Professional athletes know it. Airline pilots practice it daily. Religions have thrived for centuries because of it. What is this magic potion that creates winning seasons, consistency of service, and sustained growth? It’s the boring basics! It’s standardizing procedure protocol. It’s recare. It’s reactivation. It’s creating efficient systems and working them.
I can hear you screaming now that “this is so fundamental…everyone knows this.” Then why is it that so few dental offices truly practice the boring basics? Because it’s easier and more exciting to think that there is some other special tool, a new piece of equipment, or a more current technology that will solve their practice management problems, but all the bells and whistles at the trade show won’t fix a practice lacking in the boring basics.
|Table. Six systems basic to any dental practice
(1) exam protocol
(2) periodontal protocol
Think about the greatest athletes in sports. Their practice is not about refining those glamorous, sexy shots that break records. It’s about the boring, fundamental basics of their game, time after time. Andre Agassi practices forehand and backhand. For Tiger Woods, it’s hitting 100 golf balls before each match, practicing his basic swing. The outcome? Victory for these 2 acclaimed professionals, resulting from practicing the boring basics...over and over and over again.
Take a fresh look at the old boring basics, the 6 systems basic to any dental practice (See Table). Ask yourself and your team these questions: Why are these systems important? What is my core belief about their significance in my practice and to our patients? Once you know the “why” and the “what,” the “how” will fall into place. Answering these questions will help you and your team take a fresh look at these systems and create strategies to ensure they get done.
How do you take these boring basics of your practice systems and transform them into something the staff will actually do? How do you recycle or repackage fundamentally boring basic systems into programs primed for peak performance? Here are some strategies designed to restore them back into your practice with enthusiasm.
It’s appalling how many doctors and hygienists do at best an incomplete exam and at worst a random spot check, then call this a comprehensive or periodic exam. Restorative treatment is missed, cosmetic possibilities are ignored, and periodontal disease is neglected at an alarming rate. This is professional neglect. It’s unethical and illegal! It is imperative to have a protocol, a specific system of exam procedures, that is exactly followed every time.
As I tell my patients, “When you brush your teeth, do it the same way every time. Most people brush randomly, so of course you will miss areas and never know it!” I show them how to brush teeth Nos. 1 through 32, buccal surfaces first, then lingual, then occlusal, every time, all the time. Patients ask me, “Isn’t there something easier and less boring than flossing? Could something so simple really be that effective?” My answer? Yes, when you do it every time, all the time. These are disease control systems that ensure success.
If this example seems elementary to you, take a look at an expert example of a specialized system. Consider the airplane pilot, a licensed professional like us. Unlike us, however, pilots are responsible for not only the safety but the lives of many people. Standard pilot protocol is the take-off checklist. From novice pilots in twin-engine planes to commercial airline pilots who take us to our dental trade shows, they never take off without first going through a checklist. Why do they do this? So they don’t forget anything, regardless of the thousands of hours of experience they may have. These boring basics could save lives!
Consider yourself the pilot of your practice, with your patients’ oral health being every bit as important as passenger safety. (Actually, you could save the lives of your patients through early detection of oral cancer, high blood pressure, and medication contraindications!) Create your exam protocol, print it, laminate it, and post it in your treatment rooms where you can refer to it for every exam, regardless of how experienced you are.
Exam protocol should include the following:
•a medical history review (including blood pressure check).
•the discovery of patient values and dental concerns.
•a complete head and neck and intraoral cancer screening.
•a restorative exam of each and every tooth.
•periodontal screening (including 6-point probing on every tooth, not PSR).
•a shade guide exam to determine change of color over time.
One person dies of oral cancer in this country every hour. Oral cancer is the only major cancer that has not declined over the last 40 years. Regrettably, only 17% of all oral cancer is diagnosed in the dental office. Most oral cancers are discovered by anesthesiologists unsuccessfully attempting intubation for major surgery. You can change these statistics by being vigilant about early cancer detection in the areas you examine more regularly than a patient’s physician.
A comprehensive exam must include a periodontal screening. If you do not probe and record findings, you have not done a comprehensive exam. Hence, you must not call it that and you must not charge for it. Whitening is the door to cosmetic dentistry. By monitoring every patient’s tooth color, you plant the seeds for patient awareness of a beautiful smile. The great thing about a true comprehensive exam is that your patients will be impressed with your thoroughness. It actually doubles as an internal marketing strategy. As you build your patients’ perceived value for their appointments, you will see your open time decrease as patients look forward to complete care in your office.
