dental teams work, then you know that teams need leaders. You also know that not all people are effective at guiding others simply because they bear the title.  At a minimum, team leaders should ensure that folks are held accountable to following protocol.  Fantastic team leaders do this and help to increase team morale and foster confidence and team comradery. High levels of morale, confidence and comradery contribute directly to staff retention and the practice bottom line.

When it comes to the hygiene department, appointing a hygiene leader is advised, particularly if the hygiene team is four or more hygienists strong. Hygiene leads can be a subject matter expert for new hygienists and team members regarding hygiene protocols, and help to elevate teams to a higher level of performance through mentoring. Having a hygiene leader in the practice can also serve to take some of the day to day responsibilities of the hygiene department off of the doctor’s shoulders.

With hygiene being the backbone of most practices, selecting the best hygiene leader for the job is critical. It may seem logical to appoint the most experienced or senior hygienist in the practice. But be warned- this is not advised in every case. Being seasoned does not necessarily mean a person should, or would even want to be a leader.

On the same vein, don’t assume that because a hygienist was a leader in their former practice, they can effectively lead in your practice. Every office has its own unique dynamics and standards.

In order to select the right person to appoint as a leader, you must first decide what their responsibilities will be. If you want to find the best fit for the job, it is critical to know what the job is! The list of duties can get long; because this person will do double duty as a clinician, it is recommended to keep the list fairly short and relevant to their clinical role.

First and foremost, it is most effective to keep this person in the role of mentor, rather than manager.  The hygienists should not report to hygiene leads the same way they would to a doctor or office manager. This should be made clear to the hygiene leader as well as the rest of the team. Structuring their authority this way will help to avoid cross messaging and “too many cooks” in the management kitchen. This is especially true in a group practice setting, where clinical hygienists are not necessarily privy to management initiatives. An uninformed hygiene lead may not be on message.

The best use of a hygiene leads time is spent performing duties that a practice manager cannot. Presenting a clinical hygiene orientation for new hires, coaching and mentoring fellow hygienists on clinical protocol, hygiene product ordering, giving input into what CE courses the hygiene team should attend, and reviewing clinical performance metrics with the other hygienists are good places to start.

So what are the qualities to be looking for when selecting a hygiene lead?

 A superior hygiene lead should:

See the big picture of the practice and know where the leadership wants the practice to go. Rather than be in a hygiene department bubble, the hygiene lead should be included in meetings where policy that affects the whole practice is discussed.

Lead from behind- be a facilitator, not a dictator. This person should be able to solicit feedback from the other hygienists before making decisions that will affect the hygiene team. At the same time, this person should be able to get others to agree to disagree when required.

Have excellent written and verbal communication skills. The lead should be comfortable coaching others and giving direction; in a positive way.

Be committed and put patient care first- “Negative Nelly’s” or those who cut corners should not have a leadership role.

Be a mentor, not a manager. Hygiene leads should not be responsible for administrative duties such as time off requests, payroll issues, or employee grievances. Remember to keep their duties as clinical as possible.

Ensure they are always developing their replacement. Should your hygiene lead leave the practice for any reason, there should be another hygienist who can step in to the role.

The hygiene team represents almost 30% of the practice revenue. A great hygiene team lead is worth their weight in gold. A poorly selected one can take the whole gang south in a hurry. Be sure to take your time when selecting the person who will have such a critical role in the practice. If you do not feel you currently have such a person, you are probably right. You may need to further develop the hygienists you work with, or be on the lookout for that special person who will help take your hygiene team to the next level!

Preventing No Shows Before They Happen

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

If ever there was a common lament of dental offices everywhere, it would be openings in the hygiene schedules.  I am not sure any practice is totally immune from at least the occasional no show or last minute cancellation. The advantages of full hygiene schedules are obvious. A healthy revenue stream and patients getting the care they need are what we all strive for.

Some of the negative consequences of slow schedules are more subtle, but they affect our practices in big ways.

