By Deborah Dopson-Hartley, RDH
Time is the one thing that is equal in all of humanity. How one chooses to spend that time, however, is not.
If you often feel the stress of time, chances are good it is because you feel you just do not have enough time to do what you want to do, at the level of quality to which you are committed.
When we combine the decreasing numbers of dental personnel with the increased demands for service, challenges for time are created within the dental office.
With increasing responsibilities placed on hygienists such as managed care, insurance dilemmas, the implementation of consultants, incorporation of advanced educational courses, the indoctrination of esthetic dentistry and its demands, and the ever expanding state and federal regulations placed upon us, there is more for us to do in the same amount of time — or for production's sake, less time.
To get the most out of the time a hygienist has with a patient, it is important to have clearly defined goals and a focused agenda. Here are some key time-saving tips you and your hygiene department can use to help achieve your daily goals for more production and less stress.
• Know the daily goals. The scheduled daily production goal and the scheduled-for-next-hygiene-visit goal should no longer be the only considerations in a hygiene day. Today's progressive hygiene departments have daily sales presentations and sales acceptance goals that we are responsible for as well.
For example: my daily hygiene production goal is $1,800 per day, which I normally meet and usually exceed. My sales presentation goal (esthetics, quadrant, or comprehensive dentistry that is presented from my hygiene chairs) is $5,000 per day. And my sales acceptance goal (accepted, financials secured, and scheduled) is $3,500 per day.
I obtained these goals simply by adding my hygiene's daily production goals to my doctor's daily production goals.
Although sales acceptance goals are often difficult to track due to the patients' need to consider and organize their budget (both time and money), sales presentations are not.
Simply track the treatment plan that was discussed from the hygiene chair by writing it next to the patient's name on the day sheet. For example: Lower Left #18MO (inlay - $1,100), #19MOD (Porcelain Crown - $1,100) #20MOD (Inlay - $1,100), #21DO (2 surface direct - $250 or inlay $1,100) estimated total $4,500.
I make it easy for myself by calling everything a restoration. I say to the patient, "We will be restoring the lower left hand side on the next visit. If we could have a moment of your time, we'd like to help you with the fee for your treatment and the payment options we have available. Let's see what's most convenient for you." I then escort them into the private consultation room where the financial coordinator is waiting to complete the process.
• The afternoon huddle. At the end of the day, have a mini-afternoon huddle with the doctors, hygienists, and scheduling coordinators. Analyze each patient to see who did or did not schedule and why. These are very valuable numbers that everyone should be tracking. They will reveal people's strengths and show their weaknesses as well.
• Review patient charts while auditing the computer. Even though this course of action takes time, it is the best time-saver hygienists can do to prepare for the day. It could be done during downtime or at the end of the day. The information remains fresh in your mind when you do it before the day begins.
Reading through the progress notes while reviewing the charts allows us to be familiar with the patient before they are seated. It allows us to gain accurate knowledge of what the patient will need in hygiene services for the day. For example:
• The type of hygiene therapy
• Updating the periodontal charting
• Will radiographs or photography be necessary?
• Is the patient due for their annual examination, or will the exam be necessary due to an already known chief complaint made during confirmation?
It also alerts us to some of the other possible time pitfalls such as the need for premed or the use of nitrous oxide.
Reviewing the patient's treatment plans and reading the progress notes for past chief complaints, concerns or comments by both the doctor and hygienist allows both to formulate a presentation that is collectively well focused.
The hygiene team will know in advance what could or will be needed, such as a bite adjustment setup, imaging through a consultation, or possible work-in treatments like sealants or bleaching.
Auditing the computer by updating the patient's real treatment needs give an accurate projection of the daily production goal and treatment. Instead of using just a computer programs generic codes as your guideline, type the needed treatment, like BWX, Pano, 4910 EXAM.
• Sticky notes. The patient's name and information from the audit should be transferred to a sticky note, and written in black ink to indicate preexisting treatments. Save room for the patient's current chief complaint or for case acceptance, which should be written in a different color for easy recognition.
The sticky note is given to the doctor before he or she leaves his or her treatment room so he or she can be familiar with all treatment needs and know what has already been discussed. This in itself will make the exam time quicker, more efficient and effective.
• The morning huddle. This is the next best time-saver there is and is absolutely necessary for everyone on the team. It averts stress by effective communication by sharing not only what we learned from the audit but the phone calls too. It is here responsibility and treatment rooms are delegated.
• Rooms. Have all rooms equipped, stocked, and supplied for whoever needs to use them. The old protocol of "my room, my stuff" should no longer be acceptable as the norm — not in today's high-paced, high-demand environment. Rooms are where income is made through production and empty rooms should be considered overhead.
• Prophy polishing the coronal surfaces first. Polishing first with a mild and effective prophy paste compound before the scaling procedures will ensure that you will work in a cleaner, healthier environment. This will prevent the transmission of massive bacteria from entering the patient's bloodstream.
It saves the time normally spent re-scaling and re-polishing tenacious stain and reduces the hand fatigue commonly associated with heavy-handed stain removal.
Now both hygienist and doctor can see without the hindrance of plaque, stain and food all over the patient's teeth.
• Oral hygiene education, communication and instructions. Education means taking something that is simple and making it seem more complex. Communication is about taking something that is complex and making it sound simple.
Let's use flossing as an example. For many, flossing is the key, the answer — but really it's the solution and few are interested in solutions until they truly understand the problem. Once patients comprehend the problem, they will own their disease and will eventually want to know what they can do about it.
