Creating Hygiene Heaven: Transform Your Practice With World-Class, Patient-Focused Service

Dentistry Today


General stores are still the hub of activity and source of communication in small Cape Cod towns. After spending a week vacationing with my family there I could clearly see the many parallels between the influence these tiny “control centers” have on the communities they serve, and the influence world-class hygiene departments have on their world-class practices.
It amazes me to see the endless opportunities that exist in hygiene departments across the country. I’ve seen this even more since the onset of the specialty cosmetic practice trend. In some ways, I feel hygiene has become more of an afterthought rather than the driving force behind building a practice. I believe in building general practices that have subspecialties such as cosmetics, sedation, TMJ, etc.

Illustration by Cheryl Gloss

As we go into a contraction of our economy and a dramatic drop in consumer confidence and spending, the time is now to focus on bringing hygiene back to the forefront of practices. Whenever there is a tightening in the economy it is important to get back to the basics so that you can actually expand during a slowdown. Expanding during a recession is a lot easier than expanding during boom times. First, everyone else is shrinking and they stop doing the things that brought them success—they go into agreement with the contextual media overload of how bad things are. When a scarcity mindset prevails, it is important to take a counter-intuitive approach. Externally marketing more in a less cluttered environment will produce better return on investment. This is especially true since marketing costs are reduced, as marketing agencies operate from a place of fear and scarcity too. Internally marketing through your hygiene department is the ultimate way to turbocharge the influx of new patients at a reduced acquisition cost.
Before we get into the details of creating Hygiene Heaven let’s drill down a little deeper to simplify this strategy and get you to understand its importance. There are 3 primary ways to build a world-class practice. When you maximize each of the following 3 methods you will have a quantum leap in your productivity.
The first approach is to generate new patients. Most practitioners focus solely on this approach. The challenge here is that it takes time to build patient trust and educate them as to how they fit into your policies and procedures. Unless you’ve established a new practice, you need to regulate the number of added patients you allow in. The more time you spend without a handpiece in your palm (meeting and educating new patients), the less time off and less profitability you will enjoy. Therefore, a preparation for setting up Hygiene Heaven is to determine how many new patients you need each month.
I will discuss in this article methods that will yield 80% of patients in your recare system, at least 2 prophys a year at $75, and at least one crown per year at $850. This will create each patient as an annual value of at least $1,000. If you have 1,000 patients, then you will have a one million-dollar practice. To maintain this all you need is 15 patients per month who go through an effective new-patient experience in addressing natural attrition.
The second method in building a world-class practice is to retain patients through your recare system, and the third way is to set up a patient education protocol in hygiene that will close at least one crown per patient per year. Unless you are accurately tracking both of these, you will be surprised at how low your retention and case acceptance actually is. When my team and I first start transforming a practice, the average recare effectiveness is 42%.
Regarding case acceptance, I have come across a handful of practices in my many years that track treatment presented versus treatment accepted. Our personal experiences show total treatment acceptance averages of 34% for existing patients and a dismal 14% for the less-trusting new patients. Creating Next-Level Practice’s Hygiene Heaven will allow you to maximize the second and third methods to build your practice, make your team and patients happier, and win big as a result.



Prepare Your Team to Deliver

Sit down with your team outside of your practice so that there are no distractions. Ideally, this should be done on an off day ending with the completion of the first 3 steps (discussed below). Get an easel with oversized Post-it notes so you can stick them up around the room and refer to them as necessary. The power here is in engaging your team to give input toward creating solutions. This is how we gain team alignment, implementation, and sustained results from our programs. When you guide your team rather than dictate, you show leadership and they’ll in turn agree to follow through. When team members veer off track it is your manager’s job to steer them back to what they created. Whenever you install something new you and your team will go through a remember/forget/remember stage. Of course, you have to agree on what gets created, so ultimately your team will take ownership.
Following are the 7 Steps to Implementing the Next-Level Practice Hygiene Heaven Methodology.

Action Item 1: Create a World-Class Customer Service Agreement

The best companies in the world secure service agreements with their employees upon hiring them. Here are a few of my favorites to inspire you to create one for your team.
Ritz-Carlton: The Ritz-Carlton is a place where genuine care and comfort of our guests is our highest mission … The Ritz-Carlton experience enlivens the senses, instills well-being, and fulfills even the unexpected wishes and needs of our guests.
Disney: We create happiness by providing the finest entertainment for people of all ages, everywhere.
Dental Practice: Each and every patient will understand their condition, solution, and financial investment while having a calming experience. They will feel individually cared for and appreciated in a meticulously clean spa setting.
Once you have this finalized, display it for all to see. Your reception area, screen savers, team break room, inside lockers, or on the back of appointment cards are all great avenues for driving through the remember/forget/remember phase. Be bold and swing out. Ask your patients to call you out when something is not up to standard, then thank them and make it right. This proud presentation of what you are committed to will transform contextually how you act and interact with each other and your patients.
Instead of policing, begin to recognize your team members for how they are behaving in relation to your service agreement. If you find one or several team members not following through, just pull them aside, remind them of your pact, and shape agreements moving forward. Make this a regular topic at team meetings; recognize areas that are working and areas that need attention. Assign specific accountabilities to team members, asking them to follow up and report back during morning huddles and team meetings. New habits will be formed within one month, so stick it out.