According to the ADA, 75% to 80% of our population has periodontal disease. Does the periodontal treatment in your practice reflect this statistic? Are you treating your patients’ perio or doing “bloody prophies” and telling them to floss more and come back every 3 months? How do you know if your patients have periodontal disease if you don’t probe every patient regularly? I’m not talking about that skimpy PSR. You cannot monitor changes with a PSR. Only complete 6-point probing gives you a baseline with which to compare.
Create your periodontal protocol and stick to it. How many points of bleeding and millimeters of pocketing will you tolerate before you diagnose and treat periodontal disease? Decide with your team what will be your standard of care. Use your new protocol to take a fresh look at your patients to determine if they have neglected disease.
New research now suggests that low-grade inflammation may be the culprit causing heart attacks, even more so than cholesterol.1 A test for this exists that monitors C-reactive protein (CRP), a chemical that increases during inflammation and is particularly easy to measure. White House doctors used this test to check President Bush’s CRP level last summer. (It was extremely low.) This may well become a standard test as this research becomes mainstream. Consider the implications: low-grade inflammation begets gum disease (“It’s just a little gingivitis.”) begets...heart attack! Would this breakthrough information make it easier to enroll your patients in periodontal therapy if they thought it might save their lives? With increasing research connecting periodontal and heart disease, it may well become standard procedure for cardiologists to request a patient’s periodontal clearance prior to heart surgery. Could you produce a complete periodontal chart for any patient in your practice at their physician’s request?
Beverly Maguire’s excellent article, “The Periodontal Exam,” (July 2002, RDH) states, “This exam is not an option; it’s the foundation of how we protect patients.” She supports complete 6-probing and says, “Those chart notations of ‘WNL’ actually mean ‘we never looked!’” Create a periodontal protocol that includes complete and comprehensive screening, diagnosis, and treatment. Share with your patients what “we now know” about gum disease. It’s exciting to consider how we can impact the lives of our patients by caring for their mouths completely. It’s exciting to discover what ancient health practitioners knew; that the whole body is connected and the health of our mouth is related to the health of our entire body. Shift your perio paradigm to saving patients’ lives and this boring basic will never be boring again!
In a healthy dental practice, hygiene is the backbone of the business. It keeps your patients and your practice healthy. The hygiene appointment is not just about “a cleaning.” The hygienist identifies restorative and cosmetic opportunities for the doctor, screens for soft-tissue health, and deepens rapport with patients, creating loyalty and referrals. This cannot be done if the patient does not return. Recare is critical.
Strategies for a successful recare system include the following:
(1) Preappoint all patients. Many times, we think we are preappointing most patients while the percentage is actually much lower. Keeping a daily preappoint monitor will ensure your success with this system.
(2) Send a reminder postcard 2 weeks out. These were filled out at the last recare appointment and the patient addressed the card. Patients do respond better when they recognize their own handwriting instead of a computer-generated address label. Send these cards out weekly, not once a month.
(3) Confirmation-call one week out. This call must include the following questions:
•Did you receive your postcard?
•Have you checked your calendar?
•Does this time/date still work for you?
•Is there anything that could prevent you from keeping this appointment?
These specific questions make a much bigger impact than “I’m calling to confirm your appointment.” It forces patients to look at their schedule and commit to keeping their appointment. If they must reschedule, this one-week-out call gives you time to fill the opening.
(4) Courtesy-call one day prior to appointment. This is not a confirmation call. This is not an opportunity for your patient to change this appointment. It sounds like this: “Mrs. Jones, we’re looking forward to seeing you tomorrow at 8 am. Is there anything you’d like us to know to make your visit more comfortable?”
This is the easiest way to keep your patients “in the loop.” Create your system, be diligent about your commitment to recare, and enjoy the return of your “family” of patients. Not only will you experience decreased open time on your schedule, you’ll also be maintaining excellent preventive care for your patients.
Is this not definitely the absolutely most boring of all the boring basics? Reactivation is avoided like the plague. Staff will do anything else—stock rooms, confirm patients, clean the processor, file charts—anything but make those reactivation calls!
Many offices have never performed a chart audit. Have you? When was the last time? Ideally, chart auditing should be done once a year. Think of it like inventory at Macy’s. How can Macy’s possibly know what to buy for next year if it dooesn’t know what’s still on the shelves this year?
How many patients in your file cabinet have outstanding restorative work that needs to be completed? Would your money be better spent marketing for new patients or treating the restorative needs of patients who already exist in your practice and who already have a (presumably good) relationship with you? Sales experts tell us that 80% of business comes from 20% of one’s customers. It is imminently easier to “sell” to existing clients than to get new customers.
How many patient charts that were in your file cabinet are now in the file cabinet of another practice? Why? Did the patients move? Cheaper competition?
You didn’t take their insurance? They didn’t like you? Wouldn’t you like to know? The Rockefeller Foundation conducted a business survey to find out why people change to another place of business. The results were startling. The foundation found that people leave for the following reasons: moving (9%); competition (9%); unresolved complaints (14%); no special reason (68%).