When hygienists and team members are left with too much downtime, it breeds a host of negative feelings and frustrations that permeates the practice, particularly if their salary is paid based on production numbers. Oftentimes, team member conflicts, staff turnover, and low morale can be traced directly back to slow schedules.   When hygiene schedules are open, the doctor’s schedules will in turn be open, and then multiple providers are unproductive.  To further compound the problem, a slow schedule today can mean a slow schedule tomorrow. When patients are not in the practice, they are not telling their friends and family about their great experience in our office. That means additional lost revenue that is impossible to measure.

Sometimes it seems we put great effort into getting the hygiene schedules full, only to have them “fall apart” at the last minute.  In order to address that, we must first understand the primary reasons that patient’s no show in the first place, and here they are:

 – Patients today lead tightly scheduled lives, and their plans often changing minute to minute.

 – Patients may not see value in our services or they may not see their oral health as a priority

 – Patients are reluctant to take time away from work, regardless of the economic climate

 – Patients don’t know how much we appreciate their business

At first glance, it may seem as if there is not much we can do about any of these factors, but on the contrary, there is actually a lot we can control in these areas.  We simply need to adapt to our patients, vs. assuming that they will adapt to us.  In today’s ultra-competitive marketplace, the days of patients bending to our policies are over.

Our first priority is to make it easy for our patients to do business with us. That includes being open during convenient, and sometimes extended hours. We need to reach our patients and allow them to reach us via text and email.  We should immediately remedy any of their concerns with billing and fees, and provide solutions and options for payment.

We must keep a current short call list for those patients whose plans change at the last minute, or who prefer to come on short notice.  We need to take emergencies, and get as much treatment done as possible in one visit.

Take the time to educate patients and personalize treatment recommendations to their very specific needs and wants. Use patient education videos, brochures, and websites.  Help patients see how prevention can save them both time and money.

Finally, even in this age of technology, patients still need to feel an emotional connection to our practice, and know how much we value serving them. Patients who feel appreciated are much less likely to fail an appointment.

We can let our patients know they are appreciated by shaking their hands, using their names, and giving them our full attention. We should to listen to their concerns, and ask follow up questions.

Trying to fill holes in a hygiene schedule at the last minute is a reactive way to do business, and a practice cannot thrive that way. When we take thoughtful, proactive steps to meet our patients where they are, instead of the other way around, our efforts are rewarded with full schedules and happy patients. What could be better than that?

Back to School!

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

At Enhanced Hygiene, we teach hygiene teams that a comprehensive assessment that includes risk assessment and periodontal assessment is the basis for comprehensive care.  We coach that early to moderate periodontal disease must be treated to minimize risk of progression, that maintenance is the most important stage of periodontal therapy, and that all patients need to understand what periodontal disease is.

We remind hygienists that it is their role to thoroughly examine the patient and take responsibility for the periodontal therapy treatment plan. We help hygienists do this by refreshing them on the fundamentals of the etiology and progression of periodontal disease. We review with hygienist’s the various ways to recognize and classify disease, and how to provide the appropriate treatment regimen to include maintenance.

It may sound as if we are going “back to school” with hygienists, and in some ways, we are! For many hygienists, having their basic knowledge refreshed is critical in their ability to successfully map out a periodontal treatment plan and take ownership of it.

In dental hygiene school, we  classified our patients based on the amount of debris they presented with. We called it a prophy 1, 2 or 3, (or A, B, or C) based on the amount of time and skill required to remove the debris. Classifying patients this way is fundamental when a certain level of skill and clinic experience is required in order to ensure a thorough cleaning is performed.

In the real world practice setting however, treatment for periodontal disease is based on the ADT code required to bill out the procedure. This means that hygienists need to understand when localized or full quadrant scaling and root planing is indicated based on factors more complex than just the amount of debris. To know when each procedure is indicated, it is essential to know which disease states require scaling and root planing in order to be arrested.

For us to be confident we must first be educated. There is no shame in refreshing your knowledge. For ease, I have included a quick guide for reference, taken from the American Academy of Periodontology classifications of periodontal disease stages.

Healthy

ž  Pocket depths 1-3mm

ž  No bleeding

ž  Healthy, pink, firm gingiva

ž  No bone loss

ž  No inflammation

Gingivitis

ž  Pocket depths 1-4 mm

ž  Bleeding on probing

ž  No radiographic bone loss

ž  Tissue red, edematous

ž  Only the gingival tissues have been affected by the inflammatory process.