Action Item 2: Establish a Healthy Mouth Baseline Agreement

The root cause of all upset and frustration in practice is a missing or broken agreement. One of the most notorious agreements missing in practice today is a healthy mouth baseline. Often assumed and almost never discussed or written, the following exercise will begin to unite your team.
List specifically and without scrutiny all elements of a healthy mouth. Get an agreement from everyone on the team. Ask the question, “How many of our patients have a healthy mouth?” The average we’ve found is 10%. This means 9 out of 10 patients who have a hygiene visit will accept a treatment plan. Compare this amount to how many you have now.

Action Item 3: Establish Soft-Tissue and Hard-Tissue Standards of Care

This is the second-most misplaced agreement that wreaks havoc on case acceptance. Simmer down, my friend. I know you can’t get agreements on all procedures. We understand there are exceptions. What we are looking for here is to make decision-making more factual, creating less gray area. When we facilitate the following discipline we learn how far out of alignment a team is. For those of you who are on the same page, this exercise will take an hour; for those who are not, it can last much longer. No matter where you stand, you can get it done. When your team agrees on a hard- and soft-tissue treatment philosophy you eliminate many intangible challenges that can hinder case acceptance.

Action Item 4: Set Up a Patient Education System

Getting back to my Cape Cod general store metaphor, communication among patrons is more valuable than any news cast or juicy soap opera. What makes it so good and real is that it is largely coming from authentic people without the intention to gain something, other than to be recognized. Also, the conversation is generated by customers and workers, not by the owner. You see where I’m going here?
While you continually wield your handpiece, “general store magic” is happening all around you—at the front desk, in the hygiene area, and in your consult rooms. Highly trusted by the patients, your administrators and hygienists are engaging and educating future “customers.” Your practice will run like a well-oiled machine when you implement the first 3 steps and pay based on results. (For more on this, see “Turn Your Payroll Into a Profit Center” in my book, Million Dollar Dentistry).
I have very few “must-dos,” and here is one of them: you must have an intraoral camera in every room. You cannot effectively educate patients without one. You should also pull up these pictures in your consult room when discussing finances.

Action Item 5: Set Up a Patient Retention/Recovery System

It costs 5 times as much to acquire a patient than to retain one. Therefore, it makes sense to invest more time and energy toward establishing a great recare and recovery system. Also included here is your investment in creating a world-class customer service structure for your team. Why? Because 68% of patients leave a practice due to indifference and/or poor service, according to a survey done by the ADA.
Here is the primary recare system the NextLevel Team recommends: a preappointment, one-month reminder, personally addressed reminder card, 2-week verification call, and a 48-hour prompting call. Take special note on the 2-week call: use this call to get medical up-dates or anything that your hygienist should know before the patient’s appointment. The way to enhance individualized service is to remind patients of their future appointments without appearing as a pest. Also, organizing a 2-day final confirmation allows you time to fill if needed.
Regarding the set-up of your recovery system—hire a part-timer or designate someone to a secluded room to make calls to all patients of record who are out of the recare system. This person will ask if they would like to remain as patients of record. If the patient says yes, then schedule him or her for hygiene care. If the person declines, then ask what the practice might have done to prevent his or her return. Whatever the issue is, ask,  “If we can make it right, would you return?” (You can correct money or insurance reasons by reminding patients of the value and benefits of your office.) Make sure your recare recovery person makes notes during every conversation so you may review and notice trends or issues that need to be addressed.

Action Item 6: Set Up Daily and Monthly Tracking Systems

Imagine going to the stadium to watch your favorite team and one thing appears missing—the scoreboard. Balls were hit, players ran bases, and you had no idea what the score was. The same holds true in a practice when results aren’t tracked for each position every day. I know the knee-jerk response is that you do not have the time. Reprioritize. Just as you didn’t think you’d have time to sit and make 2-week confirmation calls or to designate a person to make recovery calls, you will find the time once you understand the value of doing so or the cost of not doing so.
Establish what I call DPOs (Daily Primary Out-comes). These shift the focus of your team from an activity-based mindset to results-driven actions, and they establish a daily scoreboard that builds self-esteem with each team member and puts factual accountability in the team members’ laps. Team members know whether they are winning the game, and if they aren’t, it is their responsibility to get the training, tools, resources, and team support to get the job done. Doing this also simplifies troubleshooting and management.

Action Item 7: Monitor  and Make It Right

To have scalability and sustainability you must have a structure in place to hold it all together. The typical frustration we hear from doctors when we first work with them is that they “tell their team members a thousand times to X-Y-Z, and they don’t do X-Y-Z.” The missing elements are those discussed in this article combined with what I call Saran Wrap. One person needs to be in place to monitor the agreements and scoreboards your team created. Regular reporting and group and individual corrections should be made on an ongoing basis.


In many corners of America the once quaint general stores where you would get your live bait and a coffee have been replaced by Starbucks. What hasn’t changed is the dissemination of communication that happens there. Your hygiene department is the hub of important communication in your practice that will allow you to meet a minimum goal of 2 prophys and one crown per year.
Firm up these areas and spend more time drinking coffee and fishin’.

Mr. Kadi transforms successful dentists into highly successful dentists—financially secure, professionally respected, and deeply satisfied with their practices and their lives. He innovated the Next Level methodology and is one of America’s leading dental practice developers. His 12 years of transforming and developing dental practices are captured in his newest book, Million Dollar Dentistry. He can be reached at (480) 361-9955,, or by visiting