Immediately following polishing, ask permission to review the patient's brushing and flossing routine. If you see a patient who might be flossing incorrectly, a great non-confrontational communication might be to pose this type of question: "I see you floss regularly; however, as part of our treatment today, I'd like to show you the proper method for flossing. Is that OK with you?"
Giving the patient a mirror, begin flossing between the maxillary central incisors. This area of flossing usually causes bleeding and will open discussions about possible periodontal issues. You can then also address any cosmetic concerns and present options for improving older restorations that may still have stain before they get out of the hygiene chair. This prevents the patient from thinking, "Why didn't they get the stain off again?"
The doctor can, if convenient, come in any time after the sticky note has been given to them and be able to see and provide a more thorough examination without the obstacle of debris.
• Topical anesthetic. The controlled application of topical anesthetic followed by thorough rinsing throughout the appointment allows for both a more comfortable and accurate periodontal probing and scaling. As always, check their medical history for prior allergies and be alert for any current reactions.
• Instrumentation. Hand instrumentation should be an important part of your armamentarium because it allows you the sensation to feel every surface on every tooth, confirming that the roots have been properly cleaned and planed.
It also allows you to feel for decayed surfaces, marginal breakdown of older worn restorations and areas of sensitivity. Many times, the patients will feel these problem areas at the same time as the therapist, which opens the doors to communication about treatment.
It also allows you the flexibility to educate and communicate to help influence the patients into understanding, accepting and owning their dental disease.
Hand instrumentation helps make communication easier and more patient friendly by overcoming the distractions that occur from the combination of the noises from the use of ultrasonic instrumentation, water, and the suctions.
• Scripts. Scripting — the study, discussion, and internalizing of words and phrases to use (and words and phrases not to use) along with all the reasons why — is the ideal way to ensure consistent five-star service in your practice.
Scripting can and has improved the service, profitability, efficiency and harmony of countless thousands of businesses. How can a staff member or any of us be expected to wing answers on the spot? Studying scripts means studying the reasons behind the scripting. You can't have one without the other.
Another important aspect of scripting is the elimination of words not to say. For example, the patient has pocketing with inflammation and bleeding. While you are aggressively scaling, the patient asks the question that is a dreaded nightmare to all hygienists, "How come no one has ever done that to me before?" Imagine if we bumble around and grasp for words; we will, at best, look unprofessional and, at worst, offend and possibly even lose the patient.
Imagine the phrases you might hear without scripting — all kinds of things that essentially add up to either bashing other dental offices or dentistry in general, "Your last dental office didn't care or something to that nature."
Patients ask lots of questions and they are not looking for a long drawn-out answer or dozens of questions in return. They want direct, honest answers.
The response I teach my clients and I use daily is, "That's a great question. Let me see how I can explain this to you so you can increase your understanding of your oral health. It's simply been too long since your roots have been cleaned, not your exposed teeth but the roots themselves. Have you ever had your roots cleaned like this before?"
Scripts allows one the freedom to continually educate, to communicate, to motivate without much thought, to alert them to either further dental needs, or educate them about today's more advanced materials that are being offered while still working on them. Patients have found this time-saving tip (scripts combined with hand instrumentation) to be both soothing and more relaxing, often distracting them from the discomfort that can occur during therapeutic scaling procedures.
This simple trick will allow you to entertain, build a rapport, deliver quality care, motivate and influence the patient by explaining through education the treatment needed, all in a shorter amount of time.
Scripting is not about being a robot. Of course, we all need to listen, be compassionate, and use our own words. But scripting is the most efficient and effective way to instill a culture of service and excel in the busiest place in the planet — the dental office.
For example, in my hygiene world, I personally could not work as effectively or efficiently as I do without my memorized scripts. In my everyday, real-life hygiene position I have to stay focused. My time with patients is filled with so many thought-provoking and diverse procedures, systems, and protocols, I'd go crazy if I didn't have my written and edited (practiced and rehearsed to the point where they can be performed like an act in a play) scripts.
I relish when patients tell me they've never been told that before (I know they have), and how much they appreciate all the time I took helping them understand their problems and the solutions. Oddly, it really was not all that much time. It's not about the quantity of time but the quality of time that is spent on patient education and rapport.
For more information about complete scripting resources for your practice visit www.OfficeMagic.com or call (800) 750-8779.
• Patient CD Rom Educational System (CAESY™). When the hygiene appointment is near completion, the problems have been found, the probable treatment options have been discussed (confirmed by the doctor), hygiene must now find the time to write the accurate treatment plan in the chart and pass it to the appropriate front desk coordinator for the final touches. This is where the educational system is invaluable, it graces hygiene with time.
Counting time isn't nearly as important as making time count. Learning to take advantage of time to its maximum is essential to arriving at your destination in a timely manner and making the journey an enjoyable one.
The point of exploiting time is not to cram more work responsibilities into the day, but to use the time we have more effectively, so that it is not squandered, but invested in the people and projects, which are most important.
As Dr. Scott Peck says in his book, The Road Less Traveled, "If you value yourself, you will value your time. If you value your time, you will use it more wisely."
Deborah Dopson-Hartley, RDH, is the 'real thing' of dental hygiene and is widely known for being the most profitable hygienist in the country. As a full-time hands-on practicing hygienist of 26 years, she works her own successful business program that not only increases her own hygiene production to over $23,000 per month while working only a three-day work week, but is instrumental in her ability to help influence and promote ideal comprehensive esthetic and restorative dentistry for her dentist.
For more information on her consulting, seminars and advanced workshop training series, please visit her website at www.DeborahHartley.com, or call (813) 985-5516.