ž  Alveolar bone level is 1 to 1.5mm from the CEJ.

Early Periodontal Disease

ž  Pocket depths 4-5mm

ž  Possible bleeding on probing

ž  Tissue may be fibrotic, with edematous areas

ž  Possible localized areas of recession

ž  Slight bone loss must be present

ž  Slight loss of the interdental septum

ž  Alveolar bone level is 3 to 4mm from the CEJ area

Moderate

ž  Pocket depths 5-6 mm

ž  Possible bleeding on probing

ž  Bone loss

ž  Possible Slight furcation involvement

ž  Possible Grade I and/or Grade II furcation invasion areas

ž  Possible Tooth Mobility of Class I

ž  Possible Alveolar bone level is 5 to 7mm from the CEJ area

Advanced

ž  May Include the Following:

ž  Pocket depths >7 mm

ž  Bleeding on probing

ž  Furcation involvement

ž  Increased tooth mobility

ž  Mobility of Class II or Class III

ž  Horizontal and vertical bone loss

ž  Alveolar bone level is 6mm or more from the CEJ area

ž  Radiographic furcations

To Sell or Not to Sell

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

Offering Oral Home Care Products in the Dental Practice

Has your practice or group struggled with the matter of selling oral home care products in the office? Has there been disagreement on which products to sell, or if you should sell any at all?

In today’s consumer driven economy, offices will need to decide if they are going to offer oral health care products for sale. Some examples of these products include; prescription strength fluoride paste, chlorhexidine rinse, teeth whitening strips, power brushes, breath products, water flossers, and xylitol. There are pros and cons to selling or not selling each, and the fact that there are so many to choose from in each category does not make the decisions any easier! Let’s see if we can take the some of the guess work out of this common dilemma!

First, the Benefits:

Convenience: Offering products at the office is convenient for patients. There is no extra trip to the store or pharmacy, which many patients will neglect to make. Once out of the office, folks tend to turn their attention to other things.

Safety:  You know what they are getting; you won’t worry that they are using a substandard or inferior product.

Effectiveness: Patients receive personalized instruction; a benefit when the product is technique sensitive, such as a power brush.

Compliance: Increased patient compliance. Patients are more likely to commit to using products they purchase from a professional.

Practice Builder: If the product works well for the patient, it’s an effective marketing tool for your practice. “Dr. Smith sold me these white strips, and they worked great! You should go and see him!”

Increased Revenue if products are priced properly.

Consider Potential Pitfalls:

If the staff is not adequately trained on the benefits of a product, they won’t recommend it, and the product will collect dust in your inventory closet.

If the staff does not believe in a products effectiveness, they won’t want to recommend it, and if they do recommend it, they won’t sound convincing.

Too many types and brands of products are less likely to move. Staff has too many indications and specifications to remember, and patients will be confused.

Overpriced products do not sell well.

Now that we’ve explored some advantages and disadvantages of selling oral home care products, what is the final answer? Only your group can decide that, but allow me to shed some light on the subject based on my experience: Selling products out of the office is a good thing, if you sell the right ones. How can you be sure you are recommending and dispensing the right ones? Consider the following:

Compliance is Key: Ask if compliance important for the proper use and effectiveness of a product? If so, then you should dispense it. Prescription strength fluoride is an ideal product to dispense out of the office. It requires a prescription if not purchased from you, it requires some verbal instruction, and proper compliance is critical. The same would be true for CHX rinse.

Personalized Instruction: If detailed personalized instruction is warranted for a product, consider dispensing it. If a patient has no experience with a power brush, they will need some education and perhaps a demonstration on how to use it to its best advantage. Power brushes are great for those who have poor homecare, orthodontics, limited ability to perform homecare, and those who have periodontal disease or high plaque loads.

Avoid products that must be purchased fairly often. An over the counter mouthwash for fresh breath, in my opinion, is best left off the list off of products dental practices should sell. The same is true for OTC strength toothpaste. Patients can likely get these cheaper in the supermarket than we can sell them for. It is perfectly acceptable to offer patients recommendations and coupons, however.