If 68% of our patients leave our practice for “no special reason,” give them a reason to stay, to return, to never even consider leaving. Call them and invite them back into your dental “family.” Don’t ever let them go!
Knowing your true “inventory” of patients is the only way to effectively forecast your business needs. This requires regular reactivation, with chart auditing. It is imperative that staff members shift their thinking when making these calls from a mindset of I have to track down these people to “fill the book” to I’m inviting these patients back into our dental family to take care of them. Having new reasons for reactivation will enable staff to focus on this system in a way that empowers them to take patient care to a new level.
I’m not saying reactivation will never be boring. (Remember forehand and backhand, over and over.) Like any practice, it does get easier. Once you complete your initial chart audit, yearly reactivation becomes much simpler, giving you the tools and information you need to keep healthy patients and maintain your healthy practice.
Monitors measure progress, success, and failure. There is simply no better way to quickly assess your business/practice at any given moment. Jack Welch, the ex-CEO of General Electric, knew this. He loved graphs and charts and used them successfully to monitor progress and pave his way to phenomenal success during his 20 years with the company. Monitors can measure production, collections, goals, procedures, preappointments...any systems. Any protocol you create can and should be measured with some type of monitor. Otherwise, how will you know if it’s working?
Monitors give you numbers and numbers tell you a story. Numbers give you a true, clear, precise picture of performance. Numbers are objective. There’s no opinion about the numbers. Numbers reflect quantitatively exactly where you are, enabling you to adjust course midstream if necessary.
If you and your team are not in the habit of using monitors, your staff may find them overwhelming at first. To ease this anxiety, monitor one system at a time. Implement one a week, starting with the easiest. As your team becomes accustomed to monitoring, it will begin to see the magic of numbers. Monitoring enables your team members to look at your practice through the eyes of a business partner and initiate appropriate changes in their respective departments.
Think of your practice as a rocket ship headed for the moon. If there is any slight deviation from your course, you will miss the moon entirely. If all your controls work properly and you’re monitoring all systems constantly, each small deviation from your path will automatically be adjusted to put you back on track. Missing the moon completely would not be the best time to wonder why the journey failed. Constant monitoring along the way provides opportunity for course correction. Monitor your way to success. Shoot for the moon!
Can you imagine any Fortune 500 company that does not have meetings? How would the employees and managers plan and communicate with each other, create marketing strategies, define new products and services, and monitor their progress? Your practice is a business and requires the same commitment to planning and communication. Some practices still think of staff meetings as unproductive down-time with no patients scheduled. Actually, effective staff meetings make you more productive so that when you do see patients, the office will flow more efficiently and you will work smarter, not harder.
Staff meetings are boring when they are always run by “you-know-who.” Here are some tips to make your meetings productive and fun:
(1) Have team members lead a staff meeting of their choice.
(2) Select a book for your team to read. Have staff members read a particular chapter to share with the team when it’s their turn to lead. (Some book examples: Demystifying Smiles, by Kristine Hodsdon; Fundamentals of Outstanding Dental Teams, by Vicki McManus; and Dentists: An Endangered Species, by Paul Homoly.)
(3) Create your meeting agenda for the facilitator to follow every time and stick to it.
(4) Decide your time parameter for meetings and stick to it.
(5) Look forward to meetings as a method of creative brainstorming and planning, not as a whining session. Offer all complaints and challenges with constructive solutions.
(6) All staff members should come to meetings prepared, ready to take notes and participate.
Having every staff member participate as a meeting facilitator develops the leadership skills of your entire team and gives the doctor a break. It also gives your team the opportunity to learn from each other.
It may help to organize your weekly meetings like this:
•Week 1. Business: review monitors, discuss goals.
•Week 2. Boring Basics: monitor internal systems.
•Week 3. Housekeeping: ordering systems, OSHA protocol, equipment maintenance.
•Week 4. Continuing Education: invite an outside guest speaker like the periodontist or orthodontist you refer to.
Strive for your meetings to be interesting, proactive, and fun. (For suggestions, consult 555 Ways To Reward Your Dental Team by Drs. Joe Blaes and Nate Booth.)
Where is the quick fix, that magic key to a successful dental practice? It’s taking the boring basics and turning them into better, brazen, breakthrough, bountiful basics—over and over and over again.
Special thanks to Dr. Mike Maroon and his team for inspiring this article. It’s not only flashy techniques and technology that take you over the top; it’s mastering and building upon the boring basics and Dr. Maroon’s team has done an awesome job at both.
1. Heart Has New Worst Enemy. Associated Press, Aug. 4, 2002.