Written by Janet Hagerman, RDH Tuesday, 30 September 2003 19:00
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.
|Table. Six systems basic to any dental practice|
(1) exam 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.
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.
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.
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.
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.
(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?”
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!
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?
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.
(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.
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