Pick One: I advise that practices pick one product in each category, and commit to being experts on it. Patients will be confused if you offer two brands of power brush or whitening formula. They will wonder which is superior. Telling patients it is a “personal preference” only adds to their confusion and implies that neither brush has distinctive qualities.  When you offer one brand or line, you can develop a relationship with that manufacturer and get superior staff training and pricing.

Educate staff: Whichever products you choose to offer, ensure staff knows it backwards and forwards and believes in its effectiveness. Have lunch n learns to educate staff, and encourage questions. Offer employee discounts on products you sell, so that staff can try products for themselves.

Price it Right: Ensure your price is reasonable and attractive for patients, and at the same time, that you are making a profit after figuring in time for patient education and any provider incentives.

Dispense only to patients of record: I advise against dispensing products to “walk ins” or those who are not patients of record.

I hope that this break down takes some of the uncertainty out of choosing the right products to dispense out of your practice. If done with careful consideration, dispensing certain products can benefit your patients and your practice!

Sales Is Not Slimy

Author: Heidi Arndt, RDH, BSDH – Dental Hygiene Performance Coach – Enhanced Hygiene 

Most dental professionals do not (or do not want to) consider themselves to be in sales.  In fact, if you mention sales and dental in the same sentence…you may spark a nerve with them.

The truth is, healthcare professionals do sell something so they are in sales!  You many not have the title “salesman or saleswomen”, but you are still in sales.  Everyone sells something.  Husbands sell ideas to their wives; teachers sell the value of education.  What do dental professionals sell?  We sell the benefits of treating disease and promoting optimal oral health.  During the process of educating our patients, we are selling! 

Sales is a learned skill, not an innate talent.  Anyone can learn to sell.  Some people may have a more natural inclination, yet anyone can learn the basic principles of sales.

Sales is not a dirty word, and it is not slimy.  Some dental professionals may feel offended by describing part of their work as sales.  The word “sales tends to bring up very unpleasant words, such as sleazy and coercive”.  Rather than view sales in a negative term, think of sales as a set of useful tools to educate your patients. 

Sales is all about helping people see the features vs. benefits.  This is a common concept taught in all sales training, and yet it applies to dentistry, as well.

So, what does this look like in dentistry:

Features:  A physical or tangible element of your product, service or procedure.  Simply put, a feature is what your product, service, or procedure has or does. It is a characteristic that is a quantifiable, indisputable fact. Some examples include: a digital camera that shoots up to 10 megapixels; or a dry cleaning service that comes right to your door. While they may be factual and convey an advantage, they don’t communicate why they are important or how they will help your customer. Measurements, colors, weights and capabilities are all features and do not sell a product.

Benefit:  By definition, a benefit is something of value or usefulness. In marketing, a benefit explains what the features mean and why they are important. It can answer the question of “What concerns or worries your customer/patient the most?”  Customers and patients are looking for solutions and a benefit shows them how your features will solve their problems or ease their pain.

Let’s use one of the features above to illustrate what the benefit could be. What is the value to a customer of a digital camera that shoots up to 10 megapixels? It could mean a more professional photo that will be sharper and have true-to-life color. The benefit stated to a potential buyer could be that more megapixels will produce a better photo and a better way to capture important memories; this will mean more to the customer than a technical description.

A benefit can also bring to light solutions to problems that a customer didn’t even know she or he had. Perhaps this 10 megapixel camera also features a blur reduction component. The benefit is that pictures will look sharp, even when taking an action shot. Suddenly, blurry pictures of the past may begin to flash in the customer’s head. S/he wasn’t looking for a blur reduction feature, but after seeing its benefits, it might just be what compels her or him to make a purchase.

Remember, people buy based on emotional experiences and “what is in it for them”.

Here is an example of how this would relate into dentistry.

Feature:  “Scaling/Root Planing is a procedure where we go below the gumline to eliminate the bacterial that is causing the periodontal infection in your mouth.”

Benefit: “We will eliminate your tender gums, bleeding and the bad breath you have been experiencing.  Not only that, this will help you improve your general health.”

Often times, the dental team will focus only on the feature, and not on the benefit.  While in reality, the benefit is the one thing that will help move your patient to seek optimal oral health.  Right?! 

For every treatment or procedure that you provide your patients, make a list of all the benefits.  Always begin with the benefits and then follow up with the features when selling to your patients.

If you focus too much on features, you may run into compliance issues with patients due to the focus on the features only.  We need to switch the emphasis to benefits; switch to the emotional components of the suggested treatment or procedure.   If your patient thinks scaling/root planing is only about scaling below the gumline, they will not accept.  And, they will have no idea about the potential harmful affects it has on their overall health.  You MUST cite the benefits, in order for your patient to make an informed decision and say “yes”. 

Turn your focus to how you are communication and selling to your patients, and how you respond to someone selling to you.  You will soon find that everyone is selling, but the things we respond to best are the ones focused on benefits.

Remember, Sales is not slimy.  Sales is about leading your patients to optimal oral health.  Go ahead, be the #1 Salesperson in your practice.  Your patients, and your practice deserve it!

Prevention Centered

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

It is a well known fact that in the United States, our healthcare system is generally focused on the treatment of disease, rather than the prevention of it. According to a September 2012 New England Journal of Medicine perspective of healthcare in the US, researchers Farshad Fani Marvasti, M.D., M.P.H., and Randall S. Stafford, M.D., Ph.D. concluded the following: “Although the United States pays more for medical care than any other country, problems abound in our health care system. Unsustainable costs, poor outcomes, poor patient satisfaction, and worsening health disparities all point to a need for transformative change. Unfortunately, many modifiable risk factors for chronic diseases are not being addressed adequately. A prevention model, focused on forestalling the development of disease before symptoms or life-threatening events occur, is the best solution.”*

In this system of treatment focused healthcare delivery, Dental Hygienists, as disease prevention experts, stand out from the crowd.  The formal definition of a Dental Hygienist according to the American Dental Hygiene Association is: “A licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Dental hygienists provide three types of services to their patients. The first of these is preventive services to promote and maintain good oral health. The second is educational services to help patients develop behaviors that promote better oral health and help them understand the importance of practicing these behaviors. The third type of service provided is therapeutic services which are treatments meant to stop disease and maintain healthy tissues in the mouth.” **

So there we have it. Dental Hygienists by their very definition are preventative specialists. Unfortunately, as prevention education experts, some hygienists are working in an environment that is not conducive to what hygienists are trained to do; prevent oral disease.

To illustrate this, most dental practices hire hygienists to provide preventative prophylaxis for patients. Commonly, this is where the preventative care in many practices begins and ends.

Whether you practice in a cosmetic, pediatric, or general office, it is a good idea to notice how much emphasis is put on the prevention of oral disease. Here are some questions to ask:

Does your office?

     – Offer in office fluoride varnish to adult patients at risk of caries?

     – Offer sealants for children and high decay risk adults?

     – Dispense or write prescriptions for at home fluoride?

     – Perform a caries risk assessment?

     – Do you periodontally probe each new patient?

     – Are you performing oral cancer screenings?

     – Do you offer smoking cessation and nutritional counseling?

If the answer is no to more than a few of these questions, the practice is not centered on prevention. Take heart, however, in knowing that becoming a more prevention centered practice is within easy reach!

The great thing about prevention in the dental office is that it is usually non-invasive and very inexpensive. Caries Risk Assessment is nothing more than a questionnaire, a conversation with the patient to determine risk factors, or possibly a saliva sample. Other than fluoride, preventative measures consist of healthy dietary changes and frequent cleanings, not medications. Radiation from digital x-rays is minimal. Oral cancer screening can be done either visually or with a harmless UV light.

In addition to being the right thing to do for our patients, prevention can be quite profitable for the practice when fluoride products are dispensed, sealants applied, and periodontal disease properly treated.

Prevention may begin in the hygiene department, but it should not stay there. Every team member should be focused on oral disease prevention. I want to advise my hygienist peers to not wait for the dentist or office manager to lead the way in prevention protocols; afterall, you were hired to be the prevention expert! 

*Farshad Fani Marvasti, M.D., M.P.H., and Randall S. Stafford, M.D., Ph.D.

N Engl J Med 2012; 367:889-891September 6, 2012DOI: 10.1056/NEJMp1206230

**www.adha.org